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Objectives: The purpose was to analyze trends in intensity of care at End-of-life (EOL), in two cohorts of patients with lung or pancreatic cancer. Setting: We used population-based registry data on health care utilization to describe proportions and intensity of care at EOL comparing the two cohorts (deceased in the years of 2010 and 2017 respectively) in the region of Stockholm, Sweden. Primary and secondary outcomes: Main outcomes were intensity of care during the last 30 days of life; systemic anticancer treatment (SACT), emergency department (ED) visits, length of stay (LOS) > 14 days, intensive care (ICU), death at acute care hospital and lack of referral to specialized palliative care (SPC) at home. The secondary outcomes were outpatient visits, place of death and hospitalizations, as well as radiotherapy and major surgery. A multivariable logistic regression analysis was used for associations. A moderation variable was added to assess for the effect of SPC at home between the cohorts. Results: Intensity of care at EOL increased over time between the cohorts, especially use of SACT, increased with 10%, p<0.001, (n = 102/754 = 14% to n = 236/972 = 24%), ED visits with 7%, p<0.001, (n = 25/754 = 3% to n = 100/972 = 10%) and ICU care, 2%, p = 0.04, (n = 12/754 = 2% to n = 38/972 = 4%). High intensity of care at EOL were more likely among patients with lung cancer. The difference in use of SACT between the years, was moderated by SPC, with an increase of SACT, unstandardized coefficient β; 0.87, SE = 0.27, p = 0.001, as well as the difference between the years in death at acute care hospitals, that decreased (β = 0.69, SE = 0.26, p = 0.007). Conclusion: These findings underscore an increase of several aspects regarding intensity of care at EOL, and a need for further exploration of the optimal organization of EOL care. Our results indicate fragmentation of care and a need to better organize and coordinate care for vulnerable patients. [ABSTRACT FROM AUTHOR]

Background: Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity among asymptomatic subjects reflects past or future disease may be difficult to ascertain.Methods: We tested 9449 employees at Karolinska University Hospital, Stockholm, Sweden for SARS-CoV-2 RNA and antibodies, linked the results to sick leave records, and determined associations with past or future sick leave using multinomial logistic regression.Results: Subjects with high amounts of SARS-CoV-2 virus, indicated by polymerase chain reaction (PCR) cycle threshold (Ct) value, had the highest risk for sick leave in the 2 weeks after testing (odds ratio [OR], 11.97; 95% confidence interval [CI], 6.29-22.80) whereas subjects with low amounts of virus had the highest risk for sick leave in the 3 weeks before testing (OR, 6.31; 95% CI, 4.38-9.08). Only 2.5% of employees were SARS-CoV-2 positive while 10.5% were positive by serology and 1.2% were positive in both tests. Serology-positive subjects were not at excess risk for future sick leave (OR, 1.06; 95% CI, .71-1.57).Conclusions: High amounts of SARS-CoV-2 virus, as determined using PCR Ct values, was associated with development of sickness in the next few weeks. Results support the concept that PCR Ct may be informative when testing for SARS-CoV-2. Clinical Trials Registration. NCT04411576. [ABSTRACT FROM AUTHOR]

Urban rainwater management is the terrain of varied initiatives that challenge existing drainage systems. The initiatives that this article refers to as Urban Rainwater Harvesting (URH), promise a more sustainable urban water approach; however, they remain isolated "niche" projects. The article aims to investigate challenges and opportunities for mainstreaming alternative URHs as sociotechnical systems (STS). It identifies six analytical categories: context, actors, instruments, processes/dynamics, outputs and impacts as a framework for the analyses of URH projects in Stockholm, Berlin and Barcelona. Despite the diversity of socio-spatial contexts, driving forces, purposes, instruments used, technical designs and scale of URH projects, relevant factors for a breakthrough of these systems are discussed. Even though URHs have not yet become a common component of rainwater management in any of the cities, context-specific combinations of these factors are found to be essential if these systems are to become complementary options for the sustainable management of rainwater in cities. [ABSTRACT FROM AUTHOR]

Sweden is a low endemicity country for hepatitis B virus (HBV). The previously reported prevalence of chronic HBV is ,1% and of overall markers ,5%. HBV is not included in the universal childhood vaccination programme. Instead, selected high-risk groups are targeted. Our aim was to examine the HBV seroprevalence in youth clinic clients in Stockholm and identify if this population might be a new target group for vaccination. In total, 515 clients aged 18-22 years were recruited. They completed a risk-assessment questionnaire and 464 (90%) had a serum specimen tested for HBV serology. Chronic HBV was found in 0.6% and 0.9% had previously been infected with HBV. A seroprevalence of 1.8% HBV markers was found among non-vaccinated persons. This is lower than reported from other countries and not different from the general population in Sweden. However, in persons originating from HBV endemic countries (n = 123), the prevalence was higher, 6.5%. Only 14% were vaccinated and the majority hence susceptible to HBV. The target groups are not reached by the present vaccination strategy. Youth clinics are ideal settings for catch-up vaccination. [ABSTRACT FROM AUTHOR]

• A positive correlation between hourly train frequency and PM10 level is verified. • The type of train passing an underground metro platform affects the PM10 level. • In Stockholm metro, the PM10 could be reduced by up to 30% by train type selection. In underground metro systems, airborne wear particles generated during the operation of metro trains are the predominant airborne contaminants on platforms. Previous researchers have found that several factors influence the airborne particle emission rate during metro train operations. However, the effect of train type has rarely been studied. In 2016 and 2020, field measurements were taken on six underground metro platforms in Stockholm, Sweden. Old and new types of trains (CX and C20) were in traffic at the same time. In the present study, based on the field measurements, the correlations between the hourly average PM10 level and the hourly frequency of the two types of trains were studied. A linear mixed model that includes the effect of hourly train frequency and train type was set up. Based on this model, CX trains have a larger particle emission rate than C20 trains. [ABSTRACT FROM AUTHOR]

• Political decisions and support for experimentation to solve socio-environmental problems have potentials to provide innovative solutions. • Small-scale projects combining urban drainage and rainwater harvesting are possible in the built environment and suited to dense areas as well. • Urban planners rather than water planners may be able to push forward for sustainable drainage projects. • Planning for blue-green infrastructure opens windows of opportunity towards urban sustainability to multiple urban challenges. • Urban rain and urban drainage should be considered a resource and not a hazard. A plethora of socioenvironmental issues, and growing concerns over the effects of climate change, are forcing cities to rethink conventional urban water management practices. However, change towards more sustainable practices has been remarkably slow. This paper examines two cases of greening projects aimed at urban rehabilitation in Stockholm and Barcelona, which have turned into examples of innovative approaches to urban rain management. Both cities share high densities and flooding problems in certain neighborhoods. Specifically, the paper attempts to answer three questions: 1) what were the driving forces and key factors that facilitated the breakthrough of urban rainwater-harvesting (URH) schemes based on the two cases?; 2) who were the actors involved and what were their roles in moving towards URH schemes?; and 3) how can URH schemes become part of multifunctional, sustainable urban systems? To answer these questions, the paper uses concepts of adaptive context and capacity, and of actor agency, drawn from the transitions literature, and opportunistic and guided flexibility planning drawn from the planning literature. Empirical material for both case studies was obtained from policy documents and semi-structured interviews with key actors. The main results show first political support for flexibility in public planning, the adaptive context and the capacity of the actors, especially in taking advantage of windows of opportunity for the materialisation of new ideas. Second, the design and implementation of these systems widened the number and scope of actors in urban water management, incorporating new professionals such as architects and involving more city agencies and organizations. Third, small scale URH systems contributed not only to control urban drainage but performed other functions such as the much-needed greening of dense areas in both cities. [ABSTRACT FROM AUTHOR]

Highlights • A two-part train traffic emission factors model is built. • The model could predict the PM10 level at a railway station platform in a tunnel. • The two terms in this model are brake effect term and accumulative effect term. • The relationship between PM10 and train frequency in both terms is linear. • The two terms equally affect the PM10 level at train station platforms. Abstract In 2017 a new railway tunnel containing two stations opened in Stockholm, Sweden. A series of field measurements were carried out on the platforms in this tunnel before and after it was opened for normal traffic. These measurements were used to investigate the contribution of airborne particle emissions from wear processes to total train emissions. This field data was used to develop a two-part train traffic emission factor model for PM10. The two parts are the accumulative effect term (relating to operating distance such as wheel-rail contact and overhead electric line sliding contact) and a brake effect term (relating to the number of braking operations such as brake disc and brake pad contact). The results show that operating a single trial train at a higher than normal frequency on an otherwise empty platform increases the platform particulate concentration until the concentration reaches a steady value. The model suggests that brake emissions account for about 50% of the total emissions measured in the tunnels. [ABSTRACT FROM AUTHOR]

Transport infrastructure is closely linked to several sustainability issues of main policy relevance, and significant impacts on biodiversity as well as resource use and construction costs relate to the corridor design and location in the landscape. The aim of this study was to develop methods for railway corridor planning, in which corridor design and location would be based on important ecological and geological sustainability criteria. The method, an MCA framework including both spatial and non-spatial MCA, was demonstrated on a railway planning proposition in an urbanising area north of Stockholm, Sweden. Alternative spatial alignments for 6 railway corridors were derived based on criteria representing biodiversity, resource efficiency and costs, developed from ecological and geological knowledge, data and models. The method identified a study area specific positive synergy between ecological and geological sustainability criteria. The evaluation part of the methodology could furthermore identify uncertainties in the input data and assumptions and conflicts between ecological criteria. In order to arrive at a well-informed decision support system, the criteria as well as the decision rules employed could be further elaborated. Other relevant sustainability issues would also need to be integrated, such as cultural landscapes, recreation, and other ecosystem services. Still, arriving at a corridor design informed by the ecological and geological conditions in the planned area, as demonstrated by this study, could improve the sustainability performance of transport infrastructure planning. [ABSTRACT FROM AUTHOR]

Knowledge about regolith thickness is important in several civil and environmental engineering fields. However, subsurface characteristics such as regolith thickness are difficult to determine through surface investigations and maps at regional scales. This paper presents four methods for estimating regolith thickness in a GIS environment for previously glaciated terrain with high frequency of rock outcrops: linear regression (LR) using topographical covariates; inverse distance weighting (IDW) interpolation of regolith thickness point data from well drillings; a trigonometrical approach (TA) developed for this study which uses outcrop slopes and distance between outcrops; and a simplified regolith model (SRM). The SRM is a model modified from TA which estimates the regolith thickness based on outcrops, slopes and the distance to outcrops in eight directions. The methods were compared for three study areas (Tyresö, Vallentuna and Österåker) in Stockholm County, Sweden. Based on the results in this paper, LR proved to be the most accurate method for regolith thickness estimation, measured through root mean square error values. Whereas IDW was the most accurate method in terms of error within ±2m, which would make it a suitable model if and when large datasets of regolith point data are available. When drilling data is scarce then both the TA and SRM methods can be used for regolith estimations. However, the SRM proved to be a more accurate regolith thickness model compared to TA. SRM shows promising results and could be used at a preliminary stage in engineering projects where little or no data is available prior to detailed field investigations in previously glaciated terrain. [ABSTRACT FROM AUTHOR]