Helsingborgs lasarett

ABSTRACT The transition to a circular economy has placed growing pressure on packaging systems to enable effective material recovery across increasingly complex waste and recycling infrastructures. Focus on aggregate recycling rates obscure the stage‐specific inefficiencies that determine whether packaging material re‐enters production, making it difficult to target packaging design efforts, infrastructure investments and policy attention effectively. Grounded in material flow analysis principles, this study presents a diagnostic decomposition model that partitions the effective recycling rate into four stages: consumer participation, collection efficiency, sorting yield and recycling process yield. The model's multiplicative structure makes explicit that a deficiency at any single stage imposes a ceiling on overall system performance, regardless of excellence elsewhere. By coupling this decomposition with the cumulative equivalent use retention function, the analysis reveals non‐linearities in long‐term material retention: Because retention follows a convex function of the effective recycling rate, improvements at higher baseline performance yield disproportionately larger gains than equivalent improvements at lower baselines. Analysis shows that, beyond moderate baseline performance, interventions targeted at the limiting stage consistently outperform evenly distributed improvements across all stages. Illustrative applications demonstrate the model's diagnostic utility, showing that identical packaging designs can exhibit markedly different recycling performance depending on system context and that design choices can restructure which stage limits performance within a given infrastructure. From a system perspective, the model shows how effective recycling performance results from the interaction between packaging design and waste and recycling systems and that packaging circularity is a system‐level outcome rather than a fixed material attribute.

ABSTRACT The tourism industry is likely to face significant challenges stemming from climate change and fluctuations in travel costs. This study investigates the potential impacts of these factors on tourism demand in Fjord Norway, and shows that both environmental conditions and travel expenses play a substantial role in influencing tourism demand. However, tourists exhibit a higher sensitivity to variations in travel costs compared to changes in climatic conditions. The findings also indicate that Norwegian tourists, who possess a strong awareness of environmental issues, are less affected by the ramifications of climate change than their domestic counterparts with lower levels of environmental consciousness. In contrast, domestic tourists with high environmental awareness do not demonstrate significant differences in their responsiveness to economic changes compared to those with lower awareness. These insights hold considerable implications for the effective management of tourism in the Fjord Norway region.

In the era of immune checkpoint inhibitors for cancers, the need for prognostic biomarkers to identify patients most likely to achieve a durable response has become increasingly more relevant. Tumour‐infiltrating lymphocytes (TILs) have gained significant interest, as they can be evaluated using standard haematoxylin and eosin‐stained slides, making it a widely accessible and cost‐effective biomarker. In addition to their practicality, TILs provide prognostic insights into the interplay between the immune system and tumour cells. While the morphological assessment of TILs has been standardised in breast cancer, comprehensive guidelines for their evaluation in gastro‐oesophageal carcinomas (GEC) are still lacking. This narrative review examines the current literature on the composition, clinical implications and therapeutic utility of TILs in GEC. These insights are used to propose a framework with recommendations for standardised evaluation and reporting of TILs in GEC, while also highlighting pitfalls specific to GEC pathology. These recommendations serve as a vital first step towards the widespread use and validation of TILs as a biomarker.

Background: The equine roundworm Parascaris spp. commonly infects foals, and high burdens can cause fatal small intestinal impactions. Progressive anthelmintic resistance challenges infection control, posing a risk for an increase of Parascaris spp. r

An elderly, right-handed, male patient presented to the emergency department at a middle sized hospital with a few hours' history of mild confusion and a difficulty expressing himself verbally. Past medical history consisted of hypertension and cured hairy cell leukemia. CT scan of the brain showed a 5 cm infarction in the left occipital lobe, and a corresponding P2 occlusion was seen. The patient was admitted to the stroke unit. While at the stroke unit, a detailed neurologic exam by a neurologist was performed. It was revealed that the patient could not read at all, but he could write perfectly with preserved spelling and handwriting. A diagnosis of "alexia without agraphia" was made. An MRI of the brain was performed, and infarctions well corresponding with prior case reports on the diagnosis were seen.

PurposeHigh-risk colon cancer may benefit from preoperative chemotherapy (preCHT), but evidence on its short-term safety and outcome is limited. Population-based evidence before its incorporation into national guidelines is lacking.MethodsPatients with final weighted stage II–III colon cancer undergoing elective resection between 2007 and 2017 were identified in the Swedish Colorectal Cancer Registry. Patients planned for preCHT, irrespective of intention, were compared with those undergoing upfront surgery. Primary outcomes were 30- and 90-day mortality and 30-day major morbidity, defined as all medical and surgical complications classified as Clavien-Dindo (CD) ≥ 3 grade. Subgroup analyses examined cT4 disease, and multivariable logistic regression was performed.ResultsAmong 20,185 eligible patients, 299 (1.5%) received preCHT. Postoperative mortality was comparable (1.7% vs. 1.7%, p = 1.00 at 30 days and 3.0% vs. 2.8%, p = 0.82 at 90 days). Overall and surgical postoperative morbidity (CD ≥ 3) was higher in the preCHT group (34.1 vs. 25.0%, p < 0.001 and 17.4% vs. 13.1%, p < 0.001), rates of anastomotic leakage were similar (3.3% vs. 3.6%, p = 0.85). Compared to upfront surgery, the preCHT group was more likely to undergo multivisceral resections (53.9% vs. 13.6%, p < 0.001), with a higher rate of R1 resections (6.4% vs. 3.2%, p < 0.001), reflecting more advanced disease (cT4: 59.5% vs. 10.5%, p < 0.001; cN1-2: 54.9% vs. 28.6%, p < 0.001). In the cT4 subgroup, short-term outcomes were comparable, and regression analyses found no independent association between preCHT and mortality or major morbidity.ConclusionPreCHT appeared feasible in cT4N0-2M0 colon cancer, with short-term outcomes comparable to upfront surgery despite more advanced primary tumour and greater surgical extent.

Standardized Care Pathway (SCP) for patients presenting with macroscopic haematuria was introduced in Sweden in 2015. In contrast to neighbouring countries, the Swedish model includes all patients with macroscopic haematuria above the age of 50, notwithstanding obvious causes. The aim of this study was to characterize the patients referred within the SCP and the presence of acute cystitis. All patients admitted to two regional hospitals in 2023, under the terms of SCP macroscopic haematuria, were included. Patient data were collected retrospectively regarding age, sex, symptoms of cystitis and cause of haematuria. The study included 782 patients. The median age was 70 years and half were women. In 89 cases, a urinary tract cancer was found (11%) and 74 (9%) had bladder cancer. The cancer-positive group was significantly older (median 75 years) and 76% were men. Half of patients (51%) had symptoms of acute cystitis on referral. This was significantly associated with the absence of bladder cancer, but only in the age groups 50-69, where no case was found among patients with symptoms of cystitis. In the age groups above, 22 cancer-positive patients (30% of all bladder cancer cases) had symptoms of cystitis. The Swedish SCP macroscopic haematuria targets younger female patients unproportionally, in comparison to where cancer is likely found. Neither symptoms of cystitis, nor positive urine cultures exclude bladder cancer in elderly, but clearly in the age groups 50-69. If excluding the latter from the SCP, a 28% reduction of examined patients can be achieved with a negligible risk of missing cancer.

Obstetrical anal sphincter injuries are complications of vaginal birth that have the potential to cause substantial maternal morbidity. Predicting these injuries might help to improve maternal care as well as antenatal counseling and patient education. Previous attempts to create prediction models have in many cases involved variables only known postpartum, which limits their use in an antenatal setting. Other models include parameters that are not applicable to a Northern European population. This study aimed to develop and validate a clinically useful model for the prediction of risk of obstetrical anal sphincter injuries. The model was developed using a retrospective nationwide cohort from the Swedish Medical Birth Register consisting of 1,209,421 deliveries between 2005 and 2016. After exclusion criteria (cesarean delivery, forceps delivery, missing data) were applied, the data set was randomly divided into a development data set (n=422,011) and a validation data set (n=422,010). In the development data set, all variables were assessed using univariable analysis with modified Poisson regression. A prediction model was then built using multivariate analysis with modified Poisson regression, wherein variables with P≤.2 were included. Both forward and backward selection were used, and variables with P≥.05 were excluded. Validation was performed by evaluating the agreement between the predicted and observed rate of obstetrical anal sphincter injuries after the prediction model was applied to the validation data set. Antenatal variables associated with increased risk of obstetrical anal sphincter injury included primiparity, previous cesarean delivery, previous sphincter injury, increasing age, increasing birthweight, and maternal origin from sub-Saharan Africa or South/Southeast Asia. Smoking, increasing maternal height, and body mass index appeared to lower the risk. Vacuum extraction also increased the risk of sphincter injury. We developed 1 model including the previously mentioned antenatal parameters and 1 model also including vacuum extraction. The final prediction model including instrumental delivery can be used for predicting the risk of sphincter injury for delivery with or without vacuum extraction with higher accuracy. This model demonstrated strong discrimination with an AUC of 0.79 (95% confidence interval, 0.78-0.79), and was able to predict risks up to 24% with moderate to high accuracy. Using antenatally available data, obstetrical anal sphincter injuries can be predicted with moderate certainty. This prediction model has been externally validated and can be used for individualized antenatal counseling and identification of persons at high risk for whom preventative strategies might improve outcomes. Further validation in other populations outside of Scandinavia is recommended before clinical implementation.

Out of hospital cardiac arrest (OHCA) is a significant public health problem associated with high mortality and high healthcare costs. The Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) randomised clinical trial showed that targeted mild hypercapnia did not lead to better neurologic outcomes at 6months compared to normocapnia after OHCA. We aimed to estimate the cost-effectiveness of mild hypercapnia compared to targeted normocapnia using data from the TAME trial. Pre-specified, prospective cost-effectiveness analysis alongside the TAME RCT from a healthcare perspective using a 6-month time horizon. The analysis included 1586 patients across 63 intensive care units (ICUs), in 17 countries. The primary measure of cost-effectiveness was the cost per quality-adjusted life year (QALY). Costs were estimated for each patient by multiplying resource use data by the relevant country-specific resource unit cost. QALYs were calculated using utility scores derived from the EQ-5D-5L administered at 6-month follow-up. There were no significant differences in costs or QALYs at 6months between groups. The incremental net monetary benefit was also not significant at a willingness-to-pay threshold of $50,000 per QALY, with the 95% CI including both negative and positive values. This analysis found that the cost-effectiveness of mild hypercapnia is highly uncertain when compared with normocapnia in adult patients following OHCA, with no significant differences in either costs or outcomes. Further research is required to determine the specific circumstances under which mild hypercapnia may provide value for money.

A common misconception that prevails within some research communities postulates that research results 'speak for themselves' and are thus sufficient to influence policy. Yet, high-fidelity uptake of research is rarely a passive process; more often, researchers need to actively engage with policymakers. This process of policy engagement strives towards producing robust science that contributes to the betterment of our societies-but it is a process for which many researchers are not adequately trained. If publicly funded research fails to influence policy, many would regard it as falling short of fulfilling its potential value to society. Herein, we provide a framework for research-policymaker engagement, framed around the questions of why, on what, with whom, when, where and how clinical and public-health researchers can and should undertake engagement with policymakers. The views presented in this Perspective are a synthesis of the diverse, collective experience of the authors across global health contexts, supported by real-world illustrative case studies. We provide tangible recommendations for researchers, funders and policymakers to facilitate bridging the gap between evidence and policy.