ECONOMIC AND TECHNICAL ANALYSIS OF ETHANOL DRY MILLING: MODEL DESCRIPTION

Ethanol, the common name for ethyl alcohol, is fuel grade alcohol that is predominately produced through the fermentation of simple carbohydrates by yeasts. In the United States, the carbohydrate feedstock most commonly used in the commercial production of ethanol is yellow dent corn (YDC). The use of ethanol in combustion engines emits less greenhouse gasses than its petroleum equivalent, and it is widely hoped that the increased substitution of petroleum by ethanol will reduce US dependence on imported oil and decrease greenhouse gas emissions. Production of ethanol within the United States is expected to double, from 3.4 billion gallons in 2004, to about seven billion gallons in the next five years. Two processes currently being utilized to produce ethanol from YDC are dry milling and wet milling. The wet mill process is more versatile than the dry mill process in that it produces a greater variety of products; starch, corn syrup, ethanol, Splenda, etc., which allows for the wet mill to better react to market conditions. However, the costs of construction and operation of a wet mill are much greater than those of a dry mill. If ethanol is the target product, then it can be produced at a lower cost and more efficiently in a dry mill plant than in a wet mill plant, under current economic conditions. Of the more than 70 US ethanol plants currently in production, only a few are of the wet mill variety. A descriptive engineering spreadsheet model (DM model) was developed to model the dry mill ethanol production process. This model was created to better understand the economics of the ethanol dry mill production process and how the profitability of dry mill plants is affected under different conditions. It was also developed to determine the economic and environmental costs and benefits of utilizing new and different technologies in the dry mill process. Specifically, this model was constructed to conduct an economic analysis for novel processes of obtaining greater alcohol yields in the dry mill process by conducting a secondary fermentation of sugars converted from lignocellulosics found in the dry mill co-product, distiller’s grains. This research is being conducted at Purdue University, Michigan State, Iowa State, USDA, and NCAUR under a grant from the US Department of Energy. The DM model is more technically precise, and more transparent, than other models of the dry mill process that have been constructed for similar purposes. The Tiffany and Eidman model (TE model) uses broad generalities of the dry mill process, based on the current state of production, to approximate the sensitivities of the process to changes in variables. The TE model parameters were well researched, but the model suffers from several drawbacks. The main limitations of this model are that the results are very sensitive to the input values chosen by the user. Unlike the DM model, complex manipulations, such as determining the effect of new technologies would require accurate parameter estimates using the TE model. The McAloon model [11].uses highly technical engineering software (ASPEN) that acts essentially as a “black box” in the dry mill production process. This very exact model does not allow for a more general examination of the dry mill process. Changes in the production process would necessitate precise engineering plans. Similar to the TE and McAloon models, the DM model is a spreadsheet model, but unlike the McAloon model it is completely self-contained. The DM model is a feed backward model, input requirements (corn, enzymes, chemicals, utilities, etc) are calculated based on the user entered values for annual production and process parameters. The mass flow rates, in pounds per hour were then calculated and used in estimating the size, in dimension or power, of each major piece of equipment. The cost associated with each piece of major equipment was then calculated as an exponential function of its corresponding size. Total capital costs associated with a dry mill plant were then estimated using the percentage of equipment costs method [13]. It was found that the DM model estimates of the total capital costs associated with medium to large dry mill plants (those with the capacity to produce between 10 and 100 million gallons of ethanol a year) were within 5% of total fixed costs estimated by BBI [2]. Operating costs were compared with the 2002 USDA survey results and also found to be very close [15]. A companion document, “Economic and Technical Analysis of Dry Milling: Model User’s Manual,” staff paper no 06-05, explains how the model is used to conduct analysis of dry milling alternatives.Ethanol, DDGS, Dry Milling, Biochemical Process Engineering, Economic Modeling, Financing, Fermentation Process Modeling

Economic and Technical Analysis of Ethanol Dry Milling: MOdel User's Manual

Using the DM model is not complex: the user changes input values of interest (plant size, conversion rates, etc.) and examines the effect of these changes on output values (annual profits, feed stock requirements, etc.). There are nine worksheets in four modules in the excel workbook- assumptions, process, economics, and technology assessment. All user inputs are entered in the assumptions module of the model, which consists of three worksheets denoted with bright yellow tabs: process assumptions, economic assumptions and physical assumptions. The values that are entered on this page are then used in each of the subsequent modules to calculate hourly flow rates, equipment size and cost, total costs, loan terms, and annual profits. At the top of each page is a title bar which describes the page, the color coding of the cells, and pertinent information from the other pages. Before each of the pages is discussed, an explanation of the different types of cells in the model is in order.model user's manual

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570