Högskolan i Skövde

Overlap of irritable bowel syndrome (IBS) with gastroduodenal disorders of gut–brain interaction (DGBI) is common and associated with more severe symptoms, but the underlying causes of these severe symptoms are unknown. Here, neuropeptide signalling, neuronal plasticity, and compartment-specific nerve architecture in the colonic mucosa were examined in this phenotype. Colonic samples from healthy controls (HC, n=8) and IBS patients with or without gastroduodenal DGBI overlap (n=16 for each group) were examined for vasoactive intestinal polypeptide (VIP) and growth-associated protein-43 (GAP43) mRNA and protein expression. VIP and GAP43 were quantified by immunohistochemistry in the crypt, lamina propria, mucosa, and muscularis mucosa.These data were integrated with rectal barostat measurements of visceral sensitivity and with self-rating of anxiety, depression, and abdominal pain, using validated questionnaires. Non-parametric correlations and comparative statistics were used to analyse differences between groups, transcription–protein coupling, and associations with symptoms. IBS patients with DGBI overlap had higher VIP and GAP43 mRNA, but not protein, expression. For each protein, expression intensity correlated closely between mucosal layers in IBS participants but not in GAP43 in HC, whereas correlations with mRNA levels and symptoms were compartment-specific. Distinct, compartment-specific correlations between markers were observed in IBS with vs. without overlapping gastroduodenal DGBI. Lamina propria and mucosal GAP43 expression correlated inversely with abdominal pain in participants with IBS, which was largely driven by individuals with overlapping DGBI. Neuronal remodelling is differentially associated with abdominal pain and spatial neuronal distribution in the colonic mucosa in people with IBS with vs. without concomitant gastroduodenal DGBI.

Background: Antibiotic resistance is an increasing global public health challenge. The spread of Extended-Spectrum Beta-Lactamase (ESBL)-producing Escherichia coli is particularly concerning, as the bacterium occurs across human, animal, and environmental contexts. This enables the circulation of resistant bacteria between domains and highlights the relevance of a One Health perspective.

Aim: The aim of this literature review was to synthesize, from a One Health perspective, how ESBL-producing E. coli circulates between humans, animals, and the environment, and to identify key structural areas with potential to limit its spread.

Method: This study was conducted as a qualitative literature review. A total of 20 peer-reviewed original research articles based on empirical data were included. The material was analysed using thematic analysis according to Braun and Clarke. Only studies explicitly addressing ESBL-producing E. coli and involving at least two One Health domains were included.

Results: The analysis identified four overarching themes: (1) environmental factors, including water, sanitation, and wastewater systems; (2) animal husbandry and food systems; (3) household and community contexts; and (4) genomic surveillance. The findings indicate that the circulation of ESBL-producing E.coli is largely shaped by structural conditions and recurrent exposures within interconnected systems rather than by isolated transmission events.

Conclusion: The study demonstrates that the spread of ESBL-producing E. coli is a complex, cross-sectoral issue requiring integrated and long-term approaches. The One Health framework is essential for identifying structural points of intervention and developing sustainable strategies to limit antibiotic resistance.

Type 1 diabetes (T1D) arises from immune-mediated destruction of pancreatic β-cells; rising incidence implicates environmental and metabolic contributors. Prospective metabolomic studies have identified altered circulating amino-acid profiles, notably elevated glutamine and proline, preceding the first islet autoantibody in children who later develop T1D. This thesis tested whether supraphysiological extracellular concentrations of L-proline and L-glutamine increase glucose consumption by innate immune cells and activate nutrient-sensing signaling pathways, particularly the mTOR axis. Human THP-1 monocytic cells were exposed to baseline (1×), 2×, and 5× concentrations of either L-glutamine or L-proline; glucose uptake/consumption was estimated from residual medium glucose at 1 hour (with an additional ±FBS, ±insulin comparison at 24 and 48 hours). Secondary outcomes were RPS6KB1 and NFE2L2 transcript levels by RT-qPCR (48 hours) and cell viability by MTS (48 hours). Contrary to the hypothesis, 5× proline and 5× glutamine was associated with higher residual glucose at 1 hour (reduced net glucose uptake/consumption), while RPS6KB1 and NFE2L2 transcript levels showed no statistically significant differences across treatments. These findings indicate that acute extracellular amino-acid elevation alters glucose utilization in THP-1 cells under the tested conditions and motivates follow-up studies using protein-level and metabolic-flux readouts.

Introduction: Vancomycinresistant enterococci are bacteria that have become resistant to vancomycin. Antibiotic resistance is a public health problem where preventive hygiene actions are needed to reduce the spread in healthcare. In Sweden, there are 21 regions where each region design their own guidelines for infection prevention measures in inpatient care.

Aim: To examine, from an ethical perspective, the Swedish regions' guidelines regarding infection prevention measures regarding carriage of Vancomycin-resistant enterococcus in inpatient care.

Methods: Qualitative content analysis of documents in accordance with Graneheim and Lundman. Criteria-based selection where all Swedish regions' guidelines for the management of patients with VRE carriage in inpatient care have been included.

Results: Three categories; patient-, visitor- and staff-related actions, were identified in the regions' guidelines. Patient-related actions included care in single rooms and risk factors that increase the risk of spreading infection. Patient-related and visitor-related actions included restrictions regarding use of common areas and actions for hand hygiene. Staff-related actions included compliance with standard hygiene precautions and need for specially assigned staff. Actions for staff regarding food hygiene and responsibilities in the team were also included.

Conclusion: Today guidelines are developed regionally, which leads to patients being treated differently. Since healthcare professionals often work in different regions, differences can create ambiguity and lack of compliance. The guidelines are designed to promote public health by preventing antibiotic resistance, but create ethical conflicts around autonomy, fairness, doing good and not harm. National risk-, ethics- and evidence-based guidelines as well as good information and staff training are needed.

Introduction: Antimicrobial resistance is a threat to public health. To reduce the development of resistance, responsible antibiotic use is of utmost importance. Primary health care centres (PHCCs) in vulnerable areas and with poor adherence to guidelines on infections, often blame their poor adherence on the fact that they are located in a vulnerable area. However, there are PHCCs in vulnerable areas with high adherence to guidelines.

Aim: The aim of this qualitative interview study was to explore employees’ experiences of success factors for responsible antibiotic use at a PHCC in a vulnerable area.

Methods: PHCCs in vulnerable areas and with a high adherence to guidelines were invited and one chose to participate. Eight employees with different professions underwent qualitative semi-structured interviews. The interviews were analysed thematically with the Theory of Planned Behavior as theoretical framework.

Results: The will to do right and the desire to stay updated among the employees, were identified as success factors. High accessibility to meeting a healthcare worker made patients feel safe and increased patients’ trust in the caregiver’s assessment. Teamwork, clear routines, an open work climate, consensus and conscious use of the competence of all professions were necessary for making things work and for the ability to maintain high accessibility.

Conclusion: Responsible use of antibiotics is possible in vulnerable areas. It requires a conscious way of organizing work, engaged management, updated employees, cooperation, consensus and high accessibility for patients to meet a healthcare worker. Hopefully other PHCCs will be able to use parts of this.

This paper introduces a methodology for incorporating risk preferences directly into forecasting model selection. The relative model information score, estimated from either a point-based information criterion or cross-validated errors, leverages the full distribution to map different risk propensities. We show that standard model selection in the literature is risk-agnostic. A risk-neutral stance is represented by the median of the relative model information score distribution, which characterises the plausibility of a model choice, while risk-averse and risk-tolerant choices correspond to its upper and lower quantiles. Our empirical evaluation demonstrates that risk-neutral and risk-averse selections consistently outperform the benchmark risk-agnostic choice in both point and quantile forecast accuracy. Moreover, we show that a risk-tolerant selection is beneficial during periods of extreme disruption. The proposed methodology provides a robust and flexible way to manage the forecast modelling risk, improving forecast accuracy and aligning forecasting modelling with stakeholders’ risk profiles.

Unsupervised multi-omics integration methods are increasingly used to uncover latent structure in high-dimensional biological data, yet their behaviour and interpretability can vary substantially depending on the underlying inference strategy. In this study, two unsupervised multi-omics factorisation frameworks, Multi-Omics Factor Analysis (MOFA2) and Group Factor Analysis (GFA), were systematically benchmarked using paired RNA sequencing and promoter-level DNA methylation data from glioblastoma tumours as a representative use case. The methods were compared with respect to latent factor structure, partitioning of shared versus modality-specific variation, variance distribution across factors, and biological interpretability based on functional enrichment analyses. Although both frameworks captured complementary transcriptomic and epigenetic signals, they differed markedly in how variation was organised within the latent space. MOFA2 produced a compact and strongly regularised representation with a small number of dominant factors, whereas GFA retained a more distributed latent structure that preserved weaker sources of variation. Overall, this study highlights fundamental methodological trade-offs between interpretability and completeness in unsupervised multi-omics integration. The results emphasise that method selection should be guided by analytical objectives rather than biological context alone, and demonstrate the value of comparative benchmarking for informed application of unsupervised integration frameworks.

Introduction: Carriage or infection with vancomycin-resistant enterococci (VRE) is notifiable and requires contact tracing in Sweden Molecular epidemiological typing is used to follow transmission chains. 

Aim: To provide a descriptive analysis of the molecular epidemiology of VRE in the Nordic countries and how it has developed over the past 25 years. 

Methods: A structured literature review. Searches were performed in Medline Ebsco and Web of Science. The analysis was conducted using narrative synthesis. 

Results: Multiple sequence types (STs) have been present in the Nordic countries between 2000 and 2025. In Denmark, E. faecium vanA ST80 and ST117 were initially observed, but around 2015 ST203 emerged, followed by ST1421 which became the dominant clone around 2019. At the same time, the proportion of vanB-carrying isolates increased, with ST80 and ST117 being most prevalent. In Sweden and Norway, various sequence types have been identified, but no clear pattern of spread can be observed in this study. Conclusions regarding the molecular epidemiological situation of VRE in Finland and Iceland cannot be drawn, as no data from these countries were included in the analysis. No conclusions could be drawn for Finland or Iceland due to lack of data. 

Conclusion: VRE E. faecium is the most prevalent VRE type in the Nordic countries, with several circulating sequence types. In Denmark, the spread of certain successful clones can be observed. To reduce the burden of VRE, robust surveillance systems and access to molecular typing are essential to identify transmission and enable appropriate interventions.

Wood supply chains are complex, involving many stakeholders, intricate processes, and logistical challenges to ensure the timely and accurate delivery of wood products to customers. Weather-related variations in forest road accessibility further complicate operations. This paper explores the challenges faced by forest managers in targeting many delivery requirements—four or more. To address this, simulation-based optimization, using NSGA-III, a many-objective optimization algorithm, is proposed to simultaneously optimize often conflicting objectives primarily by minimizing delivery lead time, delivery deviations in backlogs, and delivery variation. NSGA-III enables the exploration of a diverse set of Pareto-optimal solutions that show trade-offs across a flexible set of four, or more, delivery objectives. A Discrete Event Simulation model is integrated to evaluate objectives in a complex wood supply chain. The implementation of NSGA-III within the framework allows forestry decision-makers to navigate between different harvest schedules and evaluate how they target a set of preference-based delivery objectives. The simulation can also provide detailed insights into how a specific harvest schedule affects the supply chain when post-processing possible solutions, facilitating decision making. This study shows that NSGA-III could substitute NSGA-II to optimize the wood supply chain for more than three objective functions.

Background: Rising antimicrobial resistance of Helicobacter pylori is a public health challenge. Genomic-based susceptibility testing allows for the identification of resistance-associated mutations, complementing conventional diagnostics and advancing towards pathogen-based personalised therapies. Our study aimed to identify genes and mutations involved in antimicrobial resistance in H pylori and evaluate the extent to which these markers can be used as predictors of phenotypic resistance against clarithromycin and levofloxacin.

Methods: In this retrospective phenotypic and genotypic observational study, we included 1011 H pylori whole-genome sequences and strains of known geographical origin from the H pylori Genome Project (Hp GP) collection. We performed phenotypic clarithromycin and levofloxacin susceptibility testing on a subset of 419 Hp GP strains using Etest at a centralised laboratory. A genomic analysis was conducted to identify 23S rRNA and gyrA variants and build a curated catalogue of mutations associated with resistance to clarithromycin (ie, 23S rRNA 2142A→G, 2142A→C, and 2143A→G) and levofloxacin (ie, gyrA A88V or A88P, N87K or N87I, and D91G, D91N, or D91Y). Genotype–phenotype concordance was assessed to estimate sensitivity and specificity, and the curated catalogue of resistance-associated mutations was applied to the complete Hp GP set. Region-specific prevalence of resistance-associated mutations was calculated for a combined dataset including the Hp GP genomes and 768 whole-genome sequences retrieved from the US National Center for Biotechnology Information Sequence Read Archive repository. Associations between resistance genotypes, H pylori subpopulations, and minimum inhibitory concentrations (MICs) were tested.

Findings: Clarithromycin-resistant and levofloxacin-resistant Hp GP strains were estimated with a sensitivity and specificity of 100%, with all confidence intervals ranging from 96% to 100%. The combined analysis (n=1779) found the highest prevalence of clarithromycin resistance in the western Pacific region (173 [51·2%] of 338 in southeast Asia and 75 [29·8%] of 252 in eastern Asia), north African region (seven [38·9%] of 18), and western Asian region (12 [31·6%] of 38), whereas the highest prevalence of levofloxacin resistance was found in south Asia (14 [51·85%] of 27), Central America (48 [38·7%] of 124), eastern Europe (four [36·4%] of 11), and southern Africa (three [33·3%] of nine). Similarly, 23S rRNA and gyrA genotypes are variable across H pylori subpopulations. MIC values changed depending on the specific mutation in 23S rRNA (mean clarithromycin MIC 24·61 mg/L [95% CI 12·27–36·96] for 2143A→G and 142·25 mg/L [95% CI 77·88–206·61] for 2142A→G) and gyrA (mean levofloxacin MIC 9·66 mg/L [95% CI 6·75–12·56] for mutations on codon 91, and 27·97 mg/L [95% CI 25·82–30·11] for mutations on codon 87).

Interpretation: Mutations in specific genes are reliable indicators to clarithromycin and levofloxacin resistance in H pylori, making them useful markers for the development of diagnostic assays and molecular monitoring. Our results suggest that using clarithromycin and levofloxacin empirically, without previous susceptibility testing, is unsuitable in all geographical regions covered by this study.

Funding: Intramural Research Program of the US National Cancer Institute, the European Research Council, and the Spanish Ministry of Science and Innovation.

Declining reproductive health and fertility are global public health issues affecting an estimated 15% of reproductive-aged couples worldwide. The reasons for declining fertility are complex. However, a male contribution is thought to occur in ∼50% of infertile couples. Deficits in sperm number and/or function are undeniably a major cause of infertility, but compelling evidence suggests that additional factors in the male ejaculate also play an influential and underappreciated role. In this review, we focus specifically on extracellular vesicles within human seminal plasma and explore their emerging roles in reproduction and fertility. These seminal extracellular vesicles (SEVs) are nano-sized membrane structures secreted by various cell lineages in virtually all regions of the male reproductive tract and exert key roles in intercellular communication. Consideration is given to the well-characterized effects of SEVs in supporting sperm as they transit through the female reproductive tract and their ability to modulate the immune environment within the female reproductive tract. Building on these important roles, we also detail the emerging links between dysregulated SEV production and male fertility status, and highlight the potential utility of leveraging these vesicles to improve fertility and reproductive outcomes in infertile couples. Altogether, this review highlights how expanding knowledge of SEVs provides a new perspective on the complexity of seminal fluid physiology and the underlying aetiology of male infertility.

Introduction: Loneliness, a global health problem, increases with advancing age. The digitalization of society has the potential to either increase or decrease loneliness. This study aims to investigate the cross-sectional association between digital living and loneliness in the context of other risk factors in a sample of late middle-aged and older adults, using a measure of embracement of digitalization in daily life.

Methods: In total, 441 Swedish adults (response rate 44%) aged 55 to 93 years of age who responded from December 2023 to January 2024. Embracement of digitalization was measured using the Digital Living Index, and loneliness with the UCLA Loneliness Scale.

Results: The mean score for perceived loneliness was 35.64 (SD = 10.55), positioning the participants at the threshold between low and moderate levels of loneliness. In the final multivariate linear regression model, including established risk factors for loneliness, low digital living was estimated to be 3.3 and 4.1 units higher in loneliness compared to mid and high digital living (p = 0.005), respectively. Mental health was estimated to be the strongest predictor of loneliness, with a difference of 14.1 units between bad or very bad mental health and very good (p < 0.001).

Conclusion: Higher digital living appears to be associated with lower levels of loneliness even when other established risk factors for loneliness are controlled for. Supporting late middle-aged and older adults to overcome the digital divide, from access and use to embracement, could potentially be a tool to battle loneliness, and hence to improve public health. 

Background: Dog bites constitute a health problem, and children are a particularly vulnerable group. Such injuries may lead to both physical and psychological consequences and increased healthcare needs. Knowledge of factors contributing to dog bites in children is therefore important for preventive nursing care.

Aim: The aim was to describe factors of significance for the occurrence of dog bites in children and how these can be prevented.

Method: This study was conducted as a literature review based on quantitative research.

Results: The results showed that dog bites in children are multifactorial. The child’s age emerged as the most significant risk factor, with younger children being more prone to severe injuries, particularly to the head and face. Most incidents occurred in the home or immediate environment, and the dog involved was usually a family dog or a dog familiar to the child. Lack of supervision, limited knowledge of canine behaviour, and the dog’s previous aggression or socialisation were identified as important risk factors. Caregivers were identified as a key protective factor through active supervision and preventive measures.

Conclusion: Preventive efforts should be based on a holistic approach that considers the child’s developmental level, the dog’s characteristics, and the caregiver’s responsibility. Nurses play an important role in both acute care and preventive work through health-promoting and family-centred nursing problems.

Activities that have specialized communication needs which cannot be met by general communication systems such as mobile telephony or wireless networking need specialized communication systems. The thesis investigates the special-purpose digital radio communication systems that have been created to meet specialized needs across a range of fields. Since many of the fields where these communication systems are used are part of critical infrastructures and other important operations, the security of the communication systems may be vital to the security of the operations they support. Despite this, special-purpose digital radio communication systems often have significantly lower levels of security than more commonly used systems, such as mobile telephony or Internet-based protocols. The thesis defines special-purpose digital radio communication systems as a class of systems that, while differing in many ways, have common security properties. The common security themes among the different systems are investigated through focused case studies on two standards: Automatic Link Establishment (ALE) for high-frequency radio and TETRA, a trunked cellular professional mobile radio standard. The case study on ALE uses cryptanalysis to find weaknesses in the cryptography specified by the standard, mirroring similar weaknesses in other standards. In the TETRA case, qualitative interviews reveal how organizations that own TETRA networks make security-related decisions regarding them. The thesis proposes a number of possible explanations for the low level of security in special-purpose digital radio communication systems: lack of security by design, deficient understanding of system dependencies, normal accident dynamics, lack of feedback, and market structure. The thesis is the first to consider the different standards as members of a single class of systems and point out the commonalities.

Background: The ongoing shift in healthcare from hospital settings to care in the home reflected in the Good and Close Care reform indicates that newly graduated nurses will increasingly provide care for older persons in their own homes. Person-centred care, which underpins this integrated reform, depends on understanding the patient as a person by adopting their perspective. However, sustaining such care within a highly specialised health system remains challenging. Nursing students may feel unprepared for, and lack motivation to engage in, the care of older persons. In addition, age-related stereotypes within society and among care providers present further barriers.

These challenges highlight the need for didactic strategies that strengthen students’ knowledge of person-centred care for older persons. Age-suit simulation, which promotes perspective-taking by allowing participants to ‘walk in an older person’s shoes’, has been shown to enhance empathy and improve attitudes. However, previous research has made limited use of age suits and has rarely simulated the oldest age group (85+). Moreover, earlier studies have often overlooked realistic home environments and have lacked both longitudinal evaluation and a clear theoretical foundation.

Aim: The overall aim of this thesis was to study nursing students’ experiences of an age-suit simulation intervention grounded in experiential learning within a home environment.

Method: The four studies employed different research designs. Studies I and IV were quantitative. Study I used a quasi-experimental pre-test–post-test design with a control group, while Study IV adopted a longitudinal design. Differences between groups were analysed using the Mann–Whitney U-test, and multiple regression analysis was applied to examine effects over time. Studies II and III adopted qualitative, inductive designs. Study II was based on group interviews conducted during reflection seminars and employed reflexive thematic analysis. Study III was an observational study in which the data were also analysed using reflexive thematic analysis.

Results: Participation in the age-suit simulation had a significant effect on increasing scores on the Perspectives on Caring for Older Patients-Short Form (PCOP-SF) both immediately after the simulation and throughout the remainder of the nursing programme. This indicates that the intervention enhanced students’ favourable perspectives towards caring for older persons. Female sex and a greater number of years of prior work experience were also associated with reporting more favourable perspectives, as measured using the PCOP-SF. Students reported that the age-suit simulation increased their awareness of the vulnerability and loneliness that older persons may experience when living with various impairments. The embodied experience of the physical, psychological, and social impacts of ageing served as an important reference point in students’ post-simulation reflections. As highlighted in the findings, students’ new insights and understandings were often related to key concepts of person-centred care, such as preserving dignity and autonomy by being patient, allowing sufficient time in care situations, and getting to know and focusing on what matters to the person. The home environment, including the use of welfare technology, was described by students as presenting both potential risks—such as fall hazards or technology that is not suited to the individual—and opportunities, as an accessible home could alleviate some of the challenges associated with living with impairments. A prominent finding concerned the impact of impaired vision, which was explored further when students simulated the roles of a blind person and an attendant. During these simulations, two distinct approaches to collaboration were observed: students either adapted to one another’s limitations or became distant from each other. In both approaches, a key influencing factor was students’ ability and motivation to establish and maintain effective verbal and non-verbal communication.

Conclusions: This thesis revealed that students who participated in the age-suit simulation held more favourable attitudes towards caring for older persons compared to those who did not participate. The findings support the timing of the intervention in the second year of a three-year programme. In this study, the age suit was employed as a geriatric suit, which may account for the immersive and challenging nature of the experience. The results also provide support for using experiential learning theory as a framework for age-suit simulation, as the outcomes align with the concepts of the learning cycle. In particular, students perceived the simulation as an extraordinary experience that prompted reflection and critical thinking, leading to new insights and understanding. As demonstrated in the findings and discussed in this thesis, the age-suit simulation particularly drew students’ attention to a heightened sense of vulnerability, including experiences of isolation and loneliness. Another perspective on vulnerability emerged from dependence on a healthcare system in which personhood is often overlooked. Students further reported that the simulation influenced their anticipated clinical practice. In particular, the importance of being patient, allowing sufficient time, and being fully present was highlighted as a key takeaway from the simulation, essential for preserving dignity and autonomy when caring for older persons.

Background: Physical education (PE) research has contributed to learning-based perspectives on the why, what and how of teaching PE. Within this context, ball games have been criticized for reflecting the traditional sport discourse, which is not always conducive to a PE curriculum that focuses on equity and movement capability. Furthermore, research highlights the complexity of the teacher’s role in the gym, where clear and simple communication should clarify learning objectives and support enhanced student engagement. This article seeks to reinterpret a frequently observed behaviour in the teaching of ball games, namely teachers’ common use of exclamations like ‘good!’, ‘great!’ or ‘brilliant!’

Purpose: This article aims to (1) describe and explain how teacher exclamations during a volleyball lesson are pertinent to the teacher's and students’ creation of purposeful contexts, and (2) identify how the use of exclamations can be conducive to students learning specific PE content and aesthetics during a volleyball lesson. This article adopts a transactional perspective of teaching, framing it as a creative action that shapes the learning environment.

Method: The data consist of video recordings of volleyball lessons in Year 9. A video-ethnographic approach enables an in-depth analysis of teacher–student transactions throughout a full PE lesson. In addition to a fixed camera view of the gym, a wireless GoPro camera attached to the teacher provided a unique perspective, capturing the nuances of the teacher's verbal and non-verbal communication.

Findings: The findings reveal that exclamations are not merely expressions of encouragement but integral to creating a cohesive and purposeful learning environment. Exclamations serve as confirmations of students’ actions and operate at individual, local and general levels to address diverse student needs. This helps students remain attuned to the flow of the lesson and contributes to the accumulation of meaning.

Conclusions: By reinterpreting a frequently observed behaviour in PE teaching, namely teachers’ common use of exclamations, this analysis demonstrates that such exclamations can be important tools in the art of PE teaching and learning. Through voice, tone and timing, the teacher calls into existence an experience from multiple and durational educational transactions, guiding students towards ‘the good play’ rather than ‘the competitive play’.

Background: Alcohol use disorder (AUD) remains a major public health problem, with few effective medications currently available. However, peptides of the gut-brain axis appear to offer promising therapeutic targets for AUD as they influence the mesolimbic reward circuitry.

Methods: Here, we examined the effects of tirzepatide, a long-acting dual glucagon-like peptide-1 receptor (GLP-1R) and glucose-dependent insulinotropic polypeptide receptor (GIPR) agonist approved for diabetes and obesity, using behavioural assays (locomotor activity and conditioned place preference), alcohol intake paradigms (intermittent access two-bottle choice, drinking in the dark and the alcohol deprivation effect), and molecular analyses (microdialysis, electrophysiology and proteomics) in rodents.

Findings: First, tirzepatide effectively attenuated the rewarding properties of alcohol, measured through locomotor stimulation, conditioned place preference, and accumbal dopamine release (P < 0.001). Subsequently, this GLP-1R/GIPR agonist dose-dependently reduced voluntary alcohol consumption (P < 0.001), prevented binge (P < 0.01) and relapse-like drinking (P < 0.001), and maintained efficacy during repeated administration (P < 0.001). Finally, tirzepatide induced sustained synaptic depression in the lateral septum (P < 0.05) and further altered histone regulatory proteins in this region (P < 0.05), suggesting a potential neural substrate for its effects. Moreover, the GLP-1R/GIPR agonist affected metabolic parameters including body weight (P < 0.001), adipose tissue mass (P < 0.01), hepatic triglycerides (P < 0.01) and circulating pro-inflammatory cytokines (P < 0.05).

Interpretation: Together, our findings suggest tirzepatide modulates alcohol-related behaviours through reward-related mechanisms while also affecting physiological consequences associated with long-term alcohol use. Given tirzepatide's established clinical use and the consistency of effects observed here, these results support further investigation for treating AUD and associated complications.

The transition to a low-carbon economy is a critical global challenge. However, the relative effectiveness of renewable portfolio standards (RPS) and carbon tax policies, particularly their potential synergistic effects, remains insufficiently understood. Clarifying this relationship is essential for designing effective policies that enhance renewable energy investment and reduce carbon emissions. We develop an optimization framework in which a monopolistic electricity supplier in China invests in a hybrid energy system of conventional and renewable power. We compare profit-maximizing strategies under four policy scenarios: no policy, a carbon tax, an RPS, and a mixed policy (carbon tax + RPS). The analysis examines how these policies shape production and pricing decisions, investment, emissions, consumer surplus, and social welfare. Three main findings emerge. First, both carbon tax and RPS policies significantly encourage renewable energy investment and reduce carbon emissions. Second, mixed policies consistently outperform single policies, demonstrating the highest potential for renewable energy development and carbon emission reduction. Third, social welfare effects under mixed policies vary depending on the carbon tax and renewable energy quota level, with the highest social welfare achieved under low and medium quotas. Importantly, renewable intermittency does not alter the relative ranking of policies, though consumer environmental awareness shifts investment thresholds. Based on these findings, three recommendations emerge: integrating carbon tax with RPS accelerates renewable deployment, phased emission reduction balances neutrality targets with electricity demand, and incentives linking green electricity with consumer awareness strengthen adoption. These results provide actionable policy guidance for China and offer broader insights for economies pursuing a sustainable low-carbon transition.

Given the eruption of AI technology, the cooling requirement in data centres has drawn significant attention due to the increasing demand for data processing and storage. Indirect evaporative cooling (IEC) is a cutting-edge cooling technology with huge advantages of energy economy and environmental friendliness compared with conventional mechanical vapour compression cooling systems. Herein, we perform a levelized cost analysis (LCA) to determine the economic performance and energy consumption of the traditional mechanical vapor compression (MVC) cooling system and a novel hybrid IEC + MVC cooling system in data centre applications. A data centre model is adopted and applied in various climate zones in 10 cities from 8 countries. The results showed that the hybrid IEC + MVC system presented energy savings in all the cities, especially in Riyadh, with an energy saving of 41.3 GWh for the year. Most cities showed cost saving with the hybrid system, with London and Madrid achieving cost savings of 52–53%. All the cities showed significant CO2 reduction with the hybrid system, especially in Riyadh (23 547 tons), Jeddah (18 740 tons), and Dubai (12 432 tons). This study sheds light on the cost analysis based on levelized cost analysis (LCA) for next-generation cooling technology for data centres.

Background: Breast cancer is one of the most common forms of cancer in Sweden and has significant physical, psychological, and existential impacts on young women. Nurses play a central role in providing support, promoting health, and alleviating suffering through person-centered and ethically grounded care.

Aim: The aim of the study was to highlight young women’s experiences of treatment and care in connection with a breast cancer diagnosis.

Method: The study was conducted as a qualitative literature review in which 11 scientific articles were analyzed using an integrative analysis model inspired by meta synthesis.

Results: Young women with breast cancer experience substantial emotional, existential, and bodily challenges. Relationships, life circumstances, and inadequate coordination within healthcare influence how they manage the disease. Despite these challenges, many develop strategies for adaptation and meaning making, while expressing a clear need for individualized information, continuous support, and improved coordination in care.

Conclusion: The diagnosis triggers strong emotional and existential reactions, and bodily changes affect identity, self-esteem, and sexuality. Relationships with family, partners, and healthcare professionals can provide support but also present challenges, especially when communication is inadequate. Women find ways to adapt and create new meaning in life. The study emphasizes that individualized information, continuous support, and responsive care are essential to strengthen security, participation, and well-being in healthcare.

The use of social robots in many sectors of society is predicted to progressively increase. Therefore, exploring how expectations play a role in and change users’ experiences when interacting with these robots over time is necessary. From an interpretative and insight-driven approach, our aim was to explore how humans experience in-person interactions with the social robot Pepper, which was equipped with the OpenAI GPT-3 language model. Qualitative data from 62 video recordings of the interactions with Pepper and post-test interviews were collected from 31 participants. An experiential reflexive thematic analysis was applied. The main findings include various levels of interaction quality, different interaction strategies, and elements influencing the users’ expectations and experiences, which were synthesized into a coherent framework. It appears that the participants adapted their interaction strategies based on their expectations and the perceived capability of the robot, which influenced their experiences. This reveals that positive user experience is not solely determined by interaction quality, showing the interplay among these aspects when interacting with a social robot. To conclude, our findings underscore the intricate nature of the role of user expectations and experiences in social human–robot interaction. The work adds complementary qualitative approaches to the Human–Robot Interaction community to provide additional insights on interacting with social robots.

Colorectal cancer develops through a multistep adenoma–carcinoma sequence driven by early genetic and epigenetic alterations. While advanced Colorectal cancer has been extensively characterized, less is known about molecular changes occurring in benign colorectal polyps. This study investigated early DNA methylation alterations and oncogenic mutation status in colorectal polyps compared with healthy colon mucosa to identify potential early biomarkers of colorectal tumorigenesis. Colon mucosa samples were collected from 21 patients with colorectal polyps and 20 control individuals undergoing colonoscopy at Sahlgrenska University Hospital. DNA methylation levels of LINE-1, MLH1, MGMT, and CDKN2A (p16INK4a) were quantified using bisulfite pyrosequencing. KRAS and BRAF mutation status were assessed by digital polymerase chain reaction. Associations between methylation patterns, mutation status, and clinical variables were evaluated, and the diagnostic performance of LINE-1 methylation was assessed using receiver operating characteristic analysis. Global LINE-1 methylation was significantly reduced in polyp-adjacent mucosa compared with control mucosa and demonstrated strong discriminatory power between groups (AUC = 0.863). In contrast, no aberrant hypermethylation of MLH1 or MGMT was observed in polyp-adjacent mucosa, and CDKN2A (p16INK4a) methylation was significantly lower in polyps than in controls. MLH1 methylation remained largely absent, consistent with the lack of BRAF mutations and microsatellite instability–associated features in this cohort. No activating KRAS or BRAF mutations were detected. The CDKN2A (p16INK4a) rs3814960 variant showed genotype-dependent methylation patterns but was not an independent predictor after adjustment for clinical variables.These findings indicate that global DNA hypomethylation precedes tumor suppressor gene hypermethylation in early colorectal lesions and highlight LINE-1 hypomethylation as a promising early epigenetic biomarker in colorectal tumorigenesis.

Aim: The aim of this study was to identify factors associated with dog-related injuries by analysing data collected from 5908 patients seeking treatment at healthcare facilities in Skaraborg district, Sweden, over the years 2001–2016.

Methods: To describe factors associated with dog-related injuries, we analysed variables from four categories: people, that is, characteristics (gender and ages) of the patients who were injured; the circumstances in which the injuries occurred; the causes and types of injuries caused by dogs (injury mechanisms); and whether the injuries resulted in hospitalisation.

Results: Most injuries occurred in residential settings (58%). Half of the reported injuries (n=2954) were due to dog bites, with the same number of patients who were injured in non-bite-related events, comprising a second group. Injury mechanisms for dog-related injuries other than bites varied, as did locations where the various injuries occurred. However, slightly more than half of all non-bite-related injuries were caused by falls, especially falls on the same level involving slips and trips (n= 831, 55.3% of all fall-related injuries). Dog bites were the primary injury cause for younger groups, while non-bite injuries were the leading injury cause for adults aged 45 years and older.

Conclusions: The study showed that men and younger age groups were more likely to be injured via dog bites, while older women were more likely to be injured by tripping or falling over dogs. These findings imply that separate injury prevention strategies are required to address the different factors associated with both injury types.

This bachelor’s thesis investigates how an end-of-life furniture product can be given an extended life cycle through material reuse and re-design. The study is based on Lundbergs Möbler’s table model Sarek, whose materials are reused to develop a new product within the canteen table segment. The goal is to create a circular process in which at least 80% of the new piece of furniture consists of reclaimed material.

The project has been carried out using an adapted Double Diamond design process consisting of the phases Discover, Define, Develop, and Deliver. The methodology includes a literature review, market analysis, functional and goal analysis, interviews with company representatives and external stakeholders, and concept development. Furthermore, verification has been conducted through structural calculations, feedback from Lundbergs Möbler and users, and an analysis of the new table’s life cycle. The focus has been on design for disassembly, remanufacturing, and future refurbishment.

The results show that material reuse from the Sarek table is technically feasible and can result in a new piece of furniture with retained functionality and aesthetic qualities. The proposed design enables future refurbishment and remanufacturing, thereby strengthening the company’s circular business model. A comparative life cycle analysis further indicates a reduced climate impact compared to new production.

The conclusion is that circular furniture design, through material reuse and re-design, can contribute to reduced resource consumption and climate impact while simultaneously creating economic and functional value for both manufacturers and users. The study demonstrates how existing products can constitute a strategic resource in the transition from linear to circular furniture flows.

This report studies automated visual inspection for battery assembly using three deep learning methods with different strengths: a supervised object detector (YOLOv7), a reconstruction-based autoencoder, and EfficientAD. A common pipeline was used to ensure a fair comparison. All images were resized to 256 × 256, normalised, and augmented using brightness changes, flips, colour variations, and mild geometric transforms. Performance was evaluated at the image level using precision, recall, F1 score, and ROC–AUC, supported by confusion matrices and visual heatmaps. Stress tests were also performed under changes in background, lighting, and cell orientation.The results show that YOLOv7 is effective for enforcing clear assembly rules such as component presence, count, and left–right terminal polarity, making it suitable for stop or rework decisions. The autoencoder provides clear heatmaps that highlight missing or extra structures and is useful for monitoring data drift, but it is sensitive to background and pose changes. EfficientAD achieves the best overall anomaly detection performance and robustly highlights both texture anomalies and spatial deviations. Although EfficientAD performs best in anomaly detection, it does not produce bounding-box outputs needed for explicit rule checking. Based on this, a layered inspection strategy is proposed: YOLOv7 is used for rule-based checks, EfficientAD acts as a high-sensitivity anomaly filter, and a lightweight autoencoder monitors data drift over time. This approach improves reliability and practical deployment in real battery production lines.