Regenera+.uy: Designing a Co-Innovation Process to Apply the Principles of Regenerative Livestock Production

Consumers around the world are beginning to demand products whose production systems have environmental guarantees. Among them, those derived from regenerative agriculture have a growing demand in many markets. A comprehensive environmental assessment was carried out in 9 case studies of mixed livestock production farms (cattle and sheep) in Uruguay as a basis for the development of a system redesign process following the principles of regenerative agriculture. The results show that emission intensity was 16.0, 10.5, and 49.2 kg CO2 eq kg-1 of beef, sheep meat, and greasy wool, respectively. Also, a simulation exercise shows a significative reduction of emission through animal genetic improvement. Soil carbon stocks (59.6 to 93.6 Mg ha-1) and the different level of biodiversity assessment show a very good situation with an Ecosystem Integrity Index above 3.5, which implies more a necessity to conserve rather than regenerate. Considering this analysis, the path that farmers begin to walk following the principles of regenerative agriculture is a challenge towards maximizing biological efficiency and environmental optimization through process technology application. All these indicators and the recommended good management practices will integrate into a protocol for making verifiable the prosses and the results

New treatment bundles improve survival in out-of-hospital cardiac arrest patients : a historical comparison

Introduction: Before the introduction of the new international cardiac arrest treatment guidelines in 2005, patients with out-of-hospital cardiac arrest (OHCA) of cardiac origin in Northern Italy had very poor prognosis. Since 2006, a new bundle of care comprising use of automated external defibrillators (AEDs) and therapeutic hypothermia (TH) was started, while extracorporeal CPR program (ECPR) for selected refractory CA and dispatcher-assisted cardio-pulmonary resuscitation (CPR) was started in January 2010. Objectives: We hypothesized that a program of bundled care might improve outcome of OHCA patients. Methods: We analyzed data collected in the OHCA registry of the MB area between September 2007 and August 2011 and compared this with data from 2000 to 2003. Results: Between 2007 and 2011, 1128 OHCAs occurred in the MB area, 745 received CPR and 461 of these had a CA of presumed cardiac origin. Of these, 125 (27%) achieved sustained ROSC, 60 (13%) survived to 1 month, of whom 51 (11%) were discharged from hospital with a good neurological outcome (CPC. 64. 2), and 9 with a poor neurological outcome (CPC. >. 2).Compared with data from the 2000 to 2003 periods, survival increased from 5.6% to 13.01% (p<. 0.0001). In the 2007-2011 group, low-flow time and bystander CPR were independent markers of survival. Conclusions: OHCA survival has improved in our region. An increased bystander CPR rate associated with dispatcher-assisted CPR was the most significant cause of increased survival, but duration of CA remains critical for patient outcome

End-tidal carbon dioxide (ETCO2) and ventricular fibrillation amplitude spectral area (AMSA) for shock outcome prediction in out-of-hospital cardiac arrest. Are they two sides of the same coin?

Aim: Ventricular fibrillation amplitude spectral area (AMSA) and end-tidal carbon dioxide (ETCO2) are predictors of shock success, understood as restoration of an organized rhythm, and return of spontaneous circulation (ROSC). However, little is known about their combined use. We aimed to assess the prediction accuracy when combined, and to clarify if they are correlated in out of hospital cardiac arrest' victims. Materials and Methods: Records acquired by external defibrillators in out-of-hospital cardiac arrest patients of the Lombardia Cardiac Arrest registry were processed. The 1-min pre-shock ETCO2 median value (METCO2) was computed from the capnogram and AMSA (2\u201348 mV.Hz range) computed applying the Fast Fourier Transform to a 2-second pre-shock filtered ECG interval (0.5 1230 Hz). Support Vector Machine (SVM) predictive models based on METCO2, AMSA and their combination were fit; results were given as the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. Results: We considered 112 patients with 391 shocks delivered. METCO2 and AMSA were predictors of shock success [AUC (IQR) of the ROC curve: 0.59 (0.56 120.62); 0.68 (0.65 120.72), respectively] and of ROSC [0.56 (0.53 120.59); 0.74 (0.71 120.78),]. Their combination in a SVM model increased the accuracy for predicting shock success [AUC (IQR) of the ROC curve: 0.71 (0.68 120.75)] and ROSC [0.77 (0.73 120.8)]. AMSA and METCO2 were significantly correlated only in patients who achieved ROSC (rho = 0.33 p = 0.03). Conclusions: AMSA and ETCO2 predict shock success and ROSC after every shock, and their predictive power increases if combined. Notably, they were correlated only in patients who achieved ROSC