Evaluation of MRI characterisation of histopathologically matched lymph nodes and other mesorectal nodal structures in rectal cancer

Purpose: To evaluate current MRI-based criteria for malignancy in mesorectal nodal structures in rectal cancer. Method: Mesorectal nodal structures identified on baseline MRI as lymph nodes were anatomically compared to their corresponding structures histopathologically, reported as lymph nodes, tumour deposits or extramural venous invasion. All anatomically matched nodal structures from patients with primary surgery and all malignant nodal structures from patients with neoadjuvant treatment were included. Mixed-effects logistic regression models were used to evaluate the morphological criteria irregular margin, round shape, heterogeneous signal and nodal size, as well as the combined 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus criteria, with histopathological nodal status as the gold standard. Results: In total, 458 matched nodal structures were included from 46 patients (mean age, 67.7 years ± 1.5 [SD], 27 men), of which 19 received neoadjuvant treatment. The strongest associations in the univariable model were found for short-axis diameter ≥ 5 mm (OR 21.43; 95% CI: 4.13–111.29, p < 0.001) and heterogeneous signal (OR 9.02; 95% CI: 1.33–61.08, p = 0.024). Only size remained significant in multivariable analysis (OR 12.32; 95% CI: 2.03–74.57, p = 0.006). When applying the ESGAR consensus criteria to create a binary classification of nodal status, the OR of malignant outcome for nodes with positive ESGAR was 8.23 (95% CI: 2.15–31.50, p = 0.002), with corresponding sensitivity and specificity of 54% and 85%, respectively. Conclusion: The results confirm the role of morphological and size criteria in predicting lymph node metastases. However, the current criteria might not be accurate enough for nodal staging

Current practice of targeted breathing exercises after abdominal and cardiothoracic surgery : a national multicentre observational study

Objectives: To describe the timing and type of the first targeted breathing exercises after abdominal and cardiothoracic surgery, and to identify factors associated with early initiation (Commencement within three hours after arriival to a postoperative ward). Design: Multicentre observational study. Methods: In 18 hospitals in Sweden, the start time and type of targeted breathing exercises were recorded in consecutive series of patients who underwent abdominal or cardiothoracic surgery. Demographic data were retrieved from hospital records. Patients were divided into seven groups based on the category of surgery. Results: In total, 1492 patients were included in this study; of these, 1128 (76%) performed some form of targeted breathing exercise after surgery. Targeted breathing exercises commenced a median of 3.63 hours (interquartile range 1.58 to 11.75 hours) after arrival on a postoperative ward, with earlier commencement after minor abdominal surgery and later commencement after major abdominal surgery (P < 0.001). Most patients who performed targeted breathing exercises used positive expiratory pressure (n = 968/1492, 65%) or deep breathing without any devices (n = 207/1492, 14%). The odds of initiating breathing exercises within the first 3 hours after arrival on a postoperative ward were higher if a patient underwent pulmonary or abdominal surgery [odds ratio (OR) > 2.04; P < 0.001], or had intravenous analgesia (OR 1.50, 95% CI 1.05 to 2.14; P = 0.026). The odds were lower (OR 0.43, 95% CI 0.21 to 0.88; P = 0.021) for patients who arrived on the postoperative ward in the evening/night or for patients who had undergone laparoscopic surgery (OR 0.63, 0.43-0.92, p=0.018). Conclusion: The majority (76%) of patients undergoing abdominal or cardiothoracic surgery performed some form of targeted breathing exercise, starting a median of 3.63 hours after arrival on a postoperative ward

Visible-Light-Switchable molecular glues for reversible control of protein function

Chemically induced dimerization/proximity (CID/CIP) systems controlled by chemical dimerizers (also known as molecular glues) provide valuable means for understanding and manipulating complex, dynamic biological systems. In this study, we present the development of versatile chemo-optogenetic systems utilizing azobenzene-based photoswitchable molecular glues (sMGs) for reversible protein dimerization controlled by visible light. These systems allow multiple cycles of light-induced dimerization, overcoming the limitations of irreversible photolysis in previous systems. Through optimizing photoswitch properties and linker strategies, we achieved efficient and reversible control using blue, green, and red light. We demonstrate that these systems enable rapid and reversible control of protein function in vitro and in cells. The findings represent a significant advancement in chemo-optogenetics, offering opportunities to expand applications requiring precise spatiotemporal regulation of dynamic biological processes

Informal caregivers’ perspectives on participation in a dementia rehabilitation programme

Background: There is limited experience in combining interdisciplinary rehabilitation for persons with dementia and caregiver support. Aim: To explore how informal caregivers perceive participation in a person-centred, multidimensional, interdisciplinary rehabilitation programme targeting community-dwelling older adults with dementia and their informal caregivers, and how the programme has influenced their everyday life. Material and Methods: Fourteen informal caregivers, aged 45–84 years, participated in a qualitative interview following a randomised controlled pilot study. Transcribed interviews were analysed using qualitative content analysis. Results: The analysis resulted in seven categories and three themes: feelingchallenged and boostedto face an uncertain future, perceiving supportive activities as sources ofbothjoy and frustration in everyday life and finding relief in recognising their relative’s former self. Conclusions and Significance: Combining interdisciplinary rehabilitation for adults with dementia with education and support for caregivers was perceived as viable and valuable for the informal caregivers. They felt strengthened by the rehabilitation and better prepared for their uncertain future. However, participation also challenged everyday routines, but the benefits appeared to outweigh the strain

Navigating School, Social Life and Identity : Perceptions of Adolescent Girls With ADHD

More and more people are being diagnosed with ADHD. Considering this increasing number of diagnoses, it is important to look at social factors that may have an impact. ADHD is a well-researched disorder from a medical perspective but there is little research on ADHD related to identity; and additionally, research of girls with ADHD. This study takes a sociological approach and explores how adolescent girls construct their identities in relation to school and free time. Moreover, medical sociology is used to explore aspects of ADHD in this context. Ten interview transcripts were coded and analysed using thematic analysis. The material is analysed with the concept of social identity as well as social psychological theories about identity: Erving Goffman’s dramaturgical perspective and George Herbert Mead’s Me and I as well as the generalized other. Four themes were developed: 1) Adjusting and suppressing behaviour, 2) The complexity of identifying with ADHD, 3) Struggles in the school environment and 4) The unattainability of free time. The results suggest that ADHD is often detected in the school environment and that interventions and treatment are encouraged from school. Furthermore, adolescent girls with ADHD actively hide their personality to function in school and gain other people’s approval. Moreover, it is difficult to construct multiple identities in other areas of life, such as free time activities, because school consumes so much energy; there is a school Me and an ADHD Me which struggle to coexist. The school Me sometimes requires taking central stimulant medicine; the medicine is described as something used almost solely for the purpose of managing school. This is followed by a discussion about how society's expectations affect diagnoses and medical intervention of ADHD. The results also suggest that identifying with ADHD is complex; it is by many participants considered something to be proud of while in many situations they feel the need to suppress or hide it. iADH

Effectiveness of a resilience, gender equity and mental health group intervention for young people living in informal urban communities in North India : a cluster randomized controlled trial

Background: Mental health problems are the leading cause of disease burden among young people in India. While evidence shows that youth mental health and resilience can be improved with group interventions in school settings, such an intervention has not been robustly evaluated in informal urban settings. Objective: This study aimed to evaluate whether the Nae Disha 3 group intervention could improve youth resilience, mental health and gender equal attitudes among disadvantaged young people from low-income urban communities in India. Methods: This cluster randomised controlled trial used an analytic sample of 476 adolescents and young adults aged 11–25 years from randomised clusters in urban Dehradun, India. The 251 intervention group participants were 112 boys and 139 girls, and the 225 young people in the wait-control group were 101 boys and 124 girls. Five validated tools measuring resilience gender equity and mental health were filled by participants at three different points in time. Results: Difference in difference (DiD) analysis at T2 showed that scores improved among girls in intervention group, for adjusted model, resilience (DiD = 4.12; 95% CI: 2.14, 6.09) and among boys, for resilience (DiD = 5.82; 95% CI: 1.57, 9.74). Conclusions: The Nae Disha 3 intervention among disadvantaged urban youth moderately improved resilience for both young men and women, though it did not significantly impact mental health, self-efficacy, or gender-equal attitudes. We establish potential merit for this approach to youth mental health but recommend further research to examine active ingredients and the ideal duration of such group interventions

Intratumoural expression of dihydropyrimidine dehydrogenase is an independent prognostic factor in resected pancreatic ductal adenocarcinoma treated with adjuvant gemcitabine

Pancreatic ductal adenocarcinoma (PDAC) is associated with a poor prognosis, and biomarkers to guide treatment decisions in PDAC are generally lacking. Intratumoural expression of dihydropyrimidine dehydroge- nase (DPD) is a potential prognostic parameter in patients with PDAC undergoing surgical resection and postoperative chemotherapy. In the present study, DPD was analysed by immunohistochemistry of a tissue microarray platform including a real-world cohort of 495 patients with PDAC who had undergone resection with curative intent at any of three tertiary centres, including Northern, Western and Southeastern regions of Sweden, between 1993 and 2019. DPD level (high/low) was analysed and overall survival associations were assessed in treatment subgroups using a multivariate Cox regression model accounting for potential confounders. In patients who had not received adjuvant chemotherapy (n=182), the median overall survival time was 11.6 months (95% CI 9.6-13.5), compared with 28.8 months (25.0-32.6) among those who had (n=313; log-rank P<0.001). The most common type of chemotherapy was gemcitabine single agent (Gem, n=239) followed by gemcitabine plus capecitabine (GemCape, n=39). Tumour-Node-Metastasis (TNM) stage and DPD expression were statistically significant prognostic parameters in the Gem group (HR 1.19, 95% CI 1.01-1.41, P=0.036), with high expres- sion of DPD linked with worse survival. In addition, tumour grade and TNM stage were statistically significant prognostic factors in the group that did not receive any chemotherapy (P≤0.001). No statistically significant parameters were iden- tified in the GemCape group. Taken together, intratumoural expression of DPD may be considered a prognostic marker for patients with PDAC treated with adjuvant gemcitabine following surgical resection, with low expression levels predicting better survival. Further studies in larger cohorts of patients receiving multi-drug or non-gemcitabine based regimens are warranted

Traumabehandling för personer med PTSD och beroendeproblem - vad krävs för att kunna ge rätt hjälp?

Forskning visar på stor samsjuklighet mellan Posttraumatiskt stressyndrom (PTSD) och Substansbrukssyndrom (SUD). Vid samtidig PTSD och SUD förstärker de två tillstånden varandra, vilket ger svårare symtom och sämre prognos. Trots detta är det idag många av de drabbade i denna patientgrupp som inte erbjuds adekvat behandling. Denna studie undersökte hur kliniker i två svenska regioner ser på förutsättningar och hinder för att denna patientgrupp ska få rätt hjälp. Detta har studerats genom en tvärsnittsstudie, med en enkät utformad i syfte att belysa problemet utifrån flera nivåer. Sammanlagt besvarades enkäten av 41 kliniker från både psykiatriska enheter och beroendeenheter, med olika yrkesbakgrund och utbildningsnivå. En majoritet av respondenterna hade psykoterapeutisk vidareutbildning. Dessutom uppgav 19,5% att de hade specifik utbildning i beroendebehandling och 17,1% att de hade specifik utbildning i traumabehandling. Endast 15 % arbetade i dagsläget med behandling av båda tillstånden. Resultatet tyder på kunskapsbrister gällande samsjuklighet PTSD/SUD, att det saknas tydlig ansvarsfördelning och riktlinjer för behandling, att det råder oklarhet kring när det är lämpligt att inleda traumabehandling och hur man ska hantera återfall samt bristande motivation för att arbeta med målgruppen. Det uttrycks också ett stort behov av handledning, något som tidigare forskning även visat kan minska risken för ohälsa hos kliniker som utsätts för indirekt trauma. Även om denna studie är begränsad i sitt urval indikerar resultatet att det från klinikernas perspektiv behövs insatser kring utbildning, handledning och ökad organisatorisk tydlighet för att kunna erbjuda rätt hjälp.Previous studies indicate that comorbidity between Posttraumatic Stress Syndrome (PTSD) and Substance Use Disorders (SUD) is highly prevalent. The two conditions tend to mutually reinforce each other, resulting in a more severe symptomology and worse prognosis. However, this patient group does not always receive adequate treatment. This study aimed to examine clinicians views on prerequisites and obstacles for providing adequate care in two regions of the Swedish Health care system. The methodology was a cross-sectional study using a survey constructed to capture the problem on different levels. Altogether 41 clinicians responded to the survey. They worked in either psychiatric units or substance dependency units with different professions and degree of education. The majority had training in psychotherapy, 19,5% had specific training in treating addiction and 17,1% in trauma treatment. Only 15% reported that they provided treatment for both conditions. The result points to a lack of knowledge regarding comorbidity PTSD/SUD, a lack of clarity in responsibility and treatment guidelines, unclarity regarding when it is appropriate to initiate trauma treatment and how to manage relapse as well as lack of motivation to work with these patients. The clinicians expressed a large need for supervision, which previous studies have shown can lessen the risk of health problems in clinicians subjected to indirect trauma. Even though this study is limited by the number of participants the result indicates a need for education, supervision and organizational clarity for clinicians to provide adequate treatment

Applying a time-geographical perspective to understand tourism mobilities of families with children who use wheelchairs

Individuals with disabilities encounter numerous challenges in the realm of tourism travel. Various constraints can affect their opportunities to engage in travel, influence their choice of destinations and modes of travel, and shape their overall tourism experiences. Research on tourism for individuals with disabilities has predominantly concentrated on identifying barriers to travel. This paper employs a time-geographical framework to extend beyond this focus, examining how various constraints are negotiated and the resultant outcomes for tourism trips. The study is based on interviews with Swedish parents whose children use wheelchairs. The findings indicate that these families face multiple constraints impacting their tourism opportunities and experiences, primarily related to rules, regulations, and inaccessible physical environments. Furthermore, the interviewed parents do not perceive their children’s disabilities as constraints but rather highlight the challenges of using a wheelchair in inaccessible tourism contexts. While some constraints are negotiated to facilitate tourism, not all desired tourism activities can be fully realised. Consequently, the families in this study exhibit rather routinised travel behaviour. An important finding is that families who travel with a child with a disability should be considered part of the family tourism market, rather than the disability tourism market

KOMMUNALT FÖRTROENDE FÖR POLISEN : En kvantitativ analys av förtroende för polisen i Sverige och dess samband med anmälningar mot polisen, socioekonomisk status och utländsk bakgrund.

The purpose of this thesis is to examine the relationship between the frequency of complaintsagainst the police and public trust in the police at the municipal level in Sweden. The studyalso analyzes how factors such as education level, income, and ethnic background affect trust.The study uses theories of institutional trust, street-level bureaucracy and procedural justice,and employing linear regression and multivariate analysis on secondary data from surveysand registry data. The results show that there is no statistically significant relationshipbetween the number of complaints against the police and trust in the police. Education levelhas a positive and significant effect on trust, while income has a positive but non-significanteffect. Individuals with a foreign background generally have higher trust in the policecompared to individuals with a Swedish background. The study provides insights into howvarious factors influence trust in the police and emphasizes the need to investigate additionalvariables to understand this complex phenomenon. Previous research has shown mixedresults regarding the impact of complaints on trust, highlighting the importance of contextand additional factors