| 1. |
- Piscator, Eva, et al.
(författare)
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Low adherence to legislation regarding Do-Not-Attempt-Cardiopulmonary-Resuscitation orders in a Swedish University Hospital
- 2021
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Ingår i: Resuscitation Plus. - : Elsevier BV. - 2666-5204. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background The ethical principles of resuscitation have been incorporated into Swedish legislation so that a decision to not attempt cardiopulmonary resuscitation (DNACPR) entails (1) consultation with patient or relatives if consultation with patient was not possible and documentation of their attitudes; (2) consultation with other licensed caregivers; (3) documentation of the grounds for the DNACPR. Our aim was to evaluate adherence to this legislation, explore the grounds for the decision and the attitudes of patients and relatives towards DNACPR orders. Methods We included DNACPR forms issued after admission through the emergency department at Karolinska University Hospital between 1st January and 31st October, 2015. Quantitative analysis evaluated adherence to legislation and qualitative analysis of a random sample of 20% evaluated the grounds for the decision and the attitudes. Results The cohort consisted of 3583 DNACPR forms. In 40% of these it was impossible to consult the patient, and relatives were consulted in 46% of these cases. For competent patients, consultation occurred in 28% and the most common attitude was to wish to refrain from resuscitation. Relatives were consulted in 26% and they mainly agreed with the decision. Grounds for the DNAR decision was most commonly severe chronic comorbidity, malignancy or multimorbidity with or without an acute condition. All requirements of the legislation were fulfilled in 10% of the cases. Conclusion In 90% of the cases physicians failed to fulfil all requirements in the Swedish legislation regarding DNAR orders. The decision was mostly based on chronic, severe comorbidity or multimorbidity.
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| 2. |
- Eklöf, Karin, et al.
(författare)
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Land-use dominates climate controls on nitrogen and phosphorus export from managed and natural Nordic headwater catchments
- 2020
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Ingår i: Hydrological Processes. - : Wiley. - 0885-6087 .- 1099-1085. ; 34, s. 4831-4850
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Tidskriftsartikel (refereegranskat)abstract
- Agricultural, forestry-impacted and natural catchments are all vectors of nutrient loading in the Nordic countries. Here, we present concentrations and fluxes of total nitrogen (totN) and phosphorus (totP) from 69 Nordic headwater catchments (Denmark: 12, Finland:18, Norway:17, Sweden:22) between 2000 and 2018. Catchments span the range of Nordic climatic and environmental conditions and include natural sites and sites impacted by agricultural and forest management. Concentrations and fluxes of totN and totP were highest in agricultural catchments, intermediate in forestry-impacted and lowest in natural catchments, and were positively related %agricultural land cover and summer temperature. Summer temperature may be a proxy for terrestrial productivity, while %agricultural land cover might be a proxy for catchment nutrient inputs. A regional trend analysis showed significant declines in N concentrations and export across agricultural (-15 mu g totN L-1 year(-1)) and natural (-0.4 mu g NO3-N L-1 year(-1)) catchments, but individual sites displayed few long-term trends in concentrations (totN: 22%, totP: 25%) or export (totN: 6%, totP: 9%). Forestry-impacted sites had a significant decline in totP (-0.1 mu g P L-1 year(-1)). A small but significant increase in totP fluxes (+0.4 kg P km(-2) year(-1)) from agricultural catchments was found, and countries showed contrasting patterns. Trends in annual concentrations and fluxes of totP and totN could not be explained in a straightforward way by changes in runoff or climate. Explanations for the totN decline include national mitigation measures in agriculture international policy to reduced air pollution and, possibly, large-scale increases in forest growth. Mitigation to reduce phosphorus appears to be more challenging than for nitrogen. If the green shift entails intensification of agricultural and forest production, new challenges for protection of water quality will emerge possible exacerbated by climate change. Further analysis of headwater totN and totP export should include seasonal trends, aquatic nutrient species and a focus on catchment nutrient inputs.
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| 3. |
- Kyllmar, Katarina, et al.
(författare)
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Potential impacts of a future Nordic bioeconomy on surface water quality
- 2020
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Ingår i: AMBIO: A Journal of the Human Environment. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 49, s. 1722-1735
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Tidskriftsartikel (refereegranskat)abstract
- Nordic water bodies face multiple stressors due to human activities, generating diffuse loading and climate change. The 'green shift' towards a bio-based economy poses new demands and increased pressure on the environment. Bioeconomy-related pressures consist primarily of more intensive land management to maximise production of biomass. These activities can add considerable nutrient and sediment loads to receiving waters, posing a threat to ecosystem services and good ecological status of surface waters. The potential threats of climate change and the 'green shift' highlight the need for improved understanding of catchment-scale water and element fluxes. Here, we assess possible bioeconomy-induced pressures on Nordic catchments and associated impacts on water quality. We suggest measures to protect water quality under the 'green shift' and propose 'road maps' towards sustainable catchment management. We also identify knowledge gaps and highlight the importance of long-term monitoring data and good models to evaluate changes in water quality, improve understanding of bioeconomy-related impacts, support mitigation measures and maintain ecosystem services.
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| 4. |
- Rakovic, Jelena, et al.
(författare)
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Nordic Bioeconomy Pathways: Future narratives for assessment of water-related ecosystem services in agricultural and forest management
- 2020
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Ingår i: AMBIO: A Journal of the Human Environment. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 49, s. 1710-1721
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Tidskriftsartikel (refereegranskat)abstract
- Further development of the bioeconomy, the substitution of bioresources for fossil resources, will lead to an increased pressure on land and water resources in both agriculture and forestry. It is important to study whether resultant changes in land management may in turn lead to impairment of water services. This paper describes the Nordic Bioeconomy Pathways (NBPs), a set of regional sectoral storylines nested within the global Shared Socioeconomic Pathways (SSP) framework developed to provide the BIOWATER research program with land management scenarios for projecting future developments to explore possible conflicts between land management changes and the Water Framework Directive (WFD). The NBPs are a set of narrative storylines capturing a range of plausible future trajectories for the Nordic bioeconomy until 2050 and that are fit for use within hydrological catchment modelling, ecosystem service studies and stakeholder dialogue about possible changes in agricultural and forestry management practices.
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| 5. |
- Sandström, Sara, et al.
(författare)
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Variability in fluvial suspended and streambed sediment phosphorus fractions among small agricultural streams
- 2021
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Ingår i: Journal of Environmental Quality. - : Wiley. - 0047-2425 .- 1537-2537. ; 50, s. 612-626
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Tidskriftsartikel (refereegranskat)abstract
- Agriculture is a major source of sediment and particulate phosphorus (P) inputs to freshwaters. Distinguishing between P fractions in sediment can aid in understanding its eutrophication risk. Although streams and rivers are important parts of the P cycle in agricultural catchments, streambed sediment and especially fluvial suspended sediment (FSS) and its P fractions are less studied. To address this knowledge gap, seasonal variations in FSS P fractions and their relation to water quality and streambed sediment were examined in three Swedish agricultural headwater catchments over 2 yr. Sequential fractionation was used to characterize P fractions in both streambed sediment and FSS. All catchments had similar annual P losses (0.4-0.8 kg ha(-1)), suspended solids (124-183 mg L-1), and FSS total P concentrations (1.15-1.19 mg g(-1)). However, distribution of P fractions and the dominant P fractions in FSS differed among catchments (p < .05), which was most likely dependent on differences in catchment geology, clay content, external P sources, and flow conditions. The most prominent seasonal pattern in all catchments was found for iron-bound P, with high concentrations during low summer flows and low concentrations during winter high flows. Streambed sediment P fractions were in the same concentration ranges as in FSS, and the distribution of the fractions differed between catchments. This study highlights the need to quantify P fractions, not just total P in FSS, to obtain a more complete understanding of the eutrophication risk posed by agricultural sediment losses.
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