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Cost analysis of admitting nursing home residents to hospital at home:A Danish micro-costing approach
Full text linkOBJECTIVES: Hospital at Home (HaH) is a new care concept aimed at reducing hospital admissions by providing specialised healthcare to patients at home. The aim of this study was to compare the cost of a HaH model with traditional hospital admission for nursing home residents with acute illness in the Northern Region of Denmark.STUDY DESIGN: This study employed a retrospective micro-costing approach based on initial findings from the early implementation of the HaH model. The analysis was conducted from a healthcare sector perspective.METHODS: A comprehensive framework for cost analysis was developed based on policy documents, clinical guidelines, and interviews with administrative and leading healthcare professionals. Data on resource usage was obtained from clinical experts and case notes. Costs for resource usage were valued using payroll data for different job categories and Danish DRG-tariffs. The estimated costs of care models were compared and deterministic sensitivity analysis identified important factors for the cost difference.RESULTS: The analysis showed that the HaH model is associated with cost savings of 40-45 % compared to traditional hospital admissions. Furthermore, the sensitivity analysis indicate that it is crucial to consider the extent of additional time healthcare professionals allocate to extra care, when a nursing home resident is admitted at home, as this parameter significantly influences the costs associated with HaH.CONCLUSIONS: Based on the costing framework, we found that the HaH model was cheaper than traditional hospitalisations. These results were robust to variations in resource use of different activities in the HaH model.</p
Reflection of serum PCB concentrations in silicone wristbands, hand wipes, indoor air, and dust and the associations between exposure and thyroid hormone homeostasis
Full text linkPolychlorinated biphenyls (PCBs) are legacy contaminants that are enduring indoor environmental problems due to historical applications. Among residents living in PCB-contaminated and reference apartments, we compared the effectiveness of personal and environmental samples for determining exposure through associations with 14 serum PCBs and explored potential effects on thyroid biomarkers. Silicone wristband PCBs were strongly correlated with serum measurements, particularly for lower chlorinated PCBs (rs=0.59-0.82), and showed for the first time that wristbands are effective indicators of internal dose for PCBs. Similar correlations were observed for indoor air and dust, and hand wipes were significantly associated with serum for all congeners (rs=0.44-0.73). Stratified analyses, which accounted for some participant characteristics, demonstrated that significant relationships were specific to those living in contaminated apartments and most focused among lower chlorinated congeners. Here, residents had lived in their homes for many years (mean>10 years) and spent most of their time at home, due in part to being a majority aging population. As such, the four external exposure measures were strongly inter-correlated across the congeners. We also observed associations with free triiodothyronine (T3) and ratio between T3 and thyroxine (T4) in the exposed population. T3 and PCB-28 shared a significant, inverse dose-response relationship, with 13 and 17% decreases in T3 for the second and third serum PCB-28 tertiles, respectively. Our results suggest that any of the four sample types collected in this exposure scenario accurately pointed to elevated PCB exposure and that this exposure was associated with a change in thyroid hormone homeostasis.</p
Cancer risk with tocilizumab/sarilumab, abatacept, and rituximab treatment in patients with rheumatoid arthritis: a Danish cohort study
No full textObjectives: To investigate cancer risk in rheumatoid arthritis (RA) patients treated with tocilizumab/sarilumab, abatacept, or rituximab compared with those who received tumour necrosis factor inhibitors (TNFi) and compared with biological disease-modifying anti-rheumatic drugs (bDMARD) naïve RA patients.Methods: Nationwide registry-based cohort study of RA patients initiating treatment with tocilizumab/sarilumab, abatacept, rituximab, TNFi, and bDMARD-naive patients their second type of conventional synthetic DMARD (csDMARD). Patients were identified in DANBIO and followed for cancer from 2006-2020. Patients could contribute multiple treatments, with person years (PYRS), deaths, and cancers allocated to each treatment group in a 'latest type of treatment' manner. Inverse probability of treatment weighting and weighted cause-specific Cox models were used to calculate hazard ratios (HRs) for cancer in each tocilizumab/sarilumab, abatacept, and rituximab group compared with TNFI and bDMARD naïve groups, respectively.Results: In total, 21 982 treatment initiations, 96 475 PYRS, and 1423 cancers were identified. There were no statistically significant increased HRs for overall cancer in tocilizumab/sarilumab, abatacept, or rituximab treatment groups (HRs ranged from 0.7-1.1). More than five years of abatacept exposure showed a non-significantly increased HR compared with TNFi (HR 1.41, 95% confidence intervals CI 0.74-2.71). For hematological cancers, rituximab treatment showed non-significantly reduced HRs: vs TNFi (HR 0.09; 95%CI 0.00-2.06) and bDMARD-naïve (HR 0.13; 95%CI 0.00-1.89).Conclusion: Treatment with tocilizumab/sarilumab, abatacept, or rituximab in RA patients was not associated with increased risks of cancer compared with TNFi-treated and with bDMARD-naïve RA patients in a real-world setting.Objectives: To investigate cancer risk in RA patients treated with tocilizumab/sarilumab, abatacept or rituximab compared with those who received TNF inhibitors (TNFi) and compared with biological DMARDs (bDMARD)-naïve RA patients. Methods: Nationwide registry-based cohort study of RA patients who initiated bDMARD treatment with tocilizumab/sarilumab, abatacept, rituximab, and TNFi, as well as bDMARD-naive patients who initiated their second type of conventional synthetic DMARD. Patients were identified in the Danish Rheumatology Quality Register (DANBIO) and followed for cancer from 2006 to 2020. Patients could contribute multiple treatments, with person years, deaths and cancers allocated to each treatment group in a ‘latest type of treatment’ manner. Inverse probability of treatment weighting and weighted cause-specific Cox models were used to calculate hazard ratios (HRs) for cancer in each tocilizumab/sarilumab, abatacept and rituximab group compared with TNFi-treated and bDMARD-naïve groups, respectively. Results: In total, 21 982 treatment initiations, 96 475 person years and 1423 cancers were identified. There were no statistically significant increased HRs for overall cancer in tocilizumab/sarilumab, abatacept or rituximab treatment groups (HRs ranged from 0.7 to 1.1). More than 5 years of abatacept exposure showed a non-significantly increased HR compared with TNFi (HR 1.41, 95% CI 0.74–2.71). For haematological cancers, rituximab treatment showed non-significantly reduced HRs: vs TNFi-treated (HR 0.09; 95% CI 0.00–2.06) and bDMARD-naïve (HR 0.13; 95% CI 0.00–1.89). Conclusion: Treatment with tocilizumab/sarilumab, abatacept or rituximab in RA patients was not associated with increased risks of cancer compared with TNFi-treated and with bDMARD-naïve RA patients in a real-world setting.</p
Hierarchical online energy management for residential microgrids with Hybrid hydrogen–electricity Storage System
No full textThe increasing proportion of renewable energy introduces both long-term and short-term uncertainty to power systems, which restricts the implementation of energy management systems (EMSs) with high dependency on accurate prediction techniques. A hierarchical online EMS (HEMS) is proposed in this paper to economically operate the Hybrid hydrogen–electricity Storage System (HSS) in a residential microgrid (RMG). The HEMS dispatches an electrolyzer-fuel cell-based hydrogen energy storage (ES) unit for seasonal energy shifting and an on-site battery stack for daily energy allocation against the uncertainty from the renewable energy source (RES) and demand side. The online decision-making of the proposed HEMS is realized through two parallel fuzzy logic (FL)-based controllers which are decoupled by different operating frequencies. An original local energy estimation model (LEEM) is specifically designed for the decision process of FL controllers to comprehensively evaluate the system status and quantify the electricity price expectation for the HEMS. The proposed HEMS is independent of RES prediction or load forecasting, and gives the optimal operation for HSS in separated resolutions: the hydrogen ES unit is dispatched hourly and the battery is operated every minute. The performance of the proposed method is verified by numerical experiments fed by real-world datasets. The superiority of the HEMS in expense-saving manner is validated through comparison with PSO-based day-ahead optimization methods, fuzzy logic EMS, and rule-based online EMS.</p
Optimizing carbon emission reduction strategies in power batteries:Ensuring compliance with the EU battery regulation's carbon labeling initiatives
No full textReducing carbon emissions from power batteries is essential for the low-carbon development of electric vehicles (EVs). In response to the carbon labeling requirements of the EU battery regulation, this study developed a three-tiered supply chain model incorporating the battery material supplier, the power battery manufacturer, and the EV company. Using Stackelberg game theory, the research evaluated four carbon emission reduction strategies and analyzed the impact of consumer environmental awareness on carbon emissions. The results reveal that for batteries with lower initial carbon footprints, increased consumer environmental awareness is associated with a reduction in carbon emissions. For batteries with higher initial carbon footprints, the relationship between consumer environmental awareness and carbon emissions is more complex. Below a certain threshold, higher environmental awareness leads to carbon emission reduction; however, beyond this threshold, increased environmental awareness can elevate carbon emissions. Moreover, under low consumer environmental awareness, a strategy of comprehensive collaboration among all supply chain tiers yields the highest economic benefits, albeit with higher emissions. As environmental awareness rises, the strategy where the material supplier independently reduces emissions and the battery manufacturer and EV company collaborate on emission reductions emerges as the most effective, striking an optimal balance between economic and environmental interests.</p
Individualized Pain Treatment in Chronic Pancreatitis (INPAIN): An International, Multicenter, Investigator-initiated, Prospective, Cohort Study
No full textINTRODUCTION: Pain is the foremost complication of chronic pancreatitis (CP), affecting about 70% of patients. However, the pathophysiological understanding and management of CP-related pain is complex, likely as patients have diverse "pain phenotypes" responding differently to treatment. This study aims to develop a bedside test panel to identify distinct pain phenotypes, investigate the temporal evolution, and determine whether they can be used to predict treatment response.METHOD: The INPAIN study is an international, multi-center, observational, longitudinal cohort study comprised of 4 sub-studies. The studies will prospectively enroll 400 CP patients (50 without pain and 350 with pain) and 50 control subjects, conducting biannual observations for four years. The test panel is comprised of comprehensive subjective and objective assessment parameters. Statistical analysis strategies differ across the sub-studies. A model to predict treatment efficacy will be developed using various machine learning techniques, including an artificial intelligence approach, with internal cross-validation. Trajectories in pain parameters will be characterized by graphical analysis and mixed effect models.DISCUSSION: The INPAIN study aims to comprehensively understand pain in CP through a test panel developed for routine clinical use. This tool has the potential to personalize treatments, improve clinical practice, enhance patient care, improve quality of life, and minimize treatment side effects.</p
Advancements in Membrane Technology for Industrial Effluent Wastewater Treatment
No full textSpecifically, the chapter examines membrane technologies for industrial wastewatertreatment in three key sectors: (i) pulp and paper mills, (ii) the metalworking sector, and(iii) the oil and gas industry. In the pulp and paper industry, two notable large-scaleintegrated pilots are highlighted, which combine reverse osmosis (RO) with bioreactorsto produce high-quality water suitable for reuse, thereby reducing the demand forexternal freshwater. For metalworking wastewater (MWW), the significance of tubularceramic ultrafiltration (UF) is emphasized within two different integrated schemes,demonstrating its ability to produce reusable water when coupled with conventionalfiltration processes or thermal-based technologies. Finally, an interesting case study forproduced water (PW) treatment was reported, exploiting a pilot-scale microfiltration(MF) unit made of silicon carbide membranes that could be used with upstream physicalseparation methods to reach water reuse quality.The results from all three industrial case studies underscore the practical applicationand effectiveness of these technologies in improving the quality of treated industrialeffluents for reuse or discharge, thereby enhancing the sustainability of industrialwastewater management. However, two primary challenges remain: the high investmentcosts of these novel integrated schemes and the fouling/scaling phenomena of themembranes, which limit their implementation on an industrial scale
Et tomt review:Interesse- og foreningsfællesskaber efter Erhvervet Hjerneskade
No full textFællesskaber er et yderst aktuelt emne, og der er bred enighed om vigtigheden heraf. At kunne deltage og indgå ligeværdigt i meningsfulde fællesskaber er en helt central del af livet, men ofte bliver fællesskaber reduceret til sygdomsfællesskaber i rehabiliteringsregi – det være sig dag- og aktivitetstilbud. Det er dog vigtigt, at der også fokuseres på inddragelse af almene fællesskaber som en del af rehabiliteringen, da almene fællesskaber kan være brobyggende til lokalsamfund og derved være mere bæredygtige på lang sigt. For at indkredse betydningen af fællesskaber vil vi gennem dette review undersøge betydningen af deltagelse i foreningslignende fællesskaber efter erhvervet hjerneskade. Reviewet er udført som et scoping review med fokus på fænomenet foreningslignende fællesskaber og betydning af deltagelse i disse for personer med erhvervet hjerneskade (EH). Gennem reviewet undersøges derfor: Hvilken betydning har det at deltage i foreningslignende fællesskaber efter erhvervet hjerneskade?Der blev gennem den systematiske søgning ikke identificeret nogen studier, som imødekom inklusionskriterierne. Der er derfor tale om et tomt review. Med udgangspunkt i den manglende identificering af relevante studier diskuteres begrebet foreningslignende fællesskaber og deres betydning for mennesker med en EH, samt hvordan erfaringer fra andre områder kan kvalificere fremtidig forskning
Self-heating characteristics of rice straw in a 120-L insulated container:Experiments & CFD studies
No full textSelf-heating in biomass piles poses significant challenges for storage safety and management, yet comprehensive models that integrate the underlying microbial, chemical, and physical mechanisms remain scarce. In this study, gas flow resistance experiments were conducted on rice straw piles to characterize their physical behavior, leading to the development of a porous media flow resistance model. This model was integrated into a coupled self-heating framework that incorporates biological, chemical, and physical processes. Numerical simulations using this coupled model were conducted to investigate the self-heating behavior of rice straw within a 120 L insulated container and to evaluate the model's sensitivity and adaptability to various influencing factors. Model predictions showed good agreement with experimental data, with peak temperature errors within 2 °C. Both the Tremier-CTMI and Haug-CTMI microbial metabolism models accurately captured the dynamics of temperature evolution and oxygen consumption. Optimal predictive accuracy was achieved by increasing the initial microbial colony counts to 8 times and 16 times the baseline values for the Tremier-CTMI and Haug-CTMI models, respectively, under an initial moisture content of 65 %. Additionally, the K0.2CO2 heat production model – based on microbial CO2 generation rate and a 20 % heat generation coefficient – proved more effective in representing heat generation for rice straw with moisture content above 65 %. For lower moisture levels, adjustments to the heat generation coefficient are required to maintain predictive accuracy.</p
Diet analysis of Hazel dormouse (Muscardinus avellanarius), and best practice for studies combining DNA and micro-histologic analysis of faecal samples
No full textTo improve the conservation of the hazel dormouse (Muscardinus avellanarius), non-invasive methods are needed to identify their dietary needs and other habitat requirements. This study aimed to analyze the diet of hazel dormice using faeces collected from summer nest boxes set up as part of a monitoring program. Faeces were analysed using micro-histological and eDNA techniques. DNA analysis revealed difficulties in distinguishing hazel dormouse faeces from those of other small mammals using the same nest boxes. Of the 33 samples tested, only five were confirmed to be pure hazel dormouse faeces, while the remaining samples contained DNA from other small mammals. Micro-histological studies of the five pure hazel dormouse samples (20 faeces pellets) showed that the average volume percentage per dropping was 33% plant material, 20% hard mast, 2% soft mast, 5% insect remains, and 40% unidentified matter. DNA analysis identified 40 unique taxonomic groups of plants, distributed among 20 plant families classified as nut or fruit-bearing deciduous trees or bushes, one conifer tree species, three species of grass, seven species of herbs, and two species of honeysuckle. This study emphasizes the necessity of verifying the material used for diet analysis of dormice. For future studies, we present a best practice method for analyzing the diet of hazel dormice based on faeces from nest boxes.</p