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Routinely collected health data on 10-year genitourinary and gastrointestinal morbidity after ultra-hypofractionated versus conventionally fractionated radiotherapy for localised prostate cancer in the randomised, non-inferiority, phase 3 trial HYPO-RT-PC
No full textBackground and purposeHYPO-RT-PC was the first phase 3 trial showing the long-term efficacy and safety of extremely hypofractionated radiotherapy schedules (ultra-hypofractionation or stereotactic body radiotherapy) compared with standard radiotherapy in localised prostate cancer. We aimed to verify their safety in the context of a clinical trial, by comparing events of potentially radiotherapy-related morbidity according to routinely collected health data between the arms and with men unexposed to prostate radiotherapy.Materials and methodsWe included Swedish residents in the per-protocol population and unexposed men matched with the ultra-hypofractionation group. Primary outcomes were genitourinary and gastrointestinal events defined by linking the Common Terminology Criteria for Adverse Events version 5.0 to diagnosis and intervention codes in broad (any related condition) and narrow code sets (strongly related conditions) tested separately. Inpatient care, interventions, and causes of death, identified in Swedish national healthcare registers, were events. Outcomes were analysed as time-to-event, adjusted for Charlson Comorbidity Index and socioeconomic status.ResultsFive hundred and forty-one participants (92%) from each trial arm and 2705 unexposed men were included. We found no statistically significant differences between the radiotherapy groups (broad code sets: genitourinary events, adjusted hazard ratio 0.95, 95% confidence interval 0.71–1.25; gastrointestinal events, 1.24, 0.91–1.69). Compared with the unexposed men, 10-year excess cumulative incidence was 8% and 5% for genitourinary and 5% and 4% for gastrointestinal events when applying the broad and narrow code sets, respectively, without excess mortality events.ConclusionThe results support the HYPO-RT-PC findings by showing similar morbidity between ultra-hypofractionated and standard radiotherapy. Excess events were estimated to 4–8%, without increased associated mortality
Towards Scientific Machine Learning for Granular Material Simulations : Challenges and Opportunities
No full textMicro-scale mechanisms, such as inter-particle and particle-fluid interactions, govern the behaviour of granular systems. While particle-scale simulations provide detailed insights into these interactions, their computational cost is often prohibitive. At a recent Lorentz Center Workshop on “Machine Learning for Discrete Granular Media”, researchers explored how machine learning approaches can aid the development of constitutive laws and efficient data-driven surrogates for granular materials while also addressing uncertainty quantification. Attended by researchers from both the granular materials (GM) and machine learning (ML) communities, the workshop brought the ML community up to date with GM challenges. This position paper emerged from the workshop discussions. In this position paper, we define granular materials and identify seven key challenges that characterise their distinctive behaviour across various scales and regimes–ranging from gas-like to fluid-like and solid-like. Addressing these challenges is essential for developing robust and efficient models for the digital twinning of granular systems in various industrial applications. To showcase the potential of ML to the GM community, we present classical and emerging machine/deep learning techniques that have been, or could be, applied to granular materials. We reviewed sequence-based learning models for path-dependent constitutive behaviour, followed by encoder-decoder type models for representing high-dimensional data in reduced spaces. We then explore graph neural networks and recent advances in neural operator learning. The latter captures the emerging field evolution of interacting particles via efficient latent space representation. Lastly, we discuss model-order reduction and probabilistic learning techniques for high-dimensional parameterised systems, both of which are crucial for quantifying and incorporating uncertainties arising from physics-based and data-driven models. We present a typical workflow aimed at unifying data structures and modelling pipelines and guiding readers through the selection, training, and deployment of ML surrogates for granular material simulations. Finally, we illustrate the workflow’s practical use with two representative examples, focusing on granular materials in solid-like and fluid-like regimes
Reversing the Fuel-Electricity System Provides for Complete Fossil Fuel Replacement and a Stable Grid
No full textAs the total cost of renewable electricity falls lower than the price of fossil fuel, not only can electricity be used to replace fossil fuels using batteries in vehicles but it can also be used to produce fuels. This makes it possible to replace fuels in sectors not easily directly electrified. It also provides new ways of balancing the electricity system. When renewable electricity is cheap a lot of fuel can be produced (electro-fuels). When electricity gets more expensive than fuels, fuel production will stop. In rare, extreme situations, such fuels may even be used to produce electricity
China’s South-to-North Water Diversion Project : A Review and Reach Beyond China’s Borders
No full textThe South-to-North Water Diversion Project (SNWDP), the world’s largest water transfer initiative, is designed to address northern China’s acute water scarcity by diverting approximately 45 km3 of water annually from the south through three major routes, with completion targeted for 2050. This review demonstrates that the SNWDP has already improved water security for over 150 million people, stabilized groundwater, and supported agricultural and urban development, but also presents significant challenges, including escalating costs, large-scale resettlement, and substantial environmental concerns such as ecosystem alteration, salinity intrusion, pollutant transfer, and risks to biodiversity and water quality. While mitigation and adaptive management efforts are ongoing, their long-term effectiveness remains uncertain. Notably, the SNWDP’s influence extends beyond China: by enhancing food production self-sufficiency, it can help stabilize global food markets during concurrent droughts and serves as a model—albeit a debated one—for large-scale water management and governance. The project’s hydropolitical and geopolitical dimensions, especially regarding the planned western route and potential transboundary impacts, underscore the need for international dialog and monitoring. Overall, the SNWDP exemplifies both the opportunities and dilemmas of 21st-century megaprojects, with its legacy dependent on balancing economic, environmental, and social trade-offs and on transparent, participatory governance to ensure sustainable outcomes for China and the global community
An in-depth analysis of coronary computed tomography angiography segmental findings in acute spontaneous coronary artery dissection – a prospective multicenter study
No full textAims: Spontaneous coronary artery dissection (SCAD), causing acute coronary syndrome (ACS), primarily in middle-aged women, is diagnosed with invasive coronary angiography (ICA). Due to the risk of dissection propagation with ICA, a non-invasive diagnostic tool is needed. We investigated coronary computed tomography angiography (CCTA) findings in acute SCAD, as well as the inter-modality agreement between CCTA and ICA. Methods and results: Thirty-two (92 % women, mean age 52.4 years) SCAD patients at eight Swedish hospitals were investigated with ICA as well as dual source CCTA during the index hospitalisation between April 2021 and October 2022. ICA identified 46 dissected segments whereas CCTA detected 25, Cohen's kappa (κ) = 0.595 (95 % confidence interval [CI] 0.46–0.73). CCTA primary and secondary features were identified in 24 dissected coronary artery segments in 21 patients, 8 (32 %) tapered luminal stenosis, 11 (44 %) abrupt luminal stenosis, 3 (12 %) visible dissection membrane, 4 (16 %) intramural-hematomas, 9 (36 %) epicardial fat stranding and 8 (25 %) with coronary artery tortuosity. ICA identified 3 dissected proximal segments whereas CCTA identified 5, (κ = 0.74, 95 % CI 0.40–1.00). In distal segments, ICA identified 43 and CCTA 20 dissections, (κ = 0.57, 95 % CI 0.43–0.72). Conclusions: In patients presenting with acute SCAD, CCTA should not be considered a substitute for ICA. While CCTA demonstrated good diagnostic performance in identifying proximal SCAD lesions, its sensitivity was notably reduced in distal coronary segments, where SCAD is more frequent. Among the 25 lesions detected, CCTA successfully detected specific features in 24 lesions
Countertransference struggles of mental health psychotherapists
No full textThis study explored the struggles of countertransference (i.e., psychotherapist’s feelings and reactions) through interviews with 20 mental health therapists. Thematic analysis resulted in four themes: (1) personal vulnerability activated in the therapeutic relationship, (2) difficult-to-endure or obstructive feelings (e.g., aversion or burdening discomfort), (3) secondary distressing reactions elicited by the aforementioned, and (4) frustration related to issues in the organizational setting outside the therapeutic dyad. These themes were interconnected by underlying challenges related to feelings of uncertainty and inadequacy. Aspects of the wider context of therapy (outside the therapeutic dyad) seemed significant in relation to the mental health therapist’s countertransference
On Barracks : The Rapid Growth of the Green Sector in Northern Sweden: Labor law implications.
No full textI samband med den väldigt forcerade utbyggnaden av den gröna omställningen genom stora fabriker i norra Sverige ställs en rad frågor kring hanteringen av personal, säkerhet, likabehandling och ansvar. De arbetsrättsliga implikationerna är många. Den ursprungliga euforiska uppfattningen av etableringar som Northvolt i Skellefteå visade sig efterhand föra med sig betydande utmaningar. Texten, som är en del av ett tvärvetenskapligt, huvudsakligen arkitekturbaserat arbete, problematisera de väldigt särskilda förhållandena de här "gröna jobbet" medfört
