Socio-technical imaginaries of a circular economy in governmental discourse and among science, technology, and innovation actors: A Norwegian case study

A growing body of research is investigating the connections between the discursive construction of circular economy (CE) and its influences on public policies that promote the socio-technological transition towards circular production and consumption systems. However, surprisingly little attention has focused on how CE discourses interact with science, technology, and innovation (ST&I) actors. To address this gap, this research adopts the prism of socio-technical imaginaries to understand specific visions of circularity in science and innovation, exploring how competing imaginaries mobilize specific actors, institutions, and visions of a greener future. Our empirical material included archival documentation from the Norwegian government and funded research projects on CE. Our analysis identified two key tension points within these imaginaries: “International drivers versus regional and local transition arenas” and “Ecological modernization versus sectoral transformation.” We suggest that tensions are inherent in CE socio-technical imaginaries but are often silenced or minimized by institutional discourses on circularity. Our findings suggest that official CE policy programs tend to minimize or overtly ignore criticisms and contestation that are increasingly raised in academic circles. Our findings indicate the need for increased involvement of ST&I actors and other societal actors (such as NGOs and the private sector) in the CE policymaking process to avoid endless growth as an unexpected CE policy outcome

Marine litter : Institutionalization of attitudes and practices among Fishers in Northern Norway

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Frequência de Diarreia em Pacientes em Nutrição Enteral de uma Unidade de Cuidados Continuados Integrados / Diarrhoea Frequency in Enteral Nutrition Patients of an Integrated Continued Care Unit

Introdução: A Nutrição Enteral (NE) também conhecida como alimentação por sonda, é administrada através do Trato Gastrointestinal (TGI), geralmente a partir de um tubo, cateter ou estoma. Se o trato gastrointestinal estiver funcional, a NE deve ser a primeira opção, entretanto esta pode causar algumas complicações. A diarreia pode ser uma dessas complicações e pode ser definida pela ocorrência de três ou mais evacuações amolecidas ou líquidas nas últimas 24 horas. A diminuição da consistência habitual das fezes é um dos parâmetros mais considerados. Objetivo: o objetivo geral deste trabalho é identificar a frequência de diarreia em pacientes com nutrição enteral. Métodos: Será realizada uma pesquisa quantitativa, com delineamento transversal. O procedimento metodológico inicial será a abordagem aos cuidadores, dos pacientes que estiverem com diarreia em terapia nutricional enteral, explicando o projeto e caso queiram participar, estes devem assinar o Termo de Consentimento Livre Esclarecido (TCLE). Após isso, será coletado os dados referentes a sexo, idade, estado nutricional e duração da diarreia. Os dados foram tabulados de acordo com as categorias supracitadas.Resultados: Dos pacientes avaliados, a média de idade foi de 65 anos, do sexo masculino e com diagnóstico médico de acidente vascular cerebral e internação com média de 55 dias. A maioria dos pacientes fez uso de antibióticos durante a internação 94,4% (n=17).Conclusão: É importante conhecer a frequência dos episódios de diarreia, e implementar o indicador de qualidade na prática do setor, visando à prevenção e tratamento desta complicação, visto que o IQTN é de fácil aplicação, rápido, viável e não onoroso

TMAO e a relação com doença cardiovascular: idoso e seus aspectos fisiológicos/ TMAO and the relationship with cardiovascular disease: the elderly and their physiological aspects

Introdução: O N-óxido-trimetilamina (TMAO) é uma toxina urêmica estimulada após fermentação da colina, fosfatidilcolina e L-carnitina que acorre na microbiota intestinal (MI). Os aspectos do MI no idoso, arriscam-se a estar relacionado ao processo de envelhecimento, visto que demonstra uma microbiota altamente versátil. O processo de envelhecimento, envolve retrocesso fisiológico gradual que acomete a maioria dos sistemas biológicos. Atualmente, o Acidente Vascular Cerebral (AVC) e infarto agudo do miocárdio (IAM), são os principais agravante da mortalidade em todo o mundo, responsável por grande parte das internações em idosos e adultos.Objetivo: o objetivo desse estudo é descrito um relacionado ao caso, em que se avaliou uma correlação entre a doença cardiovascular, uma elevada concentração de TMAO e os aspectos fisiológicos do idoso. Métodos: Foi realizado um relato de caso em que se aborda a descrição do caso e usada. Resultados e discussão: O diagnóstico nutricional apontou eutrofia, com massa muscular preservada apesar da idade, entretanto, ao avaliar CB e exame físico foi possível detectar possível perda de peso involuntária, devido ao excesso de gordura abdominal e excesso de gordura em PCT. O paciente apresenta nível baixo de TMAO na admissão hospitalar de reabilitação, porém nível elevado após o período de trinta e cinco dias de intervenção dietética.A intervenção com fibra mix (solúvel e insolúvel) não regule o TMAO na corrente sanguínea, sendo divergente a outros que afirmam que a microbiota intestinal é modulada por meio de prébioticos e consequentemente ocorre a toxinas urêmicas que elevam ou TMAO sanguíneo

Prognóstico nutricional de uma paciente em reabilitação, após internação em unidade de terapia intensiva (uti) / Nutritional prognosis of a patient in rehabilitation, after hospitalization in intensive care unit (uti)

Introdução: A desnutrição proteico-calórica é frequente em pacientes com doenças que acometem o sistema respiratório, devido a ingesta alimentar apresentar-se diminuída, secundária a anorexia, e ao aumento da taxa metabólica de repouso em decorrência do esforço respiratório aumentado Pacientes com doenças pulmonares devem ser submetidos à avaliação nutricional cuidadosa e monitoramento constante. Objetivos: Sendo assim, o objetivo do estudo foi descrever a recuperação nutricional em um hospital de retaguarda, após internação em Unidade de Terapia Intensiva. Resultados: Durante as primeiras 24h da admissão, foi aplicada anamnese nutricional e observado peso de 46 Kg, altura de 1,52m, IMC de 19,9kg/m² considerado eutrófico. Contudo, ao analisar o peso pregresso, foi relatado peso habitual de 52 Kg, que demonstrou perda involuntária grave de peso no período de três meses (11,5%). Ao se avaliar as demais medidas antropométrica, como CP de 25cm, CB de 23,5cm, adequação de CB de 79% (desnutrição moderada), CMB de 19,04 cm e adequação de 87% (desnutrição leve), PCT de 14,2mm e adequação de PCT de 61% (desnutrição grave), foi possível observar que a perda de peso foi decorrente da perda de massa muscular e perda de tecido adiposo. Com relação aos exames bioquímicos, observou-se anemia por doença crônica, hiperglicemia e depleção de massa muscular. Mediante aplicação do protocolo de desmame de dieta enteral do próprio hospital, sendo três horários de dieta enteral no período da noite e restante dos horários na consistência pastosa cinco vezes ao dia, a dieta via oral foi gradualmente inserida, conforme tolerância da paciente até atingir a consistência livre, que ocorreu no período de um mês. Conclusão: O caso relatado mostra a importância de uma adequada terapia nutricional na recuperação do estado nutricional do paciente que transita pelos diferentes ambientes de assistência hospitalar

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat