The analysis quantifies the enormity of the clinical and economic burdens of NAFLD, which will likely increase as the incidence of NAFLD continues to rise. (Hepatology 2016;64:1577-1586).

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World production of rice exceeds 750 million tonnes per year of which a fifth is removed in the form of rice husk during the milling process. The use of rice husks as a source of sustainable and renewable energy is often hindered by lack of capital and a poor understanding of rice husk combustion characteristics. This results in the selection of poor quality technology which generates significant quantities of harmful crystalline silica waste. Despite previous work in the area, detailed characterisation of the combustion of rice husk ash in a TORBED reactor across a wide temperature range has not yet been attempted and little effort has been directed towards assessing the economic viability of generating quality rice husk ashes. The use of a TORBED reactor enables low residual carbon after combustion without the generation of harmful crystalline material. Rice husk was combusted in a 400mm reactor at temperatures between 700-950°C. In the subsequent characterisation studies the resulting materials were shown to be fully amorphous high purity silica (> 95%) and were readily digested in a series of alkaline digestion experiments. Complete silica conversion was only possible using uneconomic Na2O/SiO2 ratios and further optimisation of the combustion process to generate higher surface area material is necessary to increase the digestion rates further. Provisional economic analysis suggests that sales of the by-product enhance the returns from rice husk based power generation. TORBED reactors enable the combustion of rice husk with considerable operating flexibility and they generate products that could be used to displace resource intensive products and processes thus, added value from the by-products can be obtained by using TORBED reactor technology.

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IntroductionThis study aims to estimate the budget impact of increased uptake of the FreeStyle Libre Flash Glucose Monitoring system in people with type 1 diabetes mellitus (T1DM) in the UK.Research design and methodsA budget impact model was developed, applying real-world data collected in the Association of British Clinical Diabetologists (ABCD) FreeStyle Libre Nationwide Audit. Costs of diabetes glucose monitoring in a T1DM population (n=1790) using self-monitoring of blood glucose (SMBG) or the FreeStyle Libre system were compared with a scenario with increased use of the FreeStyle Libre system.ResultsThe ABCD audit demonstrates FreeStyle Libre system use reduces diabetes-related resource utilization. The cost analysis found that higher acquisition costs are offset by healthcare costs avoided (difference £168 per patient per year (PPPY)). Total costs were £1116 PPPY with FreeStyle Libre system compared with £948 PPPY with SMBG. In an average-sized UK local health economy, increasing FreeStyle Libre system uptake from 30% to 50% increased costs by 3.4% (£1 787 345–£1 847 618) and when increased to 70% increased by a further 3.3%.ConclusionIncreased uptake of the FreeStyle Libre system in the T1DM population marginally increases the cost to UK health economies and offers many system benefits.

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