Model selection and averaging in the assessment of the drivers of household food waste to reduce the probability of false positives.

Food waste from households contributes the greatest proportion to total food waste in developed countries. Therefore, food waste reduction requires an understanding of the socio-economic (contextual and behavioural) factors that lead to its generation within the household. Addressing such a complex subject calls for sound methodological approaches that until now have been conditioned by the large number of factors involved in waste generation, by the lack of a recognised definition, and by limited available data. This work contributes to food waste generation literature by using one of the largest available datasets that includes data on the objective amount of avoidable household food waste, along with information on a series of socio-economic factors. In order to address one aspect of the complexity of the problem, machine learning algorithms (random forests and boruta) for variable selection integrated with linear modelling, model selection and averaging are implemented. Model selection addresses model structural uncertainty, which is not routinely considered in assessments of food waste in literature. The main drivers of food waste in the home selected in the most parsimonious models include household size, the presence of fussy eaters, employment status, home ownership status, and the local authority. Results, regardless of which variable set the models are run on, point toward large households as being a key target element for food waste reduction interventions.

Urgent endovascular revascularization in acute on chronic critical limb ischemia.

BACKGROUND: The aim of this study was to evaluate early and one-year outcomes of urgent endovascular treatment in patients with acute on chronic critical limb ischemia (CLI). METHODS: Between January 2012 and December 2013 104 patients with acute on chronic CLI (Rutherford class 4-6) were referred to two tertiary hospitals. In all cases the urgent endovascular revascularization was considered the first therapeutic option. Twenty-seven patients (26%) were excluded from this approach (long occlusion >30 cm of the femoro-popliteal tract and/or massive gangrene with abscess/osteomyelitis/necrotizing fasciitis). RESULTS: Seventy-seven out of 104 patients received an urgent endovascular treatment. They were predominantly male (43, 55.8%) with a mean age of 76.5 years (range 47-94). In 67 cases (87%) the patients had leg/foot lesions (54, 70.1%, Rutherford class 5, and 13, 16.9%, Rutherford class 6). During the follow-up (mean duration 6.2 months, range 1-24 months) the healing of the lesions and the relief of rest pain were obtained in 46 cases (59.7%). Estimated one-year primary patency, primary assisted patency, secondary patency, and limb salvage rates were 63.6%, 68.3, 69%, and 84.1%, respectively. At uni- and multivariate analysis patients in Rutherford class 6 showed poor results in terms of primary patency, primary assisted patency, secondary patency, and limb salvage (P<0.001). CONCLUSIONS: Urgent endovascular treatment in selected patients with acute on chronic CLI represents a safe and effective option with good results in terms of healing of the ischemic lesions, relief of rest pain, and limb salvage. Patients in Rutherford class 6 showed fewer benefits with this approach.

Drug-eluting balloons to treat iliac in-stent restenosis.

BACKGROUND: To report our experience in the use of drug-eluting balloons (DEBs) for the treatment of symptomatic iliac in-stent restenosis (ISR). CASE REPORTS: Six patients underwent treatment using DEBs for iliac ISRs in our centers between September 2011 and May 2014. The patients were predominantly women (4 of 6, 66.7%) with a mean age of 67.2 years (range, 46-75 years). Technical success was achieved in all cases. During the follow-up (mean duration, 15.5 months; range, 3-30 months), healing of the lesions/relief of symptoms was obtained in 5 of 6 cases (83.3%). Estimated 2-year rates of overall patency and limb salvage were 100%. CONCLUSIONS: The use of DEBs in the treatment of iliac ISR is safe and effective. The early and 2-year outcomes are promising. However, further experience with larger patient groups is needed.

Hybrid simultaneous treatment of thrombosed prosthetic grafts for hemodialysis.

PURPOSE: The aim of the study was to evaluate our experience in the hybrid simultaneous treatment (open and endovascular) of acute thrombosis of prosthetic grafts for hemodialysis. METHODS: Between January 2011 and June 2013, 23 patients with acute thrombosis of a prosthetic graft for hemodialysis were urgently treated with a hybrid simultaneous treatment in order to obtain a prompt restoration of the flow. A new puncture of the graft was scheduled after 24 hours. RESULTS: Intraoperative technical success was 100% with a completion angiography showing the restored patency of the graft. As adjunctive procedures, in 6 patients (26.1%) locoregional thrombolysis was necessary and in all cases further endovascular manoeuvres (angioplasty/stenting) were immediately performed to solve a significant stenosis of the venous anastomosis/first tract of the vein. At 24 hours when the first puncture was done, three grafts were occluded resulting in a primary patency of 87%. During the follow-up (mean duration 5.6 months) four reocclusions occurred. In-stent restenosis occurred in all patients undergone stenting. At 1 year the rates of primary patency, primary assisted patency and secondary patency were 58.7%, 78.3% and 87%, respectively. CONCLUSIONS: In our series the combined simultaneous hybrid approach in urgency maximizes the use of different available techniques, which appeared to improve overall success rate to save a thrombosed graft for hemodialysis. The great difference showed between primary and primary assisted patency demonstrates the necessity of a close follow-up.

Bailout chimney technique for graft detachment in a mycotic infrarenal aneurysm.

Mycotic aortic aneurysm is a not-so-rare condition and its modalities of treatment are still debated. Graft detachment represents a catastrophic complication after open repair of an abdominal aortic aneurysm. The dehiscence of a graft may have several causes, such as infection, fatigue of materials, and progression of the disease. In recent years, the use of the chimney technique has increased the applicability of endovascular aortic repair for challenging neck anatomies in the abdominal aorta. We report a case involving the use of the bailout chimney technique for graft detachment in a previously treated mycotic infrarenal aortic aneurysm.

Hybrid three-stage repair of mega aorta syndrome with the Lupiae technique.

OBJECTIVE: Open surgical replacement of the whole aorta in mega aorta syndrome remains a surgical challenge. We report our experience in the treatment of patients with mega aorta syndrome using a 3-stage hybrid repair. METHODS: From January 2006 to December 2011, 12 patients with mega aorta syndrome underwent total replacement of the aorta with a 3-stage hybrid repair, consisting of total replacement of the arch (first stage), retrograde revascularization of the visceral vessels (second stage), and deployment of an endograft (third stage). The intraoperative, early (30-day), and follow-up results were analyzed. RESULTS: No intraoperative mortality occurred in any of the open or endovascular procedures. After the first stage, 1 patient died, resulting in a 30-day mortality of 8.3%. After the second stage, the overall major morbidity was 27.3% (1 surgical revision and 2 temporary dialysis treatments). After the third stage, no conversion or major complication was recorded. The overall mean follow-up period was 31.9 months (range, 1-60 months). One patient died at 10 months postoperatively, and another patient required adjunctive implantation of a stent graft for a type III endoleak. At 3 years, the estimated survival, freedom from any device-related reinterventions, and freedom from type I endoleak was 83.3%, 77.9%, and 100%, respectively. CONCLUSIONS: Our hybrid 3-stage approach seems to be effective in the treatment of mega aorta syndrome. The second stage was affected by non-negligible rates of perioperative complications. The overall mid-term results were encouraging, although a larger sample size with longer follow-up is needed to compare this technique with others.

Transradial percutaneous iliac intervention, a feasible alternative to the transfemoral route.

BACKGROUND: Percutaneous angioplasty for atherosclerotic iliac disease is commonly performed via the femoral and/or brachial route. In the coronary field a transradial approach has been shown to reduce both major and minor access site bleedings, in experienced hands. However, this route has not yet been well studied for the majority of peripheral interventions, like those involving the iliac arteries. METHODS: We investigated the feasibility and safety of a transradial approach in a consecutive series of patients undergoing percutaneous iliac intervention at our center, comparing it to a similar series of patients treated with a transfemoral approach in the same period. Endpoints of the study were procedural success, duration of procedure and event free survival at one month. RESULTS: From our database we enrolled 42 patients undergone iliac percutaneous interventions (21 with a transradial and 21 with a transfemoral approach); the 2 populations had similar baseline characteristics. Procedural success was achieved in all of our patient population. Among the secondary study endpoints analyzed we observed similar duration of the procedure and one-month clinical follow up. Technical aspects of the transradial approach are discussed. CONCLUSIONS: A transradial approach is feasible for the treatment of atherosclerotic iliac disease and does not increase procedural time in experienced hands. Further studies are needed to confirm if this approach is as safe as the transfemoral one.

A case of atherosclerotic inferior mesenteric artery aneurysm secondary to high flow state.

Inferior mesenteric artery aneurysms are very rare and they are among the rarest of visceral artery aneurysms. Sometimes, the distribution of the blood flow due to chronic atherosclerotic occlusion of some arteries can establish an increased flow into a particular supplying district (high flow state). A high flow state in a stenotic inferior mesenteric artery in compensation for a mesenteric occlusive disease can produce a rare form of aneurysm. We report the case of an atherosclerotic inferior mesenteric aneurysm secondary to high flow state (association with occlusion of the celiac trunk and severe stenosis of the superior mesenteric artery), treated by open surgical approach.