Early Initiation of Oral Antihypertensives Reduces Intensive Care Unit Stay and Hospital Cost for Patients with Hypertensive Intracerebral Hemorrhage.

Background/objectiveIntravenous nicardipine infusion is effective for rapid blood pressure control. However, its use requires hemodynamic monitoring in the intensive care unit (ICU) and is associated with high hospital cost. This study aimed to examine the effect of early versus late initiation of oral antihypertensives on ICU length of stay (LOS) and cost of hospitalization in patients with hypertensive intracerebral hemorrhage (ICH).MethodsThis is a single-center retrospective study of patients with hypertensive ICH treated with nicardipine infusion from January 1, 2013, to December 31, 2017. Patients were dichotomized into study and control groups, based on receiving oral antihypertensives within 24 h versus after 24 h of emergency department arrival. Baseline characteristics, duration of nicardipine infusion, LOS in the ICU and hospital, functional outcome at discharge, and hospital cost were compared between the two groups using univariate and multivariate analysis.ResultsA total of 90 patients in the study group and 76 in the control group were identified. There was no significant difference in demographics, past medical history, and initial SBP between the two groups. After adjusting for confounding factors with multivariate regression models, early initiation of oral antihypertensives was associated with significant reductions in duration of nicardipine infusion (55.5 ± 60.1 vs 121.6 ± 141.3 h, p <0.005), nicardipine cost ($14,207 vs$29,299, p < 0.01), ICU LOS (2 vs 5 days, p < 0.005), and cost of hospitalization ($24,564 vs$47,366, p < 0.01). There was no significant difference in adversary renal events, favorable outcomes, and mortality between the two groups.ConclusionsEarly initiation of oral antihypertensives is safe and may have a significant financial impact on patients with hypertensive ICH

Brucellosis in ruminants in two counties of Yunnan, China and the use of an integrated approach for effective control

Brucellosis is an increasing production and public health concern in many countries of Asia including China. Challenges for an effective control include lack of collaboration between sectors or uncontrolled animal movement (among others). Yunnan might be at particular risk as ruminants are increasingly introduced from other parts of China e.g. Inner Mongolia, a known high prevalence area in a response to a higher demand for milk. To face this challenges, new integrated approaches are needed such as Ecohealth to support transdisciplinary collaboration versus silo thinking, the latter rather common in the top down animal health control system of China. In the presented research, which was part of an IDRC funded ILRI-Ecozd project, veterinary, public health, animal science experts from five provincial institutions, practitioners from the project sites, and policy authorities worked together to achieve a more effective control of brucellosis. The research was carried out between 2011 and 2013 in two counties of Yunnan, Mangshi and Yiliang and consisted of a historical data review, biological sampling (milk) in herds/households with dairy ruminants and people at risk (serum). Questionnaires were used to collect management data (N=192) from farmers; focus group discussions (villagers) and in depth interviews (village vets and human doctors) gained information on perception and awareness on zoonoses in general and more specifically on the targeted disease. Results from the biological sampling indicate brucellosis as an existing and potentially emerging public health concern depending on the production system. Risk factors for the spread of brucellosis were reported and included risky handling of aborted fetus among others. Awareness and perception on zoonoses (including brucellosis) of all interviewed groups was in general low. The use of a “learning by doing” EcoHealth approach led to improve team member's capacity on Ecohealth and its practical realisation in a field study, e.g. by building up collaboration between those institutions but also stakeholders. Crucial was the support by the Agriculture Department and Health Department of Yunnan. Outcome mapping indicated a change of behaviour in the targeted groups in particular on zoonoses knowledge and willingness to share of information between sectors (vet and public health)

2-Chloro-N-{5-[(4R,5R,10S)-dehydro­abiet-4-yl]-1,3,4-thia­diazol-2-yl}benzamide

There are two independent mol­ecules in the asymmetric unit of the title compound, C28H32ClN3OS (systematic name: 2-chloro-N-{5-[(1R,4aS,10aR)-7-isopropyl-1,4a-dimethyl-1,2,3,4,4a,9,10,10a-octa­hydro­phenanthren-1-yl]-1,3,4-thia­diazol-2-yl}benzamide). In each mol­ecule, the cyclo­hexyl ring attached to the thia­diazole fragment adopts a classic chair conformation with two of its two methyl groups in the axial positions. In the crystal, pairs of inter­molecular N—H⋯N hydrogen bonds link the mol­ecules into centrosymmetric dimers, which are further linked via C—H⋯π inter­actions

Advanced progress in recycling municipal and construction solid wastes for manufacturing sustainable construction materials

The sharply increasing solid waste generation has raised the environmental concerns worldwide which currently have been escalated to a worrying level. Intending to eliminate the negative environmental impacts of solid waste and meanwhile promote sustainability on the energy- and resource-intensive construction and building sector, considerable efforts have been devoted to recycling solid waste for the possible use in sustainable construction material products. This paper reviews the existing studies on recycling municipal and construction solid waste for the manufacture of geopolymer composites. Special attention is paid to the predominate performance of these geopolymer composite products. The principal findings of this work reveal that municipal and construction solid waste could be successfully incorporated into geopolymer composites in the forms of precursor, aggregate, additive, reinforcement fiber, or filling material. Additionally, the results indicate that although the inclusion of such waste might depress some of the attributes of geopolymer composites, proper proportion design and suitable treatment technique could alleviate these detrimental effects and further smooth the recycling progress. Finally, a brief discussion is provided to identify the important needs in the future research and development for promoting the utilization of solid waste materials in the forthcoming sustainable geopolymer industry. In summary, this work offers guidance for the better ecological choice to municipal and construction solid waste through developing waste materials into highly environmental-friendly construction materials