Potential advantages in heat and power production when biogas is collected from several digesters using dedicated pipelines - A case study in the "Province of West-Flanders" (Belgium)

In the case study “West-Flanders” costs of electricity and heat production are estimated if a dedicated biogas grid using pipelines would be implemented to centralize energy production in a region. Heat may not be used effectively at digester sites, e.g. because of a change in treatment of digestate. A large scale centralized combined heat and power (CHP) engine can produce additional electrical power at a hub, i.e. central collection point, and has lower specific costs compared to decentralized CHPs at digester sites. A biogas transport model is used to calculate transport costs in a grid. These costs, partly balanced by a scale advantage in CHP costs, are attributed to the additional electrical energy (80%) and heat (20%) produced. If the hub is at a digester site, costs of additional electricity can be as low as 4.0 €ct kWhe−1 and are in many cases below 12 €ct kWhe−1, i.e. in the same order of magnitude or lower than costs of electricity from biogas produced using separate CHPs at the different digester sites; costs of heat at the hub show to be lower than 1 €ct kWhth−1 assuming an effective heat use of 50%. In case a hub is situated at a location with high potential heat demand, i.e. a heat sink, transport of biogas from one digester only to a central located hub can provide 3.4 MWth of heat at 1.95 €ct kWhth−1. For such a centrally located hub additional electrical energy costs show to be slightly higher, but with three or more digesters these costs are lower than 20 €ct kWhe−1 and heat costs are around 0.5 €ct kWhth−1. With a centralized hub more renewable energy is produced, i.e. a more efficient use of biomass feedstock. It is concluded that costs for additional electricity and heat can be at a competing level and scale advantages in a CHP can be a driver to collect biogas at a hub using a biogas grid

Staged Mucosal Advancement Flap versus Staged Fibrin Sealant in the Treatment of Complex Perianal Fistulas

Background. In this prospective randomised study, the staged mucosal advancement flap is compared with staged fibrin sealant application in the treatment of perianal fistulas. Methods. All patients with high complex cryptoglandular fistulas were randomised to closure of the internal opening by a mucosal advancement flap (MF) or injection with fibrin sealant (FS) after treatment with setons. Recurrence rate and incontinence disorders were explored. Results. The MF group (5 females and 10 males) with a median age of 51 years and a median followup of 52 months. The FS group (4 females and 11 males) with a median age of 45 years and a median followup of 49 months. Three (20%) patients of the MF group had a recurrent fistula compared to 9 (60%) of the FS group (P = 0.03). No new continence disorders developed. Conclusion. Staged FS injection has a much lower success rate compared to MF

Lessons from spatial and environmental assessment of energy potentials for Anaerobic Digestion production systems applied to the Netherlands

Anaerobic digestion (AD) can play an important role in achieving the renewable energy goals set within the European Union. Within this article the focus is placed on reaching the Dutch local renewable production goal set for the year 2020 with locally available biomass waste flows, avoiding intensive farming and long transport distances of biomass and energy carriers. The bio-energy yields, efficiency and environmental sustainability are analyzed for five municipalities in the northern part of the Netherlands, using three utilization pathways: green gas production, combined heat and power, and waste management. Literature has indicated that there is sufficient bio-energy potential in local waste streams to reach the aforementioned goal. However, the average useful energy finally produced by the AD production pathway is significantly lower, often due to poor quality biomass and difficult harvesting conditions. Furthermore, of the potential bio-energy input in the three utilization pathways considered in this article, on average: 73% can be extracted as green gas; 57% as heat and power; and 44% as green gas in the waste management pathway. This demonstrates that the Dutch renewable production goal cannot be reached. The green gas utilization pathway is preferable for reaching production goals as it retains the highest amount of energy from the feedstock. However, environmental sustainability favors the waste management pathway as it has a higher overall efficiency, and lower emissions and environmental impacts. The main lessons drawn from the aforementioned are twofold: there is a substantial gap between bio-energy potential and net energy gain; there is also a gap between top-down regulation and actual emission reduction and sustainability. Therefore, a full life cycle-based understanding of the absolute energy and environmental impact of biogas production and utilization pathways is required to help governments to develop optimal policies serving a broad set of sustainable objectives. Well-founded ideas and decisions are needed on how best to utilize the limited biomass availability most effectively and sustainably in the near and far future, as biogas can play a supportive role for integrating other renewable sources into local decentralized energy systems as a flexible and storable energy source. (C) 2016 Elsevier Ltd. All rights reserved

The Importance of Systematically Reporting and Reflecting on eHealth Development:Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care

Background: The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them. Objective: The two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap). Methods: In the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method. Results: Information on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal. Conclusions: Reflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model's underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed

Towards VocBench 3: Pushing collaborative development of thesauri and ontologies further beyond

More than three years have passed since the release of the second edition of VocBench, an open source collaborative web platform for the development of thesauri complying with Semantic Web standards. In these years, a vibrant user community has gathered around the system, consisting of public organizations, companies and independent users looking for open source solutions for maintaining their thesauri, code lists and authority resources. The focus on collaboration, the differentiation of user roles and the workflow management for content validation and publication have been the strengths of the platform, especially for those organizations requiring a centralized and controlled publication environment. Now the time has come to widen the scope of the platform: funded by the ISA2programme of the European Commission, VocBench 3 will offer a general-purpose collaborative environment for development of any kind of RDF dataset, improving the editing capabilities of its predecessor, while still maintaining the peculiar aspects that determined its success. In this paper, we review the requirements and the new objectives set for version 3, and then introduce the new characteristics that were implemented for this next iteration of the platform

Three Decades Single Center Experience of Airway Complications After Lung Transplantation

Post lung transplantation airway complications like necrosis, stenosis, malacia and dehiscence cause significant morbidity, and are most likely caused by post-operative hypo perfusion of the anastomosis. Treatment can be challenging, and airway stent placement can be necessary in severe cases. Risk factors for development of airway complications vary between studies. In this single center retrospective cohort study, all lung transplant recipients between November 1990 and September 2020 were analyzed and clinically relevant airway complications of the anastomosis or distal airways were identified and scored according to the ISHLT grading system. We studied potential risk factors for development of airway complications and evaluated the impact on survival. The treatment modalities were described. In 651 patients with 1,191 airway anastomoses, 63 patients developed 76 clinically relevant airway complications of the airway anastomoses or distal airways leading to an incidence of 6.4% of all anastomoses, mainly consisting of airway stenosis (67%). Development of airway complications significantly affects median survival in post lung transplant patients compared to patients without airway complication (101 months versus 136 months, p = 0.044). No significant risk factors for development of airway complication could be identified. Previously described risk factors could not be confirmed. Airway stents were required in 55% of the affected patients. Median survival is impaired by airway complications after lung transplantation. In our cohort, no significant risk factors for the development of airway complications could be identified.</jats:p&gt

Integrating People, Context, and Technology in the Implementation of a Web-Based Intervention in Forensic Mental Health Care:Mixed-Methods Study

BACKGROUND: While eMental health interventions can have many potential benefits for mental health care, implementation outcomes are often disappointing. In order to improve these outcomes, there is a need for a better understanding of complex, dynamic interactions between a broad range of implementation-related factors. These interactions and processes should be studied holistically, paying attention to factors related to context, technology, and people. OBJECTIVE: The main objective of this mixed-method study was to holistically evaluate the implementation strategies and outcomes of an eMental health intervention in an organization for forensic mental health care. METHODS: First, desk research was performed on 18 documents on the implementation process. Second, the intervention's use by 721 patients and 172 therapists was analyzed via log data. Third, semistructured interviews were conducted with all 18 therapists of one outpatient clinic to identify broad factors that influence implementation outcomes. The interviews were analyzed via a combination of deductive analysis using the nonadoption, abandonment, scale-up, spread, and sustainability framework and inductive, open coding. RESULTS: The timeline generated via desk research showed that implementation strategies focused on technical skills training of therapists. Log data analyses demonstrated that 1019 modules were started, and 18.65% (721/3865) of patients of the forensic hospital started at least one module. Of these patients, 18.0% (130/721) completed at least one module. Of the therapists using the module, 54.1% (93/172 sent at least one feedback message to a patient. The median number of feedback messages sent per therapist was 1, with a minimum of 0 and a maximum of 460. Interviews showed that therapists did not always introduce the intervention to patients and using the intervention was not part of their daily routine. Also, therapists indicated patients often did not have the required conscientiousness and literacy levels. Furthermore, they had mixed opinions about the design of the intervention. Important organization-related factors were the need for more support and better integration in organizational structures. Finally, therapists stated that despite its current low use, the intervention had the potential to improve the quality of treatment. CONCLUSIONS: Synthesis of different types of data showed that implementation outcomes were mostly disappointing. Implementation strategies focused on technical training of therapists, while little attention was paid to changes in the organization, design of the technology, and patient awareness. A more holistic approach toward implementation strategies-with more attention to the organization, patients, technology, and training therapists-might have resulted in better implementation outcomes. Overall, adaptivity appears to be an important concept in eHealth implementation: a technology should be easily adaptable to an individual patient, therapists should be trained to deal flexibly with an eMental health intervention in their treatment, and organizations should adapt their implementation strategies and structures to embed a new eHealth intervention