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1.
Nanomaterials (Basel) ; 14(6)2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38535664

RESUMO

In recent years, nanocarriers have been widely used as an effective solution for oral administration of pharmaceuticals. However, there is still an urgent need to speed up their translation to clinical practice. Cost-effective and industrially scalable methodologies are still needed. Herein, the production of vitamin C-loaded liposomes for nutraceutical purposes has been investigated and optimized by adopting a High-Pressure Homogenizer. Initially, the impact of process parameters on particles size, distributions, and morphology was explored. The findings document that the pressure and cycle manipulation allow for control over liposome size and polydispersity, reaching a maximum encapsulation efficiency exceeding 80%. This significantly improves the storage stability of vitamin C, as demonstrated by monitoring its antioxidant activity. Furthermore, the in vitro simulation of gastrointestinal digestion shows that liposomes could protect the active substance from damage and control its release in the gastrointestinal fluid. Thus, the whole nanodelivery system can contribute to enhancing vitamin C bioavailability. In conclusion, the results indicate that this innovative approach to producing vitamin C liposomes holds promise for clinical translation and industrial scale-up. Indeed, by utilizing food-grade materials and straightforward equipment, it is possible to produce stable and functional liposomes suitable for health products.

2.
Microb Cell Fact ; 23(1): 29, 2024 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-38245756

RESUMO

BACKGROUND: Industrial by-products accrue in most agricultural or food-related production processes, but additional value chains have already been established for many of them. Crude glycerol has a 60% lower market value than commercial glucose, as large quantities are produced in the biodiesel industry, but its valorisation is still underutilized. Due to its high carbon content and the natural ability of many microorganisms to metabolise it, microbial upcycling is a suitable option for this waste product. RESULTS: In this work, the use of crude glycerol for the production of the value-added compound itaconate is demonstrated using the smut fungus Ustilago maydis. Starting with a highly engineered strain, itaconate production from an industrial glycerol waste stream was quickly established on a small scale, and the resulting yields were already competitive with processes using commercial sugars. Adaptive laboratory evolution resulted in an evolved strain with a 72% increased growth rate on glycerol. In the subsequent development and optimisation of a fed-batch process on a 1.5-2 L scale, the use of molasses, a side stream of sugar beet processing, eliminated the need for other expensive media components such as nitrogen or vitamins for biomass growth. The optimised process was scaled up to 150 L, achieving an overall titre of 72 g L- 1, a yield of 0.34 g g- 1, and a productivity of 0.54 g L- 1 h- 1. CONCLUSIONS: Pilot-scale itaconate production from the complementary waste streams molasses and glycerol has been successfully established. In addition to achieving competitive performance indicators, the proposed dual feedstock strategy offers lower process costs and carbon footprint for the production of bio-based itaconate.


Assuntos
Glicerol , Succinatos , Glicerol/metabolismo , Succinatos/metabolismo , Glucose/metabolismo
3.
Int J Biol Macromol ; 256(Pt 2): 128472, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38029906

RESUMO

Bioactive oligosaccharides with the potential to improve human health, especially in modulating gut microbiota via prebiotic activity, are available from few natural sources. This work uses polysaccharide oxidative cleavage to generate oligosaccharides from beet pulp, an agroindustry by-product. A scalable membrane filtration approach was applied to purify the oligosaccharides for subsequent in vitro functional testing. The combined use of nano-LC/Chip Q-TOF MS and UHPLC/QqQ MS allowed the evaluation of the oligosaccharide profile and their monosaccharide complexity. A final product containing roughly 40 g of oligosaccharide was obtained from 475 g of carbohydrates. Microbiological bioactivity assays indicated that the product obtained herein stimulated desirable commensal gut bacteria. This rapid, reproducible, and scalable method represents a breakthrough in the food industry for generating potential prebiotic ingredients from common plant by-products at scale. INDUSTRIAL RELEVANCE: This work proposes an innovative technology based on polysaccharide oxidative cleavage and multi-stage membrane purification to produce potential prebiotic oligosaccharides from renewable sources. It also provides critical information to evidence the prebiotic potential of the newly generated oligosaccharides on the growth promotion ability of representative probiotic strains of bifidobacteria and lactobacilli.


Assuntos
Beta vulgaris , Microbioma Gastrointestinal , Humanos , Oligossacarídeos/farmacologia , Polissacarídeos/farmacologia , Carboidratos , Prebióticos
4.
Molecules ; 28(20)2023 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-37894538

RESUMO

One of the many advantages of supercritical fluid extraction (SFE) is the possibility of using it in sequential and selective approaches. This is due to the use of a dynamic extraction mode in addition to the possibility of altering the composition of the modifier during the extraction process. In this study, the optimization of Calendula officinalis L. extraction of non-polar and polar compounds was achieved using three-level Box-Behnken designs (BBD). For non-polar compounds, the factors were pressure, temperature, and EtOH percentage. As for the polar compounds, the three variables were temperature, the total modifier percentage, and H2O added in the modifier as an additive. The recovery of selectively rich extracts in triterpendiol esters and narcissin was possible using a sequential two-step SFE. The first step was performed at 80 °C and 15% EtOH, and the second at 40 °C and 30% EtOH:H2O 80:20 v:v with a total of 60 min of extraction. Additionally, the SFE extraction of non-polar compounds was scaled up on a pilot-scale extractor, demonstrating similar results. Finally, the SFE results were compared to ultrasound-assisted extraction (UAE).


Assuntos
Calendula , Cromatografia com Fluido Supercrítico , Triterpenos , Flavonoides , Extratos Vegetais , Cromatografia com Fluido Supercrítico/métodos , Flores , Etanol
5.
Front Public Health ; 11: 1165353, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37588121

RESUMO

Introduction: The first three years of a child's life are the most critical to child development and have an impact on the future achievement of the child. Young children's healthy development depends on nurturing care that ensures health, nutrition, responsive caregiving, safety, and security. Parents & other adult caregivers play a critical role in moderating children's early experiences, which has a lasting impact be it positive or negative on the children's future. Parenting education programs are proven to improve parental skills, capacity, and efficacy in a way that supports improved child development outcomes. Yet, most parents in low-middle-income countries such as Rwanda lack access to information and skills on how to support their children's holistic development. In response, Save The Children implemented the First Steps "Intera za Mbere" holistic parenting education project in Rwanda from 2014 to 2021. This paper reflects on how monitoring, evaluation, accountability, and learning (MEAL) approaches were applied throughout the project cycle and their impact on program improvement and national policy and advocacy. This paper explores how the aspirations for measurement for change, considerations for innovation uptake and frameworks for learning about improvement are reflected in this project. Methods: The project utilized qualitative and quantitative MEAL across the program cycle. Action research at the start of the project identified promoters and inhibitors of high-quality nurturing care and program delivery modalities. The project utilized a randomized control trial to provide insight into components that work better for parenting education. Evidence from surveys done remotely via phones was used to inform COVID-19 adaptations of the program. Results: The application of MEAL evidence led to the successful development and improvement of the program. At the policy level, evidence from the project influenced the review of the 2016 National Integrated ECD policy and the development of the national parenting education framework. Conclusion: The regular use of evidence from MEAL is critical for program improvement, scale-up, and policy influence.


Assuntos
COVID-19 , Desenvolvimento Infantil , Adulto , Criança , Pré-Escolar , Humanos , Ruanda , COVID-19/epidemiologia , COVID-19/prevenção & controle , Aprendizagem , Escolaridade
6.
Int J Health Policy Manag ; 12: 6578, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36243944

RESUMO

BACKGROUND: Estimating the number of people using illicit drugs and alcohol is necessary for informing health policy and programming. However, it is often challenging to reliably estimate the size of these marginalized populations through direct methods. In this study, we estimated the population size of these groups using the indirect Network Scale-Up (NSU) method in Iran from 2015 to 2016. METHODS: Using a self-administered questionnaire, we asked 15 124 individuals (54% men) about the number of people they know who used different types of drugs at least once in the past 12 months. Prevalence estimates were reported per 100 000 population. The uncertainty level (UL) was calculated using the bootstrap method. RESULTS: The average age of the respondents was 33 years old, and 35.1% of them were unmarried. The most common drugs and their prevalence were as follows: opium (2534 [95% UL: 2467-2598]), hashish (849 [95% UL: 811-886]), stimulants (methamphetamine, ecstasy pills, cocaine, and Ritalin) (842 [95% UL: 802-879]), heroin/crack (578 [95% UL: 550-607]), and drug injection (459 [95% UL: 438-484]). Additionally, we estimated the prevalence of alcohol use as 2797 (95% UL: 2731-2861). On average, substance use was 5.23 times more prevalent among men than women. Opium use was more prevalent among individuals aged >50 years old. Moreover, alcohol use was more prevalent among participants between 18 and 30 years old (5164 per 100 000 population). CONCLUSION: Although opium continues to be the most prevalent illicit drug in Iran, the patterns of illicit drug use are heterogeneous among different age groups, genders, and provinces. Age-gender specific and culturally appropriate interventions are warranted to meet the needs of people in different subgroups.


Assuntos
Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Irã (Geográfico)/epidemiologia , Ópio , Densidade Demográfica , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Etanol
7.
Ultrason Sonochem ; 90: 106171, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36166948

RESUMO

The ultrasound-assisted extraction (UAE) process of chlorophylls (a, b) and carotenoids in aqueous ethanol solutions from spinach leaves was upscaled from a batch laboratory reactor to a continuous modular flow-cell of pilot scale. The extraction in the laboratory scale was organized in a loop reactor, where pulp was circulated between a stirred vessel and the ultrasound reactor. The pilot scale extraction was made in a novel continuous tubular flow-cell reactor. The analysis of the experimental data proved that the ultrasound application provided a better extraction yield. In the laboratory scale, the application of ultrasound (24 kHz and 2500 W/L) showed the 2.6-fold higher maximum extraction yield compared to non-sonicated conventional solvent extraction. In the pilot scale, the effect was less significant (1.9-fold), due to smaller ultrasound power density (25 kHz and 1500 W/L). The scale-up of the UAE was based on equal extraction yield at both scales. The scale-up revealed that 2.5-fold higher volume-specific ultrasound power is required in the pilot scale to reach the yield obtained in the laboratory scale reactor.


Assuntos
Folhas de Planta , Spinacia oleracea , Carotenoides , Extratos Vegetais
8.
Bioresour Technol ; 363: 127921, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36089131

RESUMO

In order to improve the potential of cyanobacterial cell factories, Synechococcus sp. PCC7002 was engineered as 'one cell-two wells bio-refinery', for ethylene ('heterologous' hydrocarbon) and carotenoids ('natural' metabolites) production, and demonstrating its outdoor performance. Although the cultures showed better production outdoor, they experienced multiple collapses during scale-up. Hence, flux balance analysis was performed which predicted higher ethylene production with increase in carbon input under outdoor light conditions. Furthermore, FBA predicted that ethylene production will not increase beyond a threshold carbon input flux, owing to limitations on ribulose-1,5-bisphosphate regeneration. Hence, a bicarbonate-supplementation strategy was devised. Cultures grown outdoor at optimal bicarbonate concentration (20 g/L) resulted in improved growth (0.141/h) and ethylene productivity (1.88 mL/L.h) for > 10 days, with enhanced carotenoid titres (40.4 mg/L). In a 100 L air-lift photo-bioreactor; cultures exhibited efficient ethylene (2.464 mL/L.h) and biomass (0.3 g/L.d) productivities, and carotenoids titres (64.4 mg/L), establishing a significant step towards commercialization.


Assuntos
Bicarbonatos , Synechococcus , Bicarbonatos/metabolismo , Carbono/metabolismo , Carotenoides/metabolismo , Etilenos/metabolismo , Synechococcus/metabolismo
9.
BJPsych Open ; 8(5): e147, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35909348

RESUMO

We explore multi-sectoral integration as a model for scaling up evidence-based mental health and psychosocial support interventions in humanitarian settings. We introduce Self Help Plus 360, designed to support humanitarian partners across different sectors to integrate a psychosocial intervention into their programming and more holistically address population needs.

10.
Mar Drugs ; 20(8)2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-36005502

RESUMO

The production of non-fish based docosahexaenoic acid (DHA) for feed and food has become a critical need in our global context of over-fishing. The industrial-scale production of DHA-rich Thraustochytrids could be an alternative, if costs turned out to be competitive. In order to reduce production costs, this study addresses the feasibility of the non-axenic (non-sterile) cultivation of Aurantiochytrium mangrovei on industrial substrates (as nitrogen and mineral sources and glucose syrup as carbon and energy sources), and its scale-up from laboratory (250 mL) to 500 L cultures. Pilot-scale reactors were airlift cylinders. Batch and fed-batch cultures were tested. Cultures over 38 to 62 h achieved a dry cell weight productivity of 3.3 to 5.5 g.L-1.day-1, and a substrate to biomass yield of up to 0.3. DHA productivity ranged from 10 to 0.18 mg.L-1.day-1. Biomass productivity appears linearly related to oxygen transfer rate. Bacterial contamination of cultures was low enough to avoid impacts on fatty acid composition of the biomass. A specific work on microbial risks assessment (in supplementary files) showed that the biomass can be securely used as feed. However, to date, there is a law void in EU legislation regarding the recycling of nitrogen from digestate from animal waste for microalgae biomass and its usage in animal feed. Overall, the proposed process appears similar to the industrial yeast production process (non-axenic heterotrophic process, dissolved oxygen supply limiting growth, similar cell size). Such similarity could help in further industrial developments.


Assuntos
Nitrogênio , Estramenópilas , Animais , Biomassa , Reatores Biológicos/microbiologia , Conservação dos Recursos Naturais , Ácidos Docosa-Hexaenoicos , Pesqueiros , Oxigênio
11.
Int J Behav Nutr Phys Act ; 19(1): 106, 2022 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-35987776

RESUMO

BACKGROUND: To maximise their potential health benefits, school-based physical activity policies need to be implemented at scale. This paper describes the third in a sequence of trials that sought to optimise an effective strategy (PACE) to assist schools' implementation of a physical activity policy. Specifically, it aimed to determine the probability that a multi-strategy intervention adapted to reduce in-person contact (Adapted PACE) was "as good as" the original intervention (PACE) in increasing the weekly minutes of structured physical activity implemented by classroom teachers. METHODS: A noninferiority cluster randomised controlled trial was undertaken with 48 primary schools in New South Wales, Australia. Schools were randomised to receive PACE or a model with adaptations made to the delivery modes (Adapted PACE). Teachers' scheduled minutes of weekly physical activity was assessed at baseline (Oct 2018-Feb 2019) and 12-month follow-up (Oct-Dec 2019). The noninferiority margin was set at - 16.4 minutes based on previous data and decision panel consensus. A linear mixed model analysed within a Bayesian framework was used to explore noninferiority between the two PACE models. A cost minimisation analysis was conducted from the health service provider perspective, using the Australian dollar (AUD). RESULTS: The posterior estimate for the between group difference at follow-up was - 2.3 minutes (95% credible interval = - 18.02, 14.45 minutes). There was an estimated 96% probability of Adapted PACE being considered noninferior (only 4% of the posterior samples crossed the noninferiority margin of - 16.4 minutes). That is, the minutes of physical activity implemented by teachers at Adapted PACE schools was not meaningfully less than the minutes of physical activity implemented by teachers at PACE schools. The mean total cost was AUD$25,375 (95% uncertainty interval = $21,499, $29,106) for PACE and AUD$16,421 (95% uncertainty interval = $13,974, $19,656) for Adapted PACE; an estimated reduction of AUD$373 (95% uncertainty interval = $173, $560) per school. CONCLUSIONS: It is highly probable that Adapted PACE is noninferior to the original model. It is a cost-efficient alternative also likely to be a more suitable approach to supporting large scale implementation of school physical activity policies. TRIAL REGISTRATION: Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001229167).


Assuntos
Promoção da Saúde , Serviços de Saúde Escolar , Austrália , Teorema de Bayes , Exercício Físico , Humanos , Políticas , Instituições Acadêmicas
12.
Waste Manag ; 148: 106-116, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35667237

RESUMO

Several studies have addressed the potential biorefinery, through small-scale pyrolysis, of coffee silverskin (CSS), grape pomace (GP) and olive mill waste (OMW), which are respectively the main solid residues from coffee roasting, wine making and olive oil production processes. However, increasing the scale of reactor to bring these studies to an industrial level may affect the properties, and hence applications, of the resulting products. The aim of this study is therefore to perform pilot scale experiments to compare and verify the results of analytical study (TGA) and bench scale reactor runs, in order to understand the fundamental differences and create correlations between pyrolysis runs at different scales. To this end, pyrolysis liquids and biochars from the slow pyrolysis of CSS, GP and OMW, performed using different scale auger reactors (15 kg/h and 0.3 kg/h), have been analysed (TGA, pH, density, proximate and ultimate analyses, HHV, FTIR, GCMS) and compared. The results showed no major differences in biochars when the temperature and the solid residence time were fixed. However, regarding pyrolysis liquids, compounds from the lab reactor were more degraded than pilot plant ones, due to, in this case, the vapour residence time was longer. Regarding the properties of the pyrolysis products, GP 400 °C biochars showed the best properties for combustion; CSS biochars were especially rich in nitrogen, and 400 °C GP and OMW pyrolysis liquids showed the highest number of phenolics. Hence, this study is considered a first step towards industrial scale CSS, GP and OMW pyrolysis-based biorefinery.


Assuntos
Olea , Vitis , Carvão Vegetal/química , Café , Pirólise
13.
Front Microbiol ; 13: 882902, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35547122

RESUMO

Microbial keratinases exhibit a momentous role in converting keratin biowastes into exceedingly valuable protein supplements. This study reports a novel, highly stable keratinase from Bacillus pacificus RSA27 for the production of pure peptides rich in essential amino acids from chicken feathers. Purified keratinase showed a specific activity of 38.73 U/mg, 2.58-fold purification, and molecular weight of 36 kDa. Kinetic studies using a chicken feather as substrate report K m and V max values of 5.69 mg/ml and 142.40 µg/ml/min, respectively, suggesting significant enzyme-substrate affinity/biocatalysis. Identification and in silico structural-functional analysis of keratinase discovered the presence of distinct amino acid residues and their positions. Besides, keratinase possesses a high-affinity calcium-binding site (Asp128, Leu162, Asn164, Ile166, and Val168) and a catalytic triad of Asp119, His151, and Ser308, known attributes of serine protease (subtilisin family). Furthermore, a scale-up to 5 L fermenter revealed complete feather hydrolysis (94.5%) within 24 h with high activity (789 U/ml) and total amino acid of 153.97 µmol/ml. Finally, cytotoxicity evaluation of protein hydrolysate resulted in negligible cytotoxic effects (1.02%) on the mammalian hepatoblastoma cell line, signifying its potential biotechnological applications.

14.
J Environ Manage ; 316: 115222, 2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-35544978

RESUMO

Biodiesel produced from waste feedstocks can play a significant role in fighting climate change, improperly disposed waste and growing energy demand. Waste feedstocks such as used cooking oil have a great potential for energy production. However, they often have to be purified from free fatty acids prior to biodiesel production. Extractive deacidification with deep eutectic solvents is a promising alternative to conventional purification methods. To evaluate the process of extractive deacidification of waste cooking oil, a full set of physical, hydrodynamic and kinetic data were experimentally determined on a laboratory scale. Hydrodynamic and kinetic experiments were performed in three geometrically similar jacketed agitated vessels. Vessels were equipped with axial flow impeller (four pitched blade impeller). Physical properties (density, viscosity and surface tension) were experimentally determined. Preliminary hydrodynamic experiments involved several model systems without mass transfer. As a result, correlation between power number and Reynolds number as well as scale-up criterion was developed. Obtained dependencies were correlated with the physical properties. Mixing intensity for achieving complete dispersion was determined. Second stage of investigation involved two sets of experiments, hydrodynamic and kinetic, with interphase mass transfer (the extraction of free fatty acids from waste cooking oil with deep eutectic solvent, potassium carbonate:ethylene glycol, 1:10). Obtained results enabled understanding interphase mass transfer and prediction of mass transfer coefficient from the derived dimensionless correlations. The values of volumetric mass transfer coefficients were smaller for the dispersed phase, indicating that the prevailing mass transfer resistance was within the droplets. The working hypothesis was that the same process result should be achieved at the same dispersion rate, and that hypothesis was confirmed - at all scales extraction efficiency was 97.9 ± 0.1%.


Assuntos
Biocombustíveis , Ácidos Graxos não Esterificados , Biocombustíveis/análise , Culinária , Óleos de Plantas , Solventes
15.
Chemosphere ; 295: 133840, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35124086

RESUMO

Petroleum degrading enzymes can be used as an alternative way to improve petroleum bioremediation approaches. Alcanivorax borkumensis is an alkane-degrading bacteria that can produce petroleum degrading enzymes such as alkane hydroxylase and lipase. In this study, pilot-scale Alcanivorax borkumensis fermentation was developed for producing large volumes of petroleum degrading enzymes cocktail (∼900 L). Different process conditions, such as inoculum age 72 h and size 4% v/v, temperature 30 ± 1 °C, agitation speed at 150 rpm and, fermentation period 3 days were determined as the optimum for producing alkane hydroxylase and lipase activity. The oxygen transfer capacity was studied for obtaining better bacterial growth and higher enzyme activities in bioreactor process optimization as well as scale-up. Results showed that the maximum values of oxygen mass transfer coefficient (kLa), oxygen uptake rate (OUR), oxygen transfer rate (OTR), alkane hydroxylase, lipase, and cell count were 196.95 h-1, 0.92 mmol O2/L/h, 1.8 mmol O2/L/h, 222.49 U/mL, 325 U/mL, and 8.6 × 1010 CFU/mL, respectively. Compared with the bench-scale bioreactors, the 150 L fermenter showed a better oxygen transfer rate which affected the cell growth that doubled the number and enzymes production that increased. Then, the enzyme cocktail was used for a field test in a diesel source zone using a 5-spot well pattern. The results showed a significant reduction in concentrations of C10 - C50 (from 36% to > 99%) after one injection of enzyme cocktail, mainly for the contaminated soils located in the saturated zone of the unconfined aquifer. This study confirmed the scaling-up ofalkane-degrading enzyme production to an industrial-scale and its application for effective bioremediation of petroleum contaminated sites.


Assuntos
Alcanivoraceae , Petróleo , Alcanos , Biodegradação Ambiental
16.
Health Place ; 72: 102696, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34736155

RESUMO

The role of contextual factors for program implementation is well-documented; however, their changing function throughout implementation phases is less established. We conducted an institutional ethnography to understand how structural conditions for scaling up initiatives are shaped by public health policy. We conducted 25 interviews with implementers of a comprehensive sexual health testing service in Canada, 21 meeting observations, and textual analyses of key policies and reports. Our analysis revealed a disjuncture between implementers' task of scaling up programming and the actualities of working within the discursive and material confines of policies premised on HIV exceptionalism and underfunded integrated health services.


Assuntos
Infecções por HIV , Política de Saúde , Canadá , Infecções por HIV/prevenção & controle , Serviços de Saúde , Humanos , Política Pública
17.
Zdr Varst ; 60(3): 158-166, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34249162

RESUMO

INTRODUCTION: Although the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium. METHODS: This was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries. RESULTS: Four topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals. CONCLUSIONS: This study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems.

18.
Trop Med Int Health ; 26(8): 953-961, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33892521

RESUMO

OBJECTIVES: Effective coverage of non-communicable disease (NCD) care in sub-Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first-level hospitals. This study describes the facility-level implementation outcomes of this strategy. METHODS: In 2014, the Ministry of Health trained two nurses in each of the country's 42 first-level hospitals to implement and deliver nurse-led, integrated, outpatient NCD clinics, which focused on severe NCDs. Post-intervention evaluation occurred via repeated cross-sectional surveys, informal interviews and routinely collected clinical data over two rounds of visits in 2015 and 2017. Implementation outcomes included fidelity, feasibility and penetration. RESULTS: By 2017, all NCD clinics were staffed by at least one NCD-trained nurse. Among the approximately 27 000 nationally enrolled patients, hypertension was the most common diagnosis (70%), followed by type 2 diabetes (19%), chronic respiratory disease (5%), type 1 diabetes (4%) and heart failure (2%). With the exception of warfarin and beta-blockers, national essential medicines were available at more than 70% of facilities. Clinicians adhered to clinical protocols at approximately 70% agreement with evaluators. CONCLUSION: The government of Rwanda was able to scale a nurse-led outpatient NCD programme to all first-level hospitals with good fidelity, feasibility and penetration as to expand access to care for severe NCDs.


Assuntos
Assistência Ambulatorial/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde , Doenças não Transmissíveis/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Assistência Ambulatorial/normas , Prestação Integrada de Cuidados de Saúde/normas , Diabetes Mellitus Tipo 1/terapia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/terapia , Política , Estudos Retrospectivos , Serviços de Saúde Rural , Ruanda
19.
Curr Pharm Biotechnol ; 22(1): 136-149, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33372869

RESUMO

Medicinal plants produce a diverse group of phytocompounds like anthraquinones, alkaloids, anthocyanins, flavonoids, saponins, and terpenes which are used in pharmaceutical, perfume, cosmetics, dye and flavor industries. Commercial source of these metabolites is field-grown plants, which are generally influenced by seasonal changes. Biotechnology possesses a significant role in production of high-value secondary metabolites. By incorporating biotechnological methods, it is feasible to manage biosynthetic pathways of the plant to enhance phytocompound production that is of pharmaceutical interest. Plant cell suspension, shoot, adventitious root and hairy root culture are considered as alternative methods for important bioactive compound production. These methods are controllable, sustainable and overcome several inconveniences for large scale secondary metabolites production. At present research on hairy root culture for valuable bioactive compound production has gained a lot of attention. Agrobacterium rhizogenes is an agent which causes hairy root disease in a plant and this leads to the neoplastic growth of root which is characterized by higher growth rate and genetic stability. Various studies explore the hairy root culture for production of a wide range of bioactive compounds. Scale-up of hairy root culture using bioreactors has provided an opportunity to enhance bioactive compound production at the commercial level. The present review discusses the role of hairy root culture in the production of valuable bioactive compounds, the effect of culture parameters on bioactive compound production and bioreactor applications.


Assuntos
Agrobacterium/crescimento & desenvolvimento , Reatores Biológicos/microbiologia , Biotecnologia/métodos , Compostos Fitoquímicos/biossíntese , Raízes de Plantas/metabolismo , Plantas Medicinais/metabolismo , Raízes de Plantas/microbiologia , Plantas Medicinais/microbiologia
20.
Integr Environ Assess Manag ; 17(1): 292-304, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32716097

RESUMO

Recovering valuable nutrients (e.g., P and N) from waste materials has been extensively investigated at the laboratory scale. Although it has been shown that struvite precipitation from several manure sources contributes to nutrient management practices by recovering valuable nutrients and preventing them from reaching water bodies, it has not been widely applied in commercial (i.e., farm) scales. The purpose of this study is to evaluate the potential environmental impacts of the struvite recovery process from the liquid portion of the anaerobically digested dairy cow manure generated in Wisconsin, USA, dairy farms using life cycle assessment methodology for both bench- and farm-scale scenarios. The struvite precipitation process involves the use of additional chemicals and energy; therefore, investigating upstream impacts is crucial to evaluate the environmental costs and benefits of this additional treatment process. Results indicate that up to a 78% impact decrease in eutrophication potential can be achieved when P and N are recovered in the form of struvite and are applied in lieu of conventional fertilizers, rather than using the liquid portion of the anaerobically digested dairy manure as a fertilizer. Additionally, significant differences are identified in the majority of environmental impact categories when the struvite precipitation process is modeled and evaluated in a farm-scale setting. Future work should expand to evaluate the overall environmental impacts and trade-offs of struvite recovery application, including the anaerobic digestion system itself at the farm scale. Integr Environ Assess Manag 2021;17:292-304. © 2020 SETAC.


Assuntos
Compostos de Magnésio , Esterco , Estruvita , Animais , Bovinos , Feminino , Estágios do Ciclo de Vida , Compostos de Magnésio/análise , Fosfatos/análise , Fósforo , Wisconsin
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