The Case of an Agricultural Crop Business Association in Navarra as Circular Economy Intermediary.

The circular economy (CE) is an alternative economic system based on closing energy and material cycles to achieve sustainable development and create value based on innovation. In this sense, business associations (BAs) can work as intermediaries to promote CE in industrial sectors. They bring together many companies, generate trust-based relationships, support companies' strategy and collaborative innovation to construct closed-loop material flows, and increase competitiveness in sectors and regions. This study aims to show the BA's role as intermediaries of CE and promoters of industrial symbiosis (IS) as a value creation strategy among its affiliated companies (AC). Thus, this work takes the form of an exploratory case study of five different companies of the Union of Agricultural Cooperatives of Navarra (UCAN) in Spain. Researchers collected this study's data through a focus group and surveys. As a result, an original serious game was developed in 2016 and a survey in 2016 and 2020, which considers the CE's six fields of action (take, make, manufacture, distribution, use, recovery, and IS). Finally, this study proposes a methodology to promote the CE through the BAs, based on the performance of the UCAN as an intermediary of the CE and IS. Likewise, BAs' potential to promote the closure of energy and materials cycles in regions and commercial sectors such as agribusiness is demonstrated. The study also demonstrated the organizations' evolution and the improved perception of economic benefits and reduced barriers to implementing CE. This long-term analysis is valuable in novel topics such as CE.

Age-related differences in management and outcomes in hospitalized healthy and well-functioning bacteremic pneumococcal pneumonia patients: a cohort study.

BACKGROUND: Limited data are available regarding fit and healthy patients with pneumonia at different ages. We evaluated the association of age with clinical presentation, serotype and outcomes among healthy and well-functioning patients hospitalized for bacteremic pneumococcal community-acquired pneumonia. METHODS: We performed a prospective cohort study of consecutive healthy and well-functioning patients hospitalized for this type of pneumonia. Patients were stratified into younger (18 to 64 years) and older (≥65 years) groups. RESULTS: During the study period, 399 consecutive patients were hospitalized with bacteremic pneumococcal pneumonia. We included 203 (50.8%) patients who were healthy and well-functioning patients, of whom 71 (35%) were classified as older. No differences were found in antibiotic treatment, treatment failure rate, antibiotic resistance, or serotype, except for serotype 7F that was less common in older patients. In the adjusted multivariate analysis, the older patients had higher 30-day mortality (OR 6.83; 95% CI 1.22-38.22; P = 0.028), but were less likely to be admitted to the ICU (OR 0.14; 95% CI 0.05-0.39; P < 0.001) and had shorter hospital stays (OR 0.71; 95% CI 0.54-0.94; P = 0.017). CONCLUSIONS: Healthy and well-functioning older patients have higher mortality than younger patients, but nevertheless, ICU admission was less likely and hospital stays were shorter. These results suggest that the aging process is a determinant of mortality, beyond the functional status of patients with bacteremic pneumococcal pneumonia.

Escherichia coli: an unknown and infrequent cause of community acquired pneumonia.

Our aim was to describe the incidence, clinical characteristics and outcome of community acquired pneumonia (CAP) caused by Escherichia coli through the analysis of a cohort of patients with this condition. This study includes all the patients who were admitted to our hospitals because of CAP caused by E. coli, diagnosed with highly reliable microbiological techniques, such as blood culture, bronchoscopic protected specimen brush (PSB) or transthoracic needle aspiration (TNA). 29 patients were enrolled, representing 0.4% of CAP cases admitted. Main symptoms were fever and dyspnoea. 18 patients were classified into class IV and class V of the Pneumonia Severity Index (PSI). Diagnosis was based on blood culture in 24 cases, PSB in 4 cases and by TNA in 1 case. Three of the patients died, the longer time evolution of the symptoms being the only factor related to higher mortality (p<0.05). Mean hospitalization time was 7.1+/-3.1 d, and correlated with severity at admission (r=0.43; p<0.003). This study demonstrates that CAP caused by E. coli is infrequent. It has an unspecific presentation and mortality rate is 10.3%, associated with longer time before admission to hospital.

Comparison of the distances covered during 3 and 6 min walking test.

AIMS: To determine the reproducibility of the distance covered in 3 min and its correlation with the 6 min walking test, as well as compare the distances covered at different time intervals. Secondly, to evaluate the relationship between the distances covered during these time periods and the maximum oxygen intake obtained during a bicycle ergometer test. METHODS: Forty-five Chronic Obstructive Pulmonary Disesase patients were included in the study. Subjects who were either physically limited or familiar with the test, or those with acute exacerbation in the month prior to the study, were excluded. Three walking tests were carried out each day. In 30 patients for three consecutive days, and the distances covered in periods of 3 and 6 min were measured with 20 min rest between each walk. No incentive was given and the patients knew that the distances covered in 3 and 6 min would be quantified. Oxygen saturation, heart rate and degree of breathlessness (modified Borg scale) were registered at baseline. After 3 min, the distance covered and degree of breathlessness were also measured. After 6 min, oxygen saturation, heart rate, degree of breathlessness and distance covered in meters were registered. Spirometry was performed daily on each patient, and those with an FEV1 variation of less than 10% were considered clinically and functionally stable. An exercise test using bicycle ergometer was carried out to determine maximum oxygen intake. A 3 min walking test was performed in 15 patients, independently on the same day, which was followed after 20 min rest with a 6 min walking test. RESULTS: A significant increase was observed in the distance covered over 3 and 6 min in the first 5 walks, with the greatest increase seen in the first 3 walks. The correlation between the distance covered in 3 and 6 min was 0.98. The correlation between the distance covered in 3 min and oxygen intake was 0.64. No significant differences were observed between the distances covered in the 0-3 and 3 to 6 min periods. During the walking test, breathlessness was measured using the modified Borg scale, which was 1.8 after 3 min, and 3.2 after six min and 8.6 at the end of bicycle ergometer test. No significant differences were observed between the distance covered during the 3 minute test and the distance in the first 3 min of the 6 min walking test. CONCLUSIONS: A learning effect was observed when the walking test is carried out repeatedly over short time periods, with a significant increase in the first 5 walks. Correlation between the distances covered in 3 and 6 min is very good, and acceptable when the distance covered over these periods is compared with oxygen intake and walking speed is constant.