Fluconazole for empiric antifungal therapy in cancer patients with fever and neutropenia

BACKGROUND: Several clinical trials have demonstrated the efficacy of fluconazole as empiric antifungal therapy in cancer patients with fever and neutropenia. Our objective was to assess the frequency and resource utilization associated with treatment failure in cancer patients given empiric fluconazole antifungal therapy in routine inpatient care. METHODS: We performed a retrospective cohort study of cancer patients treated with oral or intravenous fluconazole between 7/97 and 6/01 in a tertiary care hospital. The final study cohort included cancer patients with neutropenia (an absolute neutrophil count below 500 cells/mm(3)) and fever (a temperature above 38°C or 100.4°F), who were receiving at least 96 hours of parenteral antibacterial therapy prior to initiating fluconazole. Patients' responses to empiric therapy were assessed by reviewing patient charts. RESULTS: Among 103 cancer admissions with fever and neutropenia, treatment failure after initiating empiric fluconazole antifungal therapy occurred in 41% (95% confidence interval (CI) 31% – 50%) of admissions. Patients with a diagnosis of hematological malignancy had increased risk of treatment failure (OR = 4.6, 95% CI 1.5 – 14.8). When treatment failure occurred the mean adjusted increases in length of stay and total costs were 7.4 days (95% CI 3.3 – 11.5) and $18,925 (95% CI 3,289 – 34,563), respectively. CONCLUSION: Treatment failure occurred in more than one-third of neutropenic cancer patients on fluconazole as empiric antifungal treatment for fever in routine clinical treatment. The increase in costs when treatment failure occurs is substantial

Distance matters – The environmental impact of regional and national supply chains of canned tomatoes

The environmental impact of food transportation depends on the trade-off between (increased) distances and the efficiency of modern logistics procedures. The relevant literature points out that such a trade-off is place and product specific, thus supporting the broadening of “food miles” research to new territories and product categories. Here we analyze the environmental impact – in terms of global warming, local pollution and traffic congestion – of two different canned tomatoes brands produced in Italy and consumed in Sassari (Sardinia, Italy). The supply chain of the first brand extends over the whole continental Italian territory, while the second one is mainly located in Sardinia. Different distribution patterns (modern vs. independent retail) and shopping modalities (foot vs. car) are also considered. The case study shows that the national supply chain contributes to global warming much more than the regional one, and therefore supports the view that shorter supply chains can be more sustainable than efficient logistics. The case study also confirms the very high impact of shopping by car, both in terms of global warming and local pollution.food miles, transportation, logistics, environmental impact, italy, canned tomatoes

Impact damage assessment by using peridynamic theory

This study presents an application of peridynamic theory for predicting residual strength of impact damaged building components by considering a reinforced panel subjected to multiple load paths. The validity of the approach is established first by simulating a controlled experiment resulting in mixed-mode fracture of concrete. The agreement between the PD prediction and the experimentally observed behavior is remarkable especially considering the simple material model used for the concrete. Subsequently, the PD simulation concerns damage assessment and residual strength of a reinforced panel under compression after impact due to a rigid penetrator