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Assessing Opportunities to Reduce the Environmental Impact of Brewery Waste in Albania

Breweries produce tons of organic solid waste and millions of liters of wastewater. When discharged into the environment without treatment, these waste streams degrade aquatic ecosystems and can pose risks to human health. Working with SHUKALB, our team investigated Albanian brewery practices and identified process improvements to reduce operating costs and breweries’ environmental impact. Our interviews with industry professionals, extensive on-site assessment, and surveys demonstrate that Albanian brewery processes compare favorably to global breweries except for a higher environmental impact due to no available industrial wastewater treatment. As costs influence brewery changes, we generated high-level recommendations for breweries to improve their environment impact

Sensor technologies for quality control in engineered tissue manufacturing

The use of engineered cells, tissues, and organs has the opportunity to change the way injuries and diseases are treated. Commercialization of these groundbreaking technologies has been limited in part by the complex and costly nature of their manufacture. Process-related variability and even small changes in the manufacturing process of a living product will impact its quality. Without real-time integrated detection, the magnitude and mechanism of that impact are largely unknown. Real-time and non-destructive sensor technologies are key for in-process insight and ensuring a consistent product throughout commercial scale-up and/or scale-out. The application of a measurement technology into a manufacturing process requires cell and tissue developers to understand the best way to apply a sensor to their process, and for sensor manufacturers to understand the design requirements and end-user needs. Furthermore, sensors to monitor component cells’ health and phenotype need to be compatible with novel integrated and automated manufacturing equipment. This review summarizes commercially relevant sensor technologies that can detect meaningful quality attributes during the manufacturing of regenerative medicine products, the gaps within each technology, and sensor considerations for manufacturing

Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis

Purpose: Infectious complications occur frequently after major abdominal surgery and have a major influence on patient outcome and hospital costs. A marker that can rule out postoperative infectious complications (PICs) could aid patient selection for safe and early hospital discharge. C-reactive protein (CRP) is a widely available, fast, and cheap marker that might be of value in detecting PIC. Present meta-analysis evaluates the diagnostic value of CRP to rule out PIC following major abdominal surgery, aiding patient selection for early discharge. Methods: A systematic literature search of Medline, PubMed, and Cochrane was performed identifying all prospective studies evaluating the diagnostic value of CRP after abdominal surgery. Meta-analysis was performed according to the PRISMA statement. Results: Twenty-two studies were included for qualitative analysis of which 16 studies were eligible for meta-analysis, representing 2215 patients. Most studies analyzed the value of CRP in colorectal surgery (eight studies). The pooled negative predictive value (NPV) improved each day after surgery up to 90 % at postoperative day (POD) 3 for a pooled CRP cutoff of 159 mg/L (range 92–200). Maximum predictive values for PICs were reached on POD 5 for a pooled CRP cutoff of 114 mg/L (range 48–150): a pooled sensitivity of 86 % (95 % confidence interval (CI) 79–91 %), specificity of 86 % (95 % CI 75–92 %), and a positive predictive value of 64 % (95 % CI 49–77 %). The pooled sensitivity and specificity were significantly higher on POD 5 than on other PODs (p < 0.001). Conclusion: Infectious complications after major abdominal surgery are very unlikely in patients with a CRP below 159 mg/L on PO

Plain abdominal radiography in acute abdominal pain; past, present, and future

Several studies have demonstrated that a diagnosis based solely on a patient's medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally, imaging workup starts with abdominal radiography. However, numerous studies have demonstrated low sensitivity and accuracy for plain abdominal radiography in the evaluation of acute abdominal pain as well as various specific diseases such as perforated viscus, bowel obstruction, ingested foreign body, and ureteral stones. Computed tomography, and in particular computed tomography after negative ultrasonography, provides a better workup than plain abdominal radiography alone. The benefits of computed tomography lie in decision-making for management, planning of a surgical strategy, and possibly even avoidance of negative laparotomies. Based on abundant available evidence, major advances in diagnostic imaging, and changes in the management of certain diseases, we can conclude that there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain presenting in the emergency department in current practic

Een buikoverzichtsfoto voor het gevoel van de dokter

Scientific research has demonstrated that the diagnostic accuracy of plain abdominal x-rays is lower than that of other imaging modalities such as CT or ultrasonography in patients with acute abdominal pain. Nevertheless, plain x-rays are continually being used in daily practice. There are several comparable examples in which the implementation of new evidence into clinical practice seems problematic. Apparently other factors such as the experience of the doctor and psychological processes make it difficult to translate clear scientific evidence into daily practic

Richtlijn 'Diagnostiek acute buikpijn bij volwassenen'

The interdisciplinary, evidence-based guideline 'Diagnostics in acute abdominal pain in adults' describes the optimal in-hospital diagnostic work-up of patients with acute abdominal pain. Amongst other recommendations, the guideline advises the use of C-reactive protein and white blood cell count to differentiate urgent from non-urgent causes in an adult with acute abdominal pain presenting at the Emergency Department. If there is clinical suspicion of an urgent condition the guideline advises that additional imaging be performed. The guideline states that conventional imaging (plain abdominal - or chest x-ray) is unnecessary as this is of no benefit. Additionally the guideline recommends that patients with acute abdominal pain and severe sepsis or septic shock are started on antibiotic treatment within an hour at the Emergency Department and not to wait for the diagnostic procedures to be complete

Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

Introduction: Diagnostic practice for acute abdominal pain at the Emergency Department varies widely and is mostly based on doctor's preferences. We aimed at developing an evidence-based guideline for the diagnostic pathway of patients with abdominal pain of non-traumatic origin. Methods: All available international literature on patients with acute abdominal pain was identified and graded according to their methodological quality by members of the multidisciplinary steering group. A guideline was synthetized, providing evidence-based recommendations together with considerations based on expertise of group members, patient preferences, costs, availability of facilities, and organizational aspects. Conclusions and Recommendations: Definition: Uniform terminology is needed in patients with acute abdominal pain to avoid difficulty in interpretation and ease comparison of findings between studies. We propose the use of the following definition for acute abdominal pain: pain of nontraumatic origin with a maximum duration of 5 days. Clinical diagnosis: Clinical evaluation is advised to differentiate between urgent and nonurgent causes. The diagnostic accuracy of clinical assessment is insufficient to identify the correct diagnosis but can discriminate between urgent and nonurgent causes. Patients suspected of nonurgent diagnoses can safely be reevaluated the next day. Based on current literature, no conclusions can be drawn on the differences in accuracy between residents and specialists. No conclusions can be drawn on the influence of a gynecological consultation. In patients suspected of an urgent condition, additional imaging is justified. CRP and WBC count alone are insufficient to discriminate urgent from nonurgent diagnoses. Diagnostic imaging: There is no place for conventional radiography in the work-up of patients with acute abdominal pain due to the lack of added value on top of clinical assessment. Computed tomography leads to the highest sensitivity and specificity in patients with acute abdominal pain. Positive predictive value of ultrasound is comparable with CT and therefore preferred as the first imaging modality due to the downsides of computed tomography; negative or inconclusive ultrasound is followed by CT. Based on current literature, no conclusions can be drawn on the added value of a diagnostic laparoscopy in the work-up of patients with acute abdominal pain. Antibiotic treatment should be started within the first hour after recognition of sepsis. Administration of opioids (analgesics) decreases the intensity of the pain and does not affect the accuracy of physical examination. (C) 2015 S. Karger AG, Base