A Comparative Life Cycle Assessment between a Metered Dose Inhaler and Electric Nebulizer

Life cycle assessment (LCA) evaluates the environmental impact of a product based on the materials and processes used to manufacture the item as well as the item’s use and disposal. The objective of this LCA was to evaluate and compare the environmental impact of a metered dose inhaler, specifically the Proventil® HFA inhaler (Merk & Co., Inc., Kenilworth, NJ, USA), and an electric nebulizer, specifically the DeVilbiss Pulmo-Aide® nebulizer (DeVilbiss, Port Washington, NY, USA). GaBi LCA software was used to model the global warming potential (GWP) of each product by using substantiated data and well-justified assumptions for the components, manufacturing, assembly, and use of both devices. The functional unit used to model each device was one dose of the active drug, albuterol sulfate. The inhaler’s GWP, 0.0972 kg CO2-eq, was greater than the nebulizer’s even when uncertain parameters were varied ±100x. During the use phase ofa the inhaler, which accounted for approximately 96% of the inhaler’s total GWP, HFA 134a is used as a propellant to deliver the drug. The total GWP for the electric nebulizer was 0.0294 kg CO2-eq assuming that the mouthpiece was cleaned in a dishwasher, while it was 0.0477 kg CO2-eq when the nebulizer mouthpiece was hand washed between uses. The GWP breakeven scenario between dishwashing and hand washing occurred when the mouthpiece accounted for 10% of the dishwasher load

Ketamine kinetics in unmedicated and diazepam‐premedicated subjects

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109775/1/cptclpt1984235.pd

Syndromic (phenotypic) diarrhea in early infancy

Syndromic diarrhea (SD), also known as phenotypic diarrhea (PD) or tricho-hepato-enteric syndrome (THE), is a congenital enteropathy presenting with early-onset of severe diarrhea requiring parenteral nutrition (PN). To date, no epidemiological data are available. The estimated prevalence is approximately 1/300,000–400,000 live births in Western Europe. Ethnic origin does not appear to be associated with SD. Infants are born small for gestational age and present with facial dysmorphism including prominent forehead and cheeks, broad nasal root and hypertelorism. Hairs are woolly, easily removed and poorly pigmented. Severe and persistent diarrhea starts within the first 6 months of life (≤ 1 month in most cases) and is accompanied by severe malabsorption leading to early and relentless protein energy malnutrition with failure to thrive. Liver disease affects about half of patients with extensive fibrosis or cirrhosis. There is currently no specific biochemical profile, though a functional T-cell immune deficiency with defective antibody production was reported. Microscopic analysis of the hair show twisted hair (pili torti), aniso- and poilkilotrichosis, and trichorrhexis nodosa. Histopathological analysis of small intestine biopsy shows non-specific villous atrophy with low or no mononuclear cell infiltration of the lamina propria, and no specific histological abnormalities involving the epithelium. The etiology remains unknown. The frequent association of the disorder with parental consanguinity and/or affected siblings suggests a genetic origin with an autosomal recessive mode of transmission. Early management consists of total PN. Some infants have a rather milder phenotype with partial PN dependency or require only enteral feeding. Prognosis of this syndrome is poor, but most patients now survive, and about half of the patients may be weaned from PN at adolescence, but experience failure to thrive and final short stature

Intestinal transplantation in children under FK 506 immunosuppression

Intestinal transplantation, solitary (n = 3) or in combination with the liver (n = 7), was performed in 10 pediatric patients with intestinal failure. The liver was only replaced if there was liver failure and portal hypertension. Immunosuppression was based on FK 506. Two patients died, one of graft-versus-host disease and one of lymphoproliferative disease. One patient was still in the intensive care unit 1 month posttransplantation due to perioperative complications. The function of the intestinal grafts in the remaining patients is normal. All nutrition and medications including immunosuppression are being administered enterally. This series indicates that small bowel transplantation, alone or in combination with the liver, is feasible in pediatric patients. © 1993

Multivisceral intestinal transplantation: Surgical pathology

We report the diagnostic surgical pathology of two children who underwent multivisceral abdominal transplantation and survived for 1 month and 6 months. There is little relevant literature, and diagnostic criteria for the various clinical possibilities are not established; this is made more complicated by the simultaneous occurrence of more than one process. We based our interpretations on conventional histology, augmented with immunohistology, including HLA staining that distinguished graft from host cells in situ. In some instances functional analysis of T cells propagated from the same biopsies was available and was used to corroborate morphological interpretations. A wide spectrum of changes was encountered. Graft-versus-host disease, a prime concern before surgery, was not seen. Rejection was severe in 1 patient, not present in the other, and both had evidence of lymphoproliferative disease, which was related to Epstein-Barr virus. Bacterial translocation through the gut wall was also a feature in both children. This paper documents and illustrates the various diagnostic possibilities.. © 1989 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted

Nurturing Children's Healthy Eating: Position statement

The relationship between eating a healthy diet and positive health outcomes is well known; nurturing healthy eating among children therefore has the potential to improve public health. A healthy diet occurs when one''s usual eating patterns include adequate nutrient intake and sufficient, but not excessive, energy intake to meet the energy needs of the individual. However, many parents struggle to establish healthy eating patterns in their children due to the pressures of modern life. Moreover, healthcare providers often do not have the time or the guidance they need to empower parents to establish healthy eating practices in their children. Based on existing evidence from epidemiologic and intervention research, the Nurturing Children''s Healthy Eating collaboration, established by Danone Institute International, has identified four key themes that encourage and support healthy eating practices among children in the modern Western world. The first — positive parental feeding — explores how parenting practices and styles, such as avoiding food restriction, allowing children to make their own food choices, and encouraging children to self-limit their portion sizes, can influence children''s dietary intake. The second — eating together — highlights the link between eating socialization through regular family meals and healthful diet among children. The third — a healthy home food environment — explores the impact on eating practices of family resources, food availability/accessibility, parental modeling, and cues for eating. The fourth — the pleasure of eating — associates children''s healthy eating with pleasure through repeated exposure to healthful foods, enjoyable social meals, and enhancement of the cognitive qualities (e.g. thoughts or ideas) of healthful foods. This paper reviews the evidence leading to the characterization of these nurturing themes, and ways in which recommendations might be implemented in the home

The transplantation of gastrointestinal organs

Over a period of 33 years, it has become possible to successfully transplant individual intra-abdominal viscera or combinations of these organs. The consequences have been, first, new information about the metabolic interrelations that the visceral organs have in disease or health; second, the addition of several procedures to the treatment armamentarium of gastrointestinal diseases; and third, a more profound understanding of the means by which all whole organ grafts are accepted. © 1993

Feature-specific terrain park-injury rates and risk factors in snowboarders : a case–control study

Background : Snowboarding is a popular albeit risky sport and terrain park (TP) injuries are more severe than regular slope injuries. TPs contain man-made features that facilitate aerial manoeuvres. The objectives of this study were to determine overall and feature-specific injury rates and the potential risk factors for TP injuries. Methods : Case–control study with exposure estimation, conducted in an Alberta TP during two ski seasons. Cases were snowboarders injured in the TP who presented to ski patrol and/or local emergency departments. Controls were uninjured snowboarders in the same TP. κ Statistics were used to measure the reliability of reported risk factor information. Injury rates were calculated and adjusted logistic regression was used to calculate the feature-specific odds of injury. Results : Overall, 333 cases and 1261 controls were enrolled. Reliability of risk factor information was κ>0.60 for 21/24 variables. The overall injury rate was 0.75/1000 runs. Rates were highest for jumps and half-pipe (both 2.56/1000 runs) and lowest for rails (0.43/1000 runs) and quarter-pipes (0.24/1000 runs). Compared with rails, there were increased odds of injury for half-pipe (OR 9.63; 95% CI 4.80 to 19.32), jumps (OR 4.29; 95% CI 2.72 to 6.76), mushroom (OR 2.30; 95% CI 1.20 to 4.41) and kickers (OR 1.99; 95% CI 1.27 to 3.12). Conclusions : Higher feature-specific injury rates and increased odds of injury were associated with features that promote aerial manoeuvres or a large drop to the ground. Further research is required to determine ways to increase snowboarder safety in the TP

Comparing the characteristics of snowboarders injured in a terrain park who present to the ski patrol, the emergency department or both

Ski patrol report forms are a common data source in ski/snowboard research, but it is unclear if those who only present to the emergency department (ED) are systematically different from those who see the ski patrol. To determine the proportion and characteristics of injured snowboarders who bypass the ski patrol before presenting to the ED, three groups of injured snowboarders were compared: presented to the ED only, ski patrol only and ski patrol and ED. Data were collected from ski patrol Accident Report Forms (ARFs), ED medical records and telephone interviews. There were 333 injured snowboarders (ED only: 34, ski patrol only: 107, both: 192). Ability, time of day, snow conditions or drugs/alcohol predicted ED only presentation. Concussions (RRR: 4.66; 95% CI: 1.83, 11.90), sprains/strains (RRR: 4.22; 95% CI: 1.87, 9.49), head/neck (RRR: 2.90; 95% CI: 1.48, 5.78), trunk (RRR: 4.17; 95% CI: 1.92, 9.09) or lower extremity (RRR: 3.65; 95% CI: 1.32, 10.07) injuries were significantly more likely to present to ski patrol only versus ski patrol and ED. In conclusion, snowboarders who presented to the ED only had similar injuries as those who presented to both

Characteristics of injuries sustained by snowboarders in a terrain park

Abstract OBJECTIVE: To determine injured body regions and injury type resulting from snowboarding on aerial and nonaerial terrain park features and the accuracy of ski patrol assessments compared with physician diagnoses. DESIGN: Case series study. SETTING: An Alberta terrain park during the 2008-2009 and 2009-2010 seasons. PATIENTS: There were 333 snowboarders injured on features (379 injuries). ASSESSMENT OF RISK FACTORS: Aerial or nonaerial terrain park feature used at injury, injured body region, injury type, and additional risk factors were recorded from ski patrol Accident Report Forms, emergency department medical records, and telephone interviews. MEASURES: Odds of injury to body regions and injury types on aerial versus nonaerial features were calculated using multinomial logistic regression. Accuracy of ski patrol injury assessments was examined through sensitivity, specificity, and kappa (κ) statistics. RESULTS: The wrist was the most commonly injured body region (20%), and fracture was the most common injury type (36%). Compared with the upper extremity, the odds of head/neck [odds ratio (OR), 2.58; 95% confidence interval (CI), 1.37-4.85] and trunk (OR, 3.65; 95% CI, 1.68-7.95) injuries were significantly greater on aerial features. There was no significant association between aerial versus nonaerial feature and injury type. The accuracy of ski patrol injury assessment was higher for injured body region (κ = 0.65; 95% CI, 0.54-0.75) than for injury type (κ = 0.29; 95% CI, 0.22-0.37). CONCLUSIONS: Snowboarders were significantly more likely to sustain head/neck or trunk injuries than upper extremity injuries on aerial features. Investigators should acknowledge potential misclassification when using ski patrol injury assessments