Siloed thinking: The case for integrating economic and environmental analysis in critical care.

In this study, the energy, economic, and environmental (3E) analysis on two waste-to-energy (WtE) technologies, for example, anaerobic digestion (AD) and incineration, for the treatment of municipal solid waste in Surat (Gujarat, India) was conducted. For energy criteria, the potential for energy recovery from municipal solid wastes (MSW) through AD and incineration was considered. The economic analysis that was carried out considered preprocessing, transportation, land, capital investment, and operational and maintenance costs that were incurred. The revenue that was generated by selling the electricity and compost was considered along with the recycling value of the paper waste. For environmental analysis, the global warming and acidification potentials (APs) were considered from the emissions that were produced during the treatment, transport, and disposal along with the displaced emissions. The results indicated that the average daily solid waste generation from Surat was 0.33 kg/person and the average total solid waste generation was 2080 t/day. Organic waste was the largest fraction (35.6%) followed by inert waste (13.5%), construction and demolition waste (12.4%), and recyclable waste, such as glass, rubber, and metal (11.2%). AD had less energy generation potential (9.89 MW) compared with incineration (16.99 MW). From an economic perspective, incineration had a higher profit (INR 1.48 million/day) than AD (INR 1.38 million/day). The environmental analysis showed that incineration had greater potential to reduce global warming and acidification compared with AD. The 3E analysis revealed that incineration was the superior technology choice.

Patients with severe, multiple, traumatic injuries are challenging to manage in critical care. Early identification of injuries and optimal resuscitation is essential for favourable outcomes. Trauma-related haemorrhage can lead to the lethal triad of hypothermia, coagulopathy and acidosis. Many trauma patients require urgent haemorrhage control and structural fixation through operative intervention. However, metabolic derangement and cardiovascular instability may delay surgery, resulting in an ongoing cycle of deterioration. Damage control surgery (DCS) may be used as a temporizing measure until the patient is stabilized in critical care. The aim of this case study is to discuss the complex issues faced in the critical care management of a severely injured patient. We conducted a patient case study, with analysis of care using published evidence. The key terms used to search for evidence were trauma, injury, damage control surgery, spinal fixation, critical/intensive care and nurse. We report the care of a trauma patient with complex, conflicting injuries requiring management of the lethal triad and DCS. The delay in subsequent definitive repair of spinal column fractures provided many challenges for critical care nurses including restricted patient mobilization, positioning and pressure ulcer prevention. A review of contemporary evidence relating to DCS reveals that whilst this technique is used increasingly in trauma, the research focuses on single system injuries. Evidence and guidelines are required to support DCS for critical care patients with multiple, conflicting injuries including spinal fractures. For patients with delayed surgical intervention, rotational bed therapy may assist critical care nurses in meeting needs.

Introduction: Content analysis, although firstly introduced in social sciences as a qualitative research method, has become a popular method for inquiry in healthcare sciences, including emergency and critical care nursing. Aim: The aim of content analysis is to interpret qualitative data through coding and analytical identification of themes or schemas. Results: There are different forms of content analysis, according to the aim of the study, (a) the conventional approach, (b) the direct approach, and (c) the summative approach. The depth of the analysis is defined by the degree to which the researcher reveals the covered meanings included in data. The range of the analysis is defined by the number of the identified themes and relevant categories of themes, and mainly of how abstract is the identified association among the different categories of themes. Balancing the strengths against the researcher-identified limitations and other weaknesses of the study, the researchers determine the value or trustworthiness of study findings, aiming to increase the transferability of the findings to other populations. Conclusion: Qualitative research is under-used as a research method in emergency and critical care despite the limitless variations of clinical research questions that can be investigated through this method of inquiry and relevant study designs, including content analysis.

Cost-effectiveness guidelines for reimbursement of pharmaceuticals: is economic evaluation ready for its enhanced status?

Energetic, economic and environmental (3E) analyses and LCOE estimation of three technologies of PV grid-connected systems under different climates

The water scarcity in the world in the near future become to a global challenge. The main aim of present study was to elucidate the performance of the three identical solar distillation units with different configurations under climatic conditions of the city of Tehran. All systems were equipped with different heating source that are thermoelectric heating modules (TEH), copper heater (CH), and solar water heater (SWH) while all system assisted with an active external condenser. Performance of all systems is scrutinized from different thermodynamic, thermoeconomic, environmental, and energy-matrices viewpoints. Findings revealed that the highest daily and annual productivity obtained by the system with CH. Economic analysis on the basis of uniform annual cost (UAC) revealed that the system with SWH has the lowest cost per liter (CPL) rather than other system while the highest CPL was for the case of TEH. Furthermore, it was concluded that the system with TEH obtain the most promising results in terms of exergoeconomic, enviroeconomic, and energy payback time (EPBT) because of the highest daily and annual energy and exergy output. Eventually, the environmental analysis indicated that the solar still with CH with 6342, 48.169, 18.46 kg emission of CO2, SO2. And NO have the best results rather than other systems

Comparative assessment and multi-objective optimization for the gray and blue ammonia synthesis processes: Energy, Economic and Environmental (3E) analysis

Life cycle assessment and techno-economic analysis for biofuel and biofertilizer recovery as by-products from microalgae

Development, experimental validation through infrared thermography and applications of a mathematical model of a direct-expansion solar-assisted heat pump with R290 based on energy, exergy, economic and environmental (4E) analyses

Approach to economic analysis in critical care

Alternative management for olive orchards grown in semi-arid environments: An energy, economic and environmental analysis

Screening of CO2 utilization routes from process simulation: Design, optimization, environmental and techno-economic analysis

The purpose of this paper is to provide a concept analysis of critical access health care. A common understanding of critical access health care would benefit those who legislate, provide, and consume health care. A review of the literature was conducted using an identical set of search terms that yielded a variety of sources; however, none were specifically related to critical access health care. No literature of concept analysis of critical access health care could be found. A concrete and measurable understanding of the concept will provide a common foundation to assist public and private entities in developing viable methods to understand healthcare policies, problems related to access, disparities in health care, and ways to increase health promotion and disease prevention.

Rationing occurs whenever the demand for a good or service exceeds its supply. Therefore rationing is an inevitable occurrence in medicine and in critical care where the potential demand for effective medical care will exceed supply. Although there are many strategies to allocate medical resources one that is often considered is based on cost-effectiveness. Cost-effectiveness analysis attempts to estimate the value of individual medical treatments in terms of dollars and outcomes. Allocation of medical treatments based on cost-effectiveness analysis requires valid estimates of both the costs and the effectiveness of treatments as well as some overarching body with the authority to enforce allocation based on these analyses. Limitations of allocation based on cost-effectiveness analysis in critical care include difficulties in estimating marginal costs of critical care treatments, limited evidence for any treatments with efficacy, and the ethical principle of rescuing identifiable lives in imminent risk of death. The prospect of a pandemic influenza-like infection has stimulated a lot of interest in hypothetical rationing strategies for the intensive care unit, none of which has been tested in actual pandemic scenarios. Given the burden of critical illness and the wide variation in resources a global approach to rationing is untenable. The article concludes with a vision of the future of allocation in critical care.

BackgroundThis study aimed to identify the current risk factors for coronavirus disease 2019 severity and examine its association with medication use.MethodsWe used data from a large United States electronic health record database to conduct an anonymized cohort study of 171,491 patients with coronavirus disease 2019. The study was conducted from January 1, 2020, to August 27, 2021. Data on age, race, sex, history of diseases, and history of medication prescriptions were analyzed using the Cox proportional hazards model analysis to calculate hazard ratios for hospitalization and severe risk.ResultsFactors that increased the risk of hospitalization and critical care were age ≥ 65 years, male sex, type 2 diabetes, hypertension, interstitial pneumonia, and cardiovascular disease. In particular, age ≥ 65 years significantly increased the risk of hospitalization (hazard ratio, 2.81 [95% confidence interval, 2.58–3.07]; P < 0.001) and critical care (hazard ratio, 3.45 [2.88–4.14]; P < 0.001). In contrast, patients with hyperlipidemia had a reduced risk. However, patients with hyperlipidemia who were not taking statins had a significantly increased risk of hospitalization (hazard ratio, 1.24 [1.16–1.34]; P < 0.001). Sodium-glucose cotransporter-2 inhibitors, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, glucocorticoids, and statins significantly reduced the risk of hospitalization and critical care. The risk of hospitalization and critical care increased in patients of all ethnicities with type 2 diabetes. The factors that significantly increased the risk of hospitalization in all regions were older age, hypertension, chronic obstructive pulmonary disease, and cardiovascular disease.ConclusionThis study identified factors that increase or reduce the risk of severe coronavirus disease. The provision of appropriate drug treatment and modification of lifestyle-related risk factors may reduce coronavirus disease severity.