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The manufacture of egg yolk powder by spray drying requires regular cleaning in order to remove fouling deposits and prevent microbiological growth on the pasteurisation heat exchanger and the spray dryer. A life cycle assessment (LCA) study on a typical powder manufacturing plant, using literature data, indicated that the egg breaking, storage and pasteurisation steps were the major contributors to the plant's environmental impacts rather than the cleaning-in-place (CIP) operations owing to their high water and electricity consumption (for refrigerated storage). CIP impacts on thermal energy and wastewater emissions were nevertheless significant, and the benefits of using intermittent flows of aqueous NaOH solution in the dryer CIP stage, reported by Yang et al. (2019), were assessed. The latter gave a 21% improvement in terrestrial ecotoxicity impact. Optimising the NaOH/temperature conditions based on experimental data gave more efficient cleaning with lower water, chemicals and energy consumption. Over-cleaning had significant impacts on terrestrial and marine ecotoxicity as well as reducing productivity. Three changes in cleaning technology were considered briefly: electrical heating, solar heating and pumping, and membrane treatment of wastewater. These gave little overall global improvement, partly due to the polluting nature of the available electricity supply (coal-fired) and local benefits to the factory being offset by impacts associated with equipment manufacture.

The manufacture of egg yolk powder by spray drying requires regular cleaning in order to remove fouling deposits and prevent microbiological growth on the pasteurisation heat exchanger and the spray dryer. A life cycle assessment (LCA) study on a typical powder manufacturing plant, using literature data, indicated that the egg breaking, storage and pasteurisation steps were the major contributors to the plant's environmental impacts rather than the cleaning-in-place (CIP) operations owing to their high water and electricity consumption (for refrigerated storage). CIP impacts on thermal energy and wastewater emissions were nevertheless significant, and the benefits of using intermittent flows of aqueous NaOH solution in the dryer CIP stage, reported by Yang et al. (2019), were assessed. The latter gave a 21% improvement in terrestrial ecotoxicity impact. Optimising the NaOH/temperature conditions based on experimental data gave more efficient cleaning with lower water, chemicals and energy consumption. Over-cleaning had significant impacts on terrestrial and marine ecotoxicity as well as reducing productivity. Three changes in cleaning technology were considered briefly: electrical heating, solar heating and pumping, and membrane treatment of wastewater. These gave little overall global improvement, partly due to the polluting nature of the available electricity supply (coal-fired) and local benefits to the factory being offset by impacts associated with equipment manufacture.

Jui-Hua Tsai, Ellen Janssen, John FP Bridges Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Abstract: Patient groups are increasingly engaging in research to understand patients’ preferences and incorporate their perspectives into drug development and regulation. Several models of patient engagement have emerged, but there is little guidance on how to partner with patient groups to engage the disease community. Our group has been using an approach to engage patient groups that we call research as an event. Research as an event is a method for researchers to use a community-centered event to engage patients in their own environment at modest incremental cost. It is a pragmatic solution to address the challenges of engaging patients in research to minimize patients’ frustration, decrease the time burden, and limit the overall cost. The community, the event, and the research are the three components that constitute the research as an event framework. The community represents a disease-specific community. The event is a meeting of common interest for patients and other stakeholders, such as a patient advocacy conference. The research describes activities in engaging the community for the purpose of research. Research as an event follows a six-step approach. A case study is used to demonstrate the six steps followed by recommendations for future implementation. Keywords: patients’ perspectives, decision making, drug approval, patient engagement, patient organization, patients’ preference

An innovative fluid-dynamic gauging (FDG) device to study the initial as well as long-term swelling or removal of soft solid layers immersed in a liquid environment in real time and in situ is presented. This sideways FDG (SiDG) device was developed for soft solid layers whose properties change significantly on contact with liquid. Calibration tests indicated a resolution of ±10 μm. The open source computational fluid dynamics (CFD) code OpenFOAM was used to model the flow in the SiDG nozzle. Good agreement was obtained between experimental and CFD results at different nozzle clearances, so that the shear stress exerted by the gauging flow can be computed accurately. A series of demonstration studies are presented, on layers of petroleum jelly, polyvinyl acetate (PVAc), gelatin and a complex model soil (CMS). Initial swelling dynamics are captured and the influence of pH on initial swelling behaviour, previously inaccessible, is reported.

Yang-Pei Chang,1 Chih-Jen Yang,2 Kai-Fang Hu,3 A-Ching Chao,4 Yu-Han Chang,5 Kun-Pin Hsieh,6 Jui-Hsiu Tsai,7 Pei-Shan Ho,8,9 Shen-Yang Lim101Department of Neurology, 2Department of Internal Medicine, 3Department of Dentistry, Kaohsiung Municipal Ta-Tung Hospital, 4Department of Neurology, College of Medicine, 5Department of Management, Kaohsiung Municipal Ta-Tung Hospital, 6School of Pharmacy, College of Pharmacy, 7Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, 8Faculty of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, 9Cancer Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan, Republic of China; 10Faculty of Medicine, University of Malaya, Kuala lumpur, MalaysiaObjective: Pneumonia is the leading cause of death in patients with Parkinson’s disease (PD). However, few studies have been performed to explore the risk factors for pneumonia development in patients with PD.Methods: We conducted a nationwide population-based cohort study of patients with PD to identify the risk factors for these patients developing pneumonia. Participants with newly diagnosed PD between 2000 and 2009 were enrolled from the 2000–2010 National Health Insurance Research Database in Taiwan. We compared patients with PD with an incidence of hospitalization with pneumonia vs those without, and Cox proportional hazard models were used to estimate the risk of pneumonia.Results: Of the 2,001 enrolled patients (mean follow-up duration 5.8 years, range: 2.7–14.7 years), 381 (19.0%) had an incidence of hospitalization with pneumonia during the study period. Multivariate Cox proportional hazards analysis identified older age group (≥80 years of age, hazard ratio [HR] =3.15 [95% confidence interval 2.32–4.28]), male sex (HR =1.59 [1.29–1.96]), certain geographic regions (northern, HR =1.36 [1.04–1.78], southern and eastern, HR =1.40 [1.05–1.88]), rural areas (HR =1.34 [1.05–1.72]), chronic heart failure (HR =1.53 [1.02–2.29]), and chronic kidney disease (HR =1.39 [1.03–1.90]) as risk factors for hospitalization with pneumonia in patients with PD. However, treatment for dental caries was a protective factor (HR =0.80 [0.64–0.99]).Conclusion: The results of this study highlight risk factors that are associated with hospitalization with pneumonia, and, for the first time, suggest a link between treated dental caries and a diminished risk of hospitalization with pneumonia in patients with PD.Keywords: pneumonia, Parkinson’s disease, dental caries, chronic heart failure, chronic kidney disease

Calcium acetate (CaAc) acutely decreases absorption of concomitantly administered zinc gluconate (Hwang et al., AJKD 1992), but its long-term effect on zinc metabolism has not been studied. This study is intended to elucidate whether use of CaAc as phosphate binder on a daily basis affects zinc status in hemodialysis (HD) patients. Effects of CaAc on serum zinc were studied in 44 HD patients for 8 weeks (short-term). In 10 of these patients, the changes of serum and hair zinc were followed for 8 months (long-term). The daily dose of CaAc contained 25.35 mmol elemental calcium. Serum and hair zinc concentrations were measured by atomic absorptiometry. Our results were as follows: (i) in the short-term study, serum zinc concentrations did not show a significant difference compared to the baseline; (ii) in the long-term study, serum zinc concentrations showed no significant difference between different time points (11.0+/-0.5 in the beginning, 11.9+/-0.4 after 2 months, 11.4+/-0.4 after 4 months and 11.3+/-0.5 micromol/L after 8 months, n=10). However, these values were all significantly lower than in the normal controls (15.7+/-0.5 micromol/L, n=16); (iii) hair zinc content was not significantly different from the baseline level (2.7+/-0.1 in the beginning, 2.4+/-0.1 after 2 months, 2.6+/-0.2 after 4 months, 3.1+/-0.1 micromol/g hair, and from that of normal controls, 2.7+/-0.2 micromol/g hair). In conclusion, daily application of CaAc does not significantly interfere with zinc absorption and storage in HD patients. However, the comparable hair zinc content in the presence of decreased serum zinc concentrations indicates that the metabolic processing of zinc in HD patients is different from that of normal individuals.