Desirable Reductions Research Articles

Development and evaluation of a continuous quality improvement programme for antimicrobial stewardship in six hospitals in Uganda

BackgroundAppropriate antimicrobial use is essential for antimicrobial stewardship (AMS). Ugandan hospitals are making efforts to improve antibiotic use, but improvements have not been sufficiently documented and evaluated.MethodsSix Ugandan hospitals implemented...

Battery Sharing: A Feasibility Analysis through Simulation

Nowadays, several alternatives to internal combustion engines are being proposed in order to reduce CO2 emissions in freight transportation and citizen mobility. According to many experts, the use of electric vehicles constitutes one of the most promising alternatives for achieving the desirable reductions in emissions. However, popularization of these vehicles is being slowed by long recharging times and the low availability of recharging stations. One possible solution to this issue is to employ the concept of battery sharing or battery swapping. This concept is supported by important industrial partners, such as Eni in Italy, Ample in the US, and Shell in the UK. This paper supports the introduction of battery swapping practices by analyzing their effects. A discrete-event simulation model is employed for this study. The obtained results show that battery sharing practices are not just a more environmentally and socially friendly solution, but also one that can be highly beneficial for reducing traffic congestion.

Clinical benefits of therapeutic drug monitoring of vancomycin therapy in patients with postoperative intracerebral hemorrhage: a retrospective cohort study

ObjectiveThe objective of this study was to investigate the clinical efficacy and safety of conducting therapeutic drug monitoring (TDM) of vancomycin in patients with postoperative intracerebral haemorrhage.MethodsWe conducted a retrospective...

A study of Bogoyavlenskii’s (2+1)-dimensional breaking soliton equation: Lie symmetry, dynamical behaviors and closed-form solutions

This paper employs the Lie symmetry analysis to investigate novel closed-form solutions to a (2+1)-dimensional Bogoyavlenskii’s breaking soliton equation. This Lie symmetry technique, used in combination with Maple’s symbolic computation system, demonstrates that the Lie infinitesimals are dependent on five arbitrary parameters and two independent arbitrary functions f1(t) and f2(t). The invariance criteria of Lie group analysis are used to construct all infinitesimal vectors, commutative relations of their examined vectors, a one-dimensional optimal system and then several symmetry reductions. Subsequently, Bogoyavlenskii’s breaking soliton (BBS) equation is reduced into several nonlinear ODEs by employing desirable Lie symmetry reductions through optimal system. Explicit exact solutions in terms of arbitrary independent functions and other constants are obtained as a result of solving the nonlinear ODEs. These established results are entirely new and dissimilar from the previous findings in the literature. The physical behaviors of the gained solutions illustrate the dynamical wave structures of multiple solitons, curved-shaped wave–wave interaction profiles, oscillating periodic solitary waves, doubly-solitons, kink-type waves, W-shaped solitons, and novel solitary waves solutions through 3D plots by selecting the suitable values for arbitrary functional parameters and free parameters based on numerical simulation. Eventually, the derived results verify the efficiency, trustworthiness, and credibility of the considered method.

Bempedoic acid, an inhibitor of ATP citrate lyase for the treatment of hypercholesterolemia: early indications and potential

ABSTRACT Introduction The lowering of low-density lipoprotein cholesterol (LDL-C), regardless of the method used, results in a reduction of cardiovascular events. Bempedoic acid is a new and until now, the only approved adenosine triphosphate citrate lyase inhibitor that works through the cholesterol-synthesis pathway (similar to statins) that leads to a safe and effective reduction in LDL-C. Areas covered We review clinical phase 2 and 3 studies on bempedoic acid’s lipid-lowering effect and approved indications. Expert opinion In the United States, bempedoic acid is currently approved for use in secondary prevention. In primary prevention, its approval is limited to individuals with heterozygous familial hypercholesterolemia (FH). However, its tolerability and safety profile may warrant its use in primary prevention besides FH. Even though its efficacy appears weaker than high-intensity statins, it may be a useful adjunct in individuals who achieve less than desirable LDL-C reductions with statins or who cannot tolerate statins, where bempedoic acid alone or in combination with ezetimibe may be useful alternatives.

Integrated inexact energy systems planning under climate change: A case study of Yukon Territory, Canada

This study developed an inexact optimization modelling approach for supporting regional energy systems decision-making and greenhouse gas emission mitigation under uncertainty. The developed model integrates multiple inexact optimization programming approaches, incorporating interval linear programming, mixed-integer programming, and chance-constrained programming in an optimization framework. Uncertainties expressed as interval values and probabilistic distributions can be effectively handled. This is the first attempt that applies an optimization-based modelling approach to Yukon Territory, Canada. Three scenarios and one business-as-usual scenario are evaluated. System costs are minimized in this model. Results obtained from this model can help identify optimal patterns of renewable energy expansions in the Yukon. The interval solutions obtained could help decision makers to identify desirable renewable energy polices and emission reductions.

Can highly saline irrigation water improve sodicity and alkalinity in sodic clayey subsoils?

The concept of irrigating crops with saline irrigation water is not new, but impacts of this practice on soil properties remain debatable, particularly the use of highly saline water. In this work, key soil chemical properties were assessed to a depth of 300 cm following 2.5 years of application of highly saline irrigation to a sodic texture-contrast soil (Brown Sodosol) in south-eastern Tasmania, Australia. Control plots (rainfall only) were compared to irrigation treatments of low (0.8 dS/m) and high salinity (16 dS/m) waters at application rates of both 200 and 800 mm/year. Whilst significant increases in both electrical conductivity and chloride concentration occurred throughout the soil profile in the high salinity treatment, these values were well below those of the irrigation water, indicating effective deep leaching. In the upper soil profile, 0–50 cm, of the high salinity treatments both the exchangeable Na+ and its ratio to total base cations (ESP) were significantly increased whilst the lower soil profile between 50 and 200 cm, was improved via both reduced alkalinity and sodicity. Leaching of the exchangeable base cations Ca2+, Mg2+ and K+ was significant in the upper soil profile (0–50 cm). As expected, the low salinity treatment (0.8 dS/m) had minimal impacts on soil chemical properties. The upper topsoil (0–10 cm) total organic carbon was significantly reduced in the high salinity plots and was negatively correlated with Cl− concentration. The data confirms the general concerns about application of saline irrigation, namely increased whole profile salinisation and upper soil profile (0–50 cm) sodicity, but they also show unexpected and desirable reductions in the lower soil profile (> 50 cm) alkalinity and sodicity. It appears the Na+ ions present in the saline waters led to differential leaching of base cations from the rooting zone, especially Ca2+ which then ameliorate the alkalinity and sodicity deeper in the soil profile (> 50 cm). Thus, surface application of gypsum may help sustain the application of highly saline waters; alternatively, subsurface irrigation above the sodic clayey subsoils could be trailed.

GAD vaccine reduces insulin loss in recently diagnosed type 1 diabetes: findings from a Bayesian meta-analysis.

GAD is a major target of the autoimmune response that occurs in type 1 diabetes mellitus. Randomised controlled clinical trials of a GAD + alum vaccine in human participants have so far given conflicting results. In this study, we sought to see whether a clearer answer to the question of whether GAD65 has an effect on C-peptide could be reached by combining individual-level data from the randomised controlled trials using Bayesian meta-analysis to estimate the probability of a positive biological effect (a reduction in C-peptide loss compared with placebo approximately 1year after the GAD vaccine). We estimate that there is a 98% probability that 20μg GAD with alum administered twice yields a positive biological effect. The effect is probably a 15-20% reduction in the loss of C-peptide at approximately 1year after treatment. This translates to an annual expected loss of between -0.250 and -0.235pmol/ml in treated patients compared with an expected 2h AUC loss of -0.294pmol/ml at 1year for untreated newly diagnosed patients. The biological effect of this vaccination should be developed further in order to reach clinically desirable reductions in insulin loss in patients recently diagnosed with type 1 diabetes.

Labor and World Development Through the Lens of Cotton: A Review Essay

Labor and World Development Through the Lens of Cotton: A Review Essay

Prestroke Weight Loss Is Associated With Poststroke Mortality Among Men in the Honolulu-Asia Aging Study

ObjectiveTo examine baseline prestroke weight loss and poststroke mortality among men. DesignLongitudinal study of late-life prestroke body mass index (BMI), weight loss, and BMI change (midlife to late life) with up to 8-year incident stroke and mortality follow-up. SettingCommunity-based aging study data. ParticipantsJapanese-American men (N=3581; age range, 71–93y) who were stroke free at baseline. InterventionsNot applicable. Main Outcome MeasurePoststroke mortality: 30 days poststroke, analyzed with stepwise multivariable logistic regression; and long-term poststroke (up to 8y), analyzed with stepwise multivariable Cox regression. ResultsWeight loss (4.5kg decrements) was associated with increased 30-day poststroke mortality (adjusted odds ratio=1.48; 95% confidence interval [CI], 1.14–1.92), long-term mortality after incident stroke (all types, n=225; adjusted hazards ratio (aHR)=1.25; 95% CI, 1.09–1.44), and long-term mortality after incident thromboembolic stroke (n=153; aHR=1.19; 95% CI, 1.01 to 1.40). Men with overweight/obese late-life BMI (≥25kg/m2, compared with healthy/underweight BMI) had increased long-term mortality after incident hemorrhagic stroke (n=54; aHR=2.27; 95% CI, 1.07–4.82). Neither desirable nor excessive BMI reductions (vs no change/increased BMI) were associated with poststroke mortality. In the overall sample (N=3581), nutrition factors associated with increased long-term mortality included the following: (1) weight loss (10lb decrements; aHR=1.15; 95% CI, 1.09–1.21), (2) underweight BMI (vs healthy BMI; aHR=1.76; 95% CI, 1.40–2.20), and (3) both desirable and excessive BMI reductions (vs no change or gain, separate model from weight loss and BMI; aHR range, 1.36–1.97; P<.001). ConclusionsAlthough obesity is a risk factor for stroke incidence, prestroke weight loss was associated with increased poststroke (all types and thromboembolic) mortality. Overweight/obese late-life BMI was associated with increased posthemorrhagic stroke mortality. Desirable and excessive BMI reductions were not associated with poststroke mortality. Weight loss, underweight late-life BMI, and any BMI reduction were all associated with increased long-term mortality in the overall sample.

Relationship between Predicted Speed Reduction on Horizontal Curves and Safety on Two-Lane Rural Roads in Spain

According to different studies, speed reduction is considered one of the major factors in contributing road safety. For that reason, several guidelines have been recommended for maximum desirable speed reductions from tangents to horizontal curves and for maximum differentials between design and operating speeds on horizontal curves. The Interactive Highway Safety Design Model (IHSDM) Design Consistency Module presents an analysis of the relationship between speed reduction and crashes for horizontal curves on U.S. two-lane rural highways. This paper presents the relationship between speed reduction and crashes for horizontal curves on Spanish two-lane rural roads. A model for using regression analysis to predict crashes is presented. Exposure, curve length (CL), and difference in 85th-percentile speeds (ΔV85) between successive tangents and horizontal curves, as well as between successive curves, are used. The model's coefficients were different from the ones obtained for U.S. highways, although the values of the goodness-of-fit criteria were similar. In addition, the relationship between crashes and different speeds is analyzed, taking the difference in speed as a speed differential not exceeded by 85% of the drivers traveling under free-flow conditions (Δ85V), instead of considering it as ΔV85. The two models (ΔV85 versus Δ85V) give very similar results. Language: en

Improving the Environmental Profile of Wood Panels via Co-Production of Ethanol and Acetic Acid

The oriented strand board (OSB) biorefinery is an emerging technology that could improve the building, transportation, and chemical sectors' environmental profiles. By adding a hot water extraction stage to conventional OSB panel manufacturing, hemicellulose polysaccharides can be extracted from wood strands and converted to renewably sourced ethanol and acetic acid. Replacing fossil-based gasoline and acetic acid has the potential to reduce greenhouse gas (GHG) emissions, among other possible impacts. At the same time, hemicellulose extraction could improve the environmental profile of OSB panels by reducing the level of volatile organic compounds (VOCs) emitted during manufacturing. In this study, the life cycle significance of such GHG, VOC, and other emission reductions was investigated. A process model was developed based on a mix of laboratory and industrial-level mass and energy flow data. Using these data a life cycle assessment (LCA) model was built. Sensitive process parameters were identified and used to develop a target production scenario for the OSB biorefinery. The findings suggest that the OSB biorefinery's deployment could substantially improve human and ecosystem health via reduction of select VOCs compared to conventionally produced OSB, gasoline, and acetic acid. Technological advancements are needed, however, to achieve desirable GHG reductions.

P1-352 Inequalities in health: relative, absolute, and an ethical dimension

IntroductionDiscussions on inequalities in health and trends in these often concentrate explicitly or implicitly on relative inequality. This paper explores practical and ethical implications of that tendency.MethodsTrends in relative and...

Functional responses of an invasive top predator Mustela erminea to invasive meso-predators Rattus rattus and Mus musculus, in New Zealand forests

Context Management of suites of invasive mammal species can lead to perverse outcomes, such as meso-predator release, or can achieve desirable reductions in the abundance of top-order predators by controlling their prey. Predictive models for predator–prey systems require estimates of predator functional responses, i.e. predation rates as functions of prey density. Aims In New Zealand, estimates of the functional responses of stoats (Mustela erminea) to mice (Mus musculus) and ship (black) rats (Rattus rattus) are required to improve management models for these invasive species. Methods We derived fitted relationships between the presence or absence of mouse or ship-rat remains in stoat guts and corresponding indices of prey abundance in beech and podocarp forests, respectively. To convert field data on stoat-gut contents to minimum kill rates, we used data on feeding activity and estimates of gut-passage time, observed in captive stoats. Key results The most parsimonious fitted curves were Type II functional responses, with a steeper stoat–mouse curve for autumn–winter, indicating a more specialist feeding habit than that in spring–summer. Estimated kill rates of mice per stoat per day reached an asymptote of 1.13 during autumn–winter. Our maximum observed kill rate for spring–summer was 11% less than the extrapolated upper limit of 1.04 mice per stoat per day for New Zealand ecosystems. No asymptote was reached within the limits of the data for the stoat–rat relationship. Conclusions Recent models for trophic interactions between stoats and the primary rodent prey have overestimated kill rates by stoats in forested ecosystems, particularly at very low and very high densities of mice. We show how data on stoat-gut contents can be rescaled to estimate minimum kill rates of rodent prey. Implications The functional-response relationships we have derived can be used to improve modelled predictions of the effects of natural or management-driven perturbations of invasive stoats and their primary rodent-prey populations.

Change in Dietary Energy Density after Implementation of the Texas Public School Nutrition Policy

Consumption of energy-dense foods has been associated with rising obesity rates and the metabolic syndrome. Reducing dietary energy density is an important strategy to address obesity, but few studies have examined the effect of nutrition policies on children's energy density. The study's objective was to assess the impact of the Texas Public School Nutrition Policy on children's energy density by using a pre- and post-policy evaluation. Analysis of variance/covariance and nonparametric tests compared energy density after the Texas policy change to intakes at baseline. Two years of lunch food records were collected from middle school students in Southeast Texas at three public middle schools: baseline (2001-2002) and 1 year after implementation of the Texas Policy (2005-2006). Students recorded the amount and source of foods consumed. The Texas Public School Nutrition Policy was designed to promote a healthy school environment by restricting portion sizes of high-fat and high-sugar snacks and sweetened beverages, fat content of foods, and serving of high-fat vegetables like french fries. Energy density (kcal/g): energy density−1 was the energy of foods only (no beverages) divided by the gram weight and has been previously associated with obesity and insulin resistance; energy density−2 included all food and beverages to give a complete assessment of all sources of calories. Following implementation of the Texas policy, students' energy density−1 significantly decreased from 2.80±1.08 kcal/g to 2.17±0.78 kcal/g ( P<0.0001). Similarly, energy density−2 significantly decreased from 1.38±0.76 kcal/g to 1.29±0.53 kcal/g ( P<0.0001). In conclusion, the Texas Public School Nutrition Policy was associated with desirable reductions in energy density, which suggests improved nutrient intake as a result of student school lunch consumption.

Implementing decision and communication aids to facilitate patient-centered care in breast cancer: A case study

Objective Decision Services (DS) provide support for breast cancer patients at the University of California, San Francisco to help ensure patient-centered care. Methods We examined a case study to explore whether our program practices matched our program theory, and what the patient in the case thought was effective and ineffective about our decision support interventions. Results The patient relied on a decision aid to educate her husband about her condition; felt that her question list contributed to a productive and efficient consultation with her oncologist; credited an audio-recording with helping her remember to follow-up with a genetic counselor; and reviewed the consultation summary 30 days into treatment in order to reflect on her decision. The patient rated the interventions highly on surveys, and experienced desirable reductions in decisional conflict, and improvements in knowledge. However, the question-prompting intervention was associated with a small decrease in self-efficacy, and the patient criticized the decision aid for omitting mention of a prognostic test. Conclusion This case illustrates how decision support interventions can be deployed to promote patient-centered care. Practice implications Breast care centers should consider distributing decision aids and assisting patients in listing questions, recording consultations, and obtaining written consultation summaries.

Predicting the response of low-aspect ratio, flexible aircraft

AbstractAccurate prediction of the response of low-aspect ratio, flexible aircraft requires correspondingly accurate modeling of the aircraft itself and of the aerodynamic forces, both respectable problems. Assuming that the wing can be modeled as a nonuniform plate, the discretisation process of choice is the finite element method (FEM), which demands a very large number of degrees of freedom for good accuracy. Moreover, accurate modeling of the aerodynamic forces acting on the aircraft suggests the use of computational fluid dynamics (CFD), which requires the use of an extremely large number of variables. On the other hand, feedback control design for the aircraft demands an aircraft model of relatively small order, so that the dimension of the FEM and CFD models must be reduced drastically. Based on physical considerations, reasonably accurate model reductions can be achieved, but a problem remains because the FEM and CFD grids are likely to differ from one another. It is shown in this paper how to achieve desirable model reductions for both the FEM and CFD and how to integrate the aerodynamic forces into the aircraft state equations. A numerical example demonstrates how the theory can be applied to the flight of a flexible aircraft. The analytical/computational approach developed here should permit parametric studies ultimately resulting in a reduction in the time required for aircraft design and flight testing.

Impacts of fisheries on seabird communities

Long-line by-catch of albatrosses and petrels may soon lead to species extinctions. Set-net bycatch has caused major reductions in certain seabird populations. Some fisheries may decrease numbers of seabirds by reducing abundance of prey-fish. Other fisheries may increase seabird numbers, by increasing prey-fish abundance through depletion of predatory fish stocks, or by provision of offal and discards. These latter impacts of fisheries on seabirds are often difficult to measure against a background of many and varied environmental and human influences. Depletion of stocks of small lipid-rich fish have reduced numbers of seabirds, in Peru, the Norwegian Sea, and the Barents Sea. However, reductions of predatory fish stocks in the North Sea have more than compensated for quantities of sandeels removed by the sandeel fishery. While piscivorous fish stocks remain low, sandeel fishery and seabirds appear to be able to coexist. However, if piscivorous fish stocks recover in the North Sea, reduced availability of sandeels to seabirds may affect certain species. Provision of discards and offal can stimulate large increases in scavenging seabird numbers. Desirable reductions in discard rates may have an unfortunate side-effect of forcing some scavenging seabirds to turn to killing smaller seabirds, with drastic consequences for community structure.

375 Low Phosphorus Controls Bedding Plant Growth

`Ultra Red' petunia (Petunia × hybrida Hort. Vilm.-Andr.), `Bonanza Orange' marigold (Tagetes patula L.), and `Marglobe' tomato (Lycopersicon esculentum Mill.) were fertilized with a low-P, water-soluble fertilizer to evaluate the potential of low-P nutrition to control growth. Beginning at transplanting, plants received N at 150 mg·L–1 fertilizer solutions twice a week until finish from 20N–4.3P–16.6K continuously (control), 20N–0P–16.6K continuously, or four or six applications of 20N–0P–16.6K followed by 20N–4.3P–16.6K to finish. Growth media were two commercial soilless substrates (Fafard 3B and Metro Mix 360), and a 2 sphagnum peat moss: 1 perlite: 1 vermiculite combination (v/v) containing no starter or granular P fertilizer. All species in the 2:1:1 growth medium responded to low P treatments with significant growth reductions. In the commercial media, presumably due to the presence of a P-containing starter fertilizer, there were no visible effects of low P on the size of ornamental species and only small reductions in the measured growth characteristics compared to the control. Tomato growth, however, was significantly reduced by low P treatments in both commercial media. This research suggests that the P requirement of some ornamental bedding species is very low and that to use low P for growth control, plants must be grown in a substrate containing no P fertilizer. Under these conditions, four or six applications of 20N–0P–16.6K followed by 20N–4.3P–16.6K to finish resulted in desirable growth reductions and no P deficiency symptoms.

Effects of individual trees on the solar radiation climate of small buildings

Under clear skies, a mid-sized sugar maple tree ( Acer saccharum Marsh.) reduced irradiance in its shade on a south-facing wall by about 80% when in leaf, and by nearly 40% when leafless. Reductions by a similar-sized London plane ( Platanus acerifolia W.) were generally slightly smaller. The percentage reductions varied with the fraction (DR) of diffuse radiation, and could be approximated by regressions with DR 2 as the independent variable. The significance of the irradiance reductions for building radiation climate was tested by using physical models of representative tree crowns (similar to sugar maple) and a representative house to evaluate shadow patterns, along with a mathematical model of average hourly solar radiation for an average day of each month. For a mid-sized tree with a 2-m clear bole located south of the house in a cloudy climate, the ratio of desirable insolation reductions during the cooling season to undesirable insolation reductions during the heating season was a low 0.74; whereas, with the same tree on the west, the ratio was a much more beneficial 4.6. In a sunny climate, the ratios were 0.55 and 3.3 for the tree on the south and west, respectively. A taller tree with a longer clear bole on the south produced more favorable ratios of cooling season to heating season insolation reductions than the tree with the short clear bole on the south.