Guía de práctica clínica para la prevención, diagnóstico y manejo de infecciones asociadas al acceso de hemodiálisis en el Seguro Social de Salud del Perú (EsSalud)

Background: This article summarizes the clinical practice guidelines (CPG) for the prevention, diagnosis and management of infections associated with hemodialysis access of the Peruvian Health Social Security (EsSalud). Objective: To provide clinical recommendations based on evidence for the prevention, diagnosis and management of infections associated with hemodialysis access in EsSalud. Material and Methods: A guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 7 clinical questions to be answered in this CPG. Systematic searches of systematic reviews and primary studies (when pertinent) were conducted in PubMed, and CENTRAL (Cochrane) from November 2019 to March 2020. The evidence was selected to answer each of the clinical questions. The accuracy of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flowchart. Finally, the CPG was approved with Resolution No. 116-IETSI-ESSALUD-2020. Results: The present CPG addressed 7 clinical questions of four topics: prevention, diagnosis and treatment. Based on these questions, 12 recommendations (11 strong recommendations and 1 weak recommendation), 33 points of good clinical practice, and 2 flowcharts were formulated. Conclusion: This paper summarizes the methodology and evidence-based conclusions from the CPG for the prevention, diagnosis and management of infections associated with hemodialysis access of EsSalud.Introducción: El presente artículo resume la guía de práctica clínica (GPC) para la prevención, diagnóstico y manejo de infecciones asociadas al acceso de hemodiálisis en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para la prevención, diagnóstico y tratamiento de infecciones asociadas al acceso de hemodiálisis en EsSalud. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas y metodólogos. El GEG formuló 7 preguntas clínicas. Se realizó búsquedas sistemáticas de revisiones sistemáticas y estudios primarios en PubMed y CENTRAL de Cochrane entre noviembre del 2019 y marzo del 2020. Se seleccionó la evidencia para responder a las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). El GEG usó la metodología GRADE para revisar la evidencia y formular recomendaciones, los puntos de buena práctica clínica y el flujograma de tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 116-IETSI-ESSALUD-2020. Resultados: La presente GPC abordó 7 preguntas clínicas, divididas en tres temas: tamizaje, diagnóstico, estadiaje y tratamiento. En base a estas preguntas se formularon 12 recomendaciones (11 fuertes y 1 condicional), 33 puntos de buena práctica clínica y 2 flujogramas de manejo. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para la prevención, diagnóstico y tratamiento de infecciones asociadas al acceso de hemodiálisis en EsSalud

Designer solvents for the extraction of glycols and alcohols from aqueous streams

The separation of polar compounds from aqueous streams is one of the most energy intensive operations within the chemical industry, because of the formation of hydrogen bonds that should be broken and the high heat of vaporization of water. Important bulk chemicals like glycols and alcohols produced from petrochemical feedstock or renewable sources through fermentation processes are classified in this category. In this thesis, the recovery of low molecular weight diols, such as Mono Ethylene Glycol (MEG), 1,2-Propanediol also known as propylene Glycol (PG) and 2,3-Butanediol (BD) that are particularly difficult to separate due to their high water affinity and important alcohols like 1-Butanol (BuOH) were studied. Their recovery by conventional multiple effect distillation is associated with high energy consumption; therefore liquid-liquid extraction technology can be a promising alternative since it can be more energy efficient. However, for conventional solvents the distribution coefficients are generally insufficient to achieve efficient extraction at low concentrations as encountered in the chemical synthesis of diols or production through fermentation. For this reason, the use of novel extraction solvents like reactive extractants or ionic liquids is needed to improve the glycol distribution coefficient and selectivity. Boronic acids derivatives were studied as they are known because of their good ability to form complexes with cis-diols. Naphtalene-2-Boronic Acid (NBA) was selected as extractant and it was diluted in 1-Ethyl-Hexanol and octanol. Aliquat 336 (N-Methyl-N,N-dioctyloctan-1-ammonium chloride) was applied as counterion to facilitate the complexation between NBA and MEG. 1-Ethyl-Hexanol was the better diluent. The partition coefficient of MEG in 1-ethyl-hexanol was 0.0025, and distributions and selectivities up to 0.026 and 0.089, respectively (at pH 11, 298K) were observed with NBA and Aliquat 336 in equal amounts at 0.2 mol/L. This maximum distribution is around 10 times better than the conventional solvents. Nevertheless further improvements in the distribution and selectivity towards the glycol are required, which could be provided by advanced solvents like ionic liquids. In Chapter 2, experimental work and molecular modelling simulation with COSMO-RS were used to support the solvent screening for (MEG). The ionic liquid design and tailoring to optimize the glycol distribution coefficient (D) and selectivity (S) was done by employing the sigma electron profile. As a result, the glycol distribution coefficients improved compare to the conventional solvents when combining a tetraoctyl ammonium cation of the IL with a carboxylate, phosphinate and boronate anion. These ILs were tailor made and evaluated in LLE experiments. They outperformed the other solvents tested with DMEG up to 0.45, and S up to 3.2 vs DMEG = 0.04 and S = 0.95 for 2-ethyl-hexanol for initial feed concentrations of 20% wt MEG. For the best performing ionic liquid tetraoctyl ammonium 2-methyl-1-napthoate [TOA MNaph], liquid-liquid equilibrium data were determined and the NRTL and UNIQUAC thermodynamic models were constructed for the three different glycols. The results, presented in Chapter 4, show that both models can properly describe the experimental data. These thermodynamic models were used to develop conceptual process designs in Aspen Plus ® and compared the different processes for the production of MEG and PG with two different technologies, conventional triple effect distillation (MED) and solvent extraction (LLE) using [TOA MNaph].The results showed that the LLE alternative could provide energy savings >50% compared to the current state-of-the-art three effect distillation technology (94% for MEG 20% wt from the petrochemical process and 54% for PG 10%wt from a fermentation process). Regarding CAPEX, the conventional technology is always preferable because less equipment is required, while for the LLE technology the CAPEX is higher due to the solvent cost, the equipment in solvent recovery section and the additional heat exchangers required for the heat integration in the process. The purification of PG has the lowest CAPEX because a lower solvent to feed ratio is required compared to MEG extraction. According to a total annualized cost analysis at the current crude oil prices, the purification of PG from a fermentation broth via LLE could be an advantageous technology to replace MED. For the MEG production we can say that currently the LLE process is not a suitable option and that a significant increase in crude oil prices should occur before the use of LLE technology with this IL can become feasible. In Chapter 6, liquid-liquid extraction of butanol from water, employing [TOA MNaph] was evaluated against distillation and extraction with conventional solvents. The results show that this IL yields the best distribution coefficient and very high selectivity (DBuOH=21, S=274), compared to the benchmark solvent oleyl alcohol (DBuOH=3.42, S=192). The conceptual design study showed that butanol extraction with [TOA MNaph] requires 73% less energy than in conventional distillation (5.65 MJ/kg BuOH vs 21.3 MJ/kg for distillation). Finally it was concluded, that the feasibility of the LLE with ILs is strongly dependent on the glycol distribution coefficient and selectivity achieved. As the conceptual process design and economic evaluation showed, there are still challenges and improvements to extend the search for additional solvents (not limited to ionic liquids), especially for extremely polar compounds like MEG, which requires an even higher capacity and selectivity than could be achieved in this study

Understanding the policies and carbon accounting frameworks which are defining the potential role of biobased products to meet climate change targets

Climate change has become an important challenge at International, European, National and Regional level. Mitigation of climate change by preventing and reducing the emission of greenhouse gases (GHG) into the atmosphere is needed to make the impacts of climate change less severe. To ensure this, different mitigation frameworks have been created. These frameworks set specific GHG reduction goals and provide a more structured approach to solve this problem. This report aims to provide information to the Dutch Ministry of Agriculture, Nature and Food Quality (LNV) on and how some climate change mitigation frameworks are including the increase forestry and agricultural biomass supply to produce chemicals and materials that can contribute to the reduction of GHG emission. This desktop research follows a ‘systems perspective approach’ to study the role of biobased materials’ 1 in the reduction of GHG emission. This approach allows the understanding of interactions between biobased products, national inventories and global agreements. Understanding these links and having knowledge on which GHG gases accounting methods are being applied is necessary for the identification of possible drawbacks and for the development of future policy guidelines. After this review, we conclude that it is important to be familiar with and recognize the value in current existing accounting methodologies. However, existing frameworks are still lacking important features which could enable more robust account methodologies for carbon sequestration and storage in biobased materials. At this moment in time, the European Commission is working on proposals like the ‘Carbon Farming framework’ and ‘carbon removals certification framework’ (December 2022) and introducing a ‘carbon storage products pool’, these proposals could play and important role on establishing clear accounting rules that connect the biomass production to biobased materials and its contribution to support National Policies towards GHG reduction targets. This will require collaboration and information exchange between European countries. Therefore, is important to follow closely the evolution of these frameworks and their proposed accounting rules. This document is organized in the following way: • Section 2, introduces terminologies, frameworks and methods for GHG accounting at different levels International, Europe and Netherlands. • Section 3 is dedicated to understanding how biobased products for could contribute to the Climate targets by substituting other GHG intensive materials, extending the life span of the product or by cascading use of the biomass. • Section 4 shows two examples on how the GHG balances of two different linear biobased supply chains are estimated at the product accounting level and how this relates to the national level inventory reporting and the global agreements. • Section 5 presents our conclusions and recommendations

Examples of regional bio-based business models : Power4Bio Deliverable 4.1

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