Increasing Incidence of Mucormycosis in University Hospital, Belgium

To determine why incidence of mucormycosis infections was increasing in a large university hospital in Belgium, we examined case data from 2000–2009. We found the increase was not related to voriconazole use but most probably to an increase in high-risk patients, particularly those with underlying hematologic malignancies

Heat recovery and water reuse in micro-distilleries improves eco-efficiency of alcohol production

The number of micro-scale spirit distilleries worldwide has grown considerably over the past decade. With an onus on the distillery sector to reduce its environmental impact, such as carbon emissions, opportunities for increasing energy efficiency need to be implemented. This study explores the potential environmental benefits and financial gains achievable through heat recovery from different process and by-product streams, exemplified for a Scotch whisky distillery, but transferrable to micro-distilleries worldwide.The eco-efficiency methodology is applied, taking into account both climate change and water scarcity impacts as well as economic performance of alcohol production with and without heat recovery. A Life Cycle Assessment, focusing on climate change and water scarcity, is combined with a financial assessment considering investment costs and the present value of the savings over the 20-year service life of the heat recovery system.The proposed heat recovery systems allow carbon emission reductions of 8–23% and water scarcity savings of 13–55% for energy and water provision for 1 L of pure alcohol (LPA). Financial savings are comparatively smaller, at 5–13%, due to discounting of the future savings – but offer a simple payback of the investment costs in under two years. The eco-efficiency of the distillery operations can be improved through all proposed heat recovery configurations, but best results are obtained when heat is recovered from mashing, distillations and by-products altogether. A sensitivity analysis confirmed that the methodology applied here delivers robust results and can help guide other micro-distilleries on whether to invest in heat recovery systems, and/or the heat recovery configuration.Uptake should be enhanced through increased information and planning support, and in cases where the distillery offers insufficient heat and water sinks to use all pre-warmed water, opportunities to link with a heat sink outside the distillery are encouraged. A 10% reduction in heating fuel use through heat recovery has the potential to save 47 kt of CO2 eq. or £7.4 M per annum in United Kingdom malt whisky production alone, based on current fuel types used and current prices (2021)

Evaluation of parenteral nutrition use in patients undergoing major upper gastro-intestinal surgery

Abstract Background After major upper gastro-intestinal surgery, enteral feeding is often hampered. There is still no consensus on which route of nutrition is preferable in patients undergoing this type of surgery. Current ESPEN guidelines recommend parenteral nutrition in undernourished patients, if caloric requirements cannot be met orally/enterally within 7 days and enteral nutrition is contraindicated. Objective The current practice of systematic parenteral nutrition at the thoracic surgery ward of the University Hospitals Leuven was evaluated based on the ESPEN guidelines. Method This prospective observational study included patients undergoing upper gastro-intestinal surgery and receiving postoperative parenteral nutrition. Parenteral nutrition use was considered appropriate when patients were undernourished and unable to obtain adequate caloric requirements by oral or enteral feeding within 7 days. Results Twenty-five out of 35 patients were nutritionally at risk. In 9 of 25 patients, the indication for parenteral nutrition was considered justified. As the intestinal tract below the anastomosis site remains accessible in the total studied population, enteral nutrition might be an option. Unfortunately, an appropriate jejunostomy tube was not available at our institution. Conclusion In accordance to the ESPEN guidelines, enteral nutrition can replace parenteral nutrition in most thoracic surgery patients, but only if an appropriate enteral access is available

Variabiliteit in farmacokinetiek van intraveneuze paracetamol bij gezonde ouderen

BACKGROUND and OBJECTIVE: Paracetamol is the most used analgesic in older people. The physiological changes occurring with ageing influence the pharmacokinetics of paracetamol and its variability. A population pharmacokinetic analysis to describe the pharmacokinetics of intravenous paracetamol in fit older people was performed. Thereafter, simulations were conducted to illustrate target attainment and variability of paracetamol exposure following current dosing regimens (1000 mg q6h, q8h) using steady-state concentration (Cssmean) of 10 mg/L as target for effective analgesia. DESIGN and METHODS: A population pharmacokinetic-analysis, using NONMEM 7.2, was performed based on 601 concentrations of paracetamol from 30 fit older people (median age = 77.3 years [61.8- 88.5], body weight = 79 kg [60-107]). All had received an intravenous paracetamol dose of 1000 mg – over 15 min – after elective knee surgery. RESULTS: A two-compartment pharmacokinetic-model best described the data. Volume of distribution of paracetamol increased exponentially with body weight. Clearance was not influenced by any covariate. Simulations of the standardized dosing regimens resulted in a Css-mean of 9.2 mg/L (q6h) and 7.2 mg/L (q8h). Variability in paracetamol pharmacokinetics resulted in a Css-mean above 5.4 (q6h) and 4.1 mg/L (q8h) in 90%, and above 15.5 (q6h) and 11.7 mg/L (q8h) in 10% of the population. CONCLUSION: The target concentration was achieved in the average patient with 1000 mg q6h, while q8h resulted in underdosing for the majority of the population. Due to large unexplained interindividual variability in paracetamol pharmacokinetics a relevant proportion of the fit older people remained either under- or overexposed

Proficiency testing for meropenem and piperacillin therapeutic drug monitoring : preliminary results from the Belgian Society on Infectiology and Clinical Microbiology Pharmacokinetic-Pharmacodynamic working group

SCOPUS: le.jinfo:eu-repo/semantics/publishe

A Moral Dilemma for the Political Psychologist: Decreasing Criminal Violence as Symptom

This article describes two approaches to decreasing criminal violence and the moral dilemma in choosing between them

Different Vancomycin Immunoassays Contribute to the Variability in Vancomycin Trough Measurements in Neonates

Substantial interassay variability (up to 20%) has been described for vancomycin immunoassays in adults, but the impact of neonatal matrix is difficult to quantify because of blood volume constraints in neonates. However, we provide circumstantial evidence for a similar extent of variability. Using the same vancomycin dosing regimens and confirming similarity in clinical characteristics, vancomycin trough concentrations measured by PETINIA (2011-2012, n = 400) were 20% lower and the mean difference was 1.93 mg/L compared to COBAS (2012-2014, n = 352) measurements. The impact of vancomycin immunoassays in neonatal matrix was hereby suggested, supporting a switch to more advanced techniques (LC-MS/MS)

Paracetamol in Older People: Towards Evidence-Based Dosing?

Paracetamol is the most commonly used analgesic in older people, and is mainly dosed according to empirical dosing guidelines. However, the pharmacokinetics and thereby the effects of paracetamol can be influenced by physiological changes occurring with ageing. To investigate the steps needed to reach more evidence-based paracetamol dosing regimens in older people, we applied the concepts used in the paediatric study decision tree. A search was performed to retrieve studies on paracetamol pharmacokinetics and safety in older people (> 60 years) or studies that performed a (sub) analysis of pharmacokinetics and/or safety in older people. Of 6088 articles identified, 259 articles were retained after title and abstract screening. Further abstract and full-text screening identified 27 studies, of which 20 described pharmacokinetics and seven safety. These studies revealed no changes in absorption with ageing. A decreased (3.9–22.9%) volume of distribution (Vd) in robust older subjects and a further decreased Vd (20.3%) in frail older compared with younger subjects was apparent. Like Vd, age and frailty decreased paracetamol clearance (29–45.7 and 37.5%) compared with younger subjects. Due to limited and heterogeneous evidence, it was difficult to draw firm and meaningful conclusions on changed risk for paracetamol safety in older people. This review is a first step towards bridging knowledge gaps to move to evidence-based paracetamol dosing in older subjects. Remaining knowledge gaps are safety when using therapeutic dosages, pharmacokinetics changes in frail older people, and to what extent changes in paracetamol pharmacokinetics should lead to a change in dosage in frail and robust older people

Population pharmacokinetics of cefazolin in maternal and umbilical cord plasma, and simulated exposure in term neonates

Background:Intra-partum cefazolin is used to prevent group BStreptococcus(GBS) vertical transmission inmothers allergic to penicillin without a history of anaphylaxis.Objectives:To investigate the maternal cefazolin dose–exposure relationship and subsequent maternal andneonatal target attainment at delivery.Methods:Data were obtained from 24 healthy, GBS-colonized pregnant women (20–41 years), undergoing vagi-nal delivery (gestational age 37 weeks). During labour, all women received a 2 g cefazolin IV infusion. Eighthours later, eight women received another 1 g in the event of delayed (>8 h) delivery. Next to maternal plasmaconcentrations (up to 10 per dosing interval, until delivery), venous and arterial umbilical cord concentrationswere determined at delivery. Target attainment in maternal/neonatal plasma was set at 1 mg/L for 60% of thedosing interval (unbound cefazolin, worst-case clinical breakpoint). A population pharmacokinetic (popPK) modelwas built (NONMEM 7.4). ClinicalTrials.gov Identifier: NCT01295606.Results:At delivery, maternal blood and arterial umbilical cord unbound cefazolin concentrations were >1 mg/Lin 23/24 (95.8%) and 11/12 (91.7%), respectively. The popPK of cefazolin in pregnant women was described by atwo-compartment model with first-order elimination. Two additional compartments described the venous andarterial umbilical cord concentration data. Cefazolin target attainment was adequate in the studied cohort,where delivery occurred no later than 6.5 h after either the first or the second dose. PopPK simulations showedadequate maternal and umbilical cord exposure for 12 h following the first dose.Conclusions:PopPK simulations showed that standard pre-delivery maternal cefazolin dosing providedadequate target attainment up to the time of delivery

Responding to the UN sustainability goals in transdisciplinary partnership through network action learning

The global water crisis, an enormous concern according to the World Economic Forum, poses a significant challenge to long-term sustainability, exacerbated by the high energy demand associated with water supply and treatment. As the renewable energy sector grows, the need for green technologies to support the water-energy nexus becomes evident. However, mere technological advancements are insufficient to address complex water-related challenges. This paper presents a transdisciplinary collaborative effort involving engineers, geographers, management researchers, and environmentalists working with practitioners in a cross-border network. The study explores through action learning research how, in a transdisciplinary partnership, network action learning influences the exploration and implementation of novel green technology and the development of innovation capabilities. The research is structured around three themes: green technology platforms, policy support and guidance, and dissemination and collaboration. It identifies the factors impacting technology exploration and application and how concurrently green innovation capabilities are developed. The study emphasizes the significance of transdisciplinary collaboration and offers valuable insights into addressing UN Sustainability Goals related to clean water, sustainable industry, and partnerships. It contributes to innovation capability theory and provides practical guidance to researchers, practitioners, and policymakers, emphasizing the need for holistic approaches to address the water-energy crisis and achieve sustainable development