The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Desafios ambientais e estratégias para condução da investigação e programas de intervenção social

Este trabalho discute os desafios que se colocam à sociedade contemporânea no âmbito do combate à vulnerabilidade social, realça a importância da abordagem holística dos problemas socioambientais através da integração transversal e simultânea das dimensões social, ambiental e económica da sustentabilidade e exorta para a necessidade do uso combinado de métodos qualitativos e quantitativos como forma de compreender o fenômenos ambientais e sociais e implementar programas de intervenção sustentáveis.<br>This article discusses challenges concerning contemporary society with respect to social vulnerability. The role of holistic approach to face socio-environmental problems by integration of the sustainability dimensions is also addressed. Finally, an approach that combines qualitative and quantitative methods is recommended as the appropriate way to understand socio-environmental processes, and perform sustainable programmes

Monitoring a fast thermophilic re-start-up of a digester treating the organic fraction of municipal solid waste

Experimental data concerning a fast re-start-up of a digester treating the organic fraction of municipal solid waste at thermophilic conditions (55°C) is analyzed according to a classical approach (evolution of mass balance and stability parameters) and a new approach, put forward here, based on the interpretation of the biogas production profiles obtained after feeding the digester. Gas production, H2 pattern in the biogas and volatile fatty acids in the digester content are the most suitable parameters using the classical approach. Using the evolution of the biogas production profiles the start-up and normal digester operation can be monitored in a satisfactory and much simpler way. This approach could assume special importance for industrial-scale digesters. © 1993 Taylor and Francis Group, LLC