Declining calcium concentration drives shifts toward smaller and less nutritious zooplankton in northern lakes.

Zooplankton community composition of northern lakes is changing due to the interactive effects of climate change and recovery from acidification, yet limited data are available to assess these changes combined. Here, we built a database using archives of temperature, water chemistry and zooplankton data from 60 Scandinavian lakes that represent broad spatial and temporal gradients in key parameters: temperature, calcium (Ca), total phosphorus (TP), total organic carbon (TOC), and pH. Using machine learning techniques, we found that Ca was the most important determinant of the relative abundance of all zooplankton groups studied, while pH was second, and TOC third in importance. Further, we found that Ca is declining in almost all lakes, and we detected a critical Ca threshold in lake water of 1.3 mg L-1 , below which the relative abundance of zooplankton shifts toward dominance of Holopedium gibberum and small cladocerans at the expense of Daphnia and copepods. Our findings suggest that low Ca concentrations may shape zooplankton communities, and that current trajectories of Ca decline could promote widespread changes in pelagic food webs as zooplankton are important trophic links from phytoplankton to fish and different zooplankton species play different roles in this context.

Association between catheter ablation of atrial fibrillation and mortality or stroke.

OBJECTIVE: Catheter ablation of atrial fibrillation effectively reduces symptomatic burden. However, its long-term effect on mortality and stroke is unclear. We investigated if patients with atrial fibrillation who undergo catheter ablation have lower risk for all-cause mortality or stroke than patients who are managed medically. METHODS: We retrospectively included 5628 consecutive patients who underwent first-time catheter ablation for atrial fibrillation between 2008 and 2018 at three major Swedish electrophysiology units. Control individuals with an atrial fibrillation diagnosis but without previous stroke were selected from the Swedish National Patient Register, resulting in a control group of 48 676 patients. Propensity score matching was performed to produce two cohorts of equal size (n=3955) with similar baseline characteristics. The primary endpoint was a composite of all-cause mortality or stroke. RESULTS: Patients who underwent catheter ablation were healthier (mean CHA2DS2-VASc score 1.4±1.4 vs 1.6±1.5, p<0.001), had a higher median income (288 vs 212 1000 Swedish krona [KSEK]/year, p<0.001) and had more frequently received university education (45.1% vs 28.9%, p<0.001). Mean follow-up was 4.5±2.8 years. After propensity score matching, catheter ablation was associated with lower risk for the combined primary endpoint (HR 0.58, 95% CI 0.48 to 0.69). The result was mainly driven by a decrease in all-cause mortality (HR 0.51, 95% CI 0.41 to 0.63), with stroke reduction showing a trend in favour of catheter ablation (HR 0.75, 95% CI 0.53 to 1.07). CONCLUSIONS: Catheter ablation of atrial fibrillation was associated with a reduction in the primary endpoint of all-cause mortality or stroke. This result was driven by a marked reduction in all-cause mortality.

On Scene Injury Severity Prediction (OSISP) model for trauma developed using the Swedish Trauma Registry.

BACKGROUND: Providing optimal care for trauma, the leading cause of death for young adults, remains a challenge e.g., due to field triage limitations in assessing a patient's condition and deciding on transport destination. Data-driven On Scene Injury Severity Prediction (OSISP) models for motor vehicle crashes have shown potential for providing real-time decision support. The objective of this study is therefore to evaluate if an Artificial Intelligence (AI) based clinical decision support system can identify severely injured trauma patients in the prehospital setting. METHODS: The Swedish Trauma Registry was used to train and validate five models - Logistic Regression, Random Forest, XGBoost, Support Vector Machine and Artificial Neural Network - in a stratified 10-fold cross validation setting and hold-out analysis. The models performed binary classification of the New Injury Severity Score and were evaluated using accuracy metrics, area under the receiver operating characteristic curve (AUC) and Precision-Recall curve (AUCPR), and under- and overtriage rates. RESULTS: There were 75,602 registrations between 2013-2020 and 47,357 (62.6%) remained after eligibility criteria were applied. Models were based on 21 predictors, including injury location. From the clinical outcome, about 40% of patients were undertriaged and 46% were overtriaged. Models demonstrated potential for improved triaging and yielded AUC between 0.80-0.89 and AUCPR between 0.43-0.62. CONCLUSIONS: AI based OSISP models have potential to provide support during assessment of injury severity. The findings may be used for developing tools to complement field triage protocols, with potential to improve prehospital trauma care and thereby reduce morbidity and mortality for a large patient population.

Cardiac tamponades related to interventional electrophysiology procedures are associated with higher risk of short-term hospitalization for pericarditis but favourable long-term outcome.

AIMS: To investigate the association of iatrogenic cardiac tamponades as a complication of invasive electrophysiology procedures (EPs) and mortality as well as serious cardiovascular events in a nationwide patient cohort during long-term follow-up. METHODS: From the Swedish Catheter Ablation Registry between 2005 and 2019, a total of 58 770 invasive EPs in 44 497 patients were analysed. From this, all patients with periprocedural cardiac tamponades related to invasive EPs were identified (n = 200; tamponade group) and matched (1:2 ratio) to a control group (n = 400). Over a follow-up of 5 years, the composite primary endpoint-death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure-revealed no statistically significant association with cardiac tamponade [hazard ratio (HR) 1.22 (95% CI, 0.79-1.88)]. All single components of the primary endpoint as well as cardiovascular death revealed no statistically significant association with cardiac tamponade. Cardiac tamponade was associated with a significantly higher risk with hospitalization for pericarditis [HR 20.67 (95% CI, 6.32-67.60)]. CONCLUSION: In this nationwide cohort of patients undergoing invasive EPs, iatrogenic cardiac tamponade was associated with an increased risk of hospitalization for pericarditis during the first months after the index procedure. In the long-term, however, cardiac tamponade revealed no significant association with mortality or other serious cardiovascular events.

Browning affects pelagic productivity in northern lakes by surface water warming and carbon fertilization.

Global change impacts important environmental drivers for pelagic gross primary production (GPP) in northern lakes, such as temperature, light, nutrient, and inorganic carbon availability. Separate and/or synergistic impacts of these environmental drivers on pelagic GPP remain largely unresolved. Here, we assess key drivers of pelagic GPP by combining detailed depth profiles of summer pelagic GPP with environmental and climatic data across 45 small and shallow lakes across northern Sweden (20 boreal, 6 subarctic, and 19 arctic lakes). We found that across lakes summer pelagic GPP was strongest associated with lake water temperatures, lake carbon dioxide (CO2 ) concentrations impacted by lake water pH, and further moderated by dissolved organic carbon (DOC) concentrations influencing light and nutrient conditions. We further used this dataset to assess the extent of additional DOC-induced warming of epilimnia (here named internal warming), which was especially pronounced in shallow lakes (decreasing 0.96°C for every decreasing m in average lake depth) and increased with higher concentrations of DOC. Additionally, the total pools and relative proportion of dissolved inorganic carbon and DOC, further influenced pelagic GPP with drivers differing slightly among the boreal, subarctic and Arctic biomes. Our study provides novel insights in that global change affects pelagic GPP in northern lakes not only by modifying the organic carbon cycle and light and nutrient conditions, but also through modifications of inorganic carbon supply and temperature. Considering the large-scale impacts and similarities of global warming, browning and recovery from acidification of lakes at higher latitudes throughout the northern hemisphere, these changes are likely to operate on a global scale.

Predictors of recurrence after catheter ablation and electrical cardioversion of atrial fibrillation: an umbrella review of meta-analyses.

AIMS: The recurrence rates after catheter ablation (CA) and direct current (DC) cardioversion remain high, although they have been established treatments of rhythm control of atrial fibrillation (AF). This umbrella review systematically appraises published meta-analyses of both observational and randomized controlled trials (RCTs) for the association of risk and protective factors for arrhythmia recurrence after CA and DC cardioversion of AF. METHODS AND RESULTS: Three bibliographic databases were searched up to June 2021. Evidence of association was rated as convincing, highly suggestive, suggestive, weak, or not significant with respect to observational studies and as high, moderate, low, or very low with respect to RCTs, according to established criteria. Thirty-one meta-analyses were included. Of the 28 associations between CA and the risk of arrhythmia recurrence, none presented convincing evidence, and only the time from diagnosis to ablation over 1 year provided highly suggestive evidence. The association between hypertension and metabolic profile provided suggestive evidence. The associations of Class IC and III antiarrhythmic drugs use with the recurrence after DC cardioversion were supported by an intermediate level of evidence. CONCLUSION: Although AF is a major health issue, few risk- and protective factors for AF recurrence have been identified. None of these factors examined were supported by convincing evidence, whereas established factors such as female gender and left atrial volume showed only weak association. An early CA strategy combined with treatment of metabolic syndrome and hypertension prior to CA may reduce the risk of arrhythmia recurrence. The use of antiarrhythmics can increase the success rate of DC cardioversion. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registry number: CRD42021270613.

Hearing Aids Mitigate Tinnitus, But Does It Matter if the Patient Receives Amplification in Accordance With Their Hearing Impairment or Not? A Meta-Analysis.

PURPOSE: The purpose of the present meta-analysis is to explore the potential effects of objective verification of hearing aid amplification on tinnitus-related outcomes. METHOD: Twenty-seven studies reporting tinnitus outcomes pre and post hearing aid fitting were identified through a systematic literature search. From these studies, data from 1,400 participants were included in the present meta-analysis. Studies were divided into subgroups based on whether they had reported performing objective verification of the participants' hearing aid amplification or not. Outcome measures were tinnitus distress and tinnitus loudness. RESULTS: Meta-analyses of all included studies indicated verified amplification to result in significantly enhanced reduction of tinnitus loudness (p < .00001), while the enhanced reduction of tinnitus distress only approached statistical significance (p = .07). However, when excluding an outlier from the subgroup of studies using unverified amplification, individuals receiving verified amplification showed significantly greater reduction of tinnitus distress (p = .02). In addition, analyses of longitudinal effects revealed that the reductions of tinnitus distress decreased over time among individuals receiving unverified amplification but increased over time among individuals receiving verified amplification. CONCLUSIONS: The present meta-analysis indicates verified hearing aid amplification to be superior to unverified amplification in terms of reduction of tinnitus loudness and distress. The longitudinal increase of mitigation of tinnitus distress with verified amplification only may reflect improved neural reorganization and/or better adherence to hearing aid use, with verified compared to unverified amplification. Due to the low cost of hearing aid verification compared to the high societal cost of tinnitus, objective verification of hearing aid amplification for tinnitus patients is recommended.

Residential fire fatality typologies in Sweden: Results after 20 years of high-quality data.

INTRODUCTION: Despite a positive long-term trend in fire mortality rates, more knowledge is required concerning the causes and typologies of fatal residential fires in order to improve preventative efforts and further decrease fatality rates. A previous study suggested that fatal residential fires can be grouped into six categories, however, the analyses were performed on a limited dataset that is now more than a decade old. As such, there are some uncertainties regarding the current situation. Also, in the previous study, no subgroups were analyzed separately, despite fatal fires being renowned for being strongly age-dependent. METHOD: This study re-analyzes the typologies for fatal residential fires in Sweden using cluster analysis, based on data for a period of 20 years with a particular focus on older adults. RESULTS: The results suggest that the original cluster analyses were relatively robust for both the total population and for the elderly population, thereby indicating that fatal fires seem to be consistently grouped into certain types. CONCLUSIONS: The results suggest that preventative efforts can be directed toward these types of events involving identified individuals. The results also suggest that the number of fatal residential fires with unknown causes has increased in relation to other fires during the 20-year study period. PRACTICAL IMPLICATIONS: Fatal residential fires with unknown causes are more often large night-time fires occurring in houses in rural locations. In order to prevent these, both prevention and reactive strategies need to be re-evaluated.

Workload of Swedish Special Forces Operators Experienced During Stressful Simulation Training: A Pilot Study.

INTRODUCTION: Stress week was included during training of Special Forces (SF) Operators in Sweden to test their ability and limits for handling stress in different unknown situations and environments at a military training facility in Sweden. The aim of the study was to examine the effects of stress and workload experienced in various tasks during firefighting and military medicine simulation training. METHODS: This pilot study was performed during the second day of stress week. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) is a validated, subjective, and multidimensional assessment tool for rating perceived workload with six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. These subscales were used as an indicator of stress experienced. The different tasks were assessed by the SF Operators by rating the NASA-TLX subscales for each task, which were then analyzed and compared using ANOVA. RESULTS: There was a significant difference between the two simulation exercises assessed by the participants and instructors, and both groups considered firefighting to be more demanding than medical. The participants perceived the mental and physical demands as more demanding in the firefighting exercises, as well as for the level of frustration and effort. However, no differences regarding performance or temporal demands between the simulation exercises were found. CONCLUSION: The principle "train as you fight" implies difficult and demanding situations. When exposing Swedish SF Operators to challenging situations, assessment of perceived stress and performance are possible.

Genetics and voice production in childhood and adolescence - a review.

Adolescence is a challenging time of change in voicing, normally and in pathology. An increased focus on voice production in relation to genetics can expand our knowledge of the onset of puberty and voice change. Our aim with this review was to connect research of genetics to voice production in adolescence. We need further understanding of the developmental background of voice in childhood and adolescence, because many genetic multi handicaps include voice production. Genetic development related to voice production was the focus in a search made by the Royal English Society of Medicine, with only a few results. We supplemented with references to genetic studies of adults and animals as well as adjacent areas of voice production. The genetic development of voice production is steered from the hypothalamus probably related to growth hormone. The genetic voice production in adults form the basis for understanding development. Some research results were found related to the pubertal steps. The findings are important in the future, using advanced voice analysis and artificial intelligence methods in patients with Multi handicaps.

Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis.

BACKGROUND: There is no consensus on the most efficient catheter ablation (CA) strategy for patients with atrial fibrillation (AF). The objective of this study was to compare the efficacy and safety of different CA strategies for AF ablation through network meta-analysis (NMA). METHODS: A systematic search of PubMed, Web of Science, and CENTRAL was performed up to October 5th, 2020. Randomized controlled trials (RCT) comparing different CA approaches were included. Efficacy was defined as arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of 6 months. RESULTS: In total, 67 RCTs (n = 9871) comparing 19 different CA strategies were included. The risk of recurrence was significantly decreased compared to pulmonary vein isolation (PVI) alone for PVI with renal denervation (RR: 0.60, CI: 0.38-0.94), PVI with ganglia-plexi ablation (RR: 0.62, CI: 0.41-0.94), PVI with additional ablation lines (RR: 0.8, CI: 0.68-0.95) and PVI in combination with bi-atrial modification (RR: 0.32, CI: 0.11-0.88). Strategies including PVI appeared superior to non-PVI strategies such as electrogram-based approaches. No significant differences in safety were observed. CONCLUSIONS: This NMA showed that PVI in combination with additional CA strategies, such as autonomic modulation and additional lines, seem to increase the efficacy of PVI alone. These strategies can be considered in treating patients with AF, since, additionally, no differences in safety were observed. This study provides decision-makers with comprehensive and comparative evidence about the efficacy and safety of different CA strategies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registry number: CRD42020169494 .

Fecal indicator organisms in northern oligotrophic rivers: An explorative study on Escherichia coli prevalence in a mountain region with intense tourism and reindeer herding.

Increasing pollution levels in waters from remote mountain areas in northern Sweden have been observed. To support a sustainable water quality management, it is necessary to know which environmental and antrophogenic factors influence the water quality. The purpose of this study was to map the Escherichia coli prevalence in the catchment area of the upper part of a large northern Scandinavian river and investigate the controlling factors of microbial contamination. A total of 112 water samples were collected from various locations in the research area between July 2020 and December 2020. These samples were analyzed for microbial and chemical characteristics, and information about tourism and reindeer herding was compiled. Additionally, microbial and physicochemical water characteristics collected by Indalsälven Water Conservation Association (IWCA, 1993-2020) and Swedish Meteorological and Hydrological Institute (SMHI, 2004-2020) were analyzed. The results showed that E. coli enumerations ranged between 0 and 500 CFU/100 ml. There was generally no obvious relation between suspected point sources, e.g., sewage treatment plants at mountain stations, and E. coli levels at downstream sampling points. Principal component analysis showed that E. coli was correlated to coliforms, total heterotrophic count, river discharge, CODMn and river color. Since microbial analyses are time-consuming, expensive and difficult to perform in remote areas, it is important to find more easily extracted water parameters that can serve as a proxy for E. coli. In particular, river color and discharge are promising parameters that may serve as an early indication of bacterial outbreak and fecal contamination in mountain waters.

Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials.

Although catheter ablation (CA) is an established treatment for paroxysmal atrial fibrillation (PAF), there is no consensus regarding the most efficient CA strategy. The objective of this network meta-analysis (NMA) was to compare the efficacy and safety of different CA strategies for PAF. A systematic search was performed in PubMed, Web of Science, and CENTRAL until the final search date, 5 October 2020. Randomised controlled trials (RCT) comparing different CA strategies and methods for pulmonary vein isolation (PVI) were included. Efficacy was defined as lack of arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of six months. In total, 43 RCTs comparing 11 different CA strategies involving 6701 patients were included. The risk of recurrence was significantly decreased in comparison with PVI with radiofrequency only for the following treatments: PVI with adjuvant ablation (RR: 0.79, CI: 0.65-0.97) and PVI with sympathetic modulation (RR: 0.64, CI: 0.46-0.88). However, PVI with radiofrequency was superior to non-PVI strategies (RR: 1.65, CI: 1.2-2.26). No statistically significant difference was found in safety between different CA strategies. Concerning different PVI strategies, no difference was observed either in efficacy or in safety between tested strategies. This NMA suggests that different PVI strategies are generally similar in terms of efficacy, while PVI with additional ablation or sympathetic modulation may be more effective than PVI alone. This study provides decision-makers with insights into the efficacy and safety of different CA strategies.

Symptoms and health-related quality of life 5 years after catheter ablation of atrial fibrillation.

OBJECTIVES: To investigate the effect of catheter ablation (CA) on symptoms and health-related quality of life (HRQoL) after 5 years, and analyze predictors of recurrence of symptoms. BACKGROUND: The primary indication for CA of atrial fibrillation (AF) is to reduce symptoms and improve HRQoL where long-term follow-up are sparse. METHODS: In this observational, long-term, single-center study, patients were recruited from Linköping University Hospital, Sweden. They were aged ≥18 years and had been referred for CA from November 2011 until June 2019. Arrhythmia-specific symptoms and HRQoL were assessed by patient-reported outcome measures (PROMs) with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA). RESULTS: In the study were 1521 patients, 69% men, mean age 62 years. At baseline, 87% of the patients and at the 5-year follow-up 80% of those eligible filled out the ASTA questionnaire. At follow-up, 50% reported freedom from symptoms, 18% had >50% symptom reduction, 14% had a minor reduction, while 18% reported no effect or a worsening of symptoms. Factors predicting symptoms were female gender (hazard ratio [HR]: 1.8; 1.2-2.8), body mass index ≥ 35 (HR: 3.9; 1.6-9.8), and ischemic heart disease (IHD) (HR: 2.6; 1.2-5.9). After 5 years, breathlessness during activity, weakness/fatigue, and tiredness were still the most common symptoms; regarding HRQoL they were impaired physical ability and deteriorated life situation. CONCLUSIONS AND CLINICAL IMPLICATIONS: This clinical cohort of patients with AF evaluated through PROMs showed that CA had long-lasting effects on symptoms and HRQoL and that the use of PROMs in clinical routines was feasible. Factors predicting symptoms after CA were female gender, IHD, and obesity, an important reminder to encourage lifestyle management.

Health problems among Swedish ambulance personnel: long-term risks compared to other professions in Sweden - a longitudinal register study.

Objectives. This study aimed to investigate whether Swedish ambulance personnel differ in the extent of suffering from health problems compared to other occupational groups. Methods. Two cohorts of ambulance personnel from 2001 and 2008, with 1778 and 2753 individuals, respectively, were followed regarding assignment of diagnostic coding (International Classification of Diseases codes) until 2016. These two cohorts represent all who were employed as ambulance personnel by public employers during these years. Two comparison groups were added: other healthcare workers and other professions. All data were retrieved from national registers. The χ2 test was were used for statistical calculation. Results. Swedish ambulance personnel are at a significantly higher risk of being affected by 'Paroxysmal tachycardia, atrial fibrillation and flutter, other cardiac arrhythmias', by 'Other intervertebral disc disorders' and by 'Arthropathies', when compared to both comparison groups in both cohorts. Almost similar results were seen for 'Gonarthrosis' and for 'Dorsopathies'. Conclusions. Swedish ambulance personnel run the risk of being affected by certain diseases and injuries to a greater extent compared to other professions.

Endocrine and Mechanical Cardiacfunction Four Months after Radiofrequency Ablation of Atrialfibrillation.

BACKGROUND: Radiofrequency ablation (RFA)is an important treatment option for patients with atrial fibrillation (AF). During RFA, a significant amount of energy is delivered into the left atrium (LA), resulting in considerable LA-injury. The impact of this damage on mechanical and endocrine LA-function, however, is often disregarded.We therefore aimed to evaluate the endocrine- and mechanical function of the heart 4-months after RFA of AF. METHODS: In total 189 patients eligible for RFA of AF were studied. The levels of the N-terminal pro-B-natriuretic peptide (NT-proBNP) and the mid-regional fragment of the N-terminal pro-atrial natriuretic peptide (MR-proANP)were measured. The maximum LAvolume (LAVmax),the LAejection fraction (LAEF) and the LA peak longitudinal strain (PALS), were measured usingtransthoracic echocardiography. The measurements were performed before and 4-months after the intervention. RESULTS: 87 patients had a recurrence during a mean follow-up of 143±36 days.NT-proBNPand MR-proANPdecreased significantly at follow-up. This reduction was greater in patients who did not suffer any recurrence after RFA.The LAVmax decreased significantly, whereasthe PALS only improved in patients who did not suffer from any recurrence. On the other hand, LAEF did not change significantly after RFA of AF. CONCLUSIONS: Despite extensiveablation during RFA of AF, the endocrine function of the heart improved 4-months after the index procedure. Patients with no arrhythmia recurrence showed a more pronounced improvement in their endocrinal function. Mechanically, the LAVmax was reduced, and the LA strain improved significantly.

Lowered nutritional quality of plankton caused by global environmental changes.

Global environmental changes are causing widespread nutrient depletion, declines in the ratio of dissolved inorganic nitrogen (N) to total phosphorus (DIN:TP), and increases in both water temperature and terrestrial colored dissolved organic carbon (DOC) concentration (browning) in high-latitude northern lakes. Declining lake DIN:TP, warming, and browning alter the nutrient limitation regime and biomass of phytoplankton, but how these stressors together affect the nutritional quality in terms of polyunsaturated fatty acid (PUFA) contents of the pelagic food web components remains unknown. We assessed the fatty acid compositions of seston and zooplankton in 33 lakes across south-to-north and boreal-to-subarctic gradients in Sweden. Data showed higher lake DIN:TP in the south than in the north, and that boreal lakes were warmer and browner than subarctic lakes. Lake DIN:TP strongly affected the PUFA contents-especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)-in seston, calanoids, and copepods (as a group), but not in cladocerans. The EPA+DHA contents increased by 123% in seston, 197% in calanoids, and 230% in copepods across a lake molar DIN:TP gradient from 0.17 to 14.53, indicating lower seston and copepod nutritional quality in the more N-limited lakes (those with lower DIN:TP). Water temperature affected EPA+DHA contents of zooplankton, especially cladocerans, but not seston. Cladoceran EPA+DHA contents were reduced by ca. 6% for every 1°C increase in surface water. Also, the EPA, DHA, or EPA+DHA contents of Bosmina, cyclopoids, and copepods increased in lakes with higher DOC concentrations or aromaticity. Our findings indicate that zooplankton food quality for higher consumers will decrease with warming alone (for cladocerans) or in combination with declining lake DIN:TP (for copepods), but impacts of these stressors are moderated by lake browning. Global environmental changes that drive northern lakes toward more N-limited, warmer, and browner conditions will reduce PUFA availability and nutritional quality of the pelagic food web components.

Debriding effect of amino acid-buffered hypochlorite on hard-to-heal wounds covered by devitalised tissue: pilot study.

OBJECTIVE: Wounds such as lower extremity ulcers are serious, costly and frequently hard to heal. Guidelines conclude that new dressings and treatments generally fail to show superiority compared with standard of care. Several mechanisms are probably responsible for impaired healing of hard-to-heal wounds, including inflammation and infection. Amino acid-buffered hypochlorite has presumed antiseptic and antibacterial properties and has been shown to be useful in the treatment of diabetic foot ulcers (DFUs). We evaluated the debriding effect of amino acid-buffered hypochlorite (ChloraSolv) on full skin hard-to-heal lower extremity ulcers covered with devitalised tissue (≥50%), with six applications over 5 weeks and follow-up at 12 weeks. METHOD: This was an open-label, single-arm, multicentre, pre-market pilot investigation. We recruited subjects with a lower extremity ulcer, covered with devitalised tissue (≥50%), who were candidates for cleansing and debridement/desloughing. There was a weekly application of the investigational device for five weeks. Follow-up for wound status evaluation was performed at 12 weeks from baseline. RESULTS: We evaluated 57 subjects (33 males, 24 females, median age 73 years, range 51-90 years) (intention-to-treat). Of these, 61.4% had a leg ulcer and 38.6% a foot ulcer. The median wound size at baseline was 7.7cm2 (range 2.1-52cm2) with devitalised tissue coverage of 76.5%. After 5 weeks, a decrease of 72.7% in devitalised tissue was seen, and 71.4% of the subjects showed a decrease in devitalised tissue of ≥50% (evaluated independently using PictZar). At 12 weeks' follow-up the decrease in devitalised tissue was 84.4%. Wound-related pain was reported by ten subjects, resulting in 17 adverse events (AEs). Among these, 12 AEs from eight subjects were recorded as possibly or probably related to the investigational device and one AE was reported to have a causal relationship with the investigational device. CONCLUSION: This clinical study suggests that amino acid-buffered hypochlorite can be effective and well tolerated in the treatment of hard-to-heal lower extremity ulcers to dissolve and remove devitalised tissue.

Influence of Soil-Borne Inoculum of Plasmodiophora brassicae Measured by qPCR on Disease Severity of Clubroot-Resistant Cultivars of Winter Oilseed Rape (Brassica napus L.).

Use of resistant cultivars is considered the most effective tool in managing clubroot. Three clubroot-resistant commercial winter oilseed rape (OSR) cultivars and a susceptible 'Cultivar mix' were evaluated for disease severity index (DSI) and yield performance in field soils, selected for varying abundance of natural inoculum of Plasmodiophora brassicae. Seven field trials were carried out during 2017-2019 in winter OSR crops, and comparative bioassays were performed in a growth chamber. Substantial variation in clubroot infection between years was observed in the field trials. For Cultivar mix, a negative correlation (y = -252.3ln(x) + 58,897.6) was found between inoculum density and seed yield in five trials, whereas no correlation was found for the resistant cultivars. In bioassays, Cultivar mix exhibited a significantly high correlation between DSIb and number of gene copies g-1 soil (R2 = 0.72). For resistant cvs., Mentor and Alister, correlation was R2 = 0.45 and 0.58, respectively, indicating that resistance was under pressure. In field trials, DSIf of the resistant cultivars was lower (<27). The recommendation is thus to use clubroot-resistant cultivars of OSR as part of Integrated Pest Management in situations where abundance of P. brassicae DNA exceeds 1300 gene copies g-1 soil.

An upgrade of the Malmö model by implementing case-based teaching and learning, in an undergraduate dental education.

BACKGROUND: At our dental education, the examination failure rate amongst students has increased, resulting in subsequent involuntary dropouts. One of the main problems seems to be that the students struggle with taking the necessary responsibility for their learning, as required by the problem-based learning (PBL) methodology. AIM: To describe the background to, and the transition process from, pure PBL to case-based teaching and learning (CBT) with flipped classroom seminars at the dental programme at [anonymised for peer review]. METHODS: In this position paper, we describe our observed problems with the PBL methodology, as implemented at this faculty, and the potential benefits of a change towards CBT. The current implementation of CBT is presented, along with educational research supporting the choice of activities. RESULTS: Tentative findings are that the flipped classroom seminars and the clearer instructions appear to be successful with higher levels of activity, engagement and attendance amongst the students, and the students have evaluated the seminars as very good learning activities. CONCLUSION: Tentative findings suggest that the current implementation of CBT may be a fruitful way of teaching in dental education today. Most of the teaching staff have been reawakened to teaching, and as a result, the content of the courses are being reviewed and improved. The students appreciate that what is expected of them has been made clearer and that there is a variety of learning activities.