Bacterial composition in Swedish raw drinking water reveals three major interacting ubiquitous metacommunities

Background Surface raw water used as a source for drinking water production is a critical resource, sensitive to contamination. We conducted a study on Swedish raw water sources, aiming to identify mutually co-occurring metacommunities of bacteria, and environmental factors driving such patterns. Methods The water sources were different regarding nutrient composition, water quality, and climate characteristics, and displayed various degrees of anthropogenic impact. Water inlet samples were collected at six drinking water treatment plants over 3 years, totaling 230 samples. The bacterial communities of DNA sequenced samples (n = 175), obtained by 16S metabarcoding, were analyzed using a joint model for taxa abundance. Results Two major groups of well-defined metacommunities of microorganisms were identified, in addition to a third, less distinct, and taxonomically more diverse group. These three metacommunities showed various associations to the measured environmental data. Predictions for the well-defined metacommunities revealed differing sets of favored metabolic pathways and life strategies. In one community, taxa with methanogenic metabolism were common, while a second community was dominated by taxa with carbohydrate and lipid-focused metabolism. Conclusion The identification of ubiquitous persistent co-occurring bacterial metacommunities in freshwater habitats could potentially facilitate microbial source tracking analysis of contamination issues in freshwater sources

A head-to-head comparison of myocardial strain by fast-strain encoding and feature tracking imaging in acute myocardial infarction

BackgroundMyocardial infarction (MI) is a major cause of heart failure. Left ventricular adverse remodeling is common post-MI. Several studies have demonstrated a correlation between reduced myocardial strain and the development of adverse remodeling. Cardiac magnetic resonance (CMR) with fast-strain encoding (fast-SENC) or feature tracking (FT) enables rapid assessment of myocardial deformation. The aim of this study was to establish a head-to-head comparison of fast-SENC and FT in post-ST-elevated myocardial infarction (STEMI) patients, with clinical 2D speckle tracking echocardiography (2DEcho) as a reference.MethodsThirty patients treated with primary percutaneous coronary intervention for STEMI were investigated. All participants underwent CMR examination with late gadolinium enhancement, cine-loop steady-state free precession, and fast-SENC imaging using a 1.5T scanner as well as a 2DEcho. Global longitudinal strain (GLS), segmental longitudinal strain (SLS), global circumferential strain (GCS), and segmental circumferential strain (SCS) were assessed along with the MI scar extent.ResultsThe GCS measurements from fast-SENC and FT were nearly identical: the mean difference was 0.01 (2.5)% (95% CI – 0.92 to 0.95). For GLS, fast-SENC values were higher than FT, with a mean difference of 1.8 (1.4)% (95% CI 1.31–2.35). Tests of significance for GLS did not show any differences between the MR methods and 2DEcho. Average strain in the infarct-related artery (IRA) segments compared to the remote myocardium was significantly lower for the left anterior descending artery and right coronary artery culprits but not for the left circumflex artery culprits. Fast-SENC displayed a higher area under the curve for detecting infarcted segments than FT for both SCS and SLS.ConclusionGLS and GCS did not significantly differ between fast-SENC and FT. Both showed acceptable agreement with 2DEcho for longitudinal strain. Segments perfused by the IRA showed significantly reduced strain values compared to the remote myocardium. Fast-SENC presented a higher sensitivity and specificity for detecting infarcted segments than FT

Effects of 6 weeks of treatment with dapagliflozin, a sodium- glucose co-transporter-2 inhibitor, on myocardial function and metabolism in patients with type 2 diabetes: A randomized, placebo-controlled, exploratory study

Aim: To explore the early effects of dapagliflozin on myocardial function and metabolism in patients with type 2 diabetes without heart failure.Materials and methods: Patients with type 2 diabetes on metformin treatment were randomized to double-blind, 6-week placebo or dapagliflozin 10 mg daily treatment. Investigations included cardiac function and structure with myocardial resonance imaging; cardiac oxygen consumption, perfusion and efficiency with [11 C]-acetate positron emission tomography (PET); and cardiac and hepatic fatty acid uptake with [18 F]-6-thia-heptadecanoic acid PET, analysed by ANCOVA as least square means with 95% confidence intervals.Results: Evaluable patients (placebo: n = 24, dapagliflozin: n = 25; 53% males) had a mean age of 64.4 years, a body mass index of 30.2 kg/m2 and an HbA1c of 6.7%. Body weight and HbA1c were significantly decreased by dapagliflozin versus placebo. Dapagliflozin had no effect on myocardial efficiency, but external left ventricular (LV) work (-0.095 [-0.145, -0.043] J/g/min) and LV oxygen consumption were significantly reduced (-0.30 [-0.49, -0.12] J/g/min) by dapagliflozin, although the changes were not statistically significant versus changes in the placebo group. Change in left atrial maximal volume with dapagliflozin versus placebo was -3.19 (-6.32, -0.07) mL/m2 (p = .056). Peak global radial strain decreased with dapagliflozin versus placebo (-3.92% [-7.57%, -0.28%]; p = .035), while peak global longitudinal and circumferential strains were unchanged. Hepatic fatty acid uptake was increased by dapagliflozin versus placebo (0.024 [0.004, 0.044] μmol/g/min; p = .018), while cardiac uptake was unchanged.Conclusions: This exploratory study indicates reduced heart work but limited effects on myocardial function, efficiency and cardiac fatty acid uptake, while hepatic fatty acid uptake increased, after 6 weeks of treatment with dapagliflozin.</p

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Physical effort and creativity Breathe and tickle. : A creative dose, thanks!

Materialinsamling under fysisk ansträngning undersöks och spelas in för att senarebli till färdiga produktioner. Tillvägagångsättet uppfattas som ett verktyg vidbristande kreativitet och motivation, men har även sina brister då det är beroendeutav faktorer såsom fysisk hälsa samt miljön och omgivningens tillstånd

Using airborne eDNA to study ecosystem dynamics

In this era of global biodiversity crisis, the need to monitor ecological communities over space and time is more pressing than ever to effectively direct biodiversity conservation and management efforts. To understand the natural dynamics of an ecosystem, and the impact of anthropogenic activities related to environmental and climate change, long time series are needed to accurately link such processes to ecosystem change. This thesis uses a unique resource of archived air filters collected in Sweden originally intended for radioactive particle measurements to reconstruct historical eDNA abundance in the most extensive time-series of airborne eDNA abundance to date - spanning across four decades. By using metabarcoding and metagenomic analysis, it is evident that airborne eDNA from a very large diversity of species is present in air, representing all major branches of the tree of life, including bacteria, fungi, plants, metazoans, and viruses, from a wide range of terrestrial and aquatic sources. These have seasonal as well as long term trends that in part can be explained by temporal variation in climate and regional differences. The data generated in this thesis comprise an extensive resource for analysis of trends related to climate and environmental change and will also allow deeper studies on phenology, phenological change, functional genomics, and potentially antibiotic resistance. The results presented here show the potential of using airborne eDNA to monitor species in the local ecosystem over time and the methods provides an efficient tool for assessment of broad scale biodiversity, in a non-invasive and cost-effective way

Social hållbarhet i kommunal planering : En utredande studie av arbetet med social hållbarhet i tretton kommuner

Social hållbarhet är tillsammans med ekonomisk och ekologisk en del av det större begreppet hållbar utveckling. Befintlig forskning inom social hållbarhet konstaterar att begreppet än idag står utan en klar definition till följd av de många tolkningar som begreppet innehar. Syftet med studien är att studera hur social hållbarhet används inom svenska kommuner. För att kunna svara på de framtagna forskningsfrågorna inom fysisk planering avgränsades teoriavsnittet till artiklar som behandlar begreppet tillgänglighet, boendesegregation, integration, urbanitet, mångfald, barriärer och allmänna platser. För att vidare få en överblick för hur den kommunala planeringen behandlar social hållbarhet genomfördes tretton intervjuer med tjänstemän representativa för kommuner. Den geografiska spridningen hade en väsentlig roll för att få en representativ bild av Sverige. Fortsättningsvis genomfördes en innehållsanalys av respektive kommuns översiktsplan utifrån de studerade begreppen för att få en omfattande bild av det kommunala arbetet. Slutligen genomfördes en jämförelseanalys mellan intervjuer och översiktsplaner för att konstatera hur kommunala tjänstemän förhåller sig mot översiktsplaner.  Resultatet av studien visar att det finns skillnader för hur olika kommuner arbetar med social hållbarhet och därmed har somliga kommit längre i utvecklingen. Social hållbarhet inom den fysiska planeringen är idag underrepresenterad ekonomisk och ekologisk hållbarhet. Erfarenheten hos tjänstemännen och samarbetet inom organisationen visar sig vidare spela en stor roll för hur arbetet med social hållbarhet fortgår inom den kommunala organisationen. Ett tydligare samarbete inom organisation främjar arbetet med social hållbarhet.  Intressant för framtida forskning inom ämnet social hållbarhet skulle vara att framställa ett mätverktyg för social hållbarhet i syfte att underlätta för tjänstemän. Social sustainability is together with economic and ecological a part of the larger concept sustainable development. Existing research within social sustainability ascertain that the concept even today does not have a clear definition due to the many interpretations of the concept. The scope of this study is to find out how social sustainability is used within spatial planning.  To be able to answer the research questions and defining social sustainability within the field of spatial planning the literature study was delimited to articles including accessibility, housing segregation, integration, urbanity, diversity, barriers and public places was made. To get a deeper insight of how spatial planning deal with the social aspect of sustainability interviews with thirteen public officials. The geographical allocation across Sweden was important to get at representative sample of Swedish municipalities. The interviews focused on how the public officials act according to the definition of social sustainability.  After the interviews an analysis of the different comprehensive plans took place to see how the municipalities work with social sustainability. Henceforth a comparison analysis between the comprehensive plan and the statements from the public officials showed that it exists differences between municipalities for how they consider guidelines according to their comprehensive plan. Municipalities mention that social sustainability is often less prioritized than economic and ecological sustainability in spatial planning. Experience and collaborations within the organization and with other actors matters when it comes to prioritizing social sustainability.  Interesting for future research in the field of social sustainability would be to produce a measuring tool for social sustainability in order to facilitate for officials.