Life Cycle Analysis and Transportation Energy

As government actors and the private sector attempt to decarbonize the economy, the role of life cycle analysis (also know as life cycle assessment or LCA) has become increasingly important. In this essay, we explore the use of life cycle analysis in the transportation sector to assess its influence in federal and state policy efforts to move to a low-carbon energy future. We first define life cycle analysis and explain its use in evaluating the environmental impacts of all stages of a product from production, to use, to disposal. We then review the use of life cycle analysis in considering the carbon emissions associated with different types of biofuels, particularly ethanol, which now makes up 10% of every gallon of gasoline sold in the United States as result of federal mandates. We then discuss the increasing application of life cycle analysis to electric vehicles (EVs), which compares the greenhouse gas emissions associated with the production, use, and disposal of EVs with conventional automobiles, and evaluates the sources of electricity used to power EVs in different parts of the country. We conclude by reflecting on the ways in which life cycle analysis can be used effectively to guide policymakers to incentivize the development of environmentally beneficial products and technologies. For instance, if today’s life cycle analysis had been used to evaluate corn ethanol in the 1990s and early 2000s, policymakers may have paused before creating the significant incentives and mandates that continue to support a fuel that many experts consider to be more environmentally harmful than petroleum. At the same time, however, there are risks in relying too heavily on life cycle analysis when information gaps exist in comparing alternative fuels and vehicles with traditional fuels and vehicles. Such information deficits may result in creating disincentives for potentially beneficial new products and technologies that, with sufficient support, may be critical to meeting decarbonization goals in the transportation sector and the economy as a whole

Ⅵ PAIN AND REGIONAL ANESTHESIA Fascia Iliaca Compartment Blockade for Acute Pain Control in Hip Fracture Patients A Randomized, Placebo-controlled Trial

Background: Hip fracture patients are in severe pain upon arrival at the emergency department. Pain treatment is traditionally based on systemic opioids. No study has examined the effect of fascia iliaca compartment blockade (FICB) in acute hip fracture pain management within a double-blind, randomized setup. Methods: Forty-eight patients with suspected hip fracture were included immediately after arrival in the emergency department, before x-ray confirmation of their fracture. Included patients were randomly assigned to two groups of 24. In the FICB group, the patients received an FICB with 1.0% mepivacaine and a placebo intramuscular injection of isotonic saline. In the morphine group, the patients received a placebo FICB with 0.9% saline and an intramuscular injection of 0.1 mg/kg morphine. Patients received intravenous rescue morphine when necessary. Results: Maximum pain relief was superior in the FICB group both at rest (P < 0.01) and on movement (P ‫؍‬ 0.02). The median total morphine consumption was 0 mg (interquartile range, 0 -0 mg) in the FICB group and 6 mg (interquartile range, 5-7 mg) in the morphine group (P < 0.01). More patients (P ‫؍‬ 0.05) were sedated in the morphine group at 180 min after block placement as compared with the FICB group. Conclusion: Pain relief was superior at all times and at all measurements in the FICB group. The study supports the use of FICB in acute management of hip fracture pain because it is an effective, easily learned procedure that also may reduce opioid side effects in this fragile, elderly group of patients

Thresholds for conjugated hyperbilirubinaemia and hepatobiliary scintigraphy in biliary atresia:A 12-year national follow-up

Aim: To investigate liver biochemistry in infants screened for biliary atresia (BA) at the time of hepatobiliary scintigraphy (HS) and to evaluate the effect of change in threshold for HS. Methods: Infants born from 2010 to 2021, who underwent HS &lt;6 months postpartum for BA, were included and data sourced from electronic medical records. The change in threshold in 2018 from ≥20 (and/or if conjugated bilirubin exceeds 20% of total bilirubin) to ≥17 μM (regardless of total bilirubin) was evaluated. Results: In the cohort of 635 infants, 48 had BA, 247 had AATD, and the remaining 343 were categorised as ‘other’. After the threshold adjustment, HS timing was unaffected (p = 0.27), but the annual HS rate rose from 39 to 87, yet evaluations following the new guideline only accounted for 12%. All liver parameters were elevated in the BA group compared with the additional groups (p &lt; 0.001). Amongst the 104 patients with non-excretory HS, gamma-glutamyl transferase (p &lt; 0.001) and alanine aminotransferase (p = 0.002) remained elevated for BA. The lowest conjugated bilirubin measured in BA children was 36 μM. Conclusion: After threshold change, HS use increased without earlier BA diagnostics, but most were not due to the new guideline. Alanine aminotransferase and gamma-glutamyl transferase should be considered in BA diagnostics.</p

Fra-1 controls motility of bladder cancer cells via transcriptional upregulation of the receptor tyrosine kinase AXL

Fos-related antigen 1 (Fra-1) is a Fos family member overexpressed in several types of human cancers. Here, we report that Fra-1 is highly expressed in the muscle-invasive form of the carcinoma of the bladder (80%) and to a lesser extent in superficial bladder cancer (42%). We demonstrate that in this type of cancer Fra-1 is regulated via a C-terminal instability signal and C-terminal phosphorylation. We show that manipulation of Fra-1 expression levels in bladder cancer cell lines affects cell morphology, motility and proliferation. The gene coding for AXL tyrosine kinase is directly upregulated by Fra-1 in bladder cancer and in other cell lines. Importantly, our data demonstrate that AXL mediates the effect of Fra-1 on tumour cell motility but not on cell proliferation. We suggest that AXL may represent an attractive therapeutic target in cancers expressing high Fra-1 level

Platelet transfusion in neonatal intensive care units of 22 European countries: a prospective observational study

Background: Platelet transfusions are given to preterm infants with severe thrombocytopenia aiming to prevent haemorrhage. The PlaNeT2/MATISSE trial revealed higher rates of mortality and/or major bleeding in preterm infants receiving prophylactic platelet transfusions at a platelet count threshold of 50 × 109/L compared to 25 × 109/L. The extent to which this evidence has been incorporated into clinical practice is unknown, thus we aimed to describe current neonatal platelet transfusion practices in Europe. Methods: We performed a prospective observational study in 64 neonatal intensive care units across 22 European countries between September 2022 and August 2023. Outcome measures included observed transfusion prevalence rates (per country and overall, pooled using a random effects Poisson model), expected rates based on patient-mix (per country, estimated using logistic regression), cumulative incidence of receiving a transfusion by day 28 (with death and discharge considered as competing events), transfusion indications, volumes and infusion rates, platelet count triggers and increment, and adverse effects. Findings: We included 1143 preterm infants, of whom 71 (6.2%, [71/1143]) collectively received 217 transfusions. Overall observed prevalence rate was 0.3 platelet transfusion days per 100 admission days. By day 28, 8.3% (95% CI: 5.5–11.1) of infants received a transfusion. Most transfusions were indicated for threshold (74.2%, [161/217]). Pre-transfusion platelet counts were above 25 × 109/L in 33.1% [53/160] of these transfusions. There was significant variability in volume and duration. Interpretation: The restrictive threshold of 25 × 109/L is being integrated into clinical practice. Research is needed to explore existing variation and generate evidence for various aspects including optimal volumes and infusion rates. Funding:Sanquin,EBA, andESPR