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OBJECTIVE To evaluate the efficacy and safety of transdermal buprenorphine in patients with diabetic peripheral neuropathic pain (DPNP). RESEARCH DESIGN AND METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group trial enrolled patients with type 1 or type 2 diabetes and stable glycemic control who had been experiencing moderate to severe DPNP for at least 6 months on maximal tolerated conventional therapy. Patients were randomly assigned to receive buprenorphine (5 μ/h) or placebo patches. The dose was titrated to effect to a maximum of 40 μ/h. Paracetamol was available as rescue analgesia. The severity of pain and other symptoms of DPNP were assessed daily in a patient diary and at clinic visits. RESULTS One hundred eight-six patients were enrolled, with 93 randomized to either buprenorphine or placebo. A high proportion of patients did not complete the study (buprenorphine 37 of 93, placebo 24 of 93). The main reason for premature withdrawal in the buprenorphine group was adverse events commonly due to untreated nausea and/or vomiting. Among the per-protocol population, more patients in the buprenorphine group (86.3%) experienced a 30% reduction in average versus baseline pain at week 12 than those in the placebo group (56.6%, P < 0.001). A nonsignificant trend favored the buprenorphine groupwithin the intention-to-treat analysis of the same end point (51.7% vs. 41.3%, P = 0.175). CONCLUSIONS Transdermal buprenorphine,when tolerated, is an effective therapy for DPNP and provides another option tomanage this challenging painful condition. Nausea and constipation need to be managed proactively to optimize treatment outcomes. © 2016 by the American Diabetes Association.


PubMed | Consulting Services and Box Hill Hospital
Type: Journal Article | Journal: Diabetes care | Year: 2016

To evaluate the efficacy and safety of transdermal buprenorphine in patients with diabetic peripheral neuropathic pain (DPNP).This multicenter, randomized, double-blind, placebo-controlled, parallel-group trial enrolled patients with type 1 or type 2 diabetes and stable glycemic control who had been experiencing moderate to severe DPNP for at least 6 months on maximal tolerated conventional therapy. Patients were randomly assigned to receive buprenorphine (5 g/h) or placebo patches. The dose was titrated to effect to a maximum of 40 g/h. Paracetamol was available as rescue analgesia. The severity of pain and other symptoms of DPNP were assessed daily in a patient diary and at clinic visits.One hundred eight-six patients were enrolled, with 93 randomized to either buprenorphine or placebo. A high proportion of patients did not complete the study (buprenorphine 37 of 93, placebo 24 of 93). The main reason for premature withdrawal in the buprenorphine group was adverse events commonly due to untreated nausea and/or vomiting. Among the per-protocol population, more patients in the buprenorphine group (86.3%) experienced a 30% reduction in average versus baseline pain at week 12 than those in the placebo group (56.6%, P < 0.001). A nonsignificant trend favored the buprenorphine group within the intention-to-treat analysis of the same end point (51.7% vs. 41.3%, P = 0.175).Transdermal buprenorphine, when tolerated, is an effective therapy for DPNP and provides another option to manage this challenging painful condition. Nausea and constipation need to be managed proactively to optimize treatment outcomes.


Bombardier E.,University of Waterloo | Booth R.K.,Consulting Services | Green H.J.,University of Waterloo | McKinley R.S.,University of British Columbia
Fish Physiology and Biochemistry | Year: 2010

The adaptability/plasticity of the highly oxidative red muscle in Atlantic salmon was demonstrated during spawning migration. Substrate concentrations and the enzymatic pathways of ATP production were examined in red muscle obtained from Atlantic salmon at different sites along their migratory route in the Exploits River, Newfoundland, Canada. Individuals were chronologically sampled from a seawater site, two sites upstream, and at spawning. The 20% decrease in salmon body weight during the later stages of migration was accompanied by large decreases (mg dry weight-1) in both glycogen (P < 0.01) and total muscle lipid (P < 0.01). In contrast, water content and protein concentration (mg dry weight-1) of the red muscle increased by 25 and 34%, respectively, at spawning. Enzymes of the glycolytic pathways demonstrated a significant (P < 0.001) decrease in maximal activity as migration proceeded whereas enzymes of the oxidative phosphorylation pathways, specifically the citric acid cycle enzymes, exhibited an increase (P < 0.001) in maximal activity at spawning. The antioxidant enzyme superoxide dismutase also demonstrated an increase (P < 0.001) in maximal activity during the latter stages of migration. These adaptations imply that the red epaxial muscle of Atlantic salmon has a more efficient means of oxidizing lipids, while minimizing free radical damage, during the later stages of migration and spawning, thereby potentially increasing post spawning survival. © 2009 Springer Science+Business Media B.V.


Lammers P.J.,Consulting Services
CAB Reviews: Perspectives in Agriculture, Veterinary Science, Nutrition and Natural Resources | Year: 2011

Life-cycle assessment (LCA) is a holistic approach to quantifying and comparing resource use and associated environmental impacts of a product, good or service. Pork is the most widely consumed meat globally and LCA methodology has been used to compare different pig production scenarios. This paper reviews LCAs of different farrow-to-finish swine systems. Generally, alternative systems (organic production, production with an emphasis on animal welfare or other niche markets) require more land per unit than conventional systems. Energy use is sometimes, but not always, lower in alternative systems. Greenhouse gas emissions are closely linked with energy use. In some situations, conventional production results in less acidification and eutrophication, but in other cases, alternative systems have lower impacts. Growing and processing pig diets was the largest single influence on resource use and resultant environmental impact. Thus, feed efficiency is a critical control point in pig production systems. Differences in acidification and eutrophication between systems can largely be explained by underlying assumptions of crop nutrient management, including manure storage and utilization. Coupling biogas and pig production, where feasible, may offset much of the energy used for pig production. Efforts to reduce resource use and environmental impacts of pig production should not ignore the under-utilized nutrient resources present in rejected foodstuffs, rendered animal products and co-products of biofuel production. © CAB International 2011.


Hawkes C.,Consulting Services | Lobstein T.,International Association for the Study of Obesity
International Journal of Pediatric Obesity | Year: 2011

Objectives. To describe the global regulatory environment around food marketing to children in 2009 and to identify changes in this environment since 2006. Methods. Informants able to provide information on national controls on marketing to children were identified and sent a standardised template for data collection, developed and refined through iterative use with informants. Responses were encouraged by sending draft versions of completed templates to informants for their approval. Results. The policy environment was described in the 27 member states of the European Union, and in a further 32 countries. Of these 59 countries, 26 have made explicit statements on food marketing to children in strategy documents, and 20 have, or are developing, explicit policies in the form of statutory measures, official guidelines or approved forms of self-regulation. These figures reflect a change in the policy environment since 2006. Although there is still resistance to change, there has been significant movement towards greater restriction on promotional marketing to children, achieved through a variety of means. Government-approved forms of self-regulation have been the dominant response, but statutory measures are increasingly being adopted. The nature and degree of the restrictions differ considerably, with significant implications for policy impact. In many cases the policy objectives remain poorly articulated, resulting in difficulty in formulating indicators to monitor and assess impact. Conclusion. To address food marketing to children, governments need to develop clearer statements of the objectives to be achieved, define the indicators that can demonstrate this achievement, and require the relevant stakeholders to account for the progress being made. © 2011 Informa Healthcare.


Budzianowski W.M.,Consulting Services
International Journal of Greenhouse Gas Control | Year: 2016

CO2 capture by gas-liquid absorption needs solvents able to overcome existing barriers for wide-scale adoption including high energy requirement, slow reaction rate, insufficient CO2 loading capacity, solvent degradation and corrosiveness, poor selectivity or limited operating window. It is challenging if not impossible for single or blended solvents to satisfy all these requirements and reach technology readiness level sufficient for economically viable deployment in large-scale CO2 capture systems, especially in the energy sector. Therefore, innovative advanced solvent processes (ASPs) attract attention as a new technology that may overcome existing barriers in CO2 capture by gas-liquid absorption. Due to significant research funding in the area of advanced solvent processes over a few recent years many new ASPs have been developed. Thus this study delivers an explorative analysis of ASPs suitable for energy efficient CO2 capture by gas-liquid absorption. The emphasis is put on ASPs such as two immiscible liquid phases, precipitating solvents, catalysed solvents, microencapsulated solvents, liquid membrane solvents, ionic liquids, and polarity-swing-assisted solvents. The analysis shows that some of recently developed ASPs made huge progress in terms of reduced energy requirement for capturing CO2. However, most advanced solvent processes have insufficient technology readiness level and, in addition, there is still place for further energy efficiency improvement. Therefore, research efforts capable of bringing ASPs to commercialisation and wide-scale adoption in real large-scale CO2 capture applications are required in next few years. © 2016 Elsevier Ltd.


Webster J.L.,University of Sydney | Dunford E.K.,University of Sydney | Hawkes C.,Consulting Services | Hawkes C.,City University London | Neal B.C.,University of Sydney
Journal of Hypertension | Year: 2011

Objective: To provide an overview of national salt reduction initiatives around the world, describe core characteristics and develop a framework for future strategy development. Methods: National strategies were identified from existing reviews and from searches of the literature and relevant websites. Standardized information was extracted about governance and strategy development, baseline assessments and monitoring and implementation. Results: Thirty-two country salt reduction initiatives were identified. The majority of activity was in Europe (19 countries). Most countries (27) had maximum population salt intake targets, ranging from 5 to 8 g/person per day. Twenty-six of the 32 strategies were led by government, five by nongovernment organizations and one by industry. Twenty-eight countries had some baseline data on salt consumption and 18 had data on sodium levels in foods. Twenty-eight countries were working with the food industry to reduce salt in foods, 10 had front-of-pack labelling schemes and 28 had consumer awareness or behaviour change programs. Five countries had demonstrated an impact, either on population salt consumption, salt levels in foods or consumer awareness. These strategies were led by government and were multifaceted including food reformulation, consumer awareness initiatives and labelling actions. Conclusion: This is the first review to concisely summarize the most important elements of the many existing salt reduction programmes and highlight the characteristics most likely to be important to programme efficacy. For most countries, implementing a national salt reduction programme is likely to be one of simplest and most cost-effective ways of improving public health. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Budzianowski W.M.,Consulting Services | Postawa K.,Renewable Energy and Sustainable Development RESD Group
Applied Energy | Year: 2016

Biorefineries are increasingly important commercial facilities for the production of biofuels, biopower and various biomaterials from biomass with potentials to displace several existing industries currently based on polluting and finite fossil resources. Biorefinery systems consist of biorefinery facilities and their entire value chain. Integration of biorefinery systems aims at optimising the use of energies and materials in the total chain from biomass plantations to end product utilisation and is therefore capable of successfully improving economic viability and sustainability of biorefineries. Total Chain Integration can minimise capital and operating expenditures, maximise the quality, quantity and value of biorefinery bioproducts as well as minimise environmental impacts and maximise societal benefits. In order to efficiently perform Total Chain Integration advanced holistic software tools dedicated to biorefinery systems need to be developed.This review study systematically analyses Total Chain Integration of sustainable biorefinery systems. Existing knowledge is systematised by characterising system boundaries, principles, and integration methodologies. Further, approaches used in integration of biorefinery systems are defined and their implementation is briefly illustrated by case studies. Finally, state-of-the-art software tools for biorefinery integration are analysed and the requirements of a software tool for Total Chain Integration are provided.The review findings show that in order to develop truly economically viable and sustainable biorefinery systems tight integration is required. Essential integration approaches include integration of platforms, exchanging wastes and products with other industries, applying more efficient conversion routes, effective ways of enlarging feedstocks base, providing ecosystem and social services, and optimising biomass supply chain. Total Chain Integration requires software tools accounting for technical, economic, environmental and societal optimisation objectives within all system boundaries and the whole life cycle. The requirements of such software are proposed. Software enhanced Total Chain Integration has a potential to successfully achieve economic viability and sustainability of biorefinery systems in the business practice. © 2016 Elsevier Ltd.


Budzianowski W.M.,Consulting Services | Postawa K.,Renewable Energy and Sustainable Development RESD Group
Renewable and Sustainable Energy Reviews | Year: 2016

Renewable energy from biogas has the potential to decarbonise energy systems. For example, biomethane derived from raw biogas may partially displace fossil fuels in the transportation sector. The implemented renewable energy actually decarbonises energy systems only if its life cycle CO2 footprint is lower than that of displaced conventional technologies, which is sometimes uncertain. Therefore, this study has been undertaken to review and synthesise knowledge available in the academic literature on the CO2 footprint of renewable energy from biogas. The typical life cycle CO2 footprint of biogas reported in literature is between 50 and 450kgCO2/MWhel. The review analyses three phases associated with biogas: (i) biomass production, (ii) biomass-to-biogas conversion, and (iii) biogas end use. It is found that remarkable CO2 footprint reduction can be achieved by innovating the biomass-to-biogas phase through limiting the amount of CO2 liberated to biogas. The mechanism for reducing CO2 footprint is proposed and suitable solutions are discussed and evaluated. The literature review is followed by a case study that improves the practical understanding of CO2 footprint reduction potentials. In the case study anaerobic digestion (AD) and pressurised anaerobic digestion (PAD) are compared in terms of their biomethane, power and heat generations, and CO2 emissions. Six plant configurations involving AD, biogas upgrading and combined heat and power (CHP) generation are modelled and simulated. The results show that due to the methane enrichment in biogas (94% CH4 at the self-sustained digester pressure of 5MPa) CO2 footprint is reduced. It is revealed that PAD based biogas plants may generate high purity biomethane with the extremely low direct CO2 footprint of about 13kgCO2/MWhf which contrasts with conventional CHP systems achieving about direct CO2 footprint of 700kgCO2/MWhel. The study also explores the fundamentals of PAD which is one of emerging biogas technologies.*Corresponding author. © 2016 Elsevier Ltd.


PubMed | Consulting Services
Type: Journal Article | Journal: International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity | Year: 2011

To describe the global regulatory environment around food marketing to children in 2009 and to identify changes in this environment since 2006.Informants able to provide information on national controls on marketing to children were identified and sent a standardised template for data collection, developed and refined through iterative use with informants. Responses were encouraged by sending draft versions of completed templates to informants for their approval.The policy environment was described in the 27 member states of the European Union, and in a further 32 countries. Of these 59 countries, 26 have made explicit statements on food marketing to children in strategy documents, and 20 have, or are developing, explicit policies in the form of statutory measures, official guidelines or approved forms of self-regulation. These figures reflect a change in the policy environment since 2006. Although there is still resistance to change, there has been significant movement towards greater restriction on promotional marketing to children, achieved through a variety of means. Government-approved forms of self-regulation have been the dominant response, but statutory measures are increasingly being adopted. The nature and degree of the restrictions differ considerably, with significant implications for policy impact. In many cases the policy objectives remain poorly articulated, resulting in difficulty in formulating indicators to monitor and assess impact.To address food marketing to children, governments need to develop clearer statements of the objectives to be achieved, define the indicators that can demonstrate this achievement, and require the relevant stakeholders to account for the progress being made.

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