Oral corticosteroids (OCS) are often prescribed to patients with asthma that remains uncontrolled with maintenance therapy. We performed a real-world analysis to describe the geographic distributions of patients with asthma and OCS dispensed in Nordic countries. This observational, retrospective study examined patient-level data from nationally prescribed drug registries from January to December 2018 for individuals aged ≥12 years in Denmark, Finland, and Sweden. Using an algorithm based on asthma treatment combinations defined by the Global Initiative for Asthma (GINA), we identified patients with asthma, those on GINA Step 4-5 treatments, and those being dispensed ≥2 courses of OCS and determined volumes of OCS dispensed to these patients over the 1-year analysis period. Data were plotted geographically within each country using colour-coded heat maps. The overall asthma prevalence rates were 7.4% in Denmark, 11.6% in Finland, and 8.1% in Sweden. In Denmark, Finland, and Sweden, respectively, the frequencies of patients on GINA Step 4-5 treatments were 19%, 15%, and 16%; among whom 10%, 23%, and 5% received ≥2 courses of OCS. The rates of patients on GINA Step 4-5 treatments who were dispensed OCS in each country were 23%, 30%, and 46%, of which 22%, 17%, and 10% were dispensed doses averaging ≥5 mg/day over the year. Heat maps revealed considerable heterogeneity in geographic densities of patients with asthma and OCS claims within each country. Taken together, these results demonstrate regional variations in estimated asthma severity, control, and OCS dispensed within and between countries. Patterns of medication use suggest that a high proportion of patients in Denmark, Finland, and Sweden are on GINA Step 4-5 treatments, many of whom are dispensed OCS; this poses a considerable corticosteroid burden to these patients. Geographic differences in medication use within and between Nordic countries may reflect variations in population characteristics and/or treatment approaches.
The importance of integrating biomarkers into the TNM staging has been emphasized in the 8 th Edition of the American Joint Committee on Cancer (AJCC) Staging system. In a pooled analysis of 2148 TNBC-patients in the adjuvant setting, TILs are found to strongly up and downstage traditional pathological-staging in the Pathological and Clinical Prognostic Stage Groups from the AJJC 8 th edition Cancer Staging System. This suggest that clinical and research studies on TNBC should take TILs into account in addition to stage, as for example patients with stage II TNBC and high TILs have a better outcome than patients with stage I and low TILs.
Objective From previous studies, it is known that the association between fibromyalgia and thyroid autoimmunity diseases exists. On the other hand, it was recently suggested that in many cases thyroid hormone treatment might be unnecessary. The aim of our study is to explore the thyroid hormone treatment among primary health care fibromyalgia patients. Our study is cross-sectional and based on fibromyalgia study from the city of Nokia Health Center. Clinical examination was performed to participants, patients filled five questionnaires and information from electronic patient records was gathered. In addition to other parameters, we studied patient’s thyroid function levels at the beginning of thyroid hormone treatment. Results From those patients participating in the study (n = 103), 34% (n = 33) had thyroid hormone treatment. From those taking thyroid hormone treatment, 48% (n = 16) had information regarding the initial TSH and T4-V levels at the beginning of the treatment. 37% (n = 6) of them had normal thyroid function. Small sample size and data gathered from single health center effects on the generalizability of our findings. However, we suggest further studies to confirm the potential association between fibromyalgia and inappropriate thyroid hormone treatment.
Background We investigated paramedic-initiated consultation calls and advice given via telephone by Helicopter Emergency Medical Service (HEMS) physicians focusing on limitations of medical treatment (LOMT). Methods A prospective multicentre study was conducted on four physician-staffed HEMS bases in Finland during a 6-month period. Results Of all 6115 (mean 8.4/base/day) paramedic-initiated consultation calls, 478 (7.8%) consultation calls involving LOMTs were included: 268 (4.4%) cases with a pre-existing LOMT, 165 (2.7%) cases where the HEMS physician issued a new LOMT and 45 (0.7%) cases where the patient already had an LOMT and the physician further issued another LOMT. The most common new limitation was a do-not-attempt cardiopulmonary resuscitation (DNACPR) order (n = 122/210, 58%) and/or ‘not eligible for intensive care’ (n = 96/210, 46%). In 49 (23%) calls involving a new LOMT, termination of an initiated resuscitation attempt was the only newly issued LOMT. The most frequent reasons for issuing an LOMT during consultations were futility of the overall situation (71%), poor baseline functional status (56%), multiple/severe comorbidities (56%) and old age (49%). In the majority of cases (65%) in which the HEMS physician issued a new LOMT for a patient without any pre-existing LOMT, the physician felt that the patient should have already had an LOMT. The patient was in a health care facility or a nursing home in half (49%) of the calls that involved issuing a new LOMT. Access to medical records was reported in 29% of the calls in which a new LOMT was issued by an HEMS physician. Conclusion Consultation calls with HEMS physicians involving patients with LOMT decisions were common. HEMS physicians considered end-of-life questions on the phone and issued a new LOMT in 3.4% of consultations calls. These decisions mainly concerned termination of resuscitation, DNACPR, intubation and initiation of intensive care.
Background Pseudoxanthoma elasticum (PXE, OMIM# 264800) is an inborn error of metabolism causing ectopic soft tissue calcification due to low plasma pyrophosphate concentration. We aimed to assess the prevalence of PXE in Finland and to characterize the Finnish PXE population. A nationwide registry search was performed to identify patients with ICD-10 code Q82.84. Information was gathered from available medical records which were requisitioned from hospitals and health centers. Misdiagnosed patients and patients with insufficient records were excluded. Results The prevalence of PXE in Finland was 1:260,000 with equal sex distribution. Patients with high conventional cardiovascular risk had more visual and vascular complications than patients with low risk. Four patients (19%) had at least one vascular malformation. A high proportion (33%) of ABCC6 genotypes were of the common homozygous c.3421C > T, p.Arg1141Ter variant. Nine other homozygous or compound heterozygous allelic variants were found. Conclusions The prevalence of diagnosed PXE appears to be lower in Finland than in estimates from other countries. Decreased visual acuity is the most prevalent complication. We suggest that various vascular malformations may be an unrecognized feature of PXE.
Background Subcutaneously retained needle fragments in people who inject drugs (PWIDs) are a possible cause of local symptoms, most commonly pain and infections. It remains unknown how common retained needle fragments are among PWIDs. Case presentation A young PWID consulted a primary care physician due to chronic left-sided groin pain. The patient suspected retention of a broken needle as the cause. She had used a re-used needle 3 months earlier. A plain pelvic radiograph confirmed a needle fragment in the patient's left groin, and a computed tomography scan located it adjacent to the femoral artery and vein. Another asymptomatic needle fragment was found in the right groin. Conclusion Needle fragments are possible causes of local symptoms among PWIDs. The clinical examination presents a potential risk of needlestick injury to the examiner, especially because patients may not be aware of all needle fragments as some are asymptomatic.
Background Falls are a common cause of emergency department (ED) visits for the older population. If osteoporosis is present, even falls from standing height can lead to unusual fractures normally associated with high-energy trauma. In this report, we analyze a rare case of an isolated sternal fracture with an unusual mechanism of injury. Our discussion aims to improve care for older adults with fall-related fractures. Case presentation An 86-year-old female presented in the ED of our hospital with a complaint of chest pain. She recalled a fall at home the previous day and described how her fist was impacted between the floor and her chest. A physical examination revealed local tenderness in the mid-chest. A lateral chest x-ray indicated a sternal fracture, and a chest computed tomography scan ruled out concomitant injuries. There were no acute changes on her electrocardiogram (ECG). Conservative outpatient treatment was started, and referrals were made with a recommendation to initiate fall prevention measures and osteoporosis screening in primary health care. Conclusions Geriatric patients can present in the ED with a rare sternal fracture even after only a minor chest trauma. Appropriate imaging and an ECG are warranted to exclude life-threatening additional injuries. An in-depth physical examination and an understanding of the exact mechanism of injury are important to avoid missing fractures in unexpected locations. Modern ED physicians could have an important role in the secondary prevention of fall-related fractures for geriatric patients.
In this current scenario, there is a broad range of use of resins in both domestic and industrial applications. Especially the importance of resins for adhesive in the wood industry is inevitable. But most of the commercially available resins for adhesive application are prepared of formaldehyde or fossil fuel-based resources which possess serious health issues. Henceforth, development of environmentally friendly resin from renewable resources through a cost-effective technique is a challenging task. Motivated by these facts and prospects, we present a novel technique for addressing non-renewability difficulties while also improving adhesive strength of the material. In this study, lignin-based composite resin with enhanced sustainability and adhesion strength have been achieved by a simply mixing of high concentration of poly (itaconic acid)-functionalized-lignin (P(IA)-f-Lignin) and aqueous emulsion of polyvinyl acetate. The P(IA)-f-Lignin was synthesized by in-situ free radical polymerization of partly neutralized IA in the presence of aqueous lignin dispersion at 90 °C using ammonium persulfate as initiator. The formation of P(IA)-f-Lignin was confirmed by Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), nuclear magnetic resonance (NMR), field emission scanning electron microscope (FESEM) and thermogravimetric analysis (TGA). Here, we have been fabricated 20, 30, 40, 50, and 60 wt% of P(IA)-f-Lignin containing composite resin with desired amount of aqueous emulsion of polyvinyl acetate (PVAc). The changes in physico-chemical interactions were established by FTIR analysis. Various properties like viscosity, thermo-stability, and adhesive properties of all the formulated composite resin were inspected thoroughly. The composite containing 40 wt% of P(IA)-f-Lignin shows excellent improvement of adhesion strength from 3.32 ± 0.12 MPa to 7.83 ± 0.45 MPa. These fabricated composite resin with a high concentration of bio-based P(IA)-f-Lignin content and strong adhesion strength is very promising for fabrication of biobased adhesives with improved sustainability.
To obtain commensurate numerical data of neuronal network morphology in vitro, network analysis needs to follow consistent guidelines. Important factors in successful analysis are sample uniformity, suitability of the analysis method for extracting relevant data and the use of established metrics. However, for the analysis of 3D neuronal cultures, there is little coherence in the analysis methods and metrics used in different studies. Here, we present a framework for the analysis of neuronal networks in 3D. First, we selected a hydrogel that supported the growth of human pluripotent stem cell-derived cortical neurons. Second, we tested and compared two software programs for tracing multi-neuron images in three dimensions and optimized a workflow for neuronal analysis using software that was considered highly suitable for this purpose. Third, as a proof of concept, we exposed 3D neuronal networks to oxygen-glucose deprivation- and ionomycin-induced damage and showed morphological differences between the damaged networks and control samples utilizing the proposed analysis workflow. With the optimized workflow, we present a protocol for preparing, challenging, imaging and analysing 3D human neuronal cultures.
Smart manufacturing is arriving . It promises a future of highly responsive manufacturing operations with advanced sensing, reasoning, and decision-making capabilities towards mass personalization . Statistical AI, e.g., machine learning technologies, has shown great potential in making manufacturing smart . However, Statistical AI’s approximative, agnostic, and context- and task-specific nature has limited its implementation in real-world manufacturing contexts, which demand guaranteed product quality, robust system performance, and ubiquitous transparency. Semantic AI – the combination of Statistical AI and Symbolic AI technologies, could be the answer to the in-depth adoption of AI technologies in industry. Semantic AI enables interpretable manufacturing decisions with augmented intelligence via integrating the merits of statistical learning and semantic reasoning. This timely special issue contains ten articles demonstrating state-of-the-art achievements on Semantic AI, focusing on a variety of technologies, i.e., knowledge graph, semantic web, knowledge discovery, meta-heuristic algorithms, reinforcement learning, and deep learning, with novel applications in machining process automation, assembly troubleshooting, system simulation, production scheduling, 4D printing and robot automation.
In this paper, we define some new distance-based graph measures and explore various properties. In particular, we develop a novel family of Szeged-like entropies and investigate several features thereof. We deduce a cut method for computing these entropies from quotient graphs, apply the obtained result to a molecular graph, and underpin the usefulness of the novel measures by numerical results.
At conventional wastewater treatment plants (WWTPs), reject waters originating from the dewatering of anaerobically digested sludge contain the highest nitrogen concentrations within the plant and thereby have potential for realising nitrogen recovery in a reusable form. At the same time, nitrogen removal from reject waters has potential to reduce the energetic and chemical demands of the WWTP due to a reduced nutrient load to the activated sludge process. In recent years, (bio)electrochemical methods have been extensively studied for nitrogen recovery from reject waters in laboratory-scale but not yet implemented in real WWTP environments, particularly due to concerns about the need for large capital investments. This study assessed the techno-economic feasibility of retrofitting a (bio)electrochemical nitrogen removal and recovery (NRR) unit into the reject water circulation line of a full-scale WWTP through modelling. Data from laboratory-scale (bio)electroconcentration ((B)EC) experiments was used to construct a simple, semi-empirical model block integrated into the Benchmark Simulation Model No. 2 (BSM2) simulating a generalised WWTP. The effects of nitrogen removal from the reject water on both the effluent quality and operational costs of the WWTP were assessed and compared to the BSM2 performance without an NRR unit. In all studied scenarios, the effluent quality index was improved by 4–11%, while both the aeration (7–19% decrease) and carbon (24–71%) requirements were reduced. The additional energy consumed by the NRR unit increased the total operational cost index by >18%, but the revenue assumed for the generated nutrient product (20 EUR kgN⁻¹) was enough to make the BEC-NRR scenarios at realistically low current densities (1 and 5 A m⁻²) economically attractive compared to the control. A sensitivity analysis revealed that electricity price and nutrient product value had the most notable effects on the feasibility of the NRR unit. The results suggest a key factor in making (bio)electrochemical NRR economically viable is to reduce its electricity consumption further, while the anticipated increases in nitrogen fertiliser prices can help accelerate the adoption of these methods in larger scale.
This article introduces stiff and tough biocomposites with in-situ polymerisation of poly (methyl methacrylate) and ductile non-dry flax fibres. According to the results, composites processed with non-dry fibres (preconditioned at 50% RH) had comparable quasi-static in-plane shear strength but 42% higher elongation at failure and toughness than composites processed with oven-dried fibres. Interestingly, the perforation energy of flax–PMMA cross-ply composites subjected to low-velocity impact increased up to 100% with non-dry flax fibres. The in-situ impact damage progression on the rear surface of composites was evaluated based on strain and thermal field maps acquired by synchronised high-speed optical and thermal cameras. Impact-induced delamination lengths were investigated with tomography. Non-dry fibres also decreased the tension–tension fatigue life degradation rate of composites up to 21% and altered the brittle failure mode of flax–PMMA to ductile failure dominated by fibre pull-out.
This paper contributes to process-oriented international business research by showing how three distinct historical approaches can enrich theoretical understanding concerning temporality in firm de-internationalization. First, we show how comparative historical analysis unleashes the causal structure of the process and provides explanatory understanding of the temporal grounding of the mechanisms driving the process. Second, we explicate how interpretive history reveals the embeddedness of de-internationalization in the prevailing spirit of the time. Finally, we consider how poststructuralist history enables us to focus on the strong subjectivity of individuals in which multiple temporalities come together in a chaotic combination underlying behavior.
Calibration and validation of aboveground biomass (AGB) (AGB) products retrieved from satellite-borne sensors require accurate AGB estimates across hectare scales (1 to 100 ha). Recent studies recommend making use of non-destructive terrestrial laser scanning (TLS) based techniques for individual tree AGB estimation that provide unbiased AGB predictors. However, applying these techniques across large sites and landscapes remains logistically challenging. Unoccupied aerial vehicle laser scanning (UAV-LS) has the potential to address this through the collection of high density point clouds across many hectares, but estimation of individual tree AGB based on these data has been challenging so far, especially in dense tropical canopies. In this study, we investigated how TLS and UAV-LS can be used for this purpose by testing different modelling strategies with data availability and modelling framework requirements. The study included data from four forested sites across three biomes: temperate, wet tropical, and tropical savanna. At each site, coincident TLS and UAV-LS campaigns were conducted. Diameter at breast height (DBH) and tree height were estimated from TLS point clouds. Individual tree AGB was estimated for ≥170 trees per site based on TLS tree point clouds and quantitative structure modelling (QSM), and treated as the best available, non-destructive estimate of AGB in the absence of direct, destructive measurements. Individual trees were automatically segmented from the UAV-LS point clouds using a shortest-path algorithm on the full 3D point cloud. Predictions were evaluated in terms of individual tree root mean square error (RMSE) and population bias, the latter being the absolute difference between total tree sample population TLS QSM estimated AGB and predicted AGB. The application of global allometric scaling models (ASM) at local scale and across data modalities, i.e., field-inventory and light detection and ranging LiDAR metrics, resulted in individual tree prediction errors in the range of reported studies, but relatively high population bias. The use of adjustment factors should be considered to translate between data modalities. When calibrating local models, DBH was confirmed as a strong predictor of AGB, and useful when scaling AGB estimates with field inventories. The combination of UAV-LS derived tree metrics with non-parametric modelling generally produced high individual tree RMSE, but very low population bias of ≤5% across sites starting from 55 training samples. UAV-LS has the potential to scale AGB estimates across hectares with reduced fieldwork time. Overall, this study contributes to the exploitation of TLS and UAV-LS for hectare scale, non-destructive AGB estimation relevant for the calibration and validation of space-borne missions targeting AGB estimation.
The current steps toward the implementation of carbon–neutral electrical energy systems lead to high levels of PV penetration especially in residential sectors. However, there are many limitations in the integration of extra PV generation units in modern distribution systems. Hence, supplementary actions are needed for providing the capability of hosting high levels of PV units in future grids. In this study, the application of Distribution System Reconfiguration (DSR) is examined in order to increase PV Hosting Capacity (PVHC) of a harmonically polluted distribution system. However, bringing several services together, DSR is studied in a multiobjective framework to improve the voltage profile and decrease the total energy loss as well as improving the PVHC. Moreover, probabilistic demand scenarios are included in this study through applying different combinations of linear and nonlinear load-levels to provide a more precise assessment of the objectives. Finally, a solution strategy is proposed for the presented multiobjective problem based on the implementation of the Non-dominated Sorting Genetic Algorithm II (NSGA-II) and fuzzy decision-making method. The proposed framework is then applied to modified 33-bus and 69-bus distribution systems in presence of nonlinear loads. According to the results, applying the proposed methodology for DSR could successfully increase the PVHC of the harmonic-polluted grid as well as providing voltage profile stabilization and a considerable decrease of the energy loss in the system.
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