Energy analysis to assess the environmental sustainability of the dairy chain

In the 1990s, attention was focused on saving energy and water with the aim of reducing production costs. Since the turn of this century, problems relating to the management of greenhouse gases have gradually assumed greater importance. Research has highlighted the problems that may arise regarding energy consumption in an Italian dairy chain. Using life-cycle assessment methods, the main steps along the production chain have been identified: breeding, dairy, and food store (FS). Our analysis shows that the different issues involved are often not easily reconcilable. Energy data need to undergo a careful and specific normalization process when dealing with specific data on different parameters (kWh/tmilk, kWh/tmilk processed, kWh/m2store). This study examined a variety of production cases (2 farms, 2 dairies, and 2 FSs) located in Lombardy, northern Italy, and electric and thermal energy consumption and carbon dioxide emissions were evaluated. A total of 2.8 kgCO2/kgcheese carbon dioxide emissions relating to the production process were recorded (39% breeding, 40% dairy, 1% FS). Further studies are needed in order to provide consumers with more precise and correct information (carbon labeling or green label). This may become an important element in consumer choice

sutured and sutureless repair of postinfarction left ventricular free wall rupture a systematic review

Summary Postinfarction left ventricular free-wall rupture is a potentially catastrophic event. Emergency surgical intervention is almost invariably required, but the most appropriate surgical procedure remains controversial. A systematic review, from 1993 onwards, of all available reports in the literature about patients undergoing sutured or sutureless repair of postinfarction left ventricular free-wall rupture was performed. Twenty-five studies were selected, with a total of 209 patients analysed. Sutured repair was used in 55.5% of cases, and sutureless repair in the remaining cases. Postoperative in-hospital mortality was 13.8% in the sutured group, while it was 14% in the sutureless group. A trend towards a higher rate of in-hospital rerupture was observed in the sutureless technique. The most common cause of in-hospital mortality (44%) was low cardiac output syndrome. In conclusion, sutured and sutureless repair for postinfarction left ventricular free-wall rupture showed comparable in-hospital mortality. However, because of the limited number of patients and the variability of surgical strategies in each reported series, further studies are required to provide more consistent data and lines of evidence

Ventricular pacemaker lead in the left hemithorax: Mechanisms and evidence-based management of a late-onset hazardous complication

Late-onset migration of pacing leads in the left hemithorax is a rare but potentially life-threatening complication. Radiological examinations are required to detect any involvement of either left ventricle or lung parenchyma, prompting immediate surgical extraction in this setting. Identification of high-risk patients is mandatory to prevent this complex iatrogenic complication

Rehabilitation of Difficult-to-Wean, Tracheostomized Patients Admitted to specialized unit: Retrospective Analyses Over 10-years.

Introduction: Rehabilitation outcomes of difficult-to-wean tracheostomized patients have been reported in relatively small case studies and described for a limited time span. This study de-scribes the characteristics and clinical outcomes of a large cohort of tracheostomized patients admitted to a specialized weaning unit over 10 years. Methods: We retrospectively analyzed da-ta collected from January 2010 to December 2019 on difficult-to-wean tracheostomized patients who underwent comprehensive rehabilitation. Clinical characteristics collected at admission were the level of comorbidity (by the Cumulative Illness Rating Scale \u2013 CIRS) and the clinical se-verity (by the Simplified Acute Physiology Score \u2013 SAPS II). The proportions of patients weaned, decannulated, and able to walk, the change in autonomy level according to the Bristol Activities of Daily Living (BADL) Scale, and the setting of hospital discharge was assessed and compared in a consecutive 5-year time periods (2010-2014 and 2015-2019) subgroup analysis. Results: A to-tal of 180 patients were included in the analysis. Patients\u2019 anthropometry and preadmission clin-ical management in acute care hospital were similar across years, but the categories of underlying diagnosis changed (p<0.001) (e.g. chronic obstructive pulmonary disease \u2013 COPD \u2013 decreased), while the level of comorbidities increased (p=0.003). Decannulation rate was 45.6%. CIRS and SAPS II at admission were both significant predictors of clinical outcomes. The proportion of pa-tients whose gain in BADL score increased 652 points decreased over time. Conclusions: This study confirms the importance of rehabilitation in the weaning units for the severely disabled subset of tracheostomized patients. Comorbidities and severity at admission are significantly as-sociated with rehabilitation outcomes at discharge

Surgical Repair of Postinfarction Ventricular Septal Rupture: Systematic Review and Meta-Analysis.

Background. Ventricular septal rupture (VSR) is a rare but life-threatening complication after acute myocardial infarction. Although surgical correction is challenging and associated with high mortality, it remains the treatment of choice. This systematic review and meta-analysis aimed to evaluate the early outcome of surgical VSR repair.Methods. We searched electronic databases from January 1998 to February 2020. Studies reporting patients undergoing surgical treatment for VSR were analyzed. The primary outcome assessed was operative mortality. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships of predefined surgical variables and clinical prognosis.Results. A total of 6361 adult patients from 41 studies were identified. Operative mortality was 38.2%. Pooled ORs showed increased odds of operative mortality in patients with preoperative or perioperative intraaortic balloon pump insertion (OR = 3.48; 95% CI, 3.01-4.02; P >= .001), right ventricular dysfunction (OR = 2.85; 95% CI, 1.47-5.52; P = .002), posterior VSR (OR = 1.73; 95% CI, 1.30-2.31; P >= .001), and emergency surgery (OR = 3.79; 95% CI, 2.52-5.72; P >= .001). Temporal trend evaluation revealed no difference over time in the operative mortality rate; it was 34% in both time-related groups (1971-2000 versus 2001-2018).Conclusions. Ventricular septal rupture repair has a high operative mortality. Patients with preoperative or perioperative intraaortic balloon pump support, right ventricular dysfunction at presentation, or posterior defects, and those undergoing emergent VSR correction have increased odds of operative mortality. (C) 2021 by The Society of Thoracic Surgeons. Published by Elsevier Inc

Environmental Impact of Food Preparations Enriched with Phenolic Extracts from Olive Oil Mill Waste

Reducing food waste as well as converting waste products into second-life products are global challenges to promote the circular economy business model. In this context, the aim of this study is to quantify the environmental impact of lab-scale food preparations enriched with phenolic extracts from olive oil mill waste, i.e., wastewater and olive leaves. Technological (oxidation induction time) and nutritional (total phenols content) parameters were considered to assess the environmental performance based on benefits deriving by adding the extracts in vegan mayonnaise, salad dressing, biscuits, and gluten-free breadsticks. Phenolic extraction, encapsulation, and addiction to the four food preparations were analyzed, and the input and output processes were identified in order to apply the life cycle assessment to quantify the potential environmental impact of the system analyzed. Extraction and encapsulation processes characterized by low production yields, energy-intensive and complex operations, and the partial use of chemical reagents have a non-negligible environmental impact contribution on the food preparation, ranging from 0.71% to 73.51%. Considering technological and nutritional aspects, the extraction/encapsulation process contributions tend to cancel out. Impacts could be reduced approaching to a scale-up process

An Exploratory Study of Field Failures

Field failures, that is, failures caused by faults that escape the testing phase leading to failures in the field, are unavoidable. Improving verification and validation activities before deployment can identify and timely remove many but not all faults, and users may still experience a number of annoying problems while using their software systems. This paper investigates the nature of field failures, to understand to what extent further improving in-house verification and validation activities can reduce the number of failures in the field, and frames the need of new approaches that operate in the field. We report the results of the analysis of the bug reports of five applications belonging to three different ecosystems, propose a taxonomy of field failures, and discuss the reasons why failures belonging to the identified classes cannot be detected at design time but shall be addressed at runtime. We observe that many faults (70%) are intrinsically hard to detect at design-time