The European Union's proposed restriction of per-and polyfluoroalkyl substances (PFAS) prompted unprecedented stakeholder engagement. This study maps industrial lobbying strategies within the 2023 European Chemicals Agency public consultation, the largest in EU history. Combining manual qualitative coding with large scale AI-assisted classification, we analysed stance, exemption requests, and argumentation patterns across 4771 unique comments. The analysis reveals a dominant strategy among industrial actors, who contributed 68.5% of all submissions. While 71% of industry stakeholders explicitly opposed the restriction, 78% of these opponents simultaneously requested technical exemptions. This approach contests the regulation's legitimacy while ensuring technical derogations to weaken its scope. Argumentation clustered around four narratives: economic competitiveness, essentiality, scientific minimization, and responsible innovation. Beyond these empirical findings, we provide an open-access sectoral dashboard to facilitate regulatory oversight and visualize these lobbying patterns. Our analysis reveals an asymmetry in lobbying power by industries that rely heavily on PFAS functionality compared to other stakeholders. The results demonstrate how technical complexity and mass participation can be strategically leveraged to influence regulatory ambition and reframe a debate on chemical risks and public health, into one centered on European competitiveness and technological indispensability.

Background: Teach-Back is a widely recommended communication method to support patient understanding, yet little is known about how healthcare professionals learn Teach-Back in everyday clinical practice. The study aimed to explore how healthcare professionals learn Teach Back within an acute hospital setting, and how this learning is experienced and enacted in everyday clinical practice.

Methods: This qualitative study invited staff in two healthcare settings that had partaken in a Teach-Back method training program. Participants included 18 healthcare professionals and four first-line managers. Data were generated through interviews conducted in the beginning and after the training program, and through observations of clinical encounters when applying the Teach-Back method. Data were analyzed using reflexive thematic analysis.

Results: Learning Teach-Back was identified as a multilevel workplace learning process that developed through interactions between individual experiences, interpersonal learning processes, organizational engagement, and workplace conditions. This was reflected in four interrelated themes: (1) Individual level: Learning by doing and experiencing Teach-Back: authentic Teach-Back encounters with patients were critical for skill development but could trigger insecurity when Teach-Back was experienced as unnatural. Emotional responses, discouragement and "aha" moments, shaped whether healthcare professionals used Teach-Back or not; (2) Interpersonal level: Learning through feedback and shared meaning: recurring peer reflection and supportive feedback were crucial for learning Teach-Back, yet often lacking; (3) Organizational level: Engaging the organization to promote learning: early adopters, ambassadors, leadership support, and interprofessional communication were decisive for learning Teach-Back; and (4) Workplace conditions: Making space for learning in a pressured work environment: staff shortages, turnover, and high workload constrained opportunities for doing and engaging in reflection and feedback about Teach-Back.

Conclusions: Learning Teach-Back can be understood as a multilevel workplace learning process that develops through opportunities for practice, reflection, and collegial feedback in everyday clinical work. Supporting Teach-Back learning requires workplace learning approaches that foster shared meaning across professional teams, organizational engagement, and protected space for learning.

Trial registration: ClinicalTrials.gov ID: NCT02925871. Registration date: first submitted 8 April 2016; first posted 6 October 2016.

This project aimed to evaluate the technical feasibility and environmental implications of using municipal solid waste incineration bottom ash (MSWBA) as a supplementary cementitious material (SCM) in concrete production. The overarching goal was to promote sustainable construction by reducing cement consumption and repurposing industrial waste in accordance with circular economy principles. Five MSWBA samples were initially assessed for their chemical properties, pozzolanic potential, and particle size distribution. Based on the obtained results, the samples B3 and B5 were selected and incorporated into concrete mixtures at 10% and 20% replacement levels of cement, both in raw and activated forms, with standard Portland cement-concrete mixtures used as reference.

Compressive strength tests up to 180 days showed that 10% raw B5-concrete specimens maintained the best compressive strength development (33,3 MPa) among MSWBA-concrete mixes. In contrast, 20% replacement of cement by MSWBAs led to marked reductions in compressive strength, while activated MSWBAs introduced variability in concrete compressive strength at 90 to 180 days of curing.

The environmental performance of MSWBA-concrete mixtures was evaluated through heavy metal content analysis and leaching tests. B5 was found to contain lower levels of hazardous elements such as Cd, Pb, Cr, and Hg, and met environmental safety criteria for leaching. In contrast, B3 displayed higher impurity levels, which may restrict its application unless further treated. Leaching tests confirmed that at 10% replacement, both raw and activated B3 samples complied with current environmental leaching thresholds for heavy metals, demonstrating their viability in limited proportions. However, the elevated loss on ignition (LOI) and trace metal variability in B3 raise long-term environmental concerns, especially under extended exposure conditions such as carbonation or chloride ingress. B5’s low LOI and minimal leachable contaminants, on the other hand, reinforce its suitability not only from a mechanical but also environmental perspective. These findings emphasize the importance of selecting MSWBA sources carefully and the potential necessity of pretreatment to ensure the safe and sustainable implementation of MSWBAs in concrete applications.

From the carbon dioxide emission perspective, the replacement of 10% cement with MSWBA resulted in an estimated reduction (production) of approximately 10% CO₂ekv. per 1 kg of concrete compared to the reference mixture. This reduction, while resulted in acceptable compressive strength and safety in the B3- and B5-concrete mixtures, underscores the material’s contribution to lowering the carbon dioxide emissions from concrete.

The study demonstrates that raw B5, used at a 10% replacement level, is a promising and environmentally sound SCM option. It offers acceptable mechanical performance while supporting material recycling and emission reduction. These findings provide a foundation for future exploration into optimized processing, broader application scopes, and long-term performance in sustainable concrete systems.

This study investigates how physical alterations of paths, including changes in surfacing and lighting conditions, impact the behaviour of pedestrians and cyclists. Using drone-based imaging technologies, data were collected from shared-use paths in two Swedish cities during periods of reduced daylight hours. The study focused on speed and slalom, examining how these measures varied across different subsets defined by combinations of physical changes and lighting conditions. The results reveal that both physical alterations and lighting conditions significantly influence pedestrian and cyclist behaviour. These findings provide valuable insights into the complex interplay between environmental factors and user behaviour on shared pathways. Understanding how changes in environmental features influence pedestrian and cyclist behaviour can guide urban planning and infrastructure design aimed at improving safety and efficiency for all path users. 

Background and Aim: Brain-derived tau (BD-tau) is a predominantly CNS-derived form of tau protein detectable in blood that reflects brain injury and has emerged as a potential biomarker in ischemic stroke for assessing neuronal damage, monitoring infarct progression, and predicting functional outcome. However, its temporal profile and the optimal timing for correlation with infarct volume remain unclear.

Methods: This prospective cohort study included patients with ischemic stroke, with venous blood samples collected daily during the first week and at 3 months after symptom onset. Infarct volume was assessed by MRI at 48-72 h. Plasma BD-tau concentrations were measured using a Simoa assay. Linear mixed-effects models were used to analyze changes in biomarker levels. The optimal time point for correlation between BD-tau and infarct volume was identified using a 24-h moving-window Pearson correlation analysis.

Results: Fifty-four patients (median age 78 years, 50% female) contributed 285 plasma samples. Plasma levels of BD-tau followed a parabolic trajectory reaching a peak approximately 5 days after symptom onset. After 90 days, the concentration of BD-tau was lower than in the last measurement of the first week. The strongest correlation between BD-tau and infarct volume occurred at 105 h (4.4 days) (r = 0.89, 95% CI: 0.78-0.95) after symptom onset.

Conclusions: Plasma BD-tau exhibits a distinct temporal profile after ischemic stroke, with peak levels and maximal correlation with infarct volume occurring around Day 4-5. These findings have important implications for interpreting BD-tau levels and optimizing sampling strategies in clinical studies.

Functionally graded Alloy 718-YSZ systems fabricated using Laser Directed Energy Deposition with powder feedstock (DED-LB/p) process offer a promising pathway to integrate structural metals with thermally insulating ceramics for high-temperature applications. However, the composition-dependent melt pool behaviour and microstructural evolution arising from laser interactions with dissimilar metal-ceramic powders remain insufficiently understood. Therefore, this study investigates the influence of gradient compositions on solidified melt pool characteristics and the resulting microstructural changes in compositionally graded Alloy 718-YSZ single tracks (in 10 wt% steps) deposited by DED-LB/p under constant processing parameters. The results revealed a distinct phase separation of Alloy 718-rich and YSZ-rich regions in the solidified melt pool, primarily driven by differential melting behaviour and limited wettability between metal and ceramic phases. With increasing YSZ content, the ceramic microstructure transitioned from sintered or partially fused grains to fully melted and solidified columnar grains, which was also reflected in the microhardness response, showing increasing hardness in the ceramic-rich regions. Despite the low laser absorptivity of YSZ, complete melting and solidification were achieved in the 100 wt% YSZ sample, attributed to local heat retention effects. Cracking behaviour was governed by both the microstructural defects and the thermal expansion mismatch between the separated metal and ceramic regions. This study provides a systematic experimental understanding of composition-dependent melting behaviour, phase separation mechanisms, and microstructural evolution across the full composition range of the Alloy 718-YSZ system.

Circulating cell-free RNA (cfRNA) has emerged as a promising minimally invasive biomarker capable of capturing transcripts originating from multiple tissues and cell types, but its utility in chronic inflammatory airway diseases remains poorly understood. Equine asthma (EA), a naturally occurring respiratory disease that shares key clinical and immunopathological features with human asthma, provides a valuable comparative model for evaluating plasma cfRNA in this context. We performed transcriptomic profiling of plasma cfRNA from horses with EA and healthy controls and compared these findings with partially matched bronchoalveolar lavage (BAL) and whole-blood (WB) transcriptomes. Differential abundance analysis of plasma cfRNA identified increased abundance of the epithelial alarmin IL33, together with signatures associated with tissue remodeling, cellular stress responses, and immune alterations. Notably, cfRNA from EA horses exhibited reduced B-cell-associated and increased T-cell-associated transcript signatures, a pattern independently supported by differential abundance, co-expression network, and deconvolution analyses. In contrast, similar immune-associated signatures were not evident in the BAL and WB transcriptomes analyzed in this study. Cross-compartment comparisons further demonstrated that plasma cfRNA captured a molecular profile largely distinct from those identified in BAL and WB, while sharing only a small set of differentially abundant transcripts across compartments. Collectively, these findings indicate that plasma cfRNA captures molecular patterns associated with EA that differ from those observed in conventional transcriptomic sampling compartments. These results support the potential utility of plasma cfRNA as a minimally invasive source of biomarkers for characterizing airway disease-associated molecular and immune alterations in both veterinary and comparative asthma research.

Objective: To explore community-dwelling older adults' expectations and perceptions of future needs and requests concerning assisted oral care from healthcare professionals in event of greater need for care.

Background: Older adults with care needs often require support with oral care from care professionals, yet cognitive impairments may hinder their ability to express needs and preferences.

Materials and Methods: A qualitative study with an inductive approach and purposive sample was conducted. Eighteen community-dwelling older adults (≥ 65 years) receiving municipal home healthcare or home help services in southwest Sweden were interviewed individually. Information on oral health, oral care and anticipated future need for assisted oral care was gathered. Interviews were audio-recorded, transcribed verbatim, and analysed using qualitative content analysis. Ethical approval was obtained, and the study adhered to the COREQ checklist.

Results: The analysis generated an overall theme: ‘Tensions between thoughts, envisioned standards and anticipated practicalities in future assisted oral care’ and three subthemes ‘Oral self-care is the last stronghold of independence, with staff support considered under specific conditions’, ‘Sensitive dialogue enables access to assisted oral care’ and ‘Tough but necessary to accept assisted oral care’.

Conclusion: There are tensions in community-dwelling older adults' expectations of assisted oral care. A desire for independence and delayed assistance contrasts with the need for early communication before health decline impairs decision-making to ensure autonomy and person-centred care.

The project ‘‘Bottom Ash as a Replacement for Cement in Climate-Improved Concrete’’ investigates the possibility of using bottom ash, produced from municipal solid waste incineration (municipal solid waste incineration bottom ash, MSWIBA), as a partial replacement for cement in concrete, with regard to the mechanical properties of concrete. Concrete is an indispensable material in the building industry and consists of cement, water, fine aggregates, and coarse aggregates. The production of cement consumes natural resources, causes air pollution, and emits greenhouse gases, leading to drastic changes in climate conditions. To counteract this, the concrete industry is working toward climate-neutral concrete by 2030, with a strategy that includes optimizing binders and reducing cement content. A significant increase in municipal waste production has been noticed due to changes in lifestyles and urbanization. The disposal of the generated waste through incineration produces MSWIBA and municipal solid waste incineration fly ash (MSWIFA). MSWIBA accounts for approximately 90% of the residue product and contains various oxides, making the ash comparable to different supplementary binders. In this project, five different MSWIBAs (named BA1–BA5) were collected. They were examined for their chemical ingredients, mineral compositions, and particle size distribution (PSD). After conducting X-ray diffraction (XRD) and PSD analyses on all samples, the samples (BA3 and BA5) that exhibited pozzolanic properties and particle sizes closer to conventional cement were selected for further studies. Various concrete mixes were prepared with 10% and 20% replacements of cement using raw and activated MSWIBAs (BA3 and BA5). A total of 81 test cubes were cast and analyzed. The properties of fresh and hardened concrete were compared to the control mix. The performance and strength developments of each mix were studied by conducting compressive strength tests at 7, 28, and 56 days. Concrete mixes with raw MSWIBAs showed similar workability to the control mix while mixes with activated MSWIBAs exhibited increased workability. The density of concrete decreased as the MSWIBAs replacement percentage increased, indicating that lighter concrete can be produced by incorporating MSWIBAs. However, the activation of MSWIBAs had no significant positive effect on the compressive strength of the concrete mixes. Although the compressive strength decreased with increasing the replacement ratio of MSWIBAs, the concrete mix with 10% replacement of raw BA5 achieved around 77% of the compressive strength of the control specimen after 56 days. For all concrete mixes containing MSWIBAs, the mix with BA3 showed better performance than the mix with BA5 after 7 days. However, at longer curing times, the concrete mix with BA5 exhibited higher compressive strength than the mix with BA3. The concrete mix with 20% raw and activated MSWIBAs obtained 58% of the compressive strength of the control specimen after 56 days. Despite the reduction in the compressive strength of concrete, this sustainable concrete offers potential benefits in terms of environmental protection and waste management. The use of MSWIBA as a substitute for cement can also contribute to the development of climate-improved concrete. This project can be extended into two different phases: (1) studying the effect of mixing MSWIBA with other supplementary cementitious materials, such as fly ash, silica fume, or ground granulated blast furnace slag, to replace part of cement. In this way, the lower reactivity of MSWIBA can be compensated. Consequently, similar or even superior compressive strength for concrete can be achieved through this synergy, along with improved durability properties. (2) Investigating MSWIBA as a substitute for aggregates in concrete. Another potential application of MSWIBA is replacing aggregates in concrete, contributing to the development of more environmentally friendly concrete. This reduces the demand for natural aggregates and helps conserve natural resources.

Background: Despite the high prevalence and clinical significance of emphysema, few genetic risk loci have been consistently replicated. We conducted a genome-wide association study (GWAS) of CT-based emphysema, with a particular focus on non-smoking-related genetic determinants.

Methods: We analyzed 25,639 individuals of European ancestry from the SCAPIS national cohort, aged 50-65 years, of which 51% were never-smokers. Emphysema was assessed through semi-quantitative visual scoring of CT scans. GWAS was performed in the whole sample and stratified on smoking status. We also examined the association of previously reported emphysema- and lung function-related variants with emphysema in our dataset.

Results: Emphysema criteria were fulfilled for 1,479 participants (5.6%), with higher prevalence among current (N = 576, 18.2%) and former smokers (N = 612, 6.5%) compared to never-smokers (N = 263, 2.0%). We identified three independent genetic loci for emphysema in smokers and no signals in never-smokers. The strongest signal was observed in the well-established nicotinic acetylcholine receptor cluster (CHRNA5-A3-B4) locus on chromosome 15. Additionally, we discovered novel associations near the dysferlin (DYSF) gene on chromosome 2 and in an intergenic region on chromosome 3. By assessing previously lung phenotype-associated variants we also found evidence supporting association with emphysema in smokers for variants in the EFEMP1/MIR217HG/PNPT1 locus on chromosome 2, previously linked to reduced FEV1/FVC ratio.

Conclusion: This study, based on the largest unselected population sample to date, provides novel insights into the genetic architecture of emphysema. However, no signals were detected in never-smokers despite the large sample-size, likely due to the low prevalence of emphysema in that group. The proposed genetic risk loci require external replication.

Background Near-peer teaching (NPT) and structured near-peer teaching programs (NPTPs) have been recognized as valuable approaches in medical education, yet relatively few studies have explored programs designed specifically for junior doctors. In response to a local shortage of clinical supervisors and educators at a non-university teaching hospital in Western Sweden, a voluntary pedagogical faculty development program was launched in 2018 as part of the mandatory medical internship. The program engaged junior doctors with a documented interest in education to supervise medical students and peers. From the outset, the program was intended not only as a teaching initiative but also as an early form of faculty development, aiming to strengthen participants’ pedagogical skills and professional identity. This study aimed to explore how junior doctors participating in a pedagogical internship track experienced the development of their teaching skills and professional identity, as well as their experience of the program. Methods We conducted a qualitative study of the pedagogical internship track using semi-structured interviews with ten former participants, enrolled between 2018 and 2024. Interviews explored their experiences of the program and its influence on subsequent professional roles. Data were analyzed using qualitative content analysis. Results We identified three main themes: Theme 1, Building a pedagogical toolbox, highlighting how the participants acquired skills in simulation, feedback and how to orchestrate teaching events. Theme 2, Establishing professional legitimacy, with a focus on how the program gave them credibility as teachers and a platform to influence the teaching environment in the hospital. Finally, Theme 3, Becoming a clinical teacher, highlighting the development of an identity as a clinical teacher, growing confidence and how the participants took on new roles as clinical teachers. Conclusions Findings from this study suggest that structured near-peer teaching programs for junior doctors strengthen teaching skills, enhance professional identity, and promote continued engagement in clinical education. By embedding such programs within internship training, hospitals may not only support individual development but also foster a sustainable pedagogical culture.

Introduction: Culturally appropriate assessment is vital for learning health systems; however, few such tools for Indigenous children exist. In 2011, Indigenous health leaders and scientists collaborated to create the Aaniish Naa Gegii: the Children’s Health and Well-being Measure (ACHWM) for Indigenous children aged 8 to 18 years. It was adapted for Inuit in Ottawa and named Qanuippit. The Government of Nunavut (GN) expressed interest in integrating the Qanuippit territory-wide. This study aimed to adapt the Ottawa Inuit version for Nunavut, to ensure they had a valid wellness measure to guide community-based health services planning for Inuit children in Iqaluit.

Methods: We used a mixed-methods approach to consider the full spectrum of health, from wellness to illness. All data gathered was governed by Inuit Qaujimajatuqangit (IQ) principles. We consulted eight Iqaluit-based experts in Inuit education, culture, and children’s health to ensure cultural relevance and identify any missing content. In February 2024, interviews were conducted by the local mental health team, with 15 Inuit children (7.7 -17.9 years). Each child completed the draft of the Qanuippit that resulted from the Expert review, and local mental health workers examined the children’s understanding of each item. The analysis focused on items with critical input from two or more participants. Once finalized, a pilot implementation study explored how mental health workers integrated the Qanuippit in practice.

Results: Experts reported eight items of concern; one had a clear solution, and the remaining seven were identified for monitoring. Children identified 11 problematic items; two had clear solutions, while consultation continued for the remaining items. Mental health workers reported that the tool was a positive, strengths-based experience. The Qanuippit aided in forming connections with clients, which positively impacted their practice.

Conclusions: The Qanuippit has proven to be a good fit to assess the health and well-being of Inuit children in Iqaluit.

The performance, combustion, and exhaust emissions analysis was carried out on a one-cylinder Direct Injection Diesel engine that was done using Mahua biodiesel blend contains (25% Mahua BD and 75% diesel along with 100 ppm of (Al2O3) nano additive and 20% exhaust gas recirculation with varying load from 0 to full load with a step of 25%. This study shows that the BTE was improved by almost 5.53% with the addition of Alumina nano additive to Mahua bio diesel blend. The combination of nano additives and 20% EGR to MB25 fuel, 3.4% raise in BTE was observed. The BSFC for nano additive mahua biodiesel blend with 20% EGR decreased by 2.34% than the Mahua biodiesel blend. This shows that using alumina additive and exhaust gas recirculation with the biodiesel blend increases the brake power and fuel efficiency than the biodiesel blend. However, concerning exhaust emissions, mahua biodiesel blend with alumina nano additive containing 20% EGR, generated 14.8% less nitrogen oxides (NOx), on the other hand, hydrocarbons (HC), carbon monoxide (CO), and smoke were increased 10.2%, 12.7%, and 9.1%, respectively than MB25. Overall, findings suggest that the use of alumina nano additive in Mahua biodiesel with 20% exhaust gas recirculation improves the engine performance and an increase in HC, CO and smoke emissions by reducing the NOx emissions than the nano additive biodiesel fuel and MB25 and biodiesel blend with 20% EGR.

While comparative analysis has become increasingly utilised within sport policy and management research, how comparative research is interpreted and translated into policy and practice is often overlooked. This review paper deconstructs six misconceptions (or myths) that distort the potential interpretation and application of comparative sport policy research: (1) the myth of comparative necessity, (2) the myth of isolated sport systems, (3) the myth of total equivalence, (4) the myth of immaculate methodology, (5) the myth of direct transferability and (6) the misconception of comparison through superficial observation. Drawing on comparative methodology, existing literature and our own experiences of researching within the Swedish and UK sport contexts, we illustrate how these misconceptions, along with the assumptions that underpin them, can lead to fundamental misinterpretations and false inferences that can inadvertently mislead policy and/or decision-making. Ultimately, this work offers critical insights for researchers, policymakers and practitioners seeking to navigate the complexities of cross-national comparisons to inform policy and decision-making.

Per- and polyfluoroalkyl substances (PFAS) are thermally persistent and can form degradation products during waste incineration. Despite this, standardised methods for measuring PFAS in flue gases have only been developed in recent years. In this study, three PFAS flue gas sampling methods were evaluated at four Swedish waste-to-energy plants. Two methods target semi-volatile polar PFAS (OTM-45 and a modified method based on EN 1948-1), while one targets volatile non-polar compounds (OTM-50). Because the methods are partly designed to capture different PFAS substance groups, the comparative part of the study focuses on the two methods targeting semi-volatile polar PFAS.

The overall aim of the study is to assess how well the methods can characterise emissions under real operating conditions, rather than to provide a comprehensive quantification of total PFAS emissions. Although these methods have been developed in recent years, their application at full-scale waste-to-energy plants remains limited, particularly regarding practical implementation, comparability, and sensitivity to spatial and temporal emission variability. This study addresses this gap through a systematic, field-based evaluation of PFAS sampling methods under real operating conditions. OTM-50, which targets volatile non-polar compounds, consistently showed substantially higher levels, with total concentrations of roughly 4–13 µg/Nm³ at background facilities (and up to ~4,600 µg/Nm³ during an episodic hexafluoropropene event).

Concentrations of semi-volatile polar PFAS, sampled using OTM-45 and EN 1948-1, were generally below 1 ng/Nm³. The compounds detected most consistently across all plants were chlorodifluoromethane (HCFC-22) and trichlorofluoromethane (CFC-11), at low concentrations of roughly 0.4–3.7 and 0.5–1.9 µg/Nm³; these compounds are not PFAS but are included in the OTM-50 target list. HCFC-22 is reported as an estimate owing to chromatographic interference. In addition, a pronounced non-target chromatographic peak was present in most samples and warrants further investigation (see Discussion). Their presence in all sampled furnaces, as well as in blank samples, indicates that multiple sources may contribute, including incomplete destruction of CFC-containing materials, possible in-stack formation via radical reactions, and background levels.

For polar PFAS, the dataset was dominated by two clearly elevated samples: an OTM-45 sample at Plant B with high concentrations of 6:2 fluorotelomer sulfonate (6:2 FTS), and an EN 1948-1 sample at Plant C with elevated levels of short-chain perfluoroalkyl carboxylic acids. Both events likely represent genuine, episodic emissions in a heterogeneous flue gas, although missing sample fractions partly hamper interpretation. When these outliers are excluded, a relatively consistent picture emerges for total polar PFAS concentrations across all plants, with levels below 1 ng/Nm³ and broadly similar chain-length profiles. This indicates that OTM-45 and EN 1948-1 provide comparable results at these concentration levels, while capturing different local emission events and partly different PFAS substance groups.

The comparison between methods for semi-volatile PFAS highlights several important limitations. First, the ratio between OTM-45 and EN 1948-1 varied by up to two orders of magnitude between plants, and in opposite directions. Together with the strong influence of individual outliers, this shows that single 2–4 h grab samples are not representative of PFAS emissions that vary spatially and temporally. Second, internal mass balance analyses show that both OTM-45 and EN 1948-1 predominantly collect PFAS in aqueous phases and on sampling train surfaces, rather than on dedicated sorbents such as XAD-2. From a practical perspective, OTM-50 proved relatively straightforward to apply logistically, but requires access to specialised sampling canisters and GC–MS infrastructure. OTM-45 and EN 1948-1 are more complex, requiring extensive glassware and solvent handling, as well as multi-step laboratory extractions. All three methods are labour-intensive and strongly dependent on rigorous quality control. Sample contamination, as well as the loss of a single canister or a missing sample fraction, can substantially affect data interpretation at low concentrations.

Overall, the study demonstrates that PFAS measurement methods can be applied at full-scale waste-to-energy plants, but that their performance and interpretability are strongly constrained by spatial variability and episodic emissions. OTM-50 is robust for measuring volatile fluorinated compounds within its calibrated target list. At the same time, OTM-45 and EN 1948-1 provide broadly comparable results for polar PFAS at low concentrations, subject to sensitivity to sampling configuration and surface interactions. The observed episodic concentration peaks indicate that the methods are sensitive to transient emission events; however, the available data and study scope do not allow assessment of the underlying causes. Consequently, results from single grab samples must be interpreted with caution if they are to be used to estimate emissions over longer time periods.

In a highly dense ultra-6G environment, synchronising decisions across all three layers of communications, computations, and controls is no longer theoretical but practical; edge servers, mobile devices, and cloud servers will have to operate in real time. Furthermore, they will have to adapt to changing link conditions and consume less power over those links, and also have to process non-IID data sets. Unfortunately, none of today’s learning-based orchestration approaches is robust in this environment. This work is an introduction to a hierarchical trust-aware orchestration framework, which is capable of working reliably in the presence of real 6G conditions. Multi-Agent Architecture for 6G Edge Intelligence (MAAFL-6G), the proposed system is comprised of a combination of agents (device level, edge level and cloud level) that utilise Hierarchical Multi-Agent eXtended Proximal Policy Optimisation based Federated Learning (H-MAXPPO) policy to make decisions on the appropriate scale in time. Reliability increases to about 99.8%, and more importantly, it stays there instead of wobbling or collapsing mid-training. The latency, which starts above two seconds in early rounds, settles comfortably around 0.48−0.55 seconds. Energy consumption remains low and steady, roughly 0.0175-0.0195 J per task, whereas centralised baselines burn significantly more. Even the subtler metrics, such as cross-layer stability and the speed at which trust scores settle, point in the same direction: the hierarchical approach is simply more resilient to the messy, multi-timescale nature of 6G environments than either centralised or purely local learning.

Encephalitis lethargica (EL), also known as the ‘European Sleeping Sickness’, emerged in Europe around 1916, with Sweden reporting the highest global incidence rate in 1921. This study investigates regional variations in EL incidence across Sweden between 1920 and 1930, with a particular focus on the major outbreak in 1921. Using data from Public Health in Sweden, incidence rates were calculated for all Swedish regions, revealing a disproportionate concentration of cases in central and northern areas, especially in the parish of Vilhelmina in Västerbotten. To contextualize this outbreak, monthly disease data from the Annual Reports of the Chief Provincial Doctor in Västerbotten were analysed to compare the local disease panorama. Notably, preceding the first EL cases in Vilhelmina, influenza/H1N1 and mumps were frequently reported. Although the aetiology of EL remains unresolved, the presence of a preceding influenza and mumps epidemic is consistent with the dual-pathogen hypothesis, suggesting that interactions between infectious agents may have contributed to the emergence of EL in local hotspots.

Introduction: Perioperative care is a central component of hip fracture treatment, yet knowledge regarding the quality of perioperative care from the patient perspective remains limited.

Aim: To investigate patients' perceptions of perioperative care quality and identify aspects in need of improvement among patients undergoing total hip arthroplasty for femoral neck fracture.

Method: 385 patients treated with total hip arthroplasty for femoral neck fracture within the Swedish arm of the Duality trial between November 2022 and November 2023 were invited to participate. 171 patients gave informed consent to participate and received questionnaires. Data were analysed using the Quality from the Patient Perspective (QPP) framework. Perceived reality (PR) and subjective importance (SI) ratings were analysed. Lower PR scores were interpreted as strengths, while quality deficiencies were identified using the Index of Quality (IQ).

Result: In total, 118 of 171 patients responded. Overall, most assessed perioperative care aspects (21 of 33, 64%) were assessed as strengths. Strengths primarily concerned medical care, accessibility and physicians' and nurses' engagement and respectful treatment. In contrast, four aspects related to pre-and postoperative information provision and patient participation during intra-and postoperative care were identified as areas requiring improvement.

Conclusion: While most aspects of perioperative care were perceived as high quality, informational and participatory aspects emerged as areas requiring improvement. Strengthening information provision and supporting patient participation may enhance patients' perceptions of perioperative care quality following hip fracture surgery.

Denna rapport har som syfte att göra en översyn av magisterprogramet i evidensbaserat socialt arbetes första år. Intervjuer har genomförts med studenter, lärare samt representanter för arbetslivet (kommuner). I rapporten presenteras följande förlag; 1) Att avsluta fri-fart, fri-start upplägget och istället införa fast fart (25% alt. 50%)  takt för studierna. Kurserna kan fortfarande bestå av inspelade föreläsningar och ha en stor flexibilitet, inom terminsgränserna. 2) Att begränsa examinationerna till fem. 3) Att ha kvar distans/nätundervisningen och att uppmuntra kursansvariga att lägga in diskussionstrådar, chat, connectmöten och bjuda in studenter som bor nära studieorten att närvara vid streamade föreläsningar. 4) Att ge möjligheter till ett program. Att erbjuda magisterkurserna som fristående kurser som sedan vägs samman i en magisterexamen. 5) Att inrätta ett programråd där återkommande diskussioner förs kring socialarbetarnas utbildning, policyns implementering och vidarutveckling.

Hot ductility recovery determines the alloy’s susceptibility to heat-affected zone (HAZ) liquation cracking during welding. In this work, the hot ductility recovery of a next-generation Ni-based superalloy, VDM Alloy 780, was physically simulated using a Gleeble thermomechanical simulator and compared with that of the widely used Alloy 718 to evaluate their relative susceptibility to HAZ liquation cracking. VDM Alloy 780 exhibits a significantly superior hot ductility recovery, resulting in a 25 °C narrower brittle temperature range despite a six-fold larger grain size and more extensive supersolidus melting. Enhanced hot ductility recovery in VDM Alloy 780 is attributable to the combined effects of a higher resolidification finish temperature, associated with substantial replacement of Fe by Co and reduced Ti content, and disrupted susceptible (random) grain boundary connectivity due to a larger proportion of coincident-site lattice (CSL) boundaries compared to Alloy 718. These findings highlight the greater HAZ liquation cracking resistance in VDM Alloy 780 compared to Alloy 718, making the new alloy a promising candidate for aero-engine fabrication. 

Background: Since 2015, multidisciplinary team (MDT) discussion is recommended for all Swedish patients diagnosed with gastric cancer. However, few studies have explored the association of MDT discussion with survival.

Methods: This study included all Swedish patients diagnosed with gastric adenocarcinoma between 2006 and 2021. Multivariable logistic regression was used to investigate the probability of receiving treatment recommendation at an MDT meeting, whereas the association between receiving an MDT treatment recommendation and overall survival was examined using Cox regression and Kaplan-Meier methods.

Results: Of 7813 patients, 5279 (68%) were discussed at an MDT meeting. Advanced age (80-89 years; odds ratio (OR) 0.30; 95% confidence interval (c.i.) 0.21 to 0.43) and lower performance status (Eastern Cooperative Oncology Group performance status 1; OR 0.68; 95% c.i. 0.56 to 0.81) were associated with a lower probability of receiving an MDT treatment recommendation. Clinical disease stages II and III, compared with stage I, were associated with a higher probability of an MDT discussion (OR 1.38 (95% c.i. 1.10 to 1.75) and 1.42; (95% c.i. 1.09 to 1.85), respectively), as was a later year of diagnosis (OR 1.37; 95% c.i. 1.35 to 1.40). In adjusted survival analysis with multivariable Cox regression, MDT discussion was associated with better survival (hazard ratio 0.89; 95% c.i. 0.83 to 0.95). In addition, median survival was longer in the group with than without MDT treatment recommendations (12.0 versus 5.9 months).

Conclusion: Receiving a treatment recommendation at an MDT meeting was associated with better survival in patients with gastric adenocarcinoma. Patients with advanced disease and older age were less likely to receive an MDT treatment recommendation but, if they did, it was associated with better survival. 

Objective: To investigate associations between short-term fluctuations in urban background air pollution and the incidence of COVID-19 across three Swedish cities using detailed individual-level data.

Methods: A case-crossover analysis was conducted using individual-level data from a prospective cohort of adults across three Swedish cities (Stockholm, Gothenburg and Uppsala), including 3999 confirmed COVID-19 cases. Subjects were classified as cases on the date of their first positive PCR test, which occurred between 7 March 2020 and 26 January 2022. Exposure data for daily levels of PM2.5, PM10 and NO₂ were obtained from urban background monitoring stations. Lag-specific and cumulative associations were examined using distributed lag models and distributed lag non-linear models, adjusting for meteorological variables.

Results: A significant association was observed between elevated PM2.5 levels and testing positive for COVID-19 on the same day (lag 0), with an OR of 1.084 (95% CI 1.011 to 1.162) per IQR (3.3 μg/m³) increase. Similar lag 0 effects were found across the three cities. For PM10, the most consistent associations were observed at lag 3. For NO₂, significant effects at lag 0 emerged only after excluding the final COVID-19 wave. Subgroup analyses showed similar effects among individuals with pre-existing respiratory conditions, though results were less consistent.

Conclusions: Our findings suggest that short-term fluctuations in air pollution, particularly for PM2.5, are associated with the timing of confirmed COVID-19 cases. A possible explanation for the short lag association is that air pollution exacerbates symptoms, prompting individuals to seek testing, rather than directly facilitating new infections.

Detta är ett PM som summerar resultaten i avhandlingen av Saana Ollila (2026), Carbon pricing in the shipping sector  Avhandlingen består av fyra individuella studier som analyserar effekter av koldioxidprissättning inom sjöfarts- och godstransportsektorn. En sammanfattning av avhandlingen återges nedan och är hämtad i sin helhet från Ollila (2026). Avhandlingen analyserar utformningen och effekterna av prissättning av koldioxid inom den nationella och internationella godstransportsektorn, med särskilt fokus på sjöfarten. Avhandlingen består av fyra individuella artiklar som undersöker både kortsiktiga och långsiktiga anpassningsmekanismer samt välfärdseffekter av koldioxidprissättning. De studerade anpassningsmekanismerna är bland annat reducerad seglingshastighet, förändringar i efterfrågan på transporter, investeringar i forskning och utveckling, överflyttning mellan transportslag samt justeringar av sändningsstorlekar. Avhandlingen studerar också internationellt samarbete och koldioxidprissättning. 

Sveriges tilnærming til styring av offentlige investeringer karakteriseres av sektorspesifikke systemer snarere enn av et enhetlig nasjonalt rammeverk. I transportsektoren spiller Trafikverket en sentral rolle. Trafikverket opererer etter en flerårig planleggingsmodell som legger vekt på nytte-kostnadsanalyse og målstyring, men som mangler formelle «stage-gate»-prosesser og systematisk tredjepartskontroll. Den siste tidens diskusjoner om kostnadsoverskridelser og ineffektiv planlegging har ført til en innsats for å forbedre kostnadsestimering og -kontroll. Samtidig er styringen av IKT-investeringer fortsatt fragmentert, med begrenset oppfølging og samordning mellom etater. Dette kapittelet tar for seg Sveriges styringsstrukturer for transport- og IKT-investeringer, belyser sentrale utfordringer og reformer og sammenligner den svenske modellen med internasjonal praksis.

Background Primary healthcare (PHC) is often a person’s first contact with the healthcare system and they often meet district nurses. The need and demand for digital care encounters are increasing in healthcare services. The aim of this study was to highlight district nurses' experiences of working with digital care encounters in PHC. Methods In this pilot study, a qualitative descriptive design was used to gain a deeper understanding of district nurses’ experiences. Data were analysed using qualitative content analysis according to Graneheim and Lundman [1]. Results The analysis resulted in one overarching theme and four categories. District nurses in PHC experienced digital patient encounters as complex, captured in the theme “complexity in navigating digital care in PHC.”, Four categories were identified: “digital care encounters entail opportunities”; “obstacles in digital care encounters”; “the impact of digital interaction on the patient encounter”; and “expectations and development needs in digital PHC.” Conclusion Digital care encounters represent a new and complex aspect of district nursing that should be considered in implementation. Clearer routines and guidelines may support both nurses and patients in optimising digital care.

Intimate partner violence (IPV) constitutes a global societal challenge. Interventions against IPV have been implemented worldwide. However, the problem still prevails and takes new forms. Despite conceptual developments and a growing body of knowledge on economic abuse (EA) in recent years, there remains a significant lack of qualitative research on experiences of economic abuse. The study aims to expose and examine discourses on household economy, economic abuse, and the financial consequences of IPV from an intersectional perspective, thereby contributing to the theoretical development of the field. The project's theoretical framework is grounded in an interactionist and constructivist perspective. We focus on symbolic and social boundaries to explore how individuals understand and position themselves in relation to others regarding the household economy and gendered economic abuse. Using discourse analysis as a method, the project focuses on conflicts in household economies, economic abuse, and the economic consequences of IPV. The study design is qualitative, exploratory, intersectional, and comparative, and it aims to develop the theoretical field of IPV and economic abuse. Sub-study one is based on narrative and discursive psychological analysis of focus group interviews with individuals between 25 and 70 years old. In sub-study two, the focus is initially on women's narratives about experiences of economic abuse and the economic consequences of IPV that they have been subjected to. In the second part of sub-study two, a re-analysis of the collected empirical material will be conducted to discern patterns in the interviewees' narratives about experiences of power and control in relation to economics. The project is expected to contribute knowledge for professionals. It will also contribute to theoretical development, conceptual clarity, and further refinement regarding EA, including what it entails, what it means, and how it is used in relation to other concepts and forms of violence.

Operationalization remains one of the least explored aspects of digital transformation, creating both a research gap and a practical challenge for implementation. To address this gap, this study aligns the tasks from the framework of active ownership of a public e-service with thirteen contexts of public digital transformation. The tasks address primarily strategic, as well as some tactical, needs, including fostering awareness of digital transformation value, securing internal and external support, enabling organizational change, challenging bureaucratic culture, managing stakeholder relationships, ensuring the attractiveness of e-services, and driving innovation. The contribution of this study is twofold: (i) it defines a set of tasks that form a representative subset of activities within transformational government, and (ii) it demonstrates how these tasks align with the various contexts of transformational government.

The electric vehicle transportation industry relies on advanced battery systems with high-voltage wiring harnesses composed of copper and aluminum conductors. Joining these dissimilar metals using conventional fusion welding is challenging due to the formation of brittle intermetallic compounds and differences in their thermal and metallurgical properties. Friction stir welding (FSW) has emerged as an effective technique for manufacturing Al–Cu joints in electric vehicle battery assemblies. In this study, dissimilar lap joints between AA6063 aluminum alloy (top) and commercially pure copper (bottom) were FSWed. A carbide-coated crown probe with a scroll-featured shoulder was used to promote material flow and suppress tunnel defects. Macrostructural, microstructural, and mechanical characterizations were conducted using optical microscopy, SEM–EDS- EBSD, and microhardness testing. Distinct particle-rich zones containing dispersed Cu particles within an Al matrix were observed along upwards flow tracks indicative of complex material transport within the stir zone. The welded interface contained primarily θ-Al₂Cu and γ-Al₄Cu₉ intermetallics (IMCs). Microhardness mapping showed pronounced softening in the aluminum stir zone (∼100 HV0.1) and heat-affected zone (∼60 HV0.1), contrasted with localized hardening near Cu-rich intermetallic compounds (∼130 HV0.1), relative to base material hardness values (∼70 HV0.1 for Al and ∼80 HV0.1 for Cu). EBSD analysis focused on the hook in the AS confirmed significant grain refinement due to dynamic recrystallization in addition to a partially-retained texture. Overall, the findings provide insights into the mechanisms involved in the material flow during the Cu hook formation in Al–Cu bi-metallic FSW joints, providing guidance for reliable bi-metallic connections in electric vehicle battery systems.

Background: Head and neck cancer comprises a heterogeneous group of tumours affecting anatomical sites of the upper aerodigestive tract. Treatment often involves surgery and either radiotherapy or chemoradiotherapy. These treatments are associated with substantial morbidity and may have long-lasting adverse effects on oral health. Oral complications can negatively affect health-related quality of life, nutritional status, and social and work-related functioning. The aim is to evaluate an oral health care programme designed to prevent or mitigate late oral sequalae, and to assess its impact on health-related quality of life, oral health, work ability, nutritional status, healthcare-related economic costs, and psychological well-being.

Methods: This is a study protocol for a Swedish multicentre, two-armed, superiority randomised controlled trial that has been ethically approved by the Swedish Ethical Review Authority. Patient inclusion commenced in September 2025, with an intended sample of 300 participants. Adult patients (≥ 18 years) planned for curative-intent treatment for head and neck cancer (oral cavity, oropharynx, larynx stage III and IV, hypopharynx, nasopharynx, salivary gland, or unknown primary) are randomised (1:1) to either an oral health care programme (intervention) or standard of care. Exclusion criteria: severe alcoholism, cognitive impairment, or inability to understand the Swedish language. Participants are followed before the start of cancer treatment and at 4 follow-ups: 6 months after completion of treatment, and 1, 2, and 3 years after the 6-month follow-up. The primary outcome measure is health-related quality of life. Secondary outcomes include quantitative oral health indicators, return to work, nutritional status, healthcare-related economic costs, and patient-reported outcome measures focusing on self-reported oral health and psychological well-being (depression, anxiety and stress), and self-efficacy.

Discussion: Oral health follow-up for head and neck cancer survivors often lacks consistency and uniformity. To date, few oral health care interventions for head and neck cancer survivors have been evaluated within the framework of a randomised controlled trial. The findings have the potential to inform clinical practice and contribute to the development of more integrated, evidence-based oral healthcare strategies within routine follow-up for head and neck cancer survivors, with the overarching goal of improving their oral health and long-term quality of life.

This thesis focuses on the notion of correct language use by Spanish L2-speakers of German. It adopts a sociolinguistic perspective and departs from the assumption that the perceptions of linguistic correctness are highly context-bound and hence shaped by language ideologies. It analyzes both the macro level of the L2-speakers’ everyday language use and the micro level of specific ubiquitous, but not necessarily accepted, grammatical forms that are referred to as prescriptively marked constructions. The thesis is conceptualized as a mixed-methods study consisting of 15 interviews with L2-speakers of German and a verbal guise experiment (VGE) conducted with 221 L1-speakers of German.

The interview study showed that the L2-speakers linked the notion of correct German to institutions, linguistic codes such as grammar books and language usage guides as well as model speakers. They also referred to language ideologies prevalent in Germany when reflecting on correct language use. While some of the interviewees reproduced these, others pointed them out in order to question their validity. Furthermore, the topic of other-corrections was examined. On the one hand, the interviewees viewed being corrected by L1-speakers of German as a resource for language learning. On the other hand, some of the interviewees employed other-corrections towards L1-speakers as an emancipatory strategy in order to position themselves as legitimate speakers. Regarding the prescriptively marked constructions, the interviewees showed different degrees of familiarity and acceptance.

Some interviewees showed concern about adhering to prescriptive norms in fear of adverse effects when using prescriptively marked or incorrect forms. However, this concern was not confirmed in the VGE: overall, the L1-speakers did not judge the L2-guise more harshly when the stimuli contained prescriptively marked or incorrect forms compared to the L1-guise containing the same forms. From a social standpoint, this of course is a positive outcome. However, it is also somewhat surprising, since opposite tendencies had previously been documented. Both methodological as well as theoretical explanations are offered and suggestions are made regarding the modification of future VGEs in order to tackle further research questions in this field.

The starting point of this article is an interest in understanding what happens when the concept of evidence-based practice (EBP) travel between countries. Understanding knowledge as something constructed between actors who shape and trade ideas and experiences, the aim is to study how EBP has been received, interpreted and practised in Swedish social work in comparison to some of the other Nordic welfare states. This is done through as coping study literature review of research on evidence-based practice(EBP) in Swedish social work within the Swedish welfare system. The review shows that two research units (CUS and IMS) at the public authority National Board of Health and Welfare have had significant influence on the travelling of EBP to Sweden. Further, the review shows that a guideline-model version of EBP has been given priority inthe diffusion process. The results also show that the interest in EBP among managers has increased over the past few years, and that the irattitude toward the concept is generally positive. At the same time Swedish social workers rarely make use of research in their work, seldom use evidence-based methods, and seems to be unsure of the meaning of the concept.

This critical realist thesis investigates occupational well-being among blue-collar temporary agency workers (BC-TAWs), through structural preconditions, perceived organisational and workplace social support and participation in occupational safety and health practices. Further, it investigates the phenomenology of a blue-collar temporary agency worker serving as a foundation for their occupational well-being.

The four papers included employ a critical realist-informed methodology, exploring structures and generative mechanisms that may explicate empirical patterns and events.

Drawing on 60 interviews and m. 397 survey answers, findings of this thesis show generative mechanisms underlying counter-supportive social interaction impairing social relations at client organisations making some workers excluded, subjugated, unrelated and alienated.

The findings of this thesis identify generative mechanisms underlying supportive social interaction favouring the formation of social relations that enable occupational well-being, participation in occupational safety and health practices within client organisations as well as fostering workplace social support, making BC-TAWs feel more related, interested, capable and self-determined.

Through its theoretical and methodological stance of critical realism, and by analytically studying the underlying structures, norms and generative mechanisms, it is demonstrated how these may explain the empirical findings, contributing important knowledge on BC-TAWs’ occupational well-being within the Swedish manufacturing industry.

The water and wastewater infrastructure of the built environment is currently operated as a linear system that delivers potable water and removes wastewater, carrying away the energy and resource potential embedded in the streams that pass through buildings. Recovering this potential through integrated water-energy systems is technically feasible, but adoption remains limited by fragmented assessment methods, divergent stakeholder priorities, and institutional structures that do not align with the resource-efficient configurations such systems require. This thesis investigates how water and energy systems in the built environment can be assessed and developed to be more sustainable, energy and resource-efficient, through four interconnected studies.

A comparative characterization of numerous water streams in a typical building was developed, integrating volume, quality, and energy content into a single reference for source-first system selection. Two rounds of semi-structured interviews with thirteen stakeholders spanning regulatory agencies, municipalities, water utilities, property owners, and consultants identified evaluation criteria covering resource efficiency, socioeconomic, and resilience dimensions. These were synthesized into a modular, decision-support framework structured around five stages: conceptualization of the project, description and classification of the site, technical-solution library, system assessment, and multi-criteria decision analysis. The framework was demonstrated through a proof-of-concept application and shown to produce consistent rankings across a wide range of weight configurations.

Two integrated case studies were numerically modelled, with key components validated against pilot installations in Gothenburg. A rainwater-based system combining evaporative cooling with toilet flushing was simulated. Using the suggested rainwater catchment area and tank size, energy savings of 19–28 % in commercial buildings during cooling periods were achieved, with residential savings falling as low as 1–7 % annually with negative energy savings for certain sizes. This was mainly due to limited cooling demand and high parasitic losses. An integrated greywater reuse and heat recovery system at the HSB Living Lab delivered approximately 22–23 % energy savings and 92 % water savings for toilet flushing, with the main trade-off appearing not as competing water- and energy-saving objectives but as a moderate increase in treated-water residence time.

Across the four studies, good technical performance emerges as necessary but is not the only constraint for implementation. Stakeholder priorities, such as environmental, cost and health aspects, are essential, but institutional barriers, such as split incentives, regulatory uncertainty, and the cost-price principle must be aligned to form an optimal environment for system implementation realization. In addition, the decentralization-centralization trade-off for downstream resource recovery has to be considered to avoid suboptimization. Further institutional alignment across climate adaptation, water management, and energy efficiency policy is a precondition for translating technical systems and stakeholder priorities into implementation at scale.

Background: The impact of anaesthetic choice on survival following metastatic cancer surgery is uncertain. Inhalational anaesthetics, such as sevoflurane, may promote inflammation and tumour progression, while the intravenous agent propofol has been suggested to be anti-inflammatory. This study aimed to evaluate the association between anaesthetic maintenance with inhalational anaesthesia versus propofol-based total intravenous anaesthesia and overall survival in patients undergoing surgery for metastatic colorectal cancer.

Methods: Adult patients (≥18 years) with metastatic colorectal cancer who underwent elective or emergency surgery under general anaesthesia from 2014 to 2019 were identified in the Swedish Colorectal Cancer Registry and matched with the Swedish Perioperative Registry. Cox regression, propensity score-matching (2:1, inhalational anaesthesia: propofol), and Kaplan-Meier analysis were used to assess survival.

Results: Of the 1233 included patients, 1011 received maintenance anaesthesia with an inhalational agent, and 222 received propofol. Cox regression analysis identified significant associations between overall survival and advanced age, higher ASA class, emergency surgery, open surgical approach and right-sided tumour location. Comparison of anaesthetics for the full unmatched cohort observed a statistically significant increased risk of death with propofol (hazard ratio [HR] 1.26, 95% CI 1.02-1.55, p = 0.032). Propensity score-matching yielded 639 matched patients (inhalants 426; propofol 213) with Kaplan-Meier analysis showing comparable survival between groups, with 1- and 3-year survival rates of 75% and 43% for inhalants versus 73% and 41% for propofol. In the matched cohort, the HR for propofol versus inhalants in a Cox regression analysis was 1.13 (95% CI 0.89-1.42, p = 0.32).

Conclusion: An apparent association between propofol maintenance and increased mortality observed in the full unmatched cohort was not confirmed in the propensity score-matched cohort. Poorer survival was independently associated with advanced age, higher ASA class, right-sided tumours and open surgical approach.

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor has been the mainstay of therapy for acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) following percutaneous coronary intervention (PCI) for more than two decades. Over this period, numerous trials have evaluated different antiplatelet strategies, initially focusing on more effective and prolonged regimens, and more recently on decreasing the intensity or duration of DAPT. Despite a wealth of accumulated evidence, the optimal antiplatelet strategy-including the ideal agent, combination, or treatment duration-remains a subject of active debate. This review summarizes the evolution of antiplatelet therapy, with particular emphasis on randomized controlled trials of DAPT in patients with ACS or CCS undergoing PCI.

In this work, we investigate the effect of pulsed substrate biasing on the microstrain, residual stress, and mechanical properties of multi-principal element TiZrNbTa nitride thin films deposited on silicon. The pulsed bias is synchronized with ionized sputtered species and gas ions during reactive high-power impulse magnetron sputtering. This was achieved by exploiting differences in their time-of-flight arising from mass contrasts allowing two distinct bias conditions. Synchronization with gas ions results in films with higher compressive stress (3.1-5.4 GPa) and an indentation hardness of 25±1 GPa. In contrast, films grown under heavy metal-ion bombardment, despite dominant Ar⁺ flux overlap, exhibit lower compressive stress (2.5-3.4 GPa) and slightly higher hardness (29±1 GPa), independent of ion energies in the range ∼25-300 eV. These films show minimal variations in metal composition, accompanied by grain coarsening, reduced microstrain, and decreased Ar incorporation below ∼100 eV. At higher ion energies (∼200-300 eV), atomic peening by Ar⁺ ions dominates, promoting strained growth. Overall, hardness is governed primarily by the metal sublattice composition, with only a weak dependence on strain and grain-size effects. These results demonstrate that synchronized pulsed biasing enables precise control of film properties without external heating.

Practical activities and laboratory work are essential parts of technology education. It brings together theory and practice by applying theoretical knowledge through practical work. The handling of instruments and laboratory equipment develops experimental hands-on skills and technical competencies, such as data handling, process control, and monitoring. Another aspect of incorporating practical elements in natural science and technical education, often highlighted by teachers and in research literature, is that it makes the subjects more interesting and engaging. This can, of course, be the case, but it is just as common for practical activities to provoke other emotions, such as anxiety about making mistakes or about damaging expensive equipment. In this study, we use Barad's theory of agential realism to examine how upper secondary school technology programme students approach and establish relationships with the materials they need to use during laboratory work in biotechnology. Barad emphasizes that everything is entangled and that these entanglements create our reality. This means that both people and matter actively contribute to shaping our world. To describe the process that occurs in these entanglements, the concept of intra-action is used. We have observed and video-recorded experimental activity sessions on different occasions over the course of one semester. Through Barad's theory of the agency of matter, we conducted the observations with a focus on the intra-actions between the students' bodies and the materials used during the laboratory sessions, as well as the emotions that became visible. In the presentation, we will elaborate on the concept of intimacy to describe certain intra-actions in which the material seems to "call" to the students, prompting them to explore it in playful and emotional ways.

Problem: Women who experience fear of birth during pregnancy are more likely to report negative birth experiences.

Background: Fear of birth and depressive symptoms may negatively influence women's birth experiences. Midwifery continuity of care (MCoC) models have been shown to improve satisfaction and may help mitigate fear and mental health challenges. Aim: To identify profiles of women based on birth experiences and emotional wellbeing after childbirth within MCoC models, and to examine associations with background characteristics, attitudes, and birth outcomes.

Methods: A longitudinal cohort study was conducted in rural Sweden, including 378 women participating in MCoC models, with high priority on women with fear of birth. Data were collected via questionnaires in midpregnancy and two months postpartum. A k-means cluster analysis was performed using the Childbirth Experience Questionnaire (CEQ), Fear Of Birth Scale (FOBS), and Edinburgh Postnatal Depression Scale (EPDS).

Findings: Three distinct profiles of women emerged based on the instruments included in the cluster analysis. The clusters differed in self-reported health, fear of birth, prenatal attitudes, continuity of care, and mode of birth. Women's attitudes and operative births were the strongest predictors of cluster membership. Continuity with a known midwife distinguished profiles characterised by elevated fear of birth and depressive symptoms.

Discussion: Women's birth experiences and emotional wellbeing cluster into distinct profiles shaped by psychological, relational, and contextual factors. Attitudes during pregnancy and mode of birth are key determinants, while continuity with a known midwife enhances the perception of professional support. Conclusion: Tailoring MCoC models to these profiles may promote more individualized, equitable, and positive care for diverse groups of women.

Objective: This study aims to compare the risk of subsequent surgery following surgical treatment of clinical adjacent-segment pathology (CASP) after lumbar fusion, specifically evaluating decompression alone versus decompression with extension of the fusion.

Methods: Using the Swespine registry, we included patients who had surgical treatment for CASP following index lumbar fusion surgery, 1997-2019. The cohort was divided according to CASP treatment: decompression alone or decompression with extended fusion. A comparison of subsequent surgeries was made with Kaplan-Meier analysis and Cox regressions adjusted for potential confounders (age, sex, body mass index, smoking status, number of operated levels at CASP surgery, number of fused levels at index fusion surgery, and diagnosis for CASP surgery).

Results: A total of 2,521 patients were included, 1,176 (47%) in the decompression-group and 1,345 (53%) in the extended fusion group and the mean follow-up was 6.1±4.4 years. Mean age at CASP surgery was 61 years and 1,588 (63%) were females. The median time to subsequent surgery was 1.7 years (range, 0.9-3.7 years). Kaplan-Meier-estimated probability of subsequent surgeries at 5 years was 18% (95% confidence interval [CI], 15%-20%) for the decompression-group and 25% (95% CI, 22%-27%) for the extended fusion group. The hazard ratio was 1.26 (95% CI, 1.02-1.56; p =0.032) for those with extended fusion.

Conclusion: Extension of fusion for CASP was associated with significantly higher risk of subsequent surgery, but causality should be interpreted with caution as radiographic information on instability, deformity, or foraminal stenosis could not be verified.

This article examines the representation of community within restorative justice (RJ) in the French film All Your Faces (Je verrai toujours vos visages, 2023), addressing central debates within RJ scholarship concerning the meaning, place, and function of community in restorative processes. By analysing the film’s verbal and visual dimensions, the article examines how community is represented and enacted through relationships, interactions, spatial arrangements, and restorative practices. The analysis identifies three forms of community: prison as a space in which multiple communities intersect; the participatory community that emerges within the restorative circle; and communities of care that support victims and offenders throughout the restorative process. Across these dimensions, All Your Faces portrays community as an evolving social process rather than a fixed category of participants. Community is progressively produced through ritualized interaction, storytelling, humor, collective vulnerability, recognition, and practices of care. These findings shift attention from who constitutes the community in RJ to how community is enacted through restorative practices and relationships. The article contributes to interdisciplinary scholarships at the intersection of sociology, law, criminology, and victimology by conceptualizing community as a relational and institutional accomplishment. It also demonstrates the value of film as a site for examining how restorative justice practices and values are culturally imagined, interpreted, and communicated to wider publics.

Införandet av just-in-time fartygsanlöp har potential för minskade kostnader och utsläpp, så kallad win-win. Trots potentialen är införandet av just-in-time i sjöfart låg, och det saknas kunskap kring det förutsättningar som krävs för att införa just-in-time. Projektet utforskar potentialen av just-in-time i svensk sjöfart kontext samt studera förutsättningar från olika aktörers perspektiv för att införa just-in-time.

Extratropical cyclones occur most frequently over the oceans, where they cause the strongest extreme surface winds. In this study, we investigate extreme surface winds during winter months in the Northern and Southern Hemispheres, when the wind storms are the strongest. The analysis focuses on storm tracks over the North Atlantic, North Pacific and Southern Ocean. We use ERA5 reanalysis data to make composites of extratropical cyclones that cause the top 100 most extreme surface wind events from 1979 until 2020 ("top 100 extremes"). We focus on large-scale atmospheric processes and find that the most prominent large-scale feature of the top 100 extremes in each basin is the presence of a pre-existing downstream cyclone a few days before the time of the maximum surface winds. Pre-existing cyclones are situated poleward and eastward of the top 100 extremes and their presence is consistent with strong upper-level winds and potential vorticity anomalies. Differences between the basins and hemispheres are quantitative. The top 100 extremes in the Northern Hemisphere develop in an environment with higher mid-tropospheric Eady growth rates, higher deepening rates and stronger surface wind speeds around the cyclones than in the Southern Hemisphere. Furthermore, we run the general circulation model ISCA with different boundary conditions to investigate their influence on the basin-wide extreme surface winds. We find a strong positive correlation between basin-wide extremes in mid-tropospheric Eady growth rates and surface winds. Zonalizing sea-surface temperatures across tropical and extratropical regions greatly reduces the differences in extreme surface winds between the North Atlantic and North Pacific; inter-hemispheric differences in extreme surface winds between the North Atlantic and Southern Ocean are greatly reduced when sea-surface temperatures are zonalized globally and made hemispherically symmetric, and orography is flat.

Over the last decades, climate change and climate-induced disturbances have had an increasing impact on European forests. As climate change and disturbances alter the operational environment of forest management, measures need to be taken not only by practitioners on the ground, but also decision-making levels involving actors within the forest policy subsystem. This study examines how forest policy subsystem actors in Germany, Poland, Slovenia and Sweden perceive the importance of the driving factors influencing practitioners' responses to climate change and climate-induced disturbances. Based on a literature review, 28 driving factors were identified and grouped into STEEP categories. These were then discussed and evaluated in focus groups, in which the actors ranked their perceived importance. The results show considerable variation between the countries in how STEEP categories are rated. In Poland, Slovenia and Sweden, actors reported significant differences in the importance of certain STEEP categories, while in Germany perceptions were more balanced. The Technological category was ranked as least important in all countries. Six driving factors were ranked as particularly influential: ownership patterns and practitioners' values, objectives and experiences (Socio-cultural category), incentives (Economic category), increased occurrence of calamities and climate-related disturbances and successfully adapted management practice (Environmental category), and policy coherence (Political category). Socio-cultural driving factors were most frequently emphasized across all categories. Integrating structural and actor-centred perspectives can improve understanding of the complex processes shaping forest management under climate change, and provides a basis for more effective and context-sensitive policy design.

With activation driving labour market policy, job-seekers are often offered subsidised employment on the condition that they fulfill certain obligations, such as job searching and participating in training. Nevertheless, such initiatives often receive criticism for their ineffectiveness, and little is known about how these policies can achieve their desired results in practice. This study explores how active labour market programme participants, caseworkers and workplace supervisors perceive the feasibility, acceptability, and value of a structured development plan within an active labour market programme (ALMP). The development plan was piloted for one month in a Swedish municipality and was followed by focus group or individual interviews. The findings indicate that the development plan was perceived as strengthening structured communication among the actors, increasing awareness and reflection on development progress through the use of concrete goals; enabling the combination of long- and short-term goals, and finally, clarifying the responsibilities of various actors involved in the ALMP process. In conclusion, this study contributes to knowledge on how individualised support can be provided in a feasible and structured way, and identifies mechanisms that may support future implementation and evaluation of individualised support within ALMPs.

Knowledge of bacterial and fungal diversity in deep biosphere environments is limited, particularly in Arctic regions. The Kiirunavaara mine provides a unique entry point into a deep subsurface system where the natural conditions have been altered by industrial activity, nutrient inputs, pollutants, and shifts in abiotic parameters. Microbial life in this environment has not previously been described. This thesis aims to characterize microbial diversity and functional traits in the Kiirunavaara iron ore mine using metagenomic, metatranscriptomic, and culture‑based methods. Chapter 1 shows that there is a diverse and metabolically active community, including taxa expressing hydrocarbon‑degradation genes. There is also a small overlap with the community composition of nearby lakes as well as that of other groundwater environments in the same bedrock, the Fennoscandia shield. Chapter 2 shows that fungal isolates from mine sediments exhibit enhanced growth and reduced uptake of iron, zinc, and copper compared to closely related isolates originating from non-mining environments, showing phenotypic differences in metal stress responses. Together, these studies provide the first description of microbial community structure and fungal metal resistance in the Kiirunavaara mine and highlight native traits relevant to future biotechnological applications, including bioremediation.

Conducting a health technology assessment (HTA) for each indication of a medicine contributes to increasing demand on HTA systems and results in delays in access. Streamlining assessments for subsequent indications has been proposed, but there is limited evidence on how this could be achieved. We aimed to quantify semantic similarity between HTA documents for different indications of the same medicine to explore whether concepts could be carried forward to subsequent assessments. Public Summary Documents (PSDs) from July 2019 to November 2024 were included if they related to new major submissions to the Australian Pharmaceutical Benefits Advisory Committee. Each paragraph was embedded using the Sentence-Bidirectional Encoder Representations from Transformers (SBERT) model. Pairwise Euclidean distances (measuring semantic similarity) were quantified between embeddings across indications for multi-indication medicines and were compared with those for single-indication medicines. Cluster analysis, followed by manual thematic review, identified recurrent concepts across indications of the same medicine. A total of 326 PSDs were included (154 single-indication medicines, 59 multi-indication medicines). Multi-indication medicines demonstrated significantly greater semantic similarity across their indications compared with single-indication medicines. However, recurrence of specific concepts across either all or similar indications of a medicine was infrequent. Despite the greater semantic similarity observed across indications of multi-indication medicines, this did not translate into substantial opportunities to carry forward assessment concepts. Therefore, it is unlikely that any concepts or information from assessments undertaken for previous indications could be carried forward to subsequent indications. The methods described provide a foundation for future research on semantic overlap in HTA and other policy areas.

Background: Aortic dissection (AD) management requires early medical therapy and surgical intervention in selected patients with type A aortic dissection (TAAD) or complicated type B aortic dissection (TBAD). The aim of this study was to assess incidence trends of AD in Sweden, and sex-based differences in management and outcomes over 25 years.

Methods: The Swedish National Patient Register and Cause of Death Register were used to identify new AD between 1999 and 2023. Incidence, management, and survival outcomes were analysed relative to the general population by matching age, sex, and year.

Results: Some 15 946 individuals had AD; 12 225 were admitted to hospital alive, and, of these, 6595 (53.9%) were treated medically. Of the 5630 surgically treated individuals, 4141 (73.6%) had TAAD and 1489 (26.4%) presented with TBAD. Incidence increased significantly to 9.32 per 100 000, with an annual percentage change (APC) of 1.4% (95% c.i. 1.2% to 1.6%). Incidence was lower for women (6.25 per 100 000) than men (10.52 per 100 000), but the APC was three-fold higher in women (APC 2.3% (95% c.i. 1.9% to 2.6%)) compared with men (APC 0.8% (95% c.i. 0.5% to 1.0%)). Women presented at an older age than men (mean of 71.9 versus 67.5 years, P < 0.001), were less likely to receive surgical treatment than men (women represented 37.8% of all dissection patients, but only 33.6% of surgically treated TAAD patients and 29.3% of surgically treated TBAD patients, P < 0.001), and had worse 10-year relative survival than men (medical management: women 70.9% and men 84.1%, P = 0.0041; TAAD surgical management: women 86.6% and men 94.9%, P < 0.0001; and TBAD surgical management: women 70.9% and men 87.5% P = 0.027).

Conclusion: The incidence of AD is increasing in Sweden, with persisting sex disparities in management and outcomes. These findings underscore the need for targeted interventions to improve the diagnosis, management, and prognostication of AD, especially in women.

Background: Adolescents living with a close relative with severe health conditions (RSHC) may experience challenges affecting their mental well-being. Previous research has largely focused on caregiving roles or specific illnesses while less is known about broader populations of adolescents with RSHC. This study aimed to describe the prevalence of adolescents with RSHC and to examine associations with mental well-being across different sociodemographic and psychosocial contexts.

Methods: The data were drawn from a cross-sectional, population-based school survey conducted in & Ouml;rebro County, Sweden, which included 4 140 adolescents aged 15-18 years. Mental well-being was assessed using the Mental Health Continuum-Short Form. Sequentially adjusted linear regression stratified by gender was used to examine associations between RSHC and mental well-being, accounting for key factors.

Results: Half of the adolescents (n=2 212) reported having at least one RSHC, with 31% reporting one and 19% reporting several RSHCs. Adolescents with RSHC reported significantly lower mean mental well-being than those without RSHC. In the fully adjusted model, substance abuse in a close relative remained associated with lower mental well-being, whereas associations for other RSHC types were attenuated. General stress and perceived availability of someone to confide in were strongly associated with mental well-being.

Conclusion: Having a relative with RSHC is common among adolescents and is associated with lower mental well-being, particularly when close relatives are affected by substance abuse. The findings suggest that adolescent mental well-being in the context of RSHC is shaped by broader psychosocial factors, including stress and available support.

Background: Patients with advanced Parkinson's disease often require treatment beyond conventional oral or transdermal therapy. However, real-world evidence across emerging advanced treatment strategies remains limited.

Objectives: To compare patient characteristics, treatment patterns, clinical outcomes, healthcare resource utilization (HCRU), and costs among Parkinson's disease patients treated with levodopa/carbidopa dispersible microtablets (LC-5), levodopa-carbidopa intestinal gel (LCIG)/levodopa-entacapone-carbidopa intestinal gel (LECIG), or continuous subcutaneous apomorphine infusion (CSAI).

Methods: Patients initiating LC-5, LCIG/LECIG, or CSAI between 2014 and 2024 were identified in Swedish national register data. Treatment groups were balanced using inverse probability weighting. Descriptive analyses, cumulative incidence estimates, and Cox proportional hazards models were used to assess outcomes.

Results: 426 LC-5, 1112 LCIG/LECIG, and 490 CSAI users were included. 63.6% of LC-5 users were women, whereas men constituted the majority in the other treatment groups. 3.5% of LCIG/LECIG and 6.1% of CSAI users discontinued treatment, compared with 28.6% of LC-5 users. Compared with LCIG/LECIG users, the mortality hazard ratio estimates were lower for LC-5 (HR 0.71, 95% CI 0.45-1.11) and CSAI users (HR 0.80, 95% CI 0.63-1.02), but neither difference was statistically significant. In the 12 months following treatment initiation, weighted estimates of healthcare costs were higher among LCIG/LECIG (€37,613) and CSAI users (€29,214) than among LC-5 users (€17,290).

Conclusions: In this nationwide Swedish cohort, no statistically significant mortality difference was detected. Weighted one-year HCRU and cost estimates were lower among LC-5 users than among infusion-therapy users; however, residual confounding by disease severity, treatment selection, and other unmeasured clinical factors limits causal interpretation.

Aim: To examine the associations of interpersonal justice with work engagement and burnout among hospital nurses in Japan, and to test whether job satisfaction moderates these relationships.

Design: A cross-sectional study using structural equation modeling (SEM), grounded in job demands-resources framework.

Methods: Survey data were collected between 2016 and 2017 from 2773 nurses across 10 Japanese hospitals. Interpersonal justice was operationalized using workplace fairness and gender equality indicators. Work engagement and burnout were measured using study-specific indicators. SEM was used to test direct and moderated pathways, with theoretically justified modifications to the measurement model resulting in acceptable fit (RMSEA = 0.052; CFI = 0.987; TLI = 0.976; SRMR = 0.023).

Results: Interpersonal justice was independently associated with higher work engagement (β= 0.28, p < 0.001) and lower burnout (β= -0.28, p < 0.001). Job satisfaction also predicted both outcomes but did not moderate the effects of interpersonal justice. These findings suggest that fair and equal work environments support nurse well-being regardless of overall job satisfaction.

Conclusion: Interpersonal justice represents an important component of healthy work environments that may inform management interventions aimed at strengthening the nursing workforce in Japan and similar contexts.

Implications for Nursing Management: Nurse managers and healthcare leaders can help promote nurse well-being by fostering fair and equal workplace interactions through transparent decision-making, equitable workload allocation and promotion practices, inclusive leadership, and mechanisms for addressing discrimination and unfair treatment. Such efforts may support higher work engagement, lower burnout, and a more sustainable nursing workforce.