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Per- and polyfluoroalkyl substances (PFAS) have been used for decades in a broad range of consumer products and industrial applications. A variety of waste and products containing PFAS inevitably end up at waste management facilities when they are no longer considered useful. Drainage water samples (n = 157) were collected from eight subsections at a waste management facility in Sweden and analyzed for 23 PFAS and extractable organofluorine (EOF). Two different sampling methods were used, grab sampling (n = 32, without filtration) and composite sampling (n = 8, produced by pooling 16 filtered samples taken at the same subsection). Although PFAS have been studied at waste sites, the information is scarce regarding how the concentrations and homologue profiles could differ within the sites. In this study, we investigated if composite sampling could be an alternative to grab sampling for PFAS monitoring purposes. Herein, the PFAS concentrations ranged from <1 to 22 μg/L; the grab samples showed systematic higher concentrations than their corresponding composite sample. Short-chain perfluoroalkyl sulfonic acids (C 4 and C 5 ) were the largest contributing sub-class, followed by short-chain perfluoroalkyl carboxylic acids (C 4 to C 6 ). EOF was measured up to approximately 140 μg/L F with 99% being unexplained by the fluorine mass balance analysis. The results from this study showed that both sampling methods were comparable for target analysis and that 11 compounds represented most of the PFAS concentrations. However, the discrepancy between the sampling methods was greater for EOF analysis and may be due to the preparation of composite samples and/or due to fluctuating discharges during the sampling period. Composite sampling was observed to be comparable to grab sampling for target analysis., Competing Interests: Declaration of competing interest The authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Waste management facilities are a known source for per- and polyfluoroalkyl substances (PFAS) to the environment. In this study, water samples from seven subsections within a waste management facility in Sweden were analyzed for PFAS and extractable organofluorine (EOF). Oxidative conversion was used to investigate how much PFAS precursors could contribute to the EOF. Out of the 23 analyzed PFAS, ten compounds accounted for a major proportion of the concentrations. Before oxidative conversion the ∑ 10 PFAS were between 0.44 μg/L and 17 μg/L. The EOF ranged from 2 μg/L F up to 79 μg/L F. There was a greater difference in concentrations and profiles between the subsections in comparison to the four sampling dates at respective sampling point, suggesting different sources of PFAS from the waste. Oxidative conversion revealed presence of precursors by elevated concentrations of perfluoroalkyl acids after oxidation, which increased the explained EOF up to 25%. Seven samples from one sampling date were selected to investigate if other fluorinated compounds (inorganic anions, ultra-short-chain PFAS, and zwitterions) could be a part of the unexplained EOF fraction. The contribution of fluorine from tetrafluoroborate and hexafluorophosphate were equal or higher proportions than the ∑ 10 PFAS. The presence of the ionic liquids tetrafluoroborate and hexafluorophosphate could originate from battery waste, due to their use as counter ions in batteries. Ultra-short-chain PFAS increased the explained EOF by an average of 8%, with trifluoroacetic acid and trifluoromethane sulfonic acid being the main contributors. However, the reported concentrations of ultra-short-chain PFAS, were underestimated due to low recovery by the additional washing step to remove inorganic fluoride for EOF analysis. The concentrations of zwitterions were low and increased the explained EOF by < 1%. Our results suggest that EOF, selected PFAS, oxidative conversion and anionic fluorinated substances give a better picture of PFAS contamination., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Assuring that emergency health care (EHC) is accessible is a key objective for health care planners. Conventional accessibility analysis commonly relies on resident population data. However, the allocation of resources based on stationary population data may lead to erroneous assumptions of population accessibility to EHC., Method: Therefore, in this paper, we calculate population accessibility to emergency departments in Sweden with a geographical information system based network analysis. Utilizing static population data and dynamic population data, we investigate spatiotemporal patterns of how static population data over- or underestimates population sizes derived from temporally dynamic population data., Results: Our findings show that conventional measures of population accessibility tend to underestimate population sizes particularly in rural areas and in smaller ED's catchment areas compared to urban, larger ED's-especially during vacation time in the summer., Conclusions: Planning based on static population data may thus lead to inequitable distributions of resources. This study is motivated in light of the ongoing centralization of ED's in Sweden, which largely depends on population sizes in ED's catchment areas., (© 2024. The Author(s).)

Background: Polychlorinated alkanes (PCAs) constitute a large group of individual congeners originating from commercial chlorinated paraffin (CP) products with carbon chain lengths of PCAs-C 10-13 , PCAs-C 14-17 , and PCAs-C 18-32 , occasionally containing PCAs-C 6-9 impurities. The extensive use of CPs has led to global environmental pollution of PCAs. This study aimed to quantify PCAs in paired serum and breast milk of lactating Swedish mothers, exploring their concentration relationship., Methods: Twenty-five paired samples of mothers' blood serum and breast milk were analysed and concentrations were determined for PCAs C 6-32 and compared to 4,4'-DDE, the PCB congener 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153), and hexachlorobenzene (HCB)., Results: The median concentrations of PCAs-C 6-9 , PCAs-C 10-13 , PCAs-C 14-17 , PCAs-C 18-32 and ΣPCAs in serum were 14, 790, 520, 16 and 1350 ng/g lipid weight (lw), respectively, and in breast milk 0.84, 36, 63, 6.0 and 107 ng/g lw. Levels of 4,4'-DDE, CB-153 and HCB were comparable in the two matrices, serum and breast milk at 17, 12 and 4.9 ng/g lw. The results show significant differences of PCAs-C 10-13 and PCAs-C 14-17 in breast milk with 22- and 6.2-times lower lw-based concentrations than those measured in serum. On wet weight the differences serum/breast milk ratios of PCAs-C 6-9 , PCAs-C 10-13 , PCAs-C 14-17 , PCAs-C 18-32 and ΣPCAs were 1.7, 3.2, 1.0, 0.4 and 1.6, respectively, while the ratio for 4,4'-DDE, CB-153 and HCB were each close to 0.1., Conclusion: Swedish lactating mothers had high serum concentrations of PCAs-C 10-13 and PCAs-C 14-17 , with the ΣPCAs median serum concentration of 1350 ng/g lw. The breast milk concentration, although considerably lower at 107 ng/g lw, still surpassed those of 4,4'-DDE, CB-153 and HCB, suggesting an exposure risk of infants to PCAs. The variation in blood and breast milk accumulation between PCAs and studied legacy POPs, is rarely discussed but warrants further studies on partitioning properties as well as associated toxicological implications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Sepsis is a life-threatening condition, causing almost one fifth of all deaths worldwide. The aim of the current study was to identify variables predictive of 7- and 30-day mortality among variables reflective of the presentation of septic patients arriving to the emergency department (ED) using machine learning., Methods: Retrospective cross-sectional design, including all patients arriving to the ED at Södersjukhuset in Sweden during 2013 and discharged with an International Classification of Diseases (ICD)-10 code corresponding to sepsis. All predictions were made using a Balanced Random Forest Classifier and 91 variables reflecting ED presentation. An exhaustive search was used to remove unnecessary variables in the final model. A 10-fold cross validation was performed and the accuracy was described using the mean value of the following: AUC, sensitivity, specificity, PPV, NPV, positive LR and negative LR., Results: The study population included 445 septic patients, randomised to a training (n = 356, 80%) and a validation set (n = 89, 20%). The six most important variables for predicting 7-day mortality were: "fever", "abnormal verbal response", "low saturation", "arrival by emergency medical services (EMS)", "abnormal behaviour or level of consciousness" and "chills". The model including these variables had an AUC of 0.83 (95% CI: 0.80-0.86). The final model predicting 30-day mortality used similar six variables, however, including "breathing difficulties" instead of "abnormal behaviour or level of consciousness". This model achieved an AUC = 0.80 (CI 95%, 0.78-0.82)., Conclusions: The results suggest that six specific variables were predictive of 7- and 30-day mortality with good accuracy which suggests that these symptoms, observations and mode of arrival may be important components to include along with vital signs in a future prediction tool of mortality among septic patients presenting to the ED. In addition, the Random Forests appears to be a suitable machine learning method on which to build future studies., (© 2021. The Author(s).)

Short-, medium-, and long-chain chlorinated paraffins (SCCPs, MCCPs, and LCCPs) were analyzed in human milk from the Yangtze River Delta (YRD) and Scandinavia. Individual samples were collected from Shanghai, Jiaxing, and Shaoxing (China), Stockholm (Sweden), and Bodø (Norway) between 2010 and 2016. Mean concentrations (range) of SCCPs, MCCPs, and LCCPs in samples from the YRD were 124 [-1 fat, respectively, all of which were significantly ( p < 0.05) higher than 15.9 (-1 fat, respectively, in samples from Scandinavia. MCCPs predominate in most samples, and LCCP concentrations exceed reported for polybrominated diphenyl ethers in human milk from the same regions. This study is the first to confirm LCCP exposure via breastfeeding. Principal component analysis showed that the YRD samples were more influenced by SCCPs than the Scandinavian samples, which mirror different exposures to CPs between the regions. Because of a large variation in concentrations among individuals, SCCP intake via breastfeeding indicated a potential health concern in the 90th percentile among Chinese infants. Further, CP concentrations in the YRD samples from first-time mothers were on average three times higher than from second-time mothers. In order to limit the worldwide CP contamination, the inclusion of SCCPs as persistent organic pollutants in the Stockholm Convention needs to be followed up, with the inclusion of MCCPs and LCCPs as well.

Purpose: The purpose of this paper is to explore tactical planning potential within hospital departments. The study had two objectives: first, to develop a framework for tactical capacity planning in healthcare departments by identifying and structuring essential components for healthcare capacity management; and, second, to identify context-specific requirements and functionality demands on tactical planning processes within healthcare., Design/methodology/approach: A framework for tactical capacity planning was developed through a literature review. Additionally, an exploratory multiple-case study was performed, with cases from three Swedish hospital departments, which provide the opportunity to study framework applicability in its natural context., Findings: Findings illustrate how an active tactical planning process can facilitate adjustments to capacity. However, the multiple-case study shows that there are contextual differences between departments, depending on available treatments and resources that affect capacity adjustments, and how the planning process activities should be structured., Originality/value: This project develops a framework for a tactical capacity-planning process adapted to healthcare provider contexts. By developing the framework, based on the literature and tactical level planning processes within three Swedish hospital case studies, the authors bridge gaps between theory and application regarding healthcare capacity planning.

Impact of waste fuels (virgin/waste wood, mixed biofuel (peat, bark, wood chips) industrial, household, mixed waste fuel) and incineration technologies on partitioning and leaching behavior of trace elements has been investigated. Study included 4 grate fired and 9 fluidized boilers. Results showed that mixed waste incineration mostly caused increased transfer of trace elements to fly ash; particularly Pb/Zn. Waste wood incineration showed higher transfer of Cr, As and Zn to fly ash as compared to virgin wood. The possible reasons could be high input of trace element in waste fuel/change in volatilization behavior due to addition of certain waste fractions. The concentration of Cd and Zn increased in fly ash with incineration temperature. Total concentration in ashes decreased in order of Zn>Cu>Pb>Cr>Sb>As>Mo. The concentration levels of trace elements were mostly higher in fluidized boilers fly ashes as compared to grate boilers (especially for biofuel incineration). It might be attributed to high combustion efficiency due to pre-treatment of waste in fluidized boilers. Leaching results indicated that water soluble forms of elements in ashes were low with few exceptions. Concentration levels in ash and ash matrix properties (association of elements on ash particles) are crucial parameters affecting leaching. Leached amounts of Pb, Zn and Cr in >50% of fly ashes exceeded regulatory limit for disposal. 87% of chlorine in fly ashes washed out with water at the liquid to solid ratio 10 indicating excessive presence of alkali metal chlorides/alkaline earths., (Copyright © 2015. Published by Elsevier B.V.)

Trace element partitioning in solid waste (household waste, industrial waste, waste wood chips and waste mixtures) incineration residues was investigated. Samples of fly ash and bottom ash were collected from six incineration facilities across Sweden including two grate fired and four fluidized bed incinerators, to have a variation in the input fuel composition (from pure biofuel to mixture of waste) and different temperature boiler conditions. As trace element concentrations in the input waste at the same facilities have already been analyzed, the present study focuses on the concentration of trace elements in the waste fuel, their distribution in the incineration residues with respect to chlorine content of waste and combustion temperature. Results indicate that Zn, Cu and Pb are dominating trace elements in the waste fuel. Highly volatile elements mercury and cadmium are mainly found in fly ash in all cases; 2/3 of lead also end up in fly ash while Zn, As and Sb show a large variation in distribution with most of them residing in the fly ash. Lithophilic elements such as copper and chromium are mainly found in bottom ash from grate fired facilities while partition mostly into fly ash from fluidized bed incinerators, especially for plants fuelled by waste wood or ordinary wood chips. There is no specific correlation between input concentration of an element in the waste fuel and fraction partitioned to fly ash. Temperature and chlorine content have significant effects on partitioning characteristics by increasing the formation and vaporization of highly volatile metal chlorides. Zinc and cadmium concentrations in fly ash increase with the incineration temperature., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To assess the presence of two major non-nucleoside reverse transcriptase inhibitors (NNRTI) drug resistance mutations (DRMs), Y181C and K103N, in minor viral quasispecies of treatment naïve HIV-1 infected East-African and Swedish patients by allele-specific polymerase chain reaction (AS-PCR)., Methods: Treatment naïve adults (n=191) with three epidemiological backgrounds were included: 92 Ethiopians living in Ethiopia; 55 East-Africans who had migrated to Sweden; and 44 Caucasians living in Sweden. The pol gene was analysed by standard population sequencing and by AS-PCR for the detection of Y181C and K103N., Results: The Y181C was detected in the minority quasispecies of six Ethiopians (6.5%), in two Caucasians (4.5%), and in one East-African (1.8%). The K103N was detected in one East- African (1.8%), by both methods. The proportion of mutants ranged from 0.25% to 17.5%. Additional DRMs were found in all three treatment naïve patient groups by population sequencing., Conclusions: Major NNRTI mutations can be found by AS-PCR in minor quasispecies of treatment naïve HIV-1 infected Ethiopians living in Ethiopia, in East-African and Caucasian patients living in Sweden in whom population sequencing reveal wild-type virus only. Surveys with standard sequencing are likely to underestimate transmitted drug resistance and the presence of resistant minor quasispecies in treatment naïve patients should be topic for future large scale studies.

In presenting examples from the most extensive and demanding fire in modern Swedish history, this paper describes challenges facing hastily formed networks in exceptional situations. Two concepts that have been used in the analysis of the socio-technical systems that make up a response are conversation space and sensemaking. This paper argues that a framework designed to promote understanding of the sensemaking process must take into consideration the time and the location at which an individual is engaged in an event. In hastily formed networks, location is partly mediated through physical systems that form conversation spaces of players and their interaction practices. This paper identifies and discusses four challenges to the formation of shared conversation spaces. It is based on the case study of the 2006 Bodträskfors forest fire in Sweden and draws on the experiences of organised volunteers and firefighters who participated in a hastily formed network created to combat the fire., (© 2014 The Author(s). Disasters © Overseas Development Institute, 2014.)

Intensive care capacity planning based on factual or forecasted mean admission numbers and mean length of stay without taking non-linearity and variability into account is fraught with error. Simulation modelling may allow for a more accurate assessment of capacity needs. We developed a generic intensive care simulation model using data generated from anonymised patient records of all admissions to four different hospital intensive care units. The model was modified and calibrated stepwise to identify important parameters and their values to obtain a match between model predictions and actual data. The most important characteristic of the final model was the dependency of admission rate on actual occupancy. Occupancy, coverage and transfers of the final model were found to be within 2% of the actual data for all four simulated intensive care units. We have shown that this model could provide accurate decision support for planning critical care resource requirements., (© 2013 The Association of Anaesthetists of Great Britain and Ireland.)

Self-assembly is the fundamental but counterintuitive principle that explains how ordered biomolecular complexes form spontaneously in the cell. This study investigated the impact of using two external representations of virus self-assembly, an interactive tangible three-dimensional model and a static two-dimensional image, on student learning about the process of self-assembly in a group exercise. A conceptual analysis of self-assembly into a set of facets was performed to support study design and analysis. Written responses were collected in a pretest/posttest experimental design with 32 Swedish university students. A quantitative analysis of close-ended items indicated that the students improved their scores between pretest and posttest, with no significant difference between the conditions (tangible model/image). A qualitative analysis of an open-ended item indicated students were unfamiliar with self-assembly prior to the study. Students in the tangible model condition used the facets of self-assembly in their open-ended posttest responses more frequently than students in the image condition. In particular, it appears that the dynamic properties of the tangible model may support student understanding of self-assembly in terms of the random and reversible nature of molecular interactions. A tentative difference was observed in response complexity, with more multifaceted responses in the tangible model condition.

Accident investigation reports usually lead to a set of recommendations for change. These recommendations are, however, sometimes resisted for reasons such as various aspects of ethics and power. When accident investigators are aware of this, they use several strategies to overcome the resistance. This paper describes strategies for dealing with four different types of resistance to change. The strategies were derived from qualitative analysis of 25 interviews with Swedish accident investigators from seven application domains. The main contribution of the paper is a better understanding of effective strategies for achieving change associated with accident investigation., (Copyright © 2011 Elsevier Ltd. All rights reserved.)