Soil-transmitted helminths primarily comprise Ascaris lumbricoides, Trichuris trichiura, and hookworms, infecting more than 600 million people globally, particularly in underserved communities. Manual microscopy of Kato-Katz thick smears is a widely used diagnostic method in monitoring and control programs, but is time-consuming, requires on-site experts and has low sensitivity, especially for light intensity infections. In this study, portable whole-slide scanners and deep learning-based artificial intelligence (AI) were deployed in a primary healthcare setting in Kenya. Stool samples (n = 965) were collected from school children and Kato-Katz thick smears were digitized for AI-based detection. Light-intensity infections accounted for 96.7% of cases. Three diagnostic methods - manual microscopy, autonomous AI and human expert-verified AI - were compared to a composite reference standard, which combined expert-verified helminth eggs in physical and digital smears. Sensitivity for A. lumbricoides, T. trichiura and hookworms was 50.0%, 31.2%, and 77.8% for manual microscopy; 50.0%, 84.4%, and 87.4% for the autonomous AI; and 100%, 93.8%, and 92.2% for expert-verified AI in smears suitable for analysis (n = 704). Specificity exceeded 97% across all methods. The expert-verified AI had higher sensitivity than the other methods while maintaining high specificity for the detection of soil-transmitted helminths in Kato-Katz thick smears, especially in light-intensity infections.

We study the discovery potential for a light Higgs boson via gg → H_SM-like → hh → bb<overline>γγ process at the Large Hadron Collider (LHC). Focusing on the 2-Higgs Doublet Model Type-I, which can accommodate light neutral Higgs states, of O(100) GeV or less in mass, while agreeing with theoretical and up-to-date experimental constraints, we explore the feasibility of a light CP-even Higgs state h via the largely unexplored final state bb<overline>γγ at Run-3 of the LHC. We further propose a few benchmark points for future searches.

Background: Caesarean section on maternal request (CSMR) is a complex ethical issue. Sweden is an intriguing case for studying CSMR due to its restrictive policy that curtail women autonomous choice regarding the mode of birth, despite overall policy developments aiming to strengthen patients' rights, promote person-centred care, and adopt a more individualized approach. This study aims to understand how the tension surrounding CSMR is manifested in Swedish media. An ethical principles approach is used to investigate what image of CSMR is created and conveyed to the public and what main arguments are used for and against CSMR.

Methods: This study covers news media and specialist press material in Sweden between March 2019 and March 2024. Searches were carried out in Retriever Research and resulted in 188 search hits. The content analysis had both an inductive and a deductive approach based on Beauchamp and Childress's four ethical principles: respect for autonomy, non-maleficence, beneficence, and justice.

Results: The analysis reveals a struggle in Swedish media over how to approach CSMR, touching on all ethical principles. Regarding autonomy, the debate focuses on whether CSMR is a medical decision about non-indicated surgery or a private choice. In terms of non-maleficence-which is the health professionals' main concern-the media highlights conflicts over interpreting risks associated with caesarean section and vaginal birth. Beneficence involves a tension between portraying vaginal birth as healthy and normal versus caesarean section as a method to protect sexual and bodily function. As regards justice, CSMR is portrayed as a challenge to the fundamental needs-principle in the healthcare system.

Conclusions: Ultimately, the ethical principles approach to analyzing the media portrayal of CSMR in Sweden highlights the need for decision guidelines and practices that are more open to a woman's own evaluation of different risks while also encouraging critical reflection on the underlying factors shaping treatment preferences for both women and healthcare professionals.

Objective: The aims of the study were to explore the attitudes of parents of young children towards prevention and screening for congenital cytomegalovirus infection, and to map the practices and recommendations in prenatal care regarding the prevention of fetal infection.

Methods: A survey was distributed across Sweden to parents of children under 2 years. Information about congenital cytomegalovirus infection was provided. Questions followed, pertaining to attitudes towards screening and prevention, hygiene behaviours during pregnancy, and recommendations from midwives.

Results: 4405 parents completed the survey; 4263 were pregnant less than 2 years prior. Parents were positive towards screening, with 85% agreeing that screening should be offered. A predicted increase in stress was positively associated with positive attitudes towards screening. Attitudes towards prevention were positive (90%). Most did not regularly perform hygiene measures to prevent cytomegalovirus infection during pregnancy, though behaviours preventing other infections were common. Recommendations by midwives rarely included cytomegalovirus prevention.

Conclusion: Parents have positive attitudes toward screening and prevention of congenital cytomegalovirus infection, despite a predicted increase in stress. Information is not being conveyed by prenatal providers about how to protect oneself against cytomegalovirus infection, which reflects a lack of hygiene routines during pregnancy related to its prevention.

Multivesicular bodies (MVBs) are vesicles of endosomal origin containing intraluminal vesicles, which upon fusion with plasma membrane, secrete exosomes. They play a significant role in the physiology and pathology of type-2 diabetes (T2D) due to disrupted intercellular communication. The role of MVBs and their influence on insulin secretory granules (ISGs) of beta-cells or their characterization is yet to be uncovered. In our study, we compared MVBs to largely well-characterized ISGs in beta-cells. This study compares the density, localization, and exocytosis of CD63+ compartments (CD63+c) with NPY labelled ISGs (NISGs) in beta-cells. For this, tetraspanin CD63 was exploited to majorly label MVBs in beta-cells. These labels preserve the structural integrity of labelled compartments and mostly do not localize with other endo-lysosomal compartments. This study showed that the beta-cells have a significantly higher density of NISGs than CD63+c. CD63+c and NISGs are spatially localized apart within beta-cells. The proteins that localize with CD63+c are different from the ones that localize with NISGs. Exocytosis of NISGs occurs at the periphery of the beta-cells and takes significantly less time when compared to the release of CD63+c, which is non-peripheral and takes a longer duration. Mechanistically, the availability of CD63+c for exocytosis was assessed and found that an equilibrium is maintained between docking and undocking states at the plasma membrane. Although there are a high number of short-term residing, visiting CD63+c at the plasma membrane, the availability of CD63+c for exocytosis is maintained due to docking and undocking states. Further, a significant reduction in the density of NISGs and CD63+c was observed in beta-cells isolated from T2D donors compared to healthy counterparts. Studying the effect of MVBs on insulin secretion in physiological and T2D conditions has huge potential. This study provides a strong basis to open new avenues for such future studies.

Pregnancy is a psycho-neuro-endocrinological transition phase presenting a window of vulnerability for mental health. Emotion regulation, a transdiagnostic factor for psychopathology, is influenced by estradiol across the menstrual cycle on the behavioral and neural level. Whether this is also the case in the antepartum period remains unknown. For the first time, behavioral and neural emotion regulation were investigated in healthy pregnant females with extremely high estradiol levels during the second trimester (N = 15) using a functional magnetic resonance imaging (fMRI) paradigm. Results were compared with naturally cycling females with high (N = 16) and low estradiol levels (N = 16). Although pregnant females reported the lowest trait use of cognitive reappraisal, all participants successfully regulated their emotions by applying cognitive reappraisal in the scanner. During downregulation of negative emotions, all females had increased activity in the left middle frontal gyrus. Pregnant females showed no significant differences in functional connectivity (psychophysiological interaction, resting-state) related to emotion regulation compared with the nonpregnant groups. However, group differences emerged for amygdala activation. In pregnant females, increased amygdala activity predicted reduced regulation success and was positively associated with depression scores. This first fMRI study during pregnancy indicates that depression scores are reflected in heightened amygdala activity already observable in the antepartum period. Thus, through its association with reduced regulation success, increased amygdala activity suggests a neural risk marker for peripartum mental health. The findings highlight the importance of investigating neural and behavioral emotion regulation in the ante- and postpartum period, eventually allowing enhanced identification, prevention, and treatment of peripartum mental ill-health.

Background: In randomized trials, the intention-to-treat effect is the effect of assignment to treatment strategies. The concept of assignment may not be clearly defined when using observational data to emulate a target trial.

Aims: We aimed to assess the practical implications of using data on prescription versus dispensation as analogues of treatment assignment in observational analyses.

Methods: We used the primary care-derived Swedish Primary Care Cardiovascular Database of individuals with newly diagnosed hypertension between 2006 and 2014 and linked registers. We compared the effect of two antihypertensive drug classes on the five-year risk of cancer and ischemic heart disease. Treatment assignment was first mapped using prescription data, and then dispensation data. With unique confounding structures, we sequentially adjusted for different classes of risk factor due to uncertainty over the choice of relevant confounders for prescription vs. dispensation.

Results: 7770 individuals were eligible when assignment was defined using prescription compared with 5964 when defined using dispensation. For both cancer and ischemic heart disease outcomes, both higher and lower relative risks of the outcome were consistent with our data. Effect estimates did not vary with the choice of prescription or dispensation data as analogues of assignment, nor with sequential adjustment for class of risk factor.

Conclusion: The mapping of prescription or dispensation data to treatment assignment influences the size and characteristics of the study population and the structure of confounding. However, we found no clear numerical differences in effect estimates in this study. Further investigation is required in other settings.

Objectives: This study aimed to estimate the prevalence of atrial fibrillation (AF) and identify its associated comorbidities in adults aged 45 years and older, using data from the Swedish general population study EpiHealth.

Design: In a cross-sectional design, data of health history, lifestyle factors, anthropometric measurement, and 1-lead ECG recordings from participants in the EpiHealth study were linked to data from the Swedish Patient Registry.

Results: Among the 22,616 participants (56.2% women), the overall prevalence of AF was 3.9%, of which 0.3% were newly diagnosed cases identified by single 1-lead ECG at cohort examination. AF prevalence was higher in men than in women across all age groups and increased with age, reaching 17.2% among men aged 75 years and older. Participants with AF had a higher prevalence of cardiovascular comorbidities compared to those without AF.

Conclusions: The findings highlight the increasing prevalence of AF with advancing age and its higher occurrence in men compared to women. The screening-detected prevalence of AF of 0.3% among participants in this general population study suggests that simple 1-lead ECG could be a manageable approach to screen for AF. The strong association between AF and cardiovascular comorbidities emphasizes the need for management strategies to address this condition, particularly in older adults.

Prostate cancer (PCa) incidence has steadily increased in Sweden, more steeply in the mid-1990s caused by increased opportunistic prostate-specific antigen (PSA) testing. Tallness, normal weight, and non-smoking are associated with more PSA testing, which increases detection of low-risk and localised PCa. We investigated time trends of height, body mass index (BMI), and smoking with PCa risk in 171,889 men in Sweden aged 50-64 years at baseline, who were linked to nationwide cancer registers during follow-up. Cox regression determined the association of these factors assessed before 1980, 1980-1994, and 1995-2004 with PCa risk. During 15 follow-up years, 8,049 men were diagnosed with PCa. The association of height with PCa was weakly positive across all calendar periods. For obesity (BMI >= 30 kg/m2) vs. normal weight (BMI 18.5-24.9 kg/m2) and current vs. never smoking, the associations changed from null before 1980 (HR 1.03, 95% CI 0.86-1.23, and 1.11, 95% CI 0.97-1.27) to negative in 1995-2004 (HR 0.83, 95% CI 0.74-0.93, and 0.86, 95% CI 0.79-0.93; pinteraction between periods = 0.05 and 0.001). In men with clinical characteristics available, height was positively associated with both aggressive and non-aggressive PCa whilst obesity and smoking showed negative associations only with non-aggressive PCa. These findings likely reflect differences in PSA testing by BMI and smoking habits and contribute important knowledge for etiological studies of PCa.

High blood pressure (BP) is a frequent cause for visits to primary healthcare centers (PHCCs) in Sweden. Guidelines on methods for BP measurements for diagnosis of hypertension have recently been updated. We aimed to study adherence to diagnostic guidelines in hypertension management and evaluate whether adherence to guidelines was related to organizational or sociodemographic characteristics. Interviews with representatives from 76 randomly selected PHCCs from eight regions in Sweden were conducted. PHCCs' use of 24-h ambulatory BP monitoring (ABPM), home BP monitoring (HBPM) and BP measurements in both arms for the diagnosis of hypertension were chosen as proxy markers for adherence to diagnostic guidelines. An adherence index was created as a composite score of these diagnostic methods. The proportion of PHCCs stating they "often use" ABPM and HBPM were 13.7% and 16.0%, respectively, and 57.3% stated they performed BP measurements in both arms. Two PHCCs did not use ABPM, HBPM or BP measurements in both arms to diagnose hypertension. None of the organizational or sociodemographic characteristics (number of listed patients, Care Need Index (CNI), geographical location, ownership, investigation primarily led by doctor/nurse, dedicated team management, special training for hypertension and local routines) were associated with the adherence index. This study shows that adherence to diagnostic guidelines vary largely between PHCCs. No organizational characteristic, not even team-based management, was associated with adherence to diagnostic guidelines. The variation raises questions about inequity healthcare and novel strategies that may be needed to improve PHCCs' adherence to diagnostic guidelines in hypertension management. 

Regular exercise has been shown to increase heart rate variability (HRV) for different populations. Acute and short-term studies using heat therapy and sauna bathing have also shown HRV improvements. However, long-term adaptations in HRV to regular exercise and sauna bathing remain unexplored. In this 1:1:1 multi-arm trial, sedentary participants (n = 38) aged 49 ± 9 years with at least one CVD risk factor were randomly assigned to regular exercise and 15-min postexercise sauna (EXS), regular exercise only (EXE), or control (CON) group, for an 8-week intervention. Indices of HRV (RR interval, RMSSD, SDNN, resting heart rate [HR], HRMAX-HRMIN, high frequency power [HFP], and low frequency power [LFP]) were measured before (PRE) and after (POST) the trial. Compared to CON, EXE increased the time-domain measure of HR_MAX-HR_MIN (p = 0.003), and elicited significantly smaller decreases in the frequency-domain measure of LFP (p = 0.022). There were no statistically significant differences between EXS and EXE for any of the HRV indices measured. Eight weeks of regular exercise conferred positive changes in both time- and frequency-domain measures of HRV. However, adding regular sauna bathing postexercise offered no additional benefits to HRV over regular exercise alone.

Clinical research is no longer a monopolistic environment wherein patients and participants are the sole voice of information. The introduction and acceleration of AI-based methods in healthcare is creating a complex environment where human-derived data is no longer the sole mechanism through which researchers and clinicians explore and test their hypotheses. The concept of self-agency is intimately tied into this, as generative data does not encompass the same person-lived experiences as human-derived data. The lack of accountability and transparency in recognizing data sources supporting medical and research decisions has the potential to immediately and negatively impact patient care. This commentary considers how self-agency is being confronted by the introduction and proliferation of generative AI, and discusses future directions to improve, rather than undermine AI-fueled healthcare progress.

We propose a method for probing CP-violation in the heavy (pseudo)scalar sector of an extended Higgs model, in which we make simultaneous use of the HVV (V=W^±,Z) and Htt<overline> interactions of a heavy Higgs state H. The CP-even component of H can be probed through the tree-level HVV interaction, while the CP-odd component of H can be probed if the final tt<overline> pair can be tested to form a ¹S₀ state. We can then confirm CP-violation if both CP-even and CP-odd components of H are discovered. This is possible at the Compact Linear Collider (CLIC) by exploiting H production from vector-boson fusion (VBF) and decay to tt<overline> pairs. We analyze the distribution of the azimuthal angle between the leptons coming from top and antitop quarks, which allows one to disentangle the CP nature of such a heavy Higgs state. We also show its implications for the two-Higgs-doublet model (2HDM) with CP-violation.

Objectives: Smartphone applications (apps) for antibiotic prescribing have been studied in observational studies. Here, we assessed whether the use of a smartphone app increased appropriate antibiotic therapy (AAT) in hospitals.

Methods: An antibiotic stewardship app (Firstline.org) was populated with local guidelines and tested in a stepped-wedged cluster randomized trial in three hospitals in the Netherlands, Sweden, and Switzerland. Defined clusters were randomized per hospital for the intervention (use of app) or standard of care. Primary outcome was AAT assessed by chart review in 15 random patients per cluster per intervention period. Secondary outcomes included clinical outcomes and user analytics. A questionnaire identifying barriers to app use was disseminated. Multivariable multilevel logistic models with time periods as fixed effects to adjust for time trend and treatment as fixed effects were employed to estimate the odds ratio of treatment.

Results: Twelve clusters in the Netherlands (1085 patients) were included, 12 in Sweden (362 patients) and 8 in Switzerland (653 patients). Overall, AAT was not increased (2.0% [95% CI,-5.92% to 9.97%]) in the intervention arm compared with control across the three centres. Mean frequency of app use by cluster was associated with an AAT increase (1.9% [95% CI, 1.18-2.62%]) across study centres; 3.2% in the Netherlands (p < 0.01), 2.8% in Switzerland (p < 0.01), and remained similar in Sweden (0.4%; p 0.46). No difference was found for the other secondary outcomes. Main barriers for app use reported in the questionnaire were easily forgetting using the app and having other tools to help prescribing antibiotics.

Discussion: Overall, the introduction of a stewardship app did not significantly increase AAT, but a prespecified secondary analysis of app use frequency was associated with a small but significant improvement of AAT. Variable uptake of the app, coexisting routes to guidelines and the impact of the COVID-19 pandemic during the trial likely had an impact on the results.

Introduction: The children of female sex workers are the victims of their circumstances from the beginning and are deprived of an environment that encourages optimal physical and psychological development. This study aimed to assess the prevalence of emotional and behavioral problems among adolescent offspring of female sex workers and compare that with adolescent offspring of slum-dwellers in Daulatdia and Dhaka city, Bangladesh.

Methods: A cross-sectional study was conducted with a sample of 394 adolescent children (196 adolescent offspring of sex workers and 198 adolescent offspring of slum dwellers) from March 2024 to May 2024 using a structured questionnaire. The study was conducted through face-to-face interviews where sociodemographic details, along with information regarding emotional and behavioral health problems, were assessed through the Strength and Difficulties Questionnaire (SDQ) scale, and health-related quality of life was assessed through the Kidscreen-10 scale. Descriptive analysis, bivariate analysis, and binary logistic regression analysis were performed.

Results: The prevalence of emotional and behavioral problems was 13% for adolescent offspring of Daulatdia and 15% for Korail slum. Age and gender in brothel settings and HRQoL in both settings were found to be significantly associated with emotional and behavioral difficulties. Adolescent offspring of FSWs with low HRQoL (OR = 4.09, p-value < 0.05, CI 1.579-10.595) were 4.09 times more likely to suffer from abnormal mental disorders than those with average or high HRQoL. While in a slum setting, it is 2.825 times higher (OR = 2.825, p-value < 0.05, CI 1.142-6.987).

Conclusion: The study concluded that the overall prevalence of emotional and behavioral problems for adolescent offspring of FSWs was significantly lower than for adolescent offspring of slum dwellers in the emotional problem subscale. Tailored interventions should be developed to address the specific needs of individuals with emotional and behavioral health problems while minimizing the detrimental impacts of their stigmatized identity.

Many neurological diseases remain difficult to treat, necessitating further elucidation of their pathogenesis. Conditional inactivation of Pdgfra in Nestin-expressing cells leads to the depletion of platelet-derived growth factor receptor-alpha⁺ (PDGFRα⁺) oligodendroglial lineage cells responsible for myelination, resulting in forebrain hypomyelination and severe, progressive neurological deficits in neonatal mice. The present study examined the cerebral cortex of these mice to better understand the mechanisms underlying such progressive neurological deficits, that are often observed in refractory neurological diseases. Histological and single-cell RNA sequencing analyses showed that, following activation of meningeal border-associated macrophages (BAMs), PDGFRα⁺ fibroblasts that escaped gene inactivation were extensively recruited from the meninges into the hypomyelinated subpial cerebral cortex. Transcriptional reprogramming suggested that these fibroblasts originated from the pial fibroblast lineage and adopted a myofibroblast-like transcriptional phenotype. The recruited fibroblasts established stable cell-cell interactions with activated brain macrophages, including BAMs and microglia, accompanied by signaling pathways associated with chronic, tissue-damaging inflammation. Subsequently, inflammatory cortical lesions emerged, characterized by glial activation, angiogenesis, and neuronal oxidative stress. Treatment with a PDGFRα-neutralizing antibody significantly reduced fibroblast recruitment and mitigated glial activation and angiogenesis. These findings suggest that meningeal BAMs and pial fibroblasts are key contributors to the formation of tissue-damaging subpial cortical lesions. The interactions between brain macrophages and pial fibroblasts may contribute to the mechanisms underlying chronic and progressive neurological deficits and represent potential therapeutic targets for refractory neurological diseases.

This article reviews recent developments in our understanding of the electron diffusion region (EDR) of magnetic reconnection, focusing on how the structure and dynamics of the EDR vary with the background plasma conditions. In particular, we highlight results from the Magnetospheric Multiscale (MMS) mission, a four-satellite NASA mission that measures plasma particles and electromagnetic fields in and around Earth's magnetosphere. Theoretical and modeling-driven predictions regarding the structure of the EDR and the key processes that enable reconnection are compared and contrasted with observational studies using in-situ MMS measurements.

We utilize Mars Atmosphere and Volatile Evolution (MAVEN) observations to investigate the ionopause boundary at Mars, the formation process of which is not yet well described. We focus on the eighth deep dip campaign (DD8), which consists of 50 consecutive orbits, and we develop an automated routine to identify ionopause boundaries in electron density and temperature data. We find ionopause boundaries in 54 out of 100 ionospheric crossings and an average ionopause altitude of 368 km. Having detected the ionopause boundaries, we then examine in detail all the DD8 orbits using complementary observations from several MAVEN instruments. We show examples of two orbits, illustrating how the shapes of the topside ionosphere and ionopause can differ among ionospheric crossings and how the ionopause formation is correlated with changes in magnetic topology and the plasma pressure balance between the ionosphere and the magnetic pile-up region (MPR). We find that 70% of the detected ionopauses are formed where there are changes in magnetic topology, particularly from closed to either open or draped magnetic field lines, and 80% of the boundaries are also formed where the ionospheric plasma pressure becomes equal to the plasma pressure of the MPR. Finally, we confirm that the ionopause boundary is more likely to be formed under high solar wind dynamic pressure conditions.

The warm plasma cloak (WPC) is a plasma population located in the outer magnetosphere. It is composed primarily of electrons and H⁺ ions with energies of tens to hundreds electronvolts and can contain significant amounts of O⁺. We conduct a statistical survey of the WPC using 9 years of observations in the dayside magnetosphere from the Magnetospheric Multiscale mission. WPC is found in 51% of the observations and it is 1.6 times more abundant in the dawn than in the dusk sector. O⁺-rich WPC is detected in 7.5% of the observations, being 3 times more probable in the dawn sector. We find that after a peak of strong geomagnetic activity, it takes approximately 9 hr to detect the WPC in the dayside magnetosphere.

  Objectives

Little is known whether the number of systemic medications, indicating worsened general health, affects the number of dental appointments needed. The hypothesis is that patients purchasing more systemic medications would have an increased number of dental appointments and respective need for treatments than patients who do not purchase as many medications.

Materials and Methods

Our cohort consists of 1495 participants from the Stockholm area, Sweden, initially examined in 1985. Using national population and patient registers (2005–2017), the association between the number of medication purchases and dental appointments was analyzed. The Anatomical Therapeutic Chemical Classification System for Medicines (ATC) was used. Descriptive statistics, chi-square tests, and logistic regressions were used with several covariates like gender and socioeconomic status.

Results

Purchases above the median of all medications showed a statistically significant association with more dental appointments and respective treatments. Most of the ATC system's main drug categories were significantly associated with more dental appointments, even when adjusting for covariates. Purchases of medications from 32 different ATC subgroups were significantly associated with the number of dental appointments above the median.

Conclusion

In the group of adult Swedes who were studied, it was found that increased purchasing of nearly all types of drugs was associated with an increased number of dental appointments between the study years 2005–2017.

Interpersonal Psychotherapy (IPT), originally developed for depression, is recommended in Sweden’s national treatment guidelines as an option for binge eating disorder and bulimia nervosa. Despite documented efficacy, IPT has primarily been studied as a comparison treatment in eating disorder research. There remains limited knowledge about the method’s functioning in Swedish clinical settings, the mechanisms of change, and how therapeutic work unfolds in practice. This thesis, using a mixed method design, examines the applicability of IPT for individuals with eating disorders and co-occurring depression. The results indicate that IPT is a promising treatment for patients within the bulimic spectrum, showing significant improvements in both eating disorder and depressive symptoms. Notably, improvements in depression preceded symptom relief in the eating disorder – but not the other way around – suggesting a potentially change-driving association. Symptom improvement occurred more rapidly when treatment explicitly and consistently linked current symptoms to emotionally charged relational themes. The qualitative findings demonstrate that this connection – the so-called mood-event connection – is co-created through a collaborative process, in which therapist and patient jointly develop an understanding of what is meaningful and what the next step in therapy should be. Patients with a more restrictive symptomatology showed no improvement. This may possibly be explained by patients’ descriptions of living with the eating disorder as something ever-present in the relating to themselves, others, and life as a whole. The findings suggest that treatment should support the externalisation of the eating disorder as an ego-dystonic condition, foster more functional ways of relating to self and others, and facilitate motivation for a new social role beyond the illness. This thesis supports IPT as a credible and independent treatment for eating disorders, especially in cases involving binge eating, compensatory behaviours, and co-occurring depression.

In digital mental health engagement rates are consistently low, which may limit its effects. Using an international multidisciplinary consensus method, including lived experience expertise and a systematic review, we identified three key challenges: (i) lack of agreed metrics for engagement; (ii) lack of evidence on how better engagement improves outcomes; (iii) lack of standards for user involvement. Three potential solutions encompassed: (i) standardisation of frameworks for reporting engagement metrics and optimal doses of digital tools, (ii) measuring engagement with more precise reporting of outcomes, including potential harms; (iii) defining standards of user involvement (including appropriate diversity, and clinician as well as user input). Digital interventions have real potential in meeting the shortfall in service provision for mental health, but this will require focus on high quality research studies of the underlying mechanisms of engagement and optimal outcomes. Our findings identify and highlight the next best steps in this process.

The early-type contact binary DU Boo exhibits consistent O'Connell effect for many years. Studies in the literature of the system are insufficient to explain this consistency in the observed O'Connell effect. Based on this gap in the literature, the aim of this study is to investigate the surface brightness distribution of the system using the Doppler imaging technique as well as the mid-resolution time series spectra.

Context: At the end of their lives, low- to intermediate-mass stars reach the asymptotic giant branch (AGB), during which their photospheres expand by up to several hundred times and strong stellar winds develop. These changes lead to various interactions with celestial bodies in their close circumstellar environments, including mass- and angular-momentum transfer.

Aims: We aim to characterize the properties of the inner companion of the S-type AGB star π¹ Gru and to identify plausible future evolutionary scenarios for this triple system.

Methods: We observed π¹ Gru with the Atacama Large Millimeter/sub-millimeter Array (ALMA) and the Spectro-Polarimetric High-contrast Exoplanet REsearch (SPHERE) instrument of the Very Large Telescope (VLT), collected archival photometric data, and used the HIPPARCOS-Gaia proper motion anomaly. We derived the best orbital parameters using Bayesian inference.

Results: In June-July 2019, the inner companion, π¹ Gru C, was located at 37.4±2.0 mas from the primary (a projected separation of 6.05±0.55 au at 161.7±11.7 pc). The best orbital solution yields a companion mass of 0.86^+0.22_-0.20 M (using the derived mass of the primary) and a semi-major axis of 7.05_-0.57^+0.54 au, corresponding to an orbital period of 11.0_-1.5^+1.7 yr. The preferred solution is an elliptical orbit with eccentricity e = 0.35_-0.17^+0.18, although a circular orbit cannot be fully excluded. The close companion could be either a K1V_K7V^F9.5V star or a white dwarf (WD). Ultraviolet and millimeter continuum photometry are consistent with the presence of an accretion disk around the close companion. The ultraviolet emission may originate from hot spots in an overall cooler disk, or from a hot disk if the companion is a WD.

Conclusions: Although the close companion and the AGB star are interacting and an accretion disk is observed around the companion, the mass-accretion rate is too low to trigger a Type Ia supernova, but it could produce novae every ≈900 yr. Short-wavelength, spatially resolved observations are required to further constrain the nature of the C companion. Searches for close-in companions similar to this system will improve our understanding of the physics of mass and angular momentum transfer, as well as orbital evolution during late evolutionary stages.

BACKGROUND: Falls threaten the health and well-being of older adults. While studies have presented effective fall prevention exercises, determining how to deliver these interventions in a way that ensures engagement and long-term sustainability is challenging. Additionally, understanding how older adults perceive and are motivated to participate in such programs is critical for broad public health promotion. This study aimed to explore older adults' experiences and perceptions regarding participation in a newly developed 8-week peer-led group-based exercise program, FallFitness.

METHODS: Participants were recruited from a randomized controlled trial (RCT) exploring a newly developed 8-week peer-led group-based exercise program. A total of 2 focus groups were conducted post intervention, comprising ten participants (8 women and 2 men) from the exercise arm of the RCT. Inductive and conventional qualitative content analysis was performed.

RESULTS: From the interviews, 5 main categories and 6 subcategories capturing the study aim are presented. Main categories included: a) social interaction and community, more than just exercise, b) increased motivational drive and self-efficacy, c) group exercise as fun, safe, and inclusive activity, d) enhanced collaboration between healthcare providers and retirement organizations for fall prevention, and e) professional peer-led trainers.

CONCLUSION: Peer-led, well-designed group-based exercise programs can holistically support physical, emotional, and social well-being. Programs that include enjoyable, multicomponent elements, both physically and mentally stimulating, can enhance participants' motivation and adherence. Additionally, the group setting is thought to promote meaningful social interaction, which is widely recognized as important for overall well-being. From a public health perspective, collaborative models for fall prevention involving older adults as a "golden resource" should be established.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT06265480 (2024-02-08).

Using 20.3 fb^-1 of e⁺e^- collision data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector operating at the BEPCII collider, the branching fractions of three hadronic charm meson decays, D⁺ → φπ⁺π⁺π^-, D⁺ → K⁰_SK⁺π⁺π^-π⁰, and D⁺ → K⁰_S K⁺ω, are measured for the first time to be (0.54 ± 0.19 ± 0.02) x 10^-4, (2.51 ± 0.34 ± 0.14) x 10^-4, and (2.02 ± 0.35 ± 0.10) x 10^-4, respectively. Futhermore, the branching fractions of D⁺ → K⁺K^-π+π+π- and D⁺ → K⁰_SK⁺η are measured with improved precision, yielding values of (0.66 ± 0.11 ± 0.03) x 10^-4 and (2.27 ± 0.22 ± 0.05) x 10^-4, respectively.

BACKGROUND: As climate change continues to challenge global health, nursing education must evolve to prepare future nurses for the impacts on care delivery and promote sustainable practices within the healthcare system which is itself a contributor to the climate crisis through emissions and waste. In this study we aimed to i) explore undergraduate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nursing education at a Swedish university, and ii) explore differences in awareness and attitudes across student groups in different semesters.

METHODS: In this cross-sectional descriptive research study, nursing students from six groups (semester 1,2,3,4,5,6) of a three-year BSc Nursing programme were asked to complete the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. Descriptive statistics were used to present mean scores for each item, and the Kruskal-Wallis test was used to identify differences in responses between different student groups. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement has been used to report this research.

RESULTS: A total of 211 (32%) students completed the questionnaires. The findings showed that nursing students across the six semesters had relatively good awareness of, and positive attitudes towards, sustainability and climate change (no mean rating below 4 on a scale 1-7). Statistically significant differences between student groups were found in four out of nine items of the SANS_2 questionnaire, with students in their second semester consistently providing the highest ratings (p < 0.05). Notably, the lowest ratings across these four items were provided by students in their last year of the programme.

CONCLUSIONS: This study found that whilst students initially felt equipped to address sustainability issues and climate change in practice, this confidence appears to diminish by the programme's end, raising concerns about the preparedness of the future workforce. This underscores the urgency and importance of continuous reinforcement of sustainability concepts in nursing education, aligning with a spiral curriculum approach which advocates for reiterating themes throughout the curriculum to deepen understanding.

CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: The transition to undertaking rehabilitation in the home or local neighbourhood calls for an extensive understanding of which aspects of the built environment are important for people with stroke.

OBJECTIVE: This qualitative study aims to explore how home and local neighbourhood environments support or hinder rehabilitation for people who have had a stroke from the perspectives of various stakeholders.

METHODS: Through a purposive selection method, data were collected through semi-structured interviews with 16 stakeholders: people with stroke (n = 3), significant others (n = 3), healthcare professionals (n = 4), care managers (n = 3) and architects (n = 3). Content analysis was used to identify patterns and create themes.

FINDINGS: Sixteen stakeholders, including 12 women and 4 men aged 30-74, participated in this study. Our findings identify areas linked to the WHO age-friendly environment framework, which addresses environmental limitations relevant to stroke rehabilitation. The categories used and factors identified: (1) Outdoor environments: accessibility, safety and supportiveness. (2) Transport and mobility: accessible and reach central services. (3) Housing: adaptations, layout and accessibility. (4) Social participation: spaces that are varied and flexible. (5) Social inclusion and non-discrimination: shared decision-making. (6) Civic engagement and employment: supporting environments. (7) Communication and information: digital accessibility. (8) Community and health services: patient-centred approach and access to varied rehabilitation.

CONCLUSION: This study brings together multiple perspectives from key stakeholders with experience within stroke care. By integrating insights, these findings highlight how built environmental factors in the home and local neighbourhood can support the transition to home-based rehabilitation, which can improve recovery and return to everyday life. In turn, this study contributes to the innovative development of home and neighbourhood environments to influence and support stroke rehabilitation. Linking the findings to the WHO framework increases our understanding of a supportive environment for people with stroke, but also for people with other long-term conditions.

PATIENT OR PUBLIC CONTRIBUTION: This qualitative study is part of a comprehensive research project '(Built Environments to support rehabilitation for people with stroke, B-SURE)', which aims to investigate how factors in the built environment influence stroke rehabilitation and to develop built environment solutions. B-SURE has a participatory methodology that essentially includes and involves the stakeholders in the multiple stages of the study and ensures an iterative and collaborative process.

The first measurement of the CP asymmetry of the decay rate (A_CP) and the CP average (ΣA_FB) and CP asymmetry (ΔA_FB) of the forward-backward asymmetry in the muon system of Λ⁺_c → pμ⁺μ^- decays is reported. The measurement is performed using a data sample of proton-proton collisions, recorded by the LHCb experiment from 2016 to 2018 at a center-of-mass energy of 13 TeV, which corresponds to an integrated luminosity of 5.4 fb^-1. The asymmetries are measured in two regions of dimuon mass near the φ-meson mass peak. The dimuon-mass integrated results are A_CP = (-1.1 ± 4.0 ± 0.5)%, ΣA_FB = (3.9 ± 4.0 ± 0.6)%, ΔA_FB = (3.1 ± 4.0 ± 0.4)%, where the first uncertainty is statistical and the second systematic. The results are consistent with the conservation of CP symmetry and the Standard Model expectations.

We study the constraint on f(R) gravity that can be obtained by photometric primary probes of the Euclid mission. Our focus is the dependence of the constraint on the theoretical modelling of the nonlinear matter power spectrum. In the Hu-Sawicki f(R) gravity model, we consider four different predictions for the ratio between the power spectrum in f(R) and that in Lambda cold dark matter (Lambda CDM): a fitting formula, the halo model reaction approach, ReACT, and two emulators based on dark matter only N-body simulations, FORGE and e-Mantis. These predictions are added to the MontePython implementation to predict the angular power spectra for weak lensing (WL), photometric galaxy clustering, and their cross-correlation. By running Markov chain Monte Carlo, we compare constraints on parameters and investigate the bias of the recovered f(R) parameter if the data are created by a different model. For the pessimistic setting of WL, one-dimensional bias for the f(R) parameter, log10|fR0|, is found to be 0.5 sigma when FORGE is used to create the synthetic data with log10|fR0| = -5.301 and fitted by e-Mantis. The impact of baryonic physics on WL is studied by using a baryonification emulator, BCemu. For the optimistic setting, the f(R) parameter and two main baryonic parameters are well constrained despite the degeneracies among these parameters. However, the difference in the nonlinear dark matter prediction can be compensated for the adjustment of baryonic parameters, and the one-dimensional marginalised constraint on log10|fR0| is biased. This bias can be avoided in the pessimistic setting at the expense of weaker constraints. For the pessimistic setting, using the Lambda CDM synthetic data for WL, we obtain the prior-independent upper limit of log10|fR0| < -5.6. Finally, we implement a method to include theoretical errors to avoid the bias due to inaccuracies in the nonlinear matter power spectrum prediction.

The Lund jet plane (LJP) is measured for the first time in t (t) over bar events, using 140 fb(-1) of root s = 13 TeV pp collision data collected with the ATLAS detector at the LHC. The LJP is a two-dimensional observable of the sub-structure of hadronic jets that acts as a proxy for the kinematics of parton showers and hadron formation. The observable is constructed from charged particles and is measured for R = 1.0 anti-k(t) jets with transverse momentum above 350 GeV containing the full decay products of either a top quark or a daughter W boson. The other top quark in the event is identified from its decay into a b-quark, an electron or a muon and a neutrino. The measurement is corrected for detector effects and compared with a range of Monte Carlo predictions sensitive to different aspects of the hadronic decays of the heavy particles. In the W-boson-initiated jets, all the predictions are incompatible with the measurement. In the top quark initiated jets, disagreement with all predictions is observed in smaller subregions of the plane, and with a subset of the predictions across the fiducial plane. The measurement could be used to improve the tuning of Monte Carlo generators, for better modelling of hadronic decays of heavy quarks and bosons, or to improve the performance of jet taggers.

The diffusion of two volatile fission products, xenon (Xe) and krypton (Kr), in zirconia (ZrO2) is investigated. Samples of Yttria (Y2O3)-stabilised tetragonal ZrO2 were implanted with either Xe or Kr, at 300 key, with a fluence of 1017 at./cm2, and subsequently analysed with time-of-flight elastic recoil detection analysis (ToF-ERDA) to obtain elemental composition depth profiles. Samples were then annealed at 1200 degrees C for 9 h, and the effect of the annealing was assessed by ToF-ERDA measurements. From these measurements, first-order approximations of diffusion coefficients for Xe and Kr in ZrO2 were derived, using a model based on Fick's second law, these being (1.36 +/- 0.87) x 10-19 m2/s and (2.94 +/- 1.96) x 10-19 m2/s at 1200 degrees C for Kr and Xe respectively. It was shown that ToF-ERDA can provide data to analyse the diffusion of elements in solid sample matrices and that a model based on Fick's Law can predict the diffusion of the implanted ions.

We describe and compare two techniques to extract the electronic stopping power of solid materials for energetic ions from energy loss spectra recorded in transmission geometry. Particular attention is attributed to the contribution of the nuclear energy loss to the total energy loss. Energy loss spectra were measured for slow N+ and Ar+ projectiles transmitted through 200 nm (N+ projectile) and 50 nm (Ar+ projectile) thick SiC membranes. The measured energy losses are successfully separated into electronic and nuclear losses with the help of a Binary Collision Approximation (BCA) code. The simulations show that the nuclear stopping power in any forward scattering geometry strongly deviates from SRIM predictions. Electronic stopping powers are calculated by two different iterative processes, yielding electronic stopping power at the mean energy or the energy for the mean stopping. The accuracy of the electronic stopping functions gained from these methods is verified by controlling whether the BCA code predicts the measured energy losses correctly using these functions for the simulated electronic stopping power. We show that both algorithms are suitable for extracting the electronic stopping power, even if it shows a pronounced non-linear energy dependence and if the contribution from elastic scattering to the energy loss is large. We compare their performance and show that simultaneous iteration of the electronic and nuclear stopping power provides the most accurate results.

Using a dataset of (27.12 ± 0.14) x 10⁸ ψ(3686) events collected by the BESIII detector operating at the BEPCII collider, we report the first observation of the decay ψ(3686) → Σ⁰Σ<over bar>⁰ω. with a statistical significance of 8.9σ. The measured branching fraction is (1.24 ± 0.16_stat ± 0.11_sys) x 10^-5, where the first uncertainty is statistical and the second is systematic. Additionally, we investigate potential intermediate states in the invariant mass distributions of Σ⁰ω, Σ<over bar>⁰ω. and Σ⁰Σ<over bar>⁰ω. A hint of a resonance is observed in the invariant mass distribution of M_Σ0_{(Σ<over bar>}0_)ω, located around 2.06 GeV/c², with a significance of 2.5σ.

By analyzing e⁺e^- collision data with an integrated luminosity of 7.9 fb^-1 collected with the BESIII detector at the center-of-mass energy of 3.773 GeV, the branching fraction of D⁺→ τ⁺ν_τ is determined as B = (9.9 ± 1.1_stat ± 0.5_syst) x 10^-4. Using the most precise result B(D⁺ → μ⁺ν_μ) = (3.981 ± 0.079_stat ± 0.040_syst) x 10^-4 [1], we determine R_τ/μ = Γ(D⁺ → τ⁺ν_τ)/Γ(D⁺ → μ⁺ν_μ) = 2.49 ± 0.31, achieving a factor of two improvement in precision compared to the previous BESIII result. This measurement is in agreement with the standard model prediction of lepton flavor universality within one standard deviation.

Background: Lyme neuroborreliosis (LNB) is a tick-borne infection caused by spirochetes of the Borrelia burgdorferi sensu lato complex. Facial nerve palsy and subacute meningitis are the most prevalent neurological manifestations. Long-term prognosis is a major concern of many parents. These concerns relate to persisting neurological deficiencies as well as long-term non-specific symptoms such as fatigue. The aim of this study is to determine long-term outcome in pediatric LNB by using patient-reported outcome measures (PROMs) of facial impairment and self-reported fatigue and to compare these outcomes between children with LNB and idiopathic facial nerve palsy (IFP).

Methods: A long-term follow-up study was performed including all children (< 18 years) who visited the departments of pediatrics, neurology, or otorhinolaryngology of Gelre hospitals Apeldoorn and Zutphen between 1 January 2010 and 31 December 2023 with the diagnosis LNB or IFP. After consent, children and/or parents (or guardians) were invited to complete an electronic questionnaire, including the Facial Clinimetric Evaluation (FaCE) scale and the Checklist Individual Strength (CIS).

Results: During the study period, 105 children were identified with facial nerve palsy and 4 with LNB with only headache. These 4 patients with meningitis but without facial nerve palsy were not included in further analyses. Seven children were lost to follow up. In total, 102 children were invited to complete the questionnaires, of which 84 responded (82%) after a median follow-up period of 93.5 months after the acute facial nerve palsy. The median total score of the FaCE scale was 99.2 (IQR 89.2-100) in children with LNB and 98.3 (IQR 93.3-100) in children with IFP and results did not differ between groups (p = 0.787). There were no significant differences between patients with LNB and IFP in the CIS total score (median (IQR), respectively 42.0 (26.3-69.5) versus 48.0 (40.3-60.5) (p = 0.301)).

Conclusions: This long-term follow-up study adds new data on self/parent reported disease specific outcomes in children with facial nerve palsy from two important patient groups (LNB and IFP). Both facial impairment and fatigue were uncommon and did not differ between LNB and IFP patients at long-term follow-up.

Context: The interaction of the solar wind (SW) with the coupled magnetosphere-exosphere-surface of Mercury is complex. Charged particles released by the SW can precipitate along planetary magnetic field lines on specific areas of the surface of the planet. The processes responsible for the particle precipitation strongly depend on the orientation of the interplanetary magnetic field (IMF) upstream of Mercury.

Aims: During the third Mercury flyby (MFB3) by BepiColombo, the properties of the SW inferred from BepiColombo observations of a highly compressed magnetosphere corresponded to those of a very dense plasma embedded in a slow SW. The Mercury Electron Analyzer (MEA) measured continuous high-energy electron fluxes in the nightside dawn sector of the compressed magnetosphere. In order to constrain further studies related to the origin of these populations, we aim to firmly confirm the initial inferences and detail the SW properties throughout MFB3.

Methods: We took advantage of a close radial alignment between Parker Solar Probe (PSP) and Mercury. We monitored the activity of the Sun using SOHO coronagraphs and we used a potential field source surface model to estimate the location of the magnetic footpoints of PSP and BepiColombo on the photosphere of the Sun. We propagated the plasma parameters and the IMF measured by PSP at BepiColombo, to check if the plasma impacted Mercury.

Results: We show that during MFB3, PSP and BepiColombo connected magnetically to the same region at the solar surface. The slow SW perturbation first measured at PSP propagated to Mercury and BepiColombo, as was confirmed by similarly elevated plasma densities measured at PSP and BepiColombo. The IMF orientation stayed southward during the whole MFB3.

Conclusions: Our results provide strong constraints for future studies of the magnetospheric structure and dynamics during MFB3, including tail reconnection, electron and ion energization, and subsequent plasma precipitation onto the surface of Mercury.

Introduction: Students experiencing poor wellbeing in elementary school can suffer lifelong consequences, including low self-esteem or depression. Understanding how to increase student wellbeing through information-based approaches is therefore important. While previous research has explored wellbeing frameworks, this study uniquely investigates the intersection of elementary school wellbeing with Internet of Things (IoT) implementation potential.

Method: We present the first comprehensive requirements analysis gathered from both staff and students for improving wellbeing in an elementary school in rural Sweden, with the aim of implementing IoT solutions. We collected qualitative data through individual interviews and workshops with 25 staff members and a survey from 464 students. We analyzed the data in an inductively and deductively way, using the Konu and Rimpel & auml;'s wellbeing framework.

Results: Our novel findings reveal alignment between staff and student perspectives across the framework's categories: having, loving, being and health. One example is the importance of motivation in each learning situation and creating a foundation for good social relations among the students. The requirements related to the health category received the least attention, reflecting less focus on individual student circumstances.

Discussion: This study contributes new knowledge by detailing wellbeing needs for elementary school and relating them to data-driven innovation, such as IoT, for gathering both objective and subjective information. We also acknowledge that this creates additional demands on current solutions and raises significant privacy concerns in school environments. Future research will incorporate expert IoT knowledge and develop prototype solution based on these identified requirements.

Equitable partnerships in global health research can counteract power imbalances in this field. Theoretical perspectives have been provided on equitable global health partnerships, but there are few reports from researchers actively engaged in such partnerships. This article departs from the experiences of four long-term global health research partnerships, two in Africa and two in Asia. It describes the challenges in enhancing an equitable research partnership and how these were addressed. The examples illustrate that funders can play a pivotal role in counteracting power imbalances by assigning leadership roles and directing primary funding to institutions where the research occurs. Such a transition requires adaptations and a new mindset on both sides. Embedded research capacity enhancement, part of all four partnership examples, is essential in correcting power imbalances. Capacity enhancement should preferably include enhancing the broader research ecosystem within the partner university, across academic institutions in the country or beyond. The development of mutual trust and respect takes time and requires long-term engagement, transparency in budgeting, project planning and all steps of the research process. Reciprocity in learning is important for all partners. It may include twinning of research students, joint degrees and efforts to bring research findings into policy and practice in all partner contexts. The partnership examples illustrate the achievements and challenges in bringing new research evidence into policy and practice, where early involvement and continuous buy-in by policymakers are crucial.

PLATO (PLAnetary Transits and Oscillations of stars) is ESA's M3 mission designed to detect and characterise extrasolar planets and perform asteroseismic monitoring of a large number of stars. PLATO will detect small planets (down to <2R_Earth) around bright stars (<11 mag), including terrestrial planets in the habitable zone of solar-like stars. With the complement of radial velocity observations from the ground, planets will be characterised for their radius, mass, and age with high accuracy (5%, 10%, 10% for an Earth-Sun combination respectively). PLATO will provide us with a large-scale catalogue of well-characterised small planets up to intermediate orbital periods, relevant for a meaningful comparison to planet formation theories and to better understand planet evolution. It will make possible comparative exoplanetology to place our Solar System planets in a broader context. In parallel, PLATO will study (host) stars using asteroseismology, allowing us to determine the stellar properties with high accuracy, substantially enhancing our knowledge of stellar structure and evolution. The payload instrument consists of 26 cameras with 12cm aperture each. For at least four years, themission will perform high-precision photometricmeasurements. Here we review the science objectives, present PLATO's target samples and fields, provide an overview of expected core science performance as well as a description of the instrument and the mission profile towards the end of the serial production of the flight cameras. PLATO is scheduled for a launch date end 2026. This overview therefore provides a summary of the mission to the community in preparation of the upcoming operational phases.

Background/Aim: The TGF-beta pathway can influence breast cancer progression and therapy efficacy, exhibiting both pro- and anti-tumoral effects. This study examined the impact of active TGF-beta signaling on recurrence and radiotherapy (RT) benefit in early-stage breast cancer, using nuclear phosphorylated Smad2 (pSMAD2) as a marker for pathway activation.

Methods: Tissue-microarrays from 1178 stage I-IIA breast cancer patients in the SweBCG91RT trial (randomized to breast-conserving surgery with or without RT) were analyzed. pSMAD2 immunohistochemistry was scored as the mean percentage of tumor cells with nuclear staining. Recurrence risk and RT benefit were evaluated.

Results: pSMAD2 scores were heavily skewed, with 45% of tumors demonstrating high staining (>= 80% tumor cells), 38% medium (21-79%), and 17% low (<= 20%). Low pSMAD2 tumors were associated with higher grade and larger size but not with subtype. Medium pSMAD2 tumors had a significantly increased ipsilateral breast tumor recurrence risk than high pSMAD2 tumors (HRadjusted = 1.82, p = 0.002), while no differences were observed for low pSMAD2 tumors. A similar result was obtained with all recurrences as endpoint. RT benefit was consistent across all pSMAD2 groups. In Luminal tumors, higher tumoral pSMAD2 levels were inversely correlated with tumor-infiltrating lymphocytes (TILs).

Conclusion: Medium pSMAD2 levels were linked to an increased recurrence risk compared to high levels, suggesting a tumor-suppressive role of TGF-beta in early breast tumorigenesis. However, no significant differences were noted for low pSMAD2 levels. In Luminal tumors, TGF-beta signaling was negatively associated with TILs. These findings indicate that therapeutic targeting of TGF-beta warrants careful consideration of tumor stage and subtype.

Background: Evidence on the association between endotoxin exposure and respiratory health in children remains inconsistent, with limited research addressing school environments-key settings for daily exposure. This study investigates the relationship between classroom endotoxin levels and respiratory health among European schoolchildren.

Methods: Within the EU-funded SINPHONIE project, endotoxin concentrations were measured in 285 classrooms across 102 schools in 22 European countries. A total of 5,140 children completed a standardized health questionnaire; 4,633 had endotoxin data, 4,170 performed spirometry, and 746 underwent fractioned exhaled nitric oxide (FeNO) testing.

Findings: Endotoxin levels varied geographically, with the highest averages in Italy and the lowest in Finland. After adjusting for confounders, exposure to endotoxin levels at or above the median was associated with higher odds of upper and lower respiratory symptoms-runny nose, nasal obstruction, cough, dry throat, breathing difficulty, and feverishness-as well as reduced lung function (p < 0.05). Meta-analysis by WHO European clusters confirmed these associations, though region-specific analyses indicated a possible protective effect of endotoxin exposure in Northern Europe.

Interpretation: Findings from SINPHONIE highlight classroom endotoxin as a potential environmental determinant of respiratory health. Reducing exposure in schools-currently an overlooked setting-may support respiratory well-being in children and inform future public health policies.

This article presents a search for a heavy charged Higgs boson produced in association with a top quark and a bottom quark, and decaying into a W boson and a 125 GeV Higgs boson h. The search is performed in final states with one charged lepton, missing transverse momentum, and jets using proton-proton collision data at √s = 13 TeV recorded with the ATLAS detector during Run 2 of the LHC at CERN. This data set corresponds to a total integrated luminosity of 140 fb^-1. The search is conducted by examining the reconstructed invariant mass distribution of the Wh candidates for evidence of a localised excess in the charged Higgs boson mass range from 250 GeV to 3 TeV. No significant excess of data over the expected background is observed and 95% confidence-level upper limits between 2.8 pb and 1.2 fb are placed on the production cross-section times branching ratio for charged Higgs bosons decaying into Wh.

High Resolution Neutron Spectrometer (HRNS) is one of the essential plasma diagnostics of ITER, whose operational role is the neutronic measurement of the nt/nd ratio in a plasma core. Coexisting with the other ITER diagnostics makes it a powerful tool for efficient and precise plasma diagnostics. The main goal of this work is to present the operating principles and key challenges associated with the High Resolution Neutron Spectrometer in ITER, with a particular focus on the Thin-Foil Proton Recoil (TPR) Spectrometer. The complexity of ITER tokamak brings with it many variables that had not been considered of primary importance until now, such as the magnetic field or high temperature in the detector region.

Polyethylene glycol (PEG)-stabilized lipodisks constitute a novel and promising class of drug nanocarriers. Their non-spherical shape, small size and deformable morphology confer advantageous features in terms of blood circulation time, biodistribution, tumour penetration and immunological behaviour. In this study, we explore the potential and conditions for using lipodisks for the co-delivery of the membranolytic anticancer peptide melittin and the chemotherapeutic agents doxorubicin (DOX) or SN-38. To this end we prepare lipodisks loaded with DOX or SN-38 alone, as well as lipodisks dually loaded with DOX or SN-38 and melittin. We investigate how variations in the lipodisk lipid composition affects the disk's drug loading capacity, and identify factors that have an important influence on the retention of the anticancer agents in the disks. Additionally, we conduct cell studies to assess and compare the in vitro cytotoxic effects of the mono and dually drug-loaded lipodisks. These studies include experiments designed to explore possible synergistic effects obtained by combining DOX or SN-38 with melittin in the same carrier. Our results indicate that clear synergistic effects can be obtained by co-delivery of SN-38 and melittin (combination index (CI) <= 0.52), while the benefits achieved by combining doxorubicin and melittin in a common lipodisk carrier are more modest (CI <= 0.95). In conclusion, our study highlights the potential of PEG-stabilized lipodisks as effective nanocarriers for the co-delivery of membranolytic peptides and chemotherapeutic agents. The overall findings underscore the versatility and promise of lipodisks in drug delivery applications.

Background and objectivesTo analyse observations of staff's hand hygiene, usage of gloves and plastic aprons, and dress code compliance at the Burn Centre, Uppsala University Hospital in Sweden, and to evaluate the association between hygiene non-compliance and outbreak periods. Furthermore, to explore the potential of using routine hygiene observations as an early warning tool for the risk of uncontrolled spread of (multidrug-resistant) bacteria.MethodsDirect observations of the personnel's compliance with hand hygiene, usage of gloves and plastic aprons, and dress code were studied in relation to two A. baumannii outbreaks in 2014 and 2020. Interrupted time series analyses were conducted from 2013 to 2017 and 2018 to 2022 to evaluate outbreak intervention measures. Rolling sums of observed hygiene errors and 90th percentiles were calculated for four-, five-, and six-month periods.ResultsDuring the study, 13,216 direct observations showed hygiene compliance ranging from 70 to 100% per category. Infection control interventions significantly reduced non-compliance after both outbreaks, with sustained improvements for two years following the first outbreak. Rolling four- to six-month sums, using 90th percentile thresholds of seven, nine, and eleven non-compliances predicted A. baumannii outbreaks.ConclusionIn this setting, compliance levels above 97% were consistently observed during outbreak-free periods, suggesting a potential protective effect. Focus on non-compliance as a key metric and rolling sums of non-compliance, may support early detection of increased outbreak risk and guide preventive interventions.

Background

The COVID-19 pandemic negatively affected adolescents’ opportunities for physical activity in many countries.

Aim

To explore experiences and opportunities for physical activity among Swedish adolescents with different backgrounds, considering both the impact of the COVID-19 pandemic and broader influencing factors during and after this period.

Methods

Data was collected through focus group interviews (n = 13) with 86 students and analysed using content analysis.

Results

Although many adolescents managed to remain physically active during the COVID-19 pandemic, socioeconomic differences affected opportunities for participation in organized sports and activities, as well as perceptions of community safety. Findings also highlighted the important role of schools and the influence of gender and performance norms on physical activity, as well as young girls’ desire for “safe spaces” to focus on their training and development.

Conclusion

The COVID-19 pandemic disrupted routines, prompting adaptations and exposing various barriers. Social belonging, socioeconomic background, and prevailing norms significantly influenced activity levels, while the balance between independence and safety emerged as a key factor. Moving forward, we recommend investing in community safety, youth sports, and supportive school policies that challenge gender and performance norms, particularly in socioeconomically disadvantaged areas.