Maine Craft Breweries: Sustainability Benchmarking

Sustainability can have many definitions and meanings, usually derived from the same set of parameters. For Maine, sustainable practices in the brewing industry are becoming even more important as our craft breweries are continuously growing. With environmental stewardship in natural resource management in mind, the Brewers Association (BA) has created the sustainability benchmarking tool for paying members in order to help brewers track and decrease their use of natural resources. University of Southern Maine (USM) interns have collaborated with the New England Environmental Finance Center (EFC) on a grant project, sponsored by the Maine Department of Environmental Protection (DEP), to connect with Maine craft breweries and engage them in the national benchmarking tool. Through an analysis of data inputs of each brewery, the BA sustainability benchmarking tool uses algorithms to show and explain the use of natural resources for the business, and then compares them to a national benchmark to show the status of their resource use. Our team compiles data inputs to enter into the benchmarking tool for Maine breweries where they are weighed against the production data of the brewery. By assisting them to evaluate the report we can help them find cost savings through source reduction, and recommend minor changes that can lead to major differences. With the acts of performing these services for Maine breweries, we are able to promote environmental stewardship for the state and sustain our limited natural resources. References: 1Maine Department of Environmental Protection. (2019). Sustainability. Retrieved from: https:// www.maine.gov/dep/sustainability/index.htm

UTAH: Using Telemedicine to improve early medical Abortion at Home:a protocol for a randomised controlled trial comparing face-to-face with telephone consultations for women seeking early medical abortion

Introduction Early medical abortion (EMA) is a two-stage process of terminating pregnancy using oral mifepristone (a progesterone-receptor antagonist) followed usually 1–2 days later by sublingual, vaginal or buccal misoprostol (a prostaglandin analogue). There are no published randomised controlled trials (RCTs) on the use of telemedicine for EMA. Our proposed research will determine if telephone consultations for EMA (the most common method of abortion in the UK) is non-inferior to standard face-to-face consultations with regard to the efficacy of EMA.Methods and analysis This study will be conducted as an RCT. The recruitment target is 1222 participants.The primary outcome is success of EMA (complete abortion rate). This will be determined based on a negative low-sensitivity urine pregnancy test result (2 weeks after misoprostol use) and absence of surgical intervention or diagnosis of ongoing pregnancy (within 6 weeks of misoprostol).Secondary outcomes include total time spent at a clinic appointment to receive EMA, self-reported preparedness for EMA, level of satisfaction with consultation and effective contraception uptake compared with when women attend for a face-to-face consultation.The main analysis will be a modified intention-to-treat analysis. This will include all randomised women (with a viable pregnancy) using EMA and follow-up for the main outcome. The study initiated on 13 January 2020 and is anticipated to finish in late 2021.Ethics and dissemination Ethical approval was given by the South East Scotland NHS Research Ethics Committee, reference: 19/SS/0111. Results will be published in peer-reviewed journals, presented at clinical and academic meetings, and shared with participants via the clinic website.Trial registration number NCT04139382

Utility of a routine ultrasound for detection of ectopic pregnancies among women requesting abortion:A retrospective review

INTRODUCTION: Routine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a community abortion service. METHODS: Retrospective case record review of women requesting abortion over a 5-year period (2015–2019) with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL) at a service (Edinburgh, UK) conducting routine ultrasound on all women. Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings. RESULTS: Only 29/11 381 women (0.25%, 95% CI 0.18%, 0.33%) had an ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). Eleven (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic pregnancy (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining six, three were PUL treated with methotrexate and three were ectopic (salpingectomy=2, methotrexate=1). In three cases, the baseline ultrasound indicated a probable early intrauterine pregnancy. CONCLUSIONS: Ectopic pregnancies are uncommon among women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may provide false reassurance that a pregnancy is intrauterine

Moving epidemic method (MEM) applied to virology data as a novel real time tool to predict peak in seasonal influenza healthcare utilisation. The Scottish experience of the 2017/18 season to date

Scotland observed an unusual influenza A(H3N2)- dominated 2017/18 influenza season with healthcare services under significant pressure. We report the application of the moving epidemic method (MEM) to virology data as a tool to predict the influenza peak activity period and peak week of swab positivity in the current season. This novel MEM application has been successful locally and is believed to be of potential use to other countries for healthcare planning and building wider community resilience