Alternative Management Research Articles

Evaluation of Fumigant Toxicity of Eucalyptus globulus Essential oil (Family: Myrtaceae) against the Mechanical Vector, American Cockroach, Periplaneta Americana (Linnaeus, 1758) (Blattodea: Blattidae)

The American cockroach, Periplaneta americana (Linnaeus, 1758), one of the largest and most resilient cockroach species, possess significant threats to public health and food safety due to its ability to transmit diseases and contaminate food. The widespread application of chemical pesticides to control cockroach infestations raises significant public health concerns due to its residual toxicity. The continued use of insecticides results in resistance development in cockroach populations which demands alternative pest management strategies wherein the chemical insecticides were completely restricted in human dwelling areas such as apartments, hospitals, restaurants and food preparation areas. The plant’s diverse profile of bioactive compounds and secondary metabolites, coupled with its complex nature, renders it a promising natural resource for the development of safe alternative against cockroach management. The median lethal dosage LD50 of E. globulus essential oil was found to be 16.74784 µL against the male American Cockroach, P. americana analysed using probit analysis. The present study was conducted to evaluate the fumigant toxicity of eucalyptus essential oil (Eucalyptus globulus) against the male American Cockroach, Periplaneta americana in a laboratory experiment. Five different doses of E. globulus essential oil 5, 10, 20, 30, 40 and 50 µL against male American Cockroach, P. americana were evaluated and compared to the untreated control (negative control). Results, indicated a dose dependent response with 100 per cent mortality achieved at 50 µL of eucalyptus essential oil followed by 40 (80%), 30 (60%), 20 (46.67%) and 5 (26.67) µL. The Eucalyptus globulus essential oil can be used as a potent fumigant against the male American Cockroach, P. americana which is an ecofriendly management of cockroach infestation.

Rice residue management alternatives and nitrogen optimization: impact on wheat productivity, microbial dynamics, and enzymatic activities

In response to the degraded soil health and lack of improvement in the yield of rice–wheat cropping systems in South Asia’s Indo-Gangetic Plains, an experiment was formulated in a split-plot design. Four rice residue management practices were the primary factor, alongside two nitrogen levels (150 and 180 kg/ha) and two nitrogen split levels (two and three splits) as sub-treatments. The findings revealed a notable increase in soil organic carbon (SOC), microbial count, and enzymatic activity in plots subjected to conservation tillage and residue treatment compared to those in plots subjected to partial residue (anchored stubbles) and conventional methods (residue incorporated with chopping). The collective analysis demonstrated a significant influence of rice residue management practices and nitrogen application levels on wheat yield attributes and productivity. Specifically, zero tillage with full residue (unchopped) in wheat exhibited a 5.23% increase in grain yield compared to conventional tillage with full residue (chopped), concurrently boosting the soil microbial count by 19.80–25%, the diazotrophic count by 29.43–31.6%, and the actinomycete count by 20.15–32.99% compared with conventional tillage. Moreover, applying nitrogen in three splits (at sowing, before the 1st irrigation, and after the 1st irrigation) led to a 6.25% increase in grain yield than that in two splits (at sowing and after the 1st irrigation), significantly impacting wheat productivity in the soil. Furthermore, the zero tillage-happy seeder with full residue elevated dehydrogenase activity from 77.94 to 88.32 μg TPF/g soil/24 h during the study year, surpassing that in the conventional plot. This increase in enzymatic activity was paralleled by a robust positive correlation between the microbial population and enzymatic activity across various residue retention practices. In conclusion, the results underscore the efficacy of crop residue retention following conservation tillage, in tandem with nitrogen optimization and scheduling, in enhancing wheat yield within the rice–wheat cropping system.

The LTAR Cropland Common Experiment at Lower Chesapeake Bay.

The Lower Chesapeake Bay (LCB) Long-Term Agroecosystem Research (LTAR) Common Experiment (CE) located in Beltsville, MD, focuses on research of concern to producers of the major regional crops, which are corn (Zea mays L.), soybean [Glycine max (L.) Merr.], wheat (Triticum aestivum L.), and various forage species. Livestock production in the region includes broiler and laying chickens (Gallus gallus domesticus L.) and dairy and beef cattle (Bos taurus L.). The LCB region is among the most heavily populated in the United States. Urban development pressure is high for both farms and natural areas. The need to restore Chesapeake Bay water quality is a major influence on regional agricultural practices. Conservation practices such as cover cropping, no-till agriculture, and nutrient management planning are more common in the region compared to nationally. However, farmers still face management challenges implementing practices that address water quality and the rise of herbicide-resistant weeds. Researchers at the LCB site recognize the need to protect the Chesapeake and Delaware Bays and maintain farmer profitability. The LCB CE compares a 3-year crop rotation system featuring alternative crop management (cover crop intensification, crop rotation diversification, and integrated weed management [IWM]) with a prevailing 2-year system (no cover crops and no IWM), both under continuous no-tillage, to identify the optimal balance to promote the sustainability of regional cropping systems. The LTAR LCB site provides data-driven tools and solutions to support farmers in the mid-Atlantic region.

Evaluation of Splint and Exercise Interventions for Carpal Tunnel Syndrome: Insights from Ultrasonographic Measurements.

BACKGROUND Carpal tunnel syndrome (CTS) is a neuropathy caused by the entrapment of the median nerve, which requires effective management strategies. The median nerve is subjected to pressure within the carpal tunnel, resulting in tingling, numbness, and pain in the median side of the hand. We compared the efficacy of splint use with an exercise program vs exercise alone in patients with mild and moderate CTS. MATERIAL AND METHODS Forty-four patients with CTS were enrolled. The patients were randomly divided into 2 groups: splint+exercise and exercise only. A range of assessment tools were used, including ultrasonography, dynamometer, the Leeds Assessment of Neuropathic Symptoms & Signs Pain Score (LANSS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and 36-Item Short Form Quality of Life Scale (SF-36) score, to provide comprehensive evaluation. RESULTS The 2 groups had comparable outcomes at the end of treatment. There were no statistically significant differences in Q-DASH (P=0.326, Cohen's d=0.067), SF-36 (P=0.329, Cohen's d=0.218), VAS (P=0.521, Cohen's d=-0.299), or LANSS scores (P=0.627, Cohen's d=0.039) between the groups (P>0.05). The results demonstrate that a targeted exercise regimen, when used in isolation, can elicit outcomes that are comparable to those achieved through the integration of splinting techniques. CONCLUSIONS The study findings align with conflicting existing data on the effectiveness of splint immobilization in conjunction with exercises for CTS. The results support the significance of regular exercises, which can be applied in the home-based setting in CTS management, and offer alternative online management strategies.

Biological performance of Bollgard II® Bt-resistant vs susceptible population of pink bollworm, Pectinophora gossypiella (Saunders) on non-toxic diet

BackgroundThe pink bollworm, Pectinophora gossypiella (Saunders), is a devastating global pest of cotton that has caused substantial economic damage to Bt Bollgard-II® cotton plants in recent years due to the evolution of Bt resistance. The associated fitness cost is assumed to be one of the factors delaying the development of resistance against Bt transgenic crops. Hence, the present study was undertaken to assess the biological performance of pink bollworms by comparing the life history and demographic parameters of a resistant (Field-R) and susceptible (Lab-S) population.ResultsProlonged larval duration (23.40 days in Field-R vs 18.80 days in Lab-S population), total life cycle (male = 50.00 vs 42.80 days; female = 53.60 vs 46.20 days), reduced fecundity (100.60 vs 154.20 eggs/female) and fertility (88.00 vs 138.00 fertile eggs/female) was observed. The demographic parameters indicated a significant reduction in the net reproductive rate (184.27 vs 276.72), innate capacity for increase in number (0.11 vs 0.15), finite rate of increase in number (1.12 vs 1.16 female progenies produced/female/day), weekly multiplication rate (2.16 vs 2.86), potential fecundity (545.06 vs 634.11 eggs), number of hypothetical F2 females (33 955.65 vs 76 572.41), but longer mean length of generation (47.54 vs 37.74 days) and population doubling time (6.30 vs 4.62 days) in Field-R compared with Lab-S population. A stage-specific life table demonstrated the differences in survival rates between susceptible and resistant populations at various life stages, with the resistant population having higher generation mortality (0.22 vs 0.19).ConclusionsThe study confirms the involvement of fitness costs associated with Bt resistance in P. gossypiella. Despite reduced reproductive fitness, the resistant population tried prolonging the larval stage as a compensatory mechanism to repair the damaged host tissues due to Bt intoxication and for accumulation of enough nutrient reserves for normal pupation and adult emergence. Presence of a high proportion of double Bt-resistant larvae in the field coupled with continued noncompliance with refug planting certainly favours the flaring up of this monophagous pest despite the observed fitness costs. The resistance cannot be effectively reversed unless suitable alternative management strategies are deployed.

Heartfelt Impact: A Descriptive Analysis of Ceftaroline-Containing Regimens in Endocarditis due to Methicillin-Resistant Staphylococcus aureus.

Infective endocarditis (IE) due to methicillin-resistant Staphylococcus aureus (MRSA) is characterized by frequent treatment failure to first-line agents and high mortality, necessitating use of alternative management strategies. Ceftaroline fosamil (CPT) is a cephalosporin antibiotic with activity against MRSA but without regulatory approval for the indication of IE. This study describes clinical experience with CPT-based regimens utilized in MRSA-IE. This is a retrospective, observational, descriptive analysis of patients from two major urban medical centers in Detroit, Michigan from 2011 to 2023. Included adult patients (≥ 18years) had ≥ 1 positive blood culture for MRSA, met definitive clinical criteria for IE, and received CPT for ≥ 72h. The primary outcome was treatment failure, defined as a composite of 30-day all-cause mortality from index culture or failure to improve or resolve infectious signs/symptoms after CPT initiation. Seventy patients were included. The median (interquartile range [IQR]) age was 51 (34-63) years and 45.7% were male. Persons with injection drug use (PWID) made up 55.7% of the cohort and right-sided IE was the most prevalent subtype (50.0%). CPT was frequently employed second-line or later, often in combination with vancomycin (10.0%) or daptomycin (72.9%). Overall, 31.4% experienced treatment failure and 30-day all-cause mortality occurred in 15.7%. These findings illustrate the challenges posed by MRSA-IE, including frequent treatment failures, and highlight the utilization of CPT as salvage therapy. Comparative studies are needed to more clearly define its role in MRSA-IE.

Advanced label-free electrochemical immunosensor for a minimally invasive detection of proteins in paintings

In recent decades, scientific methodologies applied in theCultural Heritage field have been growing, due to their pivotal role in guiding informed decisions concerning conservation strategies and daily maintenance. To achieve this goal, minimally/non-invasive quantitative and qualitative analyses are needed. However, the non-invasive and selective identification of proteinaceous binders and coatings in artworks represent an open issue in Cultural Heritage science.Herein, a novel miniaturized system is introduced, which consists of a label-free electrochemical immunosensor integrated with biocompatible Gellan gel. This method is intended to selectively and minimally invasively identify ovalbumin (OVA) on-site in paintings. The label-free immunosensor is made up on screen-printed electrodes (SPEs) by functionalizing the working electrode (WE) with a primary antibody (anti-ovalbumin) for the specific recognition of OVA. The presence of OVA produces antigen-antibody reaction, which results in the development of a bulky immunocomplex on the WE. This complex is quantified using square wave voltammetry (SWV) and a reversible redox probe: the current measured is inversely proportional to the OVA concentrations. The developed immunosensors showed good analytical performances when applied directly to painted mock-ups, exhibiting a limit of detection (LOD) of 1.6 ng/mL, a limit of quantification (LOQ) equal to 16 ng mL-1, a working range between 0.01-0.4 μg/mL and selectivity for OVA over other protein components commonly present in painted artworks, including bovine serum albumin (BSA), collagen, and casein.The outcomes highlighted the dependability of the immunosensor in detecting OVA and the efficacy of Gellan gel as a streamlined method for extracting the target protein while preventing residue accumulation on the painting surface. This advancement suggests the potential of Gellan gel-coupled immunosensor systems as viable diagnostic alternatives for artwork management and preservation.

Cervical Laminoplasty is Associated With Lower Health Care Costs as Compared With Cervical Fusion Procedures: A Systematic Review and Meta-analysis of Comparative Studies.

Systematic review and meta-analysis. The purpose of this study is to examine the cost of CLP versus CF stratified by approach to guide decision-making. Cervical laminoplasty (CLP) and cervical fusion (CF) are viable alternatives for surgical management of cervical spine myelopathy, with no clear consensus on clinical superiority. However, despite clinical equivalence in patient outcomes, there is limited data on the relative costs between CLP and CF. This study searched PubMed, CINAHL, MEDLINE, and Web of Science databases. Inclusion criteria were articles that examined the cost between CLP and any type of CF (stratified by anterior, posterior, or combined approach). A random-effects continuous model for meta-analysis was performed using standardized mean difference (SMD). Eleven articles were included. Patients (n = 21,033) had an average age of 56.0 ± 3.6 years and underwent either CLP (n = 4364), posterior CF (n = 3529), anterior CF (n = 13,084), or combined CF (n = 56). The mean reported cost among patients who underwent CLP (n=3742) was significantly lower compared with patients who underwent CF (n = 6329), irrespective of the approach for CF (P = 0.028; SMD = -2.965). For subgroup analysis by surgical approach, the mean reported cost among patients treated with CLP was significantly lower as compared with patients treated with posterior CF (P = 0.013; SMD = -1.861) and anterior CF (P < 0.001; SMD = -0.344). Patients who underwent CLP had a significantly lower mean hardware cost than patients who underwent posterior CF (P < 0.001; SMD = -3.275). CLP appears to be associated with statistically significant and clinically relevant lower reported costs than CF, irrespective of the approach based on meta-analysis of low or moderate-quality retrospective studies. CLP may also have lower reported costs than both posterior CF and anterior CF. IV.

Use of an endotracheal tube for a thoracostomy in a child in cardiac arrest: A case report

Background: Traditionally when patients arrive at an Emergency Department in cardiac arrest with a concern for a pneumothorax, a thoracostomy tube is placed for decompression. In a literature review, there are no case reports of an endotracheal tube being used in lieu of a thoracostomy tube for a pneumothorax in a child in cardiac arrest.Case Presentation: We present a case of a 4-week-old female infant who presented to the Emergency Department in cardiac arrest with a pneumothorax.Why should an emergency physician be aware of this?: It is important for clinicians to be aware of alternative management strategies for the management of a pneumothorax. Our case suggests that an endotracheal tube being used as a thoracostomy tube in a child in cardiac arrest can help acutely treat a pneumothorax by providing immediate and continuous decompression. In a prehospital or low-resource setting, an endotracheal tube may offer similar benefits to a thoracostomy tube as an immediate treatment modality.

A Systematic Review on the Potential Applications of Theranostic Nanoparticles in Diabetes and its Associated Complication Diabetic Neuropathy

Background: Diabetes neuropathy is a frequent ailment that has a substantial impact on patients by increasing the risk of falls and causing discomfort. The lower extremities are where diabetic neuropathy patients first feel pain. This discomfort could seem like a pinprick, an electric shock, or something else. Objective: Here, we give a comprehensive overview of this quickly developing theranostic appli-cation that includes all relevant imaging, diagnostic, therapeutic, and monitoring elements for the management of diabetes and diabetes neuropathy. Methods: The data for the current study was gathered by searching PubMed and Google Scholar. Several research and review publications from various publishers, including Springer Nature, Bentham Science, PLOS one, MDPI, and ACS Publishing Centre, were evaluated to compile the data. Result: Recent developments in theranostics have shown promise as alternate management ap-proaches for diabetes and ailments linked to diabetes. Numerous nanotechnology-built biosen-sors, including multiwalled carbon nanotubes, copper nanowires, zinc oxide tetrapods, and nano-particle-embedded contact lenses, offer benefits in monitoring diabetic neuropathy. Conclusion: The potency, usability, and dependability of insulin substitutes have been demon-strated by a variety of innovative methods for the management of diabetes, which includes nano-technology approaches using Gene-Based Nanoparticles (siRNA), Liposomes, Exo-somes/Extracellular Vesicles, Neuromodulation, and Inhalable Nanoparticles. Over the past few years, the development of various theranostic nanoparticles for Diabetic neuropathy has experi-enced an unprecedented expansion. Even though much work needs to be done to precisely evalu-ate the genuine benefits provided by these particles, such as issues with nanotoxicity, theranostic nanoparticles will have a significant impact on the field of nanomedicine.

Alternative therapy for lymphoma with febrile neutropenia using traditional Chinese medicine: A case report

IntroductionFebrile neutropenia is a common complication in patients undergoing chemotherapy for hematologic malignancies and is associated with significant morbidity and mortality. Primary granulocyte colony-stimulating factor (G-CSF) prophylaxis is consistently associated with a notable reduction in the risk of febrile neutropenia. However, the use of G-CSF in patients who are already neutropenic from chemotherapy remains controversial. Studies have shown that 12.9% of cancer patients incorporate traditional Chinese medicine (TCM) to alleviate chemotherapy side effects in Taiwan; thereby providing an alternative management strategy for neutropenic fever in cancer patients. Case presentationThis is an 18-year-old female with newly diagnosed precursor T-lymphoblastic lymphoma. After chemotherapy, the patient developed febrile neutropenia. Despite the use of antibiotics and G-CSF, the febrile neutropenia persisted for two months. Approximately ten days after the initiation of traditional Chinese medicine decoction with the strategy of tonifying the spleen and stomach, clearing yin fire, and uplifting yang, her absolute neutrophil count (ANC) had gradually increased. Additionally, after two weeks of treatment, her fever subsided. The patient continued with chemotherapy and was discharged in stable condition. DiscussionAntibiotic use aligns with the TCM perspective of an “attack” approach. Conversely, our TCM decoction was designed to raise the ANC by tonifying the spleen and stomach, clearing Yin Fire, and uplifting Yang. Li Dongyuan, one of the four great masters of the Jin Yuan Dynasty, created the formula: Bupiwei Shengyang Sanhuo Decoction that is notable in this regard. The herbs in our decoction have shown hematopoietic and myelosuppression-alleviating effect. For many patients who do not respond adequately to G-CSF alone, integrative treatments involving both TCM and Western medicine can offer additional therapeutic benefits by increasing blood cell counts.

Baseline survey reveals glyphosate and dicamba resistance in broadleaf weeds before sugar beet trait introduction

Abstract A pre-launch survey of broadleaf weeds was conducted to predict the weed management efficacy of a novel genetically engineered sugar beet with resistance traits for glyphosate, dicamba, and glufosinate. We targeted problematic broadleaf weed species prevalent in the sugar beet system, including kochia, common lambsquarters, Palmer amaranth, and redroot pigweed across sugar beet areas in Colorado, Nebraska, and Wyoming. The results revealed that a significant percentage of kochia populations in Colorado, Nebraska, and Wyoming exhibited resistance to glyphosate (94%, 98%, and 75%, respectively) and dicamba (30%, 42%, and 17%, respectively). Palmer amaranth populations had resistance frequencies for glyphosate and dicamba of 80% and 20% in Colorado and 20% and 3% in Nebraska, respectively. No resistance to the tested herbicides was identified in common lambsquarters or redroot pigweed. Glufosinate resistance was not identified for any species. Kochia and Palmer amaranth populations from Colorado and Nebraska exhibited glyphosate resistance primarily through 5-enolpyruvylshikimate 3-phosphate synthase (EPSPS) gene amplification. However, one glyphosate-resistant kochia population from Wyoming lacked EPSPS gene amplification, indicating the presence of an alternative resistance mechanism. We identified the previously characterized IAA16 G73N substitution in a dicamba-resistant kochia population from Nebraska. However, dicamba-resistant kochia populations from Colorado did not possess this substitution, suggesting an alternative, yet-to-be-determined resistance mechanism. The widespread prevalence of glyphosate and dicamba resistance, coupled with the emergence of novel resistance mechanisms, poses a significant challenge to the long-term efficacy of this novel genetically engineered sugar beet technology. These findings underscore the urgent need for integrated weed management (IWM) strategies that diversify effective herbicide sites-of-action and incorporate alternative weed management practices within cropping systems.

EFFECT OF SIDA CORDIFOLIA LINN. LEAF AND ROOT ETHYL ACETATE EXTRACTS ON THE GROWTH AND PHYSIOLOGICAL RESPONSE OF PANICUM REPENS AND PANICUM MAXIMUM

Due to the incessant application of synthetic herbicides in the agricultural system coupled with a rapid increase in herbicide-resistant weed species across the globe, much attention has been focused on alternative weed management, including allelopathy, which is eco-friendly and reduces reliance on synthetic herbicides. The effect of Sida cordifolia root and leaf ethyl acetate extract was evaluated under field conditions to determine its effects on growth, physiological response, stomatal index and density, and biochemical activity on weed species (Panicum maximum, Panicum repens, and Andropogon gayanus), as well as its effects on soil micronutrients. S. cordifolia root and leaf were collected from the wild in Nigeria and prepared into powder, which was dissolved to obtain the following concentrations 10, 20, 40, 60, and 80%, and distilled water served as the control. The percentage inhibition seems to be correlated with different growth indices as proven by an increase in malondialdehyde (MDA) content, reactive oxygen species (ROS), glutathione transferase (GST), and peroxidase (POD). Physiological growth indices such as plant height, leaf area, number of leaves, dry weight, stomatal density, and stomatal index were inhibited in both weed species while biochemical parameters such as Chlorophyll a, b, total chlorophyll and chlorophyll stability index were slightly reduced, increase in MDA, GST, ROS and POD were also noticed. In general, Andropogon gayanus showed a high inhibition rate compared to tomato. It is therefore recommended that concentrations of the Sida cordifolia extracts be increased to have a robust effect on the physiological processes of the weed species.

Prescription time trends in patients with high-impact chronic pain: A National Patient Registry Study.

High-impact chronic pain (HICP), defined as chronic pain with a significant impact on daily function, affects approximately 8% of the Western population. In Denmark, HICP still remains to be described at the population level. Some patients with HICP are referred to the Danish pain centres, where they are registered with a procedural code. We conducted a nationwide registry-based study of all Danish patients registered with a visit to a pain centre from January 2005 to March 2022, to explore time trends in the prescription of analgesics and sedatives in this HICP subpopulation. Furthermore, data on socioeconomics and hospital diagnoses are reported. We used data from the Central Person Registry, the Danish National Patient Registry, the Danish National Prescription Registry, combined with data on socioeconomic information from Statistics Denmark. Data was collected on prescriptions 3 months before the first visit to a pain centre. Prescriptions were stratified into five calendar periods: before 2011, 2011-2013, 2014-2016, 2017-2019, and 2020-2022. We identified 66,577 patients referred to a pain centre. Over 15 years, prescriptions before referral declined for opioids (from 53.2% to 31.7%), NSAIDs (from 28.3% to 23.5%), antidepressants (from 20.5% to 16.8%), anxiolytics (from 12.3% to 3.2%), and sleep medication (from 15.8% to 7.6%). In contrast, prescriptions increased for paracetamol (from 31.1% to 48.9%) and gabapentinoids (from 19.2% to 27.7%). In patients with HICP visiting Danish pain centres, prescriptions before referral decreased for opioids over 15 years, with a simultaneously increased prescription of gabapentinoids (gabapentin and pregabalin). This nationwide study of 66,577 Danish patients with high-impact chronic pain reveals a significant decrease in filled opioid prescriptions over the past 15 years, with a simultaneous rise in gabapentinoid use before referral to pain centres. These findings suggest a shift in clinical practice towards alternative pain management strategies. The study underscores the need for continued research into the long-term effects of these changes and their impact on patient outcomes.

Sustainability in the Next Generation Hospital. Needs and Requirements collection from healthcare infrastructures supply chain stakeholders with One Health approach

Abstract Technological, demographic, epidemiological, environmental and social changes require investment in new sustainable hospital infrastructure; there is a lack of guidelines and interaction between Stakeholders. In February 2022, the Joint Research Platform Healthcare Infrastructures (JRP HI) was established consisting of Hospital Strategic Directions and Industrial Partners in Italy. Starting from the WHO Techincal Brief “Hospitals of the Future”, a national survey was carried out via web-survey and semi-structured interviews with a sample of 30 stakeholders to collect the main drivers and constraints for innovation and the framework from a One Health perspective and in terms of sustainability. The main needs to be addressed through the guidelines refer to digitalization (27%), flexibility (32%), environmental sustainability (36%) and economic sustainability (27%) as well as flow management (18%) and hospital infection (14%). The participants consider SDG-3 ‘Good Health and Wellbeing’ to be the most relevant for development activities. Hospital managers prioritize SDG-8 ‘Decent Work and Economic Growth’ (23%); vice-versa the industrial partners suggest SDG-11 ‘Sustainable Cities and Communities’ and SDG- 13 ‘Climate Actions’ (32%) as topics to be addressed. Furthermore, 57% of the respondents state that they lack adequate training, budget or leadership to apply innovative strategies in the day-to-day management of the healthcare organization. The survey highlighted a lack of initiatives, budget, and standardization for enhancing environmental sustainability in healthcare infrastructures. The sustainability of building systems depends on factors such as energy consumption, alternative energy sources, thermal comfort, water usage, waste management, ventilation, lighting efficiency, air quality, and construction materials. Ensuring the adoption of monitoring systems and harmonized standards of performance measurement is crucial for increasing the environmental sustainability.

Anticoagulation control challenges in patients with rheumatic heart disease and mechanical heart valves operated at a cardiac surgery center in a low-income country

Abstract Background Rheumatic heart disease (RHD) prevalence is very high in many low-income countries and valve replacement surgery can sometimes be the only available therapeutic strategy for the affected patients. Mechanical valves require lifelong anticoagulation and this can be very challenging in many poor countries where several barriers to effective anticoagulation monitoring and management are faced. Methods This is a retrospective study on 145 patients with RHD who underwent valve replacement surgery at a cardiac surgery center (CSC) in a low-income country between 2001 and 2022. The study aimed to evaluate the effectiveness of anticoagulation treatment to prevent thromboembolic events in patients with RHD with mechanical valves. The patients’ information such as social and demographic data, clinical features, surgical data and international normalized ratio (INR) records were collected and analyzed. Descriptive statistics were applied to the data and expressed as mean with standard deviation or simple frequencies and percentages. Results The mean age of the operated patients was 25.9 years (± 12.6) and 60% of them were female. Most of the patients (54%) were able to monitor their anticoagulation at the center and 8.2% of them monitored it in other hospitals. Three percent (3%) of the patients use a portable device to monitor their INR. These devices are provided by the CSC to help patients that live in distant provinces and are unable to go to the capital regularly. The device is held by one patient that is a focal point and helps monitor the INR of the other patients living in the same province. The INR results are communicated to the CSC by telephone text message. Seven percent (7%) of the operated patients haven’t monitored their INR for more than one year and 24.8% of them were lost to follow-up. Sixty-four percent (64%) of the patients who monitor their INR at the center have an optimal control of their anticoagulation therapy. Most of the patients that were lost to follow-up (N=20) and most of the patients that haven’t checked their INR for more than one year (N=7) are patients who had aortic valve replacements. At least 20% of the patients that live in capital of the country and close to the CSC don’t monitor their anticoagulation regularly. Conclusion The surgical outcomes in RHD patients who undergo mitral valve repair are usually satisfactory. However, valve replacement is often the only feasible alternative and anticoagulation monitoring and management in these patients can become a serious problem especially to those coming from areas with limited resources. Illiteracy and poverty play a major role as barriers to effective monitoring of anticoagulation therapy. Efforts must be made to increase access to facilities where INR can be monitored. Our experience showed us that providing portable devices for INR monitoring to the patients living in remote areas can be a favorable short-term solution.

NICE guidance in the rapid access chest pain clinic: does it work?

Abstract Background Rapid Access Chest Pain Clinics (RACPC) were developed following the publication of the National Service Framework for Coronary Heart Disease in 2000(1). The National Institute for Health and Care Excellence (NICE) produces guidelines for the management of patients with recent onset chest pain of suspected cardiac origin(2). In 2016 the guidance was updated and recommended the use of CT coronary angiography (CTCA) as the initial investigation for patients with chest pain which was typical or atypical of angina. Adherence to the guideline may be dependent upon factors such as local availability of CT scanners and clinician preference. The RACPC in this tertiary centre is nurse-run with no medical involvement. There is good engagement with the CT department and in July 2017 the NICE guidance was adopted in the clinic. Purpose To evaluate the use of CTCA as the first line investigation for patients with typical or atypical chest pain. Methods Data from all patients reviewed in the clinic between 01/07/2017 and 31/12/2023 were prospectively collected, entered into a database, and then retrospectively analysed. The data were organised into 3 groups: patients with typical chest pain; atypical pain and those with non-cardiac sounding chest pain. The number of patients in each group who underwent a CTCA, and the outcome of the scan were evaluated. The CT scans were categorised as showing significant coronary artery disease (CAD), non-obstructive CAD, no CAD, or as inconclusive. The outcome of patients who had a positive CTCA was also recorded. Results 2986 patients were reviewed in the RACPC in the above period. 14.2% of patients presented with typical pain, 47.4% with atypical pain, and 30.6% had non-cardiac pain. The remaining patients presented with other symptoms such as breathlessness. CTCA was used as the first investigation in the majority of patients with typical or atypical pain, unless alternative investigations or management were deemed to be more clinically appropriate. In 59.5% of typical and 78.5% of atypical presentations, the CT scan showed no CAD, or non-significant CAD. There was a low incidence of positive scans in both groups, however patients with typical pain were more likely to have significant CAD (Table). All patients who had a CTCA indicating significant CAD, were referred for invasive angiography. 88.0% of typical presentations, and 64.0% of those with atypical pain, underwent revascularisation. No patient who underwent invasive angiography was found to have normal coronary arteries. Conclusion Atypical pain is the most frequent presentation in the RACPC, however the majority of these patients, and most of those with typical pain, do not have significant CAD. Careful assessment and the use of CTCA as the initial investigation, enable the identification of those patients who need invasive angiography. This is a cost-effective strategy which also reduces risk and radiation exposure for patients.

Cardioneuroablation for the treatment of carotid sinus syndrome

Abstract Introduction Carotid sinus syndrome (CSS), characterized by exaggerated vagal responses leading to asystolic pauses with carotid sinus massage (CSM), often necessitates pacemaker implantation. This study investigates cardioneuroablation (CNA) as an alternative management strategy for CSS. Methods Prospective study of consecutive patients referred for CNA. All patients underwent CSM, atropine test, 24-hour Holter monitoring and SF-36 quality of life questionary before the procedure and at 6 months. The objective of the study was to assess syncope free survival, grade of cardioinhibition with CSM and heart rate variation (HRV) and quality of life after the procedure. Results A total of 13 patients (84.6% male, mean age 63.8 ± 12.3 years) were included. After a median follow-up of 11.2 (10.6-16.3) months, none of the patients experienced syncope (0%) and none of the patients required pacemaker implantation. After the procedure all the patients had a negative CSM and only one patient (7.7%) had a positive CSM at 6 months (Figure 1). There was an improvement in the energy and health change items in the SF-36 quality of life questionary (Figure 2). There was a reduction in HR increase in the atropine test at 6 months (pre-CNA: 66% (52-84) vs. post-CNA 27.4% (21.9-90.9); p=0.027) and in most of the 24-hour Holter monitoring HRV parameters. Conclusions Cardioneuroablation emerges as a promising and effective alternative to pacemaker implantation in managing cardioinhibitory CSS. Further research is warranted to solidify these findings and explore the long-term effects of CNA in this scenario.Figure 1Figure 2

The LTAR Croplands Common Experiment at Upper Mississippi River Basin-Ames.

Agricultural systems evolve from the interactions of climate, crops, soils, management practices (e.g., tillage, cover crops, nutrient management), and economic risks and rewards. Alternatives to the corn (Zea mays L.)-soybean [Glycine max (L.) Merr.] (C-S) cropping systems that dominate in the US Midwest may provide more sustainable use of resources, reduce the documented environmental impacts of current C-S systems, and improve production efficiency and ecosystem services. Innovative management practices are needed to offer producers options to increase farm resilience to variable weather conditions and offset negative environmental impacts. In response to this need, the Upper Mississippi River Basin Long-Term Agroecosystem Research network site at Ames, IA, established a cropland experiment in 2016 to investigate an alternative crop management system that includes reduced tillage, cover crops, and right source, right rate, right time, and right place (4R) nitrogen (N) management. The experimental site is located on the Iowa State University Kelley Research Farm in Boone County, IA. Crop, soil, air, and tile drainage water measurements are made throughout the year using published methods for each agronomic and environmental metric. Our goal is to provide quantitative information to farmers, consultants, agribusiness partners, and state and federal agencies to help guide decisions on the effective use of alternative management practices. Future changes in experimental treatments will adopt a knowledge co-production approach whereby researchers and stakeholders will work collaboratively to identify problems, implement research protocols, and interpret results.

Evidence to inform spatiotemporal management of a western Pacific Ocean tuna purse seine fishery.

Fisheries can profoundly impact co-occurring species exposed to incidental capture. Spatiotemporal fisheries management holds substantial potential to balance socioeconomic benefits with ecological costs to threatened bycatch species. This study estimated the effect of the spatial and temporal distribution of effort by a western Pacific Ocean tuna purse seine fishery on catch rates of target and at-risk species by fitting spatially explicit generalized additive multilevel regression models within a Bayesian inference framework to observer data. Mean field prediction surfaces defined catch rate hotspots for tunas, silky sharks, rays, and whale sharks, informing the design of candidate area-based management strategies. Due to limited sample sizes, odontocete and marine turtle catch rate geospatial patterns were summarized using simple 2D hexagonal binning. Effort could be focused in two areas within core fishing grounds to reduce overlap with hotspots for silky sharks, rays, and whale sharks without affecting target catch. Effort could be shifted outside of core fishing areas to zones with higher target tuna catch rates to reduce overlap with hotspots for at-risk species. Sparse and small marine turtle and whale shark hotspots occurred across the fishing grounds. Results did not identify opportunities for temporally dynamic spatial management to balance target and at-risk catch rates. Research on the economic and operational viability of alternative spatial management strategies is a priority. A small subset of sets had disproportionately large odontocete captures. Real-time fleet communication, move-on rules, and avoiding sets on dolphin schools might reduce odontocete catch rates. Managing set association type and mesh size present additional opportunities to balance catch rates of at-risk and target species. Employing output controls that effectively constrain the fishery would alter the spatial management strategy to focus fishing within zones with the lowest ratio of at-risk bycatch to target tuna catch. Findings inform the design of alternative spatial management strategies to avoid catch rate hotspots of at-risk species without compromising the catch of principal market species.