Low-Cost Biobased Coatings for AM60 Magnesium Alloys for Food Contact and Harsh Environment Applications.

Low-cost, environmentally friendly and easily applicable coating for Mg alloys, able to resist in real world conditions, are studied. Coatings already used for other metals (aluminum, steel) and never tested on Mg alloy for its different surface and reactivity were deposited on AM60 magnesium alloys to facilitate their technological applications, also in presence of chemically aggressive conditions. A biobased PA11 powder coating was compared to synthetic silicon-based and polyester coatings, producing lab scale samples, probed by drop deposition tests and dipping in increasingly aggressive, salty, basic and acid solutions, at RT and at higher temperatures. Coatings were analyzed by SEM/EDX to assess their morphology and compositions, by optical and IR-ATR microscopy analyses, before and after the drop tests. Migration analyses from the samples were performed by immersion tests using food simulants followed by ICP-OES analysis of the recovered simulant to explore applications also in the food contact field. A 30 µm thick white lacquer and a 120 µm PA11 coating resulted the best solutions. The thinner siliconic and lacquer coatings, appearing brittle and thin in the SEM analysis, failed some drop and/or dipping test, with damages especially at the edges. The larger thickness is thus the unique solution for edgy or pointy samples. Finally, coffee cups in AM60 alloy were produced, as real word prototypes, with the best performing coatings and tested for both migration by dipping, simulating also real world aging (2 h in acetic acid at 70° and 24 h in hot coffee at 60 °C): PA11 resulted stable in all the tests and no migration of toxic metals was observed, resulting a promising candidate for many real world application in chemically aggressive environments and also food and beverage related applications.

Electrolyte Analysis and Replacement: Challenging a Paradigm in Surgical Patients.

Postoperative patients are susceptible to alterations in electrolyte homeostasis. Although electrolytes are replaced in critically ill patients, stable asymptomatic non-intensive care unit (ICU) patients often receive treatment of abnormal electrolytes. We hypothesize there is no proven benefit in asymptomatic patients. In 2016, using the electronic medical records and pharmacy database at a university academic medical center, we conducted a retrospective cost analysis of the frequency and cost of electrolyte analysis (basic metabolic panel [BMP], ionized calcium [Ca], magnesium [Mg], and phosphorus [P]) and replacement (potassium chloride [KCl], Mg, oral/iv Ca, oral/iv P) in perioperative patients. Patients without an oral diet order, with creatinine more than 1.4, age less than 16 years, admitted to the ICU, or with length of stay of more than 1 week were excluded. Nursing costs were calculated as a fraction of hourly wages per laboratory order or electrolyte replacement. One hundred thirteen patients met our criteria over 11 months. Mean length of stay was 4 days; mean age was 54 years; and creatinine was 0.67 ± 0.3. Electrolyte analysis laboratory orders (n = 1,045) totaled $6,978, and BMP was most frequently ordered accounting for 36% of laboratory costs. In total, 683 doses of electrolytes cost the pharmacy $1,780. Magnesium was most frequently replaced, followed by KCl, P, and Ca. Nursing cost associated with electrolyte analysis/replacement was $7,782. There is little evidence to support electrolyte analysis and replacement in stable asymptomatic noncritically ill patients, but their prevalence and cost ($146/case) in this study were substantial. Basic metabolic panels, pharmacy charges for potassium, and nursing staff costs accounted for the most significant portion of the total cost. Considering these data, further research should determine whether these practices are warranted.

Cost effectiveness of ibutilide with prophylactic magnesium in the treatment of atrial fibrillation.

BACKGROUND: In the Treatment with Ibutilide and Magnesium Evaluation (TIME) study, a retrospective multicentre cohort trial, prophylactic magnesium was found to improve the antiarrhythmic efficacy of ibutilide as demonstrated by an increase in the rate of successful chemical conversion and reduction in the need for direct current cardioversion (DCC). OBJECTIVE: The primary objective of this piggyback cost-effectiveness analysis of the TIME study was to compare the cost per successful conversion of atrial fibrillation (AF) for ibutilide in the presence and absence of magnesium prophylaxis. A secondary objective was to determine whether specific factors predict costs in the conversion of AF. METHOD: The study was conducted from the US hospital-payer perspective. Direct medical costs (USD, 2002 values) including drugs, intravenous admixture and administration, DCC, electrocardiographs and physicians' fees were obtained directly from the provider. Nonparametric bootstrapping was conducted to calculate confidence intervals for the incremental cost-effectiveness ratios. One-way sensitivity analysis was conducted varying efficacy, and drug, hospital and physician costs. Multivariate analysis was conducted to determine whether specific baseline factors were predictors of total cost. RESULTS: Total costs per patient were lower in the ibutilide plus magnesium group compared with ibutilide alone (USD1075 vs USD1201); however, the difference was not statistically significant (p = 0.116). Patients receiving ibutilide plus magnesium had lower DCC costs compared with those receiving ibutilide alone (USD261 vs USD399; p = 0.036), but higher magnesium-associated costs (USD0.50 vs USD0; p < 0.001). Bootstrapping revealed that the ibutilide plus magnesium strategy would result in lower costs and greater efficacy 93.4% of the time. These results remained robust to changes in both cost and efficacy. No baseline factors were found to be independent predictors of total costs. CONCLUSION: Our data suggest that adding prophylactic magnesium to ibutilide may be cost effective, from a US hospital-payer perspective, for the acute conversion of patients in AF or flutter compared with ibutilide alone.