Mid Sweden University

Two concepts that have been used to describe the changes with regards to media and politics during the last fifty years are the concepts of mediation and mediatization . However, both these concepts are used more often than they are properly defined. Moreover, there is a lack of analysis of the process of mediatization, although the concept as such denotes a process.Thus the purpose of this article is to analyze the concepts of mediated and mediatized politics from a process-oriented perspective. The article argues that mediatization is a multidimensional and inherently process-oriented concept and that it is possible to make a distinction between four phases of mediatization. Each of these phases is analyzed.The conclusion is that as politics becomes increasingly mediatized, the important question no longer is related to the independence of the media from politics and society. The important question becomes the independence of politics and society from the media.

Cellulose nanofibrils offer interesting potential as a native fibrous constituent of mechanical performance exceeding the plant fibers in current use for commercial products. In the present study, wood nanofibrils are used to prepare porous cellulose nanopaper of remarkably high toughness. Nanopapers of different porosities and from nanofibrils of different molar mass are prepared. Uniaxial tensile tests are performed and structure-property relationships are discussed. The high toughness of highly porous nanopaper is related to the nanofibrillar network structure and high mechanical nanofibril performance. Also, molar mass correlates with tensile strength. This indicates that nanofibril fracture controls ultimate strength. Furthermore, the large strain-to-failure means that mechanisms, such as interfibril slippage, also contributes to inelastic deformation in addition to deformation of the nanofibrils themselves.

The effects of shift work on physiological function through disruption of circadian rhythms are well described. However, shift work can also be associated with specific pathological disorders. This article reviews the evidence for a relationship between specific medical disorders and working at night or on shift systems. The strongest evidence exists for an association with peptic ulcer disease, coronary heart disease and compromised pregnancy outcome.

Fossils document the existence of trees and wood-associated organisms from almost 400 million years ago, and today there are between 400,000 and 1 million wood-inhabiting species in the world. This is the first book to synthesise the natural history and conservation needs of wood-inhabiting organisms. Presenting a thorough introduction to biodiversity in decaying wood, the book studies the rich diversity of fungi, insects and vertebrates that depend upon dead wood. It describes the functional diversity of these organisms and their specific habitat requirements in terms of host trees, decay phases, tree dimensions, microhabitats and the surrounding environment. Recognising the threats posed by timber extraction and forest management, the authors also present management options for protecting and maintaining the diversity of these species in forests as well as in agricultural landscapes and urban parks.

An estimated two-thirds of the fresh water flowing to the oceans is obstructed by approximately 40,000 large dams (defined as more than 15 m in height) and more than 800,000 smaller ones (Petts 1984, McCully 1996). Many additional rivers are constrained by artificial levees or dikes. These hydrological alterations—to ensure water for agricultural, industrial, and domestic purposes; for hydroelectricity; or for flood protection—have changed ecosystem structures and processes in running waters and associated environments the world over. In this article, we discuss the global-scale ecological changes in riparian ecosystems resulting from dam operations. Comparative studies of free-flowing and regulated rivers have increased our understanding of the environmental effects of dams (Rosenberg et al. 1995). The first studies concentrated on large reservoirs; reaches downstream from dams were of subsequent concern. Early work also focused on aquatic systems. By the 1980s rivers were viewed in a larger perspective, as central elements in entire catchment areas (Ward 1997). In this process, the importance of riparian ecosystems successively attracted more attention (Naiman and Décamps 1997). Riparian ecosystems occupy the ecotone between upland and aquatic realms (Figure 1). More precisely, the riparian ecosystem can be defined as the stream channel between the low- and high-water marks plus the terrestrial landscape above the high-water mark (where vegetation may be influenced by elevated water tables or extreme flooding and by the ability of the soils to hold water; Naiman et al. 1993). Natural riparian ecosystems include a variety of community types, including strips of spruce forest on periodically frozen ground with dense moss carpets, floodplain landscapes with deciduous trees and shrubs on heterogeneous substrates, and deltas with distinct plant zonation and well-developed forests having diverse animal communities. Some floodplain landscapes, such as those in South America, Europe, Africa, and Asia, cover tens of thousands of km2 of land (Welcomme 1979, Petts 1984). Riparian areas are particularly sensitive to variation in the hydrological cycle and serve as good indicators of the environmental change that is caused by dam operations. Moreover, riparian processes have a central ecological role in most landscapes. Riparian ecosystems offer habitats for many species, function as filters between land and water, and serve as pathways for dispersing and migrating organisms (Naiman and Décamps 1997). Riparian ecosystems also have many economic and recreational values. Dams are affecting riparian ecosystems all over the world. Consider the 139 regulated and free-flowing rivers in the United States, Canada, Europe, and former USSR that exceed 350 m3/s in mean annual discharge. Eighty-five of them, representing 77% of the total water discharge, were strongly or moderately regulated and fragmented by dams (Dynesius and Nilsson 1994). Many environmental effects of dams are immediate and obvious. For example, dams obstruct migration pathways for fish, and reservoirs trap waterborne sediment. Other environmental effects are gradual and subtle, making them difficult to predict. If a river is regulated, for example, the flood extent and the nutrient loads will certainly change but the exact nature of these changes and their magnitudes and time periods often remain unforeseeable. Every river is unique in terms of its flow patterns, the landscapes it flows through, and the species it supports, implying that the design and operating pattern of every dam is also unique. So are the effects of the dam on the river and its associated ecosystems (Johnson 1998). In most cases, dams are built to ensure less variable flows in the rivers downstream, which is attained by increasing fluctuations of water levels in the reservoir behind the dam. Welcomme (1979) described this as a change from “flood-rivers” to “reservoir-rivers.” In other cases, dams are built to facilitate diversions of water, which can leave the channels permanently or intermittently dry or at least strongly reduce flows. Conversely, dams are often built in arid areas with pronounced periods of rain and drought to ensure water availability during the dry season. In addition to modifying the environment at the dam site proper, a dam affects riparian communities upstream by raising water levels and modifying water-level fluctuations and downstream by altering flow regimes. Many rivers have been turned into chains of storage reservoirs and run-of-river impoundments without any rapids left. This includes the Volga, Mississippi, Paraná, and most hydroelectric rivers in northern Sweden. One dam controls the water up to the next dam so that the upstream and downstream effects of dams overlap (Figure 2). The dams on Earth keep back approximately 10,000 km3 of water. This is equivalent to five times the volume of water in all the rivers in the world (Chao 1995) or to a 10 cm deep layer of water spread on all the dry land in the world (Pielou 1998). Storing all this water cannot be made without far-reaching environmental consequences. These include habitat loss resulting from inundation and also the formation of new riparian zones. The most general upstream effect of a dam is that the water volume increases and inundates terrestrial and riparian areas (Figure 3). In some cases, dams have increased the volume of an existing lake but, often, running waters have been converted to reservoirs, which lead to permanent loss of habitats. This effect is especially profound where reservoirs are close to mountains, in dry areas, or in the far north where river valleys are usually the most productive landscape elements. Because many species in these environments are restricted to valley bottoms, large-scale impoundment of water is likely to extinguish entire populations. The initial effect of inundation on plants is through the root system. The waterlogged soil becomes anoxic and this leads to oxygen stress and eventual elimination of the primary root system. Many plants have special adaptations to cope with oxygen stress in soils, including the formation of aerated tissue and adventitious roots (Junk and Piedade 1997). Some species will immediately cease growth and die if the plants are entirely inundated. Others will respond by enhanced shoot elongation that restores contact with the open air (Blom and Voesenek 1996). Inundation not only leads to the loss of organisms but also introduces environmental problems. Some inundated areas were cleared of woody vegetation before damming but in many cases, especially in old dam construction projects, land was inundated together with its existing vegetation. For example, in the Tucuruí project in the Amazon, 20 million m3 of high-quality timber were inundated (Barrow 1988). It may take a long time for all this organic matter to decompose. When flooded soils and vegetation decompose, they release greenhouse gases (CO2 and CH4), which contribute to global warming (see St. Louis et al. 2000), and methylmercury, which accumulates in predatory fish (Rosenberg et al. 1997). Decomposition of flooded soils also releases nutrients such as nitrogen and phosphorous that may temporarily increase aquatic productivity. For example, increased growth of floating aquatic vegetation like giant salvinia (Salvinia molesta), water hyacinth (Eichhornia crassipes), and water lettuce (Pistia stratiotes) is a common phenomenon in tropical manmade lakes (Petr 1978). Riparian vegetation was controlled in the Senegal River by periodic drought and brackish water. Regulation of the river led to stable water levels and freshwater conditions in the Guiers Lake situated in the coastal delta. As a result, giant salvinia, coontail (Ceratophyllum demersum), and bulrush (Typha australis) increased rapidly (Cogels et al. 1997). Excessive growth of plants may reduce access to drinking water for stock, taint potable water, usurp reservoir volume, cause evapotranspirative loss, and foul pump intakes. Impounded areas eventually develop new shorelines within the range of regulated water-level fluctuations. These shorelines can vary from several kilometer wide zones in large reservoirs to approximately 1 m wide strips along run-of-river impoundments with limited water-level fluctuations. The succession of shoreline communities on pre-upland river margins depends not only on the interplay between erosion and sedimentation of substrates and invasion and extinction of organisms, but also on the duration, timing, and frequency of regulated water levels. In the tropics, terrestrial grasses may grow on reservoir shorelines during periods of drawdown. Grass vegetation on the new shoreline around the Kariba Reservoir on the Zambezi River, for example, provides grazing for large herbivores (Baxter 1977). The situation is different in northern temperate regions. Most years the entire reservoir shoreline is above water only during late winter and usually covered by ice and snow. Nilsson et al. (1997) modeled vegetation development on new shorelines in northern Sweden by using chronosequences of 43 storage reservoirs and 45 run-of-river impoundments (Figure 4). Shorelines along the storage reservoirs had low diversity in their early stages followed by a recovery phase, which lasted for approximately 30 years, but never reached predam values of species density. After 30 years, species density declined such that 50-year-old reservoirs had levels of species density similar to young reservoirs. Erosion of fine-grade substrates and a reduction of the available species pool because of constraints on dispersal likely played a role in this development pattern (Nilsson et al. 1997). Vegetation cover was extremely low throughout the study period. Species density and plant cover in run-of-river impoundments recovered to levels more similar to those before damming but absolute numbers of species were lower because regulated shorelines were narrower than natural riparian zones (Nilsson et al. 1997). On a smaller scale, shoreline vegetation shows considerable variation between years, depending on between-year differences in water-level fluctuations. This situation has been reported from the Rybinsk Reservoir on the upper Volga River in Russia (Ekzertsev 1979) and the Gardiken Reservoir on the upper Ume River in northern Sweden (Nilsson and Keddy 1988). In reservoirs with low water-level fluctuations, shoreline vegetation can persist and develop similar to that of lakes. Ekzertzev (1979) reported that reservoirs on the Volga River that are filled to a constant level every year and hold a constant summer water level might develop stable plant communities within 5–10 years. The shallow parts of the reservoirs acquire the most luxuriant growth. The plant communities change with marked water-level changes. Many regulated rivers have storage reservoirs in the headwater regions, and downstream from these regions there is an intact channel with a regulated flow. In such rivers, a single reservoir can affect the flow in almost the entire river. Such a change will modify the riparian zone and its communities and might also lead to salinization and invasion of exotic species. A common downstream effect of large dams is that the flood peak, and hence the frequency of overbank flooding, is reduced and sometimes displaced in time (Petts 1984). increased water and the formation of large reservoirs often reduce downstream discharge. downstream of dams also in the riparian zone resulting in a These changes reduce the extent of the Dams also change processes such as may trap large of the For example, a dam built the River, a to the River in of its storage in 43 years because of The water from a reservoir to its of and resulting in increased erosion downstream of the dam. This erosion leads to channel and reduced in the river for example, a of and reduced river (Johnson and a of deltas and of the River in have as has declined flood and et al. is the construction of dams on rivers that into the and where reduced of into the has changed the of its et al. (1997) reported that the River of Canada, was reduced impoundment of the River at by dams usually some regulated rivers from This in several rivers by that parts of their from The leads to an of the and increased overbank flooding 1995). Riparian communities within and regions, where are extremely for and the are most by impoundment because water is so areas are more sensitive to water than areas because the is and in flow may affect areas (Petts 1984). or the effects of and levels that river changes the species of riparian forests to that of forest more of upland areas et al. 1988). Many upland species are from in and free-flowing river channels because of to and low soil (Johnson 1994). Riparian species, on the other are to or such they have and root and growth (Johnson 1994). in the hydrological a new succession of riparian communities (Figure For example, levels resulting from river can cause a in the of followed by a of et al. 1996). of leads the succession less productive which also affects (Nilsson and 1994). reported several of such along rivers and in River in River in South Africa, River in et al. a in riparian and along the St. River in Canada, which was caused by river if changes in their may be to cause environmental that flooding affect and of many animal species. to water from of and and are strongly (see for of large herbivores are to the flooding the floodplain is to grazing during a and will not be Moreover, of the river is to the and of the floodplain et al. For example, many fish species have in with this hydrological changes will have effects on their and growth. Riparian and are usually productive and have species numbers but may river et al. 1996). Regulation of the River in has the of water the downstream The has been a of the and a pronounced on species numbers and of in the and 1995). are also by For example, channel migration is a of riparian vegetation in many regions of the world. Some species may by dams changes the et al. (1997) reported that the along on the not in the of erosion and By the effects of flow and on the of floodplain forests in the upper River, that the forest that cannot be by the low and eventually will be by species. of the is an increasing on the of the lower River in A primary cause of the to be salinization of floodplain soils caused by reduced flooding frequency in the This because to the floodplain water is not by et al. 1993). with and soil salinization are also common in many and arid areas where dams are built to water for (Figure of soils of low can cause the sometimes to accumulates in the as water This has in some areas the in The in and is of from river land areas to a of water were from and the of the This caused an of water volume of the in less than years (Figure and an increase in from to 30 over the first and 1993). The is than the has the and have of and are land in the from the million of of and soil Riparian zones are to invasion by exotic species because rivers are and have water is available all and rivers a natural for dispersal the landscape et al. 1995). These are often more pronounced in regulated rivers where natural communities are of most river in South has the natural hydrological and caused aquatic plants such as water giant salvinia, and moss to This has lead to reduced water reduced water water loss through and loss of et al. A of species that has spread along regulated rivers is the The of species with in Africa, the and the The has been to and the United where it has trees and associated 1995). The has thousands of of riparian habitat in the United by drought than the natural riparian vegetation et al. 1997). Dams and have the spread of the by large-scale changes in river systems. The is a of riparian systems. It was from the to and has rapidly spread along In the this of the of large river and 1995). the a to and is extremely in many parts of America, where it has almost any of In many cases, it has that plants and It may be difficult to new the effects of hydrological on riparian into the (Rosenberg et al. 1995). and of river which to the ecological effects of dams and contribute to the parts of hydroelectric to the and construction (Rosenberg et al. 1997). A understanding of the effects of hydrological is to the changes caused by built and to the of Such is also a for ecological that are there to be of a project for which the effects on riparian processes have been described in before all have been with understanding or of the ecological to riparian zones (Naiman et al. 1993). and processes in riparian zones at a variety of free-flowing and regulated rivers have been on different The more in the of riparian along free-flowing rivers have focused on entire rivers or catchment areas of the effects of hydrological studies This in is because dams are and to the immediate of than entire river with dams dam this there is a to increase the and at which regulated riparian are In other the effects of regulated riparian on and over and long time be the studies of large-scale effects of hydrological on riparian processes can take of effects within catchment areas, differences in effects between catchment areas, and changes with This includes effects on the and on the An for the is the between upstream and downstream especially in rivers with dams where upstream and downstream effects may The the with This may also include the of that between the stream and the the stream channel and floodplain that to the stream (Figure One good of a between riparian habitats in the upstream and downstream reaches of a river is the that is from an upstream downstream, and on a floodplain close to the where it may and to a new plant the of plants along rivers far the An of a in the upstream is the nutrients from the to the riparian vegetation in the upstream reaches of the river et al. 1998). for such most along the remain It is to this especially to the and of dams affect their on A are in the of and on are because they are to regulated water-level regimes. The between and more For example, the of dams is to riparian communities Nilsson et al. 1997). The importance of downstream dispersal and habitat in this change not on such is the of species along of species different of species along rivers, and these may change flow (Ward and This also the of species diversity in different are and change in similar as a of flow Such may that there are that can serve as for species diversity effects of hydrological and of global variation in the effects of hydrological is for the of cases, especially if these new of environmental vary in catchment and vegetation have different and and they have been to many more than flow This variation certainly affects to river and it the riparian processes are a dam is may between regions et al. between different catchment areas are One that more study on a global is variation in natural flooding between regions in of different to in flooding et al. 1997). In the Amazon, for example, a well-developed floodplain forest can of annual flooding (Junk and Piedade riparian forests the in northern Sweden can only 15 in the and of flooding may processes such as erosion and water and dispersal and and processes in the riparian It is a to global variation in the of all these Such also in the of It is more to the of flooding the absolute of flooding in the of riparian forests to water-level for some is available on the development of riparian communities along regulated water their and more stable are not One is that most studies of succession dam are on rivers that have been regulated for only a Moreover, most ecological studies for only a years, so a river that has been regulated for a long time is that changes is Some on the development of riparian by river can be by studies on 1994). is to studies where a is by (Nilsson et al. 1997). A be to environmental change using but ecosystem are In addition to these of will be the only to and changes in riparian ecosystems and a for of riparian systems. More of the effects of hydrological on riparian will be difficult to because hydrological usually riparian zones. a riparian vegetation in the new riparian trees have to at least this will be long to it difficult to between natural succession by river and succession by global In riparian zones to the most and in the world. are by The of increasing on water to riparian ecosystems to the where environmental and is at to river environments and of rivers of the most of our for this has been by the Natural the for and the for and the and for to the Riparian zone in the free-flowing River, a to the River in the Ume River northern Sweden. This riparian shows a distinct zonation of from forest to shrubs to vegetation of and water Nilsson Most free-flowing rivers of of rapids and In strongly rivers, dams have been on the the rivers into of reservoirs or impoundments and In such rivers, dam controls the water level up to the dam upstream of storage reservoirs. Lake on the River, This shoreline is a of The River to the catchment of the River The Reservoir on the River, vegetation of water hyacinth (Eichhornia is in the of and changes in riparian species density in reservoirs in northern and central Sweden. reservoirs. margins overlap with the range of water-level fluctuations, pre-upland margins were water levels were at the of to former upland The diversity of plant species during the first 20 or 30 years a dam is built and The subsequent of new species may be to a gradual of over the or a of the were with and 1993). the mean values of species for free-flowing from Nilsson et al. (1997) of riparian succession a reduced flooding downstream from The of change that may or in to dispersal riparian changed may the spread of This eventually in the extinction of riparian species. When riparian zones are and the aquatic riparian becomes and the riparian succession is The of any is a reduction of riparian The of changes during the first damming riparian along the dry of the River, This is by and dam and natural channel changes have large areas of the floodplain riparian forests and other ecosystems 1996). of of the of salinization that from in arid is to and into the soil of areas such from salinization and of the The is to through in the water remain in the soil and increase in of large of water a in the water and in the zone of close to the This phenomenon is When the water to the at which can water to the is increased and salinization is of the in and in shorelines in and were and in this it was of the Most of the water flowing in the and that the was to and river water reaches the from the in which riparian ecosystems with their The includes processes such as dispersal of riparian plants by water and nutrient by from the to the riparian The includes of such as a a fish or a trees in the riparian The includes of nutrients by water from the the floodplain to the root zone of riparian trees

INTRODUCTION: Atrial fibrillation (AF) is a common heart rhythm disorder. Several life-style factors have been identified as risk factors for AF, but less is known about the impact of work-related stress. This study aims to evaluate the association between work-related stress, defined as job strain, and risk of AF. METHODS: Data from the Swedish WOLF study was used, comprising 10,121 working men and women. Job strain was measured by the demand-control model. Information on incident AF was derived from national registers. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and AF risk. RESULTS: In total, 253 incident AF cases were identified during a total follow-up time of 132,387 person-years. Job strain was associated with AF risk in a time-dependent manner, with stronger association after 10.7 years of follow-up (HR 1.93, 95% CI 1.10-3.36 after 10.7 years, versus HR 1.11, 95% CI 0.67-1.83 before 10.7 years). The results pointed towards a dose-response relationship when taking accumulated exposure to job strain over time into account. CONCLUSION: This study provides support to the hypothesis that work-related stress defined as job strain is linked to an increased risk of AF.

A new type of nanocellulosic material has been prepared by high-pressure homogenization of carboxymethylated cellulose fibers followed by ultrasonication and centrifugation. This material had a cylindrical cross-section as shown by transmission electron microscopy with a diameter of 5-15 nm and a length of up to 1 microm. Calculations, using the Poisson-Boltzmann equation, showed that the surface potential was between 200 and 250 mV, depending on the pH, the salt concentration, and the size of the fibrils. They also showed that the carboxyl groups on the surface of the nanofibrils are not fully dissociated until the pH has reached pH = approximately 10 in deionized water. Calculations of the interaction between the fibrils using the Derjaguin-Landau-Verwey-Overbeek theory and assuming a cylindrical geometry indicated that there is a large electrostatic repulsion between these fibrils, provided the carboxyl groups are dissociated. If the pH is too low and/or the salt concentration is too high, there will be a large attraction between the fibrils, leading to a rapid aggregation of the fibrils. It is also possible to form polyelectrolyte multilayers (PEMs) by combining different types of polyelectrolytes and microfibrillated cellulose (MFC). In this study, silicon oxide surfaces were first treated with cationic polyelectrolytes before the surfaces were exposed to MFC. The build-up of the layers was monitored with ellipsometry, and they show that it is possible to form very well-defined layers by combinations of MFC and different types of polyelectrolytes and different ionic strengths of the solutions during the adsorption of the polyelectrolyte. A polyelectrolyte with a three-dimensional structure leads to the build-up of thick layers of MFC, whereas the use of a highly charged linear polyelectrolyte leads to the formation of thinner layers of MFC. An increase in the salt concentration during the adsorption of the polyelectrolyte results in the formation of thicker layers of MFC, indicating that the structure of the adsorbed polyelectrolyte has a large influence on the formation of the MFC layer. The films of polyelectrolytes and MFC were so smooth and well-defined that they showed clearly different interference colors, depending on the film thickness. A comparison between the thickness of the films, as measured with ellipsometry, and the thickness estimated from their colors showed good agreement, assuming that the films consisted mainly of solid cellulose with a refractive index of 1.53. Carboxymethylated MFC is thus a new type of nanomaterial that can be combined with oppositely charged polyelectrolytes to form well-defined layers that may be used to form, for example, new types of sensor materials.

BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. METHODS: We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. FINDINGS: We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001). INTERPRETATION: Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. FUNDING: Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.

The Hospital Anxiety and Depression Scale (HAD) was evaluated in a Swedish population sample. The purpose of the study was to compare the HAD with the Beck Depression Inventory (BDI) and Spielberger's State Trait Anxiety Inventory (STAI). A secondary aim was to examine the factor structure of the HAD. The results indicated that the factor structure was quite strong, consistently showing two factors in the whole sample as well as in different subsamples. The correlations between the total HAD scale and BDI and STAI, respectively, were stronger than those obtained using the different subscales of the HAD (the anxiety and depression subscales). As expected, there was also a stronger correlation between the HAD and the non-physical items of the BDI. It was somewhat surprising that the factor analyses were consistently extracting two factors, 'depression' and 'anxiety', while on the other hand both BDI and STAI tended to correlate more strongly with the total HAD score than with the specific depression and anxiety HAD subscales. Nevertheless, the HAD appeared to be (as was indeed originally intended) a useful clinical indicator of the possibility of depression and clinical anxiety.

Wireless Sensor Networks (WSNs) constitute one of the most promising third-millennium technologies and have wide range of applications in our surrounding environment. The reason behind the vast adoption of WSNs in various applications is that they have tremendously appealing features, e.g., low production cost, low installation cost, unattended network operation, autonomous and longtime operation. WSNs have started to merge with the Internet of Things (IoT) through the introduction of Internet access capability in sensor nodes and sensing ability in Internet-connected devices. Thereby, the IoT is providing access to huge amount of data, collected by the WSNs, over the Internet. Hence, the security of IoT should start with foremost securing WSNs ahead of the other components. However, owing to the absence of a physical line-of-defense, i.e., there is no dedicated infrastructure such as gateways to watch and observe the flowing information in the network, security of WSNs along with IoT is of a big concern to the scientific community. More specifically, for the application areas in which CIA (confidentiality, integrity, availability) has prime importance, WSNs and emerging IoT technology might constitute an open avenue for the attackers. Besides, recent integration and collaboration of WSNs with IoT will open new challenges and problems in terms of security. Hence, this would be a nightmare for the individuals using these systems as well as the security administrators who are managing those networks. Therefore, a detailed review of security attacks towards WSNs and IoT, along with the techniques for prevention, detection, and mitigation of those attacks are provided in this paper. In this text, attacks are categorized and treated into mainly two parts, most or all types of attacks towards WSNs and IoT are investigated under that umbrella: “Passive Attacks” and “Active Attacks”. Understanding these attacks and their associated defense mechanisms will help paving a secure path towards the proliferation and public acceptance of IoT technology.

Background Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight. Methods We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0–24·9 kg/m 2 ), overweight (25·0–29·9 kg/m 2 ), class I (mild) obesity (30·0–34·9 kg/m 2 ), and class II and III (severe) obesity (≥35·0 kg/m 2 ). We used an inclusive definition of underweight (<20 kg/m 2 ) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis. Findings Participants were 120 813 adults (mean age 51·4 years, range 35–103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973–2012). During a mean follow-up of 10·7 years (1995–2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7–2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5–5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1–21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9–2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1–17·9) for vascular disease followed by diabetes, 18·6 (16·6–20·9) for diabetes only, and 29·8 (21·7–40·8) for diabetes followed by vascular disease. Interpretation The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes. Funding NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.

BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. FUNDING: Gates Foundation and Bloomberg Philanthropies.

In recent years, public management research has paid increasing attention to the third sector, especially to its role in the provision of public services. Evidence of this is the rising number of publications on the topic, as well as a growing number of sessions and papers on the topic in academic conferences of the EGPA and IRSPM. However, much of the discussion on its role is motivated at least as much by ideology as by fact. We still lack a comprehensive empirical understanding of what happens when the third sector is drawn into public service provision. In this collection on Co-Production: The Third Sector and the Delivery of Public Services, we will try to enhance this understanding by presenting several new studies on the subject. We also introduce the concepts of co-production, co-management and co-governance as a conceptual framework that enables us to better understand such developments.

IMPORTANCE: The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. OBJECTIVE: To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. EVIDENCE REVIEW: Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14,244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. FINDINGS: Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905.059 deaths; 95% UI, 810,304-998,125), diarrheal diseases among older children (38,325 deaths; 95% UI, 30,365-47,678), and road injuries among adolescents (115,186 deaths; 95% UI, 105,185-124,870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. CONCLUSIONS AND RELEVANCE: Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.

This viewpoint article argues that the impacts of the novel coronavirus COVID-19 call for transformative e-Tourism research. We are at a crossroads where one road takes us to e-Tourism as it was before the crisis, whereas the other holds the potential to transform e-Tourism. To realize this potential, e-Tourism research needs to challenge existing paradigms and critically evaluate its ontological and epistemological foundations. In light of the paramount importance to rethink contemporary science, growth, and technology paradigms, we present six pillars to guide scholars in their efforts to transform e-Tourism through their research, including historicity, reflexivity, equity, transparency, plurality, and creativity. We conclude the paper with a call to the e-Tourism research community to embrace transformative research.

OBJECTIVE: To evaluate among stakeholders the support for the new, dynamic concept of health, as published in 2011: 'Health as the ability to adapt and to self-manage', and to elaborate perceived indicators of health in order to make the concept measurable. DESIGN: A mixed methods study: a qualitative first step with interviews and focus groups, followed by a quantitative survey. PARTICIPANTS: Representatives of seven healthcare stakeholder domains, for example, healthcare providers, patients with a chronic condition and policymakers. The qualitative study involved 140 stakeholders; the survey 1938 participants. RESULTS: The new concept was appreciated, as it addresses people as more than their illness and focuses on strengths rather than weaknesses. Caution is needed as the concept requires substantial personal input of which not everyone is capable. The qualitative study identified 556 health indicators, categorised into six dimensions: bodily functions, mental functions and perception, spiritual/existential dimension, quality of life, social and societal participation, and daily functioning, with 32 underlying aspects. The quantitative study showed all stakeholder groups considering bodily functions to represent health, whereas for other dimensions there were significant differences between groups. Patients considered all six dimensions almost equally important, thus preferring a broad concept of health, whereas physicians assessed health more narrowly and biomedically. In the qualitative study, 78% of respondents considered their health indicators to represent the concept. CONCLUSIONS: To prevent confusion with health as 'absence of disease', we propose the use of the term 'positive health' for the broad perception of health with six dimensions, as preferred by patients. This broad perception deserves attention by healthcare providers as it may support shared decision-making in medical practice. For policymakers, the broad perception of 'positive health' is valuable as it bridges the gap between healthcare and the social domain, and by that it may demedicalise societal problems.

The COVID-19 pandemic has halted mobility globally on an unprecedented scale, causing the neoliberal market mechanisms of global tourism to be severely disrupted. In turn, this situation is leading to the decline of certain mainstream business formats and, simultaneously, the emergence of others. Based on a review of recent crisis recovery processes, the tourism sector is likely to rebound from this sudden market shock, primarily because of various forms of government interventions. Nevertheless, although policymakers seek to strengthen the resilience of post-pandemic tourism, their subsidies and other initiatives serve to maintain a fundamentally flawed market logic. The crisis has, therefore, brought us to a fork in the road – giving us the perfect opportunity to select a new direction and move forward by adopting a more sustainable path. Specifically, COVID-19 offers public, private, and academic actors a unique opportunity to design and consolidate the transition towards a greener and more balanced tourism. Tourism scholars, for example, can take a leading role in this by redesigning their curriculum to prepare future industry leaders for a more responsible travel and tourism experience.

The literature discussing the impact of media and journalism upon democracy, typically criticizes both media and journalism for their content and their negative effects on some aspects of democracy. In turn, this raises the question of identifying news standards by which the quality of news journalism might be evaluated. But neither the proposed news standards nor the criticism levelled against them specify with sufficient clarity the model of democracy to be used as a normative departure. This article argues that the question of proper news standards cannot be addressed in isolation from the question of different normative models of democracy. In order to discover news standards by which the quality of news journalism can or should be evaluated, it analyzes four normative models of democracy and their demands upon citizens: procedural democracy, competetive democracy, participatory democracy and deliberative democracy. Building upon that analysis, the article asks: What normative implications for media and news journalism follow from the distinctive perspectives of procedural, competitive, participatory and deliberative democracy?

Persistently cold environments constitute one of our world's largest ecosystems, and microorganisms dominate the biomass and metabolic activity in these extreme environments. The stress of low temperatures on life is exacerbated in organisms that rely on photoautrophic production of organic carbon and energy sources. Phototrophic organisms must coordinate temperature-independent reactions of light absorption and photochemistry with temperature-dependent processes of electron transport and utilization of energy sources through growth and metabolism. Despite this conundrum, phototrophic microorganisms thrive in all cold ecosystems described and (together with chemoautrophs) provide the base of autotrophic production in low-temperature food webs. Psychrophilic (organisms with a requirement for low growth temperatures) and psychrotolerant (organisms tolerant of low growth temperatures) photoautotrophs rely on low-temperature acclimative and adaptive strategies that have been described for other low-temperature-adapted heterotrophic organisms, such as cold-active proteins and maintenance of membrane fluidity. In addition, photoautrophic organisms possess other strategies to balance the absorption of light and the transduction of light energy to stored chemical energy products (NADPH and ATP) with downstream consumption of photosynthetically derived energy products at low temperatures. Lastly, differential adaptive and acclimative mechanisms exist in phototrophic microorganisms residing in low-temperature environments that are exposed to constant low-light environments versus high-light- and high-UV-exposed phototrophic assemblages.

Summary 1 We used data from 35 independently published studies world‐wide to analyse the effects of plant litter on the germination, establishment, species richness and above‐ground biomass of plants. Overall, the short‐term effects of litter on vegetation were mostly negative, although their magnitude varied with vegetation variable, study method, experimental duration, latitude, habitat, type and quantity of litter and target species. 2 Species richness was more affected than above‐ground biomass by litter, suggesting that litter may play a direct role in structuring plant communities as well as influencing competition in productive habitats. Litter had a stronger overall effect on plant germination than on establishment, suggesting that a litter‐reducing disturbance will have more effect early in the growth season. 3 On average, vegetation was more affected by litter in field than in glasshouse studies and during 2‐year than during 1‐year studies. The effect on biomass switched from negative after 1 year to positive after 3 years. 4 The absolute effects of litter on germination and establishment decreased and the absolute effects on above‐ground biomass increased with latitude. Ecosystem type also influenced the effects significantly. 5 Vegetation was generally more depressed by higher litter quantities. Litter composed of forbs and tree leaves had a stronger effect on vegetation than grass litter. The impact of a certain type of litter may therefore be related to its decomposition rate. 6 Tree species were more affected than forbs and grasses by litter, at least at the colonization stage.