OBJECTIVE This study seeks to evaluate the efficacy and safety of intranasal (IN) dexmedetomidine as a sedative medication for non-invasive procedural sedation. METHODS Subjects 6 months to 18 years of age undergoing non-invasive elective procedures were included. Dexmedetomidine (3 mcg/kg) was administered IN 40 minutes before the scheduled procedure time. The IN dexmedetomidine cohort was matched and compared to a cohort of 690 subjects who underwent sedation for similar procedures without the use of dexmedetomidine to evaluate for observed events/interventions and procedural times. RESULTS One hundred (92%) of the 109 included subjects were successfully sedated with IN dexmedetomidine. There were no significant differences in the rate of observed events/interventions in comparison to the non-dexmedetomidine cohort. However, the IN dexmedetomidine group had a longer postprocedure sleep time when compared to the non-dexmedetomidine cohort (p < 0.001), which had a significant effect on recovery time (p = 0.024). Also, the dexmedetomidine cohort had longer procedure time and total admit time (p < 0.001 and p = 0.037, respectively). CONCLUSIONS IN dexmedetomidine may be used for non-invasive pediatric procedural sedation. Subjects receiving IN dexmedetomidine had a similar rate of observed events/interventions as the subjects receiving non-dexmedetomidine sedation, with the exception of sleeping time. Also, patients sedated with IN dexmedetomidine had longer time to discharge, procedure time, and total admit time in comparison to other forms of sedation.

There are many economic, social and environmental reasons to reduce the occurrence of food that is wasted. As communities consider options for managing their food waste streams, an understanding of the volume, composition and variability of these streams is needed to inform the decision-making process and potentially justify the capital investments needed for separation and treatment operations. This more detailed inventory also allows for the estimation of embodied resources in food that is wasted, demonstrated herein for greenhouse gas emissions (GHGs). Pre- and post-consumer food waste was collected from four all-you-care-to-eat Campus Dining Services (CDS) facilities at the University of Missouri, Columbia over 3 months in 2014. During the study period approximately 246.3 metric tons (t) of food reached the retail level at the four facilities. 232.4 t of this food was served and 13.9 t of it (10.1 t of edible and 3.8 t of inedible), was lost as pre-consumer waste. Over the same time period, an estimated 26.4 t of post-consumer food waste was generated at these facilities, 21.2 t of the waste edible and 5.3 t of it inedible. Overall, 5.6% of food reaching the retail level was lost at the pre-consumer stage and 10.7% was lost at the post-consumer stage. Out of the food categories examined, ‘fruits and vegetables’ constituted the largest source of food waste by weight, with grains as the second largest source of food waste by weight. GHGs embodied in edible food waste were calculated. Over the study period an estimated 11.1 t CO2e (100-yr) were embodied in the pre-consumer food waste and 56.1 t were embodied in post-consumer food waste for a total of 67.2 t. The ‘meat and protein’ category represents the largest embodiment of GHG emissions in both the pre- and post-consumer categories despite ranking fourth in total weight. Beef represents the largest contribution to post-consumer GHG emissions embodied in food waste with an estimated 34.1 t CO2e. This distinction between the greatest sources of food waste by weight and the greatest sources of GHG emissions is relevant when considering alternative management options for food waste.

Collegiate sporting venues have been leading efforts toward zero-waste events in pursuit of more sustainable operations. This study audited the landfill-destined waste generated at the University of Missouri (MU) football stadium in 2014 and evaluated the life cycle greenhouse gas (GHG) and energy use associated with waste management options, including options that do and do not comply with zero-waste definitions. An estimated 47.3 metric tons (mt) of waste was generated, the majority (29.6 mt waste) came from off-site, pre-game food preparation activities; of which over 96 percent (%) was pre-consumer and un-sold food waste. The remaining 17.7 mt originated from inside the stadium; recyclable materials accounting for 43%, followed by food waste, 24%. Eleven waste management strategies were evaluated using the Waste Reduction Model (WARM). Results indicate that scenarios achieving zero waste compliance are not necessarily the most effective means of reducing GHG emissions or energy use. The two most effective approaches are eliminating edible food waste and recycling. Source reduction of edible food reduced GHGs by 103.1 mt (carbon dioxide equivalents) CO 2 e and generated energy savings of 448.5 GJ compared to the baseline. Perfect recycling would result in a reduction of 25.4 mt CO 2 e and 243.7 GJ compared to the baseline. The primary challenges to achieving these reductions are the difficulties of predicting demand for food and influencing consumer behavior.

The use of existing water resources and sustainability problems as a result of global warming and climate change became an even bigger problem with the importance of hygiene during the COVID-19 pandemic. In this research, the water consumption behavior will be researched and the correlation between water consumption and COVID-19 case numbers will be investigated in Bursa, Turkey. The monthly mean water consumption for 758,500 domicile subscribers using the central tariff from 2018-2020 was calculated. Results obtained using the SPSS 23 IBM program observed a 20.18% increase in water consumption in Bursa in general during COVID-19. As Bursa province has both rural and industrial urban structures, when this increase is examined on a county basis, increase rates were 10% in regions with dense industry and mean 34% in rural areas. When the correlation between case numbers during the COVID-19 period (March 2020-January 2021) and water consumption is examined, a negative correlation is notable (Pearson-Correlation=-0.616). As the case numbers increased in the continuing COVID-19 pandemic, the reduction in water consumption may be explained by warnings to citizens to reduce water use through written and oral media due to reservoir fill rates falling below 5%. These results provide beneficial information revealing the effects of COVID-19 on water consumption behavior and use of water resources in urban and rural areas.

No abstract

No abstract

Background:Current guidelines adopted by the American Academy of Pediatrics calls for prolonged fasting times before performing pediatric procedural sedation and analgesia (PSA). PSA is increasingly provided to children outside of the operating theater by sedation trained pediatric providers and does not require airway manipulation. We investigated the safety of a shorter fasting time compared to a longer and guideline compliant fasting time. We tried to identify the association between fasting time and sedation-related complications.Methods:This is a prospective observational study that included children 2 months to 18 years of age and had an American Society of Anesthesiologists physical status classification of I or II, who underwent deep sedation for elective procedures, performed by pediatric critical care providers. Procedures included radiologic imaging studies, electroencephalograms, auditory brainstem response, echocardiograms, Botox injections, and other minor surgical procedures. Subjects were divided into two groups depending on the length of their fasting time (4–6 h and >6 h). Complication rates were calculated and compared between the three groups.Results:In the studied group of 2487 subjects, 1007 (40.5%) had fasting time of 4–6 h and the remaining 1480 (59.5%) subjects had fasted for >6 h. There were no statistically significant differences in any of the studied complications between the two groups.Conclusions:This study found no difference in complication rate in regard to the fasting time among our subjects cohort, which included only healthy children receiving elective procedures performed by sedation trained pediatric critical care providers. This suggests that using shorter fasting time may be safe for procedures performed outside of the operating theater that does not involve high-risk patients or airway manipulation.

Background:Pulmonary aspiration during sedation is a major concern for sedation providers, making identifying high-risk patients a priority. Gastric fluid volume (GFV), an accepted risk factor for aspiration, has not been well characterized in fasting children. We hypothesized that GFV would increase with gastrointestinal (GI) pathology and decrease with regular acid-suppressor use.Aims:The primary objective was to determine baseline GFV in fasting children. The secondary objectives were to evaluate the effect of GI pathology and regular use of acid-suppressing medications on GFV.Settings and Study Design:This was prospective, observational study.Materials and Methods:We endoscopically aspirated and measured GFV of 212 children fasting for >6 h who were sedated for esophagogastroduodenoscopy (EGD). Inclusion criteria were children up to 21 years of age, with the American Society of Anesthesiologists physical Status I and II presenting for elective EGD. After determining baseline GFV, the effect of GI pathology and effect of regular acid-suppressing medication use on GFV was analyzed.Statistical Analysis:Analysis of variance was used to compare the GFV among ages and pathology and medication groups. Student's t-test was used to compare GFV between genders and also to compare GFV in confounder analyses.Results:For the studied 212 children, average GFV was 0.469 ± 0.448 mL/kg (0–2.663 mL/kg). We found no association between GI pathology and GFV (P = 0.147), or acid-suppressor use and GFV (P = 0.360).Conclusions:Average GFV in this study falls within the range of prior EGD-measured GFV in fasting children. Contrary to our hypothesis, we found no association between pathologies or regular acid-suppressor use on GFV. On the basis of GFV, children with GI disorders or those using acid-suppressors do not appear to pose an increased risk of aspiration. Future studies should discern differences in effects on GFV of immediate preprocedural versus the regular use of acid-suppressing medications.