The Impact of Act 148 on Food-Insecure Populations in Chittenden and Essex Counties of Vermont

It is estimated that as much as 40% of the food produced in the United States goes to waste (Hall, Guo, Dore, & Chow, 2009), and much is still edible when it is disposed of. Simultaneously, the United States faces significant food insecurity, with an estimated 12.7% of the population meeting the criteria in 2015 (Coleman-Jensen, Rabbit, Gregory, & Singh, 2016). In 2012, Vermont passed the Universal Recycling of Solid Waste Act, or Act 148, which bans recyclable materials from landfills by 2020 by mandating their recovery (VT DEC, 2014). Because the law includes edible food waste and prioritizes food donation, it has the potential to increase donations to food-recovery and -distribution programs. I evaluate whether or not Act 148 has led to increased food donations; if so, whether its impact has been equal in diverse regions of the state; and if an increase in food availability has resulted in increased food access. I compare Chittenden and Essex counties, which differ greatly in population size and density, urban development, and rates of food insecurity, through a series of semi-structured interviews with directors of food-aid organizations in both counties. Of the generally larger and well-supported Chittenden organizations, 100% had heard of Act 148 and 75% had seen increases in donations as a result. The smaller organizations in Essex, serving populations with higher food insecurity, had seen no changes since the law’s implementation. These findings lead to the conclusion that the impact has not been equal across the state and has not affected the most food-insecure populations

Duration of remission after halving of the etanercept dose in patients with ankylosing spondylitis: a randomized, prospective, long-term, follow-up study

Fabrizio Cantini, Laura Niccoli, Emanuele Cassarà, Olga Kaloudi, Carlotta NanniniDivision of Rheumatology, Misericordia e Dolce Hospital, Prato, ItalyBackground: The aim of this study was to evaluate the proportion of patients with ankylosing spondylitis maintaining clinical remission after reduction of their subcutaneous etanercept dose to 50 mg every other week compared with that in patients receiving etanercept 50 mg weekly.Methods: In the first phase of this randomized, prospective, follow-up study, all biologic-naïve patients identified between January 2005 and December 2009 as satisfying the modified New York clinical criteria for ankylosing spondylitis treated with etanercept 50 mg weekly were evaluated for disease remission in January 2010. In the second phase, patients meeting the criteria for remission were randomized to receive subcutaneous etanercept as either 50 mg weekly or 50 mg every other week. The randomization allocation was 1:1. Remission was defined as Bath Ankylosing Spondylitis Disease Activity Index < 4, no extra-axial manifestations of peripheral arthritis, dactylitis, tenosynovitis, or iridocyclitis, and normal acute-phase reactants. The patients were assessed at baseline, at weeks 4 and 12, and every 12 weeks thereafter. The last visit constituted the end of the follow-up.Results: During the first phase, 78 patients with ankylosing spondylitis (57 males and 21 females, median age 38 years, median disease duration 12 years) were recruited. In January 2010, after a mean follow-up of 25 ± 11 months, 43 (55.1%) patients achieving clinical remission were randomized to one of the two treatment arms. Twenty-two patients received etanercept 50 mg every other week (group 1) and 21 received etanercept 50 mg weekly (group 2). At the end of follow-up, 19 of 22 (86.3%) subjects in group 1 and 19 of 21 (90.4%) in group 2 were still in remission, with no significant difference between the two groups. The mean follow-up duration in group 1 and group 2 was 22 ± 1 months and 21 ± 1.6 months, respectively.Conclusion: Remission of ankylosing spondylitis is possible in at least 50% of patients treated with etanercept 50 mg weekly. After halving of the etanercept dose, remission is maintained in a high percentage of patients during long-term follow-up, with important economic implications.Keywords: ankylosing spondylitis, anti-tumor necrosis factor, etanercept, remission, dose reductio

Thalidomide: Focus on its employment in rheumatologic diseases

Thalidomide is an immunomodulatory agent; although its mechanisms of action are not fully understood, many authors have described its anti-inflammatory and immunosuppressive properties. More interestingly, thalidomide has shown the ability to suppress tumor necrosis factor alpha (TNFα) production and to modify the expression of TNFα induced adhesion molecules on endothelial cells and on human leukocytes. Thalidomide has been used in several diseases (i.e. dermatological, autoimmune, gastrointestinal). In this review we focus specifically on the use of this drug in disorders with rheumatological features such as lupus erythematosus, rheumatoid arthritis and Still's disease, ankylosing spondylitis, and Behçet's disease. Despite its well known side effects, first of all peripheral nerve involvement and teratogenesis, which can be avoided by following strict guidelines, thalidomide could represent an alternative drug in some rheumatological conditions, particularly in patients who show resistance, contraindication or toxicity with other conventional treatments

An innovative technique to improve safety of volatile anesthetics suction from the cardiopulmonary bypass circuit

Context: Myocardial injury during cardiac surgery on cardiopulmonary bypass (CPB) is a major determinant of morbidity and mortality. Preclinical and clinical evidence of dose- and time-related cardioprotective effects of volatile anesthetic drugs exist and their use during the whole surgery duration could improve perioperative cardiac protection. Even if administering volatile agents during CPB are relatively easy, technical problems, such as waste gas scavenging, may prevent safe and manageable administration of halogenated vapors during CPB. Aims: The aim of this study is to improve the safe administration of volatile anesthesia during CPB. Settings and Design: Tertiary teaching hospital. Subjects and Methods: We describe an original device that collects and disposes of any volatile anesthetic vapors present in the exit stream of the oxygenator, hence preventing its dispersal into the operating theatre environment and adaptively regulates pressure of oxygenator chamber in the CPB circuit. Results: We have so far applied a prototype of this device in more than 1300 adult cardiac surgery patients who received volatile anesthetics during the CPB phase. Conclusions: Widespread implementation of scavenging system like the one we designed may facilitate the perfusionist and the anesthesiologist in delivering these cardioprotective drugs with beneficial impact on patients' outcome without compromising on safety

The Narcotic Bowel Syndrome: Clinical Features, Pathophysiology, and Management

Narcotic bowel syndrome (NBS) is a subset of opioid bowel dysfunction that is characterized by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of narcotics. This syndrome is under recognized and may be becoming more prevalent. This may be due in the United States to increases in using narcotics for chronic non-malignant painful disorders, and the development of maladaptive therapeutic interactions around its use. NBS can occur in patients with no prior gastrointestinal disorder who receive high dosages of narcotics after surgery or acute painful problems, among patients with functional GI disorders or other chronic gastrointestinal diseases who are managed by physicians unaware of the hyperalgesic effects of chronic opioids. The evidence for the enhanced pain perception is based on: a) activation of excitatory anti-analgesic pathways within a bimodal opioid regulation system, b) descending facilitation of pain at the Rostral Ventral Medulla and pain facilitation via dynorphin and CCK activation, and c) glial cell activation that produces morphine tolerance and enhances opioid induced pain. Treatment involves early recognition of the syndrome, an effective physician patient relationship, graded withdrawal of the narcotic according to a specified withdrawal program and the institution of medications to reduce withdrawal effects

Human Factors and Simulation in Emergency Medicine

This consensus group from the 2017 Academic Emergency Medicine Consensus Conference Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes held in Orlando, Florida, on May 16, 2017, focused on the use of human factors (HF) and simulation in the field of emergency medicine (EM). The HF discipline is often underutilized within EM but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of HF, its benefits in medicine, how simulation can be a catalyst for HF work in EM, and how EM can collaborate with HF professionals to effect change. Implementing HF in EM through health care simulation will require a demonstration of clinical and safety outcomes, advocacy to stakeholders and administrators, and establishment of structured collaborations between HF professionals and EM, such as in this breakout group

Discovery of a rich proto-cluster at z=2.9 and associated diffuse cold gas in the VIMOS Ultra-Deep Survey (VUDS)

[Abridged] We characterise a massive proto-cluster at z=2.895 that we found in the COSMOS field using the spectroscopic sample of the VIMOS Ultra-Deep Survey (VUDS). This is one of the rare structures at z~3 not identified around AGNs or radio galaxies, so it is an ideal laboratory to study galaxy formation in dense environments. The structure comprises 12 galaxies with secure spectroscopic redshift in an area of 7'x8', in a z bin of Dz=0.016. The measured galaxy number overdensity is delta_g=12+/-2. This overdensity has total mass of M~8.1x10^(14)M_sun in a volume of 13x15x17 Mpc^3. Simulations indicate that such an overdensity at z~2.9 is a proto-cluster that will collapse in a cluster of total mass M~2.5x10^(15)M_sun at z=0. We compare the properties of the galaxies within the overdensity with a control sample at the same z but outside the overdensity. We did not find any statistically significant difference between the properties (stellar mass, SFR, sSFR, NUV-r, r-K) of the galaxies inside and outside the overdensity. The stacked spectrum of galaxies in the overdensity background shows a significant absorption feature at the wavelength of Lya redshifted at z=2.895 (lambda=4736 A), with a rest frame EW = 4+/- 1.4 A. Stacking only background galaxies without intervening sources at z~2.9 along their line of sight, we find that this absorption feature has a rest frame EW of 10.8+/-3.7 A, with a detection S/N of ~4. These EW values imply a high column density (N(HI)~3-20x10^(19)cm^(-2)), consistent with a scenario where such absorption is due to intervening cold gas streams, falling into the halo potential wells of the proto-cluster galaxies. However, we cannot exclude the hypothesis that this absorption is due to the diffuse gas within the overdensity.Comment: 15 pages, 9 figures, accepted for publication in A&A (revised version after referee's comments and language editing

The Lyman Continuum escape fraction of galaxies at z=3.3 in the VUDS-LBC/COSMOS field

The Lyman continuum (LyC) flux escaping from high-z galaxies into the IGM is a fundamental quantity to understand the physical processes involved in the reionization epoch. We have investigated a sample of star-forming galaxies at z~3.3 in order to search for possible detections of LyC photons escaping from galaxy halos. UV deep imaging in the COSMOS field obtained with the prime focus camera LBC at the LBT telescope was used together with a catalog of spectroscopic redshifts obtained by the VIMOS Ultra Deep Survey (VUDS) to build a sample of 45 galaxies at z~3.3 with L>0.5L*. We obtained deep LBC images of galaxies with spectroscopic redshifts in the interval 3.27<z<3.40 both in the R and deep U bands. A sub-sample of 10 galaxies apparently shows escape fractions>28% but a detailed analysis of their properties reveals that, with the exception of two marginal detections (S/N~2) in the U band, all the other 8 galaxies are most likely contaminated by the UV flux of low-z interlopers located close to the high-z targets. The average escape fraction derived from the stacking of the cleaned sample was constrained to fesc_rel<2%. The implied HI photo-ionization rate is a factor two lower than that needed to keep the IGM ionized at z~3, as observed in the Lyman forest of high-z QSO spectra or by the proximity effect. These results support a scenario where high redshift, relatively bright (L>0.5L*) star-forming galaxies alone are unable to sustain the level of ionization observed in the cosmic IGM at z~3. Star-forming galaxies at higher redshift and at fainter luminosities (L<<L*) can be the major contributors to the reionization of the Universe only if their physical properties are subject to rapid changes from z~3 to z~6-10. Alternatively, ionizing sources could be discovered looking for fainter sources among the AGN population at high-z.Comment: 21 pages, 9 figures. Accepted for publication in A&