Towards a global criteria based framework for the sustainability assessment of bioethanol supply chains: application to the Swiss dilemma : is local produced bioethanol more sustainable than bioethanol imported from Brazil?

Biofuels are considered as a promising substitute for fossil fuels when considering the possible reduction of greenhouse gases emissions. However limiting their impacts on potential benefits for reducing climate change is shortsighted. Global sustainability assessments are necessary to determine the sustainability of supply chains. We propose a new global criterion based framework enabling a comprehensive international comparison of bioethanol supply chains. The interest of this framework is that the selection of the sustainability indicators is qualified on three criterions: relevance, reliability and adaptability to the local context. Sustainability issues have been handled along environmental, social and economical issues. This new framework has been applied for a specific issue: from a Swiss perspective, is locally produced bioethanol in Switzerland more sustainable than imported from Brazil? Thanks to this framework integrating local context in its indicator definition, Brazilian production of bioethanol is shown as energy efficient and economically interesting for Brazil. From a strictly economic point of view, bioethanol production within Switzerland is not justified for Swiss consumption and questionable for the environmental issue. The social dimension is delicate to assess due to the lack of reliable data and is strongly linked to the agricultural policy in both countries. There is a need of establishing minimum sustainability criteria for imported bioethanol to avoid unwanted negative or leakage effects.

Pseudoxanthoma elasticum : evaluation of diagnostic criteria based on molecular data

RÉSUMÉ EN FRANCAIS : Introduction: Le pseudoxanthome élastique (PXE) est une maladie génétique. Les mutations responsables ont été localisées au niveau du gène codant le transporteur transmembranaire ABC-C6. Des calcifications pathologiques des fibres élastiques de la peau, des yeux et du système cardiovasculaire en sont la conséquence. Buts: Evaluer les critères diagnostiques actuels du PXE en se basant sur les données moléculaires. Méthodes: 142 sujets provenant de 10 familles avec une anamnèse familiale positive pour le PXE ont été investiguées sur le plan clinique, histopathologique et génétique. Résultats: 25 sujets se sont avérés être homozygotes pour le gène PXE muté. 23 d'entre eux ont présenté les manifestations cliniques et histopathologique typiques. Les deux autres souffraient d'une élastose et d'une dégénérescence maculaire si importante qu'un diagnostic de PXE ne pouvait pas être confirmé cliniquement. 67 sujets se sont révélés être des porteurs hétérozygotes et 50 ne présentaient pas de mutation. De ces 117 sujets, 116 n'ont montré aucune lésion cutanée ou ophtalmique pouvant correspondre au PXE. Un seul des sujets sans mutation a présenté une importante élastose solaire ainsi qu'une cicatrisation de la rétine, imitant les lésions typiques du PXE. Quatre des 67 sujets hétérozygotes ont eu une biopsie de peau, dont les analyses histopathologique se sont avérées normales. Conclusion: Dans notre cohorte de patients, le PXE était transmis exclusivement de façoh autosomique récessive. La corrélation retrouvée entre le génotype et le phénotype a permis de confirmer les critères diagnostiques majeurs actuels. Le diagnostic clinique peut être difficile, voir impossible, chez des patients atteints d'une élastose solaire importante et/ou d'une dégénérescence maculaire étendue. Dans ces cas, un test moléculaire est nécessaire afin de confirmer le diagnostic de PXE. A notre connaissance, notre étude présentée ici est le premier travail comparant des données cliniques à des données moléculaires dans le domaine du PXE. ABSTRACT : Background: Pseudoxanthoma elasticum (PXE) is a genetic disorder due to mutations in the gene encoding the transmembrane transporter protein adenosine triphosphate binding cassette (ABC)-C6, resulting in calcifications of elastic fibers in the skin, eyes and cardiovascular system. Objectives: To evaluate the diagnostic criteria for PXE based on molecular data. Methods: Of 10 families with a positive history of PXE 142 subjects were investigated for clinical symptoms, histological findings and genetic haplotype analysis. Results: Of these, 25 subjects were haplotypic homozygous for PXE and 23 had typical clinical and histopathological manifestations. Two of the 25 patients showed such marked solar elastosis and macular degeneration that PXE could not be confirmed clinically. Sixty-seven subject were haplotypic heterozygous carriers and 50 haplotypic homozygous unaffected. Of these 117 subjects, 116 showed no cutaneous or ophthalmologic signs of PXE. In one of the 50 haplotypic homozygous unaffected patients important solar elastosis and scaring of the retina mimicked PXE lesions. Only four of the 67 haplotypic heterozygous carriers had biopsies of nonlesional skin; all were histopathologically normal. Conclusions: In our patients, PXE presents as an autosomal recessive genodermatosis. Correlation of haplotype and phenotype confirmed actual major diagnostic criteria. In patients with marked solar elastosis and/ or severe macular degeneration clinical diagnosis can be impossible and molecular testing is needed to confirm the presence of PXE. To the best of our knowledge our large study compares for the first time clinical findings with molecular data.

Influence of compliance to respiratory weaning consensus conference criteria on respiratory outcome within 48h after planned extubation

INTRODUCTION. A two-step assessment (readiness to wean (RW) followed by spontaneousbreathing trial (SBT)) of predefined criteria is recommended before planned extubation(PE)1.OBJECTIVES. We aimed to evaluate if compliance to all guideline criteria was associatedwith better respiratory outcome within 48 h after PE.METHODS. The data (extracted from our clinical information system) of 458 consecutivepatients who underwent PE after C48 h of invasive ventilation in our medico-surgical ICUwere analyzed. We evaluated compliance with guidelines [1] regarding respiratory rate, tidalvolume, PaO2, FiO2, PEEP, PaCO2, pH, heart rate, systolic arterial pressure and arrhythmiaduringRWand SBT assessment (RW and SBT within 2 h). A patient was classified as RW+ ifallRWcriteria were fulfilled andRW-if at least 1 criterion was violated. The same approachwas used to define SBT+ and SBT- patients. During the 48 h following PE, we assessed theoccurrence of post-PE respiratory failure (PRF) (defined as the presence of at least 1 consensuscriterion of respiratory failure [1]), reintubation (after NIV failure or because of immediateintubation criteria) and cumulative duration of post-PE ventilation (PPEV = Post-PE invasive+ non-invasive ventilation). ICU mortality was recorded. Comparisons for variousoutcomes were performed by Chi-square and t tests.RESULTS. All consensus criteria were fulfilled in 77.3% of the patients during RW and in68.1% of the patients during SBT.[Compliance to weaning criteria and outcome]N = 458 PRF (%) Reintubation (%) PPEV (min) ICU mortality (%)All patients 53.5 10.0 542 ± 664 6.1RW+ 50.0 9.3 490 ± 626 5.4RW- 65.4* 12.5 718 ± 757** 8.7SBT+ 52.6 8.0 498 ± 594 6.7SBT- 55.5 14.4*** 637 ± 788**** 4.8Occurrence of PRF only was not associated with increased ICU mortality: 4.2 versus 7.8%,p = 0.11. By contrast, ICU mortality was significantly increased in patients requiring reintubation:21.7 versus 4.4%. p\0.001; * p = 0.006 RW+ versus RW-; ** p = 0.003RW+ versus RW-; *** p = 0.035 SBT+ versus SBT-; **** p = 0.030 SBT+ versusSBTCONCLUSIONS.In our ICU, compliance to all criteria of the two-step published approach ofrespiratory weaning was not optimal but reintubation rate was comparable to published data.Compliance with consensus conference guidelines was associated with lower reintubation rateand shorter PPEV but not with ICU mortality. As mortality was increased by reintubation,more sensitive and specific criteria to predict the risk of reintubation are probably needed.REFERENCE. Boles JM, et al. Eur Respir J 2007;29:1033-56.

Implementation of raltegravir in routine clinical practice: selection criteria for choosing this drug, virologic response rates, and characteristics of failures.

BACKGROUND: Raltegravir (RAL) achieved remarkable virologic suppression rates in randomized-clinical trials, but today efficacy data and factors for treatment failures in a routine clinical care setting are limited. METHODS: First, factors associated with a switch to RAL were identified with a logistic regression including patients from the Swiss HIV Cohort Study with a history of 3 class failure (n = 423). Second, predictors for virologic outcome were identified in an intent-to-treat analysis including all patients who received RAL. Last observation carried forward imputation was used to determine week 24 response rate (HIV-1 RNA >or= 50 copies/mL). RESULTS: The predominant factor associated with a switch to RAL in patients with suppressed baseline RNA was a regimen containing enfuvirtide [odds ratio 41.9 (95% confidence interval: 11.6-151.6)]. Efficacy analysis showed an overall response rate of 80.9% (152/188), whereas 71.8% (84/117) and 95.8% (68/71) showed viral suppression when stratified for detectable and undetectable RNA at baseline, respectively. Overall CD4 cell counts increased significantly by 42 cells/microL (P < 0.001). Characteristics of failures were a genotypic sensitivity score of the background regimen <or=1, very low RAL plasma concentrations, poor adherence, and high viral load at baseline. CONCLUSIONS: Virologic suppression rates in our routine clinical care setting were promising and comparable with data from previously published randomized-controlled trials.

Analysis of Existing Work-Zone Devices with MASH Safety Performance Criteria, TPF-5(018), 2009

Crashworthy, work-zone, portable sign support systems accepted under NCHRP Report No. 350 were analyzed to predict their safety peformance according to the TL-3 MASH evaluation criteria. An analysis was conducted to determine which hardware parameters of sign support systems would likely contribute to the safety performance with MASH. The acuracy of the method was evaluated through full-scale crash testing. Four full-scale crash tests were conducted with a pickup truck. Two tall-mounted, sign support systems with aluminum sign panels failed the MASH criteria due to windshield penetration. One low-mounted system with a vinyl, roll-up sign panel failed the MASH criteria due to windshield and floorboard penetration. Another low-mounted system with an aluminum sign panel successfully met the MASH criteria. Four full-scale crash tests were conducted with a small passenger car. The low-mounted tripod system with an aluminum sign panel failed the MASH criteria due to windshield penetration. One low-mounted system with aluminum sign panel failed the MASH criteria due to excessive windshield deformation, and another similar system passed the MASH criteria. The low-mounted system with a vinyl, roll-up sign panel successfully met the MASH criteria. Hardware parameters of work-zone sign support systems that were determined to be important for failure with MASH include sign panel material, the height to the top of the mast, the presence of flags, sign-locking mechanism, base layout and system orientation. Flowcharts were provided to assist manufacturers when designing new sign support systems.

First explicit criteria to decide on the appropriateness of therapy of ulcerative colitis: the European EPATUC panel

Background: Ulcerative colitis (UC) is a chronic disease with a wide variety of treatment options many of which are not evidence based. Supplementing available guidelines, which are often broadly defined, consensus-based and generally not tailored to specifically reflect the individual patient situation, we developed explicit appropriateness criteria to assist, and improve treatment decisions. Methods: We used the RAND appropriateness method which does not force consensus. An extensive literature review was compiled based on and supplementing, where necessary, the ECCO UC 2011 guidelines. EPATUC (endorsed by ECCO) was formed by 7 gastroenterologists, 2 surgeons and 2 general practitioners from throughout Europe. Clinical scenarios reflecting practice were rated on a 9-point scale from 1 (extremely inappropriate) to 9 (extremely appropriate), based on the expert's experience and the available literature. After extensive discussion, all scenarios were re-rated at a two-day panel meeting. Median and disagreement (D) were used to categorize ratings into 3 categories: appropriate (A), uncertain (U) and inappropriate (I). Results: 718 clinical scenarios were rated, structured in 13 main clinical presentations: not refractory (n = 64) or refractory (n = 33) proctitis, mild to moderate left-sided (n = 72) or extensive (n = 48) colitis, severe colitis (n = 36), steroid- dependant colitis (n = 36), steroid-refractory colitis (n = 55), acute pouchitis (n = 96), maintenance of remission (n = 248), colorectal cancer prevention (n = 9) and fulminant colitis (n = 9). Overall, 100 indications were judged appropriate (14%), 129 uncertain (18%) and 489 inappropriate (68%). Disagreement between experts was very low (6%). Conclusions: For the very first time, explicit appropriateness criteria for therapy of UC were developed that allow both specific and rapid therapeutic decision making and prospective assessment of treatment appropriateness. Comparison of these detailed scenarios with patient profiles encountered in the Swiss IBD cohort study indicates good concordance. EPATUC criteria will be freely accessible on the internet (epatuc.ch)

Criteria for hitting probabilities with applications to systems of stochastic wave equations

We develop several results on hitting probabilities of random fields which highlight the role of the dimension of the parameter space. This yields upper and lower bounds in terms of Hausdorff measure and Bessel-Riesz capacity, respectively. We apply these results to a system of stochastic wave equations in spatial dimension k >- 1 driven by a d-dimensional spatially homogeneous additive Gaussian noise that is white in time and colored in space.

The pulmonary embolism rule-out criteria (PERC) rule does not safely exclude pulmonary embolism.

Background: The Pulmonary Embolism Rule-out Criteria (PERC) rule is a clinical diagnostic rule designed to exclude pulmonary embolism (PE) without further testing. We sought to externally validate the diagnostic performance of the PERC rule alone and combined with clinical probability assessment based on the revised Geneva score. Methods: The PERC rule was applied retrospectively to consecutive patients who presented with a clinical suspicion of PE to six emergency departments, and who were enrolled in a randomized trial of PE diagnosis. Patients who met all eight PERC criteria [PERC(-)] were considered to be at a very low risk for PE. We calculated the prevalence of PE among PERC(-) patients according to their clinical pretest probability of PE. We estimated the negative likelihood ratio of the PERC rule to predict PE. Results: Among 1675 patients, the prevalence of PE was 21.3%. Overall, 13.2% of patients were PERC(-). The prevalence of PE was 5.4% [95% confidence interval (CI): 3.1-9.3%] among PERC(-) patients overall and 6.4% (95% CI: 3.7-10.8%) among those PERC(-) patients with a low clinical pretest probability of PE. The PERC rule had a negative likelihood ratio of 0.70 (95% CI: 0.67-0.73) for predicting PE overall, and 0.63 (95% CI: 0.38-1.06) in low-risk patients. Conclusions: Our results suggest that the PERC rule alone or even when combined with the revised Geneva score cannot safely identify very low risk patients in whom PE can be ruled out without additional testing, at least in populations with a relatively high prevalence of PE.

Colorectal cancer detection: how well do appropriateness criteria perform?

Comment on: Hassan C, Di Giulio E, Pickhardt PJ, Zullo A, Laghi A, Kim DH, Iafrate F, Morini S. Cost effectiveness of colonoscopy, based on the appropriateness of an indication. Clin Gastroenterol Hepatol. 2008 Nov;6(11):1231-6.

Decision criteria for optimizing postemergence johnsongrass control in soybean crops in Argentina

Field studies were established in Zavalla and Oliveros, Argentina, during four years in order to optimize Johnsongrass (Sorghum halepense (L.) Pers.) chemical control by means of the thermal calendar model in comparison with other criteria (weed height or days after sowing). The effect of three application dates of postemergence herbicides was determined by visual control, density of tillers originated from rhizome bud regrowth, and from crown and shoot bud regrowth, and soybean yield. Following the thermal calendar model criterion, applications during the second date afforded the best control. Weed height for the first date showed little variability between experiments but was highly variable in the second and third application dates, achieving in some cases values greater than 120 cm. For all years, no significant differences were detected for crop yield between the first and second application dates, and yields were always lower for the third date. The greatest rhizome bud regrowth was observed for the earliest application date and the highest crown and shoot bud regrowth was determined for the last application date. Parameters associated with control efficiency showed the best behaviour for the second date. However, plant height at this moment may interfere with herbicide application and the variability exhibited by this parameter highlights the risk of determining control timing using only one decision criterion.

Appropriateness of initial treatment for severe Crohn's disease: application of EPACT criteria to the EC-IBD European cohort

Background: The appropriateness of use of therapy for severe active luminal Crohn's disease (CD) cases has never been formally assessed. The European panel on the appropriateness of Crohn's disease therapy [EPACT (http://www.epact.ch)] developed appropriateness criteria. We have applied these criteria to the EC-IBD prospectively assembled, uniformly diagnosed European population-based inception cohort of Inflammatory Bowel Disease (IBD) patients diagnosed between 1991 and 1993. Methods: 426 CD patients from 13 European participating centers (10 countries) were included at the time of diagnosis (first flare, naive patients, no maintenance treatment, no steroids). We used the EPACT definition of the severe active luminal CD, agreed upon by the panel experts (acute flare, hospitalized patient, without documented fistula or stenosis and who did not undergo surgery for abscess drainage or a fistulectomy). The various treatments were analyzed to determine the appropriateness of the medical decision, according to the EPACT criteria. Results: 84 (20%) patients met the inclusion criteria. Considering at least one appropriate (A) treatment as appropriate: 60 patients (71%) received an appropriate treatment, 24 patients (29%) an inappropriate treatment (I). Furthermore, in 87% of the cases with one appropriate treatment an additional mostly inappropriate treatment was added or continued. Detailed results are indicated in the table below. Conclusion: In the EC-IBD cohort, the treatment for severe active luminal CD was appropriate for more than 70% of the patients, but frequently an inappropriate treatment was continued or added, thus increasing the risk of adverse reactions, drugs interactions and costs.

Standardizing the diagnosis of inhalation injury using a descriptive score based on mucosal injury criteria.

INTRODUCTION: Inhalation injury is an important determinant of outcome in patients with major burns. However the diagnostic criteria remain imprecise, preventing objective comparisons of published data. The aims were to evaluate the utility of an inhalation score based on mucosal injury, while assessing separately the oro-pharyngeal sphere (ENT) and tracheobronchial tree (TB) in patients admitted to the ICU with a suspicion of inhalation injury. METHODS: Prospective observational study in 100 patients admitted with suspicion of inhalation injury among 168 consecutive burn admissions to the ICU of a university hospital. Inclusion criteria, endoscopic airway assessment during the first hours. ENT/TB lesion grading was 1: oedema, hyperemia, hypersecretion, 2: bullous mucosal detachment, erosion, exudates, 3: profound ulcers, necrosis. RESULTS: Of the 100 patients (age 42±17 years, burns 23±19%BSA), 79 presented an ENT inhalation injury ≥ENT1 (soot present in 24%): 36 had a tracheobronchial extension, 33 having a grade ≥TB1. Burned vibrissae: 10 patients "without" suffered ENT injury, while 6 patients "with" had no further lesions. Length of mechanical ventilation was strongly associated with the first 24 hrs' fluid resuscitation volume (p<0.0001) and the presence of inhalation injury (p=0.03), while the ICU length of stay was correlated with the %BSA. Soot was associated with prolonged mechanical ventilation (p=0.0115). There was no extubation failure. CONCLUSIONS: The developed inhalation score was simple to use, providing a unified language, and drawing attention to upper airway involvement. Burned vibrissae and suspected history proved to be insufficient diagnostic criteria. Further studies are required to validate the score in a larger population.