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A creative approach for the protection coordination of microgrids considering parallel events via the pyramidal grouping technique
No full textOver the last few years, numerous research findings have emerged that incorporate the single-event or islanded case when designing models for protection coordination of microgrids via directional overcurrent relays (DOCRs). Nevertheless, the dimensions and complexity of this issue can be significantly increased by the parallel events. This paper introduces an innovative methodology for reducing the scope of parallel events. The pyramidal grouping technique is employed to organize the selected events into separate groups. In brief, the problem's choice parameters are identified by an innovative mixed algorithm, known as the sequential quadratic, Quasi-Newton, and linear programming method (SQ-QN-LP). It is noteworthy that the SHARIAT feeder, which serves as a real-world grid, and the IEEE 399-bus network have been configured without any signs of miscoordination. In comparison to other comparable methodologies, such as SQ, QN, SQ-LP, QN-LP, and SQ-QN, the actualization of SQ-QN-LP decreases the relay's time to function by approximately 75% to 22% in the mentioned networks.</p
Sammen om at lykkes: Styring, ledelse, motivation og sammenhængskraft i offentlige organisationer
No full textEarly shift to oral antibiotic treatment for pyogenic vertebral osteomyelitis (SAVE):study protocol for an open label, non-inferiority, nation-wide randomized controlled clinical trial
No full textBACKGROUND: The current Danish National Guideline (DNG) for treatment of pyogenic vertebral osteomyelitis (PVO) recommends 6 weeks antibiotic (AB) treatment, with a 2-week intravenous (IV) AB lead-in followed by 4 weeks oral AB for uncomplicated PVO, and 12 weeks AB treatment with a 4-week IV AB lead-in followed by 8 weeks oral AB for complicated PVO. The primary objective of the current study is to investigate whether shortening the duration of IV AB to one week is non-inferior to the current DNG.METHODOLOGY: The SAVE trial is an investigator initiated, randomized (1:1), controlled, non-inferiority, parallel group, open-label trial. Patients will be included at departments of infectious diseases in Denmark. All adult patients diagnosed with and treated for PVO will be assessed for eligibility. Patients will be eligible for inclusion if they fulfill all the inclusion and none of the exclusion criteria. Exclusion criteria include among others previous episodes of PVO within the past 24 months, spinal implants inserted prior to current episode of PVO, other infectious foci necessitating >7 days of IV AB, identification of selected bacteria as well as fungi as the etiology and severe immunocompromise. Patients will be randomized if their C-reactive protein (CRP) has decreased to <75% of peak value or to <20 mg/l by day 7 of appropriate IV AB. Five-hundred thirty patients will be included and randomized. The primary endpoint is a composite of all-cause mortality, unplanned surgical intervention in relation to the spine and related to PVO, relapse of bacteremia with the primary pathogen, relapse of bacteria by culture with the initial pathogen being cultured from relevant material from infected areas in relation to the spine or iliopsoas muscle (detected by culture), renewed course of IV ABs given for >7 days for treatment of PVO. The primary endpoint will be adjudicated by a blinded end-point committee.DISCUSSION: If early transition to oral therapy is found non-inferior to the current DNG, it will provide the basis for shortening hospitalization, reducing costs, and increasing patient autonomy.TRIAL REGISTRATION: European Union Clinical Trials - EU CT Number 2023-507617-96-01: First approval 27/11/2023. Link: https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en&EUCT=2023-507617-96-01.</p
Essay: Jeg bærer vanviddet i mig, og det kan udløses af sløses dosering af insulin
No full textDet danske sundhedsvæsen har givet mig fortrinlig hjælp til at håndtere de somatiske aspekter af min diabetes, men min sukkersindssyge har jeg stået alene med og manglet ord til at forst
Temporal trends in associations between social drivers and life-years lost in newly diagnosed atrial fibrillation in Denmark, 2000-22:a nationwide cohort study
No full textBACKGROUND: Individuals with atrial fibrillation who are systemically disadvantaged often receive lower quality of care and face higher complications and mortality rates. However, data on survival inequity trends are sparse. We examined temporal trends in associations between social drivers and life expectancy loss among individuals with newly diagnosed atrial fibrillation in Denmark.METHODS: In this nationwide, registry-based, cohort study, we assessed mortality in individuals with newly diagnosed atrial fibrillation. Social drivers at diagnosis included family income (lower, medium, higher), educational attainment (lower, medium, higher), and living alone. For each social driver, we compared age-adjusted and sex-adjusted 10-year restricted mean time lost across subgroups as an absolute measure of inequity in expected survival time. Trends were compared between the periods of 2000-10 and 2011-22.FINDINGS: Among 383 566 individuals with newly diagnosed atrial fibrillation, restricted mean time lost improved across all levels of social drivers over time. Life-years lost associated with income changed modestly between periods, with a slight reduction in inequity for people with medium versus higher income (-1·65 years [95% CI -1·70 to -1·60] to -1·55 years [-1·59 to -1·50]), but a slight increase for people with lower versus higher income (-2·46 years [-2·55 to -2·37] to -2·51 years [-2·57 to -2·45]; Pinteraction=0·002). The loss associated with education improved between periods (medium versus higher: -0·77 years [-0·83 to -0·71] to -0·63 years [-0·67 to -0·58]; lower versus higher: -1·81 years [-1·87 to -1·75] to -1·75 years [-1·80 to -1·70]; Pinteraction<0·001). Life-years lost associated with living alone worsened between periods (-1·48 years [-1·52 to -1·44] to -1·56 years [-1·60 to -1·53]; Pinteraction=0·002).INTERPRETATION: Despite small improvements for income and education, substantial socioeconomic inequities in long-term survival after atrial fibrillation diagnosis persisted over two decades. The findings highlight the urgent need to address the underlying barriers driving the inequities.FUNDING: Danish Cardiovascular Academy.</p
What amount of medicine and utensils are needed for acute, basic End-Of-Life palliation? An observational cohort study
Get PDFDiabetic kidney disease phenotypes and the risk of cardiovascular events:The Silesia Diabetes-Heart Project
No full textBackground: The impact of diabetic kidney disease (DKD) phenotype on the cardiovascular (CV) risk remains ambiguous. Methods: This was a prospective, single-center study (The Silesia Diabetes-Heart Project, NCT05626413) of people with diabetes mellitus (DM). The primary outcome was a composite of CV events during a median follow up of 2.8 years (IQR 1.7; 4.0). Individuals were divided into groups based on DKD phenotypes [reduced estimated glomerular filtration rate (eGFR) (< 60 mL/min/1.73 m2), and/or elevated urinary albumin creatinine ratio (UACR) (≥ 30 mg/g)] and compared to those without DKD. Results: Among 2306 people with DM (mean age 58 ± 18 years, 51.9% males) those with DKD had higher CV events risk (aHR 1.02, 95% CI 1.01–1.03) compared to those without DKD. People with reduced eGFR (aHR 1.78, 95% CI 1.19–2.67) and those with reduced eGFR and elevated UACR (aHR 1.60, 95% CI 1.08–2.37) were at higher risk of CV events compared to people with normal eGFR and UACR, while people with elevated UACR only (aHR 0.91, 95% CI 0.62–1.32) did not had the risk heightened. Among people with DKD less frequent prescriptions with sodium-glucose co-transporter 2 inhibitors and renin–angiotensin–aldosterone system inhibitors were observed (OR 0.38, 95% CI 0.29–0.49, p < 0.001 and OR 0.39, 95% CI 0.30–0.50, p < 0.001, respectively) compared with the ones without DKD. Conclusion: People with DKD, with reduced eGFR or both reduced eGFR and elevated UACR, but not with elevated UACR alone, are at higher CV risk. Personalizing therapy based on clinic-based renal phenotyping can facilitate the initiation of CV disease modifying therapy.</p
Long-Term Outcome of Moyamoya Disease
Get PDFMoyamoya disease (MMD) is considered to run a progressive course, but little is known about its long-term outcomes. We conducted a structured phone interview to assess outcomes in a mixed cohort of conservatively and surgically treated patients a median of 9 years and up to 27 years after a diagnosis of MMD. We found that 60% of patients had a favorable outcome (modified Rankin Scale score <3), with only 16% of adult patients working full time. We conclude that MMD considerably impacts daily life in a substantial number of those affected, with only a minority able to provide for themselves.</p
Green leaf biorefining – A demonstrator for production of high-quality food-grade protein
Get PDFThe green transition of the food sector requires new approaches for obtaining high-quality protein products from sustainable plant sources. Among these, green biomass represents an underutilised resource as current production methods rely on energy-intensive processes that promote protein denaturation, resulting in products with reduced functionality and low applicability value. This work focuses on the recovery of protein from clover grass using gentle and non-destructive membrane separation in demonstrator-scale (14–25 kg of fresh leaves). Green juice was extracted using screw pressing followed by either: 1) heat treatment and centrifugation or 2) pre-filtration. Subsequently, the juice was separated by two-step crossflow membrane filtration. The first filtration produced a retentate, applicable for feed production, and a permeate free from grassy sensory attributes and green colour, which was further fractionated in the second filtration and purified by diafiltration to produce food protein powder. A food protein powder with high crude protein content (58–73 % w/w), corresponding to a yield of ∼5 % w/w (based on crude leaf protein) was recovered using the pre-filtration process option. This represents substantial improvement compared to the heat-pretreatment option (12–28 % crude protein content). The powder lacked grassy smell/taste and displayed high aqueous solubility and excellent foaming properties. The powder properties were similar over the season and largely unaffected by variations in process parameters while effects on yields were more pronounced. This work represents a substantial advancement in green biorefining and showcases the potential of membrane operations towards full and multi-purpose utilisation of sustainable bioresources.</p