Using a rigorous, straightforward scorecard as a guide, this book shows business leaders and innovators how to create breakthrough sustainable products and processes that are good for the planet, ...human health, and profits. Natural resource inputs to business operations are getting scarcer and more expensive, while climate-change-related economic shocks pose a risk to seamless operations and, more importantly, threaten business continuity. How can organizations integrate sustainable design in their overarching operations and align it with profitability and corporate strategy? Based on Paul Anastas's foundational Twelve Principles of Green Chemistry, the Sustainability Scorecard is the first scientifically rooted, data-driven methodology for creating inherently sustainable and profitable products and processes. By redesigning with sustainability as a key design element, firms open themselves to unexpected solutions, leapfrog innovations, and sources of value that simply don't occur when sustainability is leveraged purely as a risk-avoidance and compliance measure. Urvashi Bhatnagar and Anastas offer dozens of examples of how sustainable operations can yield benefits such as expanding market share, creating new service lines, and transforming supply- chain and sourcing models to drive the most consistent and highest long-term value. With this comprehensive framework, your firm will be able to identify truly innovative, inherently sustainable products as opposed to less bad products and processes that don't provide the exponential value that only breakthrough products can.
Using a rigorous, straightforward scorecard as a guide, this book shows business leaders and innovators how to create breakthrough sustainable products and processes that are good for the planet, ...human health, and profits. Natural resource inputs to business operations are getting scarcer and more expensive, while climate-change-related economic shocks pose a risk to seamless operations and, more importantly, threaten business continuity. How can organizations integrate sustainable design in their overarching operations and align it with profitability and corporate strategy? Based on Paul Anastas's foundational Twelve Principles of Green Chemistry, the Sustainability Scorecard is the first scientifically rooted, data-driven methodology for creating inherently sustainable and profitable products and processes. By redesigning with sustainability as a key design element, firms open themselves to unexpected solutions, leapfrog innovations, and sources of value that simply don't occur when sustainability is leveraged purely as a risk-avoidance and compliance measure. Urvashi Bhatnagar and Anastas offer dozens of examples of how sustainable operations can yield benefits such as expanding market share, creating new service lines, and transforming supply-chain and sourcing models to drive the most consistent and highest long-term value. With this comprehensive framework, your firm will be able to identify truly innovative, inherently sustainable products as opposed to “less bad” products and processes that don't provide the exponential value that only breakthrough products can.
Healthcare is a major emitter of environmental pollutants that adversely affect health. Within the healthcare community, awareness of these effects is low, and recognition of the duty to address them ...is only beginning to gain traction. Healthcare sustainability science explores dimensions of resource consumption and environmental emissions associated with healthcare activities. This emerging field provides tools and metrics to quantify the unintended consequences of healthcare delivery and evaluate effective approaches that improve patient safety while protecting public health. This narrative review describes the scope of healthcare sustainability research, identifies knowledge gaps, introduces a framework for applications of existing research methods and tools to the healthcare context, and establishes research priorities to improve the environmental performance of healthcare services. The framework was developed through review of the current state of healthcare sustainability science and expert consensus by the Working Group for Environmental Sustainability in Clinical Care. Key recommendations include: development of a comprehensive life cycle inventory database for medical devices and drugs; application of standardized sustainability performance metrics at the clinician, hospital/health system, and national levels; revision of infection control standards driving non-evidence-based uptake of single-use disposable devices; call for increased federal research funding; and formation of a Global Commission on the Advancement of Environmental Sustainability in Healthcare. There is an urgent need for research that informs policy and practice to address the public health crisis arising from healthcare pollution. A transformational vision is required to align research priorities to achieve a sustainable healthcare system that advances quality, safety and value.
Newer molecular diagnostics have brought paradigm shift in early diagnosis of tuberculosis TB. WHO recommended use of GeneXpert MTB/RIF Xpert for Extra-pulmonary EP TB; critics have since questioned ...its efficiency.
The present study was designed to assess the performance of GeneXpert in 761 extra-pulmonary and 384 pulmonary specimens from patients clinically suspected of TB and compare with Phenotypic, Genotypic and Composite reference standards CRS.
Comparison of GeneXpert results to CRS, demonstrated sensitivity of 100% and 90.68%, specificity of 100% and 99.62% for pulmonary and extra-pulmonary samples. On comparison with culture, sensitivity for Rifampicin Rif resistance detection was 87.5% and 81.82% respectively, while specificity was 100% for both pulmonary and extra-pulmonary TB. On comparison to sequencing of rpoB gene Rif resistance determining region, RRDR, sensitivity was respectively 93.33% and 90% while specificity was 100% in both pulmonary and extra-pulmonary TB. GeneXpert assay missed 533CCG mutation in one sputum and dual mutation 517 & 519 in one pus sample, detected by sequencing. Sequencing picked dual mutation 529, 530 in a sputum sample sensitive to Rif, demonstrating, not all RRDR mutations lead to resistance.
Current study reports observations in a patient care setting in a high burden region, from a large collection of pulmonary and extra-pulmonary samples and puts to rest questions regarding sensitivity, specificity, detection of infrequent mutations and mutations responsible for low-level Rif resistance by GeneXpert. Improvements in the assay could offer further improvement in sensitivity of detection in different patient samples; nevertheless it may be difficult to improve sensitivity of Rif resistance detection if only one gene is targeted. Assay specificity was high both for TB detection and Rif resistance detection. Despite a few misses, the assay offers major boost to early diagnosis of TB and MDR-TB, in difficult to diagnose pauci-bacillary TB.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Mixed/polyclonal infections due to different genotypes are reported in Tuberculosis. The current study was designed to understand the fate of mixed infections during the course of treatment and ...follow-up and its role in disease pathogenesis. Sputum samples were collected on 0,1,2,3,6,12 and 24 months from 157 treatment-naïve patients, cultures subjected to Drug-Susceptibility-testing (MGIT 960), spoligotyping, MIRU-VNTR and SNP genotyping. All isolated colonies on thin layer agar (7H11) were subjected to spoligotyping. One thirty three baseline cultures were positive (133/157, 84.7%), 43(32.3%) had mixture of genotypes. Twenty-four of these patients (55.8%) showed change in genotype while six showed different drug-susceptibility patterns while on treatment. Twenty-three (53.5%) patients with polyclonal infections showed resistance to at least one drug compared to 10/90 (11.1%) monoclonal infections (P<0.0001). Eight patients had recurrent TB, two with a new genotype and two with altered phenotypic DST. The coexistence of different genotypes and change of genotypes during the same disease episode, while on treatment, confirms constancy of polyclonal infections. The composition of the mixture of genotypes and the relative predominance may be missed by culture due to its limit of detection. Polyclonal infections in TB could be a rule rather than exception and challenges the age-old dogma of reactivation/reinfection.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Emerging evidence indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals are at an increased risk for coinfections; therefore, physicians need to be ...cognizant about excluding other treatable respiratory pathogens. Here, we report coinfection with SARS-CoV-2 and other respiratory pathogens in patients admitted to the coronavirus disease (COVID) care facilities of an Indian tertiary care hospital. From June 2020 through January 2021, we tested 191 patients with SARS-CoV-2 for 33 other respiratory pathogens using an fast track diagnostics respiratory pathogen 33 (FTD-33) assay. Additionally, information regarding other relevant respiratory pathogens was collected by reviewing their laboratory data. Overall, 13 pathogens were identified among patients infected with SARS-CoV-2, and 46.6% (89/191) of patients had coinfection with one or more additional pathogens. Bacterial coinfections (41.4% 79/191) were frequent, with Staphylococcus aureus being the most common, followed by Klebsiella pneumoniae. Coinfections with SARS-CoV-2 and Pneumocystis jirovecii or Legionella pneumophila were also identified. The viral coinfection rate was 7.3%, with human adenovirus and human rhinovirus being the most common. Five patients in our cohort had positive cultures for Acinetobacter baumannii and K. pneumoniae, and two patients had active Mycobacterium tuberculosis infection. In total, 47.1% (90/191) of patients with coinfections were identified. The higher proportion of patients with coinfections in our cohort supports the systemic use of antibiotics in patients with severe SARS-CoV-2 pneumonia with rapid de-escalation based on respiratory PCR/culture results. The timely and simultaneous identification of coinfections can contribute to improved health of COVID-19 patients and enhanced antibiotic stewardship during the pandemic. IMPORTANCE Coinfections in COVID-19 patients may worsen disease outcomes and need further investigation. We found that a higher proportion of patients with COVID-19 were coinfected with one or more additional pathogens. A better understanding of the prevalence of coinfection with other respiratory pathogens in COVID-19 patients and the profile of pathogens can contribute to effective patient management and antibiotic stewardship during the current pandemic.
India with a major burden of multidrug-resistant tuberculosis (MDR-TB) does not have national level data on this hazardous disease. Since 2006, emergence of extensively drug-resistant TB (XDR-TB) is ...considered a serious threat to global TB control. This study highlights the demographic and clinical risk factors associated with XDR-TB in Delhi.
The study was conducted during April 2007 to May 2010. Six hundred eleven MDR-TB suspects were enrolled from four tertiary care hospitals, treating TB patients in Delhi and the demographic details recorded. Sputum samples were cultured using rapid, automated liquid culture system (MGIT 960). Drug susceptibility testing (DST) for Rifampicin (RIF) and Isoniazid (INH) was performed for all positive M. tuberculosis (M.tb) cultures. All MDR-TB isolates were tested for sensitivity to second-line drugs Amikacin (AMK), Capreomycin (CAP), Ofloxacin (OFX), Ethionamide (ETA).
Of 611, 483 patients were infected with MDR M. tuberculosis (M.tb) strains. Eighteen MDR-TB isolates (3.7%) were XDR M.tb strains. Family history of TB (p 0.045), socioeconomic status (p 0.013), concomitant illness (p 0.001) and previous intake of 2(nd) line injectable drugs (p 0.001) were significantly associated with occurrence of XDR-TB. Only two of the patients enrolled were HIV seropositive, but had a negative culture for M. tuberculosis. 56/483 isolates were pre-XDR M. tuberculosis, though the occurrence of pre-XDR-TB did not show any significant demographical associations.
The actual incidence and prevalence rate of XDR-TB in India is not available, although some scattered data is available. This study raises a concern about existence of XDR-TB in India, though small, signaling a need to strengthen the TB control program for early diagnosis of both tuberculosis and drug resistance in order to break the chains of transmission.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Extra-pulmonary TB (EPTB) is difficult to diagnose due to paucibacillary nature of disease. Current study evaluated accuracy of Truenat MTB and MTB-Rif Dx (TN), for detection of ...Mycobacterium tuberculosis and resistance to rifampicin. Samples were collected from 2103 treatment naive adults with presumptive EPTB, and tested by smear microscopy, liquid culture (LC) (MGIT-960) and GeneXpert MTB/RIF (GX) (Microbiological Reference Standards, MRS). TN results were compared to MRS and Composite Reference Standards (CRS, Microbiology, histopathology, radiology, clinical features prompting decision to treat, response to treatment). CRS grouped patients into 551 confirmed, 1096 unconfirmed, and 409 as unlikely TB. TN sensitivity and specificity was 73.7% and 90.4% against GX. Against LC, Overall sensitivity of GX was 67.6%, while that of TN was 62.3%. Highest sensitivity by TN was observed in pus samples (89%) and highest specificity (92%) in CSF samples, similar to GX. TN sensitivity was better in fluid and biopsy samples and slightly inferior for lymph node aspirates compared to GX. TN sensitivity for RIF resistance detection was slightly superior to GX. TN and GX results were further compared to Clinical Reference Standards. TN detected 170 TB patients initiated on treatment missed by GX, while GX detected 113 such patients missed by TN. Of 124 samples with RIF resistance discordance between GX and TN, GX reported 103/124 as sensitive, 3/124 as indeterminate and 18 as resistant (13/18 samples had low/very low DNA load) while TN reported RIF resistance indeterminate in 103/111 low/very low DNA load samples. Due to paucibacillary nature of EPTB samples, culture yield was poor and phenotypic drug susceptibility testing failed to resolve the discordance. The study establishes TN at par with GX and can be utilized for quick and accurate diagnosis of EPTB.
We report new observations of A2256 with the Karl G. Jansky Very Large Array (VLA) at frequencies between 1 and 8 GHz. These observations take advantage of the 2:1 bandwidths available during a ...single observation to study the spectral index, polarization, and rotation measure as well as using the associated higher sensitivity per unit time to image total intensity features down to ∼0.''5 resolution. We find that the Large Relic, which dominates the cluster, is made up of a complex of filaments that show correlated distributions in intensity, spectral index, and fractional polarization. The rotation measure varies across the face of the Large Relic but is not well correlated with the other properties of the source. The shape of individual filaments suggests that the Large Relic is at least 25 kpc thick. We detect a low surface brightness arc connecting the Large Relic to the Halo and other radio structures, suggesting a physical connection between these features. The center of the F-complex is dominated by a very steep-spectrum, polarized, ring-like structure, F2, without an obvious optical identification, but the entire F-complex does have interesting morphological similarities to the radio structure of NGC 1265. Source C, the Long Tail, is unresolved in width near the galaxy core and is ≲ 100 pc in diameter there. This morphology suggests either that C is a one-sided jet or that the bending of the tails takes place very near the core, consistent with the parent galaxy having undergone extreme stripping. Overall it seems that many of the unusual phenomena can be understood in the context of A2256 being near the pericenter of a slightly off-axis merger between a cluster and a smaller group. Given the lack of evidence for a strong shock associated with the Large Relic, other models should be considered, such as reconnection between two large-scale magnetic domains.
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