Sandviken Hospital

Abstract Boreal forest landscapes are rapidly transformed through expanding clearcutting forestry, leading to a decline in forests with long tree continuity and an increase in even‐aged production stands. The role of remnant forests in supporting biodiversity within production forest landscapes remains poorly understood. Northern Europe provides an ideal setting for studying mosaics of clearcut and remnant continuity forests, given its long history of clearcutting and the prevalence of even‐aged forest stands. New remote‐sensing techniques have enabled the identification of forests in boreal Sweden that have maintained permanent tree cover at least since the 1950s (‘continuity forest’), meaning that they have likely never been clearcut, with removal of all trees. Using these data (including production forest as well as protected forest), we randomly selected 16 areas, each 225 km2 in size, with the proportion of continuity forest ranging from 2% to 25%. In each study area, we selected four even‐aged production forest stands aged 0–80 years and one selectively harvested (never‐clearcut) production stand aged 81–120 years. As model organisms for assessing biodiversity, we used epiphytic lichens on randomly selected Norway spruce Picea abies trees. We recorded 164 epiphytic lichen taxa on 926 trees. Species richness (including species of conservation concern) in the even‐aged forests <80 years old increased with the proportion continuity forest in the surrounding landscape. In contrast, there was no relationship between the richness of lichens and the proportion continuity forest for the older, selectively harvested production forests. Our results suggest that continuity forests are an important dispersal source for even‐aged production forests since almost all of the epiphytic lichen occurrences represent new colonization. Our results also show that continuity production forests >80 years old are important to epiphytic biodiversity since they host many species of conservation concern. Synthesis and applications. Our study has relevance for forestry and conservation across the boreal biome where a continued rapid expansion of clearcutting into primary forest landscapes is likely. Preserving continuity forests for the future would enrich the epiphytic biodiversity of younger, even‐aged production forests due to their function as dispersal nuclei. The remnant continuity forests are also conservation targets in their own right due to their rich lichen diversity.

Chlorination is widely used in seawater systems to avoid fouling and associated microbial-induced corrosion. Free chlorine is a strong oxidizing agent that prevents biofilm formation on immersed surfaces when used above a certain content. However, the presence of residual chlorine associated with the relatively high chloride content in seawater significantly increases the risk of localized corrosion for most stainless steels. In the present study, a module initially developed to quantify the formation of electroactive biofilms on stainless steels has been used to assess the corrosiveness of chlorinated seawater. Both the electrochemical potential and the cathodic current were measured on super-duplex stainless steel as a function of residual chlorine levels and seawater temperatures. In parallel, long-term localized corrosion tests have been performed in simulated environments to assess the environmental limits for the safe use of high-grade stainless steels in chlorinated seawater. It includes crevice corrosion exposure tests using adapted ISO 18070:2015 crevice formers and internal tube pitting corrosion exposure tests in model tube heat exchangers simulating heat flux from 35°C to 170°C. The synergetic effect of residual chlorine content and temperature on the risk of localized corrosion has been quantified. Corrosion resistance properties are correlated to the electrochemical monitoring data, and the environmental limits of selected base materials stainless steels have been established for duplex stainless steel UNS S32205, super-duplex stainless steel UNS S32750, hyper-duplex stainless steels UNS S32707 and UNS S33207, and the high-grade austenitic stainless steel UNS S31266.

Few people will be unaware of the global cost-of-living crisis. This paper situates the crisis in the much larger crisis of capital and, specifically, the present form of accumulation, premised at one end by parasitic capital and at the other by the impoverishment of labour. It does so by examining the immediate and underlying causes of capital’s cost-of-living crisis. It is argued that both immediate and underlying causes link the cost-of-living crisis to its basis in relations of capitalist parasitism and worker impoverishment that characterise present-day capitalism.

BackgroundSwimming-induced pulmonary edema (SIPE) occasionally occurs during swimming in cold open water. Although optimal treatment for SIPE is unknown, non-invasive positive pressure ventilation (NPPV) is an option for prehospital treatment.Research QuestionIs NPPV a feasible and safe prehospital treatment for SIPE, and which outcome measures reflect recovery after treatment?Study Design and MethodsA prospective observational study was conducted at Vansbrosimningen, Sweden’s largest open water swimming event, from 2017 through 2019. Swimmers with a diagnosis of SIPE and with peripheral oxygen saturation (Spo2) of ≤ 95%, persistent respiratory symptoms, or both were eligible for the study. NPPV was administered on site as CPAP by facial mask or as positive expiratory pressure (PEP) by a PEP device. Discharge criteria were Spo2 of > 95% and clinical recovery. Four outcome measures were evaluated: Spo2, crackles on pulmonary auscultation, pulmonary edema on lung ultrasound (LUS), and patient-reported respiratory symptoms.ResultsOf 119 treated individuals, 94 received CPAP, 24 received treatment with a PEP device, and one required tracheal intubation. In total, 108 individuals (91%) were discharged after NPPV for a median of 10 to 20 min and 11 individuals (9%) required hospital transfer. NPPV resulted in increased Spo2 from a median of 91% to 97% (P < .0001) together with improvement of six patient-reported respiratory symptoms (median numerical rating scales, 1-7 to 0-1; P < .0001). No significant decrease in auscultation of crackles (93% vs 87%; P = .508) or pulmonary edema on LUS (100% vs 97%; P = .500) was seen during NPPV treatment.InterpretationNPPV administered as CPAP or via a PEP device proved feasible and safe as prehospital treatment for SIPE with a vast majority of patients discharged on site. Spo2 and patient-reported respiratory symptoms reflected recovery after treatment, whereas pulmonary auscultation or LUS findings did not.

Objective: To investigate the occurrence of behavioural problems in patients with severe traumatic brain injury during the first year after injury and potential associations with outcome. An additional post hoc objective was to analyse the frequency of behaviours with need for intervention from staff. Design and setting: In a prospective population based cohort study 114 patients with severe traumatic brain injury were assessed at three weeks, three months and one year after injury. Main measures: Assessments included clinical examination and standardised instruments. Agitation was assessed with the Agitated Behaviour Scale, the course of recovery by the Rancho Los Amigo Scale and outcome by Glasgow Outcome Scale Extended. Results: Agitation were most common at 3 weeks post injury and 28% (n=68) of the patients showed at least one agitated behaviour requiring intervention from staff. Presence of significant agitation at 3 weeks after injury was not associated with poor outcome. At 3 months agitation was present in 11% (n=90) and apathy in 26 out of 81 assessed patients. At 3 months agitation and apathy were associated with poor outcome at one year. Conclusions: Most agitated behaviours in the early phase are transient and are not associated with poor outcome. Agitation and apathy are uncommon at three months but when present are associated with poor outcome at one year after injury. In the early phase after a severe traumatic brain injury agitated behaviour in need of interventions from staff occur in a substantial proportion of patients.

Aims: To estimate the incidence of hand eczema in dental technicians and to elucidate occupational risk factors.Methods: This was a retrospective cohort study among former dental technician students (n = 2139). Controls comprised population controls (n = 2288) with similar distribution of age and sex as the dental technicians. A mail questionnaire asked for occurrence of hand eczema including age of onset, occupational exposure and use of protective gloves. The response rate was 58%(1210 dental technicians and 1316 controls answered the questionnaire).Results: In dental technicians the incidence of hand eczema was 7.1 cases/1000 person years in males and 10.8 in females during acrylate‐exposed time. In controls the incidence of hand eczema was 3.1 in males and 3.7 in females. The relative risk (RR) for males was 2.3 (95% CI 1.6–3.4) and for females 2.9 (95% CI 2.1–4.0). 48% of the dental technicians and 30% of the controls reported more than 10 hand‐washings/day (p &lt; 0.001). 80% of the dental technicians reported skin exposure to uncured acrylates, 14% daily. 87% had skin contact with grinding dust from acrylates, 42% daily. 38% used protective gloves when handling uncured acrylates, males 29%, females 48%(p &lt; 0.001). 58% did not know for how long the normally used gloves protected the skin against uncured acrylates.Conclusions: The risk of hand eczema is more than doubled in dental technicians. The work involves frequent and unprotected exposure to acrylates and wet work. Education regarding skin protection is important.

Helicobacter pylori is a gastric pathogen that is a major cause of peptic ulcer disease, has a role in mucosa-associated lymphoid tissue (MALT) lymphoma and is associated with gastric cancer. Yet, in a large proportion of the human population, H. pylori infection has no apparent adverse clinical consequences. Furthermore, recent research suggests that H. pylori may even confer protection against gastroesophageal reflux disease. The conflicting evidence surrounding H. pylori infection was discussed at a sponsored symposium in Helsinki, introduced by Professor P. Malfertheiner, with papers presented by Dr H. J. O'Connor, Professor R. M. Genta, Dr P. Unge and Professor A. T. R. Axon. Emerging epidemiological and retrospective evidence suggests that the presence of H. pylori infection may provide some protection against gastroesophageal reflux disease, but there is other evidence that shows no benefit of H. pylori for the protection of the oesophagus. It was felt that prospective, multicentre studies are needed to explore the H. pylori-gastroesophageal disease relationship further, to avoid confusing potential benefits with known risks. Following the symposium, a discussion on the relative risks and benefits for H. pylori eradication was provided by Professor Axon and Professor Blaser. Eradication of H. pylori has been recommended in a series of management guidelines issued by consensus groups. However, accurate estimates of the relative risks and benefits of H. pylori infection in the general population, as well as in specific patient groups, is essential in order to develop a management strategy.

Culture and susceptibility testing of Helicobacter pylori strains was performed in a large multinational, multicenter randomized clinical trial. Culture was carried out on gastric biopsy samples obtained from 516 patients at entry and had a sensitivity of 99% when the [(13)C]urea breath test was used as a reference. Susceptibility testing was performed for clarithromycin and metronidazole on 485 strains by an agar dilution method and the epsilometer test (Etest) and for amoxicillin by an agar dilution method only. Resistance to clarithromycin (>1 microgram/ml) was found in 3% of the H. pylori strains, with a perfect correlation between Etest and agar dilution methods. Resistance to metronidazole (>8 microliter/ml) was found in 27% of the strains by agar dilution, but there were important discrepancies between it and the Etest method. No resistance to amoxicillin was found. The logarithms of the MICs of the three antibiotics against susceptible strains had a distribution close to normal. The impact of resistance was tested in the four arms of the trial. There were not enough clarithromycin-resistant strains to evaluate the impact of resistance on the cure rate of clarithromycin-based regimens. For metronidazole-resistant strains, the impact noted in the clarithromycin-metronidazole arm was partially overcome when omeprazole was added (76% eradication for resistant strains versus 95% for susceptible strains). Secondary resistance to clarithromycin occurred in strains from 12 of 105 patients (11.4%) after the failure of a clarithromycin-based regimen to effect eradication. The detection of point mutations in clarithromycin-resistant strains was performed by a combination of PCR and restriction fragment length polymorphism. Mutations (A2142G and 2143G) were found in all strains tested except one. This study stresses the importance of performing susceptibility tests in clinical trials in order to explain the results of different treatments.