Interrater, test-retest, and intersession reliability of a test designed to measure tibialis posterior strength with a hand-held dynamometer

Background: The tibialis posterior muscle has an important role both in stabilizing the foot and in inversion, plantar flexion, and adduction of the foot. Impaired function can lead to tibialis posterior dysfunction. A clinical test that can objectively measure tibialis posterior strength is warranted. Objectives: The aim of this study was to investigate the interrater, test-retest, and intersession reliability of a test designed to measure tibialis posterior strength with a hand-held dynamometer. Design: Interrater, between-day test-retest and intersession reliability. Setting: University laboratory. Participants: The participants comprised 20 healthy individuals (mean age 28.8 years, n = 10 women) without foot problems. Method: A test was designed to test tibialis posterior strength with a hand-held dynamometer (HHD). The test was performed on two occasions 5–15 days apart and was carried out by two raters. The intraclass correlation coefficient (ICC), 95 % confidence interval, standard error of measurement (SEM), and minimal detectable change were calculated. Results: Interrater reliability was good on both occasions (ICC: 0.769, 0.794), test-retest reliability was moderate for both raters (ICC: 0.671, 0.672), and intersession reliability was excellent (ICC: 0.934–0.967). However, the confidence interval had a large variation (-0.027–0.986) and the SEM was relatively high (2.356–3.863 N). Conclusions: This test seems to be reliable, but has some limitations. The results suggest that the current version of the test could be used to compare strength between feet, but that further development of the test is needed to achieve increased interrater and test-retest reliability

Near infrared spectroscopy versus stump pressure in detecting cerebral ischemia during carotid endarterectomy : a prospective multicenter observational study

Background: Determining the need for shunt use during carotid endarterectomy (CEA) under general anesthesia (GA) can be based on different methods, and one of the most common is stump pressure (SP). Previous studies have found favorable results of near infrared spectroscopy (NIRS). Methods: Patients undergoing CEA in 2 swedish hospitals were prospectively included. SP, rSO2 at different timepoints as well as neurological symptoms during surgery were reported for all patients. Receiver operating curve (ROC) analysis was used to determine the optimal cutoff points for SP and rSO2. Results: A total of 293 patients underwent CEA under local anesthesia (LA) and 66 under GA in 2 hospitals. Thirty two patients operated under LA had neurological symptoms. A relative change in ipsilateral rSO2 ≤ −9% had a negative predictive value (NPV) of 99% in detecting neurological symptoms during clamping. Patients who developed neurological symptoms during clamping had lower ΔrSO2 (−14% ± 6% vs. −4 ± 5%, P < 0.001) and lower SP (36 ± 21 mm Hg vs. 56 ± 19 mm Hg, P < 0.001) compared to those who did not. A ΔrSO2 of ≤ −9% had a sensitivity of 91% (95% confidence interval (CI): 75–98%) and a specificity of 82% (95% CI: 77–87%) in predicting cerebral ischemia, whereas a SP < 50 mm Hg had a sensitivity of 78% (95% CI: 58–91%) and a specificity of 60% (95% CI: 54–67%). Conclusion: This study found that NIRS could reduce unnecessary shunting while still having a higher sensitivity compared to SP. Additionally, it can also monitor shunt patency

Invasive Eurasian minnow alters the trophic niche and growth of brown trout in high-latitude lakes

Invasive species pose a major threat to aquatic ecosystems, particularly in high-latitude lakes which are characterised by low biodiversity. In northern Europe, the Eurasian minnow (Phoxinus phoxinus) has colonised lakes historically dominated by salmonids, raising concerns about the impacts of invasive cyprinids on native fish populations and food webs. We compared the trophic niche, growth, and maturation of brown trout (Salmo trutta) in lakes with and without minnow and assessed dietary overlap between the two species using stomach content and stable isotope analyses. Stable isotope analysis revealed that in lakes with minnow, trout exhibited more pronounced ontogenetic niche shifts from pelagic to littoral feeding and towards higher trophic positions compared to lakes with only trout. The isotope data also showed that small trout overlapped in trophic niche with minnows. Stomach content analysis revealed a shift in trout prey use, with reduced consumption of Eurycercus lamellatus and Gammarus lacustris, increased use of surface insects and a transition towards partial piscivory (prevalence of piscivory 5.5%). Despite potential resource competition at early life stages and shifts in diet, when coexisting with minnow, trout grew faster and females showed a tendency to mature earlier. Overall, the presence of invasive minnow does not appear to negatively affect native trout. This is likely due to a combination of flexible resource use and the opportunistic piscivory exhibited by trout. Since our study systems were recently invaded, the findings provide new insights into how native salmonids respond to invasive species shortly after their establishment in small high-latitude lakes

Characteristics of bark and wood of Norway spruce infested by spruce bark beetle and blue-stain fungi : relevance for biomass utilization

Recent droughts have accentuated problems with attacks of the European spruce bark beetle (SBB) (Ips typographus) on Norway spruce (Picea abies), one of the most important tree species in European forestry. SBB attacks are typically accompanied by infestation with Ophiostomatoid fungi causing blue stain. The chemical composition of sapwood and bark from spruce trees infested by SBB, or by both SBB and blue-stain fungi (BSF), was investigated and compared to corresponding fractions from non-infested reference (REF) trees. While sapwood from infested trees showed higher carbohydrate:lignin (C:L) ratios (SBB, 2.21; BSF, 2.47) than sapwood from non-infested trees (REF, 2.17), BSF bark showed lower C:L ratio (0.81) than REF bark (1.23). For BSF sapwood and bark, and SBB bark, the fractions of extractives were half or less than half of that of the corresponding REF materials. Group analysis using GC-FID showed significantly (p ≤ 0.01) lower levels of resin acids, fatty acids, steryl esters, and triglycerides in BSF materials than in REF materials, a phenomenon that was, however, not observed for sterols. Analysis of subgroups and individual fatty acids, resin acids, and sterols identified using GC-MS revealed complex patterns, in which many, but not all, substances exhibited lower values in BSF and SBB materials than in REF materials. Overall, the results point towards the possibility to utilize a larger portion of wood logs from trees infested by beetles and fungi for value-added applications, such as pulping, rather than as fuel wood

Percutaneous and surgical management of aortic stenosis in the SWEDEHEART registry (2013–2023) : a nationwide observational study

Background: Management of severe aortic stenosis (AS) has evolved over the past decade, driven by the widespread adoption of transcatheter aortic valve implantation (TAVI). This study aims to assess trends in procedural volumes, patient characteristics, and outcomes for patients undergoing TAVI or surgical aortic valve replacement (SAVR) in Sweden. Methods: This was a descriptive, non-comparative, nationwide cohort study using the SWEDEHEART registry. We included 21,383 patients who underwent TAVI or SAVR between 2013 and 2023 (11,366 TAVI and 10,017 SAVR). Trends in patient characteristics, preoperative risk, complications and mortality were examined. Findings: TAVI procedures increased from 307 (26.1%, n = 307/1174) in 2013 to 1851 (71.2%, n = 1851/2601) in 2023, while SAVR volumes declined from ∼1000 annually before 2018 to roughly 750 procedures annually. Median age of TAVI patients were 81 (IQR 77, 85) years and 71 (IQR 65, 76) years for SAVR patients. The median EuroSCORE II for TAVI decreased from 5.6 (IQR 3.3, 10.2) to 2.7 (IQR 1.7, 4.6) (p = 0.002), and STS-PROM from 3.3 (IQR 1.9, 4.1) to 1.6 (IQR 1.1, 2.8) (p = 0.0021). Among SAVR patients, EuroSCORE II decreased from 1.5 (IQR 1.0, 2.3) to 1.3 (IQR 0.9, 2.1) (p = 0.022) and STS-PROM from 1.8 (IQR 1.2, 3.0) to 1.6 (IQR 1.1, 2.6) (p = 0.0082). Any in-hospital complications declined significantly for TAVI (29.2%, n = 210/719 to 13.2%, n = 244/1851), while SAVR complication rates increased slightly (18.4%, n = 354/1921 to 18.7%, n = 140/750). In-hospital mortality for TAVI declined from 3.6% (n = 26/719) to 1.0% (n = 18/1851), and 1-year mortality from 11.1% to 6.9% (p = 0.019). SAVR in-hospital all-cause death decreased from 1.6% to 0.4% (n = 3/750) and 5.0% to 2.2% for 1-year mortality (p = 0.013). Interpretation: TAVI has become the predominant treatment strategy for AS in Sweden expanding access within the treated cohort. Despite this, current 2023 SAVR results demonstrate similar in-hospital complication rates compared to TAVI (18.7% vs 13.2%), but lower in-hospital (0.4% vs 1.0%) and 1-year mortality rates (2.2% vs 6.9%). Funding: This study was supported by ALF and national research funding bodies

Implicit and explicit (in)justice on the route to Paris : an analysis of justice expressions in the Paris Agreement, EU-, and Swedish climate-forest policy mixes

Forests are central to climate change mitigation, and there is consensus that climate transition efforts must be just. However, the “just transition” concept often functions as a boundary object, leading to ambiguity in its implementation. Statements of commitment to just transitions therefore require scrutiny as to what a just transition is meant to entail, what kind of justice transition policies seek to ensure, and how these ambitions are envisioned to be realised in practice. Yet, it is precisely this that is missing in the current academic literature, especially in the forest sector context. This study addresses this gap by analysing implicit and explicit justice expressions in the Paris Agreement, and EU- and Swedish climate-forest policy mixes, thereby providing empirical insights on the ‘what’ and ‘how’ of just transitions in the forest sector. Using a newly developed framework that combines the policy mix concept with distributional, recognitional, and procedural justice dimensions, the analysis reveals shared narrow foci in just transition understanding, discrepancies between expressed just transition motivations, and inconsistent mechanisms for implementation across governance levels, thus risking stakeholder disengagement. The results call for explicit discussions in policy debate on how justice can be ensured in transition efforts in the forest sector across levels, regardless of the specific understanding of justice that is adhered to, and open societal debate on what a just transition ultimately ought to mean in a forest context. Furthermore, policy makers must take the step from ambiguous promises to concrete instruments to support forest stakeholders through the transition

Gender biases in surgical residency and their association with postoperative outcomes : a qualitative study of residents in general and orthopedic surgery

Objectives: Recent studies have shown gender-based disparities in surgical outcomes, with women physicians achieving better postoperative results. However, the mechanisms underlying these differences remain poorly understood. This complex, underexplored phenomenon lacks perspectives from key stakeholders such as patients, staff, and surgeons. Surgical residents inhabit a unique position, balancing the roles of learners and healthcare providers and offering valuable insights into these disparities. Our objective was to explore resident surgeons' perceptions of the mechanisms underlying the differences observed in postoperative outcomes through interviews. Methods: We conducted a qualitative study using semi-structured interviews with men and women residents, analyzed through qualitative content analysis. Participants included 17 surgical residents from 10 ACGME-accredited orthopedic and general surgery programs across four U.S. regions. Results: Key findings were: (1) Women surgical residents experienced gender biases during training; (2) Men and women surgeons differed in their approaches to patient care and surgical practice. Residents of both genders noted that women surgeons encounter biases stemming from prevailing norms, beliefs, and expectations related to gender. These biases manifest as double standards and pressure to conform to men-dominated environments. The absence of comparable pressure on men surgeons to adapt to interactions with women colleagues or patients may lead to challenges in meeting the expectations of women patients. Participants of both genders reported that women surgeons tend to adopt a more holistic approach to patient care. Conclusions: Our findings suggest that the unique challenges faced by women surgeons may contribute to the development of refined interpersonal and surgical skills, which could be associated with improved postoperative outcomes. Raising awareness of gender-based differences in surgical practice is essential to addressing the disparities observed in postoperative results. Practical Implications: Residency programs may benefit from incorporating gender-aware training to address implicit biases, foster equitable learning environments, and optimize skill development for all trainees

Balancing grazing and biodiversity : arthropod responses to modern cattle farming practices

Ruminant production exerts severe pressure on ecosystems through land use change for pasture and fodder production, contributing to biodiversity loss, disruption of natural biogeochemical fluxes, and climate change. Whereas ruminant production can support biodiversity that has co-evolved with grasslands and grazing animals, the values of temporary grasslands are poorly understood. In this study, we assessed the effects of grazing regimes practised on modern cattle farms, including no grazing, on the abundance, biomass, and taxonomic richness of aerial and ground-dwelling arthropods. We assessed the potential value of organic management compared to grazing on conventional farms, and the role of vegetation structure on the pastures. We sampled arthropods in temporary pastures and silage grasslands, spring cereal fields, and in farmyards on 43 dairy and suckler cow farms in Finland. We show that grazing benefits the richness of ground-dwelling arthropods in fields, and the benefits were most evident at extensive levels of grazing at the farm scale. Grazing had no significant benefits for the biomass of ground-dwelling arthropods or relative abundance of aerial arthropods over field vegetation. Grazed rotational grasslands had similar levels of arthropods as mown grasslands or cereal crops, except for a higher richness of ground-dwelling arthropods. Taxonomic richness of ground-dwelling arthropods was higher on organic farms than conventional, but only at low grazing intensities. Although our study suggests several ways in which livestock farmers can maintain and increase arthropod populations on their farms, these may be associated with some reduction in production output on modern farms oriented towards high yields

Reinforced model selection for resource efficient anomaly detection in edge clouds

Web application services and networks encounter a broad range of security and performance anomalies, necessitating sophisticated detection strategies. However, performing anomaly detection in edge cloud environments, often constrained by limited resources, presents significant computational challenges and demands minimized detection time for real-time response. In this paper, we propose a model selection approach for resource efficient anomaly detection in edge clouds by leveraging an adapted Deep Q-Network (DQN) reinforcement learning technique. The primary objective is to minimize the computational resources required for accurate anomaly detection while achieving low latency and high detection accuracy. Through extensive experimental evaluation in our testbed setup over different representative scenarios, we demonstrate that our adapted DQN approach can reduce resource usage by up to 45 % and detection time by up to 85 % while incurring less than an 8 % drop in F1 score. These results highlight the potential of the adapted DQN model selection strategy to enable efficient, low-latency anomaly detection in resource-constrained edge cloud environments

Year-round variation in bryophyte-associated nitrogen fixation in the Arctic

In northern biomes, growth is nitrogen (N) limited, but bryophytes are abundant. These bryophytes often host N2-fixing microorganisms (diazotrophs) that play a crucial role in the N cycle of these ecosystems. Despite their importance, how the bryophyte-associated N2-fixation varies across species and seasons (summer, autumn, winter, and spring) remains poorly understood. We measured N2-fixation rates for 10 bryophyte species in situ throughout the entire year in the Arctic with additional incubations to verify the method. We measured positive N2-fixation during most of the year, except for the coldest period (February). The species growing in the wettest conditions (Sphagnum spp.) had the highest N2-fixation rates in summer, while bryophytes in drier conditions peaked in N2-fixation rates in spring and autumn. The seasonal variation in N2-fixation activity was pronounced, but similar patterns were found among different species. This study reveals that bryophyte-associated N2-fixation in northern ecosystems is larger than previously assumed, as it occurs over a more extended part of the year than previously inferred. Furthermore, the importance of bryophyte-associated diazotrophs cannot be quantified without considering both the diversity of bryophytes and their variation in N2-fixing seasonal activity patterns. Both future changes in climatic conditions and biodiversity of bryophytes can thus have large implications for the N cycle in arctic regions