Definition of agronomic circular economy metrics and use for assessment for a nanofertilizer case study.

Circular economy has become global priority, and fertigation make large contribution. Modern circular methodologies base their definitions, besides on waste minimisation and recovery, on the product usage U and lifetime L. We have modified a commonly used equation for the mass circularity indicator (MCI) to permit MCI determination for agricultural cultivation. We defined U as intensity for diverse investigated parameters of plant growth and L as the bioavailability period. In this way, we compute circularity metrics for the plantgrowth performance when exposed to three nanofertilizers and one biostimulant, as compared to no-use of micronutrients (control 1), and micronutrients supplied via conventional fertilizers (control 2). We determined an MCI of 0.839 for best nanofertilizer performance (1.000 denotes full circularity), while the MCI of conventional fertilizer was 0.364. Normalised to control 1, U was determined as 1.196, 1.121 and 1.149 for manganese, copper and iron-based nanofertilizers, respectively, while U was 1.709, 1.432, 1.424 and 1.259 for manganese, copper, iron nanofertilizers and gold biostimulant when normalised to control 2, respectively. Based on the learning of the plant growth experiments, a tailored process design is proposed for the use of nanoparticles with pre-conditioning, post-processing and recycling steps. A life cycle assessment shows that the additional use of pumps for this process design does not increase energy costs, while preserving environmental advantages related to the lower water usage of the nanofertilizers. Moreover, the impact of the losses of conventional fertilisers by missing absorption of plant roots, which is presumed to be lower for the nanofertilizers.

Patient satisfaction and cost savings analysis of the telemedicine program within a neuro-oncology department.

PURPOSE: Unique challenges exist in the utilization of telemedicine for neurological and surgical specialties. We examined the differences in patient satisfaction for telemedicine versus in-person visits within a Neuro-Oncology Program to assess whether there was a difference between surgical and medical specialties. We also examined the potential cost savings benefits of utilizing telemedicine. METHODS: 1189 Press Ganey surveys in the Department of Neuro-Oncology (982 in-person and 207 telemedicine) by surgical and medical neuro-oncology patients between 04/01/2020 and 06/30/2021 were reviewed. Survey results were divided into 4 categories (Access, Provider, Technology (telemedicine only), and Overall Satisfaction). Results were analyzed for the impact of telemedicine versus in-person visits, and gender, age, insurance, and specialty. Cost savings were calculated based on potential travel distance and lost productivity. RESULTS: Survey results from telemedicine visits demonstrated that patients with private insurance returned higher scores in the Provider (p = 0.0089), Technology (p = 0.00187), and Overall (p = 0.00382) categories. Surgical patients returned higher scores for Access (p = 0.0015), Technology (p = 0.0002), and Overall (p = 0.0019). When comparing telemedicine to in-person scores, in-person scored higher in Provider (p = 0.0092) for all patients, while in-person scored higher in Access (p = 0.0252) amongst surgical patients. Cost analysis revealed that telemedicine allowed patients to save an average of 4.1 to 5.6 h per visit time and a potential cost savings of up to $223.3 ± 171.4. CONCLUSION: Telemedicine yields equivalent patient satisfaction when employed in surgical as compared to medical Neuro-Oncology patients with the potential to lessen the financial and time burden on neuro-oncology patients.

Risk factors for hepatitis C virus infection at a large urban emergency department.

In 2020, Centers for Disease Control and Prevention (CDC) released guidelines recommending HCV screening in all adults 18 years and older. In the current study, we aimed to identify risk factors for HCV infection in an ED population. We performed a retrospective analysis of ED patients ≥ 18 years who were screened for HCV between 28 November 2018, and 27 November 2019, at a single urban, quaternary referral academic hospital. An HCV-antibody immunoassay (HCV-Ab) was used for screening; positive results were confirmed by measuring HCV ribonucleic acid (RNA). The outcome of interest was the number of new HCV diagnoses (presence of viremia by HCV RNA testing). Multiple logistic regression models were used to identify risk factors associated with a new HCV diagnosis. 16,722 adult patients were screened for HCV (mean age: 46 ± 15 years; 51% female). HCV seroprevalence was 5%. Independent risk factors for HCV included increasing age [10-year aOR 1.26 (95% CI 1.23, 1.30)], male sex [aOR 1.25 (95% CI 1.03, 1.51)], undomiciled housing status [aOR 2.8 (95% CI 2.3, 3.5)], history of tobacco use [aOR 3.0 (95% CI 2.3, 3.9)], history of illicit drug use [aOR 3.6 (95% CI 2.9, 4.5)], Medicaid insurance status [aOR 4.0 (95% CI 2.9, 5.5)] and Medicare insurance status [aOR 1.6 (95% CI 1.1, 2.2)].The ED services a high-risk population with regards to HCV infection. These data support universal screening of ED patients for HCV. Risk factor profiles could improve targeted screening at institutions without universal testing protocols.

Techno-environmental assessment of small-scale Haber-Bosch and plasma-assisted ammonia supply chains.

Haber-Bosch (HB) process, the main method for ammonia (NH3) production, contributes to near 2% of the global carbon emissions because the hydrogen input is obtained from fossil sources. NH3 production is concentrated in a few countries, adding emissions due to global distribution. Distributed plants next to farmers and fed by renewable energy can reduce these impacts, as well as NH3 storage, shortage risks, and price volatility. Distributed plants cannot reach low NH3 production costs as centralised plants, but they can be promoted by the environmental benefits of its products lifecycles. Therefore, life cycle assessments of NH3 production pathways and specific modelling for NH3 transport in Australia were performed, from cradle-to-site, to identify the influence of storage, transport, and energy sources in their environmental profiles. The carbon footprint of centralised production was up to 2.96 kg.CO2-eq/kg.NH3, from which 29.3% corresponded to transport. Local production demonstrated substantial avoided transport impacts and that CO2-eq can reach reductions over 100% when including co-product credits such as oxygen and carbon black. Local plants using electrolysers to supply mini-HB loops obtained rates of 0.12, -0.52, and -1.57 kg.CO2-eq/kg.NH3 using electricity from solar, wind, and biogas (other than manure) sources, respectively. The alternative using high temperature plasma reactor instead of electrolyser obtained its best rate of -0.65 kg.CO2-eq/kg using biogas different from manure. At farm electrolyser-based plants using novel non-thermal plasma reactors, considering potential energy yields and simplified NH3 separation technology, could reach a rate of -1.07 kg.CO2-eq/kg.NH3, using solar energy. Among the assessed pathways, the most notable impact was on freshwater eutrophication in the electrolyser-based plants generating reductions up to 290%, due to oxygen credits. Despite these results, the use of solar energy raises concerns on land use and terrestrial ecotoxicity due to the area needed for solar farms and the manufacture of their components.

The Australian Child Maltreatment Study (ACMS): protocol for a national survey of the prevalence of child abuse and neglect, associated mental disorders and physical health problems, and burden of disease.

INTRODUCTION: Child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence) is widely understood to be associated with multiple mental health disorders, physical health problems and health risk behaviours throughout life. However, Australia lacks fundamental evidence about the prevalence and characteristics of child maltreatment, its associations with mental disorders and physical health, and the associated burden of disease. These evidence gaps impede the development of public health strategies to better prevent and respond to child maltreatment. The aims of this research are to generate the first comprehensive population-based national data on the prevalence of child maltreatment in Australia, identify associations with mental disorders and physical health conditions and other adverse consequences, estimate attributable burden of disease and indicate targeted areas for future optimal public health prevention strategies. METHODS AND ANALYSIS: The Australian Child Maltreatment Study (ACMS) is a nationwide, cross-sectional study of Australia's population aged 16 years and over. A survey of approximately 10 000 Australians will capture retrospective self-reported data on the experience in childhood of all five types of maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence). A customised, multimodule survey instrument has been designed to obtain information including: the prevalence and characteristics of these experiences; diagnostic screening of common mental health disorders; physical health; health risk behaviours and health service utilisation. The survey will be administered in March-November 2021 to a random sample of the nationwide population, recruited through mobile phone numbers. Participants will be surveyed using computer-assisted telephone interviews, conducted by trained interviewers from the Social Research Centre, an agency with extensive experience in studies of health and adversity. Rigorous protocols protect the safety of both participants and interviewers, and comply with all ethical and legal requirements. Analysis will include descriptive statistics reporting the prevalence of individual and multitype child maltreatment, multiple logistic and linear regression analyses to determine associations with mental disorders and physical health problems. We will calculate the population attributable fractions of these putative outcomes to enable an estimation of the disease burden attributable to child maltreatment. ETHICS AND DISSEMINATION: The study has been approved by the Queensland University of Technology Human Research Ethics Committee (#1900000477, 16 August 2019). Results will be published to the scientific community in peer-reviewed journals, scientific meetings and through targeted networks. Findings and recommendations will be shared with government policymakers and community and organisational stakeholders through diverse engagement activities, a dedicated Advisory Board and a systematic knowledge translation strategy. Results will be communicated to the public through an organised media strategy and the ACMS website.

Continuous-Flow Extraction of Adjacent Metals-A Disruptive Economic Window for In†Situ Resource Utilization of Asteroids?

For the in situ resource utilization (ISRU) of asteroids, the cost-mass conundrum needs to be solved, and technologies may need to be conceptualised from first principals. By using this approach, this Review seeks to illustrate how chemical process intensification can help with the development of disruptive technologies and business matters, how this might influence space-industry start-ups, and even industrial transformations on Earth. The disruptive technology considered is continuous microflow solvent extraction and, as another disruptive element therein, the use of ionic liquids. The space business considered is asteroid mining, as it is probably the most challenging resource site, and the focus is on its last step: the purification of adjacent metals (cobalt versus nickel). The key economic barrier is defined as the reduction in the amount of water used in the asteroid mining process. This Review suggests a pathway toward water savings up to the technological limit of the best Earth-based processes and their physical limits.

Clinical risk assessment of biotin interference with a high-sensitivity cardiac troponin T assay.

Objectives Biotin >20.0 ng/mL (81.8 nmol/L) can reduce Elecsys® Troponin T Gen 5 (TnT Gen 5; Roche Diagnostics) assay recovery, potentially leading to false-negative results in patients with suspected acute myocardial infarction (AMI). We aimed to determine the prevalence of elevated biotin and AMI misclassification risk from biotin interference with the TnT Gen 5 assay. Methods Biotin was measured using an Elecsys assay in two cohorts: (i) 797 0-h and 646 3-h samples from 850 US emergency department patients with suspected acute coronary syndrome (ACS); (ii) 2023 random samples from a US laboratory network, in which biotin distributions were extrapolated for higher values using pharmacokinetic modeling. Biotin >20.0 ng/mL (81.8 nmol/L) prevalence and biotin 99th percentile values were calculated. AMI misclassification risk due to biotin interference with the TnT Gen 5 assay was modeled using different assay cutoffs and test timepoints. Results ACS cohort: 1/797 (0.13%) 0-h and 1/646 (0.15%) 3-h samples had biotin >20.0 ng/mL (81.8 nmol/L); 99th percentile biotin was 2.62 ng/mL (10.7 nmol/L; 0-h) and 2.38 ng/mL (9.74 nmol/L; 3-h). Using conservative assumptions, the likelihood of false-negative AMI prediction due to biotin interference was 0.026% (0-h result; 19 ng/L TnT Gen 5 assay cutoff). US laboratory cohort: 15/2023 (0.74%) samples had biotin >20.0 ng/mL (81.8 nmol/L); 99th percentile biotin was 16.6 ng/mL (68.0 nmol/L). Misclassification risk due to biotin interference (19 ng/L TnT Gen 5 assay cutoff) was 0.025% (0-h), 0.0064% (1-h), 0.00048% (3-h), and <0.00001% (6-h). Conclusions Biotin interference has minimal impact on the TnT Gen 5 assay's clinical utility, and the likelihood of false-negative AMI prediction is extremely low.

Direct medical costs of diabetes and its complications in Vietnam: A national health insurance database study.

AIM: To estimate the direct medical cost of type 2 diabetes mellitus (T2DM) and its complications in Vietnam. METHODS: Using the public payer perspective, the direct medical cost was estimated using routine data in the national claims database in Vietnam in 2017. People were identified as being diagnosed with T2DM if they were aged ≥ 30 years and who either (1) had at least one ICD-10 code E11 or (2) had been prescribed with oral antihyperglycemic medication on two separate visit records. The Diabetes Severity Complications Index was used to assess the presence of diabetes-related complications. All costs were standardized to 2017 United States dollars (USD). RESULTS: Of the 1,395,204 people identified with T2DM, 55% had diabetes-related complications. The most common complication was cardiovascular diseases (34%). The total direct medical cost was USD 435 million, of which 24% was spent on hospitalization, 20% on outpatient care, 7% on emergency care, 36% on non-diabetes-related medication, and 13% on antihyperglycemic medication. About 70% of the total direct medical costs were attributed to diabetes-related complications. CONCLUSION: The high proportion of hospitalization and complications costs in Vietnam suggests that the possibility exists to make economic savings through better preventative care.

An insulin-dose error assessment grid: A new tool to evaluate glucose meter performance.

OBJECTIVE: To develop a tool to assess the clinical accuracy of glucose meter performance using an insulin dosing protocol to assess the frequency and extent of error in insulin dose categories. METHODS: Retrospective comparison of 1815 glucose meter and central laboratory glucose results obtained from 1698 critically ill patients was conducted using the Parkes error grid, Surveillance error grid and an insulin dose error assessment grid with a sliding scale insulin dosing protocol used to manage critically ill patients. RESULTS: Parkes error grid and Surveillance error grid analyses indicated little risk conferred with the glucose meter results. Insulin dose error assessment grid complemented the aforementioned consensus error grids by determining quantifiable metrics, insulin dose category errors. Insulin dose error analysis indicated that 76.8% (1395/1815) would not have any change in insulin dose, 99.2% (1800/1815) within ±1 insulin dose category, 99.9% (1814/1815) within ±2 categories and 100% within ±3 insulin dose categories. CONCLUSIONS: Analysis with an insulin dose error grid provides information about the frequency and extent of insulin dose category errors with a specific insulin dosing protocol and describes potential clinical impact of glucose meter error.

The Use of Smart Phone Thermal Imaging for Assessment of Peripheral Perfusion in Vascular Patients.

BACKGROUND: Ankle-brachial index (ABI) is a reliable method to evaluate extremity perfusion but can be prohibitive to obtain secondary to patient discomfort or extremity trauma. This study investigates smart phone-based forward looking infrared imaging to assess peripheral perfusion using thermal ABI (tABI). METHODS: ABIs were measured by a certified vascular laboratory. Thermographs of each extremity (hands/feet) were obtained, and maximum surface temperature was recorded. tABI was calculated by dividing the lower extremity (LE) temperature by the upper extremity (UE). ABI and tABI were compared using Pearson's correlation and Bland-Altman plot. RESULTS: Twenty-three patients (45 limbs) had ABI's and thermographs recorded on the same day. Median ABI was 0.89 (range 0.33-1.46, IQR 0.4). Median LE temperature was 83.0°F (range 60.7-96.9°F, IQR 14.1). Median UE temperature was 91.2°F (range 81.9-94.6°F, IQR 3.4). Median tABI was 0.93 (range 0.33-1.4, IQR 0.2). Positive correlation was seen between ABI and tABI with Pearson analysis (r = 0.83, P < 0.0001) and Bland-Altman plot (bias -0.01, LOA -0.13 to -0.12). CONCLUSIONS: Thermal imaging correlates with ABI in the evaluation of extremity perfusion. Smart phone-based FLIR can be used to determine peripheral perfusion in clinical settings where ABI is difficult to obtain.

Bedside Glucose Monitoring-Is it Safe? A New, Regulatory-Compliant Risk Assessment Evaluation Protocol in Critically Ill Patient Care Settings.

OBJECTIVES: New data have emerged from ambulatory and acute care settings about adverse patient events, including death, attributable to erroneous blood glucose meter measurements and leading to questions over their use in critically ill patients. The U.S. Food and Drug Administration published new, more stringent guidelines for glucose meter manufacturers to evaluate the performance of blood glucose meters in critically ill patient settings. The primary objective of this international, multicenter, multidisciplinary clinical study was to develop and apply a rigorous clinical accuracy assessment algorithm, using four distinct statistical tools, to evaluate the clinical accuracy of a blood glucose monitoring system in critically ill patients. DESIGN: Observational study. SETTING: Five international medical and surgical ICUs. PATIENTS: All patients admitted to critical care settings in the centers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Glucose measurements were performed on 1,698 critically ill patients with 257 different clinical conditions and complex treatment regimens. The clinical accuracy assessment algorithm comprised four statistical tools to assess the performance of the study blood glucose monitoring system compared with laboratory reference methods traceable to a definitive standard. Based on POCT12-A3, the Clinical Laboratory Standards Institute standard for hospitals about hospital glucose meter procedures and performance, and Parkes error grid clinical accuracy performance criteria, no clinically significant differences were observed due to patient condition or therapy, with 96.1% and 99.3% glucose results meeting the respective criteria. Stratified sensitivity and specificity analysis (10 mg/dL glucose intervals, 50-150 mg/dL) demonstrated high sensitivity (mean = 95.2%, SD = ± 0.02) and specificity (mean = 95. 8%, SD = ± 0.03). Monte Carlo simulation modeling of the study blood glucose monitoring system showed low probability of category 2 and category 3 insulin dosing error, category 2 = 2.3% (41/1,815) and category 3 = 1.8% (32/1,815), respectively. Patient trend analysis demonstrated 99.1% (223/225) concordance in characterizing hypoglycemic patients. CONCLUSIONS: The multicomponent, clinical accuracy assessment algorithm demonstrated that the blood glucose monitoring system was acceptable for use in critically ill patient settings when compared to the central laboratory reference method. This clinical accuracy assessment algorithm is an effective tool for comprehensively assessing the validity of whole blood glucose measurement in critically ill patient care settings.

Design of a cost-effective, hemodynamically adjustable model for resuscitative endovascular balloon occlusion of the aorta (REBOA) simulation.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct technique for salvaging patients with noncompressible torso hemorrhage. Current REBOA training paradigms require large animals, virtual reality simulators, or human cadavers for acquisition of skills. These training strategies are expensive and resource intensive, which may prevent widespread dissemination of REBOA. We have developed a low-cost, near-physiologic, pulsatile REBOA simulator by connecting an anatomic vascular circuit constructed out of latex and polyvinyl chloride tubing to a commercially available pump. This pulsatile simulator is capable of generating cardiac outputs ranging from 1.7 to 6.8 L/min with corresponding arterial blood pressures of 54 to 226/14 to 121 mmHg. The simulator accommodates a 12 French introducer sheath and a CODA balloon catheter. Upon balloon inflation, the arterial waveform distal to the occlusion flattens, distal pulsation within the simulator is lost, and systolic blood pressures proximal to the balloon catheter increase by up to 62 mmHg. Further development and validation of this simulator will allow for refinement, reduction, and replacement of large animal models, costly virtual reality simulators, and perfused cadavers for training purposes. This will ultimately facilitate the low-cost, high-fidelity REBOA simulation needed for the widespread dissemination of this life-saving technique.

Development and evaluation of a novel smart device-based application for burn assessment and management.

We have developed a novel software application that provides a simple and interactive Lund-Browder diagram for automatic calculation of total body surface area (TBSA) burned, fluid formula recommendations, and serial wound photography on a smart device platform. The software was developed for the iPad (Apple, Cupertino, CA) smart device platforms. Ten burns ranging from 5 to 95% TBSA were computer generated on a patient care simulator using Adobe Photoshop CS6 (Adobe, San Jose, CA). Burn clinicians calculated the TBSA first using a paper-based Lund-Browder diagram. Following a one-week "washout period", the same clinicians calculated TBSA using the smart device application. Simulated burns were presented in a random fashion and clinicians were timed. Percent TBSA burned calculated by Peregrine vs. the paper-based Lund-Browder were similar (29.53 [25.57] vs. 28.99 [25.01], p=0.22, n=7). On average, Peregrine allowed users to calculate burn size significantly faster than the paper form (58.18 [31.46] vs. 90.22 [60.60]s, p<0.001, n=7). The smart device application also provided 5 megapixel photography capabilities, and acute burn resuscitation fluid calculator. We developed an innovative smart device application that enables accurate and rapid burn size assessment to be cost-effective and widely accessible.

Point-of-care testing for disasters: needs assessment, strategic planning, and future design.

Objective evidence-based national surveys serve as a first step in identifying suitable point-of-care device designs, effective test clusters, and environmental operating conditions. Preliminary survey results show the need for point-of-care testing (POCT) devices using test clusters that specifically detect pathogens found in disaster scenarios. Hurricane Katrina, the tsunami in southeast Asia, and the current influenza pandemic (H1N1, "swine flu") vividly illustrate lack of national and global preparedness. Gap analysis of current POCT devices versus survey results reveals how POCT needs can be fulfilled. Future thinking will help avoid the worst consequences of disasters on the horizon, such as extensively drug-resistant tuberculosis and pandemic influenzas. A global effort must be made to improve POC technologies to rapidly diagnose and treat patients to improve triaging, on-site decision making, and, ultimately, economic and medical outcomes.

Katrina, the tsunami, and point-of-care testing: optimizing rapid response diagnosis in disasters.

We assessed how point-of-care testing (POCT), diagnostic testing at or near the site of patient care, can optimize diagnosis, triage, and patient monitoring during disasters. We surveyed 4 primary care units (PCUs) and 10 hospitals in provinces hit hardest by the tsunami in Thailand and 22 hospitals in Katrina-affected areas. We assessed POCT, critical care testing, critical values notification, demographics, and disaster responses. Limited availability and poor organization severely limited POCT use. The tsunami impacted 48 PCUs plus island and province hospitals, which lacked adequate diagnostic instruments. Sudden overload of critical victims and transportation failures caused excessive mortality. In New Orleans, LA, flooding hindered rescue teams that could have been POCT-equipped. US sea, land, and airborne rescue brought POCT instruments closer to flooded areas. Katrina demonstrated POCT value in disaster responses. We recommend handheld POCT, airborne critical care testing, and disaster-specific mobile medical units in small-world networks worldwide.

Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI--initial results.

BACKGROUND AND PURPOSE: MRI is able to quantify carotid plaque size and composition with good accuracy and reproducibility and provides an opportunity to prospectively examine the relationship between plaque features and subsequent cerebrovascular events. We tested the hypothesis that the characteristics of carotid plaque, as assessed by MRI, are possible predictors of future ipsilateral cerebrovascular events. METHODS: A total of 154 consecutive subjects who initially had an asymptomatic 50% to 79% carotid stenosis by ultrasound with > or =12 months of follow-up were included in this study. Multicontrast-weighted carotid MRIs were performed at baseline, and participants were followed clinically every 3 months to identify symptoms of cerebrovascular events. RESULTS: Over a mean follow-up period of 38.2 months, 12 carotid cerebrovascular events occurred ipsilateral to the index carotid artery. Cox regression analysis demonstrated a significant association between baseline MRI identification of the following plaque characteristics and subsequent symptoms during follow-up: presence of a thin or ruptured fibrous cap (hazard ratio, 17.0; P< or =0.001), intraplaque hemorrhage (hazard ratio, 5.2; P=0.005), larger mean intraplaque hemorrhage area (hazard ratio for 10 mm2 increase, 2.6; P=0.006), larger maximum %lipid-rich/necrotic core (hazard ratio for 10% increase, 1.6; P=0.004), and larger maximum wall thickness (hazard ratio for a 1-mm increase, 1.6; P=0.008). CONCLUSIONS: Among patients who initially had an asymptomatic 50% to 79% carotid stenosis, arteries with thinned or ruptured fibrous caps, intraplaque hemorrhage, larger maximum %lipid-rich/necrotic cores, and larger maximum wall thickness by MRI were associated with the occurrence of subsequent cerebrovascular events. Findings from this prospective study provide a basis for larger multicenter studies to assess the risk of plaque features for subsequent ischemic events.