Establishment of a New Urban Solid Waste Management Programs in Mazandaran Province, North of Iran

This study reports residents’ preferences to establish a new urban solid waste management programs results from a double-bounded dichotomous choice contingent valuation method and choice experiment in Mazandaran province, north of Iran. In order to analysis the residents’ preferences, a dichotomous hypothetical market and a choice sets with different attributes and options were used For estimation of two mentioned methods, the normal logit and conditional logit were applied. In addition, an empirical comparison of the welfare measures derived from the doublebounded DC-CVM and CE is conducted. The main results show that there is no significant difference between the values derived from the two methods. The mean of WTP to establish a new solid waste management programs in CV and CE were estimated 2.45 and 2.61 US$, respectively, per a person per a month. Also the estimated marginal WTP for all attributes in CE was 8.1 US$ per a month. The results suggest that both double-bounded DC-CVM and CE can be successfully stablished for improvement environmental level quality in Mazandaran province. This paper could provide the basis for further development of other new programs on sustainable urban management of solid waste in Mazandaran province.Keywords: Dichotomous choice, Willingness to pay, Solid waste management, Mazandaran province, Ira

Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill

Introduction: Hyperlactatemia is frequent in critically ill patients and is often used as a marker of adverse outcome. However, studies to date have focused on selected intensive care unit (ICU) populations. We sought to determine the occurrence and relation of hyperlactatemia with ICU mortality in all patients admitted to four ICUs in a large regional critical care system. Methods: All adults ([greater than or equal to] 18 years) admitted to ICUs in the Calgary Health Region (population 1.2 million) during 2003 to 2006 were included retrospectively. Lactate determinations were at the discretion of the attending service and hyperlactatemia was defined by a lactate level > 2 mmol/L. Results: A total of 13,932 ICU admissions occurred among 11,581 patients. The median age was 63 years (37% female), the mean APACHE II score was 25 ± 9 (n = 13,922). At presentation (within first day of admission), 12,246 patients had at least one lactate determination and the median peak lactate was 1.8 (IQR 1.2 to 2.9) mmol/L. The cumulative incidence of at least one documented episode of hyperlactatemia was 5578/13,932 (40%); 5058 (36%) patients had hyperlactatemia at presentation, and a further 520 (4%) developed hyperlactatemia subsequently. The incidence of hyperlactatemia varied significantly by major admitting diagnostic category (P < 0.001) and was highest among neuro/trauma patients 1053/2328 (45%), followed by medical 2047/4935 (41%), other surgical 900/2274 (40%), and cardiac surgical 1578/4395 (36%). Among a cohort of 9107 first admissions with ICU stay of at least one day, both hyperlactatemia at presentation (712/3634 (20%) vs. 289/5473 (5%); P < 0.001) and its later development (101/379 (27%) vs. 188/5094 (4%); P < 0.001) were associated with significantly increased case fatality rates as compared with patients without elevated lactate. After controlling for confounding effects in multivariable logistic regression analysis, hyperlactatemia was an independent risk factor for death. Conclusions: Hyperlactatemia is common among the critically ill and predicts risk for death.</p

The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units

Introduction: Although sodium disturbances are common in hospitalised patients, few studies have specifically investigated the epidemiology of sodium disturbances in the intensive care unit (ICU). The objectives of this study were to describe the incidence of ICU-acquired hyponatraemia and hypernatraemia and assess their effects on outcome in the ICU. Methods: We identified 8142 consecutive adults (18 years of age or older) admitted to three medical-surgical ICUs between 1 January 2000 and 31 December 2006 who were documented to have normal serum sodium levels (133 to 145 mmol/L) during the first day of ICU admission. ICU acquired hyponatraemia and hypernatraemia were respectively defined as a change in serum sodium concentration to below 133 mmol/L or above 145 mmol/L following day one in the ICU. Results: A first episode of ICU-acquired hyponatraemia developed in 917 (11%) patients and hypernatraemia in 2157 (26%) patients with an incidence density of 3.1 and 7.4 per 100 days of ICU admission, respectively, during 29,142 ICU admission days. The incidence of both ICU-acquired hyponatraemia (age, admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of ICU stay, level of consciousness, serum glucose level, body temperature, serum potassium level) and ICU-acquired hypernatraemia (baseline creatinine, APACHE II score, mechanical ventilation, length of ICU stay, body temperature, serum potassium level, level of care) varied according to patients' characteristics. Compared with patients with normal serum sodium levels, hospital mortality was increased in patients with ICU-acquired hyponatraemia (16% versus 28%, p < 0.001) and ICU-acquired hypernatraemia (16% versus 34%, p < 0.001). Conclusions: ICU-acquired hyponatraemia and hypernatraemia are common in critically ill patients and are associated with increased risk of hospital mortality.</p

Information management framework; A model for clinical departments

The information management system of Department of Critical Care Medicine in Calgary Health Region was modeled using a departmental information management framework. The clinical, administrative, research and educational, decision-making and quality improvement information needs of the department are served by the system.</p

Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings

Purpose: Patient care may be inconsistent during off hours. We sought to determine whether adults admitted to or discharged from intensive care units (ICUs) on evenings and weekends have increased mortality rates. Materials and Methods: All adults admitted to ICUs in the Calgary Health Region, Alberta, Canada, during 2000 to 2006 were included. The in-hospital mortality risk was assessed with admissions or discharges on weekdays (Monday to Friday) and daytime (8:00 am to 5:59 pm) as compared with weekends (Saturday and Sunday) and nights (6:00 pm to 7:59 am). Results: Intensive care unit admissions (n = 20 466) occurred during weekends in 18%, nights in 41%, and nights and/or weekends in 49%. Among the 17 864 survivors to ICU discharge, 26% were discharged on weekends, 21% at night, and 41% on nights and/or weekends. Increased crude mortality rates were associated with both admission (24% vs 14%, P < .0001) and discharge (12% vs 5%, P < .0001) during nights as compared with days. Admission to (26% vs 16%, P < .0001) but not discharge from (6% vs 7%, P = .42) ICU during weekends as compared with weekdays was associated with increased mortality. After controlling for confounding variables using logistic regression analyses, neither weekend admission nor discharge was associated with death. However, both night admission and discharge were independently associated with mortality. Conclusions: Our observations of excess risk associated with admission to or discharge from ICU at night merits further exploration as to whether it may reflect inconsistencies in care after hours.</p

Concomitant ceftriaxone and high-concentration intravenous calcium therapy in adult critical care patients: A matched cohort study

BACKGROUND: Based on case reports in infants, the safety of concomitant use of ceftriaxone and intravenous calcium in all ages has recently come under challenge. Systematic population-based data to guide clinicians with respect to this risk are, however, lacking. OBJECTIVE: To determine whether concomitant administration of ceftriaxone and intravenous calcium was associated with the occurrence of severe cardiorespiratory events or death in critically ill adults. METHODS: We performed a matched-cohort study from retrospective data of adults admitted to intensive care units (ICUs) in Calgary, Canada, who were provided continuous high-dose intravenous calcium. Those who received ceftriaxone while on continuous renal replacement therapy were considered exposed. Up to 3 unexposed patients were selected by matching on a number of prognostic factors from the remaining subjects not concurrently exposed to ceftriaxone and calcium. Univariate methods and multivariate conditional logistic regression were used for statistical analysis. RESULTS: We identified 142 patients exposed to the implicated combination who could be matched to at least one unexposed patient. Hospital mortality was 66% in the exposed versus 63% in unexposed patients (p = 0.442). ICU length of stay, ICU mortality, hospital length of stay, and the frequency of acute oxygenation events were all similar by univariate analysis. Multivariate conditional logistic regression modeling failed to find a significant association between exposure and hospital mortality (adjusted OR 1.15, 95% CI 0.65 to 2.04) or other relevant outcomes. CONCLUSIONS: In this high-risk group, administration of high concentrations of calcium and concurrent ceftriaxone was not significantly associated with greater mortality or adverse outcomes compared to matched unexposed patients. Although this was an underpowered study and rare adverse effects from the interaction of these 2 compounds cannot be completely excluded, these data provide overall reassurance of the safety of this combination in the majority of critically ill adults.</p