A conceptual and empirical framework to analyze the economics of consumer food waste

We develop a microeconomic model to understand food waste of consumers. We capture at-home and away-from home food consumption and distinguish between food purchases and food consumption. We allow the consumer to choose the rate of food waste at home optimally to maximize her utility. We show that consumer purchases can decline or increase with a cut in the rate of consumer waste, depending on the elasticity of food demand. Using the UK data for poultry in 2012, we also show a case where for a price elastic demand food consumption increases with a reduction in the food waste rate, but food purchases (retail sales) increase

Echo rozwiązuje kliniczną zagadkę — opis przypadku amyloidozy serca

We present the case of a 53-year-old woman with New York Heart Association (NYHA) class III heart failure, despite optimal pharmacological therapy. Her medical history included: myocardial infarction with nonobstructive coronary arteries (MINOCA), heart failure with reduced ejection fraction and quadrantanopia with sensory neuropathy diagnosed as ischaemic stroke. Transthoracic echocardiography showed significant left ventricular hypertrophy with a ‘granular’ myocardial texture, global systolic dysfunction and restrictive mitral filling pattern. Two-dimensional (2D) transthoracic echo strain analysis demonstrated decreased global longitudinal strain with apical sparing, and helped to fit all the pieces of the jigsaw together to reach a consistent clinical diagnosis of cardiac amyloidosis.Przedstawiono opis przypadku 53-letniej kobiety z obniżoną tolerancją wysiłku fizycznego w III klasie czynnościowej według New York Heart Association (NYHA), mimo optymalnej farmakoterapii. W wywiadzie stwierdzono: przebyty zawał serca bez istotnych zmian w nasierdziowych tętnicach wieńcowych (MINOCA), niewydolność serca z obniżoną frakcją wyrzutową lewej komory oraz niedowidzenie kwadrantowe z neuropatią czuciową zdiagnozowane jako udar niedokrwienny mózgu. W echokardiograficznym badaniu przezklatkowym (TTE) uwidoczniono „ziarnistą” strukturę oraz znaczny przerost mięśnia sercowego lewej komory, uogólnioną dysfunkcję skurczową oraz restrykcyjny profil napływu mitralnego. Analiza dwuwymiarowa (2D) TTE wykazała zmniejszenie globalnego odkształcenia podłużnego z lepszą funkcją w obrębie koniuszka. Charakterystyczny obraz echokardiograficzny przyczynił się do złożenia wszystkich elementów klinicznych w diagnozę amyloidozy serca

Prevention of thromboembolic complications — the significance of novel oral anticoagulants in cardiology

Stosowane od dziesięcioleci leki przeciwza­krzepowe z grupy antagonistów witaminy K (VKA; acenokumarol i warfaryna — od 1954 r.) są farmaceutykami o późnym początku dzia­łania, wąskim zakresie terapeutycznym, licznych interakcjach lekowych oraz pokarmowych i wymagają prowadzenia terapii pod kontrolą międzynarodowego wskaźnika znormalizowa­nego (INR). Udokumentowano znaczne różnice między poszczególnymi pacjentami i ośrodkami dotyczące wskaźnika TTR — odsetka czasu leczenia, w jakim INR pozostaje w zakresie terapeutycznym, który determinuje zarówno skuteczność, jak i bezpieczeństwo terapii. W codziennej praktyce klinicznej wskaźnik ten osiąga wartości (ok. 44%) znacznie niższe niż TTR (66%) opisywany w grupach pacjentów włączanych do badań randomizowanych. Te trudności znacznie ograniczają możliwości stosowania VKA w coraz liczniejszej i starzejącej się populacji chorych wymagających doustnej antykoagulacji; ocenia się, że leczeniu przeciwzakrzepowemu nie jest poddanych nawet do 40% pacjentów, u których występują do tego wskazania. Z kolei heparyny niefrakcjonowana i drobnocząsteczkowe wymagają podawania w postaci iniekcji, a stosowane przewlekle zwiększają ryzyko osteoporozy. Nowe doustne antykoagulanty (NOAC) to bezpośrednie inhibitory trombiny oraz bezpośrednie inhibitory aktywnego czynnika X kaskady krzepnięcia. Oprócz szybkiego początku działania zapewniają większą przewidywalność efektu przeciwkrzepliwego, na ogół niewymagającego monitorowania. Początkowo przetestowano je w zakrzepicy żylnej i zatorowości płucnej, a następnie potwierdzono ich skuteczność w prewencji zatorowości systemowej u pacjentów z niezastawkowym migotaniem przedsionków. Zastosowanie nowych leków przeciwzakrzepowych w innych wskazaniach, takich jak ostre zespoły wieńcowe czy profilaktyka zakrzepicy po operacji zastawki, jest obecnie przedmiotem badań klinicznych. Z omawianej grupy leków trzy weszły już do praktyki klinicznej w Europie: dabigatran (w praktyce klinicznej od 2008 r.) — będący odwracalnym in­hibitorem trombiny (czynnik IIa kaskady krzepnięcia) oraz inhibitory czynnika Xa — riwaroksaban (od 2008 r.) i apiksaban (od 2011 r.). W artykule dokonano przeglądu wybranych badań randomizowanych poświęconych ocenie NOAC w grupach pacjentów z żylną chorobą zakrzepowo-zatorową, niezastawkowym migotaniem przedsionków, ostrymi zespołami wieńcowymi oraz protezami zastawkowymi. Na podstawie dostępnych wyników badań ran­domizowanych i obowiązujących wytycznych NOAC należy uznać za cenną grupę leków przeciwzakrzepowych, które znalazły zastosowanie w profilaktyce zatorowości systemowej w stale powiększającej się populacji pacjentów z nie­zastawkowym migotaniem przedsionków oraz profilaktyce i leczeniu żylnej choroby zakrzepowo-zatorowej. Antagoniści witaminy K, leki stosowane w kardiologii od ponad 50 lat, i mimo znanych ograniczeń stosunkowo bezpieczne w terapii długoterminowej, pozostają jedyną opcją leczenia u pacjentów z mechanicznymi zastawkami serca. Rola doustnych antykoagulantów w chorobie wieńcowej pozostaje tematem badań klinicznych, choć stosowanie terapii sko­jarzonej lekami przeciwzakrzepowymi i przeciw­płytkowymi wiąże się z istotnym wzrostem ryzyka powikłań krwotocznych.Oral anticoagulants belonging to the vitamin K antagonists (VKA: acenocomarol and warfa­rin) group have been clinically used since 1954 and despite proven efficacy their routine use is difficult due to delayed onset of action, narrow therapeutic window, multiple drug and dietary interactions and a need for continuing monitoring of INR. Significant differences were documented between patients and centers according time in therapeutic range (TTR) ratio — defined as the percentage of treatment time, during which INR is in the therapeutic range, a critical determinant of both efficacy and safety of the therapy. In the everyday clinical practice this index achieves 44%, which are much lower than TTR 66% reported in patients populations included to randomized trials. These drawbacks significantly limit the treatment efficacy and cause undertreatment of increasing populations of elderly patients who require oral anticoagulation. It is estimated that up to 40% of patients who have indications for antithrombotic treatment do not receive it at all. On the other hand unfractionated heparin and low molecular weight heparin is not a viable long-term alternative due to parenteral route of administration and long-term risk of osteoporosis. To novel oral anticoagulants (NOAC) belongs direct trombin inhibitors and direct inhibitors of Xa factor of coagulation cascade. Beyond fast onset of action they offer more predictive anticoagulant effect which in general need not be moni­tored. At first they have been tested in venous thromboembolism and pulmonary embolism and next their effectiveness was confirmed in the prevention of systemic embolism in patients with non-valvular atrial fibrillation. The application of NOAC in other indications, such as acute coronary syndromes or thrombosis prevention after valve replacement is nowadays the aim of clinical studies. Among described group of pharmaceutical agents three drugs have been introduced to the clinical practice in Europe: dabigatran (in clinical practice since 2008) which is a reversible trombin inhibitor (factor IIa of coagulation cascade) and inhibitors of Xa factor — rivaroxaban (since 2008) and apixaban (since 2011). This article reviews chosen randomized trials which were dedicated to the assessment of NOAC in patients with venous thromboembolic disease, non-valvular atrial fibrillation, acute coronary syndromes and valve prosthesis. On the basis of published data from randomized trials and current guidelines NOAC should be recognized as valued group of anticoagulants, which gained indications in prevention of systemic embolic events in the continuously getting grow population of patients with non-valvular atrial fibrillation and in the prevention and treatment of venous thromboembolic disease. Vitamin K antagonists, which are used in cardiology from above 50 years, despite known limitations are relatively safe in long-term therapy and remain the only option in the treatment of patients with mechanical valve prosthesis. The role of oral anticoagulants in coronary artery disease still remains the topic of clinical studies, although the application of combined therapy of anticoagulants with antiplatelet drugs implies the significant increase of bleeding complications

Relationship between echocardiographic parameters and exercise test duration in patients after myocardial infarction

Background: The interdependence between echocardiographic parameters of left ventricle function, severity of heart failure (HF) and exercise test duration has not been thoroughly examined. Methods: We compared echocardiographic data in patients after myocardial infarction divided according to NYHA class to mild (class I and II, group 1 = 24 subjects) and advanced HF group (III and IV, group 2 = 36) and assessed their correlation with exercise duration (ED) in a symptom-limited treadmill test. Then we tried to determine independent predictors of ED. Results: The group with advanced HF had lower left ventricle ejection fraction, shorter duration and deceleration times of both mitral inflow waves (Et and At, Edt and Adt) and higher E/A ratio (1.4 &#177; 1.1 vs. 0.9 &#177; 0.4; p < 0.05) with more frequent restriction and pseudonormalization pattern (56% vs. 12%). Also early wave propagation (21 &#177; 7 vs. 29 &#177; 11 cm/s; p < 0.001) and all tissue Doppler velocities were lower, but ratio of early wave peak velocity to early diastolic velocity of mitral annulus was higher (E/E&#8217; 10.5 &#177; 5 vs. 6.1 &#177; 1.3 for velocity ratio; p < 0.001) in subjects with more severe clinical symptoms. Significant negative correlation with ED was observed for difference between duration of pulmonary vein atrial reversal flow and atrial wave of mitral inflow (&#8710;At; r = &#8211;0.54) and for E/E&#8217; ratio (r = &#8211;0.48), the highest positive correlation for left ventricular ejection fraction and duration of mitral inflow atrial phase (EF; r = 0.48, At; r = 0.46). In multivariate stepwise regression analysis two independent predictors of ED were identified: age and &#8710;At (Art&#8211;At). Conclusions: Diastolic parameters showing the strongest correlation with ED (&#8710;At and E/E&#8217;) are connected with restrictive left ventricle physiology. The only independent predictors of exercise duration in patients after myocardial infarction were: age and &#8710;At

The impact of chronic alcohol overuse on heart function and prognosis: layer-specific longitudinal strain and mid-term outcome analysis

Background: The exact effects of alcohol drinking on cardiac function are not clear.Aims: This study aimed to determine the relationship between consumed amount of alcohol, myocardial injury, and prognosis.Methods: Myocardial function and cardiac outcomes were examined in subjects with chronic alcoholism by classical and strain echocardiographic parameters, including global (GLS) and layer-specific longitudinal strain of the endocardial (GLSendo) and epicardial (GLSepi) layer. One group of 65 alcohol-overusers (ALC), median (IQR, interquartile range) age 44 (38–51) years, was compared with 30 controls (CG).Results: Median (IQR) alcohol dose (in alcohol units, 1 AU = 1 g of ethanol) per week was 30 (12–51) AU in ALC and 0 in CG; P &lt;0.001, and the mean (SD, standard deviation) drinking period was 16 (9) years. ALC patients demonstrated higher left ventricular (LV) mass and impaired diastolic function. The ALC group demonstrated lower median (IQR) LV ejection fraction (EF): 52% (37%–57%) vs 60% (55%–63%) (P &lt;0.001); GLS: 17% (9%–20%) vs 19% (18%–21%) (P = 0.01); absolute layer-specific strain values. GLSendo &lt;19% and GLSepi &lt;15% predicted worsened mid-term prognosis, as did elevated N-terminal brain natriuretic peptide (NT-proBNP) and lower EF and GLS.Conclusions: Long-term alcohol overuse, even with a rather low reported median (IQR) dose of 4 (2–7) AU per day resulted in LV hypertrophy, diastolic and systolic dysfunction. Diminished GLS &lt;18%, endocardial &lt;19% and epicardial &lt;15% layer strain predicted combined endpoints but did not significantly improve the prognostic power of tested models, based on NT-proBNP and EF in follow-up

Left atrial volume changes during exercise stress echocardiography in heart failure and hypertrophic cardiomyopathy

We assessed feasibility and functional correlates of LAVI (left atrial volume index) changes during exercise stress echocardiography (ESE).ESE on bike or treadmill was performed in 363 patients with heart failure with preserved ejection fraction (HFpEF, n = 173), reduced ejection fraction (HFrEF, n = 59) or hypertrophic cardiomyopathy (HCM, n=131). LAVI stress-rest increase ≥ 6.8 ml/m2 was defined as dilation.LAVI measurements were feasible in 100%. LAVI did not change in HFrEF being at rest 32 (25-45) vs. at stress 36 (24 - 54) ml/m2, P = NS and in HCM at rest 35 (26 - 48) vs. at stress 38 (28 - 48) ml/m2, P = NS whereas it decreased in HFpEF from 30 (24 -40) to 29 (21 - 37) ml/m2 at stress, P = 0.007. LA dilation occurred in 107 (30%) patients (27% with treadmill vs. 33% with bike ESE, P = NS): 26 with HFpEF (15%), 26 with HFrEF (44%) and 55 with HCM (42%) with P 14 at rest with OR 4.4, LVEF < 50% with OR 2.9, and LAVI at rest < 35 ml/m2 with OR 2.7.LAVI assessment during ESE was highly feasible and dilation equally frequent with treadmill or bike. LA dilation was threefold more frequent in HCM and HFrEF and could be predicted by increased resting E/e' and impaired EF as well as smaller baseline LAVI

Addressing Food Loss and Waste : A Global Problem with Local Solutions

The report focuses on the role that food loss and waste (FLW) could play in reducing the environmental footprint of food systems while attempting to meet the caloric and nutrient needs of a population expected to increase by 3 billion people in the next 30 years. The performance of the global food system over the last century has been extraordinary. From a global population of 1.6 billion people in 1900 to nearly 8 billion in 2020, the agri-food sector has risen to the challenge of providing global caloric sufficiency, mainly by increasing yields of a few principal staple crops. However, this path is no longer sustainable