Ibero-American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2-4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Exergy optimization and comparison of cryogenic processes for CO2 capture

International audienc

Etude technico-économique de la production d'hydrogène à partir de l'électrolyse haute température pour différentes sources d'énergie thermique

This work focus on the techno-economic study of massive hydrogen production by the High Temperature Electrolysis (HTE) process and also deals with the possibility of producing the steam needed in the process by using different thermal energy sources. Among several sources, those retained in this study are the biomass and domestic waste incineration units, as well as two nuclear reactors (European Pressurised water Reactor - EPR and Sodium Fast Reactor - SFR). Firstly, the technical evaluation of the steam production by each of these sources was carried out. Then, the design and modelling of the equipments composing the process, specially the electrolysers (Solid Oxides Electrolysis Cells), are presented. Finally, the hydrogen production cost for each energy sources coupled with the HTE process is calculated. Moreover, several sensibility studies were performed in order to determine the process key parameter and to evaluate the influence of the unit size effect, the electric energy cost, maintenance, the cells current density, their investment cost and their lifespan on the hydrogen production cost. Our results show that the thermal energy cost is much more influent on the hydrogen production cost than the steam temperature at the outlet stream of the thermal source. It seems also that the key parameters for this process are the electric energy cost and the cells lifespan. The first one contributes for more than 70% of the hydrogen production cost. From several cell lifespan values, it seems that a 3 year value, rather than 1 year, could lead to a hydrogen production cost reduced on 34%. However, longer lifespan values going from 5 to 10 years would only lead to a 8% reduction on the hydrogen production cost.L'objectif de ce travail est d'étudier les différents éléments techniques et économiques pour la production massive d'hydrogène par le procédé d'Electrolyse Haute Température (EHT) et la possibilité d'utiliser différentes sources d'énergie thermique pour évaporer l'eau nécessaire au procédé. Parmi les sources d'énergie thermique envisagées, nous avons retenu les unités d'incinération de biomasse et de déchets ménagers, les réacteurs nucléaires à « Eau Pressurisée » (European Pressurised Reactor - EPR) et au sodium liquide (Sodium Fast Reactor - SFR). Pour chacune de ces sources, nous avons développé une étude technique concernant la production de la vapeur et ses caractéristiques. Ensuite, nous présentons la description du formalisme permettant le dimensionnement, l'évaluation économique et la modélisation des équipements constituant le procédé EHT, en particulier l'électrolyseur constitué par les cellules d'électrolyse à oxydes solides (anglais - SOEC). Finalement, le couplage des sources d'énergie thermiques avec le procédé EHT est réalisé et le coût de production d'hydrogène est déterminé pour chacune de ces sources. Ensuite, sont examinées successivement les influences du débit d'hydrogène produit, de la densité de courant imposée aux cellules, leur coût de production et leur durée de vie, du coût de l'électricité et des coûts de maintenance sur la compétitivité du procédé. Notre étude montre que le coût de production du kilogramme d'hydrogène est principalement influencé par le coût d'énergie thermique inhérent aux sources d'énergie, alors qu'il est moins influencé par la température de la vapeur produite. Il s'avère que le coût de l'électricité nécessaire au fonctionnement du procédé et la durée de vie des électrolyseurs constituent des paramètres clés pour rendre le procédé compétitif. En effet, l'électricité représente une contribution de plus de 70% dans le coût total de production d'hydrogène. La durée de vie maximale de l'électrolyseur de 3 ans au lieu de 1 an actuellement, permettrait de diminuer de 34% le coût de production d'hydrogène, mais des améliorations sur la durée de vie de 5 ans voire 10 ans ne permettraient que des réductions sur le coût de production d'environ 8%

Improved carbon capture in oxy-fuel cement facilities

International audienc

Abstract Preview of 'Solid Carbon capture in cement f' (0BKSW5)

International audienceProcess integration for energy savings and cost reductions has barely been considered as driver for Carbon Capture Storage and Reuse (CCSR) deployment. R&D has mainly focused on energy savings on the cement facility, CO 2 capture system and Air Separation Unit (ASU), this last when oxycombustion is considered. Amine and frosting technologies to capture CO 2 have not yet shown competitiveness and make rise several questions on energy penalty and exergy destruction. The novel approach on this work is to integrate the several technology bricks composing the future low carbon cement facility. ASU, carbon capture and gas streams of the facility are simulated. ASU streams serve to drastically reduce the energy needed to capture CO 2. This capture is performed by frost of the exhaust stream, CO 2 rich, which leads to high purity CO 2. Particular attention is paid to the kinetics of growth of CO 2 crystals. Results show that ASU + CCRS reduce cyclones size for an equivalent pressure drop compared to conventional cement facilities. Compared to the most studied Compression Capture process, integration of processes reduces by more than 20% the energy needed for CO 2 capture and lowers capital expenses for purchase of compressors. No text (if any) below this line will be printed in the abstract book

Waste heat reuse for enhanced CO2 liquefaction and reduced transport costs

International audienc

Etude technico-économique de la production d'hydrogène à partir de l'électrolyse haute température pour différentes sources d'énergie thermique

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