Formación en seguridad del paciente para el personal administrativo de una Mutua Colaboradora con la Seguridad Social, impacto inmediato y a los seis meses / Training in patient safety for the administrative staff of a Mutual Collaborator with Social Security, immediate impact and after six months

Introducción: El personal administrativo es un colectivo esencial. El objetivo de este estudio es analizar el impacto formativo de un curso online básico sobre seguridad del paciente para administrativos. Método: Estudio cuasi experimental antes/después en una población de 170 administrativos/as que prestaban sus servicios en los centros de la Mutua Colaboradora con la Seguridad Social MC Mutual y que realizaron un curso de seguridad del paciente. Se evaluaron los conocimientos adquiridos mediante una prueba al inicio (P1) y al final del curso (P2). Además, se eligió una muestra de conveniencia de 42 administrativos/as para evaluar sus conocimientos mediante entrevista, previos (E1) y posteriores (E2) al curso, y a los 6 meses (E3).Resultados: De los 170 administrativos/as participantes en el curso, 167 (98,2%) completaron la prueba al inicio y final, con puntuaciones medias que incrementaron de 5,7 (P1) a 7,3 (P2) (p<0,05). Aceptaron participar en las entrevistas 22 administrativos/as de una muestra de 42 (52,4%), y se consiguieron las tres entrevistas de 21 (E1), 22 (E2) y 19 (E3) administrativos/as, cuyas puntuaciones medias incrementaron desde 5,9 (E1) a 7,2 (E2) y 7,5 (E3) (p<0,05). Conclusiones: Los resultados sugieren que el curso de formación fue efectivo. La evaluación mediante la entrevista a los seis meses del curso indica un probable efecto a medio-largo plazo. La implicación de los/as profesionales administrativos/as en la atención a los usuarios de la Mutua es clave. La evaluación del impacto de una intervención es esencial para informar sobre su efectividad y orientar su planificación.(AU)

Introduction: Clerical staff are an essential part of the healthcare team, as they provide administrative and organizational support to healthcare institutions. The aim of this study is to determine the impact of a basic one-hour online training course on patient safety for these staff.Method: A quasi-experimental pre/post study carried out in a population of 170 administra-tive staff working in the centers of an Occupational Mutual Insurance Company (MC Mutu-al) who completed the patient safety training. A convenience sample of 22 administrative professionals, who agreed to participate, was chosen from this population, which made it possible to test their knowledge before and after the course, by examination (P1, P2) and interview, immediately after the course and at 6 months (E1, E2, E3).Results: Of the 170 professionals participating in the course, 167 (98.2%) completed the initial test and the post-test, with mean scores increasing from 5.7 (P1) to 7.3 (P2) (p<0.05). A total of 22 out of a sample of 42 (52.4%) agreed to participate in the interviews and all three interviews were completed by 21 (E1), 22 (E2) and 19 (E3) professionals, whose mean scores increased from 5.9 (E1) to 7.2 (E2) and 7.5 (E3) (p<0.05) Conclusions: The results suggest that the training course was effective. The evaluation by interview 6 months after the course indicates a likely medium to long term effect. The involvement of administrative professionals in the company ́s patient care is key. Evaluating the impact of an intervention is essential to inform its effectiveness and guide its plannin.(AU)

[Patient safety training for ward clerks of an Occupational Mutual Insurance Company collaborating with the Social Security, immediate impact and after six months]. / Formación en seguridad del paciente para el personal administrativo de una Mutua Colaboradora con la Seguridad Social, impacto inmediato y a los seis meses.

INTRODUCTION: Ward Clerks are an essential part of the healthcare team, as they provide administrative and organizational support in healthcare institutions. The aim of this study is to determine the training impact of a basic one-hour online course on patient safety for this staff. METHOD: A quasi-experimental before/after study carried out on a population of 170 administrative staff working in the centers of an Occupational Mutual Insurance Company (MC Mutual) who took the patient safety course. A convenience sample of 22 administrative professionals, who agreed to participate, was chosen from this population, which made it possible to reconstruct their knowledge before and after the course, by examination and interview, immediately after the course and at 6 months. RESULTS: Of the 170 professionals participating in the course, 167 (98.2%) completed the initial test and the post-test, with mean scores increasing from 5.7 (P1) to 7.3 (P2) (p<0.05). A total of 22 out of a sample of 42 (52.4%) agreed to participate in the interviews and all three interviews were achieved by 21 (E1), 22 (E2) and 19 (E3) professionals, whose mean scores increased from 5.9 (E1) to 7.2 (E2) and 7.5 (E3) (p<0.05). CONCLUSIONS: The results suggest that the training course was effective. The evaluation by interview 6 months after the course indicates a likely medium to long term effect. The involvement of administrative professionals in the the Company´s patients care is key. Evaluating the impact of an intervention is essential to inform its effectiveness and guide its planning.

Introducción: El personal administrativo es un colectivo esencial. El objetivo de este estudio es analizar el impacto formativo de un curso online básico sobre seguridad del paciente para administrativos.  Método: Estudio cuasi experimental antes/después en una población de 170 administrativos/as que prestaban sus servicios en los centros de la Mutua Colaboradora con la Seguridad Social MC Mutual y que realizaron un curso de seguridad del paciente. Se evaluaron los conocimientos adquiridos mediante una prueba al inicio (P1) y al final del curso (P2). Además, se eligió una muestra de conveniencia de 42 administrativos/as para evaluar sus conocimientos mediante entrevista, previos (E1) y posteriores (E2) al curso, y a los 6 meses (E3). Resultados: De los 170 administrativos/as participantes en el curso, 167 (98,2%) completaron la prueba al inicio y final, con puntuaciones medias que incrementaron de 5,7 (P1) a 7,3 (P2) (p<0,05). Aceptaron participar en las entrevistas 22 administrativos/as de una muestra de 42 (52,4%), y se consiguieron las tres entrevistas de 21 (E1), 22 (E2) y 19 (E3) administrativos/as, cuyas puntuaciones medias incrementaron desde 5,9 (E1) a 7,2 (E2) y 7,5 (E3) (p<0,05).  Conclusiones: Los resultados sugieren que el curso de formación fue efectivo. La evaluación mediante la entrevista a los seis meses del curso indica un probable efecto a medio-largo plazo. La implicación de los/as profesionales administrativos/as en la atención a los usuarios de la Mutua es clave. La evaluación del impacto de una intervención es esencial para informar sobre su efectividad y orientar su planificación.

MUSE-RASA captures human dimension in climate-energy-economic models via global geoAI-ML agent datasets.

This article provides a combined geospatial artificial intelligence-machine learning, geoAI-ML, agent-based, data-driven, technology-rich, bottom-up approach and datasets for capturing the human dimension in climate-energy-economy models. Seven stages were required to conduct this study and build thirteen datasets to characterise and parametrise geospatial agents in 28 regions, globally. Fundamentally, the methodology starts collecting and handling data, ending with the application of the ModUlar energy system Simulation Environment (MUSE), ResidentiAl Spatially-resolved and temporal-explicit Agents (RASA) model. MUSE-RASA uses AI-ML-based geospatial big data analytics to define eight scenarios to explore long-term transition pathways towards net-zero emission targets by mid-century. The framework and datasets are key for climate-energy-economy models considering consumer behaviour and bounded rationality in more realistic decision-making processes beyond traditional approaches. This approach defines energy economic agents as heterogeneous and diverse entities that evolve in space and time, making decisions under exogenous constraints. This framework is based on the Theory of Bounded Rationality, the Theory of Real Competition, the theoretical foundations of agent-based modelling and the progress on the combination of GIS-ABM.

Adverse events in the global healthcare practice of an Occupational Mutual Insurance Company in Spain.

BACKGROUND: Patient safety is currently a main issue in healthcare practice. Adverse events (AEs) management is a key instrument for the application of strategies to prevent harm to patients. OBJECTIVE: To analyze the type, severity and preventability, according to validated scales, of AEs occurring annually in the healthcare practice of an Occupational Mutual Insurance Company in order to implement action plans to improve patient safety. METHODS: We analyzed the reported AEs in an Incident Reporting System and AEs detected in the Audit program of clinical records as a result of treating injured or ill workers in our 88 ambulatory care centers. RESULTS: We detected 28 AEs in the clinical records (CR), representing 0.05 AE/CR, with maximum values in the COM sample (26 AEs, 0.11) and much lower in INT (1 AEs, 0.02) and MIN (1 AE, 0.02). The most frequent AE type was procedure-related, followed by infection and care. AEs of severity level D (11 cases) and E (9 cases) predominated, while level F was also detected (6 cases). Intermediate values in preventability (3 and 4) predominated, 61.5% were preventable. With the Incident Reporting System, 27 AEs were identified, predominated by procedural type. Most reported AE severities was in levels E (10 cases) and C (8 cases), 89% were preventable. CONCLUSION: Our company detects AEs via the Incident Reporting System and annual Audit program of clinical records, both of which are complementary, and may result in the implementation of more effective Patient Safety measures.

Differences in Perception of Healthcare Management between Patients and Professionals.

Patient perception and the organizational and safety culture of health professionals are an indirect indicator of the quality of care. Both patient and health professional perceptions were evaluated, and their degree of coincidence was measured in the context of a mutual insurance company (MC Mutual). This study was based on the secondary analysis of routine data available in databases of patients' perceptions and professionals' evaluations of the quality of care provided by MC Mutual during the period 2017-2019, prior to the COVID-19 pandemic. Eight dimensions were considered: the results of care, coordination of professionals, trust-based care, clinical and administrative information, facilities and technical means, confidence in diagnosis, and confidence in treatment. The patients and professionals agreed on the dimension of confidence in treatment (good), and the dimensions of coordination and confidence in diagnosis (poor). They diverged on confidence in treatment, which was rated worse by patients than by professionals, and on results, information and infrastructure, which were rated worse by professionals only. This implies that care managers have to reinforce the training and supervision activities of the positive coincident aspects (therapy) for their maintenance, as well as the negative coincident ones (coordination and diagnostic) for the improvement of both perceptions. Reviewing patient and professional surveys is very useful for the supervision of health quality in the context of an occupational mutual insurance company.

Synthesis and evaluation of potent yaku'amide A analogs.

Two full-length analogs of the anticancer peptide yaku'amide A (1a) and four partial structures have been synthesized. These analogs were identified by computational studies in which the three E- and Z-ΔIle residues of the natural product were replaced by the more accessible dehydroamino acids ΔVal and ΔEnv. Of the eight possible analogs, modeling showed that the targeted structures 2a and 2b most closely resembled the three-dimensional structure of 1a. Synthesis of 2a and 2b followed a convergent route that was streamlined by the absence of ΔIle in the targets. Screening of the compounds against various cancer cell lines revealed that 2a and 2b mimic the potent anticancer activity of 1a, thereby validating the computational studies.

Effects of a concurrent training protocol on body composition and phase angle in physically inactive young women: a quasi-experimental intervention study / Efectos de un protocolo de entrenamiento concurrente sobre la composición corporal y el ángulo de fase en mujeres jóvenes físicamente inactivas: un estudio de intervención cuasi-experimental

SUMMARY: To determine the effect of a concurrent training program on body composition and phase angle in young women. 38 women (19.26 ± 1.86 years) participated in the study, and were assigned according to convenience sampling into two groups: 11 into the control group (CG) and 27 into the intervention group (IG). The IG performed a 12-weeks concurrent training protocol. The frequency was five days a week, and the intensity was established in 40-60 % of a repetition maximum to strength exercise, and 40-65 % heart rate reserve to endurance exercise. Body composition and phase angle were evaluated by bioelectrical impedance before and after the intervention. The IG had a decrease in fat mass (pre = 24.66 ± 5.65 kg; post = 20.38 ± 4.20 kg; Cohen's d = .80; p< 0,001 [CI 95 % = 3.34,5.22]), and an increase in muscle mass (pre = 22.75 ± 3.23 kg; post: 23.50 ± 3.41 kg; Cohen's d = -0.86; p= <0,001[CI 95 % = -1.09,- 0.40]) and total phase angle (pre = 5.72º ±0.39; post: 6.24º ± 0.51; Cohen's d = -1.32; p=<0,001 [CI 95 % = -0.67,-0.36]), whereas the CG had not show significant variations in variables of body composition or total phase angle. The results suggest that a 12-weeks concurrent training program could modify positively the young women's body composition and phase angle. Hence, it is recommended using similar protocols to change variables related to young women's health.

RESUMEN: El objetivo fue determinar el efecto de un programa de entrenamiento concurrente sobre la composición corporal y el ángulo de fase en mujeres jóvenes. 38 mujeres (19.26 ± 1.86 años) participaron en el estudio, y fueron asignadas de acuerdo a un muestreo de conveniencia en dos grupos: 11 en el grupo control (CG) y 27 en el grupo de intervención (GI). El IG realizó un protocolo de entrenamiento concurrente de 12 semanas. La frecuencia fue de cinco días a la semana y la intensidad se estableció en 40-60 % una repetición máxima para el ejercicio de fuerza y 40-65 % de frecuencia cardíaca de reserva para ejercicio de resistencia. La composición corporal y el ángulo de fase se evaluaron mediante impedancia bioeléctrica antes y después de la intervención. El IG tuvo una disminución en la masa grasa (pre = 24.66 ± 5.65 kg; post = 20.38 ± 4.20 kg; d de Cohen = .80; p <0,001 [IC 95 % = 3.34,5.22]), y un aumento en la masa muscular (pre = 22,75 ± 3,23 kg; post: 23,50 ± 3,41 kg; d de Cohen = -0,86; p = <0,001 [IC 95 % = -1,09, -0,40]) y ángulo de fase total (pre = 5,72º ± 0,39; post: 6,24 º ± 0,51; d de Cohen = -1,32; p = <0,001 [IC 95 % = -0,67, -0,36]), mientras que el GC no mostró variaciones significativas en las variables de composición corporal o ángulo de fase total. Los resultados sugieren que un programa de entrenamiento concurrente de 12 semanas podría modificar positivamente la composición corporal y el ángulo de fase de mujeres jóvenes. Por lo tanto, se recomienda utilizar protocolos similares para mofificar variables relacionadas con la salud de mujeres jóvenes.

Effects of Wash Protocol and Contamination Level on Concentrations of Cortisol and Dehydroepiandrosterone (DHEA) in Swine Hair.

The effect of washing procedure and contamination level on the concentrations of cortisol and dehydroepiandrosterone (DHEA) in swine hair was explored over two studies. Hair shaved from finisher pigs (n = 8) and sows (n = 8, cortisol study 1 only) was split into two treatments (two hair samples/pig) to receive either three isopropanol or methanol washes, and two paired subsamples of hair were contaminated with feces and urine, mildly or severely. Samples were further subdivided and received one, three, or five methanol washes. Hormone concentrations were quantified from the hair and wash solvent, and the ratio of hormones in the solvent to that in the hair calculated. When grouping sow and grower hair together for analysis, hair cortisol concentrations were 13% greater after three isopropanol washes compared to methanol (22.84 ± 3.12 vs. 19.77 ± 2.64 pg/mg, respectively). When analyzing sow and grower hair separately, sow hair cortisol concentrations were 20% higher following three isopropanol washes compared to methanol washes (22.06 ± 5.21 vs. 27.72 ± 5.65 pg/mg), with no differences in grower pig hair concentrations. The solvent cortisol concentrations did not differ with wash solvent. No differences were seen for DHEA. Contamination level did not influence hormone concentrations. Hair cortisol concentrations were 24% higher after one wash compared to five washes (11.98 ± 1.47 vs. 9.05 ± 0.92 pg/mg), whereas the solvent cortisol concentrations were 80% and 84% higher after one wash compared to three and five washes, respectively (21.09 ± 4.04 vs. 4.21 ± 1.62 vs. 3.36 ± 1.32 pg/mg). The solvent-hair cortisol ratio was 65% and 73% higher following one wash compared to three and five washes (1.36 ± 0.80 vs. 0.47 ± 0.12 vs. 0.37 ± 0.14). Hair DHEA concentrations were 39% higher after one wash compared to five washes (42.39 ± 6.87 vs. 26.02 ± 5.69 pg/mg). The solvent DHEA concentrations, and the solvent-hair ratio for DHEA were 94% and 98% and 92% and 98% higher going from one wash to three and five washes, respectively (solvent: 5.07 ± 0.26 vs. 0.28 ± 0.12 vs. 0.12 ± 0.09 pg/mg and solvent-hair ratio: 0.13 ± 0.006 vs. 0.010 ± 0.004 vs. 0.003 ± 0.002). Following three methanol washes, the non-contaminated hair had 46% and 48% higher hair (17.47 ± 1.12 vs. 9.35 ± 0.80 vs. 9.05 ± 1.06 pg/mg) and a 76% and 72% higher solvent (16.31 ± 8.07 vs. 3.92 ± 0.50 vs. 4.50 ± 2.31 pg/mg) cortisol concentration compared to mild and severely contaminated hair, respectively. Wash solvent influences cortisol concentrations in swine hair, but not DHEA. Contaminated swine hair should be avoided in analyses when possible.

Towards a streamlined synthesis of peptides containing α,ß-dehydroamino acids.

Investigation of a strategy to streamline the synthesis of peptides containing α,ß-dehydroamino acids (ΔAAs) is reported. The key step involves generating the alkene moiety via elimination of a suitable precursor after it has been inserted into a peptide chain. This process obviates the need to prepare ΔAA-containing azlactone dipeptides to facilitate coupling of these residues. Z-dehydroaminobutyric acid (Z-ΔAbu) could be constructed most efficiently via EDC/CuCl-mediated dehydration of Thr. Formation of Z-ΔPhe by this or other dehydration methods was unsuccessful. Production of the bulky ΔVal residue could be accomplished by DAST-promoted dehydrations of ß-OHVal or by DBU-triggered eliminations of sulfonium ions derived from penicillamine derivatives. However, competitive formation of an oxazoline byproduct remains problematic.

Factors affecting the non-urgent consultations in the emergency department of a tertiary hospital in the Philippines: A cross-sectional study.

OBJECTIVES: The non-standard emergency medicine services and the limited utilisation of primary care providers in the Philippines may contribute towards the ED being a preferred area for patients with non-urgent conditions. Our study aims to determine the factors associated with non-urgent consultations in the ED of a tertiary hospital in the Philippines. METHODS: From 7 January to 15 February 2020, we surveyed non-urgent ED patients (n = 757) presenting to a tertiary hospital in the Philippines. We evaluated the data using descriptive statistics, while chi-squared and multivariate analyses versus urgent ED patients (n = 281) were used to show the association of factors. RESULTS: Our recruited non-urgent patients were mostly 21-40 years old (n = 576 [76%]), single (n = 437 [58%]), with full-time employment (n = 654 [86%]), have Health Maintenance Organization coverage (n = 684 [90%]), self-referred (n = 498 [66%]), and have private means of getting to ED (n = 414 [55%]). They had moderate scores of social support-seeking behaviours (mean 3.92/5; 95% confidence interval [CI] 3.88-3.96), health literacy (mean 3.58/5; 95% CI 3.56-3.61), self-efficacy (mean 3.09/5; 95% CI 3.56-3.61), whereas their ED access score (mean 4.10/5; 95% CI 4.06-4.14) was high. They had moderate self-assessed severity (mean 3.75/6; 95% CI 3.70-3.80), urgency (mean 3.83/6; 95% CI 3.78-3.88), and anxiety (mean 3.88/6; 95% CI 3.83-3.93) scores and high ED satisfaction rating (mean 4.73/6; 95% CI 4.69-4.77). They mostly had digestive (n = 203 [26.8%]) and infection-related (n = 172 [22.7%]) chief complaints and final diagnoses (n = 198 [26.2%] and n = 145 [19.2%], respectively), without previous consultations (n = 577 [76%]), and eventually discharged (n = 755 [99%]). Our urgent patients had similar characteristics, but with higher assessed patient severity, urgency, anxiety and satisfaction with ED services (P < 0.001). CONCLUSION: Non-urgent consultations in ED are attributed to multiple factors encompassing socio-demographic, socio-economic and psychosocial dimensions. These factors must be considered in improving the current healthcare management system for the appropriate utilisation of ED in the Philippines.

Patient Safety Culture in Mutual Insurance Companies in Spain.

OBJECTIVES: The aim of the study was to assess the safety culture in a mutual insurance sector, searching for improvement opportunities. This sector offers health insurance for work-related injuries and occupational illnesses and represents an annual volume of patients corresponding to approximately 10% of the working population in Europe. METHODS: A cross-sectional study was conducted to assess the safety culture in the mutual insurance sector in Spain. All physicians, nurses, and physiotherapists (N = 816) working in the organization in hospitals, outpatient clinics, and managerial settings were invited to reply to an online survey. RESULTS: A total of 499 professionals completed the questionnaire (response rate, 61%). Two dimensions were assessed: attitudinal (5 items) and instrumental (5 items). There were no differences between professional profiles or centers in the attitudinal (7.8; standard deviation, 1.3; 95% confidence interval, 7.6-7.9) or instrumental (8.5; standard deviation, 1.0; 95% confidence interval, 8.5-8.6) factors. The lowest level of implementation (<9 points) was related to the following: open disclosure after an adverse event (73%), having a quality and safety plan (75%), prioritizing the improvement of patient care (75%), and involving patients when making decisions on potential treatments (63%). Managers showed lower scores than the rest of professionals' groups (P < 0.05). CONCLUSIONS: This intent is to introduce a patient safety culture assessment in the mutual insurance companies. These results may encourage the implementation of quality and safety plans in this sector by paying more attention to attitudinal aspects.

Risk Management in the Ambulatory Care Process in a Mutual Benefit Association Covering Work-Related Accidents and Diseases: Applying Modified Failure Mode and Effect Analysis (FMEA) Methodology.

AIM: To assess the impact of different forms of use of failure mode and effect analysis methodology for risk prioritization in the ambulatory care process in a mutual benefit association covering work-related accidents and diseases. METHODS: The study is based on a previously drafted and individually prioritized risk map by a multidisciplinary team made up of patient safety committee members from health care centers and clinics in a mutual benefit association covering work-related accidents and diseases. The professionals mainly carry out their work in the field of management (individual manager group (IMG)). A group formed by clinicians subsequently completed 2 prioritizations: one based on the individual opinions of each of the members (individual clinical group (ICG)) and another in a consensual way (consensual clinical group (CCG)) as recommended by failure mode and effect analysis methodology. The risk prioritization was compared in the 3 groups (IMG, ICG, and CCG). RESULTS: The risk prioritization by the IMG defines 7 extreme risks (risk prioritization ≥ 275). When the clinical group prioritizes them in an individual way (ICG), there is no extreme risk, whereas when it does so in a consensual way (CCG), there are 21 extreme risks. With respect to the coincidences of existing causes between the 3 groups, it is noted that the "risk of falls" is rated by both the clinical and the manager group but prioritized differently. On the other hand, the ICG and CCG coincide in that pressure on health care services can contribute to carrying out incomplete anamnesis. They also both consider that internal and external waiting lists and holiday periods can cause a delay in the starting of rehabilitation. The IMG and the CCG show similarity in the risk assessment of overprescribing medication and that multiple computer sessions are initiated. Finally, the IMG and the ICG coincide in the "lack of delivery of the medication leaflet". CONCLUSIONS: The point of view of the clinicians is important in the risk prioritization of the ambulatory health care process. The difference in the risk prioritization between the clinical group at individual level and after consensus is remarkable.

Convergent Total Synthesis of Yaku'amide†A.

Total synthesis of the anticancer peptide natural product yaku'amide A is reported. Its ß-tert-hydroxy amino acids were prepared by regioselective aminohydroxylation involving a chiral mesyloxycarbamate reagent. Stereospecific construction of the E- and Z-ΔIle residues was accomplished through a one-pot reaction featuring anti dehydration, azide reduction, and O→N acyl transfer. Alkene isomerization was negligible during this process. These methods enabled a highly convergent and efficient synthetic route to the natural product.

Agent-based scenarios comparison for assessing fuel-switching investment in long-term energy transitions of the India's industry sector.

This paper presents the formulation and application of a novel agent-based integrated assessment approach to model the attributes, objectives and decision-making process of investors in a long-term energy transition in India's iron and steel sector. It takes empirical data from an on-site survey of 108 operating plants in Maharashtra to formulate objectives and decision-making metrics for the agent-based model and simulates possible future portfolio mixes. The studied decision drivers were capital costs, operating costs (including fuel consumption), a combination of capital and operating costs, and net present value. Where investors used a weighted combination of capital cost and operating costs, a natural gas uptake of ~12PJ was obtained and the highest cumulative emissions reduction was obtained, 2 Mt CO2 in the period from 2020 to 2050. Conversely if net present value alone is used, cumulative emissions reduction in the same period was lower, 1.6 Mt CO2, and the cumulative uptake of natural gas was equal to 15PJ. Results show how the differing upfront investment cost of the technology options could cause prevalence of high-carbon fuels, particularly heavy fuel oil, in the final mix. Results also represent the unique heterogeneity of fuel-switching industrial investors with distinct investment goals and limited foresight on costs. The perception of high capital expenditures for decarbonisation represents a significant barrier to the energy transition in industry and should be addressed via effective policy making (e.g. carbon policy/price).

Exploring Additive, Synergistic or Antagonistic Effects of Natural Plant Extracts on In Vitro Beef Feedlot-Type Rumen Microbial Fermentation Conditions.

Six Essential oils (EO) (tea tree oil-TeTr, oregano oil-Ore, clove bud oil-Clo, thyme oil-Thy, rosemary oil-Ros, and sage oil-Sag) in Experiment 1; and different combinations of selected oils in Experiment 2, were evaluate at four doses in an in vitro microbial fermentation system using ruminal fluid from beef cattle fed a 10:90 straw: Concentrate diet. In Experiment 1, TeTr, Ore, Clo and Thy improved rumen fermentation profile in a direction consistent with better feed utilization. In Experiment 2, TeTr mixed with Thy, Ore, Thy + Ore or Clo at 200 and 400 mg/L increased the molar proportion of propionate and decreased that of acetate, and the acetate to propionate ratio. However, the size of the effect was similar to that obtained with TeTr alone, suggesting that effects were not additive. When Thy, Ore or Thy + Ore where mixed with Clo, most effects on rumen fermentation profile disappeared, suggesting an antagonistic interaction of Clo with Thy and Ore. Results do not support the hypothesis of additivity among the EO tested, and antagonistic effects of Clo mixed with Thy or Ore were demonstrated at least in a low pH, beef-type fermentation conditions.

Declaración de Cartagena. Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición / Cartagena Declaration. The International Declaration on the Right to Nutritional Care and the Fight against Malnutrition

Frente a la necesidad de promover el derecho al cuidado nutricional, de luchar contra la malnutrición y de avanzar en temas de educación e investigación en nutrición clínica, las sociedades que constituyen la FELANPE firmaron la Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición, "Declaración de Cartagena", el 3 de mayo del presente año en la ciudad de Cartagena, en el marco del 33º Congreso de la Asociación Colombiana de Nutrición Clínica. La Declaración proporciona un marco coherente de 13 principios, los cuales podrán servir de guía a las sociedades afiliadas a la FELANPE en el desarrollo de los planes de acción. Además, servirá como un instrumento para que promuevan, a través de los gobiernos, la formulación de políticas y legislaciones en el campo de la nutrición clínica. Consideramos que el marco general de principios propuesto por la Declaración puede contribuir a crear conciencia acerca de la magnitud de este problema y a forjar redes de cooperación entre los países de la región. Aunque esta Declaración no tiene un efecto jurídico vinculante (obligatorio), tiene una fuerza moral innegable y puede proporcionar orientación práctica a los estados. Un plan de implementación permitirá desarrollar la caja de herramientas necesaria para transformar los principios en acciones

The need to promote the right to nutritional care, to fight against malnutrition and to advance in education and research in clinical nutrition has led all the FELANPE's societies to sign on May 3rd, during the 33rd Congress of the Colombian Clinical Nutrition Association (ACNC) in the city of Cartagena, the International Declaration on the Right to Nutritional Care and the Fight against Malnutrition, "Declaration of Cartagena". The Declaration provides a coherent framework of 13 principles which can serve as a guide for societies, schools and associations affiliated to FELANPE in the development of action plans. In addition, it will serve as an instrument to promote, through governments, the formulation of policies and legislation in the field of clinical nutrition. We believe that the general framework of principles proposed by the Declaration can contribute to raise awareness about the magnitude of this problem and to promote cooperation networks among Latin-American countries. Although this Declaration does not have a binding legal effect, it has an undeniable moral strength and it can provide practical guidance to States. An implementation program will allow developing a toolkit to transform principles into actions

[Cartagena Declaration. The International Declaration on the Right to Nutritional Care and the Fight against Malnutrition]. / Declaración de Cartagena. Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición.

INTRODUCTION: The need to promote the right to nutritional care, to fight against malnutrition and to advance in education and research in clinical nutrition has led all the FELANPE's societies to sign on May 3rd, during the 33rd Congress of the Colombian Clinical Nutrition Association (ACNC) in the city of Cartagena, the International Declaration on the Right to Nutritional Care and the Fight against Malnutrition, "Declaration of Cartagena". The Declaration provides a coherent framework of 13 principles which can serve as a guide for societies, schools and associations affiliated to FELANPE in the development of action plans. In addition, it will serve as an instrument to promote, through governments, the formulation of policies and legislation in the field of clinical nutrition. We believe that the general framework of principles proposed by the Declaration can contribute to raise awareness about the magnitude of this problem and to promote cooperation networks among Latin-American countries. Although this Declaration does not have a binding legal effect, it has an undeniable moral strength and it can provide practical guidance to States. An implementation program will allow developing a toolkit to transform principles into actions.

INTRODUCCIÓN: Frente a la necesidad de promover el derecho al cuidado nutricional, de luchar contra la malnutrición y de avanzar en temas de educación e investigación en nutrición clínica, las sociedades que constituyen la FELANPE firmaron la Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición, "Declaración de Cartagena", el 3 de mayo del presente año en la ciudad de Cartagena, en el marco del 33º Congreso de la Asociación Colombiana de Nutrición Clínica. La Declaración proporciona un marco coherente de 13 principios, los cuales podrán servir de guía a las sociedades afiliadas a la FELANPE en el desarrollo de los planes de acción. Además, servirá como un instrumento para que promuevan, a través de los gobiernos, la formulación de políticas y legislaciones en el campo de la nutrición clínica. Consideramos que el marco general de principios propuesto por la Declaración puede contribuir a crear conciencia acerca de la magnitud de este problema y a forjar redes de cooperación entre los países de la región. Aunque esta Declaración no tiene un efecto jurídico vinculante (obligatorio), tiene una fuerza moral innegable y puede proporcionar orientación práctica a los estados. Un plan de implementación permitirá desarrollar la caja de herramientas necesaria para transformar los principios en acciones.

Effect of meloxicam and lidocaine administered alone or in combination on indicators of pain and distress during and after knife castration in weaned beef calves.

To assess the effect of meloxicam and lidocaine on indicators of pain associated with castration, forty-eight Angus crossbred beef calves (304 ± 40.5 kg of BW, 7-8 months of age) were used in a 28 day experiment. The experiment consisted of a 2 × 2 factorial design where main factors included provision of analgesia and local anaesthesia. Analgesia consisted of: no-meloxicam (N; n = 24) single s.c. administration of lactated ringer's solution and meloxicam (M; n = 24) single dose of 0.5 mg/kg of s.c. meloxicam. Local anesthesia consisted of: no-lidocaine (R; n = 24) ring block administration of lactated ringer's solution or lidociane (L; n = 24) ring block administration of lidocaine. To yield the following treatments: no meloxicam + no lidocaine (N-R; n = 12), no meloxicam + lidocaine (N-L; n = 12), meloxicam + no lidocaine (M-R; n = 12) and meloxicam + lidocaine (M-L; n = 12). Salivary cortisol concentrations were lower (lidocaine × time effect; P < 0.01) in L calves than R calves 0.5 and 1 hours after castration, while concentrations were lower (meloxicam × time effect; P = 0.02) in M calves than N calves at 2, 4 and 48 hours. The serum amyloid-A concentrations were greater (lidocaine × time effect; P < 0.01) in R calves than L calves on days 1, 3, 21 and 28 after castration. Haptoglobin concentrations were greater (meloxicam × time effect; P = 0.01) in N calves than M calves 24 and 48 hours after castration. Lower (lidocaine effect; P < 0.01) visual analog scale (VAS) scores, leg movement frequencies and head movement distance were observed in L calves than R calves at the time of castration. Escape behaviour during castration was lower (lidocaine effect; P < 0.05) in L calves than R calves based on data captured with accelerometer and head gate devices. Scrotal circumference had a triple interaction (lidocaine × meloxicam × time; P = 0.03), where M-R calves had greater scrotal circumference than M-L calves 28 d after castration, but no differences were observed between both groups and N-R and N-L calves. No differences (P > 0.05) were observed for average daily gain (ADG), weights or feeding behaviour. Overall, both lidocaine and meloxicam reduced physiological and behavioural indicators of pain. Although there was only one meloxicam × lidocaine interaction, lidocaine and meloxicam reduced physiological and behavioural parameters at different time points, which could be more effective at mitigating pain than either drug on its own.

Effect of a single dose of subcutaneous meloxicam prior to band or knife castration in 1-wk-old beef calves: II. Inflammatory response and healing.

The aim of this study was to evaluate the effect of a single dose of subcutaneous (s.c.) meloxicam administered at the time of knife and band castration on inflammatory response and wound healing over 56-d post-castration. Seventy-two Angus crossbred calves (47.3 ± 6.70 kg of body weight [BW] and 7 to 8 d of age) were randomly assigned according to a 3 × 2 factorial design assessing castration method: sham (CT), band (BA), and knife (KN) castration, and pain mitigation: non-medicated (NM) and medicated calves (M) injected s.c. with meloxicam (0.5 mg/kg of BW). Calf BW, rectal temperature, swelling ("0": no swelling; "4": swelling needing intervention) and healing score ("1" to "5" with "5" being completely healed), scrotal circumference, and maximum scrotal temperature were measured on d -1, immediately before castration (d 0), and weekly thereafter over a 56-d period. Blood samples for haptoglobin (Hp), serum amyloid-A (SAA), and complete blood cell count were collected according to the same schedule. Hair samples were collected on d -1, 28, and 56 to determine cortisol concentrations. Standing and lying behaviors were measured using accelerometers that were placed on the calves on d -1 until d 35, and visual observations of behaviors related to pain were recorded once a week for 35 d. Knife-castrated calves achieved swelling scores of "3" and "2" between d 7 and 14, which was sooner (Z< 0.05) than in BA calves (from d 14 to 35). In addition, greater (P = 0.03) concentrations of SAA were observed in BA calves (76.9 ± 0.12 g/liter) compared with CT (57.6 ± 0.12 g/liter) and KN (51.6 ± 0.12 g/liter) from d 7 to 35. Healing scores of "2" and "4" tended to be achieved sooner (Z < 0.10) in KN calves than in BA calves, although healing scores of "3" tended to be achieved sooner (Z < 0.10) in BA calves than KN calves. No differences (P > 0.10) were observed among treatments for hair cortisol on d -1 and 28, but on d 56, hair cortisol concentrations in BA-NM calves were greater (P > 0.05) than for CT-NM, BA-M, KN-NM, and KN-M, and tended to be greater (P = 0.08) than for CT-M calves. Lying duration tended (P = 0.10) to be greater and suckling behavior tended (P = 0.08) to be lower in NM than M calves. A single s.c. injection of meloxicam did not reduce long-term inflammatory responses or improve wound healing; however, it may be useful in reducing pain and stress in band castrated calves as evidenced by reduced hair cortisol concentrations up to 56 d post-castration.

Effects of live yeast (Saccharomyces cerevisiae) and type of cereal on rumen microbial fermentation in a dual flow continuous culture fermentation system.

Live yeast additives may help optimize ruminal fermentation of high-grain diets, especially when the starch of the ration is highly fermentable. Eight dual flow continuous culture fermenters were used in a 2 × 2 factorial design in two replicated periods of 9 days (six for adaptation and three for sampling) to determine the effect of live yeast and type of cereal on rumen microbial fermentation and nutrient digestibility. Main factors were the addition of live yeast: no yeast (NY) vs. 2 × 107 CFU of yeast/g of diet (LY); and type of cereal in the diet: corn (CO) vs. barley (BA). All fermenters were fed 80 g dry matter/day of a 10-90 forage to concentrate diet and pH was allowed to fluctuate with an upper (6.6) and lower (5.5) limit. Treatment BA increased OM digestion, valerate proportion, peptides and ammonia N fractions, ammonia N flow, crude protein degradation and target copies of Megasphaera elsdenii; and decreased NDF digestion, propionate proportion, branched-chain VFA (BCVFA) concentration, AA-N fraction and nonammonia N flow. Treatment LY increased BCVFA and decreased ammonia N fraction and flow, and the target copies of Streptococcus bovis. Treatment LY decreased the slope of pH drop, the area under pH 6.0 and the gas production. These results suggest potential benefits of LY in stabilizing the fermentation of BA-based diets.