Challenges and Perspectives

Agriculture is a diverse field that produces a wide array of products vital to society. As global populations continue to grow the competition for natural resources will increase pressure on agricultural production of food, fiber, energy, and various high value by-products. With elevated concerns related to environmental impacts associated with the needs of a growing population, a life cycle assessment (LCA) framework can be used to determine areas of greatest impact and compare reduction strategies for agricultural production systems. The LCA methodology was originally developed for industrial operations but has been expanded to a wider range of fields including agriculture. There are various factors that increase the complexity of determining impacts associated with agricultural production including multiple products from a single system, regional and crop specific management techniques, temporal variations (seasonally and annually), spatial variations (multilocation production of end products), and the large quantity of nonpoint emission sources. The lack of consistent methodology of some impacts that are of major concern to agriculture (e.g., land use and water usage) increases the complexity of this analysis. This paper strives to review some of these issues and give perspective to the LCA practitioner in the field of agriculture

Are non-allergic drug reactions commonly documented as medication “allergies”? A national cohort of Veterans\u27 admissions from 2000 to 2014

Purpose: Adverse drug reactions (ADRs) including medication allergies are not well-described among large national cohorts. This study described the most common documented medication allergies and their reactions among a national cohort of Veterans Affairs (VA) inpatients. Methods: We evaluated inpatient admissions in any VA Medical Center from 1 January 2000 to 31 December 2014. Each admission was linked with allergy history preceding or upon admission. Individual drugs were aggregated into drug class category including: penicillins, sulfonamides, angiotensin converting enzyme (ACE) inhibitors, opiates, HMG-CoA reductase inhibitors (“statins”) and non-steroidal anti-inflammatory inhibitors (NSAID). Results were reported in aggregate and over time. Results: Approximately ~10.8 million inpatient admissions occurred from 2000 to 2014. We found the most commonly reported allergy drug classes were penicillins (13%, n = 1 410 080), opiates (9.1%, n = 984 978), ACE inhibitors (5.7%, n = 618 075) sulfonamides (5.1%, n = 558 653), NSAIDs (5.1%, n = 551 216) and statins (3.6%, n  = 391 983). Several allergy histories increased over time including opiates (6.2 to 11.2%), ACE inhibitors (1.3 to 10.2%), statins (0.3 to 7.3%) and NSAIDs (3.9 to 6.0%). Rash was the most commonly documented reaction on reports for penicillins (25.5%, n = 371 825), sulfonamides (25.6%, n = 165 954) and NSAIDs (10.3%, n = 65 741). The most common reaction for opiates was nausea/vomiting (17.9%, n = 211 864), cough/coughing for ACE inhibitors (41.0%, n = 270 537) and muscle pain/myalgia for statins (34.1%, n = 186 565). Conclusions: We report that penicillins and opiates are the most commonly documented drug allergies among VA inpatients, but other drug classes such as ACE inhibitors, statins and NSAIDs are becoming increasingly common. Clinicians also commonly document non-allergic ADRs in the allergy section such as cough or myalgia. Copyright © 2016 John Wiley & Sons, Ltd

The Effect of Molecular Rapid Diagnostic Testing on Clinical Outcomes in Bloodstream Infections: A Systematic Review & Meta-analysis

Background. Previous reports on molecular rapid diagnostic testing (mRDT) do not consistently demonstrate improved clinical outcomes in bloodstream infections (BSIs). This meta-analysis seeks to evaluate the impact of mRDT in improving clinical outcomes in BSIs. Methods. We searched PubMed, CINAHL, Web of science, and EMBASE through May 2016 for BSI studies comparing clinical outcomes by mRDT and conventional microbiology methods. Results. Thirty-one studies were included with 5,920 patients. Risk of morality was significantly lower with mRDT as compared to conventional microbiology methods (OR 0.66, 95% CI 0.54-0.80) yielding a NNT of 20. The risk of mortality was slightly lower with mRDT in studies with antimicrobial stewardship programs (ASPs) (OR 0.64, 95% CI 0.51-0.79) and non-ASP studies failed to demonstrate a significant decrease in risk of mortality (OR 0.72, 95% CI 0.46-1.12). Significant decreases in mortality risk were observed with both Gram-positive (OR 0.73, 95% CI 0.55-0.97) and Gram-negative organisms (OR 0.51, 95% CI 0.33-0.78) but not yeast (OR 0.90, 95% CI 0.49-1.67). Time to effective therapy decreased by a weighted mean difference of -5.03 hours (95% CI -8.60 to -1.45) and length of stay decreased by -2.48 days (95% CI -3.90 to -1.06). Conclusions. For BSIs, mRDT was associated with significant decreases in risk of mortality in the presence of a ASP, but not in its absence. Additionally, mRDT decreased time to effective therapy and length of stay. mRDT should be considered as part of the standard of care in patients with BSIs

Demonstration of the BioBaler harvesting system for collection of small-diameter woody biomass

As part of a project to investigate sustainable forest management practices for producing wood chips on the Oak Ridge Reservation (ORR) for the ORNL steam plant, the BioBaler was tested in various Oak Ridge locations in August of 2011. The purpose of these tests and the subsequent economic analysis was to determine the potential of this novel woody biomass harvesting method for collection of small-diameter, low value woody biomass. Results suggest that opportunities may exist for economical harvest of low-value and liability or negative-cost biomass. (e.g., invasives). This could provide the ORR and area land managers with a tool to produce feedstock while improving forest health, controlling problem vegetation, and generating local employment

Biomass supply chain management in North Carolina (part 1): predictive model for cropland conversion to biomass feedstocks

Increased interest in biomass cultivation requires detailed analysis of spatial production potential of possible biorefinery locations, with emphasis on feedstock production cost minimization. Integrated assessment of publicly available spatial data on current crop production, soil type, and yield potential, coupled with techno-economic production cost estimates, can support a functional method for rapid analysis of potential biorefinery sites. A novel predictive model was developed to determine cropland conversion using a probabilistic profit based equation for multiple biomass crops: giant reed, miscanthus, switchgrass, and sorghum (with either canola or barley as a winter crop). The three primary regions of North Carolina (Mountains, Piedmont, and Coastal Plain) were used as a case study and with a single parameter uncertainty analysis was completed. According to the model, the county chosen to represent the Coastal Plain (Duplin County) had the largest potential acreage that would be converted (15,071 ha, 7.1% total land, 9.3% of cropland) primarily to sorghum with canola as a winter crop. Large portions were also predicted to convert to giant reed and switchgrass, depending on the price and yield parameters used. The Piedmont (Granville County, 7697 ha, 5.5% total land, 6.9% cropland) and Mountain (Henderson County, 2117 ha, 2.2% total land, 2.3% cropland) regions were predicted to convert primarily to switchgrass acreage for biomass production, with much less available biomass overall compared to the Coastal Plain. This model provided meaningful insight into regional cropping systems and feedstock availability, allowing for improved business planning in designated regions. Determination of cropland conversion is imperative to develop realistic biomass logistical operations, which in conjunction can assist with rapid determination of profitable biomass availability. After this rapid analysis method is conducted in-depth on-ground biorefinery feasibility analysis can occur, ensuring resource are used only in locations with a high potential for available low cost biomass feedstocks

Perspective on Schistosomiasis Drug Discovery: Highlights from a Schistosomiasis Drug Discovery Workshop at Wellcome Collection, London, September 2022

In September 2022, the Drug Discovery Unit at the University of Dundee, UK, organised an international meeting at the Wellcome Collection in London to explore the current clinical situation and challenges associated with treating schistosomiasis. The aim of this meeting was to discuss the need for new treatments in view of the clinical situation and to ascertain what the key requirements would be for any potential new anti-schistosomals. This information will be essential to inform ongoing drug discovery efforts for schistosomiasis. We also discussed the potential drug discovery pathway and associated criteria for progressing compounds to the clinic. To date, praziquantel (PZQ) is the only drug available to treat all species causing schistosomiasis, but it is often unable to completely clear parasites from an infected patient, partially due to its inactivity against juvenile worms. PZQ-mediated mass drug administration campaigns conducted in endemic areas (e.g., sub-Saharan Africa, where schistosomiasis is primarily prevalent) have contributed to reducing the burden of disease but will not eliminate the disease as a public health problem. The potential for Schistosoma to develop resistance towards PZQ, as the sole treatment available, could become a concern. Consequently, new anthelmintic medications are urgently needed, and this Perspective aims to capture some of the learnings from our discussions on the key criteria for new treatments

Perspective on Schistosomiasis Drug Discovery:Highlights from a Schistosomiasis Drug Discovery Workshop at Wellcome Collection, London, September 2022

In September 2022, the Drug Discovery Unit at the University of Dundee, UK, organised an international meeting at the Wellcome Collection in London to explore the current clinical situation and challenges associated with treating schistosomiasis. The aim of this meeting was to discuss the need for new treatments in view of the clinical situation and to ascertain what the key requirements would be for any potential new anti-schistosomals. This information will be essential to inform ongoing drug discovery efforts for schistosomiasis. We also discussed the potential drug discovery pathway and associated criteria for progressing compounds to the clinic. To date, praziquantel (PZQ) is the only drug available to treat all species causing schistosomiasis, but it is often unable to completely clear parasites from an infected patient, partially due to its inactivity against juvenile worms. PZQ-mediated mass drug administration campaigns conducted in endemic areas (e.g., sub-Saharan Africa, where schistosomiasis is primarily prevalent) have contributed to reducing the burden of disease but will not eliminate the disease as a public health problem. The potential for Schistosoma to develop resistance towards PZQ, as the sole treatment available, could become a concern. Consequently, new anthelmintic medications are urgently needed, and this Perspective aims to capture some of the learnings from our discussions on the key criteria for new treatments