Business models and supply chains for the circular economy

The Circular Economy is increasingly seen as a possible solution to address sustainable development. An economic system that minimises resource input into and waste, emission, and energy leakage out of the system is hoped to mitigate negative impacts without jeopardising growth and prosperity. This paper discusses the sustainability performance of the circular business models (CBM) and circular supply chains necessary to implement the concept on an organisational level and proposes a framework to integrate circular business models and circular supply chain management towards sustainable development. It was developed based on literature analysis and four case studies. The proposed framework shows how different circular business models are driving circular supply chain in different loops: closing loops, slowing loops, intensifying loops, narrowing loops, and dematerialising loops. The identified circular business models vary in complexity of the circular supply chain and in the value proposition. Our research indicates circular business and circular supply chain help in realising sustainability ambitions.This work was supported by the EPSRC Centre for Innovative Manufacturing in Industrial Sustainability [grant number EP/I033351/1

A challenging coexistence of central diabetes insipidus and cerebral salt wasting syndrome: A case report

Background: Combined central diabetes insipidus and cerebral salt wasting syndrome is a rare clinical finding. However, when this happens, mortality is high due to delayed diagnosis and/or inadequate treatment. Case presentation: A 42-year-old white man was referred to neurosurgery due to a non-functional pituitary macroadenoma. He underwent a partial resection of the tumor on July 2, 2015. On the day following surgery he presented polyuria with sodium 149 mEq/L, plasma osmolality 301 mOsm/kg, and urine osmolality 293 mOsm/kg. He started nasal desmopressin 0.05 mg/day with good response. He was already on dexamethasone 4 mg and levothyroxine 75 mcg due to hypopituitarism after surgery. On July 9 he became confused. Cerebral computed tomography was performed with no significant changes. His natremia dropped to 128 mEq/L with development of polyuria despite maintenance of desmopressin dose. His hemoglobin and hematocrit rose from 9.1 g/L to 11.6 g/L and 27.5 to 32.5, respectively. His thyroid function was normal and he was on hydrocortisone 30 mg/day. At 12 p.m. 150 mg/hydrocortisone infusion was initiated, but sodium did not increase. Plasma and urine osmolality were 264 mOsm/kg and 679 mOsm/kg, respectively. At 4 p.m. hydrocortisone was increased and hypertonic saline replacement started. Two hours later he was dehydrated with polyuria and vomiting, and natremia of 124 mEq/L. Hyponatremia was very resistant to treatment despite hypertonic saline replacement, hence desmopressin was suspended. The following day, urine spot analysis showed that natriuresis was 63 mEq/L with serum sodium 132 mEq/L. This was interpreted as a cerebral salt wasting syndrome and control was achieved with aggressive hypertonic saline replacements and fludrocortisone 0.1 mg/three times a day. Conclusions: We present a rare case of a patient with diabetes insipidus and cerebral salt wasting syndrome, who was successfully treated. Hyponatremia in a patient with diabetes insipidus may erroneously be interpreted as inadequate diabetes insipidus control or as syndrome of inappropriate antidiuretic hormone secretion, leading to therapeutic errors. Thus, all clinical and analytical data should be evaluated together for early and correct diagnosis

Advances on Bacterial and Fungal Biofilms for the Production of Added-Value Compounds

Simple Summary The production of bio-based materials, including organic acids, antibiotics, enzymes, ethanol, and hydrogen, is generally done by the cultivation of suspended cells rather than using immobilized cells. However, several studies suggest the application of productive biofilms as a reliable alternative for biocatalysis, with many advantages over suspended-growth systems. This review gives an overview of the breakthrough in the application of biofilm platforms for the sustainable production of valuable compounds, with particular insight into the latest advances in the production of recombinant proteins. Productive biofilms are shown to improve production rates and product yields, demonstrating great potential for industrial applications. In recent years, abundant research has been performed on biofilms for the production of compounds with biotechnological and industrial relevance. The use of biofilm platforms has been seen as a compelling approach to producing fine and bulk chemicals such as organic acids, alcohols, and solvents. However, the production of recombinant proteins using this system is still scarce. Biofilm reactors are known to have higher biomass density, operational stability, and potential for long-term operation than suspended cell reactors. In addition, there is an increasing demand to harness industrial and agricultural wastes and biorefinery residues to improve process sustainability and reduce production costs. The synthesis of recombinant proteins and other high-value compounds is mainly achieved using suspended cultures of bacteria, yeasts, and fungi. This review discusses the use of biofilm reactors for the production of recombinant proteins and other added-value compounds using bacteria and fungi

Optimal dimensioning model of water distribution systems

This study is aimed at developing a pipe-sizing model for a water distribution system. The optimal solution minimises the system’s total cost, which comprises the hydraulic network capital cost, plus the capitalised cost of pumping energy. The developed model, called Lenhsnet, may also be used for economical design when expanding existing hydraulic networks. The methodology developed includes an iterative dynamic calculation process as well as a hydraulic simulation model. The performance of the method is tested against 4 benchmark examples in the literature. The results obtained show the feasibility of this model, presenting it as a viable alternative for water distribution systems. The method is easily used, once it is performed under EPANET2 software interface

Estrogen receptor, progesterone receptor, and bcl-2 are markers with prognostic significance in CIN III

There are no known biological markers or technologies to predict the natural history of an individual CIN III. The probability of progression is considered greater with the persistence of high-risk human papillomavirus (HPV) infection and age. p53 polymorphism has been associated with cervical carcinogenesis. Hormone-induced cervical cancer is mediated by estrogen receptor (ER) and progesterone receptor (PR). In cervical cancer, increased bcl-2 and Bax immunoreactivity is generally associated with a better prognosis. The purpose of this study was to evaluate the value of HPV 16 and HPV 18 typing and p53 codon polymorphism genotyping by polymerase chain reaction and ER, PR, bcl-2, and Bax expression by immunohistochemistry in predicting the CIN III clinical behavior of CIN III lesions. We studied the expression of these prognostic factors in the CIN III adjacent to squamous cell microinvasive carcinomas of the cervix (MIC) from 29 patients with FIGO stage IA1 cervical cancer and in 25 patients with CIN III and no documented focus of invasion. In the MIC group, only the CIN III was considered at least 2 mm away from the microinvasive complex. The ER, PR, bcl-2, and Bax immunoreactivity was scored as positive (>10% staining cells) and negative (<10% staining cells). No significant difference was observed between MIC and CIN III group concerning HPV infection and p53 polymorphism. The ER, PR, bcl-2, and Bax immunohistochemical expression was stronger and more frequent in the CIN III group. After multivariable analysis, coexpression of ER, PR, and bcl-2 was the only independent factor in defining low risk of progression for CIN III. Our study suggests that coexpression of ER, PR, and bcl-2 may be a useful tool in identifying the CIN III lesions with low risk of progression to cervical cance

Inducibility of Atrial Fibrillation During Electrophysiologic Evaluation is Associated with Increased Dispersion of Atrial Refractoriness

The impact of atrial dispersion of refractoriness (Disp_A) in the inducibility and maintenance of atrial fibrillation (AF) has not been fully resolved. AIM: To study the Disp_A and the vulnerability (A_Vuln) for the induction of self-limited (<60 s) and sustained episodes of AF. METHODS AND RESULTS: Forty-seven patients with paroxysmal AF (PAF): 29 patients without structural heart disease and 18 with hypertensive heart disease. Atrial effective refractory period (ERP) was assessed at five sites--right atrial appendage and low lateral right atrium, high interatrial septum, proximal and distal coronary sinus. We compared three groups: group A - AF not inducible (n=13); group B - AF inducible, self-limited (n=18); group C - AF inducible, sustained (n=16). Age, lone AF, hypertension, left atrial and left ventricular (LV) dimensions, LV systolic function, duration of AF history, atrial flutter/tachycardia, previous antiarrhythmics, and Disp_A were analysed with logistic regression to determine association with A_Vuln for AF inducibility. The ERP at different sites showed no differences among the groups. Group A had a lower Disp_A compared to group B (47+/-20 ms vs 82+/-65 ms; p=0.002), and when compared to group C (47+/-20 ms vs 80+/-55 ms; p=0.008). There was no significant difference in Disp_A between groups B and C. By means of multivariate regression analysis, the only predictor of A_Vuln was Disp_A (p=0.04). Conclusion: In patients with PAF, increased Disp_A represents an electrophysiological marker of A_Vuln. Inducibility of both self-limited and sustained episodes of AF is associated with similar values of Disp_A. These findings suggest that the maintenance of AF is influenced by additional factors

Comparative fitness analysis of D-cycloserine resistant mutants reveals both fitness-neutral and high-fitness cost genotypes

Drug resistant infections represent one of the most challenging medical problems of our time. D-cycloserine is an antibiotic used for six decades without significant appearance and dissemination of antibiotic resistant strains, making it an ideal model compound to understand what drives resistance evasion. We therefore investigated why Mycobacterium tuberculosis fails to become resistant to D-cycloserine. To address this question, we employed a combination of bacterial genetics, genomics, biochemistry and fitness analysis in vitro, in macrophages and in mice. Altogether, our results suggest that the ultra-low rate of emergence of D-cycloserine resistance mutations is the dominant biological factor delaying the appearance of clinical resistance to this antibiotic. Furthermore, we also identified potential compensatory mechanisms able to minimize the severe fitness costs of primary D-cycloserine resistance conferring mutations

Mineralocorticoid receptor antagonists eplerenone and spironolactone modify adrenal cortex morphology and physiology

Mineralocorticoid receptor antagonists (MRAs) are a class of anti-hypertensive drugs that act by blocking aldosterone action. The aim of this study was to evaluate whether the MRAs spironolactone and eplerenone influence adrenal cortical physiology and morphology. Spontaneous hypertensive rats (SHR, n = 18) and normotensive rats (WKY, n = 18) were randomly exposed to a daily dose of spironolactone (n = 6), eplerenone (n = 6), or no drug (n = 6) over 28 days. After that, aldosterone, corticosterone, and 11-deoxycorticosterone plasma concentrations were quantified. Adrenal glands were subjected to morphological analysis to assess lipid droplets content, capsular width, cell proliferation, and steroidogenic proteins expression. The adrenal cortex in untreated SHR showed higher lipid droplet content as than in WKY. In SHR, MRA treatment was associated with higher circulating aldosterone levels and Ki-67 expression in aldosterone-secreting cells. In WKY, the only difference observed after MRA spironolactone treatment was a narrower capsule. There was no difference in abundance of steroidogenic enzyme between groups. In conclusion, MRAs modify adrenal gland function and morphology in SHR. The effects observed within the adrenal glomerulosa with aldosterone-secreting cell proliferation and higher circulating aldosterone levels suggests that MRA treatment provokes activation of the renin angiotensin system. The prognostic value of hyperaldosteronism secondary to MRAs blockade requires further investigation.Funding: This research was funded by the Associação dos Amigos do Serviço de Endocrinologia do Hospital de São João (2020–2021). Unit for Multidisciplinary Research in Biomedicine (UMIB) is funded by the Foundation for Science and Technology (FCT)-Portugal (UIDB/00215/2020 and UIDP/00215/2020—approval date: 2019)

Predicting nursing leadership roles of patient safety in the operating room

Objetivo: identificar a liderança percecionada pelos enfermeiros perioperatórios e determinar os papéis de liderança preditores da segurança do doente no bloco operatório. Método: estudo descritivo e explicativo numa amostra de 1.001 enfermeiros, com recurso ao questionário de segurança do doente no bloco operatório e ao instrumento de liderança de Quinn adaptado à saúde. No tratamento de dados utilizou-se a aplicação IBM SPSS Statistics, versão 25.0. Resultado: todas as dimensões de liderança obtiveram valor superior ao ponto médio da escala (M>4). Observado um valor mínimo no papel de Inovador (M=4,63) e máximo no Produtor (M=5,04). Os modelos de regressão permitiram salientar que os papéis de liderança são preditores da segurança do doente no bloco operatório, destacando-se os papéis Monitor, Produtor e Facilitador. Conclusão: os enfermeiros perioperatórios têm perceção moderadamente positiva do exercício da liderança, indiciando a necessidade de se promover o desenvolvimento dos diferentes papéis de liderança exercidos pelos enfermeiros gestores perioperatórios.Objective: to identify the leadership perceived by perioperative nurses and to determine the role of leadership predictors of patient safety in the operating room. Method: descriptive and explanatory study in a sample of 1,001 nurses, using the patient safety questionnaire in the operating room and Quinn’s leadership instrument adapted to health. The IBM SPSS Statistics application, version 25.0, was used in the data processing. Result: all leadership dimensions were higher than the midpoint of the scale (M>4). A minimum value was observed in the role of Innovator (M=4.63) and maximum in the Producer (M=5.04). The regression models allowed pointing out that leadership roles are predictors of patient safety in the operating room, especially the roles Monitor, Producer and Facilitator. Conclusion: perioperative nurses have moderately positive perception of leadership exercise, indicating the need to promote the development of different leadership roles exercised by perioperative management nurses.Objetivo: identificar el liderazgo percebido por las enfermeras perioperatorias y determinar el papel de los predictores de liderazgo de la seguridad del paciente en el quirófano. Método: estudio descriptivo y explicativo en una muestra de 1.001 enfermeras, utilizando el cuestionario de seguridad del paciente en el quirófano y el instrumento de liderazgo de Quinn adaptado a la salud. La aplicación IBM SPSS Statistics, versión 25.0, se utilizó en el procesamiento de datos. Resultado: todas las dimensiones de liderazgo fueron superiores al punto medio de la escala (M>4). Se observó un valor mínimo en el rol de Innovador (M=4,63) y máximo en el Productor (M=5,04). Los modelos de regresión permitieron señalar que los roles de liderazgo son predictores de la seguridad del paciente en el quirófano, especialmente los roles Monitor, Productor y Facilitador. Conclusión: las enfermeras perioperatorias tienen una percepción moderadamente positiva del ejercicio de liderazgo, indicando la necesidad de promover el desarrollo de diferentes roles de liderazgo ejercidos por las enfermeras administradoras de quirofanoinfo:eu-repo/semantics/publishedVersio