Resource Burden Research Articles

Efficiency at Heart: Navigating the Hybrid Single-Ventricle Pathway

BackgroundSingle-ventricle cardiac defects (SVCDs) are among of the most health care resource–intensive congenital diseases. Although SVCDs are traditionally palliated using the Norwood pathway, in the last 2 decades select programs have used the hybrid strategy, which redistributes the operative and interstage risks. This study sought to characterize resource use for a cohort of patients with hybrid-palliated SVCD. MethodsAll patients with SVCDs who underwent palliation with the hybrid strategy and who were followed up exclusively at our institution from January 2008 to December 2021 were included. End points were death, Norwood conversion, orthotopic heart transplantation, 6 months post-Fontan status, or 4 years of age in those patients who had not completed staged palliation. Primary end points included total days hospitalized, number of cardiology visits, echocardiograms, catheterizations, and advanced imaging performed. ResultsOf 135 patients with a diagnosis of SVCD, 72 survived for 6 months after the Fontan procedure. By patient-year for the entirety of the pathway, patients had a median hospital length of stay of 16 days (interquartile range [IQR], 12-25 days), 7 cardiology visits (IQR, 6-9), 8 echocardiograms (IQR, 7-10), and 0.7 catheterizations (IQR, 0.4-1.1). The interstage 1 period had the heaviest resource burden requiring intense cardiology follow-up and echocardiography surveillance. Cardiac catheterizations and advanced imaging were most prevalent during interstage 2 period, with a median of 2 (IQR, 1-2) catheterizations and 36 (40%) patients undergoing advanced imaging. The total median number of hospital days per patient was 63 days (IQR, 47-98.5 days). ConclusionsResource use for the care of patients with SVCDs is significant. The intensity of surveillance decreases as patients progress through the pathway. In comparison with published Norwood pathway data, resource intensity and use patterns in hybrid palliation are comparable.

Abstract 1295: CancerCare coping circle workshop for patients with cancer and covid-19

Abstract Background: Despite an end to the US COVID-19 public health emergency, COVID-19 remains an ongoing public health priority (1). Patients with cancer can be at increased risk of progression to severe COVID-19 due to their cancer type or to receipt of immunosuppressives or treatment (2). Their mental and emotional well-being have also been impacted negatively (3). There is a need for awareness and education on managing and navigating risk of COVID-19 infection in patients with cancer. Method: Coping Circle Workshop series webinar ‘Navigating the Ongoing Impact of COVID-19 on Cancer Patients’ was designed for patient/caregivers to reduce feelings of isolation caused by ongoing challenges associated with COVID-19; provide attendees with the tools to communicate effectively with medical teams; offer tips on utilizing and enhancing their support systems; and help develop adaptive coping mechanisms and provide resources for support. Pre- and post-webinar polls were analyzed to assess webinar impact. Training was provided by a social worker and a mindfulness practice was incorporated. Results: Webinar had 11 attendees; 91% had skipped a cancer medical appointment due to COVID-19. Post-webinar, all participants responded that the webinar provided new topic information or insights at a level of ≥3 (scale 0-5; Table 1). Attendees’ confidence in understanding and managing their potential risks associated with COVID-19 infection increased from 5.8±1.3 (mean± standard deviation) pre-survey to 8.2±1.8 post-survey (scale 0-10). Conclusions: Delivery of COVID-19 education by an aligned provider supports enhanced scientific discourse and disease management resource utilization and awareness. It may also serve to reduce time and resource burden on oncology providers when engaging in educating patients and improve patients COVID-19 care and management. Conclusions are limited by small participation size.

The local tackling of global issues: a governance paradox in federal states

ABSTRACT This study focuses on a paradox of federalism. In disputed policy issues, subnational government units can initiate bottom-up policy change while the federal government remains inactive. This typically occurs in public health or climate change fields, where there might be a mismatch between the required and the effective scale of action. In such cases, subnational entities bear the costs of a politically risky action to produce a higher-level public good. Based on a study of tobacco control in 14 Swiss member states, we investigate why some subnational governments take the lead, while others adopt a wait-and-see attitude. We find a set of four configurations favourable to state activism (window of opportunity effect, reallocation effect, innovative identity effect, regionalisation effect) and four unfavourable (municipal resource burden effect, diffusion of responsibility effect, local autonomy effect, economic dependency effect). These bottom-up dynamics are crucial for understanding collaborative policy processes.

Clinical Significance and Resource Burden of Double Duct Sign in Non-jaundiced Patients.

Aim The study aims to determine the incidence of malignancy at presentation and subsequent risk of malignancy (at 12 months follow-up) in a cohort of patients with double duct sign (DDS) on cross-sectional imaging but no visible stigmata of jaundice. The study also correlates malignancy with liver enzyme dysfunction and estimates the resource burden incurred during the investigation of these patients. Methods A search for the key term "double duct sign" was undertaken in the radiological database of a tertiary hepatopancreatobiliary (HPB) centre between March 2017 and March 2022. Radiological reports, clinic letters, blood results, and multidisciplinary team meeting (MDT) outcomes were reviewed during this period and at one year. The national tariff payment system was reviewed to identify tariffs for different investigations required for the cohortand to calculate the total cost incurred. Results Ninety-seven patients with DDS were identified. Sixty-four patients (66%) had a normal bilirubin (0-21 µmol/L) at presentation and were included in the analysis. Seven patients (10.9%) were diagnosed with malignant peri-ampullary tumours, and 21 (32.8%) were diagnosed with benign diseases. In 34 patients (53%) with DDS, the underlying cause remained uncharacterised. Most patients had mild abnormalities of liver enzymes, but two patients (4.3%) were diagnosed with malignant peri-ampullary tumours despite having normal serological values. Patients who had a benign diagnosis and/or who had cancer excluded without a definitive diagnosis did not go on to develop a malignancy at 12 months follow-up. However, in those patients where the underlying aetiology could not be characterised, extended surveillance was required with a total of 80 MDT discussions and multiple surveillance scans (103 CT and 65 MRI scans). Twenty-six patients underwent endoscopic ultrasound (EUS) with three patients requiring more than one EUS examination (29 investigations in total). The cost of these investigations was £38,926.89. Conclusion This study confirms that DDS even in patients without clinical jaundice or with normal liver enzymes requires careful investigation to exclude malignancy despite the resource burden this entails. This supports previously reported results in the literature, and despite the increased use of cross-sectional imaging, DDS remains a clinically significant finding. Large cohort risk stratification studies would be useful to determine clinical urgency and allow the appropriate allocation of resources.

The economic and resource burden of e-scooter-related orthopaedic injuries: A district general hospital's experience

PurposeElectric scooters (e-scooters) are an increasingly popular method of transportation worldwide. However, there are concerns regarding their safety, specifically with regards to orthopaedic injuries. We aimed to investigate the overall burden and financial impact on orthopaedic services as a result of e-scooter-related orthopaedic injuries. MethodsWe retrospectively identified all e-scooter-related injuries requiring orthopaedic admission or surgical intervention in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Injuries sustained, surgical management, inpatient stay and resources used were calculated. ResultsSeventy-nine patients presented with orthopaedic injuries as a result of e-scooter transportation with a mean age of 30.1 years (SD 11.6), of which 62 were males and 17 were females. A total of 86 individual orthopaedic injuries were sustained, with fractures being the most common type of injury. Of these, 23 patients required 28 individual surgical procedures. The combined theatre and recovery time of these procedures was 5500 min, while isolated operating time was 2088 min. The total cost of theatre running time for these patients was estimated at £77,000. A total of 17 patients required hospital admission under Trauma and Orthopaedics, which accounted for total combined stay of 99 days with a mean length of stay of 5.8 days. ConclusionWhile there are potential environmental benefits to e-scooters, we demonstrate the risks of injury associated with their use and the associated increased burden to the healthcare system through additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.

Telodendrimer functionalized hydrogel platform for sustained antibiotics release in infection control

Wound infection commonly causes delayed healing, especially in the setting of chronic wounds. Local release of antibiotics is considered a viable approach to treat chronic wounds. We have developed a versatile telodendrimer (TD) platform for efficient loading of charged antibiotic molecules via a combination of multivalent and synergistic charge and hydrophobic interactions. The conjugation of TD in biocompatible hydrogel allows for topical application to provide sustained antibiotic release. Notably, a drug loading capacity as high as 20 % of the drug-to-resin dry weight ratio can be achieved. The payload content (PC) and release profile of the various antibiotics can be optimized by fine-tuning TD density and valency in hydrogel based on the charge and hydrophobic features of the drug, e.g., polymyxin B (PMB), gentamycin (GM), and daptomycin (Dap), for effective infection control. We have shown that hydrogel with moderately reduced TD density demonstrates a more favorable release profile than hydrogel with higher TD density. Antibiotics loaded in TD hydrogel have comparable antimicrobial potency and reduced cytotoxicity compared to the free antibiotics due to a prolonged, controlled drug release profile. In a mouse model of skin and soft tissue infection, the subcutaneous administration of PMB-loaded TD hydrogel effectively eliminated the bacterial burden. Overall, these results suggest that engineerable TD hydrogels have great potential as a topical treatment to control infection for wound healing. Statement of significanceWound infection causes a significant delay in the wound healing process, which results in a significant financial and resource burden to the healthcare system. PEGA-telodendrimer (TD) resin hydrogel is an innovative and versatile platform that can be fine-tuned to efficiently encapsulate different antibiotics by altering charged and hydrophobic structural moieties. Additionally, this platform is advantageous as the TD density in the resin can also be fine-tuned to provide the desired antibiotic payload release profile. Sustained antibiotics release through optimization of TD density provides a prolonged therapeutic window and reduces burst release-induced cytotoxicity compared to conventional antibiotics application. Studies in a preclinical mouse model of bacteria-induced skin and soft tissue infection demonstrated promising therapeutic efficacy as evidenced by effective infection control and prolonged antibacterial efficacy of antibiotics-loaded PEGA-TD resin. In conclusion, the PEGA-TD resin platform provides a highly customizable approach for effective antibiotics release with significant potential for topical application to treat various bacterial wound infections to promote wound healing.

Managing End of Life Care for the Critically Ill: A Novel Program to Deliver Bedside Critical Care Without Transfer to the Intensive Care Unit

Background: Navigating medical care at the end of life can be a challenging experience for patients. There are also significant resource burdens, including intensive care unit (ICU) admissions, accompanying terminal illness. For actively dying patients, developing a care plan based on patient goals and delivering care at the bedside can enhance patient well-being, avoid inappropriate transfers or interventions, and improve resource management. Methods: The Rapid Response Team (RRT) is an around the clock intensivist service that responds to all acutely decompensating patients in our hospital. Through the Appropriate Care Escalation (ACE) program, the RRT intensivist identifies amongst decompensating patients, terminally ill individuals for whom prognosis is extremely poor irrespective of available interventions. These patients receive discussions about goals of care, code status, and management options. They receive care on a dedicated stepdown unit without escalation to the ICU. If aligned with patient goals, care plans incorporate critical care interventions including ventilator and vasopressor therapy. Results: Over 5 years, RRT identified 413 terminally ill patients under the ACE program to continue end of life care on the stepdown unit. Following discussions of goals, 60.8% of patients requested DNR/DNI, 30.9% were full code, and 8.5% requested DNR/OK-TO-INTUBATE status. At discharge, 82.1% of ACE patients expired compared to 23% of all RRT consultations. Patients received 233 critical care procedures at bedside including intubations, central access catheters and bronchoscopy. Conclusion: The ACE program helped identify, in real time, actively dying, terminally ill patients, establish patient goals, and expand critical care services outside the ICU.

An integrated primary care service to reduce cardiovascular disease risk in people with severe mental illness: Primrose-A - thematic analysis of its acceptability, feasibility, and implementation

BackgroundCardiovascular disease among patients with severe mental illness in England is a major preventable contributor to premature mortality. To address this, a nurse and peer-coach delivered service (Primrose-A) was implemented in three London general practices from 2019 (implementation continued during COVID-19). This study aimed to conduct interviews with patient and staff to determine the acceptability of, and experiences with, Primrose-A.MethodsSemi-structured audio-recorded interviews with eight patients who had received Primrose-A, and 3 nurses, 1 GP, and 1 peer-coach who had delivered Primrose-A in three London-based GP surgeries were conducted. Reflexive thematic analysis was used to identify themes from the transcribed interviews.FindingsOverall, Primrose-A was viewed positively by patients and staff, with participants describing success in improving patients’ mental health, isolation, motivation, and physical health. Therapeutic relationships between staff and patients, and long regular appointments were important facilitators of patient engagement and acceptance of the intervention. Several barriers to the implementation of Primrose-A were identified, including training, administrative and communication issues, burden of time and resources, and COVID-19.ConclusionsIntervention acceptability could be enhanced by providing longer-term continuity of care paired with more peer-coaching sessions to build positive relationships and facilitate sustained health behaviour change. Future implementation of Primrose-A or similar interventions should consider: (1) training sufficiency (covering physical and mental health, including addiction), (2) adequate staffing to deliver the intervention, (3) facilitation of clear communication pathways between staff, and (4) supporting administrative processes.

Machine learning models for COVID-19 diagnosis based on medical images and audio

The COVID-19 pandemic presents a significant danger to human health, with far-reaching consequences for the global economy and political dynamics. It presents complex challenges in terms of rapid and accurate diagnosis, where machine learning holds potential to enhance diagnostic speed and precision while reducing time and resource burdens. Consequently, this research employs CT images and cough audio recordings as training data to create machine learning models for data classification, with the goal of aiding in the diagnosis of COVID-19. Using the Edge Impulse platform, a Convolutional Neural Network, MobileNetV2, is customized for efficient image recognition. On the audio front, the preprocessing phase encompassed three distinct feature extraction techniques: Mel Frequency Cepstral Coefficients, Mel-Filterbank Energy (MFE), and Mel spectrogram. Subsequently, model frameworks were meticulously adjusted to accommodate the classification requirements. The results of this effort are highly encouraging. In the domain of CT image recognition, the top-performing model achieved a remarkable accuracy of 93.98%. In the concurrent task of categorizing cough audio data, the best performance reached 81.8%. These findings underscore the capability of this approach as an effective supplementary tool for medical diagnostics. In the face of COVID-19s persisting impact, such machine learning advancements could significantly aid in swift and reliable diagnoses, ultimately contributing to the global battle against the pandemic.

Qualified Domestic Minimum Top-Up Tax: Should Developing Countries Adopt It?

The Qualified Domestic Minimum Top-up Tax (QDMTT) is presented as the preferred choice for developing countries. However, given its unfamiliar design, complexity, limited revenue gain, peer review and resource burdens, the QDMTT is unsuitable for developing countries. Instead, such countries should reform their tax incentives, and consider an across-the-board minimum tax.

Challenges and opportunities for improving mental health care and preventing suicide among people living with HIV: Perspectives of mental health professionals in Tanzania.

People living with HIV (PLWH) experience unique stressors that contribute to emotional distress, and PLWH are more than twice as likely to die by suicide when compared to the general population. In countries like Tanzania, there is a relatively high burden of HIV but few resources to support mental health needs. To gain a better understanding of mental health challenges experienced by PLWH in northern Tanzania and identify opportunities for intervention, we interviewed 12 mental health professionals working in the Kilimanjaro region. Thematic analysis was used to explore drivers and impacts of emotional distress, community influences on mental health, and gaps and barriers to existing mental health care. Perspectives from mental health workers highlight the compounding effects of stress related to HIV status, family conflict, finances, and other social challenges, which can lead to poor HIV treatment outcomes and suicidal ideation. Cultural beliefs and stigma surrounding both mental health and HIV limit care-seeking behavior for mental health issues. Those who do seek care often encounter barriers related to poor mental health infrastructure, including a lack of providers, limited financial resources, and little integration into other health services. There is a clear need for investment in the mental health care system, as well as interventions to improve knowledge and perceptions of mental health and comprehensively address stressors. We describe feedback on a proposed telehealth counseling intervention integrated into routine HIV services, which shows strong potential to mitigate barriers to mental health treatment, reduce suicidal ideation, and support the wellbeing of PLWH.

A New Integrated Approach for Cloud Service Composition and Sharing Using a Hybrid Algorithm

The concept of a “Smart City” emphasizes the need to employ information and communication technologies to strengthen the quality, connectivity, and efficiency of various municipal services. Cloud computing and the Internet of Things are shaping future tech. Both ideas greatly impact smart city application and solution development. Cloud computing is amazing at managing and storing remote service access. Several companies have switched to cloud leasing to reduce local resource burden. Due to the intricacy and flexibility of cloud-maintained services, selecting jobs that best suit client needs should be optimized. Quality of service criteria for each cloud service are the best tools for choosing and optimizing cloud carriers. Genetic algorithms (GAs) and ant colony optimization (ACO) are combined to make cloud computing. It is discovered that the recommended ACO + GA obtains an accuracy of 82% when compared to existing methods of energy- and reliability-aware multiobjective optimization method and the hybrid cuckoo particles swarm, artificial bee colony optimization (CPS + ABCO) where accuracy is 68% and 75%, respectively.

Rates, Outcomes, and Resource Burden of Extracorporeal Membrane Oxygenation Use in Hospitalizations in the United States During the Pandemic.

Extracorporeal membrane oxygenation (ECMO) is a lifesaving medical intervention for patients with severe refractory cardiopulmonary dysfunction. This study aims to characterize hospitalizations and resource use burdens associated with ECMO use during the onset of the pandemic. We performed a retrospective analysis of ECMO use in United States (US) hospitals between 2019 and 2020, utilizing data from the National Inpatient Sample database. Patient demographics, comorbidities, admission characteristics, inpatient mortality, length of hospital stay (LOS), healthcare costs, and ECMO utilization trends were assessed. Of the 17,520 hospitalizations analyzed, the most common reasons for admission were diseases and disorders of the circulatory system (40.5%) and diseases and disorders of the respiratory system (31.2%). The average patient age was 52.5 years, with a male predominance (64.2%). Hospitalizations were predominantly for White Americans (59.5%), followed by Blacks (16.3%) and Hispanics (14.8%). Nearly 88.2% of cases were at an extremely high risk of mortality without intervention. Inpatient mortality was significantly associated with Hispanic descent, a higher Charlson Comorbidity Index (CCI) score, age >60 years, and a higher All Patients Refined Diagnosis Related Groups (APRDRG) risk of mortality. Hospitalizations involving ECMO had a significantly higher inpatient mortality rate compared to non-ECMO hospitalizations (43.1% vs. 2.1%, p<0.0001). The mean LOS was 26 days for ECMO hospitalizations, with ECMO initiation occurring approximately five days from admission. ECMO-related hospitalizations often involve over 10 unique procedures, resulting in an average healthcare cost of US$967,647 per hospitalization, totaling US$16.7 billion. Comparatively, non-ECMO hospitalizations had shorter LOS and lower mean costs (mean LOS, 4.7 days, and US$52,659, respectively). ECMO utilization increased significantly from 2019 to 2020, reflecting rising demand for this life-saving therapy. Compared to non-ECMO hospitalizations, ECMO patients had higher inpatient mortality, associated with Hispanic descent, higher CCI scores, an age >60 years, and a higher APRDRG risk. ECMO hospitalizations had longer stays (26 days) and higher costs (US$967,647 per case, US$16.7 billion total) compared to pre-pandemic levels. ECMO use increased significantly from 2019 to 2020, reflecting rising demand.

Applications of Pyrrole and Pyridine-based Heterocycles in Cancer Diagnosis and Treatment.

The escalation of cancer worldwide is one of the major causes of economy burden and loss of human resources. According to the American Cancer Society, there will be 1,958,310 new cancer cases and 609,820 projected cancer deaths in 2023 in the United States. It is projected that by 2040, the burden of global cancer is expected to rise to 29.5 million per year, causing a death toll of 16.4 million. The hemostasis regulation by cellular protein synthesis and their targeted degradation is required for normal cell growth. The imbalance in hemostasis causes unbridled growth in cells and results in cancer. The DNA of cells needs to be targeted by chemotherapeutic agents for cancer treatment, but at the same time, their efficacy and toxicity also need to be considered for successful treatment. The objective of this study is to review the published work on pyrrole and pyridine, which have been prominent in the diagnosis and possess anticancer activity, to obtain some novel lead molecules of improved cancer therapeutic. A literature search was carried out using different search engines, like Sci-finder, Elsevier, ScienceDirect, RSC etc., for small molecules based on pyrrole and pyridine helpful in diagnosis and inducing apoptosis in cancer cells. The research findings on the application of these compounds from 2018-2023 were reviewed on a variety of cell lines, such as breast cancer, liver cancer, epithelial cancer, etc. Results: In this review, the published small molecules, pyrrole and pyridine and their derivatives, which have roles in the diagnosis and treatment of cancers, were discussed to provide some insight into the structural features responsible for diagnosis and treatment. The analogues with the chromeno-furo-pyridine skeleton showed the highest anticancer activity against breast cancer. The compound 5-amino-N-(1-(pyridin-4- yl)ethylidene)-1H-pyrazole-4-carbohydrazides was highly potent against HEPG2 cancer cell. Redaporfin is used for the treatment of cholangiocarcinoma, biliary tract cancer, cisplatin-resistant head and neck squamous cell carcinoma, and pigmentation melanoma, and it is in clinical trials for phase II. These structural features present a high potential for designing novel anticancer agents for diagnosis and drug development. Therefore, the N- and C-substituted pyrrole and pyridine-based novel privileged small Nheterocyclic scaffolds are potential molecules used in the diagnosis and treatment of cancer. This review discusses the reports on the synthesis of such molecules during 2018-2023. The review mainly discusses various diagnostic techniques for cancer, which employ pyrrole and pyridine heterocyclic scaffolds. Furthermore, the anticancer activity of N- and C-substituted pyrrole and pyridine-based scaffolds has been described, which works against different cancer cell lines, such as MCF-7, A549, A2780, HepG2, MDA-MB-231, K562, HT- 29, Caco-2 cells, Hela, Huh-7, WSU-DLCL2, HCT-116, HBL-100, H23, HCC827, SKOV3, etc. This review will help the researchers to obtain a critical insight into the structural aspects of pyrrole and pyridine-based scaffolds useful in cancer diagnosis as well as treatment and design pathways to develop novel drugs in the future.

Language inclusion in ecological systematic reviews and maps: Barriers and perspectives.

Systematic reviews and maps are considered a reliable form of research evidence, but often neglect non-English-language literature, which can be a source of important evidence. To understand the barriers that might limit authors' ability or intent to find and include non-English-language literature, we assessed factors that may predict the inclusion of non-English-language literature in ecological systematic reviews and maps, as well as the review authors' perspectives. We assessed systematic reviews and maps published in Environmental Evidence (n = 72). We also surveyed authors from each paper (n = 32 responses), gathering information on the barriers to the inclusion of non-English language literature. 44% of the reviewed papers (32/72) excluded non-English literature from their searches and inclusions. Commonly cited reasons included constraints related to resources and time. Regression analysis revealed that reviews with larger author teams, authors from diverse countries, especially those with non-English primary languages, and teams with multilingual capabilities searched in a significantly greater number of non-English languages. Our survey exposed limited language diversity within the review teams and inadequate funding as the principal barriers to incorporating non-English language literature. To improve language inclusion and reduce bias in systematic reviews and maps, our study suggests increasing language diversity within review teams. Combining machine translation with language skills can alleviate the financial and resource burdens of translation. Funding applications could also include translation costs. Additionally, establishing language exchange systems would enable access to information in more languages. Further studies investigating language inclusion in other journals would strengthen these conclusions.

Leveraging dairy cattle to upcycle culled citrus fruit for emission mitigation and resource co-benefits: A case study

Fruit and vegetable wastes are the largest components of global food loss and waste (FLW), leading to tremendous management, resource, and environmental burdens. The objective of this study is to find ways for effectively upcycling fruit waste via dairy cattle and to assess multiple sustainability benefits. Fresh citrus waste from a fruit processing center was incorporated into treatment diet (7.1 kg cow−1 day−1), fed to 160 cows for 24 days at a research dairy facility, in comparison with control diet. Additionally, at a commercial dairy farm, fresh citrus waste was co-ensiled with grass hay to prevent spoilage and preserve the feeding value, the resulting silage subsequently incorporated into diet and fed to lactating cows. Both feeding trials supported cow productivity and lowered feed cost. Sustainability implications were quantitatively assessed, including GHG emission mitigation and the sparing of land, water, fertilizer and herbicide uses due to substitution of conventional feed ingredients.

A critical analysis of challenges and opportunities for upcycling food waste to animal feed to reduce climate and resource burdens

Global food loss and waste has not abated despite tremendous efforts to reduce it. Food wastage has profound consequences including our inability to combat hunger, contributions to unsustainable resource exploitation, and represents about half of the greenhouse gas emissions of the entire agrifood system. Mitigating the problems for a sustainable future requires managing food waste using the most appropriate approach. Upcycling food waste to animal feed is an essential strategy to capture the greatest value compared with other recycling options. The overall goal of this critical analysis is to provide evidence that upcycling of many food waste sources to animal feed can be successfully achieved in support of sustainable productivity. We describe multiple dimensions of reducing emissions and improving resource utilization efficiency, characterize the suitability of various food waste sources and limitations as animal feed, and describe the needs for de-risking strategies, overcoming legislative bottlenecks, and filling knowledge gaps to accelerate greater use of this high impact sustainability strategy.

Evidence of animal productivity outcomes when fed diets including food waste: A systematic review of global primary data

Enormous amounts of food waste are generated that could potentially be used for livestock feeding to support sustainable food production and reduce climate and resource burdens. Many studies have documented animal productivity parameters (growth, yield, feed use efficiency) when fed food waste, but their findings remain fragmented. Our objective is to synthesize results from these studies to uncover collective evidence on how animal productivity is affected. A systematic literature review identified 102 studies, which originated from 31 countries and encompassed all major food-producing animal species fed food waste of various types and rates. The field-based primary data were normalized to discern patterns and trends. Animals in 75–77 % of all cases performed as optimally or increased productivity compared to those fed control diet; the remaining 23–25 % had decreased performance. Meta-analysis of a subset of data indicated that pig growth did not differ between control and treatment diets of varying food waste rates. Ultimately, balancing major nutrients from all feed ingredients are key for maintaining optimal productivity while pursuing sustainability.

Smart Devices in Optometry: Current and Future Perspectives to Clinical Optometry.

There is a huge unmet need for eye care with more than a hundred million people living without basic eye care services and facilities. There is an exigency to deploy adequate resources in terms of manpower and equipment to address this. The usage of smart devices in optometry and eye care practice has been gaining momentum for last half a decade, due to the COVID-19 pandemic and technological advancements in telemedicine. These smart devices will help facilitate remote monitoring of important visual functions, ocular signs and symptoms, thus providing better eye care services and facilities and promoting outreach services. Smart devices in optometry exist in the form of gadgets that can be worn in the wrist, and spectacle-mounted or head-mounted devices. On the other hand, with the ubiquitous nature of smartphones, a large number of smartphone applications have been developed and tested for advanced optometry and primary eye care practice, which may potentially reduce the burden of inadequate resources and the unmet need for eye care. This article aims to give an overview of the current trends and future perspectives on the application of such smart devices in optometric practice.

Influence of Human Resource Management on Work Efficiency of Healthcare Professionals

Background: World Health Organization (WHO) defines human resource pl anning in the healthcare industry as "The process of estimating the number of people, knowledge, skills, and attitudes needed to achieve a set of goals".Human resource planning is the most important part of the work of organizational management. Objective: The aim of the study was to point out the importance of timely and optimal planning of human resources and their impact on the work efficiency of healthcare professionals. Methods: This research is a comparative, descriptive-analytical study which used a questionnaire created according to the Likert model. The questionnaire containes statements related to factors affecting work efficiency, work analysis, position systematization, human resource planning, professional selection, work process design, management and manager's style, etc. Results and Discussion: A total of 450 respondents (healthcare professionals, both docotrs and nurses) participated in this research. Participation (inclusion) critaria in the research is employment in healthcare institutions in Canton Sarajevo, of different ages, of both genders. The planning process begins with a quality job analysis and human resource analysis to get an answer to several very important questions. How many people are needed to realize the set goals of the organization? What kind of people are needed: what skills, knowledge, and abilities? How to attract the necessary people (internal, external filling, selection procedure). How to adjust the current employee’s training so that they can adequately respond to all work tasks in the future, more demanding business environment of the health organization? The lack of human resources that have the necessary skills and knowledge, and the burden of inadequate resources (disabled workers), have slowed down the development of many companies. We are experiencing significant negative manifestation on the existing staff through reduced work efficiency and reduced quality of health care provided. Due to the above, it is necessary to timely plan human resources as an integral part of planning, business, and development of the entire organization. The planning of human resources in a health institution is influenced by the following factors: a) institutional factors b) level of health care c) type of health care institutiond) size of health care institution e) infrastructure of the existing institution. Conclusion: Human resource planning is a fundamental management activity from which all other activities arise,and contents of human resource management planes are based.