Drones can be used to provide dispatch centres with on-site photos before arrival of EMS in time critical incidents.

BACKGROUND: Drones are able to deliver automated external defibrillators in cases of out-of-hospital cardiac arrest (OHCA) but can be deployed for other purposes. Our aim was to evaluate the feasibility of sending live photos to dispatch centres before arrival of other units during time-critical incidents. METHODS: In this retrospective observational study, the regional dispatch centre implemented a new service using five existing AED-drone systems covering an estimated 200000 inhabitants in Sweden. Drones were deployed automatically over a 4-month study period (December 2022-April 2023) in emergency calls involving suspected OHCAs, traffic accidents and fires in buildings. Upon arrival at the scene, an overhead photo was taken and transmitted to the dispatch centre. Feasibility of providing photos in real time, and time delays intervals were examined. RESULTS: Overall, drones were deployed in 59/440 (13%) of all emergency calls: 26/59 (44%) of suspected OHCAs, 20/59 (34%) of traffic accidents, and 13/59 (22%) of fires in buildings. The main reasons for non-deployment were closed airspace and unfavourable weather conditions (68%). Drones arrived safely at the exact location in 58/59 cases (98%). Their overall median response time was 3:49 min, (IQR 3:18-4:26) vs. emergency medical services (EMS), 05:51 (IQR: 04:29-08:04) p-value for time difference between drone and EMS = 0,05. Drones arrived first on scene in 47/52 cases (90%) and the largest median time difference was found in suspected OHCAs 4:10 min, (IQR: 02:57-05:28). The time difference in the 5/52 (10%) cases when EMS arrived first the time difference was 5:18 min (IQR 2:19-7:38), p = NA. Photos were transmitted correctly in all 59 alerts. No adverse events occurred. CONCLUSION: In a newly implemented drone dispatch service, drones were dispatched to 13% of relevant EMS calls. When drones were dispatched, they arrived at scene earlier than EMS services in 90% of cases. Drones were able to relay photos to the dispatch centre in all cases. Although severely affected by closed airspace and weather conditions, this novel method may facilitate additional decision-making information during time-critical incidents.

A data management framework for strategic urban planning using blue-green infrastructure.

Spatial planning of Blue-Green Infrastructure (BGI) should ideally be based on well-evaluated and context specific solutions. One important obstacle to reach this goal relates to adequate provisioning of data to ensure good governance of BGI, i.e., appropriate planning, design, construction, and maintenance. This study explores the gap between data availability and implementation of BGI in urban planning authorities in Sweden. A multi method approach including brainstorming, semi-structured interviews with urban planners and experts on BGI and Geographical Information System (GIS), and validating workshops were performed to develop a framework for structured and user-friendly data collection and use. Identified challenges concern data availability, data management, and GIS knowledge. There is a need to improve the organisation of data management and the skills of trans-disciplinary cooperation to better understand and interpret different types of data. Moreover, different strategic goals require different data to ensure efficient planning of BGI. This calls for closer interactions between development of strategic political goals and data collection. The data management framework consists of three parts: A) Ideal structure of data management in relation to planning process, data infrastructure and organisational structure, and B) A generic list of data needed, and C) The development of structures for data gathering and access. We conclude that it is essential to develop pan-municipal data management systems that bridge sectors and disciplines to ensure efficient management of the urban environment, and which is able to support the involvement of citizens to collect and access relevant data. The framework can assist in such development.

Assessment of barriers and drivers for implementation of blue-green solutions in Swedish municipalities.

Due to increased urbanisation, and climate change, there have been calls for a more sustainable management of stormwater. Blue-green measures have been recognised as a sustainable solution and a necessary complement to pipe-bound approaches. The aim of this study is to identify barriers and drivers in the implementation of blue-green measures in a Swedish context, to increase the understanding of how they could be implemented in a more successful manner. The study is qualitative and based on semi-structured interviews. Through the lens of transition theory, barriers and drivers for blue-green measures were identified and they give an updated picture of Swedish urban stormwater management. Many factors encourage municipal actors to implement blue-green solutions, such as increased need for recreation, protection of biodiversity and climate change. Identified barriers are found within the municipal stormwater management it-self, but can also be found outside the storm water management structure, such as lack of knowledge among politicians, officials, exploiters and civilians, fragmented roles and responsibilities in general, as well as uncertainty of the effects and cost of new alternatives. The study has three main findings; Several barriers were mentioned by most of the interviewees clearly show that a wide range of changes are needed to alter the current stormwater management regime; Niche innovations are often put forward as a way to enhance socio-technical transition, but this study is that such an approach is over-simplified instead elaborated suggestions for an alteration of urban stormwater management is given, both with top-down and bottom-up perspective. For the success of blue-green solutions, educational efforts are important at different levels in the planning, building and maintenance process of blue-green solutions. Therefore, employees must have a good general knowledge of both blue and green issues as well as having contacts in the different sectors of the municipality. To conclude we argue that a transition can not only be induced by pilot projects but requires change in legal structures as well as altered financing models for blue-green solutions. Moreover, the ongoing, but slow, change should therefor probably be interpreted as a shift to a new regime, but rather an evolutionary transition where new approaches are combined with traditional, pipe-bound solutions.

Microalgae as biological treatment for municipal wastewater - effects on the sludge handling in a treatment plant.

A mix of microalgae and bacteria was cultivated on pre-sedimented municipal wastewater in a continuous operated microalgae-activated sludge process. The excess material from the process was co-digested with primary sludge in mesophilic and thermophilic conditions in semi-continuous mode (5 L digesters). Two reference digesters (5 L digesters) fed with waste-activated sludge (WAS) and primary sludge were operated in parallel. The methane yield was slightly reduced (≈10%) when the microalgal-bacterial substrate was used in place of the WAS in thermophilic conditions, but remained approximately similar in mesophilic conditions. The uptake of heavy metals was higher with the microalgal-bacterial substrate in comparison to the WAS, which resulted in higher levels of heavy metals in the digestates. The addition of microalgal-bacterial substrate enhanced the dewaterability in thermophilic conditions. Finally, excess heat can be recovered in both mesophilic and thermophilic conditions.

Anaerobic co-digestion of sludge and microalgae grown in municipal wastewater - a feasibility study.

In this study a natural mix of microalgae grown in wastewater of municipal character was co-digested with sewage sludge in mesophilic conditions, in both batch and semi-continuous modes. The semi-continuous experiment was divided into two periods with OLR1 (organic loading rate) of 2.4 kg volatile solids (VS) m-3 d-1 and HRT1 (hydraulic retention time) of 15 days, and OLR2 of 3.5 kg VS m-3 d-1 and HRT2 of 10 days, respectively. Results showed stable conditions during both periods. The methane yield was reduced when adding microalgae (from 200 ± 25 NmL CH4 g VSin-1, to 168 ± 22 NmL CH4 g VSin-1) but VS reduction was also decreased by 51%. This low digestibility was confirmed in the anaerobic batch test. However, adding microalgae improved the dewaterability of the digested sludge. The high heavy metals content in the microalgae resulted in a high heavy metals content in the digestate, making it more difficult to reuse the digestate as fertilizer on arable land. The heavy metals are thought to originate from the flue gas used as a CO2 source during the microalgae cultivation. Therefore the implementation of CO2 mitigation via algal cultivation requires careful consideration regarding the source of the CO2-rich gas.

Fluoride-promoted carbonylation polymerization: a facile step-growth technique to polycarbonates.

Fluoride-Promoted Carbonylation (FPC) polymerization is herein presented as a novel catalytic polymerization methodology that complements ROP and unlocks a greater synthetic window to advanced polycarbonates. The overall two-step strategy is facile, robust and capitalizes on the synthesis and step-growth polymerization of bis-carbonylimidazolide and diol monomers of 1,3- or higher configurations. Cesium fluoride (CsF) is identified as an efficient catalyst and the bis-carbonylimidazolide monomers are synthesized as bench-stable white solids, easily obtained on 50-100 g scales from their parent diols using cheap commercial 1,1'-carbonyldiimidazole (CDI) as activating reagent. The FPC polymerization works well in both solution and bulk, does not require any stoichiometric additives or complex settings and produces only imidazole as a relatively low-toxicity by-product. As a proof-of-concept using only four diol building-blocks, FPC methodology enabled the synthesis of a unique library of polycarbonates covering (i) rigid, flexible and reactive PC backbones, (ii) molecular weights 5-20 kg mol-1, (iii) dispersities of 1.3-2.9 and (iv) a wide span of glass transition temperatures, from -45 up to 169 °C.

Life cycle assessment of sludge management with phosphorus utilisation and improved hygienisation in Sweden.

To provide input to sewage sludge management strategies that address expected new regulations in terms of hygienisation and phosphorus recovery in Sweden, an environmental life cycle assessment (LCA) was made. The LCA identified environmental hot spots for methods that may permit sludge or phosphorus from sludge to be applied on agricultural land. In particular, thermophilic digestion, pasteurisation, thermal hydrolysis, urea treatment and mono-incineration with phosphorus recovery were compared. In addition, a sludge management system involving drying of sludge before use in forestry was investigated. The results showed that some major impacts are related to large uncertainties, such as those related to emissions from sludge storage. It also showed that large gains can be achieved when products from the systems replace other products, in particular when biogas is used to replace natural gas in vehicles, but also when sludge is used in agriculture and forestry. In general, there are small differences between the sludge management methods. Retaining the sludge matrix to allow for its utilisation in agriculture may conflict with keeping emissions to air and water from the sludge matrix low. It is recommended that any sludge management option minimises emissions from sludge to air and water and that resources are recovered and used, in line with the principles of a circular economy.

Generation of a neutral FST baseline for testing local adaptation on gill raker number within and between European whitefish ecotypes in the Baltic Sea basin.

Divergent selection at ecologically important traits is thought to be a major factor driving phenotypic differentiation between populations. To elucidate the role of different evolutionary processes shaping the variation in gill raker number of European whitefish (Coregonus lavaretus sensu lato) in the Baltic Sea basin, we assessed the relationships between genetic and phenotypic variation among and within three whitefish ecotypes (sea spawners, river spawners and lake spawners). To generate expected neutral distribution of FST and to evaluate whether highly variable microsatellite loci resulted in deflated FST estimates compared to less variable markers, we performed population genetic simulations under finite island and hierarchical island models. The genetic divergence observed among (FCT = 0.010) and within (FST = 0.014-0.041) ecotypes was rather low. The divergence in gill raker number, however, was substantially higher between sea and river spawners compared to observed microsatellite data and simulated neutral baseline (PCT > FCT ). This suggests that the differences in gill raker number between sea and river spawners are likely driven by divergent natural selection. We also found strong support for divergent selection on gill raker number among different populations of sea spawners (PST > FST ), most likely caused by highly variable habitat use and diverse diet. The putative role of divergent selection within lake spawners initially inferred from empirical microsatellite data was not supported by simulated FST distributions. This work provides a first formal test of divergent selection on gill raker number in Baltic whitefish, and demonstrates the usefulness of population genetic simulations to generate informative neutral baselines for PST -FST analyses helping to disentangle the effects of stochastic evolutionary processes from natural selection.

Impacts of climate change on rainfall extremes and urban drainage systems: a review.

A review is made of current methods for assessing future changes in urban rainfall extremes and their effects on urban drainage systems, due to anthropogenic-induced climate change. The review concludes that in spite of significant advances there are still many limitations in our understanding of how to describe precipitation patterns in a changing climate in order to design and operate urban drainage infrastructure. Climate change may well be the driver that ensures that changes in urban drainage paradigms are identified and suitable solutions implemented. Design and optimization of urban drainage infrastructure considering climate change impacts and co-optimizing these with other objectives will become ever more important to keep our cities habitable into the future.

Spatiotemporal classification of environmental monitoring data in the Yeongsan River basin, Korea, using self-organizing maps.

Environmental monitoring data for planning, implementing and evaluating the Total Maximum Daily Loads (TMDL) management system have been measured at about 8-day intervals in a number of rivers in Korea since 2004. In the present study, water quality parameters such as Suspended Solids (SS), Biochemical Oxygen Demand (BOD), Dissolved Oxygen (DO), Total Nitrogen (TN), and Total Phosphorus (TP) and the corresponding runoff were collected from six stations in the Yeongsan River basin for six years and transformed into monthly mean values. With the primary objective to understand spatiotemporal characteristics of the data, a methodologically systematic application of a Self-Organizing Map (SOM) was made. The SOM application classified the environmental monitoring data into nine clusters showing exclusively distinguishable patterns. Data frequency at each station on a monthly basis identified the spatiotemporal distribution for the first time in the study area. Consequently, the SOM application provided useful information that the sub-basin containing a metropolitan city is associated with deteriorating water quality and should be monitored and managed carefully during spring and summer for water quality improvement in the river basin.

Genetic population structure of perch Perca fluviatilis along the Swedish coast of the Baltic Sea.

In this study, the genetic variation of perch Perca fluviatilis from 18 different sites along the Swedish coast of the Baltic Sea was assessed. There was a relative strong support for isolation by distance and the results suggest an overall departure from panmixia. The level of genetic divergence was moderate (global F(ST) = 0·04) and indications of differences in the population genetic structure between the two major basins (central Baltic Sea and Gulf of Bothnia) in the Baltic Sea were found. There was a higher level of differentiation in the central Baltic Sea compared to the Gulf of Bothnia, and the results suggest that stretches of deep water might act as barriers to gene flow in the species. On the basis of the estimation of genetic patch size, the results corroborate previous mark--recapture studies and suggest that this is a species suitable for local management. In all, the findings of this study emphasize the importance of considering regional differences even when strong isolation by distance characterize the genetic population structure of species.

Paediatric drug use with focus on off-label prescriptions in Swedish outpatient care--a nationwide study.

AIM: To determine drug prescription and proportion of off-label dispensing in the Swedish paediatric outpatient population. METHODS: All dispensed outpatient prescriptions to children aged 0 < 18 years as well as the proportion of off-label drug use during 2007 were analysed using data from the Swedish Prescribed Drug Register. RESULTS: In total, 2.19 million drug prescriptions of 898 different drug substances were dispensed to paediatric patients, and of those substances, 64% had been dispensed off-label at least once. The overall off-label rate of all prescriptions was 13.5%, among which topical drugs as well as sex hormones were the most commonly prescribed off-label drugs. More than half of all children in Sweden had received at least one prescribed drug in 2007. CONCLUSIONS: There is a high prescribing of medicines to children in outpatient care in Sweden with a considerable amount of off-label prescriptions. Topically administered drugs, sex hormones, antidepressants, hypnotics, cardiovascular drugs and nonsteroidal anti-inflammatory drugs were commonly prescribed off-label.

Preferred sound levels of portable music players and listening habits among adults: a field study.

The main purpose of this descriptive field study was to explore music listening habits and preferred listening levels with portable music players (PMPs). We were also interested in seeing whether any exposure differences could be observed between the sexes. Data were collected during 12 hours at Stockholm Central Station, where people passing by were invited to measure their preferred PMP listening level by using a KEMAR manikin. People were also asked to answer a questionnaire about their listening habits. In all, 60 persons (41 men and 19 women) took part in the questionnaire study and 61 preferred PMP levels to be measured. Forty-one of these sound level measurements were valid to be reported after consideration was taken to acceptable measuring conditions. The women (31 years) and the men (33 years) started to use PMPs on a regular basis in their early 20s. Ear canal headphones/ear buds were the preferred headphone types. Fifty-seven percent of the whole study population used their PMP on a daily basis. The measured LAeq60 sec levels corrected for free field ranged between 73 and 102 dB, with a mean value of 83 dB. Sound levels for different types of headphones are also presented. The results of this study indicate that there are two groups of listeners: people who listen less frequently and at lower, safer sound levels, and people with excessive listening habits that may indeed damage their hearing sensory organ in time.

Clinical trial: the effects of a fermented milk containing three probiotic bacteria in patients with irritable bowel syndrome - a randomized, double-blind, controlled study.

BACKGROUND: The effects of probiotic bacteria in IBS remain controversial. AIM: To study the effects of a probiotic product on IBS symptoms. METHODS: We randomized 74 IBS patients to receive 8 weeks of daily treatment with 400 mL milk fermented with the yoghurt bacteria and containing Lactobacillus paracasei, ssp. paracasei F19, Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 (Cultura; active) or acidified milk without these bacteria (control). The primary endpoint was the proportion of subjects reporting adequate relief of their IBS symptoms at least 50% of the weeks. IBS symptom severity, psychological symptoms and quality of life were assessed. RESULTS: The proportion of responders was 38% (14/37 patients) in the active group and 27% (10/37 patients) in the control group (P = 0.3). IBS symptom severity improved significantly in both groups during the treatment period. This change was greater in the active group during the first 2 weeks, but thereafter, no significant group differences were seen. CONCLUSIONS: We could not detect a clearly positive effect of fermented milk containing three probiotic bacteria on GI symptoms in IBS patients compared with the control treatment. However, a trend towards a more favourable effect during the first weeks was seen in the active group.

Timeliness of care in patients with lung cancer: a systematic review.

BACKGROUND: Timeliness is an important dimension of health care quality. It is unclear whether timeliness improves clinical outcomes in patients with lung cancer. METHODS: This study systematically reviewed studies that described timeliness of care, examined associations between timeliness and clinical outcomes or tested an intervention to improve timeliness of care in patients with lung cancer. English language studies published between 1 January 1995 and 1 June 2007 were included. Two reviewers independently abstracted data on study methods, population, sample size, relevant time intervals and outcomes. RESULTS: 49 studies were identified that reported at least one time interval in lung cancer care, 18 studies that examined the association between timeliness and clinical outcomes and 8 studies that described interventions aimed at improving timeliness. Most studies were performed in European Union member countries, including 24 studies performed in Great Britain and Ireland. Median times to diagnosis (range 8-60 days) and times to treatment (range 30-84 days) often exceeded published recommendations. Three studies found that timely care was associated with better survival, eight found no association and four reported better survival in patients who received less timely care. Interventions that improved timeliness included nurse-led care coordination, multidisciplinary meetings via teleconference and a standardised expedited "two-stop" diagnostic process. CONCLUSIONS: Times to diagnosis and treatment of lung cancer are often longer than recommended. Factors associated with timeliness have been incompletely examined, and it remains unclear whether more timely care improves outcomes.

Determination of detergents in washing machine wastewater with a voltammetric electronic tongue.

A voltammetric electronic tongue (ET) and a conductivity meter were used to predict amounts of detergents in process water from washing machines. The amount of detergent in over sixty samples was also determined by a HPLC reference method. Prediction was more accurate for the electronic tongue, but both techniques could be used. The composition of the detergent, e.g. supporting electrolyte, is an important factor for the ability to predict the detergent quantity by conductivity. Also two different surfactants, alkyl benzyl sulfonate (ABS) and etoxylated fatty alcohol (EOA), were fingerprinted by the HPLC. Their behaviour during the wash cycle differs from each other, ABS rinses away in the same proportions as the supporting electrolyte, but EOA appears to stay within the machine and laundry. Prediction models for ABS are accurate both with ET and conductivity meter, mostly due to the correlation with supporting electrolyte. The behaviour of EOA, with almost no correlation to the supporting electrolyte makes it difficult to predict using conductivity but ET prediction models give promising indications of its capabilities.

Enantioseparation of omeprazole and its metabolite 5-hydroxyomeprazole using open tubular capillary electrochromatography with immobilized avidin as chiral selector.

The present paper demonstrates the enantiomeric separation of omeprazole and its metabolite 5-hydroxyomeprazole performed with open tubular capillary electrochromatography (OT-CEC). The protein avidin was used as the chiral selector. Avidin was immobilized by a Schiffs base type of reaction where the protein was via glutaraldehyde covalently bonded to the amino-modified wall of a fused-silica capillary, 50 microm i.d. Both racemates were baseline resolved. Resolution was 1.9 and 2.3, respectively, using ammonium acetate buffer, pH 5.8, 5% methanol, with UV-detection. These values of resolution using OT-CEC are higher than earlier published results regarding chiral separation of omeprazole and 5-hydroxyomeprazole on packed CEC. The number of theoretical plates also indicated good separation efficiency.

The osmotic link between hypoglycaemia and hypovolaemia.

OBJECTIVE: Hypoglycaemia is regularly accompanied by hypovolaemia. To suggest a mechanism for this phenomenon, we reviewed data from eight studies conducted by our group and examined the circumstances under which rebound hypoglycaemia develops after intravenous infusion of glucose solutions. MATERIAL AND METHODS: Forty healthy volunteers and 40 patients received a total of 122 infusions of glucose solutions at different rates, volumes and concentrations. Plasma glucose and the haemodilution were measured repeatedly during and for at least 2 h after the infusions ended. Glucose kinetics was calculated using a one-compartment turnover model and the plasma volume expansion was estimated from changes in Hb. RESULTS: A strong linear correlation was found between the glucose level and the plasma volume expansion in all series of experiments (p<0.001). After infusion, there was a risk of hypoglycaemia and hypovolaemia developing in healthy volunteers with a high glucose clearance and when infusing glucose solutions of higher concentrations than 2.5 %. Few and mild hypoglycaemic events occurred in patients with insulin resistance, such as in diabetics and in those undergoing surgery. The immediate linear relationship between hypoglycaemia and hypovolaemia suggests an osmotic link between the two parameters. More specifically, infused fluid accompanies glucose during uptake into the cells, while volume expansion by the same fluid has already elicited an effective diuretic response. CONCLUSION: Hypovolaemia is a consequence of hypoglycaemia after intravenous infusion of glucose solution and is caused by the osmotic translocation of fluid from the extracellular to the intracellular fluid space that occurs despite effective renal elimination.

Image analysis for monitoring the barley tempeh fermentation process.

AIMS: To develop a fast, accurate, objective and nondestructive method for monitoring barley tempeh fermentation. METHODS AND RESULTS: Barley tempeh is a food made from pearled barley grains fermented with Rhizopus oligosporus. Rhizopus oligosporus growth is important for tempeh quality, but quantifying its growth is difficult and laborious. A system was developed for analysing digital images of fermentation stages using two image processing methods. The first employed statistical measures sensitive to image colour and surface structure, and these statistical measures were highly correlated (r=0.92, n=75, P<0.001) with ergosterol content of tempeh fermented with R. oligosporus and lactic acid bacteria (LAB). In the second method, an image-processing algorithm optimized to changes in images of final tempeh products was developed to measure number of visible barley grains. A threshold of 5 visible grains per Petri dish indicated complete tempeh fermentation. When images of tempeh cakes fermented with different inoculation levels of R. oligosporus were analysed the results from the two image processing methods were in good agreement. CONCLUSION: Image processing proved suitable for monitoring barley tempeh fermentation. The method avoids sampling, is nonintrusive, and only requires a digital camera with good resolution and image analysis software. SIGNIFICANCE AND IMPACT OF THE STUDY: The system provides a rapid visualization of tempeh product maturation and qualities during fermentation. Automated online monitoring of tempeh fermentation by coupling automated image acquisition with image processing software could be further developed for process control.

Using catchment models to establish measure plans according to the Water Framework Directive.

A participatory modelling process (DEMO) has been developed and applied in a 350 km2 catchment in southern Sweden. The overall goal is to improve the dialogues between experts and local stakeholders by using numerical models as a platform for discussions. The study is focused on reducing nutrient load and on the development of a locally established measure plan, which is requested by the European Water Framework Directive. The HBV-NP model was chosen as it can calculate effects and costs for different allocations of several combined measures in a catchment. This paper shows the impact of including local data in the modelling process vs. using more general data. It was found that modelled diffuse nutrient pollution was highly modified when including local know-how, soft information and more detailed field investigations. Leaching from arable land was found to be 35% higher using more detailed information on for instance, agricultural practices, crop and soil distribution. Moreover, the stakeholders' acceptance of model results and reliance on experts was increased by applying the participatory process and involving stakeholders in the modelling procedure.