Techno-economic Implications of Fed-batch Enzymatic Hydrolysis

As ethanol production continues to increase in the United States, cellulosic ethanol continues to gain traction as a viable option for meeting ethanol demands. In this work, a literature review of techno-economic analyses for cellulosic ethanol was conducted. It was found that pretreatment methods greatly affect the ethanol production costs. There is a lack of techno-economic data comparing a batch enzymatic hydrolysis to a fed-batch enzymatic hydrolysis for a separate hydrolysis and fermentation production process. Consequently, a techno-economic analysis comparing cellulosic ethanol production using batch versus fed-batch enzymatic hydrolysis was conducted. SuperPro Designer software (Intelligen, Scotch Plains, New Jersey), a process simulation tool, was used to simulate ethanol production. The simulation revealed that the biggest difference between batch and fed-batch hydrolysis was facilities costs, which decreased by 41% when using fed-batch enzymatic hydrolysis. A sensitivity analysis revealed that our ethanol production costs were most sensitive to the cost of the corn stover biomass. In general our results support the idea that fed-batch enzymatic hydrolysis does improve the techno-economics of cellulosic ethanol production, even if the improvements came in process steps we did not expect. Advisor: Deepak R. Keshwan

Effect of wheat bran derived prebiotic supplementation on gastrointestinal transit, gut microbiota, and metabolic health: a randomized controlled trial in healthy adults with a slow gut transit

Acute intake of the wheat bran extract Arabinoxylan-Oligosaccharide (AXOS) modulates the gut microbiota, improves stool characteristics and postprandial glycemia in healthy humans. Yet, little is known on how long-term AXOS intake influences gastrointestinal (GI) functioning, gut microbiota, and metabolic health. In this randomized, placebo-controlled, double-blind study, we evaluated the effects of AXOS intake on GI function and metabolic health in adults with slow GI transit without constipation. Forty-eight normoglycemic adults were included with whole-gut transit time (WGTT) of >35 h receiving either 15 g/day AXOS or placebo (maltodextrin) for 12-wks. The primary outcome was WGTT, and secondary outcomes included stool parameters, gut permeability, short-chain fatty acids (SCFA), microbiota composition, energy expenditure, substrate oxidation, glucose, insulin, lipids, gut hormones, and adipose tissue (AT) function. WGTT was unchanged, but stool consistency softened after AXOS. 12-wks of AXOS intake significantly changed the microbiota by increasing Bifidobacterium and decreasing microbial alpha-diversity. With a good classification accuracy, overall microbiota composition classified responders with decreased WGTT after AXOS. The incretin hormone Glucagon-like protein 1 was reduced after AXOS compared to placebo. Energy expenditure, plasma metabolites, AT parameters, SCFA, and gut permeability were unchanged. In conclusion, intake of wheat bran extract increases fecal Bifidobacterium and softens stool consistency without major effects on energy metabolism in healthy humans with a slow GI transit. We show that overall gut microbiota classified responders with decreased WGTT after AXOS highlighting that GI transit and change thereof were associated with gut microbiota independent of Bifidobacterium. NCT02491125.</p

Impactos da pandemia da covid-19 na saúde mental dos profissionais de enfermagem / Impacts of the covid-19 pandemic on the mental health of nursing professionals

Introdução: A pandemia da COVID-19 é um grande desafio para os sistemas mundiais de saúde, e também para os profissionais que os compõe. Especialmente entre os enfermeiros que cuidam desses pacientes infectados pela doença, são altamente propensos a desenvolver níveis elevados de estresse e de estresse pós-traumático. Esses impactos comprometem diretamente na capacidade de tomada de decisão rápida e na interação com os pacientes. Objetivo: Analisar os impactos da pandemia do novo coronavírus à saúde mental dos profissionais de enfermagem atuantes na linha de frente. Método: Trata-se de uma revisão integrativa da literatura, realizada a partir da pergunta norteadora: “quais os impactos da pandemia da COVID-19 à saúde mental dos profissionais de enfermagem da linha de frente no combate, e quais fatores contribuem para esse desgaste psicológico?”, cuja busca de artigos foi realizar através das bases de dados Medical Literature Analysis and Retrieval Sistem On-line (MEDLINE/PUBMED), na Literatura Latino-Americana e do Caribe (LILACS) e no diretório de revistas Scientific Eletronic Library Online (SCIELO). Foram selecionados estudos do ano de 2020 que tratava da temática em questão e que estavam nos idiomas inglês, português e espanhol, e foram excluídos artigos que não se encaixavam no assunto abordado e não estavam disponíveis. Resultados: Foram encontrados 207 estudos, dos quais 14 se encaixavam na temática e nos critérios estabelecidos. A alta taxa de pessoas infectadas causa colapso nas unidades de saúde e consequente sobrecarga de trabalho para os profissionais de enfermagem que, com o desconhecimento da doença, medidas de segurança rígidas e o medo de infectar-se com o vírus, desenvolvem sinais e sintomas propícios para o aparecimento de transtornos de ordem psicológica. Considerações finais: Portanto, para reduzir a incidência de sintomas mentais negativos e o aparecimento de doenças de ordem psicológica, medidas são necessárias. O apoio psicológico aos enfermeiros durante o enfrentamento da pandemia, é uma medida eficaz para que consigam lidar melhor com a grande incidência da perda de pacientes devido ao COVID-19. A melhor organização das escalas de plantões é viável para diminuir a carga horária de trabalho excessiva e prevenir o esgotamento físico destes profissionais

Análise de melhoramento de solos com adição de cal hidratada para utilização em base e sub-base de pavimentos / Analysis of soil improvement with addition of hydrated lime for basic use and underbase of pavement with low volume of traffic

O solo tem grande importância nas atividades de engenharia rodoviária de modo que há em diversas áreas do país uma relação de dependência extrema, uma vez que as características físicas e mecânicas dos solos utilizados em camadas de pavimentos são determinantes para seu desempenho. Muitas áreas, entretanto, apresentam perfis geológicos pouco adequados à utilização em plataformas de infraestrutura rodoviária, sendo necessário obter tais materiais de regiões mais afastadas. Uma forma de tentar solucionar esse tipo de problema, é a aplicação de medidas de melhoramento como forma de garantir a estabilização do solo. Neste contexto, este trabalho objetivou estudar, a partir de ensaios de laboratório, o efeito causado pela adição de cal hidratada em solos cujas características não atendiam aos limites mínimos para utilização em sub-base de pavimentos rodoviários na região de Caruaru/PE. Mediante os resultados obtidos de resistência contatou-se, que os incrementos no percentual de CBR foram satisfatórios. Foram feitas adições com percentual de 1%, 3% e 5% promover estabilização química, e obteve-se elevado ganho de resistência, tornando assim possível o uso dos dois solos melhorados, em camadas de sub-base de pavimentos rodoviários

“Being Guided”: What Oncofertility Patients’ Decisions Can Teach Us About the Efficacy of Autonomy, Agency, and Decision-Making Theory in the Contemporary Critical Encounter

Recent research on patient decision-making reveals a disconnect between theories of autonomy, agency, and decision-making and their practice in contemporary clinical encounters. This study examines these concepts in the context of female patients making oncofertility decisions in the United Kingdom in light of the phenomenon of “being guided.” Patients experience being guided as a way to cope with, understand, and defer difficult treatment decisions. Previous discussions condemn guided decision-making, but this research suggests that patients make an informed, autonomous decision to be guided by doctors. Thus, bioethicists must consider the multifaceted ways that patients enact their autonomy in medical encounters

Durvalumab Plus Carboplatin/Paclitaxel Followed by Maintenance Durvalumab With or Without Olaparib as First-Line Treatment for Advanced Endometrial Cancer: The Phase III DUO-E Trial

PURPOSE Immunotherapy and chemotherapy combinations have shown activity in endometrial cancer, with greater benefit in mismatch repair (MMR)-deficient (dMMR) than MMR-proficient (pMMR) disease. Adding a poly(ADP-ribose) polymerase inhibitor may improve outcomes, especially in pMMR disease. METHODS This phase III, global, double-blind, placebo-controlled trial randomly assigned eligible patients with newly diagnosed advanced or recurrent endometrial cancer 1:1:1 to: carboplatin/paclitaxel plus durvalumab placebo followed by placebo maintenance (control arm); carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib placebo (durvalumab arm); or carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib (durvalumab + olaparib arm). The primary end points were progression-free survival (PFS) in the durvalumab arm versus control and the durvalumab + olaparib arm versus control. RESULTS Seven hundred eighteen patients were randomly assigned. In the intention-to-treat population, statistically significant PFS benefit was observed in the durvalumab (hazard ratio [HR], 0.71 [95% CI, 0.57 to 0.89]; P = .003) and durvalumab + olaparib arms (HR, 0.55 [95% CI, 0.43 to 0.69]; P < .0001) versus control. Prespecified, exploratory subgroup analyses showed PFS benefit in dMMR (HR [durvalumab v control], 0.42 [95% CI, 0.22 to 0.80]; HR [durvalumab + olaparib v control], 0.41 [95% CI, 0.21 to 0.75]) and pMMR subgroups (HR [durvalumab v control], 0.77 [95% CI, 0.60 to 0.97]; HR [durvalumab + olaparib v control] 0.57; [95% CI, 0.44 to 0.73]); and in PD-L1-positive subgroups (HR [durvalumab v control], 0.63 [95% CI, 0.48 to 0.83]; HR [durvalumab + olaparib v control], 0.42 [95% CI, 0.31 to 0.57]). Interim overall survival results (maturity approximately 28%) were supportive of the primary outcomes (durvalumab v control: HR, 0.77 [95% CI, 0.56 to 1.07]; P = .120; durvalumab + olaparib v control: HR, 0.59 [95% CI, 0.42 to 0.83]; P = .003). The safety profiles of the experimental arms were generally consistent with individual agents. CONCLUSION Carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab with or without olaparib demonstrated a statistically significant and clinically meaningful PFS benefit in patients with advanced or recurrent endometrial cancer

Privatisation, outsourcing and employment relations in Israel

This chapter focuses on the effect that outsourcing, as a subset of privatization, has had on employment relations in Israel. In particular, chapter highlights the adverse, and perhaps counter-intuitive, effects that the law has had on the plight of Israeli contract workers. Israeli governmental agencies and local councils have turned to outsourcing as a means to circumventing post limits and due to the Ministry of Finance’s pressures to increase ‘flexibility’ in the civil service. Intriguingly, paradoxically, and tragically, the law’s effort to regulate this growing phenomenon has led employers resorting to tactics which have redefined agency workers (teachers, nurses, etc) as workers subject to the “outsourcing of services” (teaching, nursing, etc). This has moved such workers into a legal void, depriving them of rights and protection

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Dengue: aspectos epidemiológicos no município de Salgueiro do Sertão Pernambucano, Brasil / Dengue: epidemiological aspects in the municipality of Salgueiro do Sertão Pernambucano, Brazil

A dengue é atualmente a arbovirose mais prevalente no Brasil, configurando-se como um agravo na saúde pública nas últimas décadas. O presente trabalho tem como objetivo analisar estatisticamente dados cadastrados em planilhas eletrônicas do SINAN. Foi realizado um estudo de série histórica observacional do tipo transversal dos casos notificados de dengue no município de Salgueiro- PE, Brasil, entre os anos de 2007 a 2012. O Sinan online notificou para o intervalo de tempo em estudo, 1818 casos de dengue, desses 62,65% eram do sexo feminino e 37,35% do sexo masculino. Os dados demonstram que houve uma quantidade significativa de casos para região, porém a questão da subnotificação é notável, além disso, cabe aos órgãos de saúde pública do município, melhorar a qualidade de prevenção desse agravo