The use of intracellular dyes to create a multiplexed flow cytometry-based red blood cell phenotyping assay.

BACKGROUND AND OBJECTIVES: Flow cytometry can be used to phenotype red blood cell antigens, allowing for high-throughput testing while using low reagent volumes. This article utilizes intracellular dyes to pre-label red blood cells to further multiplex flow cytometry-based red blood cell antigen phenotyping. MATERIALS AND METHODS: Red blood cells were pre-labelled using the intracellular dyes V450 and Oregon Green. These dyes are detected fluorescently via flow cytometry. Four combinations of intracellular staining were used to allow four patient or donor red blood cells to be analysed in a single test well. Antigen phenotyping was then performed via flow cytometry using a previously described method. RESULTS: The intracellular dyes showed uniform staining when measured in mean fluorescence intensity and allowed the red blood cells to be clearly distinguished from one another. The presence or absence of red blood cell antigens was determined with 100% accuracy. CONCLUSION: The use of intracellular dyes allowed a fourfold increase in the throughput of our previously described flow cytometry-based red blood cell antigen phenotyping method. The described method allows up to 48 patients to be simultaneously phenotyped using a single 96-well microplate. Furthermore, additional fluorescent dyes could potentially increase the throughput exponentially.

Development of multiplexed flow cytometry-based red blood cell antibody screen and identification assays.

BACKGROUND AND OBJECTIVES: The purpose of this study was to develop a high-throughput method of performing red blood cell antibody screens and identification by utilizing flow cytometry and intracellular dyes to allow a multiplexed assay where three-cell screens can be performed in a single test well and 11-cell panels in three test wells. MATERIALS AND METHODS: Reagent red blood cells were labelled using Violet Proliferation Dye 450 (V450) and Oregon Green fluorescent dyes, which bind intracellular proteins to allow up to four cells to be interrogated in a single test well. Sixteen 3-cell screen panels and ten 11-cell identification panels were tested using sera with known antibody specificity. Antibody binding was detected using secondary anti-immunoglobulin G and anti-immunoglobulin M fluorescently labelled antibodies. RESULTS: Intracellular dyes allowed clear separation of the different screen and identification panel test cells. Three distinct populations of V450+, Oregon Green+ and negative for both stains were demonstrated in the screening panel and an additional double positive for V450 and Oregon Green was utilized to include a fourth cell in the identification panel testing to increase throughput. A total of 158 screen or identification panel RBC/serum combinations were tested against different known antibodies, and expected results were obtained with 100% concordance. CONCLUSION: This study demonstrates the successful development of a high-throughput multiplexed flow cytometry-based red cell antibody screen and identification panel assays. This method could be implemented in clinical laboratories to complement existing antibody detection methods. The multiplexing enabled via intracellular staining could be utilized to further augment other flow cytometry-based transfusion assays.

National Greenhouse Gas Emission Reduction Potential from Adopting Anaerobic Digestion on Large-Scale Dairy Farms in the United States.

Waste-to-energy systems can provide a functional demonstration of the economic and environmental benefits of circularity, innovation, and reimagining existing systems. This study offers a robust quantification of the greenhouse gas (GHG) emission reduction potential of the adoption of anaerobic digestion (AD) technology on applicable large-scale dairy farms in the contiguous United States. GHG reduction estimates were developed through a robust life cycle modeling framework paired with sensitivity and uncertainty analyses. Twenty dairy configurations were modeled to capture important differences in housing and manure management practices, applicable AD technologies, regional climates, storage cleanout schedules, and methods of land application. Monte Carlo results for the 90% confidence interval illustrate the potential for AD adoption to reduce GHG emissions from the large-scale dairy industry by 2.45-3.52 MMT of CO2-eq per year considering biogas use only in renewable natural gas programs and as much as 4.53-6.46 MMT of CO2-eq per year with combined heat and power as an additional biogas use case. At the farm level, AD technology may reduce GHG emissions from manure management systems by 58.1-79.8% depending on the region. Discussion focuses on regional differences in GHG emissions from manure management strategies and the challenges and opportunities surrounding AD adoption.

Surgical and non-surgical interventions for primary and salvage treatment of growth hormone-secreting pituitary adenomas in adults.

BACKGROUND: Growth hormone (GH)-secreting pituitary adenoma is a severe endocrine disease. Surgery is the currently recommended primary therapy for patients with GH-secreting tumours. However, non-surgical therapy (pharmacological therapy and radiation therapy) may be performed as primary therapy or may improve surgical outcomes. OBJECTIVES: To assess the effects of surgical and non-surgical interventions for primary and salvage treatment of GH-secreting pituitary adenomas in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases was 1 August 2022. We did not apply any language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of more than 12 weeks' duration, reporting on surgical, pharmacological, radiation, and combination interventions for GH-secreting pituitary adenomas in any healthcare setting. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts for relevance, screened for inclusion, completed data extraction, and performed a risk of bias assessment. We assessed studies for overall certainty of the evidence using GRADE. We estimated treatment effects using random-effects meta-analysis. We expressed results as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) for continuous outcomes, or in descriptive format when meta-analysis was not possible. MAIN RESULTS: We included eight RCTs that evaluated 445 adults with GH-secreting pituitary adenomas. Four studies reported that they included participants with macroadenomas, one study included a small number of participants with microadenomas. The remaining studies did not specify tumour subtypes. Studies evaluated surgical therapy alone, pharmacological therapy alone, or combination surgical and pharmacological therapy. Methodological quality varied, with many studies providing insufficient information to compare treatment strategies or accurately judge the risk of bias. We identified two main comparisons, surgery alone versus pharmacological therapy alone, and surgery alone versus pharmacological therapy and surgery combined. Surgical therapy alone versus pharmacological therapy alone Three studies with a total of 164 randomised participants investigated this comparison. Only one study narratively described hyperglycaemia as a disease-related complication. All three studies reported adverse events, yet only one study reported numbers separately for the intervention arms; none of the 11 participants were observed to develop gallbladder stones or sludge on ultrasonography following surgery, while five of 11 participants experienced any biliary problems following pharmacological therapy (RR 0.09, 95% CI 0.01 to 1.47; 1 study, 22 participants; very low-certainty evidence). Health-related quality of life was reported to improve similarly in both intervention arms during follow-up. Surgery alone compared to pharmacological therapy alone may slightly increase the biochemical remission rate from 12 weeks to one year after intervention, but the evidence is very uncertain; 36/78 participants in the surgery-alone group versus 15/66 in the pharmacological therapy group showed biochemical remission. The need for additional surgery or non-surgical therapy for recurrent or persistent disease was described for single study arms only. Surgical therapy alone versus preoperative pharmacological therapy and surgery Five studies with a total of 281 randomised participants provided data for this comparison. Preoperative pharmacological therapy and surgery may have little to no effect on the disease-related complication of a difficult intubation (requiring postponement of surgery) compared to surgery alone, but the evidence is very uncertain (RR 2.00, 95% CI 0.19 to 21.34; 1 study, 98 participants; very low-certainty evidence). Surgery alone may have little to no effect on (transient and persistent) adverse events when compared to preoperative pharmacological therapy and surgery, but again, the evidence is very uncertain (RR 1.23, 95% CI 0.75 to 2.03; 5 studies, 267 participants; very low-certainty evidence). Concerning biochemical remission, surgery alone compared to preoperative pharmacological therapy and surgery may not increase remission rates up until 16 weeks after surgery; 23 of 134 participants in the surgery-alone group versus 51 of 133 in the preoperative pharmacological therapy and surgery group showed biochemical remission. Furthermore, the very low-certainty evidence did not suggest benefit or detriment of preoperative pharmacological therapy and surgery compared to surgery alone for the outcomes 'requiring additional surgery' (RR 0.48, 95% CI 0.05 to 5.06; 1 study, 61 participants; very low-certainty evidence) or 'non-surgical therapy for recurrent or persistent disease' (RR 1.22, 95% CI 0.65 to 2.28; 2 studies, 100 participants; very low-certainty evidence). None of the included studies measured health-related quality of life. None of the eight included studies measured disease recurrence or socioeconomic effects. While three of the eight studies reported no deaths to have occurred, one study mentioned that overall, two participants had died within five years of the start of the study. AUTHORS' CONCLUSIONS: Within the context of GH-secreting pituitary adenomas, patient-relevant outcomes, such as disease-related complications, adverse events and disease recurrence were not, or only sparsely, reported. When reported, we found that surgery may have little or no effect on the outcomes compared to the comparator treatment. The current evidence is limited by the small number of included studies, as well as the unclear risk of bias in most studies. The high uncertainty of evidence significantly limits the applicability of our findings to clinical practice. Detailed reporting on the burden of recurrent disease is an important knowledge gap to be evaluated in future research studies. It is also crucial that future studies in this area are designed to report on outcomes by tumour subtype (that is, macroadenomas versus microadenomas) so that future subgroup analyses can be conducted. More rigorous and larger studies, powered to address these research questions, are required to assess the merits of neoadjuvant pharmacological therapy or first-line pharmacotherapy.

Validation of a flow-cytometry-based red blood cell antigen phenotyping method.

BACKGROUND AND OBJECTIVES: Current manual and automated phenotyping methods are based on visual detection of the antigen-antibody interaction. This approach has several limitations including the use of large volumes of patient and reagent red blood cells (RBCs) and antisera to produce a visually detectable reaction. We sought to determine whether the flow cytometry could be developed and validated to perform RBC phenotyping to enable a high-throughput method of phenotyping using comparatively miniscule reagent volumes via fluorescence-based detection of antibody binding. MATERIALS AND METHODS: RBC phenotyping by flow cytometry was performed using monoclonal direct typing antisera (human IgM): anti-C, -E, -c, -e, -K, -Jka , -Jkb and indirect typing antisera (human IgG): anti-k, -Fya , -Fyb , -S, -s that are commercially available and currently utilized in our blood transfusion services (BTS) for agglutination-based phenotyping assays. RESULTS: Seventy samples were tested using both flow-cytometry-based-phenotyping and a manual tube standard agglutination assay. For all the antigens tested, 100% concordance was achieved. The flow-cytometry-based method used minimal reagent volume (0.5-1 µl per antigen) compared with the volumes required for manual tube standard agglutination (50 µl per antigen) CONCLUSION: This study demonstrates the successful validation of flow-cytometry-based RBC phenotyping. Flow cytometry offers many benefits compared to common conventional RBC phenotyping methods including high degrees of automation, quantitative assessment with automated interpretation of results and extremely low volumes of reagents. This method could be used for high-throughput, low-cost phenotyping for both blood suppliers and hospital BTS.

Global Life Cycle and Techno-Economic Assessment of Algal-Based Biofuels.

Techno-economic analyses (TEAs) and life cycle assessments (LCAs) of algal biofuels often focus on locations in suboptimal latitudes for algal cultivation, which can under-represent the sustainability potential of the technology. This study identifies the optimal global productivity potential, environmental impacts, and economic viability of algal biofuels by using validated biophysical and sustainability modeling. The biophysical model simulates growth rates of Scenedesmus obliquusbased on temperature, photoinhibition, and respiration effects at 6685 global locations. Region-specific labor costs, construction factors, and tax rates allow for spatially resolved TEA, while the LCA includes regional impacts of electricity, hydrogen, and nutrient markets across ten environmental categories. The analysis identifies optimal locations for algal biofuel production in terms of environmental impacts and economic viability which are shown to follow biomass yields. Modeling results highlight the global variability of productivity with maximum yields ranging between 24.8 and 27.5 g m-2 d-1 in equatorial regions. Environmental impact results show favorable locations tracked with low-carbon electricity grids, with the well-to-wheels global warming potential (GWP) ranging from 31 to 45 g CO2eq MJ-1 in South America and Central Africa. When including direct land use change impacts, the GWP ranged between 44 and 55 g CO2eq MJ-1 in these high-productivity regions. Low-carbon electricity also favors air quality and eutrophication impacts. The TEA shows that minimum algal fuel prices of $1.89-$2.15 per liter of gasoline-equivalent are possible in southeast Asia and Venezuela. This discussion focuses on the challenges and opportunities to reduce fuel prices and the environmental impacts of algal biofuels in various global regions.

Regionalized Life-Cycle Water Impacts of Microalgal-Based Biofuels in the United States.

While algal biofuels have the potential to reduce the national reliance on fossil fuels, high water consumption associated with algal biomass cultivation represents a major concern potentially compromising the sustainable commercialization of this technology. This study focuses on quantifying the water footprint (WF) and water scarcity footprint (WSF) of renewable diesel derived from algal biomass and provides insights into where algal cultivation is less water-intensive than traditional ethanol and biodiesel feedstocks. Results are generated with an engineering process model developed to predict the life-cycle water consumption, considering green, blue, and gray water, of algae facilities across the United States at a high spatiotemporal resolution. The total WFs for Florida and Arizona are determined to be 13.1 and 17.6 m3 GJ-1, respectively. The blue WF in Arizona is shown to be 8.5 times larger than in Florida, while the green WF is 4.5 times smaller, but when combined into a total WF, there is just a 26% difference between the two locations. The analysis reveals that the total life-cycle WFs of algal renewable diesel are smaller than the optimal WFs of corn ethanol and soybean biodiesel. Algal systems benefit from higher growth rates and offer the opportunity to manage wastewater streams, therefore generating smaller green and gray WFs than those of conventional biofuels. The WSF analysis identifies the Gulf Coast as the most suitable region for algal cultivation, with cultivation in the western US shown to exacerbate local water stress levels.

Cost-effectiveness of direct surgery versus preoperative octreotide therapy for growth-hormone secreting pituitary adenomas.

PURPOSE: The objective of this study was to compare the cost-effectiveness of preoperative octreotide therapy followed by surgery versus the standard treatment modality for growth-hormone secreting pituitary adenomas, direct surgery (that is, surgery without preoperative treatment) from a public third-party payer perspective. METHODS: We developed an individual-level state-transition microsimulation model to simulate costs and outcomes associated with preoperative octreotide therapy followed by surgery and direct surgery for patients with growth-hormone secreting pituitary adenomas. Transition probabilities, utilities, and costs were estimated from recent published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs [2020 United States (US) Dollars], quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). RESULTS: Under base case assumptions, direct surgery was found to be the dominant strategy as it yielded lower costs and greater health effects (QALYs) compared to preoperative octreotide strategy in the second-order Monte Carlo microsimulation. The ICER was most sensitive to probability of remission following primary therapy and duration of preoperative octreotide therapy. Accounting for joint parameter uncertainty, direct surgery had a higher probability of demonstrating a cost-effective profile compared to preoperative octreotide treatment at 77% compared to 23%, respectively. CONCLUSIONS: Using standard benchmarks for cost-effectiveness in the US ($100,000/QALY), preoperative octreotide therapy followed by surgery may not be cost-effective compared to direct surgery for patients with growth-hormone secreting pituitary adenomas but the result is highly sensitive to initial treatment failure and duration of preoperative treatment.

Application of unsupervised machine learning to identify areas of blood product wastage in transfusion medicine.

BACKGROUND: Wastage of blood products can be a significant cost to blood banks. However, the cause of wastage is often complex and makes it difficult to determine wastage-associated factors. Machine learning techniques may be useful tools to investigate these complex associations. We investigated whether unsupervised machine learning can identify patterns associated with wastage in our blood bank. MATERIALS AND METHODS: Data on red blood cells, platelets and frozen products were obtained from the laboratory information system of the Central Zone Blood Transfusion Services at Nova Scotia Health Authority. A total of 879 532 transactions were analysed by association rule mining, a type of machine learning algorithm. Associations with lift scores greater than 25 and with clinical relevance were flagged for further examination. RESULTS: Association rule mining returned a total of 3355 associations related to wastage. Several notable associations were identified. For example, certain wards were associated with wastage due to thawing unused frozen products. Other examples included association between smaller blood banks and evening work shifts with product wastage due to excess time outside the laboratory or returning products with high temperatures. CONCLUSION: This paper demonstrates the effective use of unsupervised machine learning for the purpose of investigating wastage in a large blood bank. The use of association rule mining was able to identify wastage factors, which can help guide quality improvement initiatives. This technique can be automated to provide rapid analysis of complex associations contributing to wastage and could be utilized in modern blood banks.

Time-Resolved Cost Analysis of Natural Gas Power Plant Conversion to Bioenergy with Carbon Capture and Storage to Support Net-Zero Emissions.

The ongoing construction of natural gas combined cycle (NGCC) power plants is incompatible with a transition to global net-zero greenhouse gas emissions. This work evaluates the emission pricing and technology costs required to convert an existing NGCC power plant to a biomethane-based bioenergy with carbon capture and storage (BECCS) system. The conversion was evaluated using techno-economic analysis and time-resolved life cycle assessment. At current technology costs, carbon dioxide equivalent emission prices of $142 and $215 per metric ton are required to allow a BECCS conversion to compete with normal operation or shutdown, respectively, of an existing NGCC power plant. These results show further technological development must occur in parallel with emission pricing to make BECCS viable. If mid-range emission pricing estimates are implemented ($25-$105 per metric ton), BECCS capital cost targets range from $1434 to $2098 per kW of capacity, while operational costs range from $32 to $51 per MWh of electricity produced to enable conversion. These findings indicate that operational costs associated with fuel consumption and production must be significantly reduced to make a BECCS conversion viable, even with emission pricing. All data and methods of this work have been made publicly available in an open-source model.

A contemporary description of patients' estimated blood losses from diagnostic phlebotomy in a census of hospital episodes from a Canadian tertiary care center.

BACKGROUND: Phlebotomy for diagnostic testing is among the commonest hospital procedures, but hospital-wide surveys of all inpatients characterizing blood draw volumes have not been published. The objectives were to characterize the daily blood volumes drawn for diagnostic testing from patients discharged from a Canadian tertiary care center, describe the daily distributions of phlebotomy volumes across service locations, and describe changes in hemoglobin (Hb) and transfusion across service locations. STUDY DESIGN AND METHODS: Data were obtained on all patients discharged between 2012 and 2014 using linked discharge abstract and laboratory data. Cumulative daily blood volume and draw frequency were reported by service and days since admission. Changes in Hb and red blood cell (RBC) transfusion rates were reported for nontransfused and transfused patients. RESULTS: Data were included on 59,715 subjects. Mean daily estimated blood loss varied from 8.5 ± 6.5 mL/day onward to 27.2 ± 20.0 mL/day in the intensive care unit (ICU; p < 0.001). Phlebotomy volumes were highest on the first day of admission and declined thereafter (p < 0.001). For nontransfused individuals in the first week of admission, Hb levels decreased by the highest percentage in the ICU. The rate of RBC unit transfusion was highest in the ICU (232.4 units/1000 patient-days; 95% confidence interval, 225.8-239.2; p < 0.0001 compared with all other locations). CONCLUSION: Considerable variation was observed in estimated blood loss due to diagnostic phlebotomy across different services within one teaching hospital. Thi information is foundational for planning interventions to minimize estimated blood loss from phlebotomy.

The successful implementation of an automated institution-wide assessment of hemoglobin and ABO typing to dynamically estimate red blood cell inventory requirements.

BACKGROUND: Blood bank inventories must balance adequate supply with minimal outdate rates. The day-to-day practice of ordering red blood cell (RBC) inventory usually involves manually comparing current inventory levels with predetermined thresholds calculated from historical usage and ordering the difference. To date, there have been no published methods for ordering RBC inventory based on laboratory characteristics of admitted patients. STUDY DESIGN AND METHODS: We designed and implemented a blood ordering algorithm to provide a more accurate measure of predicted RBC utilization in our institution. Cerner Command Language (Cerner Millennium) was used to extract and combine historical RBC unit usage, current inventory levels, and system-wide hematology values and blood groups. This report contains a suggested order based on current inventory, historical inventory data, ABO group, and the current "anemia index" for the institution. RESULTS: The mean daily total RBC inventory was significantly reduced after implementation (401.7 units vs. 309.0 units, p < 0.05). There was a significant reduction in monthly RBC outdates in this period (19.1 vs. 8.1, p < 0.05). The age of RBCs at time of transfusion was reduced as well. CONCLUSION: We developed a novel algorithm that automatically generates a suggested RBC inventory order using real-time hospital-wide survey of patient ABO typing, hematology values, and historical data. After implementation of the algorithm we demonstrated a significant reduction in daily inventory levels and RBC outdate rates.

Time Value of Greenhouse Gas Emissions in Life Cycle Assessment and Techno-Economic Analysis.

Life cycle assessment is a fundamental tool used to evaluate the environmental impact of products. Standard life cycle assessment methodology ignores the impact of greenhouse gases relative to when they are emitted. In this paper, we present a method for leveraging the social cost of greenhouse gases to account for the temporal impacts of emissions in life cycle assessment and techno-economics. To demonstrate, we use this method to analyze the present value of the monetized impacts of emissions across multiple electricity generation technologies. Results show that accounting for time increases the present value across all but one of the technologies considered. Carbon intensive technologies show the highest increase, with coal rising between 26% and 62% depending on social cost scenario. Additionally, we demonstrate a second method that combines temporally resolved greenhouse gas emissions with techno-economic analysis. Considering temporal impacts of emissions within techno-economic analysis increases the levelized cost of electricity (LCOE) across all technologies considered. Carbon intensive technologies increase significantly, with the LCOE from coal rising between 37% and 263% depending on the social cost scenario. The proposed methods show that temporal resolution in life cycle assessment is critical for comparing the monetized impacts of greenhouse gas emissions across technologies.

Conversion of Distiller's Grains to Renewable Fuels and High Value Protein: Integrated Techno-Economic and Life Cycle Assessment.

Distiller's grains are a byproduct of corn ethanol production and provide an opportunity for increasing the economic viability and sustainability of the overall grain-to-fuels process. Typically, these grains are dried and sold as a ruminant feed adjunct. This study considers utilization of the residuals in a novel supplementary fermentation process to produce two products, enriched protein and fusel alcohols. The value-added proposition and environmental impact of this second fermentation step for distiller's grains are evaluated by considering three different processing scenarios. Techno-economic results show the minimum protein selling price, assuming fusel alcohol products are valued at $0.79 per liter gasoline equivalent, ranges between $1.65-$2.48 kg protein-1 for the different cases. Environmental impacts of the systems were evaluated through life cycle assessment. Results show a baseline emission results of 17 g CO2-eq (MJ fuel)-1 for the fuel product and 10.3 kg CO2-eq kg protein-1 for the protein product. Sensitivity to allocation methods show a dramatic impact with results ranging between -8 to 140 g CO2-eq (MJ fuel)-1 for the fuel product and -0.3 to 6.4 kg CO2-eq kg protein-1 for the protein product. The discussion is focused on the potential impact of the technology on corn ethanol production economics and sustainability.

Process mining is an underutilized clinical research tool in transfusion medicine.

BACKGROUND: To understand inventory performance, transfusion services commonly use key performance indicators (KPIs) as summary descriptors of inventory efficiency that are graphed, trended, and used to benchmark institutions. STUDY DESIGN AND METHODS: Here, we summarize current limitations in KPI-based evaluation of blood bank inventory efficiency and propose process mining as an ideal methodology for application to inventory management research to improve inventory flows and performance. RESULTS: The transit of a blood product from inventory receipt to final disposition is complex and relates to many internal and external influences, and KPIs may be inadequate to fully understand the complexity of the blood supply chain and how units interact with its processes. Process mining lends itself well to analysis of blood bank inventories, and modern laboratory information systems can track nearly all of the complex processes that occur in the blood bank. CONCLUSION: Process mining is an analytical tool already used in other industries and can be applied to blood bank inventory management and research through laboratory information systems data using commercial applications. Although the current understanding of real blood bank inventories is value-centric through KPIs, it potentially can be understood from a process-centric lens using process mining.

From Clozapine to Cognitive Remediation.

OBJECTIVE: Although a minority of persons with schizophrenia (SCZ) commits violent acts, SCZ remains a risk factor for violence. Here, we present a broad overview of evidence-based treatments for violence in SCZ, including biological and psychosocial interventions. METHOD: We conducted MEDLINE and PsychINFO literature searches to retrieve articles relating to treatments for violent, hostile, or aggressive behaviours in SCZ. RESULTS: Clozapine shows the strongest evidence for treating the acute violence of SCZ. Other atypical antipsychotics also possess antiaggressive effects, although the evidence is not as robust as that for clozapine. Psychosocial treatments can be useful adjuncts to pharmacotherapy once patients' positive symptoms have stabilized. Cognitive behavioural therapy for psychosis and cognitive remediation are 2 psychosocial interventions that have demonstrated positive outcomes for violence in SCZ. Most psychosocial studies that examined violence as an outcome were conducted in forensic psychiatric settings. CONCLUSIONS: Effective treatments exist for persons with SCZ who pose a risk for violent and aggressive behaviour, although the overall evidence base remains relatively weak. More randomized controlled trials of programs showing evidence for reduction of violence in SCZ are required. Further research should delineate which patients could benefit from multimodal treatment and where and when such treatments are optimally delivered.

Global evaluation of biofuel potential from microalgae.

In the current literature, the life cycle, technoeconomic, and resource assessments of microalgae-based biofuel production systems have relied on growth models extrapolated from laboratory-scale data, leading to a large uncertainty in results. This type of simplistic growth modeling overestimates productivity potential and fails to incorporate biological effects, geographical location, or cultivation architecture. This study uses a large-scale, validated, outdoor photobioreactor microalgae growth model based on 21 reactor- and species-specific inputs to model the growth of Nannochloropsis. This model accurately accounts for biological effects such as nutrient uptake, respiration, and temperature and uses hourly historical meteorological data to determine the current global productivity potential. Global maps of the current near-term microalgae lipid and biomass productivity were generated based on the results of annual simulations at 4,388 global locations. Maximum annual average lipid yields between 24 and 27 m(3)·ha(-1)·y(-1), corresponding to biomass yields of 13 to 15 g·m(-2)·d(-1), are possible in Australia, Brazil, Colombia, Egypt, Ethiopia, India, Kenya, and Saudi Arabia. The microalgae lipid productivity results of this study were integrated with geography-specific fuel consumption and land availability data to perform a scalability assessment. Results highlight the promising potential of microalgae-based biofuels compared with traditional terrestrial feedstocks. When water, nutrients, and CO2 are not limiting, many regions can potentially meet significant fractions of their transportation fuel requirements through microalgae production, without land resource restriction. Discussion focuses on sensitivity of monthly variability in lipid production compared with annual average yields, effects of temperature on productivity, and a comparison of results with previous published modeling assumptions.

Impact of inorganic contaminants on microalgae productivity and bioremediation potential.

As underdeveloped nations continue to industrialize and world population continues to increase, the need for energy, natural resources, and goods will lead to ever increasing inorganic contaminants, such as heavy metals, in various waste streams that can have damaging effects on plant life, wildlife, and human health. This work is focused on the evaluation of the potential of Nannochloropsis salina to be integrated with contaminated water sources for the concurrent production of a biofuel feedstock while providing an environmental service through bioremediation. Individual contaminants (As, Cd, Cr, Co, Cu, Pb, Ni, Hg, Se, and Zn) at various concentrations ranging from a low concentration (1X) to higher concentrations (10X, and 40X) found in contaminated systems (mine tailings, wastewater treatment plants, produced water) were introduced into growth media. Biological growth experimentation was performed in triplicate at the various contaminant concentrations and at 3 different light intensities. Results show that baseline concentrations of each contaminant slightly decreased biomass growth to between 89% and 99% of the control with the exception of Ni which dramatically reduced growth. Increased contaminant concentrations resulted in progressively lower growth rates for all contaminants tested. Lipid analysis shows most baseline contaminant concentrations slightly decrease or have minimal effects on lipid content at all light levels. Trace contaminant analysis on the biomass showed Cd, Co, Cu, Pb, and Zn were sorbed by the microalgae with minimal contaminants remaining in the growth media illustrating the effectiveness of microalgae to bioremediate these contaminants when levels are sufficiently low to not detrimentally impact productivity. The microalgae biomass was less efficient at sorption of As, Cr, Ni, and Se.

Who kills whom? The micro-dynamics of civilian targeting in civil war.

Prior research on civilian targeting in civil war has focused on characteristics of either the government or rebel group that make them more or less likely to target civilians. However, no government or rebel group targets a population, but rather individuals within it. To date, no study has explored the issue of why particular civilians would be chosen by one actor versus the other. This study examines the divergent civilian-targeting strategies of governments and rebel groups. We argue that unique identification problems facing each political actor in civil war leads the parties to resort to social stereotypes based on data derived from known enemy subjects killed in combat. We specify and then test a model that accounts for time and space and the demographic characteristics of each victim utilizing a new dataset on the personal, political, and demographic characteristics of individual civilians targeted by the state and rebels in the civil war in Nepal (1996-2006). The findings demonstrate for the first time that governments (and rebels) tend to kill the same types of individuals in non-combat settings as they kill in combat exchanges, and the civilians targeted by each actor differ significantly in the extent that they share certain social traits.

Implementation of a novel real-time platelet inventory management system at a multi-site transfusion service.

BACKGROUND: Blood platelets (PLTs) are a valuable commodity. Management of their inventory has implications both for patient care and for the cost of health care delivery. There are a variety of different methods of managing PLT inventory currently in practice and multiple theoretical models aimed at improving PLT inventory metrics. In this study we evaluate the ability of a novel electronic dashboard system that monitors and displays both PLT inventory and patient data to improve transfusion metrics at a quaternary health care center. STUDY DESIGN AND METHODS: The Capital District Health Authority is a quaternary health care center that transfuses approximately 2500 PLT units annually. To improve PLT discard rates a novel, low-overhead system that interfaces with the laboratory information system and displays real-time data between transfusion sites on PLT inventory and orders was implemented in November 2011. This study examines the transfusion quality metrics data from the 24 months before and after implementation. RESULTS: A significant reduction in mean monthly PLT outdate rate was observed after the implementation of the PLT dashboard suite from 24.5% (n = 24, SD ± 6.4%) to 15.1% (n = 24, SD ± 6.4%; p < 0.001). PLT age at time of transfusion was also reduced from 3.60 days (n = 4796, SD ± 0.97 days) to 3.46 days (n = 4881, SD ± 1.00 days; p < 0.001). CONCLUSIONS: This study describes the implementation of a novel PLT dashboard suite. This suite significantly reduced PLT outdate rates at our institution over the 48-month study period.