Sequencing batch reactor process for the removal of nitrogen from anaerobically treated domestic wastewater

This work presents the performance of a sequencing batch reactor (SBR) system used as a means of removing nitrogen from domestic wastewater containing a low chemical oxygen demand (COD) to nitrogen ratio due to pre-treatment with an anaerobic reactor. The aim of the work was to determine the feasibility of this system for the removal of nitrogen from the domestic wastewater. An SBR with a working volume of 5 L was investigated at different cycle times of 12, 8 and 6 h, at 18 °C. The efficiency of the SBR varied together with the duration of the cycle, where the optimum performance was seen in the 6 h cycle with the anoxic-aerobic-anoxic sequence. Due to the low quantity of organic matter present in the domestic wastewater after the anaerobic treatment, an additional supply of external carbon was necessary before the second anoxic stage. The removal efficiencies obtained were: 98% for total Kjeldahl nitrogen, 84% for total nitrogen and 77% for soluble COD. The reactor was thus shown to be viable, and it was concluded that this process may be successfully applied as a post-treatment for the removal of nitrogen from anaerobically treated domestic wastewater.

Recirculation of gas emissions to achieve advanced denitrification of the effluent from the anaerobic treatment of domestic wastewater

A denitrifying pilot plant was designed, constructed and operated for more than five months. The plant treated domestic wastewater with high ammonium nitrogen concentration, which had previously undergone an anaerobic process at 18 °C. The process consisted of one biofilter with 2 h of hydraulic retention time for denitritation. Different synthetic nitrite concentrations were supplied to the anoxic reactor to simulate the effluent of a nitritation process. This work investigates the advanced denitritation of wastewater using the organic matter and other alternative electron donors present in an anaerobic treatment process effluent: methane and sulfide. The denitrifying bacteria were able to treat wastewater at an inlet nitrite concentration of 75 mg NO₂^--N/L with a removal efficiency of 92.9%. When the inlet nitrite concentration was higher, the recirculation of the gas from the top of the anoxic reactor was successful to enhance the nitrite removal, achieving a NO₂^- elimination efficiency of 98.3%.

Corneal melting after cataract surgery in a patient with autoimmune disease

CASE REPORT

A 78-year-old woman with rheumatoid arthritis and secondary Sjögren's syndrome presented with corneal melting three days after cataract extraction that required penetrating keratoplasty. By the fourth month, a second corneal transplant was needed due to a new descemetocele associated with her systemic disease.

DISCUSSION

The underlying disease, together with the surgical history, was responsible for the complication presented. The correct anamnesis prior to cataract surgery, a refined technique, and a close post-operative follow-up can avoid such a serious complication. Immunomodulatory treatments are essential in this type of patient.

Denitrification of the anaerobic membrane bioreactor (AnMBR) effluent with alternative electron donors in domestic wastewater treatment

A fixed film bioreactor for the denitrification of the effluent from an anaerobic membrane bioreactor (AnMBR) treating domestic wastewater was designed, built and investigated. After anaerobic treatment, the wastewater usually has a low C/N ratio (∼1.3), and a remaining chemical oxygen demand of around 117mg O₂/L, which is not enough to make conventional heterotrophic denitrification possible. That effluent also holds methane and sulfide dissolved and oversaturated after leaving the AnMBR. This paper demonstrates the feasibility of using these reduced compounds as electron donors in order to remove 80mg NO_x^--N/L at 18°C and 2h of hydraulic retention time. In addition, the influence of the NO₂^-/NO₃^- ratios in the feed was studied. Total nitrogen removal was achieved in all the cases studied, except for a feed with 100% NO₃^-. Methane was the main electron donor used to remove the nitrites and nitrates, with a participation rate of over 70%.

Electric and Mechanical Switching of Ferroelectric and Resistive States in Semiconducting BaTiO3-δ Films on Silicon

Materials that can couple electrical and mechanical properties constitute a key element of smart actuators, energy harvesters, or many sensing devices. Within this class, functional oxides display specific mesoscale responses which often result in great sensitivity to small external stimuli. Here, a novel combination of molecular beam epitaxy and a water-based chemical-solution method is used for the design of mechanically controlled multilevel device integrated on silicon. In particular, the possibility of adding extra functionalities to a ferroelectric oxide heterostructure by n-doping and nanostructuring a BaTiO₃ thin film on Si(001) is explored. It is found that the ferroelectric polarization can be reversed, and resistive switching can be measured, upon a mechanical load in epitaxial BaTiO_3-δ /La_0.7 Sr_0.3 MnO₃ /SrTiO₃ /Si columnar nanostructures. A flexoelectric effect is found, stemming from substantial strain gradients that can be created with moderate loads. Simultaneously, mechanical effects on the local conductivity can be used to modulate a nonvolatile resistive state of the BaTiO_3-δ heterostructure. As a result, three different configurations of the system become accessible on top of the usual voltage reversal of polarization and resistive states.

Effectiveness and safety of sofosbuvir-based regimens plus an NS5A inhibitor for patients with HCV genotype 3 infection and cirrhosis. Results of a multicenter real-life cohort

Patients with HCV genotype 3 (GT3) infection and cirrhosis are currently the most difficult to cure. We report our experience with sofosbuvir+daclatasvir (SOF+DCV) or sofosbuvir/ledipasvir (SOF/LDV), with or without ribavirin (RBV) in clinical practice in this population. This was a multicenter observational study including cirrhotic patients infected by HCV GT3, treated with sofosbuvir plus an NS5A inhibitor (May 2014-October 2015). In total, 208 patients were included: 98 (47%) treatment-experienced, 42 (20%) decompensated and 55 (27%) MELD score >10. In 131 (63%), treatment was SOF+DCV and in 77 (37%), SOF/LDV. Overall, 86% received RBV. RBV addition and extension to 24 weeks was higher in the SOF/LDV group (95% vs 80%, P=.002 and 83% vs 72%, P=.044, respectively). A higher percentage of decompensated patients were treated with DCV than LDV (25% vs 12%, P=.013). Overall, SVR12 was 93.8% (195/208): 94% with SOF+DCV and 93.5% with SOF/LDV. SVR12 was achieved in 90.5% of decompensated patients. Eleven treatment failures: 10 relapses and one breakthrough. RBV addition did not improve SVR (RR: 1.08; P=.919). The single factor associated with failure to achieve SVR was platelet count <75×10E9/mL (RR: 3.50, P=.019). In patients with MELD <10, type of NS5A inhibitor did not impact on SVR12 (94% vs 97%; adjusted RR: 0.49). Thirteen patients (6.3%) had serious adverse events, including three deaths (1.4%) and one therapy discontinuation (0.5%), higher in decompensated patients (16.7% vs 3.6%, P<.006). In patients with GT3 infection and cirrhosis, SVR12 rates were high with both SOF+DCV and SOF/LDV, with few serious adverse events.

Ultrasonic irradiation for ultrafiltration membrane cleaning in MBR systems: operational conditions and consequences

Ultrasonic irradiation is one of the most promising membrane cleaning techniques for membrane bioreactors (MBRs) because of several advantages such as high flux-recovery capacity and in situ application without interrupting the filtration process. However, significant contradictions may be found and, consequently, this method has not yet been widely developed. In this paper, four MBRs equipped with hollow-fibre polyvinylidene fluoride ultrafiltration membranes were operated continuously. The cleaning method applied consisted of sonication at low power (15 W) with different frequencies (20, 25, 30, and 40 kHz) for each module and aerated backwashing. The different MBRs were analysed comparatively between them and with a conventional MBR in order to check the effects of the irradiated waves on membrane integrity, effluent quality and process performance. Effluent turbidity and chemical oxygen demand, total and volatile suspended solid concentration and activated sludge viscosity were affected by biomass fragmentation or membrane cake removal, mainly at lower frequencies. The best transmembrane pressure control was achieved at the frequency of 20 kHz without a significant effect on membrane integrity. The results showed that under these operational conditions, no negative effects on effluent quality or membrane integrity were found, suggesting that this method was suitable for this type of membrane.

Goldfish hippocampal pallium is essential to associate temporally discontiguous events

There is general agreement that the hippocampus of vertebrates, from fish to mammals, is involved in map-like spatial memory. However, in mammals the role of the hippocampus goes beyond the spatial domain as it is also involved in binding the temporally separate events that compose episodic memories. In this regard, the hippocampus of mammals is essential for trace classical conditioning, in which a stimulus-free time gap separates the conditioned stimulus (CS) and the unconditioned stimulus (US), but not for delay conditioning, in which both stimuli coincide in time. Although the involvement of the hippocampus in encoding relational memories based on a temporal frame-work has been extensively studied in mammals, there is scarce evidence about the possible contribution of the hippocampus of non-mammalian vertebrates to the temporal, non-spatial dimension of relational memories. The present work was aimed to determine if the ventral part of the lateral division of the area dorsalis telencephali (Dlv) of goldfish, proposed as homologous to the hippocampus of mammals, is also involved in trace classical conditioning. With this purpose, goldfish with lesions in Dlv, complete telencephalon ablation and sham operation, were trained in delay and trace heart rate classical conditioning. Dlv lesions severely impaired the acquisition of the conditioned response when a stimulus-free time gap was elapsed between the CS and the US (trace conditioning), but not when both stimuli overlapped in time (delay conditioning), revealing that this region, like the hippocampus of mammals, is essential to form the temporal associative memories required by trace conditioning. Present data suggest that the presence of a hippocampal pallium involved in relational, episodic-like memory that preserves both the spatial and the temporal dimensions of past events, could be a primitive feature of the vertebrate brain that has been conserved through evolution.

A Solution-Doped Polymer Semiconductor:Insulator Blend for Thermoelectrics

Poly(ethylene oxide) is demonstrated to be a suitable matrix polymer for the solution-doped conjugated polymer poly(3-hexylthiophene). The polarity of the insulator combined with carefully chosen processing conditions permits the fabrication of tens of micrometer-thick films that feature a fine distribution of the F4TCNQ dopant:semiconductor complex. Changes in electrical conductivity from 0.1 to 0.3 S cm^-1 and Seebeck coefficient from 100 to 60 μV K^-1 upon addition of the insulator correlate with an increase in doping efficiency from 20% to 40% for heavily doped ternary blends. An invariant bulk thermal conductivity of about 0.3 W m^-1 K^-1 gives rise to a thermoelectric Figure of merit ZT ∼ 10^-4 that remains unaltered for an insulator content of more than 60 wt%. Free-standing, mechanically robust tapes illustrate the versatility of the developed dopant:semiconductor:insulator ternary blends.

Photoperiod modulates the reproductive axis of European sea bass through regulation of kiss1 and gnrh2 neuronal expression

The onset of puberty is characterized by activation of the brain-pituitary-gonad axis. However, the molecular and endocrine mechanism involved in the process of puberty and the influence of environmental conditions, such as photoperiod signalling, are not well understood in fish. In this study, 1-year-old male European sea bass (Dicentrarchus labrax) were exposed to photoperiod manipulation in combination with size-sorting. Two treatment groups, a puberty accelerating photoperiod (AP) group and a continuous light (LL) group, were studied from August to February. Our results indicate that AP and LL are able to entrain the rhythms of both kiss1 and gnrh2 mRNA levels in the brain, while kiss2 and gnrh1 mRNA expression does not seem to be directly affected by the photoperiod, at least during testicular growth. It is likely that AP and LL photoperiod regimes affected both plasma Fsh and 11-KT profiles, which might explain, respectively, the phase shift and reduction of testes maturation seen under these conditions. We therefore hypothesize that the unbalanced production of this androgen regulated by circulating Fsh might be limiting the stimulation of germ cell proliferation in European sea bass males. In summary, our study establishes that photoperiod modulates the expression of kiss1 and gnrh2 in the forebrain-midbrain, which may be involved in the translation of the light stimulus to activate the reproductive axis.

Distinguishing between Mechanical and Electrostatic Interaction in Single Pass Multi Frequency Electrostatic Force Microscopy Measurements on a Molecular Material

Single-pass electrostatic force microscopy is postulated as one of the most advanced techniques in terms of spatial resolution and fastness in data acquisition for the study of electrostatic phenomena at the nanoscale. However, crosstalk anomalies, in which mechanical interactions combine with tip-sample electrostatic forces, are still a major issue to overcome, specifically in soft and biological samples. In this paper we propose a novel method based on bimodal-atomic force microscopy to distinguish mechanical crosstalk from electrostatic images. The method is based in the comparison of bimodal AFM images with electrostatic ones, where pure mechanical interaction can be discerned from a mixture of mechanical and electrostatic interactions. The proposed method is optimized and demonstrated using a supramolecular charge transfer material. Finally, the method is used as a tool to depict different crosstalk levels in tetrathiafulvalene-based (TTF) assemblies, discerning between electrical and mechanical interactions. This kind of observation is important for obtaining accurate descriptions of charge distribution in samples made from organic and molecular layers and materials.

Stem cell-like transcriptional reprogramming mediates metastatic resistance to mTOR inhibition

Inhibitors of the mechanistic target of rapamycin (mTOR) are currently used to treat advanced metastatic breast cancer. However, whether an aggressive phenotype is sustained through adaptation or resistance to mTOR inhibition remains unknown. Here, complementary studies in human tumors, cancer models and cell lines reveal transcriptional reprogramming that supports metastasis in response to mTOR inhibition. This cancer feature is driven by EVI1 and SOX9. EVI1 functionally cooperates with and positively regulates SOX9, and promotes the transcriptional upregulation of key mTOR pathway components (REHB and RAPTOR) and of lung metastasis mediators (FSCN1 and SPARC). The expression of EVI1 and SOX9 is associated with stem cell-like and metastasis signatures, and their depletion impairs the metastatic potential of breast cancer cells. These results establish the mechanistic link between resistance to mTOR inhibition and cancer metastatic potential, thus enhancing our understanding of mTOR targeting failure.

Relational and procedural memory systems in the goldfish brain revealed by trace and delay eyeblink-like conditioning

The presence of multiple memory systems supported by different neural substrata has been demonstrated in animal and human studies. In mammals, two variants of eyeblink classical conditioning, differing only in the temporal relationships between the conditioned stimulus (CS) and the unconditioned stimulus (US), have been widely used to study the neural substrata of these different memory systems. Delay conditioning, in which both stimuli coincide in time, depends on a non-relational memory system supported by the cerebellum and associated brainstem circuits. In contrast, trace conditioning, in which a stimulus-free time gap separates the CS and the US, requires a declarative or relational memory system, thus depending on forebrain structures in addition to the cerebellum. The distinction between the explicit or relational and the implicit or procedural memory systems that support trace and delay classical conditioning has been extensively studied in mammals, but studies in other vertebrate groups are relatively scarce. In the present experiment we analyzed the differential involvement of the cerebellum and the telencephalon in delay and trace eyeblink-like classical conditioning in goldfish. The results show that whereas the cerebellum lesion prevented the eyeblink-like conditioning in both procedures, the telencephalon ablation impaired exclusively the acquisition of the trace conditioning. These data showing that comparable neural systems support delay and trace eyeblink conditioning in teleost fish and mammals suggest that these separate memory systems and their neural bases could be a shared ancestral brain feature of the vertebrate lineage.

[Pediatric urinary tract catheters.]

Urinary tract catheters are hollow and flexible tubes used to facilitate urine output or to achieve urine transit through them. We can find different types of catheters depending on the purpose they have been designed for: urethral, cystostomy and ureteral catheters among others. We review the indications for insertion of these catheters, their designs, composition, covering materials, insertion techniques and associated complications. Pediatric catheters are behind what is produced for adults, so we perform a bibliographic review about urinary catheters in general with emphasis on the pediatric patient.

Evolution of regional oxygen saturation in the peri-operative of thoracic surgery and its relationship with central venous saturation

OBJECTIVE

To study the relationship between the values of SvcO2 and SrcO2 in lung resection with one lung ventilation (OLV) and changes in these variables and mean arterial pressure (MAP) and arterial oxygen saturation (SpO2) during the perioperative period.

MATERIAL AND METHODS

Prospective, observational study of 25 patients in whom pulmonary resection was performed with OLV. The values of MAP, SpO2, SvO2, and SrcO2 were recorded at 6 different times: 1)baseline; 2)double-lung ventilation before the OLV (VBP1); 3)during OLV; 4)after double-lung ventilation (VBP2); 5)30minutes after surgery, and 6)6hours after surgery.

RESULTS

The SrcO2 showed a significant increase from baseline to starting ventilation (65.72±9.05% vs 70.44±7.24%; P<.01). There were no significant changes in their values at the different intraoperative times. Post-operatively, as in the case of the SvcO2, a significant decrease (P<.001) of its value compared with the previous value was observed.

CONCLUSIONS

SrcO2 showed a significant increase after induction of anaesthesia and initiation of mechanical ventilation compared to baseline, and a significant decrease at the end of surgery after extubation in the immediate postoperative period. Being a tissue monitoring, non-invasive technique and with continuous values it can alert the clinician of changes in the ratio of oxygen consumption (VO2) to oxygen delivery (DO2) at times of greatest risk, such as OLV, extubation, and the early postoperative period.

Initial experience with a new biodegradable airway stent in children: Is this the stent we were waiting for?

OBJECTIVE

To report our experience with a new type of biodegradable airway stent in the setting of severe tracheobronchial obstruction in children.

DESIGN AND METHODOLOGY

We conducted a retrospective and prospective (since June 2014) study of pediatric patients with severe airway obstruction treated with biodegradable stents in our institution between 2012 and 2015. The following data were collected: demographics, indication for stenting, bronchoscopic findings, insertion technique complications, clinical outcome, stent related complications, re-stenting, and time of follow-up.

RESULTS

Thirteen custom-made polydioxanone stents were placed in four infants (mean age, 4 months) with severe tracheobronchial obstruction: tracheomalacia (two patients), bronchomalacia (1), and diffuse tracheal stenosis (1). All the stents were bronchoscopically inserted uneventfully. Immediate and maintained clinical improvement was observed in every case. No major stent related complications have occurred and only mild or moderate granulation tissue was observed during surveillance bronchoscopy. Two patients required repeated stenting as expected. All the patients are alive and in a good respiratory condition with a follow-up ranging from 5 to 40 months.

CONCLUSIONS

Biodegradable airway stents seem to be safe, effective, and cause fewer complications than other types of stents. They can be an alternative to the classic metallic or plastic stents for severe tracheal stenosis or malacia in small children. More experience is needed in order to establish the definite clinical criteria for their use in pediatric patients. Pediatr Pulmonol. 2016;51:607-612. © 2015 Wiley Periodicals, Inc.

Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or HIV/Hepatitis C Virus Coinfection

BACKGROUND

It has been suggested that routine CD4 cell count monitoring in human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads and CD4 cell counts >300 cell/μL could be reduced to annual. HIV/hepatitis C virus (HCV) coinfection is frequent, but evidence supporting similar reductions in CD4 cell count monitoring is lacking for this population. We determined whether CD4 cell count monitoring could be reduced in monoinfected and coinfected patients by estimating the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression.

METHODS

The PISCIS Cohort study included data from 14 539 patients aged ≥16 years from 10 hospitals in Catalonia and 2 in the Balearic Islands (Spain) since January 1998. All patients who had at least one period of 6 months of continuous HIV suppression were included in this analysis. Cumulative probabilities with 95% confidence intervals were calculated using the Kaplan-Meier estimator stratified by the initial CD4 cell count at the period of continuous suppression initiation.

RESULTS

A total of 8695 patients were included. CD4 cell counts fell to <200 cells/µL in 7.4% patients, and the proportion was lower in patients with an initial count >350 cells/µL (1.8%) and higher in those with an initial count of 200-249 cells/µL (23.1%). CD4 cell counts fell to <200 cells/µL in 5.7% of monoinfected and 11.1% of coinfected patients. Of monoinfected patients with an initial CD4 cell count of 300-349 cells/µL, 95.6% maintained counts ≥200 cells/µL. In the coinfected group with the same initial count, this rate was lower, but 97.6% of coinfected patients with initial counts >350 cells/µL maintained counts ≥200 cells/µL.

CONCLUSIONS

From our data, it can be inferred that CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts >300 cells/µL and HIV/HCV-coinfected patients with counts >350 cells/µL.

A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations

BACKGROUND

Healthcare organizations have far greater maintenance needs for their medical equipment than other organization, as many are used directly with patients. However, the literature on asset management in healthcare organizations is very limited. The aim of this research is to provide more rational application of maintenance policies, leading to an increase in quality of care.

METHODS

This article describes a multicriteria decision-making approach which integrates Markov chains with the multicriteria Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), to facilitate the best choice of combination of maintenance policies by using the judgements of a multi-disciplinary decision group. The proposed approach takes into account the level of acceptance that a given alternative would have among professionals. It also takes into account criteria related to cost, quality of care and impact of care cover.

RESULTS

This multicriteria approach is applied to four dialysis subsystems: patients infected with hepatitis C, infected with hepatitis B, acute and chronic; in all cases, the maintenance strategy obtained consists of applying corrective and preventive maintenance plus two reserve machines.

CONCLUSIONS

The added value in decision-making practices from this research comes from: (i) integrating the use of Markov chains to obtain the alternatives to be assessed by a multicriteria methodology; (ii) proposing the use of MACBETH to make rational decisions on asset management in healthcare organizations; (iii) applying the multicriteria approach to select a set or combination of maintenance policies in four dialysis subsystems of a health care organization. In the multicriteria decision making approach proposed, economic criteria have been used, related to the quality of care which is desired for patients (availability), and the acceptance that each alternative would have considering the maintenance and healthcare resources which exist in the organization, with the inclusion of a decision-making group. This approach is better suited to actual health care organization practice and depending on the subsystem analysed, improvements are introduced that are not included in normal maintenance policies; in this way, not only have different maintenance policies been suggested, but also alternatives that, in each case and according to viability, provide a more complete decision tool for the maintenance manager.