Improved Waste Heat Management and Energy Integration in an Aluminum Annealing Continuous Furnace Using a Machine Learning Approach.

Annealing furnaces are critical for achieving the desired material properties in the production of high-quality aluminum products. In addition, energy efficiency has become more and more important in industrial processes due to increasing decarbonization regulations and the price of natural gas. Thus, the current study aims to determine the opportunities to reduce energy consumption in an annealing continuous furnace and the associated emissions. To this end, the heat transfer phenomenon is modeled and solutions for the decreasing fuel consumption are evaluated so that the overall performance of the process is enhanced. A heat transfer model is developed using the finite difference method, and the heat transfer coefficient is calculated using machine learning regression models. The heat transfer model is able to predict the heat transfer coefficient and calculate the aluminum temperature profile along the furnace and the fuel consumption for any given operating condition. Two solutions for boosting the furnace exergy efficiency are evaluated, including the modulation of the furnace temperature profiles and the energy integration by the recycling of exhaust flue gases. The results show that the advanced energy integration approach significantly reduces fuel consumption by up to 20.7%. Sensitivity analysis demonstrates that the proposed strategy can effectively reduce fuel consumption compared with the business-as-usual scenario for a range of sheet thicknesses and sheet velocities.

[The benefits of reading aloud in geriatric wards and institutions]. / Les bienfaits de la lecture à voix haute dans les services et institutions de gériatrie.

The number of elderly patients hospitalized in geriatric wards and institutions on a temporary or more permanent basis is increasing. We know that thymic symptoms, such as depression, behavioral disorders and boredom, are common in these patients. We also know that the drug therapies used to treat these symptoms are sometimes a source of iatrogenesis and can be ineffective. That's why "non-drug" therapies are so useful. What if reading aloud could be part of the management of our elderly patients?

[Acupuncture, a non-drug approach to the management of chronic pain in geriatrics]. / L'acupuncture, une approche non médicamenteuse pour la prise en charge des douleurs chroniques en gériatrie.

It is recognized that multimodal management of chronic pain is necessary. This management requires the use of both drug and non-drug approaches. Acupuncture is a non-medicinal approach that has been shown to be effective in treating chronic musculoskeletal and arthritic pain. It has few side effects and contraindications. Its use should be developed in geriatrics as a complement to usual analgesics and other non-drug approaches.

Sustainable polyesters via direct functionalization of lignocellulosic sugars.

The development of sustainable plastics from abundant renewable feedstocks has been limited by the complexity and efficiency of their production, as well as their lack of competitive material properties. Here we demonstrate the direct transformation of the hemicellulosic fraction of non-edible biomass into a tricyclic diester plastic precursor at 83% yield (95% from commercial xylose) during integrated plant fractionation with glyoxylic acid. Melt polycondensation of the resulting diester with a range of aliphatic diols led to amorphous polyesters (Mn = 30-60 kDa) with high glass transition temperatures (72-100 °C), tough mechanical properties (ultimate tensile strengths of 63-77 MPa, tensile moduli of 2,000-2,500 MPa and elongations at break of 50-80%) and strong gas barriers (oxygen transmission rates (100 µm) of 11-24 cc m-2 day-1 bar-1 and water vapour transmission rates (100 µm) of 25-36 g m-2 day-1) that could be processed by injection moulding, thermoforming, twin-screw extrusion and three-dimensional printing. Although standardized biodegradation studies still need to be performed, the inherently degradable nature of these materials facilitated their chemical recycling via methanolysis at 64 °C, and eventual depolymerization in room-temperature water.

Implementation of personalized medicine in a context of moral hazard and uncertainty about treatment efficacy.

This paper analyzes the decision of a health authority to implement personalized medicine. We consider a model in which the health authority has three possibilities. It can apply either the same treatment (a standard or a new treatment) to the whole population or implement personalized medicine, i.e., use genetic information to offer the most suitable treatment to each patient. We first characterize the drug reimbursement contract of a firm producing a new treatment with a companion genetic test when the firm can undertake an effort to improve drug quality. Then, we determine the conditions under which personalized medicine should be implemented when this effort is observable and when it is not. Finally, we show how the unobservability of effort affects the conditions under which the health authority implements personalized medicine.

[How to value the work of geriatric caregivers]. / De l'importance de valoriser le travail des soignants en gériatrie.

Geriatric caregivers are subjected to physically and psychologically demanding situations. A geriatric short-stay service has implemented measures with a unique, creative and dynamic approach. These include participatory management, benevolence and the enhancement of the quality of work.

Synthesis of single and interplant non-isothermal water networks.

This paper addresses the synthesis problem of non-isothermal water networks using a mathematical programming approach. A heat-integrated water network superstructure and its corresponding mixed integer nonlinear programming (MINLP) model is proposed for the synthesis of individual as well as interplant water networks. A new feature of the proposed model includes piping installation cost within the objective function minimising the total annual cost of the network. This introduces additional trade-offs between operating and investment costs that can impact a final network design. Three examples were solved in order to demonstrate the applicability and effectiveness of the proposed model and solution approach. The results show that additional saving in total annual cost can be achieved by enabling direct water integration between plants. Improved solutions were obtained compared to those reported in the literature considering freshwater and utilities consumption as well as total annual cost.

Methodology for the optimal design of an integrated first and second generation ethanol production plant combined with power cogeneration.

The application of methodologies for the optimal design of integrated processes has seen increased interest in literature. This article builds on previous works and applies a systematic methodology to an integrated first and second generation ethanol production plant with power cogeneration. The methodology breaks into process simulation, heat integration, thermo-economic evaluation, exergy efficiency vs. capital costs, multi-variable, evolutionary optimization, and process selection via profitability maximization. Optimization generated Pareto solutions with exergy efficiency ranging between 39.2% and 44.4% and capital costs from 210M$ to 390M$. The Net Present Value was positive for only two scenarios and for low efficiency, low hydrolysis points. The minimum cellulosic ethanol selling price was sought to obtain a maximum NPV of zero for high efficiency, high hydrolysis alternatives. The obtained optimal configuration presented maximum exergy efficiency, hydrolyzed bagasse fraction, capital costs and ethanol production rate, and minimum cooling water consumption and power production rate.

Round-the-clock power supply and a sustainable economy via synergistic integration of solar thermal power and hydrogen processes.

We introduce a paradigm-"hydricity"-that involves the coproduction of hydrogen and electricity from solar thermal energy and their judicious use to enable a sustainable economy. We identify and implement synergistic integrations while improving each of the two individual processes. When the proposed integrated process is operated in a standalone, solely power production mode, the resulting solar water power cycle can generate electricity with unprecedented efficiencies of 40-46%. Similarly, in standalone hydrogen mode, pressurized hydrogen is produced at efficiencies approaching ∼50%. In the coproduction mode, the coproduced hydrogen is stored for uninterrupted solar power production. When sunlight is unavailable, we envision that the stored hydrogen is used in a "turbine"-based hydrogen water power (H2WP) cycle with the calculated hydrogen-to-electricity efficiency of 65-70%, which is comparable to the fuel cell efficiencies. The H2WP cycle uses much of the same equipment as the solar water power cycle, reducing capital outlays. The overall sun-to-electricity efficiency of the hydricity process, averaged over a 24-h cycle, is shown to approach ∼35%, which is nearly the efficiency attained by using the best multijunction photovoltaic cells along with batteries. In comparison, our proposed process has the following advantages: (i) It stores energy thermochemically with a two- to threefold higher density, (ii) coproduced hydrogen has alternate uses in transportation/chemical/petrochemical industries, and (iii) unlike batteries, the stored energy does not discharge over time and the storage medium does not degrade with repeated uses.

[Views of general practitioners on the frailty in elderly: a qualitative study]. / Représentations des médecins généralistes au sujet de la fragilité des personnes âgées : une étude qualitative.

The concept of frailty in the elderly denotes patients at higher risk of fall, hospitalization, dependency and death. Its prevalence is estimated in France at 15% for people over 65 years. Frailty could be a target for preventing avoidable loss of autonomy. To explore the views of French general practitioners (GPs) on the concept of frailty in the elderly, we have conducted two focus groups with GPs, and five interviews with GPs qualified in geriatrics. Data collection was guided by an adaptive topic schedule. The analysis of the verbatims shows that the concept of frailty is fairly well defined by GPs, but its implementation in clinical practice raises difficulties. They consider that screening frail elderly is possible, but indicate that they don't have any tool adapted to their practice. They feel competent for the diagnostic assessment and the management of the patients detected as frail, and are ready to get further involved, especially within the framework of inter-professional approaches, in particular with nurses. The expected benefits of screening and managing frailty in the elderly needs to be based on data from clinical research. Inter-professional collaborations should be developed in the outpatient setting, as well as referral to hospital whenever comprehensive assessment or management of frail patients is needed.

When the group practice breaks up: a qualitative study.

BACKGROUND: Group practices are increasingly common for primary care physicians worldwide. Although breakups are likely to happen frequently within group practices, their process has not been studied to date. The aims of this study were therefore to explore the reasons for breakups of group practices of general practitioners and to describe the associated feelings. METHODS: We conducted a qualitative study consisting of in-depth interviews of 21 general practitioners and one secretary from past group practices in the Rhône-Alpes region, France, who experienced a breakup. RESULTS: When getting started in group practice for the first time, young doctors did not feel ready and supported, and did not necessarily share the same expectations as their partners. The reasons for the breakups involved imbalances within the groups, contrasting working and management styles, and breakdowns in communication. The breakup process often generated long-persistent feelings of suffering and failure for almost every partner who experienced a breakup, particularly for the partner who was leaving. CONCLUSIONS: Weakening factors exist from the very beginning of a partnership, and problems are likely to increase at every change or event occurring in the group. We provide several recommendations, including fair management, a shared project based on a precise contract, the consultation of third parties as necessary and, in the worst case scenario, leaving the group practice in time.

Hydrothermal gasification of waste biomass: process design and life cycle asessment.

A process evaluation methodology is presented that incorporates flowsheet mass and energy balance modeling, heat and power integration, and life cycle assessment Environmental impacts are determined by characterizing and weighting (using CO2 equivalents, Eco-indicator 99, and Eco-scarcity) the flowsheet and inventory modeling results. The methodology is applied to a waste biomass to synthetic natural gas (SNG) conversion process involving a catalytic hydrothermal gasification step. Several scenarios are constructed for different Swiss biomass feedstocks and different scales depending on logistical choices: large-scale (155 MW(SNG)) and small-scale (5.2 MW(SNG)) scenarios for a manure feedstock and one scenario (35.6 MW(SNG))for a wood feedstock. Process modeling shows that 62% of the manure's lower heating value (LHV) is converted to SNG and 71% of wood's LHV is converted to SNG. Life cycle modeling shows that, for all processes, about 10% of fossil energy use is imbedded in the produced renewable SNG. Converting manure and replacing it, as a fertilizer, with the process mineral byproduct leads to reduced N20 emissions and an improved environmental performance such as global warming potential: -0.6 kg(CO2eq)/MJ(SNG) vs. -0.02 kg(CO2eq)/MJ(SNG) for wood scenarios.

Use of the monoclonal antibody anti-HER2 trastuzumab in the treatment of metastatic breast cancer: a cost-effectiveness analysis.

BACKGROUND: This open controlled prospective study aimed at evaluating the medical and economical impact of first line chemotherapy for metastatic breast cancer (MBC). PATIENTS AND METHODS: Two groups of HER +++ MBC patients were compared: 26 were treated by a combination of trastuzumab and paclitaxel in 4 "prescriber" centers (group A) and 19 patients were treated by any chemotherapy without addition of trastuzumab, in 6 control centers (group B). The cost of chemotherapy and related hospitalizations was taken into account during the first 8 cycles. RESULTS: Forty-five patients, mean age 51 years have been included. The objective response rate was significantly higher in group A (42% vs. 6%, P = 0.036). The median overall survival was 17 months longer in the group A (29 vs. 12 months). The median progression free survival rate was 12.2 months longer in the group A (19 vs. 7 months). The 1-year survival rate was 85% in the group A and 47% in the group B. The mean overall care cost was 33.271 euro per patient in group A versus 11.191 euro per patient in group B. The additional cost per saved year of life expressed as the incremental cost-effectiveness ratio is 15.370 euro 2002. CONCLUSION: The related additional cost seems affordable for an European health care system and justifies the recommendation for its use in the subpopulation overexpressing HER2.