Third-generation Use Research Articles

Optimizing sustainable multiple biomass-to-biofuel conversion network with integrated water resource management utilizing data-driven robust planning

Until now, the biofuel supply chain has lacked an integrated approach to address its fundamental challenges in real-world implementation. The first challenge is maintaining a continuous supply flow in the biofuel network, which can significantly impact economic outcomes and performance measures. The second challenge involves managing water resources for biofuel production to preserve freshwater reserves. The third challenge is managing operational risks, such as uncertainty in biofuel demand, which leads to conservative planning and underscores the need for realistic uncertain programming approaches. To address these challenges, the proposed study designs a biofuel conversion network that utilizes third-generation feedstocks and non-edible seed sources, sourcing necessary water from wastewater resources. This practical solution addresses water-energy relationship concerns, reducing dependency on limited freshwater supplies. To achieve a continuous and cost-effective feed supply, this study incorporates a pre-processing phase using a hybrid Multi-Criteria Decision-Making model. This approach ensures the feed supply remains consistent, economical, and sustainable. To manage the uncertainty in biofuel demand, we developed a robust optimization model with an intersected uncertainty set using a data-driven approach. This approach aims to reduce conservatism in the obtained solutions, making the model more practical for real-world implementation. The numerical results reveal some practical implementation for policymakers. The proposed robust optimization using the configured uncertainty set offers a tool to manage the conservatism of renewable energy demand uncertainty and operational risks more effectively than traditional approaches (0.914%). This formulation can help policymakers to maintain greater robustness against fluctuations in confidence levels. Additionally, the simultaneous use of third-generation and non-edible feedstocks creates a multi-biomass-to-biofuel conversion network, offering practitioners a practical solution that significantly reduces reliance on freshwater resources. Furthermore, policymakers can leverage the proposed pre-processing phase to promote economic and continuous supply feed based on geographical, resource accessibility, and infrastructure criteria.

Risk factors and molecular epidemiology of fecal carriage of carbapenem resistant Enterobacteriaceae in patients with liver disease

BackgroundCarbapenem resistant Enterobacteriaceae (CRE) colonization is a risk factor for CRE infection. CRE infection results in an increase in mortality in patients with cirrhosis. However, minimal data regarding the prevalence and the risk factors of CRE colonization in patients with liver disease yet without liver transplantation are available. The present study aimed to investigate the prevalence, risk factors and molecular epidemiology characteristics of CRE fecal carriage among patients with liver disease.MethodsStool specimens from 574 adult inpatients with liver disease were collected from December 2020 to April 2021. CRE were screened using selective chromogenic agar medium and identified by the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined using the broth microdilution method. Carbapenemase genes were characterized by polymerase chain reaction (PCR) and DNA sequencing. Multilocus sequence typing (MLST) was performed for Carbapenem Resistant Klebsiella pneumoniae (CR-KPN) isolates and Carbapenem Resistant Escherichia Coli (CR-ECO) isolates.ResultsThe total number of stool specimens (732) were collected from 574 patients with liver disease. 43 non-duplicated CRE strains were isolated from 39 patients with a carriage rate of 6.79% (39/574). The carriage rate was 15.60% (17/109) in patients with acute-on-chronic liver failure (ACLF). Multivariate analysis indicated that ACLF (P = 0.018), the history of pulmonary infection within past 3 months (P = 0.001) and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months (P = 0.000) were independent risk factors of CRE colonization in patients with liver disease. Klebsiella Pnuemoniae (KPN) (51.28%) and Escherichia coli (ECO) (30.77%) were main strains in these patients. All CRE strains showed high resistance to most antimicrobials except for polymyxin B and tigecycline. Most (83.72%, 36/43) of the CRE carried carbapenemase genes. blaKPC-2 was the major carbapenemase gene. The molecular epidemiology of KPN were dominated by ST11, while the STs of ECO were scattered.ConclusionsThe present study revealed that CRE fecal carriage rates were higher in patients with ACLF than in patients without liver failure. ACLF, the history of pulmonary infection within past 3 months and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months were independent risk factors of CRE colonization in patients with liver disease. Regular CRE screening for hospitalized patients with liver disease should be conducted to limit the spread of CRE strain.

Ongoing initiatives in Azerbaijan to improve the use of antibiotics; findings and implications

ABSTRACTBackground: There have been a numerous initiatives in Azerbiajan in recent years to improve antibiotic utilization including educational programmes among patients, pharmacists and physicians. Consequently, this study aimed to analyse the influence of these multiple initiatives on antibiotic utilization as a basis for suggesting future initiatives.Methods: Observational retrospective study of total antibiotic utilization from 2011 to 2015 based on import data. The quality of aggregated antibiotic prescribing was assessed against recognised indicators including those of WHO Europe, as well as compared to neighbouring countries as reference points.Results: There was a significant reduction in total antibiotic utilization from 17.1 DIDs in 2011 in Azerbaijan to 8.02 DIDs in 2015, the lowest level compared with similar countries. Beta lactam antibiotics were typically the largest group of antibiotics with low overall use of co-amoxiclav (although relative utilisation rising), macrolides, cephalosporins and fluoroquinolones. There are concerns with rising use of tetracyclines in recent years in place of penicillins with changing pricing policies, as well as high relative use of third generation cephalosporins.Conclusions: Multiple interventions in Azerbaijan in recent years appear to have resulted in low use of antibiotics when compared with similar countries. However, there are some concerns especially with third generation cephalosporins. There needs to be a closer look at indications to further improve antibiotic use.

Multi-institution case-control and cohort study of risk factors for the development and mortality of Clostridium difficile infections in Japan.

ObjectiveTo examine risk factors for Clostridium difficile infection (CDI) morbidity and mortality in Japan.DesignMultimethod investigation including a case–control study and cohort study.Setting47 participating facilities of the National Hospital Organization (NHO).Participants1026 patients with CDI and 878 patients in the control group over the age of 18 years admitted to the subject NHO facilities from November 2010 to October 2011.Main outcome measuresIn a case–control study, we identify risk factors for CDI development. Next, in a cohort study, we identify risk factors for all-cause mortality within 30 days following CDI onset.ResultsA total of 1026 cases of CDI meeting the definitions of this investigation were identified, encompassing 878 patients at 42 of the 47 subject facilities. In the case–control study, we identified, compared with no antibiotics use, use of first-generation and second-generation cephem antibiotics (OR 1.44; 95% CI 1.10 to 1.87), use of third-generation and fourth-generation cephem antibiotics (OR 1.86; 95% CI 1.48 to 2.33) and use of carbapenem antibiotics (OR 1.87; 95% CI 1.44 to 2.42) the risk factors for CDI development. However, use of penicillin was not identified as a risk factor. In the cohort study, sufficient data for analysis was available for 924 CDI cases; 102 of them (11.0%) resulted in death within 30 days of CDI onset. Compared with no anti-CDI drug use, use of vancomycin was associated with reduced risk of mortality (OR 0.43; 95% CI 0.25 to 0.75) whereas metronidazole was not.ConclusionsThe findings mirror those of previous studies from Europe and North America, identifying the administration of broad-spectrum antibiotics as a risk factor for CDI development. The use of vancomycin is associated with a decreased risk of mortality.

An investigation into the use of 3G mobile communications to provide telehealth services in rural KwaZulu-Natal.

We investigated the use of third-generation (3G) mobile communications to provide telehealth services in remote health clinics in rural KwaZulu-Natal, South Africa. We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance. Services included database access to manage chronic disease, local support and management of patients (to reduce unnecessary travel to the hospital), emergency care (up to 8 h for an ambulance to arrive), e-mail, access to up-to-date information (Web), and teleclinics. We made site measurements at a representative set of health clinics to determine the type of coverage (general packet radio service [GPRS]/3G), its capabilities to support videoconferencing (H323 and Skype™ [Microsoft, Redmond, WA]) and audio (Skype), and throughput for transmission control protocol (TCP) to gain a measure of application performance. We found that none of the remote health clinics had 3G service. The GPRS service provided typical upload speed of 44 kilobits per second (Kbps) and download speed of 64 Kbps. This was not sufficient to support any form of videoconferencing. We also observed that GPRS had significant round trip time (RTT), in some cases in excess of 750 ms, and this led to slow start-up for TCP applications. We found audio was always so broken as to be unusable and further observed that many applications such as Web access would fail under conditions of very high RTT. We found some health clinics were so remote that they had no mobile service. 3G, where available, had measured upload speed of 331 Kbps and download speed of 446 Kbps and supported videoconferencing and audio at all sites, but we frequently experienced 3G changing to GPRS. We conclude that mobile communications currently provide insufficient coverage and capability to provide reliable clinical services and would advocate dedicated wireless services where reliable communication is essential and use of store and forward for mobile applications.

Effects of short-term radiation emitted by WCDMA mobile phones on teenagers and adults.

BackgroundWith the rapid increasing use of third generation (3 G) mobile phones, social concerns have arisen concerning the possible health effects of radio frequency-electromagnetic fields (RF-EMFs) emitted by wideband code division multiple access (WCDMA) mobile phones in humans. The number of people, who complain of various symptoms such as headache, dizziness, and fatigue, has also increased. Recently, the importance of researches on teenagers has been on the rise. However, very few provocation studies have examined the health effects of WCDMA mobile phone radiation on teenagers.MethodsIn this double-blind study, two volunteer groups of 26 adults and 26 teenagers were simultaneously investigated by measuring physiological changes in heart rate, respiration rate, and heart rate variability for autonomic nervous system (ANS), eight subjective symptoms, and perception of RF-EMFs during sham and real exposure sessions to verify its effects on adults and teenagers. Experiments were conducted using a dummy phone containing a WCDMA module (average power, 250 mW at 1950 MHz; specific absorption rate, 1.57 W/kg) within a headset placed on the head for 32 min.ResultsShort-term WCDMA RF-EMFs generated no significant changes in ANS, subjective symptoms or the percentages of those who believed they were being exposed in either group.ConclusionsConsidering the analyzed physiological data, the subjective symptoms surveyed, and the percentages of those who believed they were being exposed, 32 min of RF radiation emitted by WCDMA mobile phones demonstrated no effects in either adult or teenager subjects.

QUANTITATIVE ANALYSIS OF THE CONSUMPTION OF ANTIBACTERIALS PRESCRIBED IN THE AMBULATORY CARE AND REIMBURSED BY HII IN ALBANIA DURING 2011-2012

Background: Emphasis on the misuse of antibacterials in Albania and an increased sensibility on the antibacterial resistance have been reported in the grey literature lately. However, until now there are no consistent data on antibacterial use, its related misuse and antibacterial resistance, either other reports produced by health institutions. Objective: The objective of this study is to assess the trend of antibacterial utilization reimbursed by the Health Insurance Institute (HII) in the ambulatory care in Albania during the period 2011-2012. Materials and Methods: Data from the HII database for all the reimbursed and dispensed antibacterial in the ambulatory care were taken and the methodology of ATC/DDD for the study of antibacterial utilization was applied. Antibacterial grouped in ATC class were measured in defines daily doses (DDDs) and DDD/1000 inhabitant/day (DIDs) and then compared with the data of the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) reports. Results:Results of the total consumption of antibacterials reimbursed by the HII measured during 2011 are (3.174 DIDs) and in 2012 (2.794 DIDs).The penicillin’s total consumption in 2011 are (1.604 DID) and in 2012 (1.306 DID). From 2011 to 2012 there are no significant differences in the total antibacterial consumption. However, an enhancement of the use of third generation of cephalosporin’s was distinguished within the class of cephalosporin’s during the year 2012 (0.038 DID) whereas in the year 2011 was (0.006 DID). Conclusions:The quantities of antibacterial reimbursed for HII covered population during 2011 and 2012 are lower than the average consumption of EU/EAA countries part of ESAC-Net project. However, cephalosporin’s and tetracycline’s quantities reimbursed and dispensed were similar with the relative data of some countries of EU/EAA countries part of the ESAC-Net project.

Factors affecting behavioural intention to adopt 3G mobile value-added services in India

This paper extends the unified theory of acceptance and use of technology (UTAUT) model to explain the acceptance and use of third generation mobile value-added services (3G MVASs) by consumers. The UTAUT model was found limited only to the utilitarian perspective, whereas previous literature established that purchase intentions are also product of hedonic/experiential perspective. Hence, present study uses a modified UTAUT model that comprises hedonic construct represented by experiential motives (EM) to study the behavioural intention of the Indian consumers in adoption of 3G MVAS. The results confirmed effort expectancy, experiential motives and facilitating conditions as explanations for behavioural intention and adoption of 3G MVAS, but social influence and performance expectancy could not be used as such for explanations. Furthermore, unlike extant literature, age, experience and voluntariness were found to have an impact on behavioural intention though it could not be proved for gender. The theoretical and managerial implications are presented.

Trends in long‐term mechanical circulatory support for advanced heart failure in the UK

Heart transplantation (HTx) is limited by the scarcity of suitable donor hearts. Consequently, more patients with advanced heart failure require a ventricular assist device (VAD). We report U.K. activity, trends, and outcome for long-term VAD support as a bridging therapy to HTx. Patients were grouped into three eras: E1, February 2004-March 2006; E2, April 2006-March 2009; and E3, April 2009-March 2011. Exclusions were patients who received isolated short-term support or extracorporeal membrane oxygenation without prior or subsequent long-term VAD support. A total of 247 patients received VAD support; 202 left ventricular (LVAD) support alone and 45 both left and right ventricular support. Activity increased over time, from 36 patients implanted in E1 to 123 in E3. Overall, 46 patients received a first-generation device, 80 a second-generation device, and 121 a third-generation device. Use of third-generation devices increased from <6% in E1 to 78% in E3. Median duration of LVAD support increased from 141 days in E1 to 578 days in E3 (P < 0.001). Overall survival to 1 year after LVAD implant rose from 58.3% [95% confidence interval (CI) 40.7-72.4%] in E1 to 72.5% (95% CI 63.3-79.8%) in E3 (P = 0.21), and improved significantly with device generation; at 1 year, 50% of patients with first-generation devices were alive compared with 68.1% and 76.9% of patients with second- and third-generation devices, respectively (P = 0.002). These differences remained after risk adjustment. HTx following LVAD implant reduced over time (P < 0.001). VAD activity and duration of support have increased. There has been a shift from first- and second- to third-generation devices, and an associated improvement in survival.

Semi-Collusion on Investments in the Mobile Internet Market

This model analyzes mobile network operators' (MNOs) incentives to invest in their facilities in the era of the mobile internet, given a widespread use of third generation (3G) services. Usually, MNOs agree on reciprocal roaming to offer full service to their subscribers. Roaming induces investment spillovers, as due to roaming agreements also rival customers benefit from investment of a MNO. It will be analyzed how different regimes of access regulation affect MNOs' incentives to invest. Semi-collusion on investments should be allowed, if investment spillovers are sufficiently large. The model is able to provide a rational for a ''bill-and-keep'' access pricing regime, proposed by the European Commission, given that a regulator is both able to determine access prices and investments. Given that a social planer only regulates access prices, an access price of zero may lead to over-and underinvestments from a welfare perspective.

European Surveillance of Antimicrobial Consumption (ESAC): outpatient cephalosporin use in Europe

Data on outpatient cephalosporin use in Europe were collected from 25 countries within the ESAC project, funded by DG SANCO of the European Commission, using the WHO ATC/DDD methodology. For the period 1997-2003, data on outpatient use of systemic cephalosporins aggregated at the level of the active substance were collected and expressed in DDD (WHO, version 2004) per 1000 inhabitants per day (DID). Use was analysed in detail, using the new ATC codes J01DB, J01DC, J01DD and J01DE, introduced in the 2005 issue of the WHO ATC index and assigned to the four cephalosporin generations. Total outpatient cephalosporin use in 2003 varied by a factor of 270 between the country with the highest (6.18 DID in Greece) and lowest (0.02 DID in Denmark) use. First-, second- and third-generation cephalosporins were used most in 6, 16 and 3 countries, respectively. We observed fourth-generation use (mainly cefepime) in ambulatory care in 11 countries. From 1997 to 2003 cephalosporin use decreased in 13 countries, in France by more than 1 DID. A relative increase of second-generation (mainly cefuroxime) or third-generation use (mainly cefpodoxime or cefixime) by more than 10% in 12 countries coincided with an equally large decrease of first-generation use in eight countries (mainly cefadroxil, cefalexin or cefatrizine). In six countries, first-generation use increased, second-generation use decreased or both occurred. The new ATC codes allow a more detailed description of outpatient cephalosporin use. The variation in antibiotic use in Europe is most extreme for this class of antibiotics, suggesting that in many countries in Europe these antibiotics are prescribed inappropriately.

"Increased Number of Induced Abortions in Norway after Media Coverage of Adverse Vascular Events from the Use of Third-generation Oral Contraceptives."

Abstract After the press release in Lancet (October 18, 1995) of increased risks for adverse vascular events in users of pills containing desogestrel and gestodene, the total sales of oral contraceptives dropped over a two-month period by 17%, while sales of the only desogestrel brand available (Marvelon) dropped by over 70% in Norway. From sales, we can estimate that more than 45,000 women either changed from Marvelon to a second- or first-generation brand or stopped using OCs. In total, more than 25,000 women discontinued OC use in Norway during November and December of 1995. Abortion data from one Norwegian county, representing 6–7% of the Norwegian population, show no statistically significant changes in the total number of induced abortions from the first quarter of 1996 as compared with that of the first quarter in preceding years. However, abortion rates that had been steadily decreasing from 1992 through 1995 in women 24 years old or younger, were promptly interrupted by a significant 36% increase during the first quarter of 1996. Most of the additional cases were found among single, childless studients. The observed increased abortion rate among younger women is most probably linked to changes in contraceptive use during the pill scare of late October through December of 1995, during which time these women conceived.