Side effects of green technologies: the potential environmental costs of Lithium mining on high elevation Andean wetlands in the context of climate change

Lithium-based batteries are the key component of booming green technologies, including hybrid electric, plug-in hybrid electric and battery electric vehicles. Nearly 80% of the global lithium resources are located in the subtropical “Puna” highlands of Argentina, Bolivia and Chile. In these arid ecosystems, most biodiversity is related to wetlands: this highly valuable biodiversity includes the emblematic native camelids, flamingos, and a rich variety of endemic plants, and other animals. Climatic trends during the past decades, and future climate models suggest persistent drying tendencies. As other mining operations, lithium exploitations of salty flats require relatively large amounts of water. We discuss the research questions and priorities to preserve these valuable ecosystems in the context of growing potential conflicts for the use of water.Fil: Izquierdo, Andrea Elisa. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales E Instituto Miguel Lillo. Instituto de Ecología Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Grau, Hector Ricardo. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales E Instituto Miguel Lillo. Instituto de Ecología Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Carilla, Julieta. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales E Instituto Miguel Lillo. Instituto de Ecología Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Casagranda, Elvira. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo. Instituto de Ecología Regional; Argentin

Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department.

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained

Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department.

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained

Management of transient loss of consciousness of suspected syncopal cause, after the initial evaluation in the Emergency Department

The recommendations enclosed in the present document have been developed by a group of experts appointed by the Gruppo Multidisciplinare per lo Studio della Sincope (Multidisciplinary Group for the Study of Syncope; GIMSI) and Academy of Emergency Medicine and Care (AcEMC). The aim is to define the diagnostic pathway and the management of patients referred to the Emergency Department (ED) for transient loss of consciousness of suspected syncopal cause, which is still unexplained after the initial evaluation. The risk stratification enables the physician to admit, discharge or monitor shortly the patient in the intensive short-stay Syncope Observation Unit (SOU). There are three risk levels of life-threatening events or serious complications (low, moderate, high). Low risk patients can be discharged, while high risk ones should be monitored and treated properly in case of worsening. Moderate risk patients should undergo clinical and instrumental monitoring in SOU, inside the ED. In all these three cases, patients can be subsequently referred to the Syncope Unit for further diagnostic investigations

Priorities for Emergency Department Syncope Research

Study objectives There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of ED-based syncope research. Methods We recruited a multinational panel of syncope experts. A preconference survey identified research priorities, which were refined during and after the conference through an iterative review process. Results There were 31 participants from 7 countries who represented 10 clinical and methodological specialties. High-priority research recommendations were organized around a conceptual model of ED decisionmaking for syncope, and they address definition, cohort selection, risk stratification, and management. Conclusion We convened a multispecialty group of syncope experts to identify the most pressing knowledge gaps and defined a high-priority research agenda to improve the care of patients with syncope in the ED

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

An Adaptive Multi-Scaling Imaging Technique Based on a Fuzzy-Logic Strategy for Dealing with the Uncertainty of Noisy Scattering Data

Inverse scattering data, even though collected in a controlled-environment, are usually corrupted by noise, which strongly affects the effectiveness of the reconstruction techniques because of the intrinsic ill-positioning of the problem. In order to limit the effects of the noise on the retrieval procedure and to fully exploit the information content available from the measurements, an innovative inversion scheme based on the integration of an adaptive multiscale procedure and a fuzzy-logic (FL)-based strategy is proposed. The main goal of the approach is to reduce the complexity of the problem as well as to improve the robustness of the inversion procedure allowing an accurate retrieval of the profile under test. The approach is based on an adaptive, coarse-to-fine successive representation of the unknown object obtained through a sequence of reconstructions where suitable weighting coefficients are defined through a FL. Key elements of the theoretical analysis are given and several numerical examples, concerned with synthetic and experimental test cases, illustrate the consequences of the proposed approach in terms of both resolution accuracy and robustness as well as computational costs. (c) 2007 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works

Fuzzy-Logic Reasoning for Estimating the Reliability of Noisy Data in Inverse Scattering Problems

Inverse scattering data, even though collected in a controlled environment, are usually corrupted by electromagnetic noise, which strongly affects the effectiveness of the reconstruction techniques because of the intrinsic ill-positioning of the problem. In order to limit the effects of the noise on the retrieval procedure and to fully exploit the limited information content available from the measurements, an innovative inversion scheme based on the integration of an adaptive multi-scale procedure and a fuzzy-logic-based decision strategy is proposed. The approach is based on an adaptive, coarse-to-fine successive representation of the unknown object obtained through a sequence of nonlinear reconstructions where suitable weighting coefficients are defined using fuzzy logic. Numerical examples from synthetic and experimental test cases are given to illustrate the advantages brought by the proposed approach in terms of reconstruction quality

Enhancement of the Contrast Source Inversion Method Using Fuzzy Logic

The problem of determining the proprieties of an unknown object by means of electromagnetic waves probing the object is intrinsically instable with respect to the presence of noise and measurement errors on scattering data. In several practical condition in the framework of medical imaging, non-destructive testing, and sub-surface inspection, these errors are unavoidable and the ill-posedness of the system leads to inaccurate reconstructions of the scenario under test. In [1], an innovative fuzzy-logic-based strategy has been proposed for properly taking into account the presence of the noise and errors on the data. Such a system provides, in an unsupervised way, two series of coefficients that can be used as weighting parameters of the arising cost function to be minimized. In that paper, the mathematical formulation was presented considering the contrast and the fields equations. In this work, a further assessment of the proposed fuzzy-logic approach is carried out operating with data and state equations expressed in terms of the contrast and the contrast sources as suggested in [2]. Selected results from the numerical simulations are reported to assess the performances of the system with single and multi-frequency data with and without total-variation-based regularization. This is the author's version of the final version available at IEEE

Assessment of the Reliability and Exploitation of the Information Content of Inverse Scattering Data through a Fuzzy-Logic-Based Strategy - Preliminary Results

The presence of the noise in the measured data should be carefully considered in inverse scattering methodologies, because of the intrinsic ill-conditioning of the problem. To limit the effects of the noise on the retrieval procedure, this paper presents an innovative fuzzy-logic-based approach. The proposed strategy allows one to take into account the corrupted nature of the data by fully exploiting all the available information content of the measurements. Selected synthetic and experimental test cases are considered for assessing the effectiveness of the proposed approach also in comparison with a reference inverse scattering technique