Sundsvall Municipality

Abstract Acute myeloid leukemia (AML) is an aggressive hematologic cancer characterized by proliferation of immature myeloblasts 1 . It shows profound molecular heterogeneity, which has been primarily studied through genetic abnormalities, providing the basis for disease classification, prognostication, and therapeutic choice 2–8 . However, genetic factors alone may not fully explain AML pathogenesis and diversity, while leaving the role of abnormal epigenome, particularly chromatin state, largely unexplored in a large cohort of patients. Here we show that AML is classified into 16 subgroups with distinct chromatin accessibility profiles based on ATAC-seq in 1,563 AML cases, derived from the encyclopedia of chromatin in AML (eCHROMA AML) dataset, including novel AML subgroups not previously recognized in conventional genomic classifications. By integrating multi-omics analyses of genome, transcriptome, and major histone marks, we show that these epigenetic subgroups exhibit unique features in clinical presentation, gene mutations, differentiation states, gene expression, and super-enhancer profiles, which are validated across independent cohorts. Single-cell sequencing demonstrates the presence of subgroup-specific ATAC signatures that are shared by all leukemic cells, confirming the key role of the epigenome in the ATAC-based classification. Mechanistically, each subgroup is associated with a distinct gene regulatory network centered on key transcription factors, where subgroup-specific super-enhancers play a pivotal role. These ATAC subgroups also have prognostic significance independent of genomic classification, and help reveal unexpected drug sensitivities. In summary, ATAC-based chromatin profiling in this large sample set, combined with multi-omics data, provides new insights into AML pathogenesis beyond genomic profiling and also serves as an invaluable resource for AML research.

Extracorporeal membrane oxygenation (ECMO) provides temporary support for patients with severe acute cardiac or respiratory failure. Although thrombotic complications are common during ECMO, the real-time detection and management of thrombosis-related complications remain challenging. In this study, we introduce a noninvasive approach for detecting thrombi using an acoustic detection technique. The presence of blood clots in the ECMO circuit has been correlated with an increase in the amplitude of the acoustic spectrum <20 Hz. This amplification allows for the prediction of clots in the ECMO circuit using acoustic measurements. The predicted results were compared with visual observations, and the technique achieved a total accuracy of 84%. Hypothesizing that some of the false positives were indicators of clots in the circuitry, the accuracy may be up to 96%. This technique could be integrated with the existing clot detection method to enhance patient outcomes.

BackgroundThe Geneva Conventions form the core of International Humanitarian Law (IHL), safeguarding healthcare and protecting civilians from the brutality of war. Unfortunately, these conventions are often disregarded. Attacks on healthcare have devastating effects on healthcare systems, and it is therefore vital to document such attacks and detect possible temporal patterns. This study aims to assess temporal trends in attacks on healthcare in five conflict-affected countries: Lebanon, Myanmar, occupied Palestinian territory (oPt), Sudan and Ukraine.MethodsThis study used two publicly available databases: the World Health Organization Surveillance System for Attacks on Health Care (WHO SSA) and the Insecurity Insight Safeguarding Health in Conflict Coalition (SHCC). Start dates and key events were determined for each conflict based on grey literature searches. From the start dates onward, data on attacks on healthcare were collected. The data collection ended on December 31, 2024. Statistical analysis entailed chi-square tests for temporal trends.ResultsThe WHO SSA and SHCC database reported a total of 4,289 and 5,454 attacks, respectively, in the five investigated conflict-affected countries. For all conflict-affected countries except Lebanon, there were significant differences between the databases regarding the reported number of attacks. Temporal trend analyses revealed that, in Myanmar, oPt, Sudan and Ukraine, the highest number of attacks occurred during the 0–2 month period. In Lebanon, the highest number of attacks was observed in the 9-11-month period. All peaks in the number of attacks were associated with either the immediate or early phase of the conflict or with major conflict escalations.ConclusionsTemporal trend analyses of five ongoing armed conflicts revealed that spikes in attacks on healthcare were either associated with the immediate or early phases of the conflict or with major conflict escalations. Although major differences exist between the WHO SSA and SHCC database, particularly regarding the reported number of attacks, the observed patterns were largely similar.

Forensic mental health services (FMHS) seek to alleviate mental illness and reduce the risk of (violent) recidivism, but they may also be understood to be responsible for supporting patients with many other aspects of their often challenging lives. In practice, the task of an inpatient institution such as FMHS is concluded when the patient can transition to outpatient care, a move which is governed by law. Therefore, the practical goals are at least partly set by legal criteria for transition to outpatient care. Using qualitative comparative analysis, this study identifies systematic patterns of rehabilitative needs as assessed by clinicians that differentiate between FMHS patients who are deemed ready for outpatient care and those who are not. It also identifies how such systematic patterns align with legal criteria governing the transition to outpatient care. We find systematic patterns of rehabilitative needs that are associated with being considered ready for outpatient care and that these patterns map meaningfully onto the legislative criteria for forensic psychiatric care in Sweden. Mental health needs, violence risk needs, and needs associated with social functioning all bear on readiness for outpatient care but only in conjunction with one of the other. The results indicate that the transition to forensic outpatient care in Sweden depends on aspects outside the core objectives of non-recidivism and mental health, and rest on efforts by actors external to FMHS. This places high demands on clarity of institutional boundaries and the role of social functioning needs in decisions about compulsory care.

ABSTRACT Chagas disease (CD), caused by Trypanosoma cruzi, remains a major public health concern in Latin America, particularly in Bolivia, which reports one of the highest infection burdens worldwide. While congenital transmission has gained importance in many countries, vectorial transmission persists in rural and peri-urban areas. This study aims to assess the epidemiological characteristics and seroprevalence of CD among mothers and their children in Postervalle, a Bolivian community officially classified as having low vector infestation. Methods A cross-sectional study was conducted in July 2023, including 58 mothers and 104 children aged 4 to 17 years. Participants were recruited from the local school and underwent serological screening using three different diagnostic tests. Individuals testing positive on at least two assays were classified as seropositive. Sociodemographic data and exposure history were collected through structured questionnaires. Bivariate analysis was performed to identify associations between seropositivity and risk factors. Results Seroprevalence was 15.8% among mothers and 3.8% among children. All seropositive children were born to seronegative mothers, suggesting likely vectorial rather than congenital transmission. Children who tested positive were more likely to have lived in rural areas and in houses with mud walls (p = 0.046 and p = 0.012, respectively). Among mothers, being bitten by kissing bugs was significantly associated with seropositivity (p = 0.004). No significant differences were found in age or number of children between groups. Conclusion Despite its classification as a low-infestation area, Postervalle presents evidence of ongoing vectorial transmission of T. cruzi. These findings underscore the need for continued entomological surveillance and integrated vector control strategies, especially in vulnerable communities. The absence of congenital cases further highlights the importance of local vector-related risk factors. AUTHORS’ SUMMARY Chagas disease is a tropical infection caused by a parasite, known as Trypanosoma cruzi. This disease is mostly transmitted by vectors known as kissing bugs, but it can also be transmitted congenitally. In many Latin American countries, including Bolivia, this disease continues to affect large numbers of people, especially in rural areas where the vector is endemic. While some countries have made progress in controlling the vector that carries the parasite, transmission still occurs, often silently. In this study, we worked with mothers and their children in a small Bolivian town called Postervalle, which has been categorized as a low-risk area for the insect that spreads Chagas disease. We tested both the mothers and their children to see if they had been infected by the parasite. Surprisingly, none of the infected children had mothers who tested positive, suggesting they may have been infected by kissing bugs, not through birth. We also found that children who lived in homes with mud walls or rural areas were more likely to be infected. Our findings show that even in places thought to be low-risk, people—especially children—are still getting infected. This highlights the need for ongoing efforts to monitor and prevent Chagas disease, even in areas where it is assumed to be under control.

Purpose Employee participation in quality improvement is essential for fostering engagement and job satisfaction and delivering high-quality care, as highlighted in the total quality management literature. However, how employee participation is facilitated during quality improvement processes within healthcare organizations remains largely unexplored. Previous studies have identified a research gap, highlighting the importance of examining this phenomenon from the perspective of health professionals. The purpose of this study was to gain a deeper understanding of how health professionals in nursing homes experience their participation in quality improvement. The underlying aim was to describe their involvement and how it can be strengthened, ultimately improving the quality of care. Design/methodology/approach This study is based on interviews with 17 health professionals from 2 nursing homes in a medium-sized Swedish municipality. Data were analysed with Reflexive Thematic Analysis. Findings The themes identified through the analysis are “experiences of barriers at the organizational level that limit participation in quality improvement” and “experiences of barriers in daily care that limit participation in quality improvement”. Originality/value The themes address barriers to participation in quality improvement, reflecting an organizational structure that hinders participation and quality improvement. A quality culture, along with structured approaches to improve quality and foster employee participation is lacking. Implementing total quality management could help address the challenges faced by health professionals in these settings.

To identify the health planning, health provision, and health lessons learned from unplanned or spontaneous mass gathering events. This research used a scoping review design. Data was collected from 4 databases, using search terms relating to "mass gathering events," "spontaneous events," and "health services." Data was extracted relating to the event characteristics, health usage, and patient outcomes. Extracted data were deductively coded against the surge capacity domains of staff, stuff/supplies, space, and systems. Ten papers were included in this review. Most spontaneous mass gathering events were related to riots, civil unrest, or unplanned large parties, which required a response from the health care system. Health staff were predominantly from an ambulance, pre-\hospital, or emergency medical services. Additional personal protective equipment, such as ballistic equipment and respiratory protection, was required. The planning for a health care response to a spontaneous mass gathering event requires a risk-based approach. Such an approach should be applied in local disaster and mass casualty plans as a hazard-specific response. Preparation and response should include interagency collaboration. Enhancing the reporting of spontaneous mass gathering events will provide insights for future planning and response.