Challenges and opportunities of hydrothermal carbonisation in the UK; case study in Chirnside

The latest research and development in hydrothermal carbonisation (HTC) processes are reviewed and the feasibility of application to small towns in the UK is assessed. The HTC process designed in this report is theoretically evaluated for the biodegradable municipal waste and sewage waste produced by the small town of Chirnside, in the Scottish Borders. Calculation of mass and energy balances of the process are carried out alongside the evaluation of challenges and environmental, social and economic opportunities presented. The hypothetical HTC plant is capable of processing 267.14 t per year of food waste and 105.12 t per year of faecal sludge produced by Chirnsides estimated 2250 residents in 2041. The plant would be capable of producing 99.08 t per year of hydrochar with an estimated total energy content of 540.26 MWh per year. When used in a Biomass Combined Heat and Power Plant, the hydrochar would be capable of supplying Chirnsides residents with 0.71% and 3.43% of its domestic thermal energy demand and domestic electrical energy demand in 2041, respectively. Both the expected opportunities and challenges for the application of HTC are discussed, shedding light on the associated research in regards to this sustainable technology.

The latest research and development in hydrothermal carbonisation (HTC) processes are reviewed and the feasibility of application to small towns in the UK is assessed.     

Retracted Article: Challenges and opportunities of hydrothermal carbonisation in the UK; case study in Chirnside

The latest research and development in hydrothermal carbonisation (HTC) processes are reviewed and the feasibility of application to small towns in the UK is assessed. The HTC process designed in this report is theoretically evaluated for the biodegradable municipal waste and sewage waste produced by the small-town Chirnside, in the Scottish Borders. Calculation of mass and energy balances of the process are carried out alongside the evaluation of challenges and environmental, social and economic opportunities presented. The hypothetical HTC plant is capable of processing Chirnside''s waste at a rate of 72.5 kg h⁻¹ and has a positive net energy. The hydrochar produced is capable of producing 1452 MW h per year which equates to 35.6% of Chirnside''s predicted energy demand in 2041. Both the expected opportunities and challenges for the application of HTC are discussed, sheding light on the associated research on sustainable technology.

Hydrothermal carbonization: a great technology converting biomass waste to energy.     

A case for clinical co-teaching: Challenges and opportunities

Co-teaching in clinical courses in nursing education is uncommon. It might initially be perceived as time-consuming and challenging. However, co-teaching has the potential to enhance the learning experience of students as well as transform the teaching practice of clinical instructors. Relevant literature was reviewed illustrating the challenges and opportunities related to co-teaching. An exemplar involving clinical instructors co-teaching nursing students on an acute care unit in an urban hospital was presented. The exemplar of co-teaching was then compared with the literature. Emerging strategies to facilitate collaborative clinical co-teaching include co-planning and ongoing preparation; understanding the co-instructor's teaching philosophy; clear communication between co-instructors and with students; and fostering an equitable relationship where power is shared.     

放射性核素诊疗一体化:挑战与机遇

放射性核素诊疗一体化为实现精准诊断与治疗分化型甲状腺癌、神经内分泌肿瘤与前列腺癌等恶性肿瘤提供了个体化方案,既带来巨大机遇,也在开发新靶点、研发新型放射性药物、辐射剂量学与安全性评估等方面带来挑战。本文就放射性核素诊疗一体化面临的挑战与机遇进行展望。     

Challenges and opportunities in achieving healing

The current health care system in the United States must shift from a primary focus on acute care and cure to also emphasize maintenance of function and the relief of suffering that derives from the ailments associated with chronic disease and illness. To achieve this goal, the individual components of the health care equation must all respond and work in concert. These components include the provider, the venue, the patient, the community, our society, and the fiscal realities of paying for care. However, the barrier for change stems from the marked heterogeneity that exists in the definition of each of these individual components. Thus, the fundamental question is, can our current and future medical care system respond to the imperative of focusing on healing with a particular emphasis on chronic diseases? A solution is the provision of individualized care in a mindful practice and the purposeful cultivation of a healing relationship suffused with compassion and empathy in the therapeutic alliances between patient, provider, and advocates.     

Challenges and opportunities in the treatment of ventilator-associated pneumonia

Introduction: Ventilator-associated pneumonia (VAP) is a distinct clinical entity characterized by an onset after 48 hours of the application of mechanical ventilation (MV). Protocols exist to aid in the prevention of VAP, but this infection carries a devastating impact on patient morbidity and potentially mortality.

Areas covered: In this review we present key concepts from existing guidelines to aid clinicians. Challenges remain in defining this disease and, most importantly appropriate empiric antimicrobial treatment is the main determinant of outcome. We highlight that the selection of initial antibiotics is critical, as VAP can by caused by a broad array of drug resistant organisms (DROs), the appropriate duration of treatment for VAP is an evolving concept, but may, in part, be guided by biomarkers, and provide focus on diagnostic challenges, initial therapies and treatment strategies for VAP. Both traditional and novel antimicrobials are presented, including developments in the modes of delivery.

Expert commentary: The clinical approach to VAP continues to evolve. Recent evidence regarding the changes in microbiology, diagnostics approaches, and treatment strategies for VAP are important for clinicians to remain informed of to provide optimal patient care.     

Challenges and opportunities: the health of women and newborns in the Russian Federation

Dramatic socio-political, economic, and health care changes are occurring in the Russian Federation. Over time they are projected to have a positive impact on the health and well-being of women and newborns. The key to health care reforms is the emergence of a strong nursing profession. Notably, international collaborative efforts are strengthening the work of Russian nurses in improving perinatal health. In this millennium of global migration, where the world is growing increasingly smaller, it is important to understand health care systems and the health concerns of women and newborns living in other countries. Celebrating cultural differences, while embracing global similarities, is essential in ensuring that culturally sensitive and competent care is provided to women and newborns.     

Challenges and opportunities for reinvigorating the physician-scientist pipeline

Physician-scientists, with in-depth training in both medicine and research, are uniquely poised to address pressing challenges at the forefront of biomedicine. In recent years, a number of organizations have outlined obstacles to maintaining the pipeline of physician-scientists, classifying them as an endangered species. As in-training and early-career physician-scientists across the spectrum of the pipeline, we share here our perspective on the current challenges and available opportunities that might aid our generation in becoming independent physician-scientists. These challenges revolve around the difficulties in recruitment and retention of trainees, the length of training and lack of support at key training transition points, and the rapidly and independently changing worlds of medical and scientific training. In an era of health care reform and an environment of increasingly sparse NIH funding, these challenges are likely to become more pronounced and complex. As stakeholders, we need to coalesce behind core strategic points and regularly assess the impact and progress of our efforts with appropriate metrics. Here, we expand on the challenges that we foresee and offer potential opportunities to ensure a more sustainable physician-scientist workforce.     

Challenges of breastfeeding preterm infants: a case study

Promoting breastfeeding of preterm infants offers clinical challenges for maternal-child nurses, and requires understanding the experience of the mother. Maternal-child nurses, in collaboration with hospital- and community-based lactation specialists, can meet the unique needs of preterm infants and their mothers. There are several opportunities for nurses to educate other health care professionals in the care of preterm infants and their mothers. The case study in this article presents one mother's experience of delivering a preterm infant and the many obstacles to breastfeeding that she encountered, and it also offers suggestions for what nurses and other health care professionals can do to make sure other mothers have a more positive experience.     

Image analysis and machine learning in digital pathology: Challenges and opportunities

With the rise in whole slide scanner technology, large numbers of tissue slides are being scanned and represented and archived digitally. While digital pathology has substantial implications for telepathology, second opinions, and education there are also huge research opportunities in image computing with this new source of “big data”. It is well known that there is fundamental prognostic data embedded in pathology images. The ability to mine “sub-visual” image features from digital pathology slide images, features that may not be visually discernible by a pathologist, offers the opportunity for better quantitative modeling of disease appearance and hence possibly improved prediction of disease aggressiveness and patient outcome. However the compelling opportunities in precision medicine offered by big digital pathology data come with their own set of computational challenges. Image analysis and computer assisted detection and diagnosis tools previously developed in the context of radiographic images are woefully inadequate to deal with the data density in high resolution digitized whole slide images. Additionally there has been recent substantial interest in combining and fusing radiologic imaging and proteomics and genomics based measurements with features extracted from digital pathology images for better prognostic prediction of disease aggressiveness and patient outcome. Again there is a paucity of powerful tools for combining disease specific features that manifest across multiple different length scales.The purpose of this review is to discuss developments in computational image analysis tools for predictive modeling of digital pathology images from a detection, segmentation, feature extraction, and tissue classification perspective. We discuss the emergence of new handcrafted feature approaches for improved predictive modeling of tissue appearance and also review the emergence of deep learning schemes for both object detection and tissue classification. We also briefly review some of the state of the art in fusion of radiology and pathology images and also combining digital pathology derived image measurements with molecular “omics” features for better predictive modeling. The review ends with a brief discussion of some of the technical and computational challenges to be overcome and reflects on future opportunities for the quantitation of histopathology.     

Challenges and opportunities in the recovery of gold from electronic waste

Rapid global technological development has led to the rising production of electronic waste that presents both challenges and opportunities in its recycling. In this review, we highlight the value of metal resources in the printed circuit boards (PCBs) commonly found in end-of-life electronics, the differences between primary (ore) mining applications and secondary (‘urban’) mining, and the variety of metallurgical separations, in particular those that have the potential to selectively and sustainably recover gold from waste PCBs.

Rapid global technological development has led to the rising production of electronic waste that presents both challenges and opportunities in its recycling.

The rapid global rise in technology, tied in with consumer pressures for upgrades in functionality and design, has generated advanced electrical and electronic equipment with short lifespans. A consequence of this is the production of electronic waste (e-waste) which, in 2018 amounted to 50 million tonnes,^1,2 with a projected annual growth of 3–5%, three times more than for other waste streams.³ Reports on recycling rates vary, with estimates of around 20–30%.^1,4 It is estimated that more than 70% of globally produced waste electronics and electrical equipment (WEEE) enter China, Africa and India for reprocessing, much of it illegally, and often using crude, hazardous and inefficient processes.^5,6 Dumping and incinerating large amounts of WEEE has severe impact on human life and the environment,⁷ as it leads to the release of toxic heavy elements such as lead, mercury, chromium, nickel, beryllium, arsenic and antimony into the air, soil and water cycles.⁸An end-of-life printed circuit board (PCB) may contain up to 60 different chemical elements,⁹ and have a metal content as high as 40% by weight,¹⁰ so should be viewed as a valuable secondary source of precious and base metals. The metal content of a PCB is typically ten to a hundred times higher than that of conventionally mined ores.¹¹ It is estimated that recycling one ton of mobile phones could produce on average 130 kg of copper, 3.5 kg of silver, 0.34 kg of gold and 0.14 kg of Pd.¹² On this basis, the global e-waste management market is projected to produce an annual revenue of USD 62.5 billion by the end of 2020.^2,13 With an estimated 97% of the world population owning a mobile phone,¹⁴ it can be viewed as a plentiful feedstock for a recycling process. As such, the treatment of e-waste not only helps minimise the environmental impact of our technology-driven society by reducing pollution and energy demands compared to conventional mining practice,¹⁵ it also presents economic drivers for wealth creation and circular economies.^16–21In this review, we outline some of the latest chemical approaches that have been reported for the recovery of gold from discarded mobile phones and other WEEE.^22,23 Gold is the most valuable component of e-waste, with estimates for its consumption to fuel our technology-driven society at 263.3 MT per year.^7,24 We provide an overview of metal concentrations that are present in waste PCBs from end-of-life mobile phones, analyse the different pre-treatment steps that can be used to separate the metallic and non-metallic components of PCBs, and highlight various metallurgical methods for the extraction of gold from waste PCBs. For this latter aspect, we focus on methods in the primary research literature for which an understanding of the chemical mode of action has been developed; as such, a detailed analysis of the patent literature is not in the scope of this review.     

Researching the rehabilitation needs of patients with life-limiting disease: Challenges and opportunities

Abstract

People with life-limiting disease are among the most vulnerable groups accessing healthcare. Given this vulnerability, polarized views have been expressed in the literature regarding such individuals' involvement in research studies. This is further compounded when the research is focused on rehabilitation, the concept of which is often misunderstood by patients, carers, and medical professionals. A number of factors can affect how we conduct research to elicit the needs of people with life-limiting disease, including social, historical, and cultural influences. Despite advances in palliative care research, challenges remain for those working across the specialism. In this review, we discuss the challenges of conducting rehabilitation research in this distinct clinical specialism and important considerations when involving patients and carers. We highlight the opportunities for understanding patient rehabilitation needs through mixed methods research design for studies involving those undergoing potentially complex rehabilitation interventions across settings.

Note

People with life-limiting disease will be referred to as ‘patients’ in the context of their being involved with the healthcare system and receiving care from a clinician.     

Challenges and opportunities in the manufacture and expansion of cells for therapy

Introduction: Laboratory-based ex vivo cell culture methods are largely manual in their manufacturing processes. This makes it extremely difficult to meet regulatory requirements for process validation, quality control and reproducibility. Cell culture concepts with a translational focus need to embrace a more automated approach where cell yields are able to meet the quantitative production demands, the correct cell lineage and phenotype is readily confirmed and reagent usage has been optimized.

Areas covered: This article discusses the obstacles inherent in classical laboratory-based methods, their concomitant impact on cost-of-goods and that a technology step change is required to facilitate translation from bed-to-bedside.

Expert opinion: While traditional bioreactors have demonstrated limited success where adherent cells are used in combination with microcarriers, further process optimization will be required to find solutions for commercial-scale therapies. New cell culture technologies based on 3D-printed cell culture lattices with favourable surface to volume ratios have the potential to change the paradigm in industry. An integrated Quality-by-Design /System engineering approach will be essential to facilitate the scaled-up translation from proof-of-principle to clinical validation.     

Challenges and opportunities of nursing care in special-needs shelters.

Hurricanes Katrina and Rita forced many individuals along the coast of Texas and Louisiana to seek shelter inland. Among the evacuees were residents with special needs and residents of nursing homes and group homes caring for mentally retarded and physically disabled persons. Many nurses volunteered to provide health care for those in need. This article discusses challenges and opportunities that were encountered by nurses volunteering in special-needs shelters. Issues related to human and physical resources, patient care, and confidentiality are discussed including lessons learned. As nurses who cared for evacuees in the shelter, it is hoped some of the lessons learned can be utilized in future disasters.