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A randomized embedded multifactorial adaptive platform for extra corporeal membrane oxygenation (REMAP ECMO) : design and rationale of the left ventricular unloading trial domain
No full textBackground The use of Extracorporeal Membrane Oxygenation (ECMO) remains associated with high rates of complications, weaning failure and mortality which can be partly explained by a knowledge gap on how to properly manage patients on ECMO support. To address relevant patient management issues, we designed a "Randomized Embedded Multi- factorial Adaptive Platform (REMAP)" in the setting of ECMO (REMAP ECMO) and a first embedded randomized controlled trial (RCT) investigating the effects of routine early left ventricular (LV) unloading through intra-aortic balloon pumping (IABP). Methods REMAP ECMO describes a registry-based platform allowing for the embedding of multiple response adaptive RCTs (trial domains) which can perpetually address the effect of relevant patient management issues on ECMO weaning success. A first trial domain studies the effects of LV unloading by means of an IABP as an adjunct to veno-arterial (V-A) ECMO versus V-A ECMO alone on ECMO weaning success at 30 days in adult cardiogenic shock patients admitted to the Intensive Care Unit (ICU). The primary outcome of this trial is "successful weaning from ECMO" being defined as a composite of survival without the need for mechanical circulatory support, heart transplantation, or left ventricular assist device (LVAD) at 30 days after initiation of ECMO. Secondary outcomes include the need for interventional escalation of LV unloading strategy, mechanistic endpoints, survival characteristics until 1 year after ECMO initiation, and quality of life. Trial data will be analysed using a Bayesian statistical framework. The adaptive design allows for a high degree of flexibility, such as response adaptive randomization and early stopping of the trial for efficacy or futility. The REMAP ECMO LV unloading study is approved by the Medical Ethical Committee of the Erasmus Medical Center and is publily registered. Conclusion This REMAP ECMO trial platform enables the efficient roll-out of multiple RCTs on relevant patient management issues. A first embedded trial domain will compare routine LV unloading by means of an IABP as an adjunct to V-A ECMO versus V-A ECMO alone. Trial registration ClinicalTrials.gov, NCT05913622 (Am HeartJ 2025;279:81-93.)Background The use of Extracorporeal Membrane Oxygenation (ECMO) remains associated with high rates of complications, weaning failure and mortality which can be partly explained by a knowledge gap on how to properly manage patients on ECMO support. To address relevant patient management issues, we designed a "Randomized Embedded Multi- factorial Adaptive Platform (REMAP)" in the setting of ECMO (REMAP ECMO) and a first embedded randomized controlled trial (RCT) investigating the effects of routine early left ventricular (LV) unloading through intra-aortic balloon pumping (IABP). Methods REMAP ECMO describes a registry-based platform allowing for the embedding of multiple response adaptive RCTs (trial domains) which can perpetually address the effect of relevant patient management issues on ECMO weaning success. A first trial domain studies the effects of LV unloading by means of an IABP as an adjunct to veno-arterial (V-A) ECMO versus V-A ECMO alone on ECMO weaning success at 30 days in adult cardiogenic shock patients admitted to the Intensive Care Unit (ICU). The primary outcome of this trial is "successful weaning from ECMO" being defined as a composite of survival without the need for mechanical circulatory support, heart transplantation, or left ventricular assist device (LVAD) at 30 days after initiation of ECMO. Secondary outcomes include the need for interventional escalation of LV unloading strategy, mechanistic endpoints, survival characteristics until 1 year after ECMO initiation, and quality of life. Trial data will be analysed using a Bayesian statistical framework. The adaptive design allows for a high degree of flexibility, such as response adaptive randomization and early stopping of the trial for efficacy or futility. The REMAP ECMO LV unloading study is approved by the Medical Ethical Committee of the Erasmus Medical Center and is publily registered. Conclusion This REMAP ECMO trial platform enables the efficient roll-out of multiple RCTs on relevant patient management issues. A first embedded trial domain will compare routine LV unloading by means of an IABP as an adjunct to V-A ECMO versus V-A ECMO alone. Trial registration ClinicalTrials.gov, NCT05913622 (Am HeartJ 2025;279:81-93.)A
Fictions of financialization : rethinking speculation, exploitation and twenty-first century capitalism /
No full text"For decades, many people on the left have decried the finance sector as the main culprit for the toxic effects of capitalism. Financialization is commonly invoked to explain everything from growing inequality to the housing crises and the destruction of the environment. Only by confronting finance, so the story goes, can there be any hope for a more sustainable economy. In this new intervention, Nick Bernards makes the case against the dominance of this story. Arguing that the concept of financialization is ill-understood and overworked, Bernards shows how we risk glossing over the true nature of capitalism when focusing on the mythical powers of finance. The moralistic distinction between harmful 'financial' and more honest 'real' economies leads to an impasse if we want to better understand how exploitation truly manifests. Rather than indulging in the harmful fantasy that confronting the financial elite will fix the economy, Bernards provides an alternative approach. Starting from the premise that risk and speculation are core to the operation of all capital and not just the hallmark of a perverted financial sector, this Marxist reading of the interconnection between capitalism's uneven exploitation of labour and nature and financial capital lays the groundwork for a much-needed view of the real powers of finance." -- Page 4 of cover.Includes bibliographical references (pages 208-255)."For decades, many people on the left have decried the finance sector as the main culprit for the toxic effects of capitalism. Financialization is commonly invoked to explain everything from growing inequality to the housing crises and the destruction of the environment. Only by confronting finance, so the story goes, can there be any hope for a more sustainable economy. In this new intervention, Nick Bernards makes the case against the dominance of this story. Arguing that the concept of financialization is ill-understood and overworked, Bernards shows how we risk glossing over the true nature of capitalism when focusing on the mythical powers of finance. The moralistic distinction between harmful 'financial' and more honest 'real' economies leads to an impasse if we want to better understand how exploitation truly manifests. Rather than indulging in the harmful fantasy that confronting the financial elite will fix the economy, Bernards provides an alternative approach. Starting from the premise that risk and speculation are core to the operation of all capital and not just the hallmark of a perverted financial sector, this Marxist reading of the interconnection between capitalism's uneven exploitation of labour and nature and financial capital lays the groundwork for a much-needed view of the real powers of finance." -- Page 4 of cover
Magnetic labelling and extraction of micrometer-sized microplastics from soil
No full textUbiquitous microplastics (MP) have emerged as a global environmental concern, recently also in soils. However, limited attention has been given to the behaviour of small-sized MP (< 10 μm) due to the challenges associated with separating and quantifying MP from an exceedingly complex matrix. Here, we show that magnetic labelling of MP greatly increases the efficiency of MP extraction from soil using a magnetic field. Magnetic labelling was achieved by exploiting the glass transition of polystyrene MP sphere. By heating MP (4 µm polystyrene spheres), to induce surface melting in a suspension containing Fe3O4 magnetic nanoparticles (MNS), the MNS were adsorbed onto the MP surface. Subsequent cooling to room temperature, led to fixation of the MNS into the MP surface layer enabling MP extraction using a magnet. Incubating MP and MNS at 90°C for 2.5 h gave the highest MP recovery rate of 92 ± 7% in water. The same MP were then added to a sandy soil suspension to assess and optimize labelling and extraction efficiency of the MP from the soil. The following parameters were optimized: dispersant type, organic matter digestion, and MNS size, concentration, and storage time. Compared to conventional MP detection methods, the MP recovery using magnetic extraction improved from 26% to 94 ± 12%. To the best of our knowledge, this research represents the first successful quantitative extraction of MP < 10 μm from soil and opens new possibilities for fate assessing of small MP and cleaning the environment.Ubiquitous microplastics (MP) have emerged as a global environmental concern, recently also in soils. However, limited attention has been given to the behaviour of small-sized MP (< 10 μm) due to the challenges associated with separating and quantifying MP from an exceedingly complex matrix. Here, we show that magnetic labelling of MP greatly increases the efficiency of MP extraction from soil using a magnetic field. Magnetic labelling was achieved by exploiting the glass transition of polystyrene MP sphere. By heating MP (4 µm polystyrene spheres), to induce surface melting in a suspension containing Fe3O4 magnetic nanoparticles (MNS), the MNS were adsorbed onto the MP surface. Subsequent cooling to room temperature, led to fixation of the MNS into the MP surface layer enabling MP extraction using a magnet. Incubating MP and MNS at 90°C for 2.5 h gave the highest MP recovery rate of 92 ± 7% in water. The same MP were then added to a sandy soil suspension to assess and optimize labelling and extraction efficiency of the MP from the soil. The following parameters were optimized: dispersant type, organic matter digestion, and MNS size, concentration, and storage time. Compared to conventional MP detection methods, the MP recovery using magnetic extraction improved from 26% to 94 ± 12%. To the best of our knowledge, this research represents the first successful quantitative extraction of MP < 10 μm from soil and opens new possibilities for fate assessing of small MP and cleaning the environment.C
Absolute environmental sustainability assessment of the arid Central Asia by downscaling planetary boundaries
No full textAssessing absolute environmental sustainability (AES) is essential to ensure that human activities remain within a safe operating space. However, it remains unclear whether the planetary boundaries (PBs) have been breached in Central Asia. This study analyzed environmental pressures in arid Central Asia from 2000 to 2020 by downscaling PBs and evaluating AES ratios. Environmental distance was applied to identify environmental surpluses or overshoots, while an integrated environmental sustainability index (IESI) was to identify priority management areas. Domestic consumption dominated the environmental footprint during 2000-2020. Besides land footprint, water, carbon, nitrogen, phosphorus and human appropriation of net primary production to Central Asia were mainly from Europe and Asia. Kazakhstan and Uzbekistan were identified as IESI level III, becoming priority management areas for sustainable development. Improving resource utilization efficiency and strengthening trade cooperation can strengthen the PBs of arid Central Asia and promote sustainable environmental development.Assessing absolute environmental sustainability (AES) is essential to ensure that human activities remain within a safe operating space. However, it remains unclear whether the planetary boundaries (PBs) have been breached in Central Asia. This study analyzed environmental pressures in arid Central Asia from 2000 to 2020 by downscaling PBs and evaluating AES ratios. Environmental distance was applied to identify environmental surpluses or overshoots, while an integrated environmental sustainability index (IESI) was to identify priority management areas. Domestic consumption dominated the environmental footprint during 2000-2020. Besides land footprint, water, carbon, nitrogen, phosphorus and human appropriation of net primary production to Central Asia were mainly from Europe and Asia. Kazakhstan and Uzbekistan were identified as IESI level III, becoming priority management areas for sustainable development. Improving resource utilization efficiency and strengthening trade cooperation can strengthen the PBs of arid Central Asia and promote sustainable environmental development.A
Digestive systems in Radclyffe Hall’s Adam’s Breed (1926)
No full textRadclyffe Hall's prize-winning, now largely forgotten 1926 novel Adam's Breed is organised around the processes of eating, digestion, and indigestion. Depicting a community of shopkeepers and restauranteurs in the Italian expat community of London's Soho, it focuses on a waiter who, witnessing a post-WW1 frenzy of hedonistic dining and consuming, becomes disgusted with food and human appetites, eventually retreating from society to become a hermit in the New Forest. In 1924, the British Medical Association had declared 'war on modern diet', condemning just such rich, luxurious, dainty, concentrated, preserved, and foreign foods as fill the shops, restaurants, and pages of Hall's novel. This article demonstrates how Adam's Breed interacts with and satirises such discussions about food and health occurring in the medical sphere, foregrounding food-external food networks, ecologies, and technologies, but also internal embodied experiences of eating-as fundamentally entangled with identity. In addition, it suggests that the novel's form is structured to mirror digestive processes. From tantalising descriptions of food in the early stages of the plot, the novel progresses to unhealthy forms of consuming, stages of surfeit, sickening, indigestion, and finally the expelling and 'passing' of the protagonist. The novel makes experimental use of the digestive system to chew over and break down the complex emotions around, and tensions between, self and community in the wake of the war.Radclyffe Hall's prize-winning, now largely forgotten 1926 novel Adam's Breed is organised around the processes of eating, digestion, and indigestion. Depicting a community of shopkeepers and restauranteurs in the Italian expat community of London's Soho, it focuses on a waiter who, witnessing a post-WW1 frenzy of hedonistic dining and consuming, becomes disgusted with food and human appetites, eventually retreating from society to become a hermit in the New Forest. In 1924, the British Medical Association had declared 'war on modern diet', condemning just such rich, luxurious, dainty, concentrated, preserved, and foreign foods as fill the shops, restaurants, and pages of Hall's novel. This article demonstrates how Adam's Breed interacts with and satirises such discussions about food and health occurring in the medical sphere, foregrounding food-external food networks, ecologies, and technologies, but also internal embodied experiences of eating-as fundamentally entangled with identity. In addition, it suggests that the novel's form is structured to mirror digestive processes. From tantalising descriptions of food in the early stages of the plot, the novel progresses to unhealthy forms of consuming, stages of surfeit, sickening, indigestion, and finally the expelling and 'passing' of the protagonist. The novel makes experimental use of the digestive system to chew over and break down the complex emotions around, and tensions between, self and community in the wake of the war.A