Träd i hårdgjord stadsmiljö

Syftet med arbetet har varit att undersöka de 26 träden som är planterade på Spårvägsgatans norra sida i Malmö. Detta för att ta reda på varför vissa träd har etablerats sämre än andra. Arbetet är genomfört genom litteraturstudie på träd i urbanmiljö allmänt och inventering av den i examensarbetet gällande platsen. Träd i stadsmiljö är viktiga för vårt välmående. De bidrar till grönska och förbättrar den förorenade luften som kommer från bilar och fabriker. I dagens moderna samhälle utsetts träd i stadsmiljö för många olika typer av stress. Främst är det utrymmet under mark som minskas på grund av att dagens moderniteter som vattenledningar och kablar av olika slag ska samsas med trädens rötter och växtbäddar. Andra faktorer som bidrar till stressen är förstörd jordstruktur, vattenbrist, halkbekämpning i form av salt och täta material på ytlagret. Träd som är planterade på Spårvägsgatans norra sida i Malmö undersöks och bedöms i jämförelse med träd i stadsmiljö allmänt. 26 träd av arterna Tilia x vulgaris, Ginkgo biloba, Carpinus betulus och Acer pseudoplatanus som är planterade längs Spårvägsgatans norra sida bedömdes genom inventeringar. Arterna är indelade i ett delområde för varje art från 1-4 längs gatan och varje delområde är inventerat var för sig. Kortfattat är ståndorten längs hela gatan hårdgjord och urban, med undantag för delområde 4 med Acer pseudoplatanus där träden är planterade i en gräsyta mellan trottoar och bilväg. Mikroklimatet längs hela gatan är varmt med många ytmaterial som reflekterar värmen även nattid. Resultatet av inventeringen visade att träden överlag har en dålig vitalitet och är stressade. De flesta träd har beskärningsskador och en dålig tillväxt. Ginkgo biloba och Carpinus betulus på delområde 2 respektive 3 är placerade i mycket små växtbäddar på 1,3 m³ var. Litteraturundersökningen visade att ett träd i stadsmiljö beroende på storlek och art behöver en växtbädd på minst 10-20 m³. Växtbäddar för delområde 1 och 4 har inte fåtts fram till detta arbete. Avloppsledningar är placerade mycket nära växtbäddarna på delområde 2 och 3 vilket kan ha lett till att växtbäddarna gjorts så små. Acer pseudoplatanus på delområde 4 är planterade i en gräsyta med buskage intill. Träden där har en ojämn tillväxt med tanke på att de enligt en tidigare inventering är planterade år 1985. Något träd är 7 m högt medan andra når en höjd på 14 m. En teori är att gräset konkurrerar med träden vid närings- och vattenupptag. En slutsats om generella lösningar på platsen tas upp som diskussion. De främsta lösningarna är att växtbäddar måste förstoras och/eller förbättras om träden ska uppnå god vitalitet

The risk of HCV RNA contamination in serology screening instruments with a fixed needle for sample transfer

AbstractBackgroundHepatitis C diagnostics involve antibody screening and confirmation of current infection by detection of HCV RNA positivity. In screening instruments with fixed pipetting needle, there is a risk of sample carry-over contamination.ObjectivesThe aim of this study was to evaluate the risk of such contamination in a proposed clinical setting.Study designIn the present study, known HCV RNA positive (n=149) and negative (n=149) samples were analysed by anti-HCV Abbott in an Architect instrument in an alternating fashion in order to test for contamination.ResultsIn subsequent retesting of the previously HCV RNA-negative samples, six samples (4%) were positive by the Cobas Taqman assay with a maximum level of 33IU/mL. The results show that there is a risk for transfer of HCV in the Architect instrument but they also show that the levels of HCV RNA observed are low.ConclusionsWe conclude that complementary HCV RNA testing on samples identified as anti-HCV positive by screening can be recommended because the complementary results are reliable in the majority of cases when either HCV RNA is negative or HCV RNA is positive with a level >1000IU/mL. In a minority of cases, with low HCV RNA after anti-HCV antibody screening, cross-contamination should be suspected and a new sample requested for HCV RNA testing. This strategy would reduce the need for obtaining a new sample from the vast majority of patients with a newly discovered HCV antibody positivity

Incidence and time trends of second primary malignancies after non-Hodgkin lymphoma:a Swedish population-based study

Considering treatment changes and an improved prognosis of non-Hodgkin lymphoma (NHL) over time, knowledge regarding long-term health outcomes, including late effects of treatment, has become increasingly important. We report on time trends of second primary malignancies (SPMs) in Swedish NHL patients, encompassing the years before as well as after the introduction of anti-CD20 antibody therapy. We identified NHL patients in the Swedish Cancer Register 1993 to 2014 and matched comparators from the Swedish Total Population Register. The matched cohort was followed through 2017. By linking to the Swedish Lymphoma Register, subcohort analyses by NHL subtype were performed. Flexible parametric survival models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of SPM among patients and comparators. Among 32 100 NHL patients, 3619 solid tumors and 217 myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) cases were observed, corresponding to a 40% higher rate of solid tumors (HR(solid tumors) = 1.4; 95% CI, 1.4-1.5) and a 5-fold higher rate of MDS/AML (HR(MDS/AML )= 5.2; 95% CI, 4.4-6.2) than for comparators. Overall, the observed excess risks for solid tumors or MDS/AML remained stable over the study period, except for follicular lymphoma, where the excess rate of MDS/AML attenuated with time (P for trend = .012). We conclude that NHL survivors have an increased risk of both solid tumors and hematologic malignancies, in particular MDS/AML. Stable excess risks over time indicate that contemporary treatment standards are not associated with modified SPM risk. Encouragingly, decreasing rates of MDS/AML were noted among patients with follicular lymphoma, possibly due to the increasing use of nonchemotherapy-based treatments

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Observerad klimatförändring i Sverige 1860–2021

Historiska observationer av temperatur, vegetationsperiodens längd, nederbörd, snö, globalstrålning och geostrofisk vind i Sverige har analyserats. Längden på de tillgängliga tidsserierna varierar mellan de olika variablerna. Det finns dagliga temperaturobservationer från Uppsala så långt tillbaka som 1722, medan startåret för de globalstrålningsmätningar från åtta svenska stationer som analyserats här är så sent som 1983. Klimatindikatorer som baseras på dessa observationer visar att:• Sveriges årsmedeltemperatur har ökat med 1,9 °C jämfört med perioden 1861–1890. • Sveriges årsnederbörd har ökat sedan 1930 från 600 mm/år till nästan 700 mm/år. • Antalet dagar med snötäcke har minskat sedan 1950. • Globalstrålningen har ökat med cirka 10 % sedan mitten av 1980-talet. • Någon förändring av den geostrofiska vinden kan inte fastslås från 1940.De ovan listade förändringarna syftar alla till årliga genomsnitt för hela Sverige. De är statistiskt signifikanta i de flesta fall. Bilden blir mer tvetydig då genomsnitt för olika landsdelar eller säsonger undersöks. Exempelvis är den ökade årsnederbörden mest ett resultat av ökad nederbörd under vinter och höst, medan det inte finns någon tydlig trend för sommar och vår. Det är också generellt sett svårare att fastslå förändringar i extremvärden. Exempelvis finns ingen signifikant trend vad gäller vinterns största snödjup, trots en tydlig minskning i antalet dagar med snötäcke.Historical Swedish observations of temperature, length of vegetation period, precipitation, snow, global radiation, and geostrophic wind have been analysed. The length of available time series varies among these variables. Whereas there are temperature observations for Uppsala ranging back to 1722 continuous measurements of global radiation at eight Swedish stations start only in 1983. Climate indicators based on these observations show that: • The annual mean temperature for Sweden has increased by 1.9 °C compared to the period 1861• The amount of annual precipitation increased since 1930 from about 600 mm/year to almost 700 mm/year. • The number of days with snow cover has reduced since 1950. • The global radiation increased with circa 10 % since the mid-1980’s. • The geostrophic wind has no clear change pattern since 1940. The listed changes are annual averages for Sweden. These are robust and statistically significant in most cases. The picture is getting more diverse when investigating smaller regions or different seasons instead of annual means. For instance, the increase of precipitation is mainly related to enhanced precipitation during autumn and winter whereas there are no obvious trends in spring and summer. Moreover, changes in extremes are generally harder to identify. For instance, despite the clear negative trend in the number of days with snow cover there is no significant trend for the maximum snow depth. –1890.Denn

Effects of 12 mg vs. 6 mg dexamethasone on thromboembolism and bleeding in patients with critical COVID-19-a post hoc analysis of the randomized, blinded COVID STEROID 2 trial

BackgroundThromboembolism is more common in patients with critical COVID-19 than in other critically ill patients, and inflammation has been proposed as a possible mechanism. The aim of this study was to investigate if 12 mg vs. 6 mg dexamethasone daily reduced the composite outcome of death or thromboembolism in patients with critical COVID-19.MethodsUsing additional data on thromboembolism and bleeding we did a post hoc analysis of Swedish and Danish intensive care unit patients enrolled in the blinded randomized COVID STEROID 2 trial comparing 12 mg vs. 6 mg dexamethasone daily for up to 10 days. The primary outcome was a composite outcome of death or thromboembolism during intensive care. Secondary outcomes were thromboembolism, major bleeding, and any bleeding during intensive care.ResultsWe included 357 patients. Whilst in intensive care, 53 patients (29%) in the 12 mg group and 53 patients (30%) in the 6 mg group met the primary outcome with an unadjusted absolute risk difference of - 0.5% (95% CI - 10 to 9.5%, p = 1.00) and an adjusted OR of 0.93 (CI 95% 0.58 to 1.49, p = 0.77). We found no firm evidence of differences in any of the secondary outcomes.ConclusionsAmong patients with critical COVID-19, 12 mg vs. 6 mg dexamethasone daily did not result in a statistically significant difference in the composite outcome of death or thromboembolism. However, uncertainty remains due to the limited number of patients

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications