Resistance to aztreonam-avibactam among clinical isolates of E. coli is primarily mediated by altered penicillin binding protein 3 and impermeability.

Herein, we investigated decreased susceptibility (DS; MICs 0.25-4 mg/L) and resistance (R; MICs >4 mg/L) to aztreonam-avibactam (ATM-AVI). Contemporary non-replicate clinical isolates of carbapenemase-producing Escherichia coli (n=90) (CP-EC) and ESBL-producing E. coli (n=12) (EP-EC) was used. CP-EC belonged to 25 distinct sequence types (STs) and all EP-EC belonged to ST405. All strains were isolated through 2019-2022 at the Karolinska University Laboratory, Stockholm, Sweden. ATM-AVI MICs were determined with broth microdilution and the EUCAST epidemiological cutoff value of 0.125 mg/L was used to define the wildtype (WT). Whole genome sequences (Illumina) were analyzed for detecting of resistance determinants among WT vs non-WT isolates. Among 102 isolates, 40 (39%) and 62 (61%) were WT and non-WT respectively. Among non-WT isolates 20 were R and 42 were DS. Resistance was observed among 14/47 NDM-producers, 5/43 OXA-48 group producers, and 1/12 EP-EC. DS was observed among 29/47 NDM, 13/43 OXA-48 group, and 3/12 EP-EC. Resistant isolates predominantly belonged to ST405 followed by STs 410, 361, 167, 617, and 1284. Presence of PBP3 inserts (YRIK/YRIN) were observed in 20/20 and presence of CMY-42 in 5/20 resistant isolates. Several mutations in the ftsI (encoding PBP3) and regulatory genes of outer membrane proteins (OmpC and OmpF) and efflux pumps (AcrAB-TolC) were detected. A ≥2-fold reduction in MICs were observed among 20/20 vs 7/20 isolates tested in the presence of the membrane permeabilizer PMBN and efflux inhibitor PAßN, respectively. In conclusion, resistance to ATM-AVI is a result of interplay of various determinants, including target alterations, deactivating enzymes, and decreased permeability.

Effects of bottom trawling and environmental factors on benthic bacteria, meiofauna and macrofauna communities and benthic ecosystem processes.

Soft sediment marine benthic ecosystems comprise a diverse community of bacteria, meiofauna and macrofauna, which together support a range of ecosystem processes such as biogeochemical cycling. These ecosystems are also fishing grounds for demersal species that are often caught using bottom trawling. This fishing method can have deleterious effects on benthic communities by causing injury or mortality, and through alteration of sediment properties that in turn influence community structure. Although the impacts of bottom trawling on macrofauna are relatively well studied, less is known about the responses of meiofauna and bacteria to such disturbances, or how bottom trawling impacts benthic ecosystem processes. Quantifying trawling impacts against a background of natural environmental variability is also a challenge. To address these questions, we examined effects of bottom trawling and a range of environmental variables (e.g. water chemistry and physical and biochemical surface sediment properties) on a) bacterial, meiofaunal and macrofaunal community structure and b) benthic ecosystem processes (nutrient fluxes, extracellular enzyme activities and carbon turnover and degradation rates). We also investigated the link between the benthic macrofauna community and the same ecosystem processes. While there was a significant effect of bottom trawling intensity on macrofaunal community structure, the same was not seen for bacterial or meiofaunal community composition, which were more affected by environmental factors, such as surface sediment properties. The labile component of the surface sediment carbon pool was higher at highly trawled sites. Carbon degradation rates, extracellular enzyme activities, oxygen fluxes and some nutrient fluxes were significantly affected by trawling, but ecosystem processes were also strongly linked to the abundance of key bioturbators (Macoma balthica, Halicryptus spinulosus, Scoloplos armiger and Pontoporeia femorata). Although benthic ecosystems were affected by a combination of trawling and natural variability, disentangling these showed that the anthropogenic effects were clearest on the larger component of the community, i.e. macrofauna composition, and on ecosystem processes related to sedimentary carbon.

Information Technology and Medical Technology Personnel's Perception Regarding Segmentation of Medical Devices: A Focus Group Study.

Objective: Segmentation is one way of improving data protection. The aim of this study was to investigate Information Technology (IT) and Medical Technology (MT) personnel's perception in relation to ongoing segmentation of medical devices and IT infrastructure in the healthcare sector. Methods: Focus group interviews with 9 IT and 9 MT personnel in a county council in southern Sweden were conducted. The interviews focused on two areas: Positive expectations and misgivings. Digital recordings were transcribed verbatim and analyzed using qualitative content analysis. Results: Responses related to 2 main areas: Information security and implementation of segmentation. Informants stated that network segmentation would increase the overall level of cybersecurity for medical devices, addressing both insider and outsider threats. However, it would also increase the need for administration and the need for knowledge of the communication patterns of medical devices from the manufacturer's perspective. Conclusion: IT and MT personnel in a county council in southern Sweden believed that segmentation would increase cybersecurity but also increase administration and resource needs, which are important opinions to take into consideration. The present study can be used as a model for others to increase awareness of opinions of healthcare organizations.

Early integration of palliative care: translation, cross-cultural adaptation and content validity of the Supportive and Palliative Care Indicators Tool in a Swedish healthcare context.

BACKGROUND: Timely identification of patients with palliative care needs is a prerequisite for being able to carry out effective and equal palliative care. The Supportive and Palliative Care Indicators Tool (SPICT) identifies patients likely to benefit from a palliative approach. AIM: The main objective was to describe the translation, cross-cultural adaptation and content validation process of the SPICT-SE. In this process, the prefinal SPICT-SE was tested in focus group interviews to explore how the tool was perceived and interpreted by healthcare professionals in a Swedish healthcare context. METHODS: In this qualitative descriptive study, the translation, cross-cultural adaptation and content validation process of the SPICT-SE was based on a recommended method for cross-cultural adaptation of self-report measures. The process included two independent forward translations, a synthesis, and one independent back-translation. An expert committee consolidated all the versions and developed the prefinal version of the SPICT-SE. The prefinal version of the SPICT-SE was tested in four focus group interviews with physicians and nurses engaged in inpatient or outpatient care in south-west Sweden. A thematic analysis of the transcribed interviews was performed. The SPICT-SE was then revised to the final version. RESULTS: In the thematic analysis, four themes were constructed that together described how the SPICT-SE was perceived and interpreted by healthcare professionals: The mindset is familiar and relevant; the tool needs to be adjusted in order to be clearer; the purpose and consequences of the tool are ambiguous; and the tool supports a palliative approach. CONCLUSION: The SPICT-SE has now been successfully translated, culturally adapted and content validated in a Swedish healthcare context.

Bottom trawl fishing footprints on the world's continental shelves.

Bottom trawlers land around 19 million tons of fish and invertebrates annually, almost one-quarter of wild marine landings. The extent of bottom trawling footprint (seabed area trawled at least once in a specified region and time period) is often contested but poorly described. We quantify footprints using high-resolution satellite vessel monitoring system (VMS) and logbook data on 24 continental shelves and slopes to 1,000-m depth over at least 2 years. Trawling footprint varied markedly among regions: from <10% of seabed area in Australian and New Zealand waters, the Aleutian Islands, East Bering Sea, South Chile, and Gulf of Alaska to >50% in some European seas. Overall, 14% of the 7.8 million-km2 study area was trawled, and 86% was not trawled. Trawling activity was aggregated; the most intensively trawled areas accounting for 90% of activity comprised 77% of footprint on average. Regional swept area ratio (SAR; ratio of total swept area trawled annually to total area of region, a metric of trawling intensity) and footprint area were related, providing an approach to estimate regional trawling footprints when high-resolution spatial data are unavailable. If SAR was ≤0.1, as in 8 of 24 regions, there was >95% probability that >90% of seabed was not trawled. If SAR was 7.9, equal to the highest SAR recorded, there was >95% probability that >70% of seabed was trawled. Footprints were smaller and SAR was ≤0.25 in regions where fishing rates consistently met international sustainability benchmarks for fish stocks, implying collateral environmental benefits from sustainable fishing.

Stable isotopes reveal the effect of trawl fisheries on the diet of commercially exploited species.

Bottom trawling can change food availability for benthivorous demersal species by (i) changing benthic prey composition through physical seabed impacts and (ii) by removing overall benthic consumer biomass increasing the net availability of benthic prey for remaining individuals. Thus trawling may both negatively and positively influence the quantity and quality of food available. Using δ 13C and δ 15N we investigated potential diet changes of three commercially exploited species across trawling gradients in the Kattegat (plaice, dab and Norway lobster (Nephrops)) and the Irish Sea (Nephrops). In the Kattegat, trawling affected primarily the biomass of benthic consumers, lowering competition. Nephrops showed significant positive relationships for δ 13C and a domed relationship for δ 15N with trawling. In the Irish Sea, intense trawling had a negative effect on benthic prey. δ 13C and δ 15N thus showed the inverse relationships to those observed in the Kattegat. Plaice from the Kattegat, showed a significant relationship with trawling intensity for δ 13C, but not for δ 15N. No relationship was found for dab. Changes of δ 13C and δ 15N correlated with changes in condition of species. The results show that the removal of demersal competitors and benthos by trawling can change the diets of commercial species, ultimately affecting their body condition.

Questionnaire-based evaluation of mobile phone interference with medical-electrical equipment in Swedish hospitals.

National recommendations in Sweden recommend a safety distance of 3 meter (m) between mobile phones and medical-electrical (ME) equipment in hospitals. A questionnaire was used to investigate how often mobile phones were reported to interfere with ME products in clinical practice across Sweden. The results confirmed that ME equipment can be affected by mobile phone use but, the risk of the patient's outcome being affected were minimal; no cases were identified which led to injury or death. In conclusion, the results support recommendations for a general safety distance of 0.5 m between mobile phones and ME equipment in care environments.

Population structure in Atlantic cod in the eastern North Sea-Skagerrak-Kattegat: early life stage dispersal and adult migration.

BACKGROUND: In marine fish species, where pelagic egg and larvae drift with ocean currents, population structure has been suggested to be maintained by larval retention due to hydrographic structuring and by homing of adult fish to natal areas. Whilst natal homing of adults has been demonstrated for anadromous and coral reef fishes, there are few documented examples of philopatric migration in temperate marine fish species. RESULTS: Here, we demonstrate temporally stable genetic differentiation among spawning populations of Atlantic cod (Gadus morhua L.), and present genetic and behavioural evidence for larval drift and philopatric migration in the eastern North Sea-Skagerrak-Kattegat area. We show that juvenile cod collected in the eastern Skagerrak and central Kattegat are genetically similar to cod from offshore spawning areas in the eastern North Sea. Genetic assignment of individual 2-5 year old fish indicates that cod residing at, or migrating towards, spawning areas in Kattegat and the North Sea display philopatric behaviours. CONCLUSIONS: Together these findings suggest a loop between spawning, larval drift and adult return-migrations to spawning areas and underlines that both oceanographic processes and migratory behaviour in the adult phase may be important for stock separation and integrity in marine temperate fishes such as Atlantic cod.

Problematization of perspectives on health promotion and empowerment in mental health nursing--within the research network "MeHNuRse" and the Horatio conference, 2012.

Mental illness is increasing worldwide, while society's response seems to be a trend toward narrower and more specialized mental health care. This development is creating great demands on mental health nurses to include a health promotion perspective in care and support of persons with mental illness. A health promotion perspective emphasizes cooperation and communication with people who suffer from long-term mental illness, focusing on their independence and health. From a health perspective, every human being is an actor in his/her own life, with an inherent ability to make his/her own choices. However, persons who suffer from long-term mental illness are at risk of losing power and control over areas of their lives and their health. Mental health nurses are in a position to support these individuals in promoting health and in maintaining or regaining control over their lives. The emphasis of this paper is to problematize mental health nurses' responsibility to provide health-promoting nursing care in relation to empowerment by means of emancipation, self-efficacy, and self-management. We argue that mental health nurses can work from a health-promoting perspective by using these concepts and that this challenges some of the traditional ideas of health promotion in mental health nursing. The theoretical background discussions in this paper have their origin in the research network "Mental Health Nursing Research in Scandinavia" (MeHNuRse) and from the professional discussions developed during a 2012 workshop that included mental health nurses and researchers at the European Horatio Festival in Stockholm.

Experience of living with a family member with bipolar disorder.

Bipolar disorder (BD) is a severe illness that has a serious impact on the lives of those affected and on their families. The aim of this study was to elucidate what it means for family members to live with an adult person who has BD, with reference to their views concerning the condition of the person affected and the future. During 2005, 17 family members of people with the disorder were interviewed, and the data obtained were subjected to a qualitative content analysis. The findings showed that family members felt alone with their experiences and struggled to make sense of and to maintain normality, as their life was encroached on by the condition. Bearing the burden of responsibility and control made it difficult for family members to focus on their own future. To build hope, they needed opportunities to share their experiences with others, increased understanding of the condition, and relief from the burden they bore. This study underlines the importance of strengthening support holistically for family members living with an adult person with BD. Support and interventions concerning these families' needs have to be developed and should be provided by all mental health-care services.

Persons living with bipolar disorder--their view of the illness and the future.

The aim of this study is to describe the meaning of living with bipolar disorder (BD) based on individuals' views of the illness and their future. Interviews were conducted with 18 participants who resided in Sweden and had been diagnosed with bipolar disorder. Qualitative content analysis was employed. The findings revealed that daily life of those with BD was characterized by insecurity and challenges of accepting, understanding, and managing the illness. Increased hope of being able to influence the condition and receiving support to achieve a stable structure in life facilitates the management of daily life. Further research is needed on the next of kins' experiences of living with persons with BD.