The versatility of anaerobic digestion (AD) as an effective technology for solving central challenges met in applied biotechnological industry and society has been documented in numerous publications over the past many decades. Reduction of sludge volume generated from wastewater treatment processes, sanitation of industrial organic waste, and benefits from degassing of manure are a few of the most important applications. Especially, renewable energy production, integrated biorefining concepts, and advanced waste handling are delineated as the major market players for AD that likely will expand rapidly in the near future. The complex, biologically mediated AD events are far from being understood in detail however. Despite decade-long serious academic and industrial research efforts, only a few general rules have been formulated with respect to assessing the state of the process from chemical measurements. Conservative reactor designs have dampened the motivation for employing new technologies, which also constitutes one of the main barriers for successful upgrade of the AD sector with modern process monitoring instrumentation. Recent advances in Process Analytical Technologies (PAT) allow complex bioconversion processes to be monitored and deciphered using e.g. spectroscopic and electrochemical measurement principles. In combination with chemometric multivariate data analysis these emerging process monitoring modalities carry the potential to bring AD process monitoring and control to a new level of reliability and effectiveness. It is shown, how proper involvement of process sampling understanding, Theory of Sampling (TOS), constitutes a critical success factor. We survey the more recent trends within the field of AD monitoring and the powerful PAT/TOS/chemometrics application potential is highlighted. The Danish co-digestion concept, which integrates utilisation of agricultural manure, biomass and industrial organic waste, is used as a case study. We present a first foray for the next research and development perspectives and directions for the AD bioconversion sector.
BackgroundIn 2013, Danish policy-makers on a nationwide level decided to set up a national quality of care database for hospital-based emergency care in Denmark including the selection of quality indicators. The aim of the study was to describe the Delphi process that contributed to the selection of quality indicators for a new national database of hospital-based emergency care in Denmark.MethodsThe process comprised a literature review followed by a modified-Delphi survey process, involving a panel of 54 experts (senior clinicians, researchers and administrators from the emergency area and collaborating specialties). Based on the literature review, we identified 43 potential indicators, of which eight were time-critical conditions. We then consulted the Expert panel in two consecutive rounds. The Expert panel was asked to what extent each indicator would be a good measure of hospital-based emergency care in Denmark. In each round, the Expert panel participants scored each indicator on a Likert scale ranging from one (=disagree completely) through to six (=agree completely). Consensus for a quality indicator was reached if the median was greater than or equal to five (=agree). The Delphi process was followed by final selection by the steering group for the new database.ResultsFollowing round two of the Expert panel, consensus was reached on 32 quality indicators, including three time-critical conditions. Subsequently, the database steering group chose a set of nine quality indicators for the initial version of the national database for hospital-based emergency care.ConclusionsThe two-round modified Delphi process contributed to the selection of an initial set of nine quality indicators for a new a national database for hospital-based emergency care in Denmark. Final selection was made by the database steering group informed by the Delphi process.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0203-x) contains supplementary material, which is available to authorized users.
The aim of this study was to perform a comprehensive systematic review of emergency department performance indicators in relation to evidence. A systematic search was performed through PUBMED, EMBASE, CINAHL and COCHRANE databases with (and including synonyms of) the search words: [emergency medicine OR emergency department] AND [quality indicator(s) OR performance indicator(s) OR performance measure(s)]. Articles were included according to the inclusion/exclusion criteria using the PRISMA protocol. The level of evidence was rated according to the evidence levels by the Oxford Centre for Evidence-Based Medicine. Performance indicators were extracted and organized into five categories; outcome, process, satisfaction, equity and structural/organizational measures. Six thousand four hundred and forty articles were initially identified; 127 provided evidence for/against a minimum of one performance indicator: these were included for further study. Of the 127 articles included, 113 (92%) were primary research studies and only nine (8%) were systematic reviews. Within the 127 articles, we found evidence for 202 individual indicators. Approximately half (n=104) of all this evidence (n=202) studied process-type indicators. Only seven articles (6%) qualified for high quality (level 1b). Sixty-six articles (51%) were good retrospective quality (level 2b or better), whereas the remaining articles were either intermediate quality (25% level 3a or 3b) or poor quality (17% level 4 or 5). We found limited evidence for most emergency department performance indicators, with the majority presenting a low level of evidence. Thus, a core group of evidence-based performance indicators cannot currently be recommended on the basis of this broad review of the literature.
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