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Measurements of pleural fluid biomarkers for rapid identification of complicated parapneumonic effusion (CPPE) are crucial for optimal management. Previous studies for biomarker evaluation were however based on pleura culture, not modern DNA technique. Lactate has not been thoroughly studied earlier as a potential biomarker in this regard. To evaluate whether the routine biomarkers pH, glucose, lactate dehydrogenase (LDH) measured in pleural fluid in a microbiological well characterised cohort could differentiate simple parapneumonic effusion (SPPE) from CPPE and if pleural fluid lactate could be of additional use in this discrimination. Pleural fluid prospectively collected from adult patients (n = 112) with PPE admitted to the Departments of Infectious Diseases (DIDs) at four Stockholm County hospitals were characterised microbiologically with bacterial culture and 16S rDNA sequencing, and biochemically with pH, glucose, LDH and lactate. Forty and seventy two patients were categorised as SPPE/CPPE. The median values between SPPE/CPPE differed significantly for all biomarkers with varying overlap. Receiver operating characteristics (ROC) curves showed the area under the curve (AUC) for pH 0.905 (CI 0.847–0.963), glucose 0.861 (CI 0.79–0.932), LDH 0.917 (CI 0.860–0.974) and lactate 0.927 (CI 0.877–0.977), corresponding to best cut-off levels and sensitivity/specificity for pH of 7.255, 0.819/0.9, glucose 5.35 mmol/L, 0.847/0.775, LDH 9.8 µcat/L, 0.905/0.825 and lactate 4.9 mmol/L, 0.875/0.85. To distinguish between SPPE/CPPE, pH and LDH performed well, but optimal cut-off values differed from earlier established recommendations. Pleura lactate had the largest AUC of the investigated biomarkers and may be used in the analyses of PPE-staging.

Following the outbreak of COVID-19 in 2020, the majority of European countries imposed lockdowns, whereas Sweden introduced comparatively moderate constraints. The Public Health Agency of Sweden stated that sports and physical activity could continue if conducted ‘safely’ and recommended outdoor activities. This article aims to identify new spatial practices and strategies developed by organised recreational sport providers (i.e. sport clubs, commercial providers) following the outbreak of the pandemic. Further, it identifies obstacles and opportunities for new spatial solutions, as well as possible long-term (lasting) effects of the strategies imposed. Also, it discusses these obstacles and opportunities in relation to contemporary sport facility challenge. The data draws upon 24 semi-structured interviews with sport coaches and leaders. All interviews were transcribed verbatim and analysed using a thematic analysis. The results suggest that most respondents show adaptability by moving their activities outdoors. Generally, for-profit organisations have been more innovative and adaptive. Obstacles for new spatial solutions include localisation, weather, (perceived) need of equipment, leadership, competing interests in public space, and notably the perception of what sport is. Positive examples of spatial adaptability show that there is a potential for sport providers to open up for different spatial solutions and more flexibility in relation to their activities, in order to ease the pressure on formal indoor (and, to some extent, outdoor) sport facilities while amending the perception of sport activities. Research methods The data draws upon 24 semi-structured interviews with sport coaches and leaders. All interviews were transcribed verbatim and analysed using a thematic analysis. Results and findings The results suggest that most respondents show adaptability by moving their activities outdoors. Generally, for-profit organisations have been more innovative and adaptive. Obstacles for new spatial solutions include localisation, weather, (perceived) need of equipment, leadership, competing interests in public space, and notably the perception of what sport is. Implications Positive examples of spatial adaptability show that there is a potential for sport providers to open up for different spatial solutions and more flexibility in relation to their activities, in order to ease the pressure on formal indoor (and, to some extent, outdoor) sport facilities while amending the perception of sport activities.

The IMO Ship Energy Efficiency Management Plan (SEEMP) is the sole international regulatory instrument expected to affect rising CO2 emissions from shipping in the short-term. In this article, we discuss present gaps in the SEEMP guidelines through a comparison with the international standard for energy management systems, ISO 50001, and with the International Safety Management (ISM) Code, which sets requirements for safety management systems in shipping companies. We show that the SEEMP lacks crucial features found in typical management system standards, such as requirements on policy and management reviews. Moreover, best-practice in the form of the ISO 50001 addresses important aspects, such as monitoring, energy auditing, design, and procurement processes in much more detail. In the context of previous research on these instruments and on energy efficiency in general, we argue that these gaps may be detrimental to the success of the SEEMP, both from the societal perspective of CO2 abatement and from the perspective of companies’ success in energy management. This requires further attention by academia, policy-makers and industry.

The aim of the study was to evaluate the effect of client-centred, self-care intervention (CCSCI) on (i) activities of daily living (ADL) and life satisfaction in persons with stroke, (ii) caregiver burden, use of informal care and home-help services, and (iii) the feasibility of the study design.Randomized controlled trial, a pilot study of an intervention group (IG) receiving CCSCI or a control group (CG) receiving ordinary training.Forty persons with stroke (IG n = 19, CG n = 21) were included: non-demented, able to follow instructions, dependent regarding self-care and referred for rehabilitation, and their significant others (IG n = 8, CG n = 8).Data were collected at baseline and three months later using established instruments regarding ADL, life satisfaction, caregiver burden, and use of health services from medical records, the county register, and by interviews.There were no differences in ADL, life satisfaction, caregiver burden, or use of services at three months. Both groups improved significantly and clinically important improvements were achieved by 86% in IG and 63% in CG.The CCSCI appears promising for the recapturing of self-care after stroke and a large randomized controlled trial is warranted, in which the present design and methods with some modification will be feasible.

In clinical practice it may be difficult to evaluate the cause of acute dysphonia and aphonia. With the aim of elucidating the aetiology, diagnosis and management of patients with acute voice disorder, we have studied different populations with acute laryngitis and psychogenic voice disorder (PVD). The results indicate that bacterial infection is common only in patients with acute laryngitis (65%) whereas asthma-like symptoms are reported in a high proportion of patients with PVD (37%). The two populations are rather similar with regard to age, gender, smoking habits, perceptual features of dysphonia and occurrence of concomitant minor laryngeal abnormalities. Neurogenic disorders may sometimes give rise to peculiar vocal symptoms with rapid onset, here illustrated by two clinical cases: bilateral recurrent nerve palsy with acute onset of aphonia, and mutism due to sclerosis multiplex of the brain.

The stability of albumin, protein HC, immunoglobulin G, κ- and λ-chain immunoreactivity, orosomucoid and α1 -antitrypsin in urine stored at -20°C for up to 24 months was investigated. Significant decreases of the median concentration values for protein HC, IgG and α1-antitrypsin were observed for native urine. Addition to urine of a preservative solution containing benzamidinium chloride, EDTA, tris(hydroxymethyl)-aminomethane and azide prevented the decreases of the concentration values for protein HC and IgG but not for α1-antitrypsin. The median concentration values for albumin, orosomucoid and κ-and λ-chain immunoreactivity did not change significantly upon storage of native urine, nor for urine with the preservative solution.

Urine samples from 10 randomly selected patients with advanced renal disease were each divided into six aliquots and a preservative solution containing benzamidinium chloride, EDTA, tris(hydroxymethyl)-aminomethane and azide was then added to three of the aliquots. Aliquots with and without additive were then stored at room temperature for up to 7 days, at 4 degrees C for up to 30 days and at -20 degrees C for up to 6 months. The concentrations of albumin, protein HC, IgG, orosomucoid and alpha 1-antitrypsin as well as the kappa- and lambda-chain immunoreactivities in the samples were determined by automated immunoturbidimetry or by single radial immunodiffusion after 1, 3, 7, 14, 30, 90 and 180 days of storage. All investigated proteins, except alpha 1-antitrypsin in native urine, were stable for 7 days in the samples stored at room temperature both in the presence and absence of additives. All investigated proteins, except alpha 1-antitrypsin in native urine, were stable for 30 days in the samples stored at 4 degrees C both in the presence and absence of additives. A more complex pattern was observed for the stability of the proteins in the frozen samples. The IgG level decreased rapidly in several samples stored without additives but not in samples stored with additives. The alpha 1-antitrypsin concentration decreased rapidly to about 50% of the initial value in several samples stored both with and without additives. The rate of the decrease for both the IgG and the alpha 1-antitrypsin level varied between samples and the main decrease for several samples was seemingly caused by the freezing and/or thawing per se and not by the storage period in between.

Many concepts for deep underground storage of high level radioactive waste include the use of bentonite (sodium-montmorillonite) as a backfill material surrounding the waste. It is therefore necessary to model the chemical conditions in the system sodium-montmorillonite-granitic groundwater-granitic rock in order to be able to predict the speciation and solubility of actinides and fission products in this environment. In this study, the chemical interactions and the evolution of the chemical composition of the water in such a system have been modeled using the geochemical computer code PHREEQE. The parameters considered are the pH, Eh, and the chemical composition in aqueous solution. Mineral formation has been taken into account in some cases. The speciation and solubility of uranium in this system have also been calculated.

Background factors, symptoms and signs were analysed in 40 consecutive patients with psychogenic dysphonia. Their voice profile was compared with that of 40 patients with infectious laryngitis. The majority of the patients were young females, non-smokers, who were not professional voice users. Criteria for acute infectious laryngitis prior the voice disorder were met in no more than 10% of the patients. Nevertheless as many as 40% of the patients had been treated with various antibiotics. The prevalence of reported asthma/allergy-like symptoms was high, 37.5%. Perceptual analysis of voice profiles demonstrated similarity of aberrancies in psychogenic dysphonia and in acute laryngitis. Since it may be difficult to distinguish psychogenic dysphonia from acute laryngitis, careful analysis of anamnestic data may be helpful for a correct diagnosis.