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Overcoming barriers to renewable energy adoption : A decision-making framework for strategy evaluation and implementation prioritization
No full textTransitioning from fossil fuels to renewable energy is essential for sustainable development. However, a wide range of economic, technical, regulatory, and social barriers hinder this transition. This study aims to identify these barriers and propose prioritized strategies to overcome them. A novel decision-making framework is developed, combining an adapted Quality Function Deployment (QFD) model with a new hybrid fuzzy MultiCriteria Decision-Making (MCDM) method, named the Fuzzy ARASKOR (F-ARASKOR) method. Data collection involved one in-depth expert interview and four structured questionnaires, completed by a panel of domain experts. First, a comprehensive list of barriers to renewable energy development was identified from the literature. Their importance weights were assessed using the first questionnaire. Then, strategies to overcome the barriers were derived through expert interviews and analyzed via the second questionnaire using a QFD approach. Next, these strategies were evaluated against seven criteria: impact on barriers, implementation cost, duration, capability, risk, complexity, and acceptability. Criterion weights were obtained through the Analytic Hierarchy Process (AHP) using the third questionnaire, and strategy performance was assessed through the fourth. Final prioritization was conducted using the F-ARASKOR method. The results identified 75 barriers and 38 strategies. Among them, "Policy Stability and Long-Term Commitment," "Promote Renewable Energy as a Climate Solution," and "Develop Training and Certification Programs" emerged as top-priority strategies. This study offers practical guidance for governments and industries to formulate stable, targeted policies, make effective investments, and address the key barriers hindering renewable energy development
Complex relationship between soil fungi and conservation value assessments in boreal forests
No full textLarge-scale industrial forestry is a threat to biodiversity and imposes long-lasting changes to many forested biomes. Preserving forests as reserves is an important component of the strategy for safeguarding forest biodiversity. Yet, the selection of forests of high biodiversity value is usually based on proxies (i.e., subsets of aboveground habitat characteristics) rather than on direct assessments of species occurrences. This approach is based on the assumption that the diversity and community composition of all organism groups are well represented by the assessed habitat characteristics. We investigated how conservation value, assessed according to common practices based on aboveground habitat heterogeneity, corresponded to the abundance, richness, and community composition of 12 taxonomic and ecological groups of soil fungi across northern and southern Swedish forests. Overall, the assessed conservation value reflected the abundance, diversity, and community composition of deadwood-associated saprotrophs well, likely because they depend directly on the availability of the structures that the assessment is based on. However, the conservation assessment value failed to capture the overall variability for most of the soil-dwelling fungal guilds. Although the assessed value was positively associated with the diversity of ectomycorrhizal fungi, root-associated Ascomycota, and saprotrophic Basidiomycota in the southern region, no such association was evident in the northern region. Soil fertility was the best predictor of the variation in community composition in all fungal guilds. The relative abundance and diversity of most saprotrophic guilds increased as soil fertility increased, whereas root-associated guilds decreased as soil fertility increased. Current methods for assessing conservation value captured only specific subsets of soil fungi, and the predictability of capturing fungal diversity varied depending on the region. To more comprehensively preserve soil fungi, assessment methods should incorporate additional environmental parameters, especially those linked to fungal community composition, such as soil fertility
The Swedish Renal Registry : a nationwide registry for chronic kidney disease of all stages
No full textBackground National registries that capture patients with chronic kidney disease (CKD) across all stages are scarce. We present here the Swedish Renal Registry (SRR), a nationwide prospective register covering the whole spectrum of CKD. Methods Created in 1991, SRR enrolls CKD patients referred to adult nephrologist care (non-dialysis CKD [ND-CKD], kidney transplantation, maintenance dialysis), with an overall coverage of nearly all nephrology clinics in Sweden. SRR encompasses several interconnected databases in which longitudinal clinical, biological, kidney-related, patient-reported data, as well as provider-level information are collected. This report presents the design of the registry, as well as patients characteristics and temporal trends between 2008 and 2021. Results A total of 45 590 new ND-CKD patients [72 years, 16 656 (36%) women, eGFR 26 ml/min per 1.73 m(2)], and 8829 incident kidney transplant recipients (51 years, 35% women) were enrolled in SRR between 2008 and 2021. SRR also included 16 034 new patients [68 years, 5420 (34%) women] on maintenance dialysis [70% hemodialysis (HD), 30% peritoneal dialysis (PD)]. Between 2015 and 2021, 4753 patients [59 years, 1884 (40%) women, eGFR 37 ml/min per 1.73 m(2)] had a registered kidney biopsy. We observed a decrease in HD incidence (69% to 60%, P for trend <.01) and an increase in PD incidence (26% to 32%, P < .01) and pre-emptive transplantation (4.7% to 7.5%, P < .01). The prevalence of comorbidities is high in all CKD stages and increase as eGFR declines. While nephroangiosclerosis and diabetic kidney disease are the most common etiologies, glomerulonephritis are the most frequent diagnoses in biopsied and transplanted patients. Conclusion The SRR is a nationwide register which aims to contribute to address gaps in our understanding of CKD, to identify important challenges and health priorities, evaluate real-life clinical management and analyze international variations, improve health outcomes, improve quality of life, and reduce the burden of CKD
Refined Lactulose Hydrogen Breath Test for Small Intestinal Bacterial Overgrowth Subgrouping Irritable Bowel Syndrome With Low and High Breath Hydrogen
No full textBackground: Small intestinal bacterial overgrowth (SIBO) is suggested in irritable bowel syndrome (IBS). Our primary aim was to define a discriminating threshold for a positive lactulose hydrogen breath test (LHBT) in SIBO. As a secondary aim, IBS was subdivided into SIBO and non-SIBO groups. Methods: LHBT performed in 206 subjects, 74 healthy subjects, 39 SIBO patients with intestinal lesions, 77 IBS patients, and 16 nonhydrogen producers. Using scintigraphy and LHBT, orocecal transit time was set to 80 min. Peak hydrogen levels were compared between the groups. Values are mean and 95% confidence interval. Results: Using an 80-min orocecal cutoff time, LHBT in healthy subjects had peak values of 8 (6–9) ppm and SIBO 38 (31–45) ppm (p < 0.0001). The diagnostic cutoff 20 ppm verified a sensitivity of 77% and specificity of 88% and positive and negative predictions of 77% and 88%. With the same cutoff for IBS, the mean peak value was 21 (16–26) ppm (p < 0.0001 vs. healthy) with a sensitivity of 39% and a specificity of 78% and positive and negative predictions of 77% and 84%. Separating IBS at 20 ppm, the low-hydrogen group had a peak value of 6 (5–7) ppm (ns vs. healthy), and the high-hydrogen group had a peak of 44 (38–49) ppm (p < 0.0001 vs. healthy). After antibiotics, IBS with low hydrogen remained unchanged, whereas those with high hydrogen were reduced to control (p < 0.01). Conclusion: With cutoff at 20 ppm, LHBT differentiates SIBO in patients with early high breath hydrogen peaks, subdividing IBS into non-SIBO and SIBO groups; the latter may benefit from antibiotic treatment
Characterising acute and chronic care needs : insights from the Global Burden of Disease Study 2019
No full textChronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.Anders O. Larsson och Johan Sundström ingår i gruppen GBD 2019 Acute and Chronic Care CollaboratorsFor complete list of contributors see https://doi.org/10.1038/s41467-025-56910-x</p
Autoantibodies to joint-related peptides as predictive markers in early rheumatoid arthritis
No full textObjective For better management of RA, new biomarkers are needed to predict the development of different disease courses. This study aims to identify autoantibodies against epitopes on proteins in the joints and to predict disease outcome in patients with new onset RA. Methods Sera from new-onset RA patients from the Swedish BARFOT (Better Anti Rheumatic PharmacOTherapy) and TIRA-2 (Swedish acronym for 'tidiga insatser vid reumatoid artrit') cohorts (n = 1986) were screened for autoantibodies to selected peptides (JointIDs) in a bead-based multiplex flow immunoassay. Disease outcomes included Boolean remission 1.0, swollen joint count and radiographic destruction. Multivariate logistic regression and zero-inflated negative binomial models that accounted for clinical factors were used to identify JointIDs with the strongest potential to predict prognosis. Results Boolean remission was predicted with 42% sensitivity and 75% specificity in male patients positive for antibodies to a non-modified collagen type II (COL2) peptide at 12 months. When antibodies to a specific citrullinated cartilage oligomeric protein (COMP) peptide were absent and the patient was in Boolean remission at 6 months, the sensitivity was 13% and the specificity 99%. Positivity for the non-modified COL2 peptide also reduced the frequency of swollen joints by 41% and 33% at 6 and 12 months, respectively. Antibodies to CCP predicted joint destruction with low specificity (58%). Positivity for a COL2 and a glucose-6-phosphate dehydrogenase peptide in citrullinated forms increased specificity (86%) at the expense of sensitivity (39%). Conclusion Autoantibodies against joint-related proteins at RA diagnosis predict remission with high specificity and, in combination with clinical factors, may guide future treatment decisions
Many hurdles to take : Explaining peacekeepers' ability to engage in human rights activities
No full textHuman rights are a fundamental principle and purpose of the United Nations (UN). Yet, UN peacekeeping operations (PKOs) exhibit substantial variation in their ability to engage in human rights activities. While existing research has investigated deployment and mandates, we explain what peacekeepers can actually do on the ground. We argue that the UN Security Council's permanent member states (the P5) limit human rights mandates if they have private interests in PKO host countries, thereby diminishing peacekeepers' ability to promote and protect human rights. Moreover, armed conflict shifts priorities away from human rights activities. We use novel data on 21 human rights activities in African countries (1991-2016) and item response models to capture PKOs' latent ability to engage in these activities. Random and fixed effects regression and mediation analyses with sensitivity tests support our expectations. We find that the P5's economic interests in the PKO host country negatively correlate with the strength of human rights mandate provisions, which in turn negatively correlates with PKOs' ability to engage in human rights activities. We find similar, although less consistent, correlations for P5's security interests. Yet, while mandates partly define the scope of PKOs' activities, field-level conditions also have an influence. Specifically, ongoing armed conflict negatively correlates with PKOs' ability to engage in human rights activities. Our results suggest that rising challenges to the liberal international order by powerful states, coupled with the more frequent deployment of PKOs in conflict zones, will likely increase the hurdles that UN PKOs need to overcome to meet expectations regarding their human rights engagement
Discovering the diversity of Acarosporaceae (Acarosporales, Lecanoromycetes) with carbonized epihymenial accretions in North America
No full textSix new species are described: Acarospora anthracina, A. austrooccidentalis, A. oscurensis, and A. profusa from southwestern North America; A. aquatica from wetlands in eastern North America; and A. minuta from the Holarctic flora of Canada. In total, 13 species of Acarosporaceae with carbonized epihymenial accretions are known from North America. No European taxa of Acarospora or Sarcogyne with carbonized epihymenial accretions were found in North America, except A. lapponica, which is part of the Holarctic flora in Alaska, and the lichenicolous calciphyte Sarcogyne pusilla. A key to North American Acarosporaceae with carbonized epihymenial accretions is provided. Sarcogyne joshuaensis is transferred to Acarospora
String integrability on the Coulomb branch
No full textThe Coulomb branch of the N = 4 super-Yang-Mills theory is described by a D3-brane in the bulk of AdS5 × S5. We show that the boundary conditions on the D-brane preserve integrability of the string sigma-model by constructing a dynamical and spectral parameter dependent reflection matrix that encodes an infinite number of conserved charges
Thrombosis, major bleeding, and mortality in 1079 patients with myelofibrosis : a matched population-based study
No full textBleeding and thrombotic events are known complications in myeloproliferative neoplasms (MPNs), but few studies have exclusively focused on patients with myelofibrosis (MF). In this nationwide population-based study, we assessed the frequency of major bleeding, thrombotic events, and all-cause mortality in 1079 patients diagnosed with MF and 5395 matched controls using multiple Swedish health care registers. Major bleeding, arterial, and venous events were seen at a rate of 2.55, 2.59, and 1.06 events per 100 years, respectively, in patients with MF. Compared to controls, the rates of bleedings, arterial events, venous events, and mortality were increased, with hazard ratios of 3.78 (95% confidence interval [CI], 2.98-4.79; P < .001), 1.73 (95% CI, 1.40-2.12; P < .001), 2.75 (95% CI, 1.93-3.90; P < .001), and 3.92 (95% CI, 3.50-4.40; P < .001), respectively. Patients treated with JAK inhibitors (JAKis) had higher rates of major bleeding (5.33), arterial events (4.67), and venous events (1.56) than patients with no ongoing symptom-directed therapy (rates, 2.32, 2.15, and 0.79) or hydroxyurea (rates, 2.05, 2.35, and 1.27, respectively). The use of JAKis or low-molecular-weight heparin, previous arterial or venous events, and older age were identified as independent risk factors for new arterial or venous events. A previous venous event, higher leukocyte count at diagnosis, and ongoing JAKi treatment were associated with an increased risk of major bleeding. This study shows that patients with MF have higher rates of thromboembolic events and major bleeding than described in other MPNs, and thromboembolic complications and major bleeding diverge in the different treatment groups