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Background An effective emergency medical dispatch process is vital to provide appropriate prehospital care to patients. It increases patient safety and ensures the sustainable use of medical resources. Although Copenhagen has a sophisticated emergency medical services (EMS) system with a significant focus on public welfare, more than 10% of emergency cases are still being categorized as an "unclear problem category" (UPC) and are thus not categorized as "symptom-specific". Therefore, the objective of this research is to gain a better understanding of the patient and dispatch characteristics of emergency cases categorized as "unclear". Methods This register-based study based on medical emergency cases data describes patient and dispatch characteristics of emergency cases categorized as “unclear” through the use of numbers and proportions. Moreover, these cases were compared to non UPC cases. Use of UPC was stratified by month to determine the impact of alerting medical dispatchers to reduce its use. Results From 296,398 included cases UPC accounted for 11.4% of the cases. The median age of those triaged with the UPC was 66 years vs 58 years for individuals triaged with other symptom-specific categories. Moreover, after having been triaged with the UPC, 9,661 (34.7%) of the dispatched EMS vehicles ended up being cancelled. Sensitizing medical dispatchers about the use of the UPC likely contributed to the decreased use of the UPC over time. Conclusion The UPC has different dispatch characteristics than the symptom-specific categories, with potential negative effects on the medical dispatch process. Moreover, the median age of individuals triaged with the UPC is higher than those triaged with symptom-specific categories. Nonetheless, the use of the UPC decreased throughout the study period after the medical dispatchers were alerted about the implications of its use.

ObjectiveAn effective emergency medical dispatch process is vital to provide appropriate prehospital care to patients. It increases patient safety and ensures the sustainable use of medical resources. Although Copenhagen has a sophisticated emergency medical services (EMS) system with a significant focus on public welfare, more than 10% of emergency calls are still being categorized as an "unclear problem" and are thus not categorized as "symptom-specific". Therefore, the objective of this research is to gain a better understanding of underlying implications that lead to the categorization of an emergency call as "unclear". This research investigates the effects of the "unclear problem" category (UPC) on the medical dispatching process at the emergency medical dispatch center in Copenhagen. Also, it explores the effectiveness of educating medical dispatchers about the use of the UPC to reduce its use. MethodsThis was a register-based study based on medical emergency call data. Descriptive analyses were conducted to investigate the effect of using the UPC on the medical dispatching process and determine the impact of alerting medical dispatchers to reduce its use. ResultsThe UPC accounted for 11.4% of the calls. Elderly patients were most often dispatched with the UPC. The UPC could impact the medical dispatching process in several potentially harmful, ways. Namely, it could lead to under or over triage and lead to inefficient use of EMS resources. Sensitizing medical dispatchers about the use of the UPC could have contributed to the decrease in the use of the UPC. ConclusionThe use of the UPC could have negative implications on patients' outcomes and the efficient use of EMS resources due to its possible impact on over-or under triage. The UPC is mainly used when dispatching the elderly. Nonetheless, the use of the UPC decreased throughout the study period after the medical dispatchers were alerted about the implications of its use.

Considerable efforts have been made to estimate the lifetime of power devices, e.g., IGBTs, when they are subjected to a specific loading profile, which is affected by real field mission profiles. In those cases, a yearly mission profile, e.g., ambient temperatures, wind speeds and solar irradiance levels, is adopted. However, the prior art assumes that the same accumulated damage is caused in each year during the operation of the solutions. In practice the mission profile will vary, making the assumption invalid. This paper thus examines the assumption of equally distributed damage accumulation throughout the lifetime, by analyzing multiple years of mission profiles.

In power electronic-based power systems (PEPS), challenges are arising such as how to ensure a reliable power system, although increasingly efforts have been made to enhance the reliability of power electronics at the component-level and converter-level. Existing methods for single converter reliability analysis might not be scalable for system-level reliability analysis in power systems. Thus, this paper presents a general concept on the reliability analysis in PEPS to curb the arising issues. The concept considers the individual reliability matrices and more importantly, takes the complicated interactions and cross coupling-effects among multiple converters into account and thereby improve the reliability of next generation power systems. This will be beneficial for power system operators, end-users and the average electrical consumer with the possibility to decrease the costs related to component failures, maintenance and also system downtime as a result of advancing the system reliability.

Of the two constraint criteria in Article 76(5–6) of the 1982 United Nations Convention on the Law of the Sea, only the distance constraint may be applied on submarine ridges. But on submarine elevations that are natural components of the continental margin, the two constraints may be combined. In its Scientific and Technical Guidelines, the Commission on the Limits of the Continental Shelf recommends a number of considerations regarding the selection of points along the 2,500-meter isobath with regard to the construction of applicable depth constraint lines. However, in its considerations of coastal states’ outlined outer limits, there are clear inconsistencies between the principles adopted by the Commission and the Guidelines governing the determination of valid 2,500-meter isobaths for the purpose of delineating the outer limits of the continental shelf. Further, and more importantly, the consistency of the approach embraced by the Commission with Article 76(6) of the LOS Convention may be questioned.

In Moraxella (Branhamella) catarrhalis and Moraxella nonliquefaciens strains isolated from clinical specimens in the south of Sweden two variants of beta-lactamase were distinguished by isoelectric focusing (IEF). The BRO-1 (Ravasio type) enzyme was the most common in Branhamella catarrhalis, constituting about 90% of the beta-lactamase found in this species, while the BRO-2 enzyme (1908 type) was as common as BRO-1 in Moraxella nonliquefaciens. The determinants mediating the production of BRO-1 and BRO-2 were both transferable by conjugation. Cell-bound beta-lactamase from reference strains producing BRO-1 and BRO-2 could be solubilized by papain digestion. The isoelectric point of the solubilized enzymes differed distinctly between BRO-1 (pI 6.5) and BRO-2 (pI 6.9). The molecular species of BRO-1 and BRO-2 released by papain digestion were purified by affinity chromatography with phenylboronic acid agarose gel. They had identical molecular weights of approximately 28,000. Their kinetic constants were indistinguishable for a number of substrates and beta-lactamase inhibitors.

The plasmid-mediated beta-lactamase in Branhamella catarrhalis (BRO-1), also occurring in Moraxella nonliquefaciens, differs from other known plasmid-mediated beta-lactamases in Gram-negative bacteria regarding substrate profile and isoelectric point. B. catarrhalis strains previously reported to produce beta-lactamases deviating from BRO-1 were tested, and the beta-lactamases did not differ significantly from BRO-1 in substrate profile, isoelectric point or relative substrate affinity index (RSAI). Further investigations of strains of various geographic origin should be undertaken. RSAI seems to be a useful tool for screening of beta-lactamases in B. catarrhalis since values for a large number of strains can easily be determined. The previously reported conjugational transfer of BRO-1 production within species B. catarrhalis and from M. nonliquefaciens to B. catarrhalis was confirmed. Four bands of extrachromosomal DNA were regularly detected by agarose gel electrophoresis in beta-lactamase-producing as well as in beta-lactamase-negative strains of B. catarrhalis and M. non-liquefaciens, provided that the excessive nuclease activity in the preparations was inhibited.

Intrageneric and intergeneric conjugational transfer of beta-lactamase production to a Branhamella catarrhalis recipient is described. The branhamella donor strains were fresh isolates subcultured onto penicillin-containing media directly from the primary plates. A beta-lactamase positive Moraxella nonliquefaciens served as donor in the intergeneric matings. The substrate profiles of the branhamella and moraxella enzymes were indistinguishable as determined by biological assays. Excessive endonuclease activity did not permit a conclusive characterization of isolated extrachromosomal DNA from the branhamella donors.