There is considerable variation between GP practices in England in their use of urgent referral pathways for suspected cancer.
To determine the association between practice use of urgent referral and ...cancer stage at diagnosis and cancer patient mortality, for all cancers and the most common types of cancer (colorectal, lung, breast, and prostate).
National cohort study of 1.4 million patients diagnosed with cancer in England between 2011 and 2015.
The cohort was stratified according to quintiles of urgent referral metrics. Cox proportional hazards regression was used to quantify risk of death, and logistic regression to calculate odds of late-stage (III/IV) versus early-stage (I/II) cancers in relation to referral quintiles and cancer type.
Cancer patients from the highest referring practices had a lower hazard of death (hazard ratio HR = 0.96; 95% confidence interval CI = 0.95 to 0.97), with similar patterns for individual cancers: colorectal (HR = 0.95; CI = 0.93 to 0.97); lung (HR = 0.95; CI = 0.94 to 0.97); breast (HR = 0.96; CI = 0.93 to 0.99); and prostate (HR = 0.88; CI = 0.85 to 0.91). Similarly, for cancer patients from these practices, there were lower odds of late-stage diagnosis for individual cancer types, except for colorectal cancer.
Higher practice use of referrals for suspected cancer is associated with lower mortality for the four most common types of cancer. A significant proportion of the observed mortality reduction is likely due to earlier stage at diagnosis, except for colorectal cancer. This adds to evidence supporting the lowering of referral thresholds and consequent increased use of urgent referral for suspected cancer.
Low-frequency noise from large wind turbines Møller, Henrik; Pedersen, Christian Sejer
The Journal of the Acoustical Society of America,
06/2011, Volume:
129, Issue:
6
Journal Article
Peer reviewed
Open access
As wind turbines get larger, worries have emerged that the turbine noise would move down in frequency and that the low-frequency noise would cause annoyance for the neighbors. The noise emission from ...48 wind turbines with nominal electric power up to 3.6 MW is analyzed and discussed. The relative amount of low-frequency noise is higher for large turbines (2.3-3.6 MW) than for small turbines (≤ 2 MW), and the difference is statistically significant. The difference can also be expressed as a downward shift of the spectrum of approximately one-third of an octave. A further shift of similar size is suggested for future turbines in the 10-MW range. Due to the air absorption, the higher low-frequency content becomes even more pronounced, when sound pressure levels in relevant neighbor distances are considered. Even when A-weighted levels are considered, a substantial part of the noise is at low frequencies, and for several of the investigated large turbines, the one-third-octave band with the highest level is at or below 250 Hz. It is thus beyond any doubt that the low-frequency part of the spectrum plays an important role in the noise at the neighbors.
The human genome is generally organized into stable chromosomes, and only tumor cells are known to accumulate kilobase (kb)-sized extrachromosomal circular DNA elements (eccDNAs). However, it must be ...expected that kb eccDNAs exist in normal cells as a result of mutations. Here, we purify and sequence eccDNAs from muscle and blood samples from 16 healthy men, detecting ~100,000 unique eccDNA types from 16 million nuclei. Half of these structures carry genes or gene fragments and the majority are smaller than 25 kb. Transcription from eccDNAs suggests that eccDNAs reside in nuclei and recurrence of certain eccDNAs in several individuals implies DNA circularization hotspots. Gene-rich chromosomes contribute to more eccDNAs per megabase and the most transcribed protein-coding gene in muscle, TTN (titin), provides the most eccDNAs per gene. Thus, somatic genomes are rich in chromosome-derived eccDNAs that may influence phenotypes through altered gene copy numbers and transcription of full-length or truncated genes.
Anaerobic digestion (AD) is an important tool for reducing greenhouse gas emissions from agricultural production. A prolonged retention time by adding an extra anaerobic digestion step can be ...utilized to further degrade the digestates, contributing to increased nitrogen mineralisation and reducing decomposable organic matter. These modifications could influence the potential N fertiliser value of the digestate and soil carbon sequestration after field application. This study investigated the effects of prolonging retention time by implementing an additional anaerobic digestion step on carbon and nitrogen dynamics in the soil and soil carbon sequestration. Two digestates obtained from two biogas plants operating at contrasting hydraulic retention times, with and without an additional digestion step, were applied to a loamy sand soil. N mineralisation dynamics were measured during 80 days and C mineralisation during 212 days. After 80 days of incubation, the net inorganic N release from digestates obtained from a secondary AD step increased by 9–17 % (% of the N input) compared to corresponding digestates obtained from a primary AD step. A kinetic four-pool carbon model was used to fit C mineralisation data to estimate carbon sequestration in the soil. After 212 days of incubation, the net C mineralisation was highest in undigested solid biomass (68 %) and digestates obtained from the primary AD step (59–65 %). The model predicted that 26–54 % of C applied is sequestered in the soil in the long-term. The long-term soil C retention related to the C present before digestion was similar for one- and two-step AD at 12–16 %. We conclude that optimizing the anaerobic digestion configurations by including a secondary AD step could potentially replace more mineral N fertiliser due to an improved N fertiliser value of the resultant digestate without affecting carbon sequestration negatively.
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•A secondary anaerobic digestion (AD) step increases net inorganic N release from digestates in soil.•Two-step AD decreases digestate carbon mineralisation in soil due to extended decomposition in the AD process.•The fertiliser value of digestates can be improved by prolonged digestion time without affecting the long-term soil C retention.•Effects of a second step AD on C and N dynamics are dependent on hydraulic retention time utilized in the primary AD step.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective To assess the overall effect of the English urgent referral pathway on cancer survival.Setting 8049 general practices in England.Design Cohort study. Linked information from the national ...Cancer Waiting Times database, NHS Exeter database, and National Cancer Register was used to estimate mortality in patients in relation to the propensity of their general practice to use the urgent referral pathway.Participants 215 284 patients with cancer, diagnosed or first treated in England in 2009 and followed up to 2013. Outcome measure Hazard ratios for death from any cause, as estimated from a Cox proportional hazards regression.Results During four years of follow-up, 91 620 deaths occurred, of which 51 606 (56%) occurred within the first year after diagnosis. Two measures of the propensity to use urgent referral, the standardised referral ratio and the detection rate, were associated with reduced mortality. The hazard ratio for the combination of high referral ratio and high detection rate was 0.96 (95% confidence interval 0.94 to 0.99), applying to 16% (n=34 758) of the study population. Patients with cancer who were registered with general practices with the lowest use of urgent referral had an excess mortality (hazard ratio 1.07 (95% confidence interval 1.05 to 1.08); 37% (n=79 416) of the study population). The comparator group for these two hazard ratios was the remaining 47% (n=101 110) of the study population. This result in mortality was consistent for different types of cancer (apart from breast cancer) and with other stratifications of the dataset, and was not sensitive to adjustment for potential confounders and other details of the statistical model.Conclusions Use of the urgent referral pathway could be efficacious. General practices that consistently have a low propensity to use urgent referrals could consider increasing the use of this pathway to improve the survival of their patients with cancer.
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Here, we demonstrate the applicability of national strategies towards massive biogas deployment, through a case study Denmark. First, a variety of sustainable agricultural intensification measures to ...produce additional biomass resources were investigated; as a result, it was found that the biomass currently used in Denmark's biorefineries (including biogas) could be tripled without compromising soil carbon and inducing little to no land use changes. The degree to which these resources could be mobilized for the biogas sector was analysed through examining the extremes, here labelled as LOW and HIGH biomass-to-biogas scenarios. The resulting biomethane production was calculated considering three combinations of biogas production and upgrading technologies: (i) conventional biogas production and upgrading technologies; (ii) plants with prolonged retention time and conventional upgrading technologies and (iii) as in (ii), but upgrading via biological methanation of carbon dioxide in the biogas, using renewable hydrogen. These scenarios revealed a biomethane potential of 24–111 PJ y−1. The key finding of our study is that only the extreme deployment measures, in terms of biomass and technology, allowed to fulfill the emerging gas demands, namely buffering the deficits from fluctuating power and transport (light- and heavy-duty vehicles, urban buses, coaches), quantified at 95 PJ y−1. Yet, just harnessing the full sustainable potential of animal manure, straw and perennial grass allows to supply half of this demand. In the LOW and HIGH biomass scenarios, doubling the retention time brought an increased methane production of 20% (energy-wise), while this increase was 87% when methanation was added.
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•A methodology is presented to uncover the limits for future reliance on biomethane.•Denmark was used as a national case study to quantify the limits of massive biogas deployment.•Covering 85% of today's national gas demand by biogas requires methanation technologies.•80% of the biogas potential is ensured by animal manure, straw and perennial grasses.•More grass via less rape & cereal areas while supplying the nutritional demand is possible.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Anaerobic co-digestion of poultry droppings (PD) and briquetted wheat straw (BWS) with alkali additive in the form of KOH (BWSadd) or without any additive (BWSraw) was conducted using continuously ...stirred tank reactors (CSTRs) under both mesophilic (35 °C) and thermophilic (53 °C) conditions. The aims of the study were to compare 1) co-digestion of PD and BWS versus mono-digestion of PD; 2) co-digestion of PD and BWS with or without additives; and 3) mesophilic and thermophilic anaerobic digestion (AD).
Co-digestion of PD and BWS was superior to mono-digestion of PD in terms of gas production. Co-digestion of PD with BWSadd at thermophilic temperatures resulted in a higher methane volumetric yield per kg substrate compared to mesophilic conditions. With and without additive, co-digestion with BWS produced 8% and 11% higher yields at thermophilic conditions than at mesophilic conditions. Co-digestion of PD with BWSadd resulted in, respectively, 14% and 27% more methane produced at mesophilic and thermophilic conditions over mono-digestion of PD. When mono-digesting PD, the mesophilic temperature was superior to the thermophilic since methane yield was higher in the mesophilic temperature regime.
•Mesophilic mono-digestion of poultry dropping (PD) is superior to thermophilic.•Thermophilic co-digestion of PD with straw works better than mesophilic.•Pre-treatment of straw with 2%w/w KOH promotes hydrolysis rate and methane yield.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
•Starvation significantly affects microbial AD performance.•Irreversibly altered microbial communities after starvation perturbations.•Starvation leads to accumulation of VFAs, H2S and ...ammonia.•Methanogenesis shifts to hydrogenotrophic pathway under perturbed state.•Increased presence of syntrophic acetate oxidizing populations after starvation.
The evolution and population dynamics of complex anaerobic microbial communities in anaerobic digesters were investigated during stable operation and recovery after prolonged starvation. Three thermophilic reactor systems fed with cattle manure were operated continuously in parallel for 167days. Significant changes in the microbial communities were observed for both the bacterial and archaeal populations as the reactor systems were subjected to changing feeding regimes. The ecosystems developed from being relatively similar in structure to more specialised communities, with large population shifts within the acetogenic and methanogenic communities, which appeared to shift towards the hydrogenotrophic methanogenesis pathway. All reactor systems showed signs of adaptation to a harsher environment under high VFA, H2S and ammonia concentrations, but remained at a lower degree of stability after 45days of recovery compared to stable period of operation before starvation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
One of the main obstacles for a more widespread use of wheat straw for renewable energy production is the absence of a low-cost technology which promotes its biodegradation. The aim of this study was ...to determine whether methane yield from wheat straw could be improved by using alkali at low concentration and ambient temperature if the fiber fraction had previously undergone mechanical pretreatment. After combining mechanical and alkali pretreatment, a linear correlation between alkali concentration and hydrolysis of the fiber content, mainly hemicelluloses, was found. A positive effect by combining briquetting of wheat straw with sodium hydroxide addition was found with the hemicellulose content decreasing by up to 66%. In general, alkali improved the ultimate methane yield and the methane yield obtained after 30 days. Briquetting reduced the optimal alkali concentration needed to reach the maximal improvement in methane yield compared to merely shredding. The results proved that it is not necessary to work with the high alkali concentrations traditionally used to improve methane production if the straw is mechanically pretreated prior to alkali addition. Methane yield obtained after 30 days as well as net energy yield rose by around 40% when briquetting was combined with 2% sodium hydroxide. Therefore, a low concentration of alkali, especially sodium hydroxide, applied at ambient temperature can improve the energy and the economic balance of pretreatment.
•A combination of briquetting and alkali is presented in this work.•A linear correlation between alkali and fiber hydrolysis was found.•Briquetting decreased the alkali concentration needed to improve methane yield.•The best combination in terms of methane yield and net energy was BWS with 2% NaOH.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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