1. The correlation between water chemistry, physical variables and fish community composition was examined in 40 small (£30 ha) coastal lakes in northern Sweden. Twenty of the 40 lakes were isolated from other water bodies and 20 were connected to the Baltic Sea. Lakes were fished in summer, using three different methods. Water chemistry was sampled in late winter prior to ice-out and pH was measured additionally in summer. 2. Our central question was whether water chemistry plays a greater role in the composition of fish communities in isolated lakes than in connected lakes, as isolated lakes cannot be recolonised once a species has become extinct. 3. Results indicate that winter anoxia affects community composition only in isolated lakes, whereas acidity is of importance in both connected and isolated lakes. Methane (indicating anoxia), was significantly correlated with variation in fish community composition in isolated lakes, and a group of variables that indicate anoxia (CH 4 , pCO 2 , inorganic carbon and dissolved oxygen) explained 24-34% of the variation. pH alone explained 12% of the variation in community composition for connected lakes and a group of variables indicating acidity (summer and winter pH and ANC) explained 10-20% of the variation in isolated lakes. Lake area was the most important physical variable, being significantly correlated with the variation in fish community composition in connected lakes. 4. In isolated lakes, the presence of pike (Esox lucius), perch (Perca fluviatilis) and roach (Rutilus rutilus) was associated with low CH 4 . The occurrence of crucian carp (Carassius carassius) and roach was positively correlated with pH, and the crucian carp was apparently also affected by predation by pike and perch. In connected lakes the effect of anoxia was low, probably due to the possibility of recolonisation and pockets of oxygenated water, allowing pike and perch to persist and thereby limiting the distribution of crucian carp.

ObjectivesTo test if impaired oxygenation or major haemodynamic instability at the time of emergency intensive care transport, from a smaller admitting hospital to a tertiary care centre, are predictors of long-term mortality.DesignRetrospective observational study. Impaired oxygenation was defined as oxyhaemoglobin %–inspired oxygen fraction ratio (S/F ratio)<100. Major haemodynamic instability was defined as a need for treatment with norepinephrine infusion to sustain mean arterial pressure (MAP) at or above 60 mm Hg or having a mean MAP <60. Logistic regression was used to assess mortality risk with impaired oxygenation or major haemodynamic instability.SettingSparsely populated Northern Sweden. A fixed-wing interhospital air ambulance system for critical care serving 900 000 inhabitants.ParticipantsIntensive care cases transported in fixed-wing air ambulance from outlying hospitals to a regional tertiary care centre during 2000–2016 for adults (16 years old or older). 2142 cases were included.Primary and secondary outcome measuresAll-cause mortality at 3 months after transport was the primary outcome, and secondary outcomes were all-cause mortality at 1 and 7 days, 1, 6 and 12 months.ResultsS/F ratio <100 was associated with increased mortality risk compared with S/F>300 at all time-points, with adjusted OR 6.3 (2.5 to 15.5, p<0.001) at 3 months. Major haemodynamic instability during intensive care unit (ICU) transport was associated with increased adjusted OR of all-cause mortality at 3 months with OR 2.5 (1.8 to 3.5, p<0.001).ConclusionMajor impairment of oxygenation and/or major haemodynamic instability at the time of ICU transport to get to urgent tertiary intervention is strongly associated with increased mortality risk at 3 months in this cohort. These findings support the conclusion that these conditions are markers for many fold increase in risk for death notable already at 3 months after transport for patients with these conditions.

Study Objectives: To characterize postings made on the reddit.com forum titled "opiates." In particular, we tested the hypothesis that the proportion of online posts glorifying opiate use is greater than the proportion advocating harm reduction. We further characterized posts across a variety of categories.Methods: This is an analysis of posting to the reddit.com forum "Opiates" (reddit.com/ r/opiates). On May 1, 2018, an extraction of the most recent 500 posts made to this forum was performed. Duplicate posts and posts with unanalyzable content such as unreadable text were excluded. The posts were then categorized by their main topic, including such categories as "glorifying use, including obtaining and consuming", "harm reduction", "avoiding law enforcement" and "interacting with physicians". We also identified specific characteristics of posts to quantify how often these characteristics appeared, such as those which endorse unsafe behavior (beyond opioid use), those which discuss obtaining and the safe use of naloxone, those which discuss medication assisted therapy, those which discuss pharmaceutical opioid use, and those which discuss polysubstance abuse. Posts endorsing unsafe opioid behavior were identified as those endorsing combinations of opioids and other respiratory depressants, using opioids while operating dangerous machinery and other dangerous behaviors while combined with opioids.Results: 500 posts were obtained, 34 were excluded as duplicates or unanalyzable, and 466 were analyzed. The proportion "glorifying use" was 205/466 (43.9%) and the proportion "advocating harm reduction" was 72/466 (15.4%). Difference in proportion was +28.5% (95% CI +22.7% to +34.3%). 10 posts (2.1%) discuss avoiding law enforcement and 13 posts (2.8%) discuss interacting with physicians, including how to obtain stronger or longer prescriptions. Within the above topics, 19.3% of posts endorse unsafe behavior, beyond use for simple analgesia. These include many posts endorsing polysubstance use, especially combining opioids with benzodiazepines or alcohol, as well as one unique post encouraging patients to follow reports of deadly fentanyl outbreaks to obtain more potent opioids. Only 15% of posts encouraged harm reduction, including ways to quit, encouragement for those quitting, and reducing side effects and risky behavior, and 1% discussed obtaining naloxone or the appropriate administration of naloxone. The consumption of pharmaceutical opioids appears very common, with 47.6% (123 of 258) of the posts discussing the use of opioids specifically identifying pharmaceutical opioids being consumed. 26 posts (5.6%) discuss medication assisted therapy including buprenorphine or methadone.Conclusions: Online forums such as the reddit.com forum "Opiates" advertise themselves as harm reduction forums, but our data show that these forums instead have a small amount of harm reduction information. Many posts glorify unsafe drug use. Sites like these may represent an impediment to educating patients with opiate use disorder on saf...

Background We aimed to test if impaired oxygenation or major hemodynamic instability at the time of emergency intensive care transport between hospitals are predictors of long-term mortality.Methods From a regional hospital intensive care transport research database, the study cohort was identified as those emergency intensive care cases transported in fixed-wing air ambulance from outlying hospitals to a regional tertiary care center during 2000–2016 for adults (16 years old or older). Impaired oxygenation was defined as oxyhemoglobin % - inspired oxygen fraction ratio (S/F ratio) < 100. Major hemodynamic instability was defined as need for treatment with noradrenaline infusion to sustain mean arterial pressure (MAP) at or above 60 mmHg or having a mean MAP < 60. All-cause mortality at 3 months after transport was the primary outcome, and secondary outcomes were all-cause mortality at 6 and 12 months. Multivariate cumulative survival and hazard analysis was performed for intervals 3, 6 and 12 months.Results There were 2142 patients included in the analysis. The S/F ratio < 100 was associated with increased mortality risk compared to S/F > 300 at all time-points, with hazard ratio (HR) 2.9 (1.9–4.4 95% CI, p < 0.001) at 12 months. Major hemodynamic instability during ICU transport was associated with increased HR of all-cause mortality up to one year with hazard ratio 1.9 (1.5–2.5, p < 0.001).Conclusion Major impairment of oxygenation and/or major hemodynamic instability at the time of ICU transport to get to urgent tertiary intervention is strongly associated with reduced survival at least up to one year after the transport, in this cohort. These findings support the conclusion that these conditions are markers for many fold increase in risk for death notable already at 3 months after transport for patients with these conditions. How much this risk is modifiable is not assessable in this analysis.