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Rhetorics of Care + Care-full Rhetoric
No full textAuthor(s):Erin McClellan, Phaedra Pezzullo, Millicent Elewosi, Pamela Pietrucci, Joaquin TorreSession details: HYBRID: Rhetorics of Care + Care-full Rhetori
A Nationwide Factorial Randomized Trial of Electronic Nudges to Patients with Chronic Kidney Disease and Their General Practices for Increasing Guideline-Directed Medical Therapy:The NUDGE-CKD Trial
No full textBACKGROUND: Many individuals with chronic kidney disease (CKD) face a considerable but modifiable risk of cardiovascular and renal outcomes because of suboptimal implementation of guideline-directed medical therapy (GDMT). We investigated whether electronic letter-based nudges delivered to individuals with CKD and their general practices could increase GDMT uptake. METHODS: This was a nationwide 2×2 factorial implementation trial with randomization at the patient and general practice level and analyzed at the patient level. All Danish adults with a hospital diagnosis of CKD and access to the official Danish electronic letter system were individually randomized at a 1:1 ratio to usual care (no letter) or to receive an electronic letter-based nudge on GDMT for CKD; general practitioners of individuals with CKD were independently randomized (1:1) to receive no letter or an electronic informational letter on GDMT. Intervention letters were delivered on August 19, 2024. Data were collected through the Danish administrative health registries. The primary end point was a filled prescription of a renin-Angiotensin system inhibitor or a sodium-glucose cotransporter 2 inhibitor within 6 months of intervention delivery. RESULTS: A total of 22 617 patients with CKD were randomized to the patient-level intervention, with 11 223 allocated to receive the electronic nudge letter and 11 394 to usual care. Separately, 1540 general practices caring for 28 069 patients with CKD were randomized to the provider-level intervention, with 774 practices (13 959 patients) allocated to the intervention and 766 practices (14 110 patients) to usual care. During follow-up, 7303 (65.1%) allocated to the patient-directed nudge had filled a prescription for a renin-Angiotensin system inhibitor or sodium-glucose cotransporter 2 inhibitor compared with 7505 (65.9%) in usual care (difference,-0.79 percentage points [95% CI,-2.03 to 0.45]; P=0.21). Among patients of practices receiving the provider-directed letter, 8921 (63.9%) filled a prescription for a renin-Angiotensin system inhibitor or sodium-glucose cotransporter 2 inhibitor compared with 9086 (64.4%) in the usual care group (difference,-0.49 percentage points [95% CI,-1.64 to 0.66]; P=0.41). No interaction was observed between the two interventions (Pinteraction=0.85). CONCLUSIONS: In this nationwide pragmatic, 2×2 factorial implementation trial, electronic letter-based nudges on GDMT delivered to patients with CKD or their general practice did not increase the uptake of a renin-Angiotensin system inhibitor or sodium-glucose cotransporter 2 inhibitor as compared with usual care. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06300086.</p
Hydrothermal co-liquefaction of rye straw, shellfish, and beef tallow using CaO-MgO-apatite composite catalyst: Hybrid models of biomacromolecules under sub-, near, and supercritical conditions for predicting yield and properties of multiphase HTL products.
No full textIntegrating co-hydrothermal liquefaction (CO-HTL) into a biorefinery requires comprehensive models to predict the yield and quality of all multiphase products. Existing models focus primarily on biocrude yield, with limited consideration of aqueous, gas, and solid co-products, and lack broad applicability to feedstock. This work develops novel hybrid KCV models based on biomacromolecular composition and process variability to predict the yields, O/C and H/C ratios, and HHV values of crude oil and hydrochar. Furthermore, Pearson correlation analysis was implemented to determine the antagonist and synergy effects of N/C ratios, gas yield, aqueous phase properties (TP, TOC, TN), and P content in oil and hydrochar. A total of 34 slurry mixtures was prepared from real feedstocks, rye straw, crab waste, and beef tallow, with the compositional ranges fixed as follows: 0.00–82.45 dw% carbohydrates, 0.00–98.55 dw% lignin, 0.00–40.00 dw% proteins, 0.00–71.62 dw% lipids, and 0.00–40.00 dw% ash. Batch CO-HTL experiments were conducted at 350–400 °C with 0–5 % catalyst derived from crab shells. XRD analysis revealed that the calcined crab shell (CCS) catalyst comprises CaO, CaCO₃, MgO, and SO₃−-bearing apatites, forming a bifunctional heterogeneous surface with strong basic (Ca/Mg-oxide) and acid–base (apatite) sites. CCS promoted deoxygenation via CO2 and H2O removal, yielding low O/C, high H/C biocrude without denitrogenation. It also underwent in-situ carbonation, converting CaO to CaCO3 by consuming CO2 and favoring decarboxylation. Model validation showed high accuracy (ANOVA: p ≤ 0.0001, 0.70 ≤ R2 ≤ 0.97) and consistency with external literature, supporting expandability to other organic feedstocks
Towards Trustworthy AI: A Framework for Integrating Ethics Committees into Product Development
No full textProduct teams developing artificial intelligence (AI) increasingly create so-lutions with societal consequences and ethical implications. However, they often lack the ability to anticipate or mitigate ethical risks during develop-ment, relying primarily on legal compliance review and ex-post accounta-bility. To address this challenge, this paper proposes that product teams can learn from structured ethical oversight procedures, well-established in healthcare, defense, and other high-stakes domains. Guided by this logic, we introduce the Sprint Ethics Board (SEB), a lightweight governance framework that adapts established committee models to agile workflows in product teams. The SEB is defined by three features (1) clear trigger points tied to product milestones, (2) a core group of members—product decision authority, ethical and domain expertise, and an external stakeholder advo-cate—that together form the minimum credible quorum for oversight, and (3) artefacts—a one-page Ethics Brief and a machine-readable Decision Log—that integrate into the sprint toolchain in product development. To-gether, these features enable the SEB to satisfy regulatory demand and move toward trustworthy AI in product development. The paper offers a design framework and outlines a research agenda to evaluate the SEB empirically in industry contexts. By suggesting how ethical review procedures can be translated into agile decision-making in product teams, the SEB reframes ethics oversight from a retrospective safeguard into a proactive, enforceable, and auditable function of product delivery. If adopted, the SEB framework can serve as a firm foundation for Ethical AI development
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
A concept for high efficiency operation of a proton exchange membrane electrolyzer
No full textWe present fundamental calculations to identify operating conditions of a proton exchange membrane electrolyzer such that the product gases are exactly saturated with water vapor. The required stoichiometric flow ratios depend strongly on the electrolyzer temperature and reactant pressures, and they are below = 3 which necessitates a symmetric electrolyzer design and uniform water feeding. Preheating the incoming water leads to a voltage gain in the order of 50 mV, and it is shown, how the electrolyzer temperature can conceivably be controlled via the water flow rate. The analysis results in diagrams to determine suitable operating conditions for three different electrolyzer operation modes: standby operation to reduce the startup time, normal operation and high-power operation with efficiencies of 96%, 91%, and 86%, respectively. A comparison with literature data gives indications about the expected current densities at the respective voltages. Finally, it is suggested that electrolyzer operation where the anode side pressure is at a partial vacuum can facilitate the proposed operation mode as well as reduce the iridium loading
Recent advancements in antibiotics removal by bio-electrochemical systems (BESs): From mechanisms to application of emerging combined systems
No full textRecent advancements in bio-electrochemical systems (BESs) for antibiotic removal are receiving great attentions due to the electro-active bacteria on the electrode that could elevate the removal efficiency. Enhanced detoxification performance of BESs compared to the traditional biological processes indicates the great potential serving as a sustainable alternative or a pre-/post-processing unit to improve the performance of biological processes. However, the successfully application of BESs to antibiotic-polluted water remediation requires a deeper discussion on their operational performance and emerging coupled systems. In order to address BESs as a practical option for antibiotic removal, we deeply analyze the detoxification mechanism of antibiotic treatment by BESs, involving BES fundamentals, extracellular electron transfer and degradation pathways via functional enzymes of microorganisms, followed by systematic evaluations of the operational conditions. Furthermore, the recently-emerged BESs combined with other techniques for practical applications has been summarized and emphasized. This review further directions the current limitations such as the potential risk of antibiotic resistance genes, etc., and prospects for the attenuation of antibiotics via BESs related techniques, promoting the development of practical application
Elevated lipoprotein(a) levels are independently associated with the presence of significant coronary stenosis in de-novo patients with stable chest pain
No full textBackground: The role of lipoprotein(a) (Lp(a)) in the risk-assessment of patients with de-novo stable chest pain is sparsely investigated. We assessed the association between Lp(a) concentration and the presence of coronary stenosis on coronary computed tomography (CT) angiography in a broad population of patients referred with stable chest pain. Methods: Lp(a) measurements and coronary CT angiography were performed in 4,346 patients with stable chest pain and no previous history of coronary artery disease. The patients were included in the trial program, the Danish study of Non-Invasive testing in Coronary artery disease, Dan-NICAD. The prevalence and odds ratios for stenosis were calculated comparing normal Lp(a) (< 20 nmol/l) with moderately elevated (20 to <125 nmol/l), high (125 to <200 nmol/l), and very high (≥200 nmol/l) Lp(a) concentrations in both univariate and multivariate analyses. Results: In total, 2,418 (55.6%), 1,276 (29.4%), 425 (9.8%), and 227 (5.2%) patients had normal, moderately elevated, high, and very high Lp(a) levels, respectively. The prevalences of coronary stenosis increased with increasing Lp(a) concentration (n = 569 (23.5%), n = 328 (25.7%), n = 129 (30.4%), and n = 77 (33.9%) in patients with normal, moderately elevated, high, and very high Lp(a), respectively). Likewise, the prevalence of patients with multivessel disease increased with increasing Lp(a) concentration (n = 252 (10.4%), n = 149 (11.7%), n = 61 (14.4%), and n = 41 (18.1%) in patients with normal, moderately elevated, high, and very high Lp(a), respectively). In an unadjusted model, odds ratios for stenosis increased with increasing Lp(a) concentrations odds ratio 95% CI: 1.12 (0.96-1.31), 1.42 (1.13-1.77), and 1.67 (1.24-2.22) for moderately elevated, high, and very high Lp(a) versus normal Lp(a), respectively). Adjustment for age, sex, and cardiovascular risk factors did not affect the association. Conclusions: In stable, symptomatic patients without established coronary artery disease, Lp(a) levels are positively associated with the presence of coronary stenosis on coronary CT angiography. These findings may warrant using Lp(a) in the diagnostic management of patient with suspected coronary artery disease. Trial Registration: The 3 studies within the Dan-NICAD program are registered on ClinicalTrials.gov: Dan-NICAD, NCT02264717, https://clinicaltrials.gov/study/NCT02264717?term=dan-nicad&rank=1. Dan-NICAD 2, NCT03481712, https://clinicaltrials.gov/study/NCT03481712?term=dan-nicad&rank=3. Dan-NICAD 3, NCT04707859, https://clinicaltrials.gov/study/NCT04707859?term=dan-nicad&rank=2.</p
Screening for dysphagia in older people: A validation study of the psychometric properties of the Danish 4 Question Test (4QT-DK)
No full textAIM: The four-item questionnaire test (4QT) is a simple screening measure of dysphagia for older people. A positive answer to any item indicates the need for further assessment. The 4QT is fast, simple to apply and requires no training beforehand. However, it is not translated to Danish, and the psychometric properties in an older Danish population are unknown. The aim was to translate the 4QT to Danish, determine criterion validity according to the existing measures, the Minimal Eating Observation Form-II (MEOF-II) and Volume-Viscosity Swallow Test (V-VST), and determine construct and structural validity and reliability by exploring whether 4QT fits the assumptions of the Rasch model.METHODS: The 4QT was translated and back-translated. A total of 73 participants aged ≥65 years were included and screened with the 4QT-DK, and assessed using the V-VST and MEOF-II. Criterion validity was assessed compared with the V-VST and MEOF-II according to sensitivity, specificity and predictive values. Construct and structural validity were examined using confirmatory factor analysis and Rasch model analysis investigating item and person fit, differential item functioning for sex, age, primary disease and local dependency. Reliability was assessed using Cronbach's coefficient alpha.RESULTS: For criterion validity, the 4QT-DK showed high sensitivity (84% and 90% with the V-VST and MEOF-II, respectively). As expected, specificity was lower (36%, and 42%). Analyses confirmed the psychometric validity of the 4QT-DK. Reliability was low (Cronbach's alpha = 0.58) due to the number of items.CONCLUSION: The 4QT-DK is a valid and sensitive measure for screening older people for dysphagia. Further studies are required to assess the psychometric properties and confirm findings in a larger Danish sample. Geriatr Gerontol Int 2025; 25: 294-299.</p
Clinical likelihood models calibrated against observed obstructive coronary artery disease on computed tomography angiography
No full textAims: Models predicting the likelihood of obstructive coronary artery disease (CAD) on invasive coronary angiography exist. However, as stable patients with new-onset chest pain frequently have lower clinical likelihood and preferably undergo index testing by non-invasive tests such as coronary computed tomography angiography (CCTA), clinical likelihood models calibrated against observed obstructive CAD at CCTA are warranted. The aim was to develop CCTA-calibrated risk-factor- and coronary artery calcium score-weighted clinical likelihood models (i.e. RF-CLCCTA and CACS-CLCCTA models, respectively). Methods and results: Based on age, sex, symptoms, and cardiovascular risk factors, an advanced machine learning algorithm utilized a training cohort (n = 38 269) of symptomatic outpatients with suspected obstructive CAD to develop both a RF-CLCCTA model and a CACS-CLCCTA model to predict observed obstructive CAD on CCTA. The models were validated in several cohorts (n = 28 340) and compared with a currently endorsed basic pre-test probability (Basic PTP) model. For both the training and pooled validation cohorts, observed obstructive CAD at CCTA was defined as >50% diameter stenosis. Observed obstructive CAD at CCTA was present in 6443 (22.7%) patients in the pooled validation cohort. While the Basic PTP underestimated the prevalence of observed obstructive CAD at CCTA, the RF-CLCCTA and CACS-CLCCTA models showed superior calibration. Compared with the Basic PTP model, the RF-CLCCTA and CACS-CLCCTA models showed superior discrimination (area under the receiver operating curves 0.71 [95% confidence interval (CI) 0.70-0.72] vs. 0.74 (95% CI 0.73-0.75) and 0.87 (95% CI 0.86-0.87), P < 0.001 for both comparisons). Conclusion: CCTA-calibrated clinical likelihood models improve calibration and discrimination of observed obstructive CAD at CCTA.</p