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Evaluating Continuous Glucose Monitoring After Total Pancreatectomy With or Without Islet Autotransplantation
No full textObjectives This scoping review aims to provide evidence synthesis of continuous glucose monitoring (CGM) and insulin pump use after undergone total pancreatectomy (TP) with or without islet autotransplantation (TPIAT).Methods The review was conducted adhering to PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist.Results Fifteen studies including 147 patients (adult n = 71/pediatric n = 76) reported on CGM use post-TP (n = 42) and TPIAT (n = 105). Four were randomized controlled trials and 10 observational studies. Six studies evaluated CGM use in the perioperative and 6 in the immediate postoperative period (n = 8) with variable follow-up (14 hours to 20 months). CGM was used as a stand-alone device (8 studies), which allowed assessment of glycemic variability (n=5) and detection of hypoglycemia (n = 1), resulting in lower glucose levels (n = 1). Six studies evaluated insulin pump with CGM with reduction in postoperative mean glucose (n = 4) and hypoglycemic episodes (n = 2). No patient-reported outcome measures (PROMs) or quality of life (QoL) measures were reported.Conclusions CGM can be used following TP for glucose monitoring and/or linked with insulin pump device in the perioperative period with improved glycemic control. However, the data are limited by short follow-up and lack of PROMs and QoL measures
A pragmatic individually randomized trial to evaluate bivalent RSV prefusion F protein–based vaccine effectiveness for preventing RSV hospitalizations in adults aged 60 years or above (DAN-RSV):Rationale and trial design
Get PDFBackground: Respiratory syncytial virus (RSV) can cause serious illness in older adults and those with chronic conditions. While the bivalent RSVpreF vaccine has been shown to protect against RSV-related respiratory tract disease, its impact on severe RSV-related and broader cardiorespiratory hospitalizations remains untested in a fully powered randomized trial. This pragmatic, individually randomized, open-label, parallel-group trial aims to evaluate RSVpreF vaccine effectiveness (VE) in reducing the risk of RSV-related and all-cause cardiorespiratory hospitalizations in adults aged 60 and older. Methods: DAN-RSV is randomizing Danish adults 1:1 to receive either RSVpreF or no RSV vaccine. The trial uses nationwide registries for recruitment, where eligible citizens are identified and invited via the national electronic messaging system and can provide electronic informed consent remotely. Baseline, safety, and outcome data are collected through the national health registries using the civil registration number provided at consent. Up to 130,000 participants will be enrolled during the 2024/2025 winter season. The primary objective is to assess vaccine effectiveness (VE) against RSV-related respiratory tract disease hospitalization. Secondary endpoints include RSV-related and all-cause lower respiratory tract disease hospitalizations, RSV-related and all-cause cardiorespiratory hospitalizations, and all-cause death. Conclusion: DAN-RSV is an innovative trial combining the gold standard of individual randomization with pragmatic data collection via centralized health records and national health registries. This design offers a feasible approach to assess the impact of RSVpreF on clinically meaningful cardio-respiratory outcomes in adults ≥60 years in a real-world setting – while minimizing bias through use of randomization. The results will support cost-effectiveness analyses and inform future vaccination policies. Trial registration: NCT06684743, registered November 9, 2024 (https://clinicaltrials.gov/study/NCT06684743)</p
Offering semen cryopreservation to transgender persons birth-assigned male:qualitative interviews on motivation and attitudes
Get PDFResearch question: What are the considerations and opinions of individuals assigned male at birth (AMAB) when offered fertility preservation in Denmark, where the preservation of gametes is reimbursed? Design: Qualitative study (n = 10); participants were AMAB individuals undergoing or initiating feminizing gender affirming hormone therapy (GAHT) and recruited from a large Centre for Gender Identity in Denmark and through Danish Facebook groups. The participants underwent semi-structured online interviews supported by an interview guide based on a rigorous information retrieval from published research. The interviews were transcribed and thematic analysis conducted. Results: A number of themes emerged from the data, which highlighted important factors influencing the participants’ fertility preservation decision-making. These included discomfort with the thoughts of delivering male genetic material; infertility being the price to pay; and difficulty imagining the future owing to mental unclarity and gender discomfort in general. The participants generally expressed a parental desire, but not exclusively for biological children. Postponing hormonal treatment and financial considerations about fertility preservation were stated as hypothetical barriers, as those were irrelevant to the Danish participants. Conclusion: The findings emphasized the need for comprehensive fertility preservation counselling before GAHT. The themes were comparable to findings in previous international studies apart from the economic and treatment postponement aspects.</p
Humans can use multimodal osseoperceptive sensory feedback to enhance their sensorimotor control of a robotic hand
Get PDFThe somatosensory function is essential for hand motor control, but it is lost following hand amputation. This study explores the potential of osseoperception — auditory and vibrotactile sensations evoked through bone stimulation — to be used as a multimodal supplementary sensory feedback modality for myoelectric robotic prostheses during object manipulation. By stimulating the wrist at the pisiform bone, the feedback system developed in this study conveyed to the user the two types of information from the digits of a robotic hand prosthesis: discrete contact events and continuous but transitory force feedback, evoking either auditory or vibrotactile sensations by varying the stimulation frequency. Non-disabled participants used the prosthetic hand to perform pick-and-lift tasks of a virtually fragile instrumented object with a predefined breaking threshold. The results demonstrated that when osseoperceptive feedback was provided, participants completed significantly more successful trials with improved motor coordination, enhanced task intuitiveness, and reduced cognitive workload. These findings suggest that osseoperceptive feedback, achieved by stimulating distal bones, is a reliable method to improve force control and overall subjective experience when using upper-limb prostheses, showcasing the potential of osseoperception in assistive robotic technologies.</p
3D CFD modelling of self-heating and self-ignition with parametric investigations in solid fuel stockpiles
No full textOpen-air stockpiles of solid fuels, such as coal and biomass, are susceptible to self-heating and spontaneous combustion due to low-temperature oxidation, moisture migration, and, in the case of biomass, biological processes. Computational fluid dynamics (CFD) combined with experimental data plays a crucial role in predicting and preventing such hazardous occurrences. Compared to conventional 1D and 2D models, 3D modelling provides distinct advantages by faithfully replicating the intricate geometry of the stockpile and accurately accounting for realistic ambient flow conditions, resulting in more reliable simulation results. In this study, a 3D CFD model is developed to numerically replicate the self-heating and self-ignition process within a coal pile as previously reported in the literature. The CFD model, developed using Ansys Fluent, incorporates essential considerations such as low-temperature coal oxidation and water evaporation, and implements various source terms reflective of the chemical and physical processes within the coal pile through User Defined Functions (UDFs). Since the thermal conductivity and mass diffusivity in a coal pile may be in the same order as the local turbulent conductivity and diffusivity, it is crucial to assess whether the flow within the pile is turbulent or laminar and accommodate the correct flow regime within the pile. Our simulation results reveal three distinct stages of self-heating within the coal pile, which are consistent with the observations reported in the literature. Notably, the upper-middle zone inside the coal pile exhibits high temperatures and relatively low oxygen content, primarily limited by the internal air velocity. Key parameters, such as coal pile height, moisture content, wind speed, and heat loss at the pile bottom, are found to significantly impact the self-heating process. The developed CFD model lays the groundwork for a comprehensive and systematic parametric study, from which applicable guidelines for preventing and mitigating fire accidents in coal piles are suggested. This model will be extended to biomass stockpiles by incorporating biological reactions as well as addressing the differences between low-temperature biomass and coal oxidation.</p
Techno-economic evaluation of maximizing minimum liquid discharge from seawater desalination for the fertilizer industry
Get PDFThe Middle East and North Africa region faces critical water scarcity and food security challenges that threaten economic development. Fertilizer use supports food self-sufficiency, but its production is highly water intensive. Supplying desalinated water to a decarbonized fertilizer plant offers an environmentally sustainable pathway.This study investigates co-locating a decarbonized fertilizer plant with a seawater desalination facility, optionally implementing minimum liquid discharge (MLD) to generate additional revenue through recovery of magnesium hydroxide and sodium chloride (NaCl). Three configurations were modeled: a conventional seawater reverse osmosis (SWRO)-based plant; and two MLD configurations using high-pressure RO (HPRO), osmotically-assisted RO (OARO), and crystallizers. Financial performance was assessed using a novel discounted and allocated levelized cost (DALC) method, internal rate of return (IRR), and net present value (NPV).In a Moroccan case study, the conventional configuration achieved the lowest DALC and energy consumption (0.70 USD/m3water and 3.8 KWhel/m3), with an IRR of 23.9 %. The first MLD configuration had higher costs (0.94 USD/m3water, 12.0 KWhel/m3) and a lower IRR (14.5 %), with water recovery limited to 71.4 % due to nonuse of magnesium crystallizer effluent (60.4 % in the conventional setup). Reusing this effluent in the second MLD configuration increased water recovery to 96.7 %, yet higher impurities at the NaCl crystallizer feed reduced the IRR to 9.7 %, which could be improved through financing strategies such as lowering capital costs to endorse the MLD-maximizing option.The findings emphasize advancing impurity removal methods and exploring innovative project financing strategies to enable financially and environmentally sustainable seawater desalination for decarbonized fertilizer production
Rare but Respected: Sustainable Intent in Online Product Search
Get PDFWe study how ethically minded consumers express sustainability in online product search and how query autocompletion (QAC) systems mediate this intent. Using a 1% random sample (3.95 M queries) from the AmazonQAC dataset, we identify sustainable- and consumption-oriented vocabulary through a hybrid lexicon-based approach and analyse how QAC preserves, removes, or introduces such terms. Only about 1% of queries contain explicit sustainability intent, concentrated in categories like Food & Grocery and Health & Beauty. QAC preserves users’ sustainable intent in 60% of cases and adds sustainability-related tokens in a further 40%, indicating that it can reinforce rather than suppress ethical consumption cues. Regression analyses show that these additions occur more often in longer and more frequent queries. Our findings challenge the assumption that digital search infrastructures inherently bias users toward unsustainable consumption and highlight opportunities for QAC design to support responsible shopping behaviour
There Will Be Blood: Fulvia and the Funeral of Clodius
No full textThe role of women in civil war is mostly hidden from plain sight. An exception is Fulvia’s role in the Perusine War and its aftermath. This scrutiny extends also to her role in the funeral of Clodius, which has received its fair share of scholarly attention already. Yet a reappraisal of her role in the funeral of her husband, emphasising at the same time the tremendous value of this event for understanding antebellum Rome, is fertile ground for a new study. It may help us to understand Rome’s systemic breakdown before the civil war proper. By displaying Clodius’ unwashed wounds, Fulvia set a precedent for Antonius’ display of Caesar’s body later. This was a conspicuous stasis/antebellum statement. Consequently, Polybius’ famous description of Roman aristocratic funerals cannot be used in order to reconstruct the funeral of Clodius. This was not yet another development of a longstanding ritual. Nor, in a similar vein, was the funeral of Clodius a straightforward display of wealth as might be expected from typical aristocratic funerary practice. In fact, it was the exception that proves the rule(s). So far from intending to enhance the status of the family or even Clodius, this event—so I will suggest—was rather an intended mobilisation of resentment against the current order of things. Fulvia’s decision to display in public the unwashed and mangled body of Clodius might be compared with Marius’ display of his wounds for political gains. But the context is more cynical and sinister: this was a negative exemplum because of the internal struggles at Rome. More than anything, what we have is a conspicuous and visible political statement, an expression of crisis, as well as an attempt – by Fulvia – to bring stasis and perhaps even civil war back to Rome. This was about cultural and symbolic capital; about reacting to political violence by provoking more of the same. This was an extremely potent statement!<br/
Detailed assessment of dynamic startup, shutdown, and flexibility of the adiabatic, gas-and water-cooled methanol fixed bed reactor: Comparison for power to methanol application
No full textIntegration of intermittent renewable energy with methanol synthesis requires that the reactor and separation system be flexible and tolerant to frequent stop–start operation. In this paper, the dynamic load flexibility, start-up, and shutdown characteristics of the water-cooled, gas-cooled, and adiabatic fixed bed reactor are investigated under hot and cold start modes. Parameters such as the flow rates, compositions, reactor temperature evolution with start-up and shutdown, start-up and shutdown time, and the heat transfer characteristics of the reactor are assessed. Different standby and heat management strategies are discussed. It is shown that the load flexibility range of 20–110 % is attainable in the adiabatic and water-cooled reactor systems applied for mildly exothermic methanol synthesis. The gas-cooled reactor system can tolerate a load range of 40–110 %. The gas-cooled reactor has a shorter start-up (21 min) and shutdown time (6 min) followed by the water-cooled and thereafter adiabatic reactor when nitrogen is used for hot standby management. Using H2 during hot standby shortens the start-up time of the reactors up to 15, 30, and 36 min for the gas-cooled, water-cooled, and adiabatic reactors, respectively. While to reduce cost and alleviate safety concerns during long-duration cold standby, the use of N2 is recommended. Cold start-up can take several hours and depends on thermal transients of the catalysts and reactors. Reactors can tolerate fast ramp rates up to 2.22 %/min for load change range (up and down to 20–110 %), up to 2.7–16.67 %/min for start-up, and 0.067–16.67 %/h for shutdown. Fast ramp rates reduce the CO2 emissions during the start-up. Reactors can operate safely with no load/ramp-induced wrong-way behavior and violation of path constraints
The dynamics of selective environmental disclosure:Earnings pressure and environmental committee
No full textIn an era where environmental information holds growing importance for stakeholders, the phenomenon of selective environmental disclosure remains underexplored in literature. This study centers on this phenomenon and posits that it serves as a catalyst for environmental irresponsibility. Drawing on stakeholder-agency theory, we examine how earnings pressure, measured as the discrepancy between analyst forecast consensus and actual performance, influences a firm’s propensity for selective environmental disclosure. We further investigate the moderating role of environmental committees and their characteristics in shaping the relationship between earnings pressure and selective environmental disclosure. Using data from 1,321 U.S. publicly listed firms from 2005 to 2021, our analysis reveals that earnings pressure significantly increases managers’ engagement in selective environmental disclosure; and the presences of an environmental committee and a CEO serving on that committee amplify this effect. Our findings contribute to the discourse on sustainable operations and offer insights for managerial practices and policy formulation.</p