Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 213
Filtrar
1.
Poult Sci ; 103(11): 104165, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-39214059

RESUMEN

Poultry is a ubiquitous and highly sought-after protein source valued for its accessibility, notable protein content, and lack of religious constraints. However, the demand for poultry has resulted in a surge in intensive production practices. The transition from subsistence agricultural practices to intensive food production resulted in the widespread adoption of antibiotics for both therapeutic and economic purposes. These interventions were intended to enhance meat yield, promote bird health, and enhance cost-effectiveness of production. However, this inadvertently contributed to the rise of antimicrobial resistance (AMR). Therefore, the need to explore alternative approaches to mitigate the problems associated with AMR has become increasingly pressing. In response, metal-based compounds have emerged as a promising substitute to conventional antibiotics. In this study, the effects of a water soluble metallo-antimicrobial supplement, ferric sillen core-linked polymer (FSCLP), on body weight gain, feed conversion, water intake, volatile fatty acid (VFA) production, cecal microbiome and intestinal morphology in broilers was examined. The findings of this study suggested that the addition of the FSCLP resulted in better bird performance, even during a period of heat stress. Volatile fatty acids analysis of cecal contents indicated that there were significantly higher levels (p < 0.05) of butyric and valeric acids. Cecal microbiome analysis confirmed significantly lower abundance (p < 0.05) of Proteobacteria (e.g., E. coli) and a significantly greater abundance of VFA-producing bacteria such as Intestinimonas butyriciproducens, Blautia and Lachnospiraceae. The intestinal morphology data showed supplementation with the FSCLP at 80 ppm resulted in a significantly higher (p < 0.05) villus height of the jejunum. This study emphasises the potential of FSCLP as a feasible solution to the issues faced by AMR in chicken production, providing insights into its beneficial impacts on performance, microbial composition, and intestinal health.


Asunto(s)
Alimentación Animal , Pollos , Dieta , Suplementos Dietéticos , Microbioma Gastrointestinal , Animales , Pollos/fisiología , Pollos/crecimiento & desarrollo , Alimentación Animal/análisis , Suplementos Dietéticos/análisis , Microbioma Gastrointestinal/efectos de los fármacos , Dieta/veterinaria , Polímeros/administración & dosificación , Polímeros/química , Masculino , Compuestos Férricos/administración & dosificación , Compuestos Férricos/farmacología , Ciego/microbiología , Ciego/efectos de los fármacos , Distribución Aleatoria
2.
J Am Pharm Assoc (2003) ; : 102193, 2024 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-39089627

RESUMEN

OBJECTIVE: To understand perspectives on vaccine administration at complementary sites (such as pharmacies, mobile clinics, and pop-up clinics) by non-physician healthcare providers (NPHPs), and the policies/barriers surrounding administration. METHODS: We performed interviews with healthcare providers (HCPs) and vaccination policy experts to elicit perspectives on including vaccination program scope, facilitators and barriers to NPHPs administering vaccines, and recommendations for improvement of vaccine administration. Eligible participants were required to either work directly in vaccination administration or work in vaccination policy. RESULTS: Thirty-eight participants completed interviews. Participants reported that US individuals have a positive view of vaccination at complementary sites and by NPHPs, especially since the COVID-19 pandemic, where vaccination was often performed by NPHPs at complementary sites. Concerns expressed by participants included language barriers, out-of-pocket costs, and mistrust among marginalized communities. Participants described the complexity of state and local regulations, particularly scope of practice laws, as a barrier to implementation of NPHP vaccination programs at complementary sites. CONCLUSIONS: NPHPs and vaccination advocates report that complementary sites represent a potentially important step to ensuring broader, more equitable vaccination service in the US.

3.
Microorganisms ; 12(8)2024 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-39203404

RESUMEN

Antibiotics and antibiotic growth promoters have been extensively employed in poultry farming to enhance growth performance, maintain bird health, improve nutrient uptake efficiency, and mitigate enteric diseases at both sub-therapeutic and therapeutic doses. However, the extensive use of antimicrobials in poultry farming has led to the emergence of antimicrobial resistance (AMR) in microbial reservoirs, representing a significant global public health concern. In response, non-antibiotic dietary interventions, such as yeast mannan-rich fraction (MRF), have emerged as a promising alternative to modulate the gut microbiota and combat the AMR crisis. This study investigated whether a yeast mannan-rich fraction containing feed supplement impacted the performance of laying hens, their microbiomes, and the associated carriage of antimicrobial resistance genes under commercial conditions. High-throughput DNA sequencing was utilised to profile the bacterial community and assess changes in the antibiotic resistance genomes detected in the metagenome, the "resistome", in response to MRF supplementation. It was found that supplementation favourably influenced laying hen performance and microbial composition. Notably, there was a compositional shift in the MRF supplemented group associated with a lower relative abundance of pathobionts, e.g., Escherichia, Brachyspira and Trueperella, and their AMR-encoded genes, relative to beneficial microbes. Overall, the findings further demonstrate the ability of prebiotics to improve laying hen performance through changes associated with their microbiome and resistome.

4.
Commun Eng ; 3(1): 119, 2024 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-39191889

RESUMEN

Mosquitoes and other biting arthropods transmit diseases worldwide, causing over 700,000 deaths each year, and costing about 3 billion USD annually for Aedes species alone. Insect vectored diseases also pose a considerable threat to agricultural animals. While clothing could provide a simple solution to vector-borne diseases, modern textiles do not effectively block mosquito bites. Here we have designed three micro-resolution knitted structures, with five adjustable parameters that can block mosquito bites. These designs, which exhibit significant bite reduction were integrated into a computer numerical control knitting robot for mass production of bite-blocking garments with minimal human labor. We then quantified the comfort of blocking garments. Our knits enable individuals to protect themselves from insects amidst their day-to-day activities without impacting the environment.

5.
Open Forum Infect Dis ; 11(7): ofae321, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38947737

RESUMEN

Dolutegravir resistance is emerging in routine clinical contexts in southern Africa, primarily in patients with prior treatment experience failing dolutegravir-based antiretroviral therapy (ART). This potential issue was raised by The Nucleosides and Darunavir/Dolutegravir in Africa trial that compared dolutegravir and boosted protease inhibitor-based therapy as second-line ART, in which new dolutegravir resistance was observed at failure. However, recent data suggest that also at risk are patients who were transitioned to dolutegravir from non-nucleoside reverse transcriptase inhibitor-based ART while viremic. Identifying patients experiencing failure of dolutegravir with resistance will be difficult given current gaps in viral load monitoring and limited capacity for genotypic resistance testing. As a result, in the short term, most patients affected will go unrecognized, with particularly important implications for patients affected who have advanced HIV or who are pregnant/breastfeeding. Prospective research is needed to understand the scope of the problem, identify additional risk factors, and determine best management. In the short term, for most patients with dolutegravir resistance and prior non-nucleoside reverse transcriptase inhibitor exposure, the best option will be a timely switch to a regimen anchored by a boosted protease inhibitor, with a high genetic barrier to resistance.

7.
Curr Med Res Opin ; : 1-6, 2024 May 16.
Artículo en Inglés | MEDLINE | ID: mdl-38745451

RESUMEN

OBJECTIVE: To understand clinicians' current teclistamab step-up dosing (SUD) model and how they envision future administration models, as well as perceived barriers and facilitators to these models in day-to-day clinical practice. METHODS: Interviews of clinicians with RW experience administering teclistamab, with a subsequent roundtable discussion to discuss interview findings. Topics of interest included managing adverse events (AE), and handling logistics of SUD and transition of care (ToC). RESULTS: 20 clinicians representing 19 practices participated. Of 14 practices administering inpatient teclistamab SUD, 12 (86%) utilized a single admission. A day 1-3-5 dosing schedule with a 7-day length of stay was planned in 10/14 (71%). The remaining 5 practices employed outpatient or hybrid SUD. SUD models depended on cellular therapy experience, patient volume, and monitoring capabilities. Clinicians desired to administer SUD outpatient for convenience and reduced healthcare resource use. 11% of practices reported using tocilizumab for cytokine release syndrome (CRS) prophylaxis, whilst it was uniformly used to treat grade 2+ CRS. Corticosteroids were the preferred treatment for neurotoxicity. Infection prophylaxis with intravenous immunoglobulin was reported by 89% of practices. Patient- and institution-level factors affected decision-making of transitioning patients back to referring sites after SUD. CONCLUSION: The results consolidated practice-based experiences and indicated diverse RW SUD models and patient management strategies in practices with familiarity with teclistamab AE management and ToC protocols. Inpatient SUD is common, with expectations that approaches will evolve toward outpatient or community-based administration. Further research is needed to investigate outcomes of different care models and AE management strategies.


Multiple myeloma is a blood cancer that forms in plasma cells. Teclistamab is a new treatment for patients with multiple myeloma who have received prior treatment but for whom their multiple myeloma has come back or stopped responding to treatment multiple times. Because teclistamab works differently than other existing multiple myeloma treatments, there is a need to understand how oncologists who have experience with teclistamab are managing their patients in order to inform best practices for use by more healthcare providers. We interviewed oncologists that treat patients with multiple myeloma to understand their experiences with teclistamab, including how they manage initial dosing (step-up dosing) processes, treat adverse events, and transition patients to outpatient or external clinics for continued care. Most practices were administering step-up dosing of teclistamab in an inpatient setting soon after teclistamab became a treatment option, with a high level of desire to move the initial dosing to an outpatient setting in the near future. Those that were already administering step-up dosing in an outpatient setting had models unique to their practice. Oncologists described numerous processes for monitoring and managing adverse events of the treatment, including treating patients with preventative medications and regularly monitoring vital signs throughout step-up dosing. Oncologists expected that their teclistamab administration processes will likely evolve over time as they gain more familiarity with the treatment, and will need to consider patient-level factors to administer step-up dosing in an outpatient setting.

8.
EClinicalMedicine ; 71: 102571, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38606166

RESUMEN

Background: Hospital-acquired infections (HAI) are a leading cause of morbidity and mortality globally. These infections are diverse, but the majority are lower respiratory tract infection (LRTI), surgical site infection (SSI), bloodstream infection (BSI), and urinary tract infection (UTI). For most sub-Saharan African countries, studies revealing the burden and impact of HAI are scarce, and few systematic reviews and meta-analysis have been attempted. We sought to fill this gap by reporting recent trends in HAI in sub-Saharan Africa (SSA) with attention to key patient populations, geographic variation, and associated mortality. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a literature search of six electronic databases (Web of Science, Pubmed, APA PsycInfo, CINAHL, Embase, and the Cochrane Library) to identify studies assessing the prevalence of HAI in SSA countries. Studies published between 01 January 2014 and 31 December 2023 were included. We applied no language or publication restrictions. Record screening and data extractions were independently conducted by teams of two or more reviewers. Using the R software (version 4.3.1) meta and metafor packages, we calculated the pooled prevalence estimates from random-effect meta-analysis, and further explored sources of heterogeneity through subgroup analyses and meta-regression. This study is registered with PROSPERO, CRD42023433271. Findings: Forty-one relevant studies were identified for analysis, consisting of 15 from West Africa (n = 2107), 12 from Southern Africa (n = 2963), 11 from East Africa (n = 2142), and 3 from Central Africa (n = 124). A total of 59.4% of the patient population were associated with paediatric admissions. The pooled prevalence of HAI was estimated at 12.9% (95% CI: 8.9-17.4; n = 7336; number of included estimates [k] = 41, p < 0.001). By subregions, the pooled current prevalence of HAI in the West Africa, Southern Africa, East Africa and Central Africa were estimated at 15.5% (95% CI: 8.3-24.4; n = 2107; k = 15), 6.5% (95% CI: 3.3-10.7; n = 2963; k = 12), 19.7% (95% CI: 10.8-30.5; n = 2142; k = 11) and 10.3% (95% CI: 1.1-27.0; n = 124; k = 3) of the patient populations respectively. We estimated mortality resulting from HAI in SSA at 22.2% (95% CI: 14.2-31.4; n = 1118; k = 9). Interpretation: Our estimates reveal a high burden of HAI in SSA with significant heterogeneity between regions. Variations in HAI distribution highlight the need for infection prevention and surveillance strategies specifically tailored to enhance prevention and management with special focus on West and East Africa, as part of the broader global control effort. Funding: No funding was received for this study.

9.
Anim Microbiome ; 6(1): 9, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38438939

RESUMEN

BACKGROUND: Alternatives to antibiotic as growth promoters in agriculture, such as supplemental prebiotics, are required to maintain healthy and high performing animals without directly contributing to antimicrobial resistance bioburden. While the gut microbiota of broiler hens has been well established and successfully correlated to performance, to our knowledge, a study has yet to be completed on the effect of prebiotic supplementation on correlating the mature laying hen productivity and microbiota. This study focused on establishing the impact of a yeast derived prebiotic, mannan rich fraction (MRF), on the cecal microbiota of late laying hens. This study benefitted from large sample sizes so intra- and intergroup variation effects could be statistically accounted for. RESULTS: Taxonomic richness was significantly greater at all taxonomic ranks and taxonomic evenness was significantly lower for all taxonomic ranks in MRF-supplemented birds (P < 0.005). Use of principal coordinate analyses and principal component analyses found significant variation between treatment groups. When assessed for compositional uniformity (an indicator of flock health), microbiota in MRF-supplemented birds was more uniform than control birds at the species level. From a food safety and animal welfare perspective, Campylobacter jejuni was significantly lower in abundance in MRF-supplemented birds. In this study, species associated with high weight gain (an anticorrelator of performance in laying hens) were significantly lower in abundance in laying hens while health-correlated butyrate and propionate producing species were significantly greater in abundance in MRF-supplemented birds. CONCLUSIONS: The use of prebiotics may be a key factor in controlling the microbiota balance limiting agri-food chain pathogen persistence and in promoting uniformity. In previous studies, increased α- and ß-diversity indices were determinants of pathogen mitigation and performance. MRF-supplemented birds in this study established greater α- and ß-diversity indices in post-peak laying hens, greater compositional uniformity across samples, a lower pathogenic bioburden and a greater abundance of correlators of performance.

10.
JSES Int ; 8(2): 371-377, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38464438

RESUMEN

Background: Proximal ulna fracture-dislocations are challenging injuries with a myriad of existing classification systems. The Coronoid, proximal Ulna, Radius, and Ligaments classification (CURL) is a simple framework designed to focus attention on the key components affecting outcome and guide surgical management. This study evaluates interobserver and intraobserver reliability of this new classification. Methods: Four observers independently reviewed plain radiographs and computed tomography (CT) scans of patients with proximal ulna fracture-dislocations. Each observer scored the Coronoid (C), proximal Ulna (U), and Radius (R) components for each fracture on 2 occasions. The osseous components were subclassified as 'intact', 'simple', or 'complex'. The Ligament component (L) was not rated as this requires intraoperative classification. Interobserver and intraobserver reliability was calculated using Cohen's weighted kappa coefficients. X-ray and CT were compared for patients with both imaging modalities. The Landis and Koch criteria were used to interpret the strength of the kappa statistics. Results: One hundred seventy seven patients had plain X-rays; 58 patients had both X-ray and CT scans. Overall, in the X-ray only cohort, there was 'almost perfect' interobserver reliability for the radial head (k = 0.94) and coronoid (k = 0.83), and 'substantial' reliability (k = 0.68) for the proximal ulna. For the X-ray and CT cohort, interobserver reliability was 'almost perfect' across both modalities for the radial head (k = 0.88 and k = 0.93, respectively) and 'moderate' for the proximal ulna (k = 0.48 and k = 0.52, respectively). For the coronoid, interobserver reliability for X-ray interpretation was 'substantial' (k = 0.74) and for CT was 'almost perfect' (k = 0.89). Intraobserver reliability was 'almost perfect' for all components, other than CT assessment of the proximal ulna which demonstrated 'substantial' reliability (k = 0.74). Conclusion: The Coronoid, proximal Ulna, Radius, and Ligaments classification demonstrates strong interobserver and intraobserver reliability, supporting use of the classification for proximal ulna fracture-dislocations. CT is recommended for improved characterization of any fracture with a coronoid component.

11.
Animals (Basel) ; 13(19)2023 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-37835739

RESUMEN

The effect of supplementing organic trace minerals (OTM), in the form of mineral proteinates (Bioplex® Cu, Fe, Mn, and Zn, Alltech Inc., Nicholasville, KY, USA), in the diets of laying hens was examined using Comprehensive Meta-Analysis (CMA) statistical software. The impact on production performance, egg quality traits, and sustainability parameters related to the carbon footprint of egg production was assessed. Data were obtained from 32 global studies, comprising 107 dietary assessments of 30,992 laying hens. Overall pooled effect size (raw mean difference) of production performance when dietary organic trace minerals were supplemented either in basal diets, partial replacement of inorganic trace minerals (ITM), or total replacement of ITM, indicated that use of Bioplex minerals resulted in 2.07% higher hen-day production (HDP), whilst feed conversion ratio (FCR) was lower by 51.28 g feed/kg egg and 22.82 g feed/dozen eggs, respectively. For egg quality traits, daily egg mass was 0.50 g/hen/day higher and egg weight was 0.48 g per egg greater when Bioplex minerals were incorporated in the diet. The mean difference in egg loss was -0.62%. Eggshell thickness was greater by 0.01 mm, and a higher eggshell strength of 0.14 kgf was observed. Eggshell weight was heavier by 0.20 g, eggshell percentage was higher by 0.15%, and Haugh unit was 1 point higher (0.89). We also carried out a meta-regression of the effects of the study factors (location, year of study, hen breed/strain, age of hens, number of hens, and study duration) on the overall pooled effect size of the production performance and egg quality traits in response to supplementary OTM inclusion, and it indicated that certain factors had a significant (p < 0.05) impact on the results. Finally, a life cycle assessment (LCA) model was selected to evaluate the impact of feeding organic trace mineral proteinates on the carbon footprint (feed and total emission intensities) of the egg production using the data generated from the meta-analysis. Results showed that the inclusion of OTM proteinates resulted in an average drop in feed and total emission intensities per kg eggs of 2.40% and 2.50%, respectively, for a low-global-warming-potential (GWP) diet and a drop of 2.40% and 2.48% for feed and total emissions, respectively, based on high-GWP diet. Based on the overall results, the inclusion of organic trace mineral proteinates in layer diets can benefit production performance and egg quality traits while contributing to a lower carbon footprint.

12.
Open Forum Infect Dis ; 10(10): ofad472, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37808894

RESUMEN

Background: Evidence for efficacy of single, high-dose liposomal amphotericin B (LAmB) in HIV-associated cryptococcal meningitis and histoplasmosis is growing. No systematic review has examined the safety of this regimen across multiple studies. Methods: We systematically searched Medline, Scopus, and the Cochrane Library from inception to April 2023 for studies reporting grade 3 and 4 adverse events (AEs) with single high-dose LAmB vs traditional amphotericin regimens for HIV-associated fungal infections. Results: Three trials (n = 946) were included. Compared with traditional regimens, single high-dose LAmB was associated with equivalent risk of grade 3 and 4 AEs (risk ratio [RR], 0.75; 95% CI, 0.53-1.06) and lower overall risk of grade 4 AEs (RR, 0.68; 95% CI, 0.55-0.86), grade 4 renal (RR, 0.43; 95% CI, 0.20-0.94) and grade 4 hematological AEs (RR, 0.46; 95% CI, 0.32-0.65). Conclusions: Single, high-dose LAmB is associated with a lower risk of life-threatening AEs compared with other World Health Organization-endorsed amphotericin B-based regimens in invasive HIV-related fungal infection.

13.
J Insect Sci ; 23(4)2023 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-37527466

RESUMEN

The 2021 Student Debates of the Entomological Society of America (ESA) were held at the Annual Meeting in Denver, CO. The event was organized by the Student Debates Subcommittee (SDS) of the Student Affairs Committee (SAC). The theme of the 2021 Student Debates was "Transforming Entomology to Adapt to Global Concerns", with 3 topics. Each topic had an unbiased introduction and 2 teams. The debate topics were (i) Nonnative insect introduction is an ethical approach for counteracting proliferation and overpopulation of consumers, (ii) What is the best technology to control undesirable insect pests in urban and agricultural settings? and (iii) Compared to other solutions, like plant-based diets, insect farming is the best method to address rising human global food and nutrient supply demands. Unbiased introduction speakers and teams had approximately 6 months to prepare for their presentations.


Asunto(s)
Agricultura , Entomología , Humanos , Animales , Granjas , Insectos , Estudiantes
14.
BMC Infect Dis ; 23(1): 474, 2023 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-37460960

RESUMEN

BACKGROUND: There have been calls for "person-centered" approaches to drug-resistant tuberculosis (DR-TB) care. In 2020, Charles James Hospital in South Africa, which incorporated person-centered care, was closed. Patients were referred mid-course to a centralized, tertiary hospital, providing an opportunity to examine person-centered DR-TB and HIV care from the perspective of patients who lost access to it. METHODS: The impact of transfer was explored through qualitative interviews performed using standard methods. Analysis involved grounded theory; interviews were assessed for theme and content. RESULTS: After switching to the centralized site, patients reported being unsatisfied with losing access to a single clinic and pharmacy where DR-TB, HIV and chronic disease care were integrated. Patients also reported a loss of care continuity; at the decentralized site there was a single, familiar clinician whereas the centralized site had multiple, changing clinicians and less satisfactory communication. Additionally, patients reported more disease-related stigma and less respectful treatment, noting the loss of a "special place" for DR-TB treatment. CONCLUSION: By focusing on a DR-TB clinic closure, we uncovered aspects of person-centered care that were critical to people living with DR-TB and HIV. These perspectives can inform how care for DR-TB is operationalized to optimize treatment retention and effectiveness.


Asunto(s)
Infecciones por VIH , Tuberculosis Resistente a Múltiples Medicamentos , Humanos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Investigación Cualitativa , Sudáfrica , Hospitales , Infecciones por VIH/tratamiento farmacológico , Antituberculosos/uso terapéutico
16.
Plants (Basel) ; 12(14)2023 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-37514238

RESUMEN

Climate change-related impacts have hampered the productivity of agricultural lands in recent times, affecting food security globally. Novel technology-based agricultural production systems such as controlled-environment agriculture (CEA) are a way to reduce the impact of climatic variation and pests that harm current global crop production and ensure consistent crop development. These systems often use artificial lighting and soilless mediums to produce crops. This meta-analysis has investigated the key influencing factors on crop production within these systems, using previous studies on lettuce (the most cultivated crop in these systems) to understand what affects yield within CEA. This analysis has found that on average, CEA systems yield twice that of field-based agriculture (3.68 kg m-2 vs. 1.88 kg m-2), with the most influencing factors being the variety of cultivars grown, the season, the nutrient delivery method, and the lighting type. The cultivation time for this study was 40 days, with 94% of papers having trial periods of 70 days or less, much lower than field-based agriculture (60-120 days). Vertical farming (stacked vertical CEA cultivation) studies were found to especially drive up yield per area (6.88 kg m-2). The results of this meta-analysis are useful for starting to understand the key influencing factors on CEA growth and highlight the breadth of research ongoing in the CEA industry.

17.
Artículo en Inglés | MEDLINE | ID: mdl-37134060

RESUMEN

BACKGROUND: Diabetic foot infections (DFIs) can lead to limb loss and mortality. To improve patient care at a safety-net teaching hospital, we created a multidisciplinary limb salvage service (LSS). METHODS: We recruited a cohort prospectively and compared it to a historical control group. Adults admitted to the newly established LSS for DFI during a 6-month period from 2016 to 2017 were included prospectively. Patients admitted to the LSS had routine endocrine and infectious diseases consultations according to a standardized protocol. A retrospective analysis of patients admitted to the acute care surgical service for DFI before creation of the LSS during an 8-month period from 2014 to 2015 was performed. RESULTS: A total of 250 patients were divided into two groups: the pre-LSS (n = 92) and the LSS (n = 158) groups. There were no significant differences in baseline characteristics. Although all patients were ultimately diagnosed with diabetes, more patients in the LSS group had hypertension (71% versus 56%; P = .01) and a prior diagnosis of diabetes mellitus (92% versus 63%; P < .001) compared to the pre-LSS group. Significantly, with the LSS, fewer patients underwent a below-the-knee amputation (3.6% versus 13%; P = .001). There was no difference in the length of hospital stay or 30-day readmission rate between the groups. Further broken down into Hispanic versus non-Hispanic, we noted that Hispanics had significantly lower rates of below-the-knee amputations (3.6% versus 13.0%; P = .02) in the LSS cohort. CONCLUSIONS: The initiation of a multidisciplinary LSS decreased the below-the-knee amputation rate in patients with DFIs. Length of stay was not increased, nor was the 30-day readmission rate affected. These results suggest that a robust multidisciplinary LSS dedicated to the management of DFIs is both feasible and effective, even in safety-net hospitals.


Asunto(s)
Enfermedades Transmisibles , Diabetes Mellitus , Pie Diabético , Adulto , Humanos , Recuperación del Miembro/métodos , Pie Diabético/cirugía , Pie Diabético/diagnóstico , Estudios Retrospectivos , Amputación Quirúrgica , Enfermedades Transmisibles/cirugía
18.
Int J Life Cycle Assess ; 28(5): 566-589, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37077273

RESUMEN

Purpose: Carbon fibre-reinforced composite materials offer superior mechanical properties and lower weight than conventional metal products. However, relatively, little is known about the environmental impacts and economic costs associated with composite products displacing conventional metal products. The purpose of this study is to develop an integrated life cycle assessment and life cycle costing framework for composite materials in the aviation industry. Methods: An integrated life cycle assessment (LCA) and life cycle costing (LCC) framework has been developed. The displacement of a conventional aluminium door for an aircraft by a composite door is presented as an example of the use of this framework. A graphical visualisation tool is proposed to model the integrated environmental and economic performances of this displacement. LCA and LCC models for composite applications are developed accordingly. The environmental hotspots are identified, and the sensitivity of the environmental impact results to the different composite waste treatment routes is performed. Subsequently, the research suggests a learning curve to analyse the unit price for competitive mass production. Sensitivity analysis and Monte Carlo simulation have been applied to demonstrate the cost result changes caused by data uncertainty. Results: Energy consumption was the hotspot, and the choice of composite waste treatment routes had a negligible effect on the LCA outcomes. Concerning the costs, the most significant cost contribution for the unit door production was labour. The future door production cost was decreased by about 29% based on the learning curve theory. The uncertainties associated with the variables could lead to variations in the production cost of up to about 16%. The comparison between the two doors shows that the composite door had higher potential environmental impacts and cost compared to the conventional aluminium door during the production stage. However, the composite door would have better environmental and financial performance if a weight reduction of 47% was achieved in future designs. Conclusions: The proposed framework and relevant analysis models were applied through a case study in the aerospace industry, creating a site-specific database for the community to support material selection and product development. The graphical tool was proved to be useful in representing a graphical visualisation comparison based on the integration of the LCA and LCC results of potential modifications to the composite door against the reference door, providing understandable information to the decision-makers. Supplementary Information: The online version contains supplementary material available at 10.1007/s11367-023-02164-y.

19.
J Environ Manage ; 336: 117684, 2023 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-36924711

RESUMEN

Environmental rating ecolabels are a new generation of ecolabels. They are intended to enable consumers to compare the environmental impacts of multiple products and make more sustainable consumption choices. Falling outside of the three types defined in the ISO 14020 environmental label and declarations series, the recent proliferation of these business-to-consumer communication instruments has resulted in the creation of a plethora of methodologies to derive product performance ratings. Interest from consumers wanting more information on the products they purchase, as well as the promise of policy instruments aiming to increase transparency and combat greenwashing, are fuelling further multiplication of schemes. A move towards more credible, evidence-based environmental rating ecolabels is therefore urgently needed to promote assessment based on scientific understanding, gain consumer trust, and realise policy objectives. We propose a framework based on four core principles - i) relevance, ii) scientific robustness, iii) trust and transparency, and iv) feasibility (scalability, affordability) - with 18 guidelines that can be followed by rating scheme developers. We characterise the rise of environmental rating ecolabels in geographical Europe and build an inventory of 33 existing schemes, at various stages of development and implementation, to which we apply the framework. This reveals the potential for significant improvement in current schemes, indicating important areas for development. The framework provides a valuable guide for the development of new schemes or an evaluation grid for existing initiatives.


Asunto(s)
Comercio , Ambiente , Europa (Continente) , Comunicación , Comportamiento del Consumidor
20.
Artículo en Inglés | MEDLINE | ID: mdl-36735915

RESUMEN

Attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy is an essential tool for the determination of mineral chelation in proteinates used as animal feed additives. With advances in feed formulations and stringent regulatory requirements to confirm the degree of chelation in animal feed supplements, the aim of this work was to further refine the method and demonstrate its applicability to newly formulated, higher concentration (20% (w/w)) manganese and zinc proteinates of industrial relevance. Calibration and prediction models were created using multivariate analysis with R2 > 0.99 for both mineral proteinates tested. Root mean square error of calibration (RMSEC) values were found to be 1.7% and 2.1% respectively for the manganese and zinc products. The refined method produced reliable data for various applications with excellent specificity, selectivity, and reproducibility. Consequently, the proposed refinements are expected to be of interest from a regulatory perspective and for those in the feed industry for conclusively determining the percentage chelation of minerals in high concentration proteinate products.


Asunto(s)
Manganeso , Zinc , Animales , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Reproducibilidad de los Resultados , Minerales , Alimentación Animal/análisis , Análisis de los Mínimos Cuadrados
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA