Norrköping Hospital

Abstract This study examines the benefits and limitations of different supply chain models for recycled concrete aggregates (RCA), a highly resource- and CO 2 -intensive material. Focusing on Sweden, it combines material science insights with policy analysis and logistics modelling to assess the potential of RCA in construction. RCA demonstrate strong reuse potential in both bound (new concrete) and unbound (road and backfilling) applications, with life cycle assessments indicating lower climate impacts than virgin aggregates. However, barriers to achieve circularity persist, including fragmented regulations, limited infrastructure, and weak market demand. Using qualitative data from industry actors and quantitative modelling, three scenarios are developed: high-utility reuse of elements, consolidated recycling into bound and unbound applications, and low-utility recycling for backfilling. Results highlight the importance of selective demolition, traceability, procurement models, and strategic placement of concrete material terminals. The study concludes that coordinated policy, logistics planning, and procurement practices are critical to scaling RCA adoption.

Objective: Antibiotic prophylaxis reduces infection risk following transrectal prostate biopsy. Studies in countries with high antibiotic resistance show that fosfomycin, given an hour or more before biopsy, has equal or better outcomes than ciprofloxacin. This study aimed to evaluate if fosfomycin, administered immediately before biopsy, is as effective as ciprofloxacin in Sweden, where antibiotic resistance is low. Material and Methods: A randomised, non-inferiority study of different antibiotic prophylactic regimes, including men undergoing transrectal prostate biopsy, was conducted. A total of 3448 patients were planned to be included. Primary outcome was hospitalisation due to urinary tract infection (UTI) within 14 days. Men without risk factors for infection received either fosfomycin or ciprofloxacin immediately before biopsy. Patients with risk factors received additional doses post-biopsy. Results: The study was stopped by the safety board after enrolment of 42 men. Four of 20 men (25%) in the fosfomycin group were hospitalised due to UTI, including two with positive blood cultures for Pseudomonas , whereas no hospitalisations (0%) occurred in the ciprofloxacin group. The main limitation was the small sample size. Conclusion: Fosfomycin administered immediately before biopsy was not supported by this study. The results may be skewed by the high incidence of Pseudomonas infections. Level of evidence: 2

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare neurological condition. Tubal ectopic pregnancy is an important cause of maternal morbidity and mortality worldwide. Regular pregnancy has a disease-modifying effect on MOGAD, with an increased relapse rate postpartum. Still, there are neither case reports nor cohort studies on abortions and ectopic pregnancy as a disease-modifying event for MOGAD. This is a case report on a severe MOGAD relapse after ectopic pregnancy and laparoscopic abortion. For the first time we described that elevated interleukin-1 (IL-1), which was found in cerebrospinal fluid in the current case may be pathogenetically related to ectopic pregnancy. Rituximab (anti-CD20 treatment), downregulated IL-1 and TNF-alfa inflammatory pathways thus is an appropriate drug of choice to treat relapse. Cytokines secreted during ectopic pregnancy could play a disease-modifying role in multiple sclerosis and Guillian-Barré syndrome. The first case report of a MOGAD severe relapse after ectopic pregnancy and laparoscopic abortion which resolved with rituximab treatment.

On a daily basis, everyone is exposed to many chemical compounds that have been classified as endocrine disrupting chemicals (EDCs). These are natural and artificially produced substances that are widely available in the environment today. The aim of the study is to determine the effect of endocrine disrupting chemicals on hormonal processes occurring in the human body and to determine their mechanisms of action. The research method used was a literature review on the Pubmed platform. Studies show that EDCs affect prenatal growth, thyroid function, glucose metabolism, obesity development, and puberty and fertility processes by mimicking hormones naturally occurring in the human body, which very often leads to disorders in the hormonal axis at various levels. Recent research reports say that EDCs interact through epigenetic mechanisms. These substances are considered safe individually, but the subject of research remains the "cocktail effect", which consists in exposing several EDCs to the body at the same time. The key here is to limit human contact with these substances as much as possible. Studies have so far proven the negativin effects of many of them on our body, but many of the long-term effects have yet to be studied. Fortunately, more and more countries are introducing restrictions on the use of these substances and are looking for methods to replace them with less harmful substitutes. Further research is needed to understand the effects of these substances on humans, which will further enable the development of appropriate regulation of EDCs.

Fractures of the distal radius are the most common fractures of the upper extremity. The choice of surgical method has been debated and studies show that short-term differences, in favour of volar locking plates, are indistinguishable at 1 year follow-up. Few studies have investigated long-term outcomes beyond one year. The aim of this study was to investigate long-term (6-10 years) patient-reported outcomes after distal radius fracture surgery, and to determine how fracture pattern/complexity (Buttazzoni fracture type) affects the results. 303 patients surgically treated for a distal radius fracture, from 2012-2016 were included. The questionnaires used were PRWE, Quick-DASH and EQ-5D. Previous studies have shown that fracture type influences the choice of surgical method and therefore fracture type was adjusted for in the statistical analysis. We found that patients treated with K-wires had significantly better Quick-DASH scores (p <0.05) and a lower degree of pain (PRWE pain scale) (p <0.05) than patients treated with volar locking plates. There was no difference between the two groups regarding the remaining outcome measures for any Buttazzoni type of fracture. On the basis of these results, K-wires can be considered an equivalent option to locking plates because of equal or better long-term outcomes, lower costs, and shorter operation times.

Introduction:The Battle of Mosul (2016-2017) involved asymmetric warfare and excess civilian causalities. Emergency Management Centre (EMC) was a designated trauma center for the battle, located 80 km from Mosul. Exploratory laparotomy outcomes in local hospitals are poorly studied compared to military hospitals. Improving response to complex emergencies requires better contextual understanding.Method:Prehospital and hospital data were collected from all patients undergoing exploratory laparotomy at EMC during the battle. Data were collected and validated by EMC’s chief surgeon. New Injury Severity Scores (NISS) were calculated from operative data.Results:Seventy-three patients were included. 22 (30.1%) were children; 40 (54.8%) were non-combatant adults. 51 (69%) were male. Bullets caused 74.0% of injuries. Children had prolonged time from injury to first laparotomy compared to adults (600 vs 208 minutes, p&lt;0.05). Median hospital length of stay (LOS) was six days (IQR 4-10; children 16.4 days vs adults 8.6 days, p=0.05). Median NISS was 18 (IQR 12-27). NISS were significantly higher for women (28.5 vs 19.8), children (28.8 vs 20), and re-laparotomy (32.0 vs 19.0) compared to men, adults, and primary laparotomy, respectively. In univariate and multivariate analysis, NISS was associated with hospital, but not ICU, LOS (p&lt;0.01). Twelve patients were re-laparotomies after surgery elsewhere: ten (83.3%) were for failed repairs or missed injuries. Median time to re-operation was 5.5 days (IQR 1-8). Re-operations had longer ICU (4.5 vs 2.9, p&lt;0.01) and hospital stays (20.7 vs 7.6, p&lt;0.01). Three (4%) patients died; two of which were re-laparotomies.Conclusion:During the battle, civilians and combatants had similar injury mechanisms and outcomes. Children had a long time to present and LOS. Low mortality likely reflects high prehospital mortality. Prolonged times to admission suggest the need for improved hospital transport. Re-operation was associated with increased complications and LOS. NISS demonstrated predictive value for hospitals, but not ICU, or LOS.

Iraq, like most Middle Eastern countries, is suffering from the effects of Climate Change. The effects are in form of deterioration and degradation of lands, including agricultural lands, an increase in dust storms, an increase in daily temperatures, decreasing annual rainfall, decreasing annual snowfall, decreasing annual water income in the main rivers, streams and ephemeral wadis, increasing of desertification, increasing of areas covered by sand dunes, decreasing of green areas, decreasing of wetlands. According to regional studies, the living conditions and environment after 3 -4 decades in Iraq and some neighboring countries will be very difficult, especially due to increasing daily temperatures and decreasing annual rainfall. To conduct the current study, we have reviewed tens of published articles, and scientific reports followed by relevant interviews on TV, and daily observations of events caused by climate change. One of the most common reasons for climate change is the emission of CO 2 , and the most common reason contributing to the increase of the effects of climate change is the absence of awareness in the community and the deficient official preparedness. The preparedness, however, to avoid and/ or mitigate the effects of climate change is very low, not only on the governmental level but also on popular scales. Therefore, the harsh effect of climate change increasing in severity and causing great damage to infrastructure, and personal properties, and is leading to more causalities. Recommendations to mitigate the consequences of climate change are given in two scales, governmental and popular.

Climate Changes have impacted our planet since the beginning of time. These were manifested by cyclic Ice Ages and Warm Periods ever since. The changes were caused by natural forcing such as, continental drift, plate tectonics, major volcanic eruptions, and internal dynamics of earth and oceans interactions with the atmosphere. The present warm period, the “Holocene Epoch”, is not different from other such periods except for the sharp global warming which began at the onset of the industrial revolution. This was proven by scientific research to be due to anthropogenic drives, i.e., increased fossil fuel burning and increased Co2 and other Green House Gases (GHG) emissions into the atmosphere. These gases trap the sun radiation reflected from earth surface and result in higher earth temperature. The steep rate of rise in temperature trend since 1960s is directly linked to the use of much more fossil fuels in power production and transportation. This has led to more research to quantify the changes and their impacts on the environment and humans. This paper gives a brief history of the scientific research carried out hitherto and policy suggestions made so far to combat the negative impacts of the increasing global warming of the world. Needed future scientific research in this field is outlined, while at the same time suggesting the needs of Iraq of such research. This includes among other things, forming a regional scientific panel for the Middle East countries (ME. IPCC) for carrying out research on regional level, fostering research on national level, encouraging academics for climate change-oriented research and providing the necessary funds and facilities for such research.

Abstract This is the third article in our series of articles exploring connections between dynamical systems of Stäckel‐type and of Painlevé‐type. In this article, we present a method of deforming of minimally quantized quasi‐Stäckel Hamiltonians, considered in Part I to self‐adjoint operators satisfying the quantum Frobenius condition, thus guaranteeing that the corresponding Schrödinger equations possess common, multitime solutions. As in the classical case, we obtain here both magnetic and nonmagnetic families of systems. We also show the existence of multitime‐dependent quantum canonical maps between both classes of quantum systems.