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Objectives While glucocorticoid (GC) treatment initiated for COVID-19 reduces mortality, it is unclear whether GC treatment prior to COVID-19 affects mortality. Long-term GC use raises infection and thromboembolic risks. We investigated if patients with oral GC use prior to COVID-19 had increased mortality overall and by selected causes.Design Population-based observational cohort study.Settings Population-based register data in Sweden.Participants All patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153).Outcome measures Any prior oral GC use was defined as ≥1 GC prescription during 12 months before index. High exposure was defined as ≥2 GC prescriptions with a cumulative prednisolone dose ≥750 mg or equivalent during 6 months before index. GC users were compared with COVID-19 patients who had not received GCs within 12 months before index. We used Cox proportional hazard models and 1:2 propensity score matching to estimate HRs and 95% CIs, controlling for the same confounders in all analyses.Results 3378 deaths occurred in subjects with any prior GC exposure (n=48 806; 6.9%) and 14 850 among non-exposed (n=1 151 347; 1.3%). Both high (HR 1.98, 95% CI 1.87 to 2.09) and any exposure (1.58, 1.52 to 1.65) to GCs were associated with overall death. Deaths from pulmonary embolism, sepsis and COVID-19 were associated with high GC exposure and, similarly but weaker, with any exposure. High exposure to GCs was associated with increased deaths caused by stroke and myocardial infarction.Conclusion Patients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.

This article argues for a broader and more socially relevant photosynthesis instruction in compulsory science education. Presently, the predominant practice is traditional instruction, focusing on students' conceptual understanding of photosynthesis based on molecular and energy-related principles. Views of what is referred to as scientific literacy change in line with the new values and demands of a globalised society. Scientific literacy has evolved from a narrow conception of natural sciences to a broader teaching approach, addressing science from a whole society perspective. The article discusses how photosynthesis instruction can be redirected to future issues such as societal and sustainability and argues for a wider approach to scientific literacy involving active citizenship to address present and future sustainability challenges. A scientific literacy model is presented, along with its relation to the concept of powerful knowledge, defined as the kind of knowledge students need to have control and agency in their own lives. Powerful knowledge is discussed in terms of how photosynthesis instruction could be used to address societal and sustainability issues such as climate change, food chains, energy issues and food production. The need for a new and updated photosynthesis education 2.0 is presented.

Our joint environmental and energy commitments mean we must reduce the building’s energy use. Improved central heating control can play a role in how this is accomplished. There are three common control strategies: feedforward (traditional), feedback, and model predictive control (MPC). The latter two often work in parallel, where feedback uses indoor temperature sensors to adjust the supply water temperature. In contrast, the supply temperature setpoint is continuously calculated in MPC, fed with weather forecasts. The weather forecasts are often highlighted as essential ingredients in MPC, but at the same time, it is emphasized that temperature sensors are used to ensure a pleasant indoor temperature. To an outside observer, it is difficult to determine what is what in such combined control arrangements. Is energy saved because of the room sensors or because of the model? And what role do the weather forecasts play? This study quantifies the impact of the control strategy on energy use and indoor temperature. It concludes that PI-based feedback heating control saves approximately as much energy as MPC, and weather forecasts do not save significantly more energy than real-time weather data but are easier to obtain. The overall results for both control strategies align with the lower end of the result ranges of previous studies. The novelty is that the impact of weather forecasts has been studied separately and that different control strategies are compared against each other based on a model of a typical Swedish multi-family building.

Europe needs to save energy, and lowered indoor temperature is frequently promoted as part of the solution. To facilitate this, heating control systems with feedback from indoor temperature sensors are often required to avoid thermal discomfort and achieve long-term temperature reductions. This article describes a measurement- and interview-based study on feedback control where 107 Swedish multifamily buildings were analysed. The obtained results show that buildings with lowered indoor temperatures had reduced annual heating demand by 4 kWh/m2 and a reduced indoor temperature of 0.4 °C. There were, however, significant individual differences and even buildings with increased indoor temperatures, which harmed the energy savings. Temperature fluctuation was most often significantly reduced, but the impact on heating power demand during cold weather was, on average, only 2%. An interview with different actors indicated higher energy savings, possibly due to their stock’s original room temperature levels. Several interviewees also mentioned other advantages of temperature mapping. Most of the results obtained in this study were in line with several previous investigations. The study’s novelty lies in the large number of investigated buildings with mature commercial heat control technology, including PI-control for adjusting supply temperature, indoor temperature sensors in almost every apartment and a parallel analysis of additional affected parameters.

Abstract Background We designed this observational study to investigate the level of patients’ and doctors’ ratings of patient-centred aspects of the primary care consultation. Methods Questionnaire study with patients and doctors. Consecutive patients in a primary care setting and 16 doctors responding post visit. Results are presented as proportions with 95% confidence intervals. Results 411 questionnaires, 223 from patients and 188 from doctors, covered 251 consultations. Both patients and doctors gave the highest possible estimations on the aspects of patient-centred communication and satisfaction less frequently when the patient had other reasons for visit than purely somatic. Unlike the doctors’ estimations, the frequency of highest possible estimations in patient responses dropped if the patients had two to six reasons for visit rather than one. Among the six patient-centred aspects, both patients and doctors gave the highest possible estimation least frequently on the aspect of shared decision-making. Conclusion The results suggest that the nature of the reason, as well as the number of reasons for visit, interferes with the doctors’ level of patient-centred communication. Our results furthermore confirm the findings of previous studies that doctors insufficiently involve patients in their care.

Objectives Migrant physicians (MPs) who wish to practise their profession in a new country often must undergo a recertification process, including a licensing exam. In many cases, this is the same licensing exam used for peers educated within the country; however, the pass rate of MPs is usually lower. This study aimed to explore MPs exam results, focusing on MPs that had participated in a complementary programme (CPP) for physicians with a medical degree from outside the European Union/European Economic Area (EU/EEA), and aspects that may influence these.Methods Mixed methods were applied. The data consisted of 2013 to 2019 licensing exam results of 564 physicians in Sweden that were educated outside of the EU. The data was analysed using linear and logistic regression analysis. Further, 14 interviews with MPs were conducted and thematically analysed.Results An interaction between age and CPP participation was found for both the total score in per cent (p=0.01) and for the proportion failing their first attempt (p=0.04). Age was found to be a very strong predictor for failing on the first attempt, with those 45 and older failing on the first attempt in 72 and 82 per cent for CPP and non-CPP participants, respectively. Interview data was categorised into two themes: preparations and biographical aspects, and the exam and exam situation.Conclusions Age seems to be an important predictor for failing the first attempt. MPs have had less time to familiarise themselves with the exam type and the language used on the exam. To improve exam results, MPs used different strategies and tools, that is, studying with nationally trained physicians, and using old exams and a web-based study tool consisting of common exam subjects. At the same time, these strategies and tools have also become mediators in the socialisation of MPs into the exam context.

Abstract Background There is extensive documentation on skeletal muscle protein depletion during the initial phase of critical illness. However, for intensive care unit (ICU) long-stayers, objective data are very limited. In this study, we examined skeletal muscle protein and amino acid turnover in patients with a prolonged ICU stay. Methods Patients (n = 20) were studied serially every 8–12 days between days 10 and 40 of their ICU stay as long as patients stayed in the ICU. Leg muscle protein turnover was assessed by measurements of phenylalanine kinetics, for which we employed a stable isotope-labeled phenylalanine together with two-pool and three-pool models for calculations, and results were expressed per 100 ml of leg volume. In addition, leg muscle amino acid flux was studied. Results The negative leg muscle protein net balance seen on days 10–20 of the ICU stay disappeared by days 30–40 (p = 0.012). This was attributable mainly to an increase in the de novo protein synthesis rate (p = 0.007). It was accompanied by an attenuated efflux of free amino acids from the leg. Leg muscle protein breakdown rates stayed unaltered (p = 0.48), as did the efflux of 3-methylhistidine. The arterial plasma concentrations of free amino acids did not change over the course of the study. Conclusions In critically ill patients with sustained organ failure and in need of a prolonged ICU stay, the initial high rate of skeletal muscle protein depletion was attenuated over time. The distinction between the acute phase and a more prolonged and more stable phase concerning skeletal muscle protein turnover must be considered in study protocols as well as in clinical practice. Trial registration Australian New Zealand Trial Registry, ACTRN12616001012460 . Retrospectively registered on 1 August 2016.

Children in malaria endemic areas acquire immunity to severe malaria faster than to mild malaria. Only a minority of children suffers from severe malaria and it is not known what determines this. The aim of this study was to establish how P. falciparum infections during the first years of life affect the risk of severe malaria. A matched case-control study was nested within a large birth cohort set up to study the immunoepidemiology of pneumococci on the Kenyan coast. Infection patterns in three-monthly blood samples in cohort children admitted to hospital with severe malaria were compared to controls matched on age, residential location and time of sampling. P. falciparum detected at least once from birth conferred an increased risk of severe malaria and particularly if multiclonal infections, as characterized by genotyping of a polymorphic antigen gene, were ever detected. The results show for the first time that children with severe malaria have more infections early in life compared to community controls. These findings provide important insights on the immunity to severe disease, knowledge essential for the development of a vaccine against severe malaria.

The PdII atom in the title compound, [Pd(C24H49P2)Cl], has a distorted square-planar CClP2 coordination geometry with the P,C,P′-tridentate ligand forming two five-membered metallacycles. The cyclohexane ring is aligned with the PdII coordination plane due to C—H activation in an equatorial position, giving a tri-equatorial conformation of the cyclohexyl ring.

BACKGROUND: Intermittent preventive treatment (IPT) of malaria involves administration of curative doses of antimalarials at specified time points to vulnerable populations in endemic areas, regardless whether a subject is known to be infected. The effect of this new intervention on the development and maintenance of protective immunity needs further understanding. We have investigated how seasonal IPT affects the genetic diversity of Plasmodium falciparum infections and the risk of subsequent clinical malaria. MATERIAL AND METHODS: The study included 2227 Ghanaian children (3-59 months) who were given sulphadoxine-pyrimethamine (SP) bimonthly, artesunate plus amodiaquine (AS+AQ) monthly or bimonthly, or placebo monthly for six months spanning the malaria transmission season. Blood samples collected at three post-interventional surveys were analysed by genotyping of the polymorphic merozoite surface protein 2 gene. Malaria morbidity and anaemia was monitored during 12 months follow-up. RESULTS: Monthly IPT with AS+AQ resulted in a marked reduction in number of concurrent clones and only children parasite negative just after the intervention period developed clinical malaria during follow-up. In the placebo group, children without parasites as well as those infected with ≥2 clones had a reduced risk of subsequent malaria. The bimonthly SP or AS+AQ groups had similar number of clones as placebo after intervention; however, diversity and parasite negativity did not predict the risk of malaria. An interaction effect showed that multiclonal infections were only associated with protection in children without intermittent treatment. CONCLUSION: Molecular typing revealed effects of the intervention not detected by ordinary microscopy. Effective seasonal IPT temporarily reduced the prevalence and genetic diversity of P. falciparum infections. The reduced risk of malaria in children with multiclonal infections only seen in untreated children suggests that persistence of antigenically diverse P. falciparum infections is important for the maintenance of protective malaria immunity in high transmission settings.