Type 1 diabetes is more prevalent in Finland than anywhere else in the world, affecting approximately 50,000 people. New automated insulin delivery pumps have significantly improved diabetes care, while also increasing treatment costs. A recent study conducted at the University of Eastern Finland and Kuopio University Hospital assessed the long-term cost-effectiveness of automated insulin delivery pumps, comparing them to continuous subcutaneous insulin infusion pump treatment combined with continuous glucose monitoring. The study included 336 children and adults with type 1 diabetes.
The results showed that automated insulin delivery pumps significantly improved quality of life and reduced diabetes-related complications. The quality-adjusted life expectancy increased by an average of 2.3 years for individuals using an automated insulin delivery pump. Although the overall costs of automated insulin delivery pump treatment were higher than those of conventional insulin pump treatment, its cost-effectiveness ratio was only 11,184 euros per quality-adjusted life-year, which is well below the generally accepted willingness-to-pay threshold of 50,000 euros in Finland.
This is the first cost-effectiveness study of automated insulin delivery pumps conducted in Finland. The results support the use of automated insulin delivery pumps for patients with type 1 diabetes.
Source:
University of Eastern Finland (UEF Viestintä)
Journal reference:
Vallivaara, H-L., et al. ((2025) Long-term health economic evaluation of automated insulin delivery system compared with continuous subcutaneous insulin infusion pumps and CGM in a real-world setting in Finnish paediatric and adult individuals with type 1 diabetes. Diabetes, Obesity and Metabolism. doi.org/10.1111/dom.16520.
PODGORICA (Montenegro) – When it came to determining who would represent Montenegro at FIBA EuroBasket 2025, Nikola Vucevic’s commitment was never in question.
The Chicago Bulls’ big man is relishing the opportunity to compete in his fourth FIBA EuroBasket this summer, where Montenegro will head to Tampere, Finland, to meet world champions Germany, as well as Lithuania, Sweden, and Great Britain in Group B.
“
I think after the EuroBasket, that’ll be it
Nikola Vucevic
“It’s always a joy to come and play for your country, especially at major tournaments, where all the best players gather,” Vucevic said in an interview withVijesti.
“It’s different from playing for a club. The feeling is different, the chemistry between players, the energy… You have one national team you play for. You represent your people – your whole country is watching. That’s a special thrill.”
Vucevic admits this summer could mark his final run in a Montenegro jersey, but he’s ready to give it all on what may prove to behis last rodeo.
“I feel good. I’ve been training for a while, and I expect to be 100 percent ready and healthy when preparations begin. There have been a lot of withdrawals, and we don’t know what things will look like when we gather,” he said.
“Right now, I have no expectations in terms of goals—I’m thinking about how the preparation period will go, how everything will look, whether we’ll be healthy. Later, we’ll have a clearer picture when it comes to expectations.”
Nikola Vučević has been a mainstay with Montenegro since 2011
With joy and that special thrill of putting on the Montenegro jersey comes responsibility. The 14-year NBA veteran is eager to excel in a tournament where Montenegro has not advanced past the Round of 16 since its debut in 2011.
The task hasn’t been made easier with the absence of Bojan Dubljevic, Nikola Ivanovic, Nemanja Radovic, Dino Radoncic, Petar Popovic, Fedor Zugic, Luka Bogavac, David Mirkovic, and Andrija Grbovic. Still, Vucevic leads a side aware of what awaits them in Tampere.
“It’s a tricky group,” he admits. “These are teams with quality players. Finland has the home-court advantage and will be motivated. They’re led by [Lauri] Markkanen, who is an excellent player.
Lauri Markkanen ready for FIBA EuroBasket 2025
Markkanen all-in for EuroBasket with Finland chasing more history
“Lithuania is an experienced team, yes, they’ve had withdrawals too, but they’re still very good. They play tough and physical; it’s always hard against them. Germany is one of the favorites. I don’t know as much about Great Britain and Sweden.”
Despite his pride and being a mainstay in the international fold since his first EuroBasket in 2011, the 35 year old has also hinted that this is likely to be his last dance for the national team.
“I think after the EuroBasket, that’ll be it,” Vucevic conceded.
“I’ll give my best, enjoy it, and try to achieve the best result possible. I’m entering the final phase of my career. My focus will shift – to rest during summers, to be with my family. It’s not 100 percent certain, but at the moment I believe these will be my last games for the national team.”
Whatever Vucevic plans after EuroBasket will be decided then. Until that point, he will head to Tampere as one of the competition’s biggest names.
Since making his senior debut at EuroBasket 2011, Vucevic has averaged 12.9 points and 7.2 rebounds, with a career-best 19.8 points and 8.8 rebounds at the FIBA Basketball World Cup 2023 in the Philippines.
And away from basketball, he has made lifelong connections and friendships within the national team, most notably with teammate Vladimir Mihailovic, who, like Vucevic , debuted in 2011, and head coach Bosko Radovic.
Along with Vucevic hinting about international retirement, he also indicates that Mihailovic might join him as well, which could bring a storybook ending to two tremendous lines of service.
“
This might be the last time both of us play for the national team, the last EuroBasket.
Nikola Vucevic
“It will be a great experience for both of us, we’re friends off the court, our families hang out. It’s always nice when we play together – during the preparation period, we spend time together,” Vucevic said of Mihailovic.
“These are experiences that go beyond basketball. Sharing the court and these memories with someone who’s a great friend – that’s special.
“We often talk about it. This might be the last time both of us play for the national team, the last EuroBasket. It’s a beautiful story – starting our national careers together and possibly finishing them together.”
Vucevic added: “I have a great relationship with the coach. We’ve known each other since the Qualifiers for EuroBasket in Lithuania. We’ve always had a good working relationship and a strong bond. We stay in touch often.
Vladimir Mihailovic also made his international debut at EuroBasket 2011
“Bosko Radovic has done a great job since taking over. Three major tournaments, good results—that shows the kind of relationship he has built with the players. The trust and the way he has brought everything together show how big of an influence he has had.”
As for the victor of EuroBasket 2025? Vucevic has singled out his neighbours to go all the way.
“I would single out Serbia,” he admits. “Serbia is the main favorite. The most complete team, with the most experience, they’ve been playing together for a long time.
“They’re led by Nikola Jokic, the best player in the world. That team had a great result at the Olympics, and I think they’ll win gold this year. I’d personally love that for them—they have the quality to take the title.
“After Serbia, it’s Germany. France is quite weakened, and I’m not sure what kind of squad Spain will have.”
Of course, Vucevic is aiming for Montenegro to progress as far as they can, after which he will begin to ponder what he will do following EuroBasket.
Rapidly identifying certain bacteria allows antibiotic treatments to be optimized. A team from the University of Zurich, supported by the SNSF, has developed molecules to detect and capture certain species.
The discovery of antibiotics revolutionized medicine in the 20th century, saving countless lives. However, the emergence of resistant bacteria has quickly become a new challenge. One key factor in tackling this issue is being able to pinpoint the bacteria causing an infection. This enables healthcare providers to use targeted and effective antibiotics and reduce the risk of new forms of resistance development.
With the support of the Swiss National Science Foundation (SNSF), scientists have developed molecules to detect certain bacteria quicker than before. Their research has recently been published in the journal Communications Biology. These molecules pave the way for accelerated medical diagnostic methods, particularly – but not only – in cases of bloodstream infections. “The developed molecules are already being used in a partnership with the Zurich start-up Rqmicro, which provides tools to monitor water quality,” says Markus Seeger, the biochemist who led this study at the University of Zurich’s Institute of Medical Microbiology.
Speeding up certain diagnoses
“In the race between the evolution of resistant bacteria and the development of new antibiotics, we don’t stand a chance. Bacteria have been at war with viruses for millions of years and are used to evolving to escape new dangers,” says the researcher. The only solution we currently have is to use antibiotics efficiently and sparingly. This prevents bacteria from being constantly exposed to residues or traces of antibiotics in their environment, so that when antibiotics are used for treatment, they are still effective at killing the bacteria. This strategy requires medical diagnoses that are as fast and accurate as possible. However, traditional identification methods take time. They involve collecting bacteria from the patient and then growing them until there are enough to carry out detailed analyses. The growth phase can take up to 12 hours for some species, sometimes longer. The analyses then take another two hours. Markus Seeger and his team are looking to speed up this process: “Our idea is to detect certain bacteria more quickly, even in small numbers, by giving them specific colours. We aim to capture them directly in the blood to increase their density and analyse them more quickly”. This approach does not deliver a conclusive diagnosis, but it means we can confirm more quickly than using traditional methods whether certain bacteria are present. This saves valuable time, especially in cases of bloodstream infections when waiting one or two days for detailed analyses may not be feasible.
Markus Seeger’s team concentrated on detecting the bacteria Escherichia coli (E. coli), commonly linked to urinary tract infections and bloodstream infections. In addition, resistance rates for this species of bacteria increased in Switzerland between 2004 and 2024, rising fourfold for certain classes of antibiotics. “Knowing whether an infection involves Escherichia coli or something else is already a good basis on which to make an initial decision about which treatment to administer,” says the biochemist. In fact, the tools developed by his team would save around six hours of the twelve needed for traditional diagnostics.
Penetrating the “jungle of sugars”
Markus Seeger and his team had to solve two problems to capture Escherichia coli. On the one hand, they needed to find the right bait, i.e. a specific element common to all Escherichia coli bacteria. On the other hand, the researcher admits that he “underestimated the complexity of the jungle of sugars acting as a barrier around the bacteria.” This jungle is so dense that few molecules can penetrate it.
As a hook, the scientists opted for miniature antibodies, known as nanobodies. Their small size allows them to pass easily between the sugar branches. They are also more stable than conventional antibodies, meaning they remain functional for longer periods at room temperature. This is a key element to obtain detection tools that can be transported and stored without having to worry about cold chains. The team searched an international database and a register of bacteria detected in Swiss hospitals. By analysing the genome of the recorded Escherichia coli-type bacteria, a protein was identified – OmpA – a specific form of which is found only in Escherichia coli. The group subsequently developed nanobodies capable of detecting this version of OmpA in a targeted and effective way in over 90 percent of species members. The nanobodies function like a hook that specifically captures Escherichia coli bacteria.
This solution means that bacteria can be coloured but not captured. As Markus Seeger explains, “To detect Escherichia coli, this works well. We can attach tiny colourant molecules to the nanobodies without significantly increasing their size. However, to capture the bacteria, we use larger magnetic beads, and they can’t penetrate the jungle of sugars that surrounds the bacteria.” The scientists, therefore, created a sort of fishing rod for their detection kit – a molecular thread that was developed to connect the nanobodies (the hook) to the magnetic beads blocked by the sugars (the handle).
We now have a tool to detect and capture Escherichia coli. I hope we can successfully implement it in clinical diagnostics. We’re already using it for environmental analyses.”
Markus Seeger, biochemist
Source:
Swiss National Science Foundation (SNSF)
Journal reference:
Sorgenfrei, M., et al. (2025). Rapid detection and capture of clinical Escherichia coli strains mediated by OmpA-targeting nanobodies. Communications Biology. doi.org/10.1038/s42003-025-08345-9.
The chief executive of the Co-op has apologised to its customers after admitting that all 6.5 million of the mutual’s members had their data stolen in a recent cyber-attack.
Shirine Khoury-Haq told the BBC she was “incredibly sorry” for the attack in which names and addresses and contact information was obtained by hackers.
She said no financial information, such as credit or debit card details, or transaction data was stolen in the hack, which occurred in April.
“We know a lot of that information is out there anyway, but people will be worried and all members should be concerned,” she said.
Previously, the company had only said that a “significant number” of its customers’ data had been accessed by the hackers, but did not give a precise figure.
“It hurt my members, they took their data and it hurt our customers and that I do take personally,” Khoury-Haq said.
The group, which owns more than 2,000 grocery stores, more than 800 funeral parlours and also offers legal and financial services, was forced to shut down parts of its IT systems in late April after discovering an attempted hack, days after Marks & Spencer also faced a serious cyber-incident.
The cyber-attack on the Co-op led to gaps on shelves in its grocery stores while its funeral parlours forced to return to operating some services via paper-based systems without access to digital services.
Co-op executives told MPs recently that many of its systems were protected from attack because it had defences in place which detected unusual behaviour within a few hours.
However, the company admitted it was not expecting to make “any significant recovery” of the costs of the hack from insurers as it chose to invest in detection systems rather than cyber-insurance policies.
Last week, four people including three teenagers were arrested at addresses in the West Midlands, Staffordshire and London as part of an investigation into the cyber-attacks on the Co-op, M&S and Harrods, which all occurred within days of one another.
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The National Crime Agency, which is investigating the hacks alongside the police, is looking at the involvement of Scattered Spider, a loose collective of native English-speaking hackers.
The Information Commissioner’s Office, the UK’s data protection watchdog, has said those concerned about their personal information should visit its website for advice and support.
Retailers and their suppliers have faced a series of cyber-attacks in recent years including Morrisons, which was affected by an incident at its tech supplier Blue Yonder in the run-up to Christmas last year.
In 2023, WH Smith was hit by an attack in which company data was accessed illegally, including the personal details of current and former employees.
Meta has developed an open-source AI tool to design concrete mixes that are stronger, more sustainable, and ready to build with faster—speeding up construction while reducing environmental impact.
The AI tool leverages Bayesian optimization, powered by Meta’s BoTorch and Ax frameworks, and was developed with Amrize and the University of Illinois Urbana-Champaign (U of I) to accelerate the discovery of high-performance, low carbon concrete.
Meta successfully deployed a concrete mix that was optimized with the AI tool at a data center construction site. Being open-sourced and freely available, the AI-tool could help increase the adoption and optimization of sustainable concrete mixes in the construction industry at large.
Low carbon concrete solutions are essential for advancing ourgoal of net zero emissions in 2030. Concrete production is a major contributor to the embodied carbon emissions in data center construction and accounts for 8% of all global CO2 emissions, according to the World Economic Forum. Conventionally, concrete is optimized for strength (28-day compressive strength) and cost. But modern constructions – including data centers – require concrete that is optimized for sustainability, curing speed, workability, and finishability as well.
Innovation in concrete formulations is difficult and slow. Compared to traditional concrete, current formulas for low carbon concrete face several challenges: slower curing speeds, issues with surface quality, and complications in supply chains when novel materials are involved.
But concrete suppliers can utilize AI to develop and scale innovative concrete mixes as drop-in replacements, accelerating the discovery and integration of sustainable materials for large-scale use.
By collaborating with Amrize — one of the world’s largest cement manufacturers and major concrete suppliers — and the University of Illinois Urbana-Champaign (U of I), we’ve developed an AI model and pipeline to accelerate the discovery of new concrete mixtures that meet traditional requirements alongside newer sustainability needs.
Our work with Amrize and U of I has already resulted in the successful design and deployment of AI-designed green concrete at ournew data center in Rosemount, MN.
Meta’s AI model for green concrete
Designing concrete formulas is a complex, multi-objective problem. The designer must choose between various types and proportions of cement, lower-carbon supplementary cementitious materials (SCMs), water-to-binder ratios, coarse and fine aggregate types, and admixtures. SCMs’ impact on concrete performance varies by source location and seasonality, requiring long-term tests for validation. Finally, time-consuming tests taking days and weeks are needed to fully validate the performance of new mixes. Thus, it is important for the design process to be as efficient as possible.
There are several key ingredients often used in a sustainable concrete mix:
Cement is the “glue” that holds concrete together. It’s made from calcining limestone, clay, and other minerals in a high-temperature rotary kiln – the process which contributes significantly to CO2 emissions. The cement is then mixed with water, SCMs, aggregates, and admixtures at a ready mix plant to create concrete. When the cement paste hydrates and stiffens over time, it forms a hard, binding gel that gives concrete its strength.
Slag is a byproduct of steel production. It’s a molten waste material that’s cooled and ground into a fine powder. In concrete, slag helps reduce concrete’s embodied carbon by replacing cement, and improves long-term strength, durability, and resistance to external chemicals.
Fly ash is a type of industrial by-product from coal-fired power plants. It’s collected from the air pollution control systems and can be used as a substitute for some of the cement in concrete. Fly ash helps reduce the embodied carbon in concrete by replacing cement, and also improves its long-term strength, durability, and workability.
Fine aggregate, like sand, is smaller than coarse aggregate and fills in the gaps between the larger rocks or gravel. Sand helps to create a smooth, even surface, and improves the overall texture of the concrete.
Coarse aggregate refers to crushed stone or gravel that are added to concrete to provide bulk volume and load-bearing capacity, helping the concrete resist cracking and shrinkage.
Mixing these ingredients together in different proportions gives rise to concrete with varying strength and sustainability properties. The properties of each ingredient varies by origin and condition of manufacturing. Furthermore, some of the SCMs are declining in availability, necessitating the discovery and incorporation of novel materials for which little-to-no data is available. All of this adds to the challenges of concrete design. The goal of our approach is to optimize the trade-off between strength and sustainability.
Several key ingredients used to generate concrete mixes, clockwise from top left: fly ash, coarse aggregates, fine aggregate, and cement.An example of a low carbon concrete mix design, showing the relative amount of ingredients by weight.
To accelerate the concrete mix design process, Meta developedan AI model for sustainable concrete usingBoTorch andAx, Meta’s open-source software for Bayesian optimization and adaptive experimentation, respectively. This model uses multi-objective Bayesian optimization algorithms to learn and optimize concrete compositions. The approach predicts compressive strength curves for different mixtures, optimizing short- and long-term strength properties and sustainability.
(For technical details of the model and optimization algorithm, see our technical report, “Sustainable Concrete via Bayesian Optimization” and our open source SustainableConcrete repository with the associated data and code.)
The basis of the approach is a model that predicts the compressive strength curves associated with different concrete mixtures.
The figure below shows an example of two strength curve predictions, one associated with a concrete mix including pure portland cement (purple)—the most commonly used type of cement—and a second one where a part of the cement was substituted by fly ash (blue), whose carbon impact is lower than that of cement. We then leveraged the strength predictions at various times to jointly optimize the short- and long-term strength properties, as well as the sustainability of the associated mixes, to generate new formulas that can be validated through testing.
By using AI, we can accelerate the discovery process and drive efficiency in the experiment process.
Two strength curve predictions carried out by our model during early development. The more sustainable mix (green) exhibits lower compressive strength early on but overtakes the traditional mix (blue) later on, a common trade-off of more sustainable concrete mixes.
To train this AI model with real data, we collaborated with Professor Nishant Garg and his research group at U of I. In each iteration, the AI suggests new promising concrete mixes based on performance predictions, which are updated with the latest data. We validated these predictions with lab testing and used the results to refine the AI for subsequent iterations. Our AI pipeline consists of the workflow of generating baseline data, training an AI model, using it to develop and validate new hypotheses, and then improving the baseline data and AI training.
In implementing the first AI pipeline, we focused on several key metrics: compressive strength, curing speed, slump, and sustainability, which we quantify using a proxy for the carbon footprint of the concrete mix. The compressive strength of concrete is crucial for determining both its long-term structural integrity, typically specified as its 28-day compressive strength, and its short-term curing speed, specified as the time needed to achieve certain strength requirements such as strength one, three, and five days after the pour. When densely sampled x-day strength data is available, a strength curve can be generated.
These attributes can be tested on concrete cylinders in the lab, allowing for rapid and systematic data generation necessary for training the AI. Larger-scale tests can be conducted after the new formulas, discovered through iterative testing, have been reviewed by concrete experts. By conducting research and development in stages, we can focus the AI on critical metrics and expedite progress.
The resulting AI pipeline is illustrated below:
Adaptive experimentation steps to implement an AI pipeline.
The figure below shows how AI is able to learn and further optimize x-day strength versus sustainability (quantified using a proxy for the carbon footprint of the concrete mix) over several iterations, exceeding the initial human-designed formulas.
Over time, this AI pipeline has generated high-quality data for AI training and development, containing over a hundred unique concrete mixes, comprehensive x-day compressive strength data, and global warming potential (GWP, measured in terms of kilograms of CO2 per cubic meter).
Developing an AI pipeline for industrial green concrete
In 2024, we started collaborating withAmrize to explore how Meta’s AI can be used at scale in the concrete industry.
Amrize shared basic concrete performance data, supporting Meta’s open source approach. They developed an AI pipeline at their batch plant near St. Paul, MN, extending the discovery and testing process.
Critical to data centers are the concrete slabs that serve as surfaces for deploying servers and associated power and cooling equipment. Data center slabs to be flat, level, smooth, and durable to enable reliable servicing of the equipment that reside on it. Therefore, their concrete formulations must meet additional high-quality finish requirements. Our AI algorithms incorporate specific water-to-binder ratios and volumetric material constraints, and discover high-performing formulas with faster curing and lower GWP values that meet the stricter requirements.
Distinguishing between formulas suitable for slabs, and those more suitable for other applications, we can compare their performance against industry standard formulas (see below). Within two iterations, and with minor human adjustments, the AI pipeline discovered formulas that exceeded standard low carbon industry formulas in terms of strength, speed, and sustainability.
The strength curves of standard industry low carbon formulas compared to AI-optimized formulas. AI-optimized formulas are faster, stronger, and have lower carbon emissions.
Applying Amrize’s AI-designed concrete formulation at Meta’s Rosemount data center
Further testing is needed to apply AI-generated formulas in real-world applications. We therefore extended the first AI pipeline to incorporate additional steps and further tests, as shown in the figure below.
Amrize collaborated with Mortensen, a general contractor responsible for the construction of our datacenter, to test the new formula’s workability and finishability. Successful slab tests led to at-scale application in a site support section in one of the data center building slabs at Meta’s Rosemount, MN data center project.
The development and scaling-up process to test and validate AI-generated concrete formulas. Human experts assess the outputs of each stage and iteration, refine the AI to incorporate additional constraints, and/or adjust individual constraints such as total binder amount and water-to-binder ratio.
Formal tests show that the team exceeded all the technical requirements while achieving good workability and finish performance required for the application.
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Open source for more sustainable construction
At Meta, we believe AI can generate high-performance, low carbon concrete mixes for major construction projects such as data centers. Open source AI can benefit every level of the construction industry, from the construction companies and contractors, to suppliers, providers, architects, and, of course, building owners.
We will continue our collaboration with Amrize to further scale the use of AI in the concrete industry. The basic AI solution will remain open source to enable further commercial productization, application, and R&D.
Our aim is to scale the use of low carbon concrete in data centers and encourage the adoption of performance-based requirements at minimum risk. Meta will continue to engage with other hyperscalers to collaboratively test and prove low carbon concrete formulas to further decrease carbonemissions. Meta will also leverage organizations such as iMasons and the Open Compute Project to publish reference designs, AI-informed formulas, case studies, and best practices.
Learn more about Meta’s AI for sustainable concrete
Gen V (2023-present), the recent iteration of the wildly successful superhero satire The Boys (2019), thrives on scenes of bodily outrage. One such episode concerns a young woman who is able to shrink – an ability triggered by self-induced vomiting.
Her boyfriend persuades her to use her powers during sex and we see her touching his penis, which is now taller than she is. We also understand why the boyfriend is so insistent about her transformation: relatively speaking, he has a small penis.
In Companion (2025), a film about a young man who has an abusive sexual relationship with a self-conscious robot, a small penis is also mocked. When the robot gains autonomy, and has an intelligence boost, she confronts and shames the abusive man, claiming that he is motivated in his violent and controlling behaviour by “a below average-sized penis”.
What interests me about these works, as a researcher of sexuality and film, is that they are otherwise committed to questioning reductive ideas about the body. Yes, in the universe of The Boys there is undoubted glee at all the exploding heads and superpowered, murderous buttocks, but the keynote is pathos.
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The girl who changes her shape through vomiting is arguably representing bulimic experience and there are characters whose superpowers can be understood to negotiate, for example, self-harm and dysmorphia. But when it comes to a man with a small penis, it’s a different story. His body is understood to directly influence both his actions and sense of morality.
Likewise, in Companion, which is in so many senses a meditation on the fraught relationship between mind and body, the small penis of the young man is understood to be the obvious source of his repressive actions.
In both cases, the audience is expected to laugh at the abuser because of his small penis. The small penis is framed as both a signifier and cause of abusiveness.
‘We are still so medieval about penis size’
It could be argued that in Companion and Gen V, the small penis itself is not what is being mocked. The men involved in both are young, white and heterosexual. The idea is, perhaps, that mocking those with small penises is acceptable, because in this the creators are really questioning white, heterosexual and male power structures, and that the inadequacy of that power, its mythic nature, is exposed.
One difficulty in this is that as only power held by men with small penises is mocked, the power of the well endowed, regardless of racial or sexual identity, is naturalised.
Equally, those people of colour or queer people who have small penises might implicitly be included in the mockery, with the implication that they are somehow the beneficiaries of power structures, misuse this power, and have obvious, biologically rooted motivations in so doing.
The trailer for Gen V.
Gen V qualifies the laughter – the girl , talking later to a friend, makes clear that there is nothing wrong in having a small penis, just “don’t be a dick about it”. But the only small-penised character we see is, of course, being “a dick”.
There have been a number of television shows that focus on penis size, but each explores the pathos of having a large penis: Hung (2009), The Hard Times of RJ Berger (2010), Sex Education (2019). Imagine an equivalent concerning a character with a small – or even simply not large – penis.
As journalist Caitlin Moran wrote in a 2023 Guardian article introducing her book, What About Men:
We are still so medieval about penis size that we see male genitalia as being inimical to a man’s soul. Remember when Stormy Daniels told the world that Donald Trump’s penis was ‘smaller than average – a dick like the mushroom character in Mario Kart’. And we were all like: ‘Yes, it makes sense the horrible man has a small, weird mushroom penis.’ The whole world joined in on that one.
Let us instead question the relationship between biology and destiny. And let this action be taken not to frame heterosexual white men as a disadvantaged group, but for the good of us all. Our bodies are ours to negotiate, with ourselves, and with our significant others, as well as those others that find in them indifference, or more troubling affects.
As Gen V and Companion suggest, in recent science fiction stories that otherwise reimagine the body, the small penis can only be imagined as shameful. It is taken to be an obvious motivation for abusive behaviour. Such an understanding helps no one. As the science fiction genre is especially well placed to question common-sense ideas about the human and its form, it would be a good place to begin.
On September 26, 2024, the US Food and Drug Administration (FDA) approved xanomeline and trospium chloride capsules (Cobenfy), a muscarinic agent, for schizophrenia.1
10 months later, the future of muscarinic agents was discussed at the 2025 Southern California Psychiatry Conference (So Cal Psych) in Huntington Beach, CA, from July 11 – 12, 2025.
In this interview at So Cal Psych, Chelsie Monroe, APN, PMHNP-BC, a psychiatric nurse practitioner and founder of a group private practice, Balanced Mental Wellness in Colorado, talked about muscarinic agents—why they are exciting, their robust efficacy data, and when to consider xanomeline trospium chloride (Cobenfy) over clozapine.
HCPLive: What is exciting about muscarinic agents?
Monroe: This is really exciting because it’s a whole new mechanism of action to use in treating schizophrenia. We’re really working off of a whole new pathway, so this is cholinergic pathways to modulate dopamine, which doesn’t have the same baggage as our D2 antagonists.
HCPLive: If a clinician is considering trying this with a patient, what should they be thinking about?
Monroe: We should be thinking about a whole conglomerate of symptoms that we’re wanting to improve, and so this particular medication has the opportunity to change both positive, negative, and cognitive symptoms in schizophrenia. We want to be mindful, though, that if they’re on current medications for antipsychotics with their schizophrenia, that if there is an anticholinergic on board…combining that with this muscarinic agonist [can lead to] some potential changes that you need to be aware of in the muscarinic system. It’s a little bit different, as this medication is typically used as monotherapy, but in reality, we’re all trying to figure out how to treat schizophrenia really well, and so we need to be mindful of what other medications are on board.
HCPLive: What does the data show that really makes people think this is what we want to be trying?
Monroe: The effect sizes of the first 3 trials that were done for Cobenfy, for this muscarinic agonist…are pretty robust. We’re looking at in comparison to other antipsychotics; we see that the effect sizes are pretty up there, point 5, 6. If you look at other antipsychotics, the only outlier that’s much higher than that is clozapine, which we know is really used well for treatment-resistant schizophrenia, but this has the efficacy that we’re looking for in a robust antipsychotic without the baggage of metabolic syndrome, tardive dyskinesia, motor movements.
HCPLive: You mentioned treatment-resistant schizophrenia. What are the thoughts on using Cobenfy treatment?
Monroe: I have some mixed thoughts. We always think as clinicians, ‘Oh, a new drug is out there. I’m going to use this for my most difficult client, that nothing will work for them, and now this is a new thing, let me try it.’
I want to provide some caution around that we know that about 30% of clients with schizophrenia may be treatment resistant, and that may not be solely due to a dopaminergic problem. So, there is a dopaminergic dysfunction in most patients with schizophrenia, but in those treatment-resistant cases, it may not just be dopamine; it may also be other things like glutamate. And so, there is a reason why we should provide some caution for something like clozapine.
I would definitely not rip clozapine off and try this new medication, because those folks who have met the criteria for clozapine generally can be destabilized very easily. We want to exercise some caution if you’re going to use it… with clozapine…. because clozapine is highly anticholinergic, and if you’re adding in an anticholinergic with this medication, you want to be really cautious that we’re not causing more anticholinergic effects for the client.
Persistently around Clozapine. I’m worried about constipation and ileus, those sorts of things. And so, there’s a way to potentially manage both, but I would not switch one for the other.
HCPLive: What advice would you give a clinician to talk to their patient who is nervous about adverse events?
Monroe: I would give them reassurance that we actually have been managing schizophrenia all along with all this baggage of side effects that you have to follow for that patient’s life, right? Every 6 months to a year, we’re really managing metabolics. We’re constantly looking for tardive dyskinesia. The long haul of this medication, you don’t have some of those same concerns that I’ve been dealing with for the entirety of schizophrenia in my career. All I have to worry about is the first 2 weeks to a month, and that’s just getting past the hump of someone potentially having cholinergic side effects that’s very different than what they’re used to for other antipsychotics.
I would encourage the clinician to actually have some hope and excitement and encourage the client, the patient, that this is a whole new mechanism of action. This is not your typical antipsychotic. It’s not just another med that I’m giving you, that you have some predictive value of what you’ve been experiencing in the past. It’s a whole new mechanism. Now, there may be some side effects early on, but if we can mitigate those and get you through the first couple of weeks, we may be in the clear and have the efficacy that we’ve been looking for all along without all the downsides.
HCPLive: Any other thoughts or tips that you want to share with people?
Monroe: I would say have openness. You know that you really have to think critically when using these new muscarinic agonists, and it’s not necessarily just an easy drug to throw at your patient. You have to think through a little bit in the beginning how to start them on the medication…our patients really do deserve the highest level of care, and getting past some of these residual positive symptoms that many of them experience, let alone the cognitive and the negative symptoms, I think that this really has the opportunity to change psychiatry, and this is the first of several that will be in the line thereafter. We really need to challenge ourselves to get used to using these agents and learning about the muscarinic system.
HCPLive: What else is in the pipeline, and what we might be can you talk about that?
Monroe: They’re looking at really isolating the different muscarinic receptors. Right now, we have an M1 M4 agonist, but there’s some things in the pipeline where they’re really looking at M1 specifically, M4 specifically, positive allosteric modulators…and so really there’s an expansion around muscarinics right now.
There may be several molecules out there in the future that can modulate these muscarinics and dopamine pre-synaptically. That’s really what we’re getting to; instead of blocking everything after the fact, like a leaky basement, you’ve got this flood going on in your basement with dopamine. Instead of taking a bucket and throwing out that water 1 by 1 with our normal antipsychotics, we now can shut the water off at the faucet. It’s exciting times be looking out there for all of the other muscarinic agents that should be coming in the future.
References
Derman, C. FDA Approves Xanomeline and Trospium Chloride (Cobenfy) for Schizophrenia. HCPLive. September 26, 2024. https://www.hcplive.com/view/fda-approves-xanomeline-and-trospium-chloride-cobenfy-for-schizophrenia. Accessed July 15, 2025.
