Production and performance of bio-based mineral fertilizers from agricultural waste using ammonia (stripping-)scrubbing technology

Development and optimization of nutrient recovery technologies for agricultural waste is on the rise. The full scale adoption of these technologies is however hindered by complex legal aspects that result from lack of science-based knowledge on characterization and fertilizer performance of recovered end-products. Ammonium sulfate (AS) and ammonium nitrate (AN), end-products of (stripping-)scrubbing technology, are currently listed by the European Commission as high priority products with the potential of replacing synthetic N fertilizers. The legal acceptance of AS and AN will be highly dependent on critical mass of scientific evidence. This study describes four different (stripping-)scrubbing pathways to recover ammonia with an aim to (i) assess product characteristics of ammonium nitrate (AN) and ammonium sulfate (AS) produced from different installations, (ii) evaluate fertilizer performance of recovered end-products in greenhouse (Lactuca sativa L.) and full field (Zea mays L.) scale settings and (iii) compare the observed performances with other published studies. Results have indicated that the recovered products might have a different legal status, as either mineral N fertilizer or yet as animal manure, depending on the used (stripping-)scrubbing process pathway. Nevertheless, no significant differences in respect to product characterization and fertilizer performance of AN and AS have been identified in this study as compared to the conventional use of synthetic N fertilizers. This indicates that recovered AS and AN are valuable N sources and therefore might be used as N fertilizers in crop cultivation.</p

BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 1

peer reviewedApproximately 30-40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma

BHS GUIDELINES ON THE MANAGEMENT OF RELAPSED AND REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA: PART 2

peer reviewedApproximately 30-40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma

Impact of previous sepsis on the accuracy of procalcitonin for the early diagnosis of blood stream infection in critically ill patients

<p>Abstract</p> <p>Background</p> <p>Blood stream infections (BSI) are life-threatening infections in intensive care units (ICU), and prognosis is highly dependent on early detection. Procalcitonin levels have been shown to accurately and quickly distinguish between BSI and noninfectious inflammatory states in critically ill patients. It is, however, unknown to what extent a recent history of sepsis (namely, secondary sepsis) can affect diagnosis of BSI using PCT.</p> <p>Methods</p> <p>review of the medical records of every patient with BSI in whom PCT dosage at the onset of sepsis was available between 1^stSeptember, 2006 and 31^stJuly, 2007.</p> <p>Results</p> <p>179 episodes of either primary (<it>n </it>= 117) or secondary (<it>n </it>= 62) sepsis were included. Procalcitonin levels were found to be markedly lower in patients with secondary sepsis than in those without (6.4 [9.5] vs. 55.6 [99.0] ng/mL, respectively; <it>p </it>< 0.001), whereas the SOFA score was similar in the two groups. Although patients in the former group were more likely to have received steroids and effective antibiotic therapy prior to the BSI episode, and despite a higher proportion of candidemia in this group, a low PCT value was found to be independently associated with secondary sepsis (Odd Ratio = 0.33, 95% Confidence Interval: 0.16–0.70; <it>p </it>= 0.004). Additional patients with suspected but unconfirmed sepsis were used as controls (<it>n </it>= 23). Thus, diagnostic accuracy of PCT as assessed by the area under the receiver-operating characteristic curves (AUROCC) measurement was decreased in the patients with secondary sepsis compared to those without (AUROCC = 0.805, 95% CI: 0.699–0.879, vs. 0.934, 95% CI: 0.881–0.970, respectively; <it>p </it>< 0.050).</p> <p>Conclusion</p> <p>In a critically ill patient with BSI, PCT elevation and diagnosis accuracy could be lower if sepsis is secondary than in those with a first episode of infection.</p

Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience"

Background: Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Methods: Process evaluation of an action research project (2003-2007) guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC). A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. Results: The overall ACIC score improved from 1.45 (limited support) at the start of the study to 5.5 (basic support) at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Conclusion: Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care delivery in a primary care system with limited structure. The study succeeded in achieving a considerable improvement of the overall support for diabetes patients but further improvement requires a shift towards system thinking among policy makers. Currently primary care providers lack the opportunities to take up full responsibility for chronic care

Uremic toxin concentrations are related to residual kidney function in the pediatric hemodialysis population

PubMedID: 31022857Protein-bound uremic toxins (PBUTs) play a role in the multisystem disease that children on hemodialysis (HD) are facing, but little is known about their levels and protein binding (%PB). In this study, we evaluated the levels and %PB of six PBUTs cross-sectionally in a large pediatric HD cohort (n = 170) by comparing these with healthy and non-dialysis chronic kidney disease (CKD) stage 4-5 (n = 24) children. In parallel ß2-microglobulin (ß2M) and uric acid (UA) were evaluated. We then explored the impact of age and residual kidney function on uremic toxin levels and %PB using analysis of covariance and Spearman correlation coefficients (rs). We found higher levels of ß2M, p-cresyl glucuronide (pCG), hippuric acid (HA), indole acetic acid (IAA), and indoxyl sulfate (IxS) in the HD compared to the CKD4-5 group. In the HD group, a positive correlation between age and pCG, HA, IxS, and pCS levels was shown. Residual urine volume was negatively correlated with levels of ß2M, pCG, HA, IAA, IxS, and CMPF (rs -0.2 to -0.5). In addition, we found overall lower %PB of PBUTs in HD versus the CKD4-5 group, and showed an age-dependent increase in %PB of IAA, IxS, and pCS. Furhtermore, residual kidney function was overall positively correlated with %PB of PBUTs. In conclusion, residual kidney function and age contribute to PBUT levels and %PB in the pediatric HD population. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.Federal Agency for Science and Innovation: IWT, IWT-TBM 150195 National Institute for Health Research Baxter International AmgenFunding: This research was funded by the Agency for Innovation by Science and Technology (IWT), from the ‘Applied Biomedical Research with a Primary Societal Goal’ (TBM) program in Flanders (Belgium): UToPaed project, grant number IWT-TBM 150195. R.S. holds a Career Development Fellowship with the National Institute for Health Research. A part of the work took place in the Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.Conflicts of Interest: The authors E.S., G.G., M.V.D., K.V.H., N.G., B.R., L.C., N.C., M.F., L.O., C.S., R.V.H., K.A., N.G., M.L., F.P., V.A., M.V.D., A.B., B.S., E.H. and S.R. declare no conflicts of interest. W.V.B: Lecture fees IPOD-PD study. A.R.: Lecture fees Ferring Pharmaceuticals and travel fees Novonordisk. J.V.W.: Paid advisory boards of Alexion, Astellas, Kyowa Kirin, and Ferring Pharmaceuticals for the last 2 years. Lecture fees Astellas and Ferring Pharmaceuticals. S.E.: Lecture fees and travel support Fresenius Medical Care and Meditor. C.P.S.: Travel grants and speaker honoraria from Baxter, Fresenius Medical Care, and Hoizon; consulting honoraria from Baxter, Kyowa Kirin, and Zytoprotec, research support from Amgen. F.S.: Travel grants and speaker honoraria from Baxter, consulting honoraria from Fresenius Medical Care. R.S.: Speaker honoraria from Fresenius Medical Care and Amgen. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results

Fromm’s Dialectic of Freedom and the Praxis of Being

Positive freedom, according to Fromm’s definition, is the capacity for “spontaneous relationship to man and nature, a relationship that connects the individual with the world without eliminating his individuality” (1941, p. 29). Negative freedom according to Fromm exists in dialectical relationship to this as “freedom from” (1941, p. 34) external restraints that limit the exercise of free will