Search results for: hospital waste

Authors: Supakij Saisopon

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The process of economic development incurs spatial transformation. This spatial alternation also causes environmental impacts, leading to higher pollution. In the case of Thailand, there is still a lack of price-endogenous quantitative analysis incorporating relationships among economic growth, land-use change, and environmental impact. Therefore, this paper aimed at developing the Computable General Equilibrium (CGE) model with the capability of stimulating such mutual effects. The developed CGE model has also incorporated the nested constant elasticity of transformation (CET) structure that describes the spatial redistribution mechanism between agricultural land and urban area. The simulation results showed that the 1% decrease in the availability of agricultural land lowers the value-added of agricultural by 0.036%. Similarly, the 1% reduction of availability of urban areas can decrease the value-added of manufacturing and service sectors by 0.05% and 0.047%, respectively. Moreover, the outcomes indicate that the increasing farming and urban areas induce higher volumes of solid waste, wastewater, and air pollution. Specifically, the 1% increase in the urban area can increase pollution as follows: (1) the solid waste increase by 0.049%, (2) water pollution ̶ indicated by biochemical oxygen demand (BOD) value ̶ increase by 0.051% and (3) air pollution ̶ indicated by the volumes of CO₂, N₂O, NOₓ, CH₄, and SO₂ ̶ increase within the range of 0.045%–0.051%. With the simulation for exploring the sustainable development path, a 1% increase in agricultural land use efficiency leads to the shrinking demand for agricultural land. But this is not happening in urban, a 1% scale increase in urban utilization results in still increasing demand for land. Therefore, advanced clean production technology is necessary to align the increasing land-use efficiency with the lowered pollution density.

Keywords: CGE model, CET structure, environmental impact, land use

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Authors: Zemenu Yohannes

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Introduction: The pandemic overstretched the weak health systems in developing countries, including Ethiopia. This study aims to assess and explore the effect of COVID-19 on antenatal care (ANC) provision. Methods: A concurrent mixed methods study was applied. An interrupted time series design was applied for the quantitative study, and in-depth interviews were implemented for the qualitative research to explore maternity care providers' perceptions of ANC provision during COVID-19. We used routine monthly collected data from the health management information system (HMIS) in fifteen hospitals in the Sidama region, Ethiopia, from March 2019 to February 2020 (12 months) before COVID-19 and from March to August 2020 (6 months) during COVID-19. We imported data into STATA V.17 for analysis. ANC provision's mean monthly incidence rate ratio (IRR) was calculated using Poisson regression with a 95% confidence interval. The qualitative data were analysed using thematic analysis. Findings from quantitative and qualitative elements were integrated with a contiguous approach. Results: Our findings indicate the rate of ANC provision significantly decreased in the first six months of COVID-19. This study has three identified main themes: barriers to ANC provision, inadequate COVID-19 prevention approach, and delay in providing ANC. Conclusion and recommendation: Based on our findings, the pandemic affected ANC provision in the study area. The health bureau and stakeholders should take a novel and sustainable approach to prevent future pandemics. The health bureau and hospital administrators should establish a task force that relies on financial self-reliance to close gaps in future pandemics of medical supply shortages. Pregnant women should receive their care promptly from maternity care providers. In order to foster contact and avoid discrimination the future pandemics, hospital administrators should set up a platform for community members and maternity care providers.

Keywords: ANC provision, COVID-19, mixed methods study, Ethiopia

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Authors: John Sodeau, David O'Connor, Shane Daly, Stig Hellebust

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This study is the first to employ the online WIBS (Waveband Integrated Biosensor Sensor) technique for the monitoring of bioaerosol emissions and non-fluorescing “dust” released from a composting/green waste site. The purpose of the research was to provide a “proof of principle” for using WIBS to monitor such a location continually over days and nights in order to construct comparative “bioaerosol site profiles”. Current impaction/culturing methods take many days to achieve results available by the WIBS technique in seconds.The real-time data obtained was then used to assess variations of the bioaerosol counts as a function of size, “shape”, site location, working activity levels, time of day, relative humidity, wind speeds and wind directions. Three short campaigns were undertaken, one classified as a “light” workload period, another as a “heavy” workload period and finally a weekend when the site was closed. One main bioaerosol size regime was found to predominate: 0.5 micron to 3 micron with morphologies ranging from elongated to elipsoidal/spherical. The real-time number-concentration data were consistent with an Andersen sampling protocol that was employed at the site. The number-concentrations of fluorescent particles as a proportion of total particles counted amounted, on average, to ~1% for the “light” workday period, ~7% for the “heavy” workday period and ~18% for the weekend. The bioaerosol release profiles at the weekend were considerably different from those monitored during the working weekdays.

Keywords: bioaerosols, composting, fluorescence, particle counting in real-time

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Authors: Ashim Kanti Dey, Briti Sundar Bhowmik

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This paper presents an idea to improve the soft soil by using lime grits which are normally produced as waste product in the paper manufacturing industries. This waste material cannot be used as a construction material because of its light weight, uniform size and poor compaction control. With scarcity in land, effective disposal of lime grit is a major concern of all paper manufacturing industries. Considering its non-plasticity and high permeability characteristics the lime grit may suitably be used as a drainage material for speedy consolidation of cohesive soil. It can also be used to improve the bearing capacity of soft clay. An attempt has been made in this paper to show the usefulness of lime grit in improving the bearing capacity of shallow foundation resting on soft clayey soil. A series of undrained unconsolidated cyclic triaxial tests performed at different area ratios and at three different water contents shows that dynamic shear modulus and damping ratio can be substantially improved with lime grit. Improvement is observed to be more in case of higher area ratio and higher water content. Static triaxial tests were also conducted on lime grit reinforced clayey soil after application of 50 load cycles to determine the effect of lime grit columns on cyclically loaded clayey soils. It is observed that the degradation is less for lime grit stabilized soil. A study of model test with different area ratio of lime column installation is also included to see the field behaviour of lime grit reinforced soil.

Keywords: lime grit column, area ratio, shear modulus, damping ratio, strength ratio, improvement factor, degradation factor

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Authors: Daniela Rimnacova, Maryna Vorokhta, Martina Svabova

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CO₂ adsorption capacity of several materials - waste (power fly ash, slag, carbonized sewage sludge), rocks (Czech Silurian shale, black coal), and carbon (synthesized carbon, activated carbon as a reference material) - were measured on dry samples using a unique hand-made manometric sorption apparatus at a temperature of 45 °C and pressures of up to 7 MPa. The main aim was finding utilization of the waste materials and rocks for removal of the air or water pollutants caused by anthropogenic activities, as well as for the carbon dioxide storage. The equilibrium amount of the adsorbate depends on temperature, gas saturation pressure, porosity, surface area and volume of pores, and last but not least, on the composition of the adsorbents. Given experimental conditions can simulate in-situ situations in the rock bed and can be achieved just by a high-pressure apparatus. The CO₂ excess adsorption capacities ranged from 0.018 mmol/g (ash) to 13.55 mmol/g (synthesized carbon). The synthetized carbon had the highest adsorption capacity among all studied materials as well as the highest price. This material is usually used for the adsorption of specific pollutants. The excess adsorption capacity of activated carbon was 9.19 mmol/g. It is used for water and air cleaning. Ash can be used for chemisorption onto ash particle surfaces or capture of special pollutants. Shale is a potential material for enhanced gas recovery or CO₂ sequestration in-situ. Slag is a potential material for capture of gases with a possibility of the underground gas storage after the adsorption process. The carbonized sewage sludge is quite a good adsorbent for the removal and capture of pollutants, as well as shales or black coal which show an interesting relationship between the price and adsorption capacity.

Keywords: adsorption, CO₂, high pressure, porous materials

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Authors: Ahmad Kayvani Fard, Gordon Mckay, Muataz Hussien

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Adsorption/sorption is believed to be one of the optimal processes for the removal of heavy metals from water due to its low operational and capital cost as well as its high removal efficiency. Different materials have been reported in literature as adsorbent for heavy metal removal in waste water such as natural sorbents, organic polymers (synthetic) and mineral materials (inorganic). The selection of adsorbents and development of new functional materials that can achieve good removal of heavy metals from water is an important practice and depends on many factors, such as the availability of the material, cost of material, and material safety and etc. In this study we reported the synthesis of doped Activated carbon and Carbon nanotube (CNT) with different loading of metal oxide nanoparticles such as Fe2O3, Fe3O4, Al2O3, TiO2, SiO2 and Ag nanoparticles and their application in removal of heavy metals, hydrocarbon, and organics from waste water. Commercial AC and CNT with different loadings of mentioned nanoparticle were prepared and effect of pH, adsorbent dosage, sorption kinetic, and concentration effects are studied and optimum condition for removal of heavy metals from water is reported. The prepared composite sorbent is characterized using field emission scanning electron microscopy (FE-SEM), high transmission electron microscopy (HR-TEM), thermogravimetric analysis (TGA), X-ray diffractometer (XRD), the Brunauer, Emmett and Teller (BET) nitrogen adsorption technique, and Zeta potential. The composite materials showed higher removal efficiency and superior adsorption capacity compared to commercially available carbon based adsorbent. The specific surface area of AC increased by 50% reaching up to 2000 m2/g while the CNT specific surface area of CNT increased by more than 8 times reaching value of 890 m2/g. The increased surface area is one of the key parameters along with surface charge of the material determining the removal efficiency and removal efficiency. Moreover, the surface charge density of the impregnated CNT and AC have enhanced significantly where can benefit the adsorption process. The nanoparticles also enhance the catalytic activity of material and reduce the agglomeration and aggregation of material which provides more active site for adsorbing the contaminant from water. Some of the results for treating wastewater includes 100% removal of BTEX, arsenic, strontium, barium, phenolic compounds, and oil from water. The results obtained are promising for the use of AC and CNT loaded with metal oxide nanoparticle in treatment and pretreatment of waste water and produced water before desalination process. Adsorption can be very efficient with low energy consumption and economic feasibility.

Keywords: carbon nanotube, activated carbon, adsorption, heavy metal, water treatment

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Authors: Breanna Wright, Peter Bragge

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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.

Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error

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Authors: Shammael Selorfia

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The Quality improvement project aimed to improve junior doctors and nurses’ knowledge and confidence in diagnosing and managing delirium on inpatient surgical wards in a tertiary hospital. The study aimed to develop a standardised assessment and management checklist for all staff working with patients who were presenting with signs of delirium. The aim of the study was to increase confidence of staff at dealing with delirium and improve the quality of referrals that were being sent to the Mental Health Liaison team over a 6-month period. A significant proportion of time was being spent by the Mental Health Liaison triage nurses on referrals for delirium. Data showed 28% of all delirium referrals from surgical teams were being closed at triage reflecting a poor standard of quality of those referrals. A qualitative survey of junior doctors in 6 surgical specialties in a UK tertiary hospital was conducted. These specialties include general surgery, vascular, plastic, urology, neurosurgery, and orthopaedics. The standardised checklist was distributed to all surgical wards. A comparison was made between the Mental health team caseload of delirium before intervention was compared and after. A Qualitative survey at end of 3-month cycle and compare overall caseload on Mental Health Liaison team to pre-QIP data with aim to improve quality of referrals and reduce workload on Mental Health Liaison team. At the end of the project cycle, we demonstrated an improvement in the quality of referrals with a decrease in the percentage of referrals being closed at triage by 8%. Our surveys also indicated an increase in the knowledge of official trust delirium guidelines and confidence at managing the patients. This project highlights that a new approach to delirium using multi-component interventions is needed, where the diagnosis of delirium is shared amongst medical and nursing staff, and everyone plays role in management. The key is improving awareness of delirium and encouraging the use of recognized diagnostic tools and official guidelines. Recommendations were made to the trust on how to implement a long-lasting change.

Keywords: delirium, surgery, quality, improvement

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Authors: Nadia Konstantina Zygouri

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This paper aims to provide a concise analysis of the symbolic nature of cinematic light portrayed in Apichatpong Weerasethakul's film Cemetery of Splendour (2015). The study explores the philosophical hypostasis of lighting mechanisms, the idea of which is based on political motives and, in addition, metaphysical theories originating from the Isan region of Thailand. In the film, the colourful hospital space and narcoleptic soldiers represent the deep and tumultuous history of the Thai nation, revealing a symbolic allegory through an incurable disease that the protagonists suffer from, addressing with this metaphor a collective political apathy. Specifically, the film follows Jen, a woman with a leg disability who takes care of Itt, an ex-soldier fallen into narcolepsy amidst a multi-coloured roomful of other comatose soldiers. The film's central theme, as well as the central setting, concerns an abandoned former school now used as a treatment clinic for military patients, each connected to a mechanism of light that can affect their dreams while sleeping. The audience later discovers from two mythological figures emerging from Thailand's ancient religious past that the hospital grounds are built over the ruins of an ancient kingdom's cemetery. The symbolic political implication is that ancient rulers have captured the soldiers’ spirits to fight their eternal battles, leaving their unconscious bodies in torpor, as similar politics of the past and present affect the nation to this day and enforce political apathy. In a contrasting tone, the colourful tubes are present to relieve the soldiers' symptoms and create better memories in their subconscious minds. As a result, the concluding argument of this hypothesis places Apichatpong's direction of cinematic light towards a philosophical and political commentary that, although derived from ancient national history, remains thoroughly contemporary.

Keywords: Apichatpong Weerasethakul, cemetery of Splendour, filmosophy, politics, aesthetics, direction of photography, light in cinema, metaphysics, visual philosophy

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Authors: Jared Abuga, Wesley Too

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Medical error is the third leading cause of death in US, with approximately 98,000 deaths occurring every year as a result of medical errors. The world financial burden of medication errors is roughly USD 42 billion. Medication errors may lead to at least one death daily and injure roughly 1.3 million people every year. Medical error reporting is essential in creating a culture of accountability in our healthcare system. Studies have shown that attitudes and practice of healthcare workers in reporting medical errors showed that the major factors in under-reporting of errors included work stress and fear of medico-legal consequences due to the disclosure of error. Further, the majority believed that increase in reporting medical errors would contribute to a better system. Most hospitals depend on nurses to discover medication errors because they are considered to be the sources of these errors, as contributors or mere observers, consequently, the nurse’s perception of medication errors and what needs to be done is a vital feature to reducing incidences of medication errors. We sought to explore knowledge among nurses on medical errors and factors affecting or hindering reporting of medical errors among nurses working at the emergency unit, KNH. Critical care nurses are faced with many barriers to completing incident reports on medication errors. One of these barriers which contribute to underreporting is a lack of education and/or knowledge regarding medication errors and the reporting process. This study, therefore, sought to determine the availability and the use of reporting systems for medical errors in critical care unity. It also sought to establish nurses’ perception regarding medical errors and reporting and document factors facilitating timely identification and reporting of medical errors in critical care settings. Methods: The study used cross-section study design to collect data from 76 critical care nurses from Kenyatta Teaching & Research National Referral Hospital, Kenya. Data analysis and results is ongoing. By October 2022, we will have analysis, results, discussions, and recommendations of the study for purposes of the conference in 2023

Keywords: errors, medical, kenya, nurses, safety

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Authors: Balasooriya B. M. C. M., Sujeeva N., Thowfeek Z., Siddiqa Omo, Liyanagunawardana J. E., Jayawardana Saiu, Manathunga S. S., Katulanda G. W.

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Introduction and objectives: Adrenal venous sampling (AVS) is the gold standard to discriminate unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and only performed in a limited number of centers worldwide. To the best of our knowledge, Except for one study conducted in India, no other research studies on this area have been conducted in South Asia. This study aimed to evaluate the effectiveness of AVS in the management of primary aldosteronism. Methods: A total of 32 patients who underwent AVS at the National Hospital of Sri Lanka from April 2021 to April 2023 were enrolled. Demographic, clinical and laboratory data were obtained retrospectively. A procedure was considered successful when adequate cannulation of both adrenal veins was demonstrated. Cortisol gradient across the adrenal vein (AV) and the peripheral vein was used to establish the success of venous cannulation. Lateralization was determined by the aldosterone gradient between the two sides. Continuous and categorical variables were summarized with mean, SD, and proportions, respectively. The mean and standard deviation of the contralateral suppression index (CSI) were estimated with an intercept-only Bayesian inference model. Results: Of the 32 patients, the average age was 52.47 +26.14 and 19 (59.4%) were males. Both AVs were successfully cannulated in 12 (37.5%). Among them, lateralization was demonstrated in 11(91.7%), and one was diagnosed as a bilateral disease. There were no total failures. Right AV cannulation was unsuccessful in 18 (56.25%), of which lateralization was demonstrated in 9 (50%), and others were inconclusive. Left AV cannulation was unsuccessful only in 2 (6.25%); one was lateralized, and the other remained inconclusive. The estimated mean of the CSI was 0.33 (89% credible interval 0.11-0.86). Seven patients underwent unilateral adrenalectomy and demonstrated significant improvement in blood pressure during follow-up. Two patients await surgery. Others were treated medically. Conclusions: Despite failure due to procedural difficulties, AVS remained useful in the management of patients with PA. Moreover, the success of the procedure needs experienced hands and advanced equipment to achieve optimal outcomes in PA.

Keywords: adrenal venous sampling, lateralization, contralateral suppression index, primary aldosteronism

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Authors: Lahoucine Zaama, Sanae Douama

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In this work, we present the results of a dosimetry study in a Moroccan radiology department . The results are compared with those of a similar study in France. Furthermore, it determines the coefficient of transmission of the lead sheets of different thicknesses depending on the voltage (KV) in a direct exposure. The objective of this study is to choose the thickness of the radiation means to determine the leaf sample sealed with the smallest percentage value radiation transmission, and that in the context of optimization. Thus the comparison among the studies is essential to consider conduct studies and research in this framework to achieve the goal of optimization.

Keywords: radiology, dosimetry, radiation, dose, transmission

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Authors: A. A. Adebayo, A. O. Ogunkeyede, A. O. Adeigbe

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Digital globalisation and yarn of Nigeria society to overcome the digital divide have resulted in contamination of soil by heavy metals (HMs) from e-waste activities at Alaba international market, Lagos, Nigeria. The aim of this research was to determine the concentration of various metals {Cadmium (Cd), Chromium (Cr), Copper (Cu), and Lead (Pb)} and identify their ecological and health risks for the people within the study area. A total of 60 soil samples were collected at Alaba market study area. Two types of samples were collected from each sampling points: topsoil (0-15 cm), subsoil (15 -30 cm). The metal concentration results showed that the soils were heavily contaminated by HMs at topsoil and subsoil. The geoaccummulation and ecological risk indices revealed high pollution level from all studied site. The health risk assessment results suggested that there is high possibility of carcinogenic risk to humans because the carcinogenic risk via corresponding exposure pathways exceeded the safety limit of 10-6 (the acceptable level of carcinogenic risk for human). Furthermore, inhalation of soil particles is the main exposure pathway for Cr to enter the human body for all ages. Children in the vicinity are exposed more to ingestion of Pb since they tend to eat earth (pica) and repeatedly suck their fingers. This study provides basic information to create awareness for a need to introduce pollution control measures and the need to protect the ecosystem and human health within the study area at Alaba international market.

Keywords: contaminated soil, ecological risk, hazard index, risk factor, exposure pathways, heavy metals

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Authors: Suheyla Kocaman, Gulnare Ahmetli, Alaaddin Cerit, Alize Yucel, Merve Gozukucuk

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Shell wastes represent a considerable quantity of byproducts in the shellfish aquaculture. From the viewpoint of ecofriendly and economical disposal, it is highly desirable to convert these residues into high value-added products for industrial applications. So far, the utilization of shell wastes was confined at relatively lower levels, e.g. wastewater decontaminant, soil conditioner, fertilizer constituent, feed additive and liming agent. Shell wastes consist of calcium carbonate and organic matrices, with the former accounting for 95-99% by weight. Being the richest source of biogenic CaCO₃, shell wastes are suitable to prepare high purity CaCO₃ powders, which have been extensively applied in various industrial products, such as paper, rubber, paints and pharmaceuticals. Furthermore, the shell waste could be further processed to be the filler of polymer composites. This paper presents a study on the potential use of mussel shell waste as biofiller to produce the composite materials with different epoxy matrices, such as bisphenol-A type, CTBN modified and polyurethane modified epoxy resins. Morphology and mechanical properties of shell particles reinforced epoxy composites were evaluated to assess the possibility of using it as a new material. The effects of shell particle content on the mechanical properties of the composites were investigated. It was shown that in all composites, the tensile strength and Young’s modulus values increase with the increase of mussel shell particles content from 10 wt% to 50 wt%, while the elongation at break decreased, compared to pure epoxy resin. The highest Young’s modulus values were determined for bisphenol-A type epoxy composites.

Keywords: biocomposite, epoxy resin, mussel shell, mechanical properties

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Authors: Majid Azizi, Payam Ghorbannezhad, Mostafa Amiri, Mohammad Ghofrani

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Environmental issues in the furniture industry are of great importance due to the use of natural materials such as wood and chemical substances like adhesives and paints. These issues encompass environmental conservation and managing pollution and waste generated. Improper use of wood resources, along with the use of chemicals and their release, leads to the depletion of natural resources, damage to forests, and the emission of greenhouse gases. Therefore, identifying influential indicators in the life cycle assessment of classic furniture and proposing solutions to reduce environmental impacts becomes crucial. In this study, the life cycle of classic furniture was evaluated using a hierarchical analytical process from cradle to grave. The life cycle assessment was employed to assess the environmental impacts of the furniture industry, ranging from raw material extraction to waste disposal and recycling. The most significant indicators in the furniture industry's production chain were also identified. The results indicated that the wood quality indicator is the most essential factor in the life cycle of classic furniture. Furthermore, the relative contribution of each type of traditional furniture was proposed concerning impact categories in the life cycle assessment. The results showed that among the three proposed types, the design and production of furniture with prefabricated parts had the most negligible impact in categories such as global warming potential and ozone layer depletion compared to furniture design with solid wood and furniture design with recycled components. Among the three suggested types of furniture to reduce environmental impacts, producing furniture with solid wood or other woods was chosen as the most crucial solution.

Keywords: life cycle assessment, analytic hierarchy process, environmental issues, furniture

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Authors: Sairah Bashir, Liu Yang, John Liggat, James Thomason

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Glass fibre is currently used as reinforcement in over 90% of all fibre-reinforced composites produced. The high rigidity and chemical resistance of these composites are required for optimum performance but unfortunately results in poor recyclability; when such materials are no longer fit for purpose, they are frequently deposited in landfill sites. Recycling technologies, for example, thermal treatment, can be employed to address this issue; temperatures typically between 450 and 600 °C are required to allow degradation of the rigid polymeric matrix and subsequent extraction of fibrous reinforcement. However, due to the severe thermal conditions utilised in the recycling procedure, glass fibres become too weak for reprocessing in second-life composite materials. In addition, more stringent legislation is being put in place regarding disposal of composite waste, and so it is becoming increasingly important to develop long-term recycling solutions for such materials. In particular, the development of a cost-effective method to regenerate strength of thermally recycled glass fibres will have a positive environmental effect as a reduced volume of composite material will be destined for landfill. This research study has demonstrated the positive impact of sodium hydroxide (NaOH) and potassium hydroxide (KOH) solution, prepared at relatively mild temperatures and at concentrations of 1.5 M and above, on the strength of heat-treated glass fibres. As a result, alkaline treatments can potentially be implemented to glass fibres that are recycled from composite waste to allow their reuse in second-life materials. The optimisation of the strength recovery process is being conducted by varying certain reaction parameters such as molarity of alkaline solution and treatment time. It is believed that deep V-shaped surface flaws exist commonly on severely damaged fibre surfaces and are effectively removed to form smooth, U-shaped structures following alkaline treatment. Although these surface flaws are believed to be present on glass fibres they have not in fact been observed, however, they have recently been discovered in this research investigation through analytical techniques such as AFM (atomic force microscopy) and SEM (scanning electron microscopy). Reaction conditions such as molarity of alkaline solution affect the degree of etching of the glass fibre surface, and therefore the extent to which fibre strength is recovered. A novel method in determining the etching rate of glass fibres after alkaline treatment has been developed, and the data acquired can be correlated with strength. By varying reaction conditions such as alkaline solution temperature and molarity, the activation energy of the glass etching process and the reaction order can be calculated respectively. The promising results obtained from NaOH and KOH treatments have opened an exciting route to strength regeneration of thermally recycled glass fibres, and the optimisation of the alkaline treatment process is being continued in order to produce recycled fibres with properties that match original glass fibre products. The reuse of such glass filaments indicates that closed-loop recycling of glass fibre reinforced composite (GFRC) waste can be achieved. In fact, the development of a closed-loop recycling process for GFRC waste is already underway in this research study.

Keywords: glass fibers, glass strengthening, glass structure and properties, surface reactions and corrosion

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Authors: G. Lambe, D. Mansukhani, A. Shetty, S. Khodaiji, C. Rodrigues, F. Kapadia

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Introduction: Sepsis is known to cause impairment of both innate and adaptive immunity and involves an early uncontrolled inflammatory response, followed by a protracting immunosuppression phase, which includes decreased expression of cell receptors, T cell anergy and exhaustion, impaired cytokine production, which may cause high risk for secondary infections due to reduced response to antigens. Although human cytomegalovirus (CMV) is widely recognized as a serious viral pathogen in sepsis and immunocompromised patients, the incidence of CMV reactivation in patients with sepsis lacking strong evidence of immunosuppression is not well defined. Therefore, it is important to determine an association between CMV reactivation and sepsis-induced immunosuppression. Aim: To determine the association between incidence of CMV reactivation and immune modulation in sepsis-induced immunosuppression with time. Material and Methods: Ten CMV-seropositive adult patients with severe sepsis were included in this study. Blood samples were collected on Day 0, and further weekly up to 21 days. CMV load was quantified by real-time PCR using plasma. The expression of immunosuppression markers, namely, HLA-DR, PD-1, and regulatory T cells, were determined by flow cytometry using whole blood. Results: At Day 0, no CMV reactivation was observed in 6/10 patients. In these patients, the median length for reactivation was 14 days (range, 7-14 days). The remaining four patients, at Day 0, had a mean viral load of 1802+2599 copies/ml, which increased with time. At Day 21, the mean viral load for all 10 patients was 60949+179700 copies/ml, indicating that viremia increased with the length of stay in the hospital. HLA-DR expression on monocytes significantly increased from Day 0 to Day 7 (p = 0.001), following which no significant change was observed until Day 21, for all patients except 3. In these three patients, HLA-DR expression on monocytes showed a decrease at elevated viral load (>5000 copies/ml), indicating immune suppression. However, the other markers, PD-1 and regulatory T cells, did not show any significant changes. Conclusion: These preliminary findings suggest that CMV reactivation can occur in patients with severe sepsis. In fact, the viral load continued to increase with the length of stay in the hospital. Immune suppression, indicated by decreased expression of HLA-DR alone, was observed in three patients with elevated viral load.

Keywords: CMV reactivation, immune suppression, sepsis immune modulation, CMV viral load

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Authors: Irit Rutman Halili, Tehila Zvulun, Natali Elgabsi, Revaya Cohen, Shlomo Sarig

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Active sand dunes (ASD) may cause significant damage to field crops and livelihood, and therefore, it is necessary to find a treatment that would enhance ADS soil stability. Biological soil crusts (biocrusts) contain microorganisms on the soil surface. Metabolic polysaccharides secreted by biocrust cyanobacteria glue the soil particles into aggregates, thereby stabilizing the soil surface. Filter cake powder (FCP) is a waste by-product in the final stages of the production of sugar from sugarcane, and its disposal causes significant environmental pollution. FCP contains high concentrations of polysaccharides and has recently been shown to be soil stability enhancing agent in ASD. It has been reported that adding FCP to the ASD soil surface by dispersal significantly increases the level of penetration resistance of soil biocrust (PRSB) nine weeks after a single treatment. However, it was not known whether a similar effect could be obtained by administering the FCP in liquid form by means of spraying. It has now been found that spraying a water solution of FCP onto the ASD soil surface significantly increased the level of penetration resistance of soil biocrust (PRSB) three weeks after a single treatment. These results suggest that FCP spraying can be used as a short-term soil stability-enhancing agent for ASD, while administration by dispersal might be more efficient over the long term. Finally, an additional benefit of using FCP as a soil stabilizer, either by dispersal or by spraying, is the reduction in environmental pollution that would otherwise result from the disposal of FCP solid waste.

Keywords: active sand dunes, filter cake powder, biological soil crusts, penetration resistance of soil biocrust

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Authors: Arvind Aggarwal

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We have developed a comprehensive global healthcare delivery System based on information technology. It has medical consultation system where a virtual consultant can give medical consultation to the patients and Doctors at the digital medical centre after reviewing the patient’s EMR file consisting of patient’s history, investigations in the voice, images and data format. The system has the surgical operation system too, where a remote robotic consultant can conduct surgery at the robotic surgical centre. The instant speech and text translation is incorporated in the software where the patient’s speech and text (language) can be translated into the consultant’s language and vice versa. A consultant of any specialty (surgeon or Physician) based in any country can provide instant health care consultation, to any patient in any country without loss of time. Robotic surgeons based in any country in a tertiary care hospital can perform remote robotic surgery, through patient friendly telemedicine and tele-surgical centres. The patient EMR, financial data and data of all the consultants and robotic surgeons shall be stored in cloud. It is a complete comprehensive business model with healthcare medical and surgical delivery system. The whole system is self-financing and can be implemented in any country. The entire system uses paperless, filmless techniques. This eliminates the use of all consumables thereby reduces substantial cost which is incurred by consumables. The consultants receive virtual patients, in the form of EMR, thus the consultant saves time and expense to travel to the hospital to see the patients. The consultant gets electronic file ready for reporting & diagnosis. Hence time spent on the physical examination of the patient is saved, the consultant can, therefore, spend quality time in studying the EMR/virtual patient and give his instant advice. The time consumed per patient is reduced and therefore can see more number of patients, the cost of the consultation per patients is therefore reduced. The additional productivity of the consultants can be channelized to serve rural patients devoid of doctors.

Keywords: e-health, telemedicine, telecare, IT-based healthcare

Procedia PDF Downloads 179

Authors: Nasrin Amirrajab, Yasaman Razavi Ghahfarokhi, Zahra Tootak, Maryam Hadian, Fatemeh Abooali Shamshiri

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Urinary tract infections (UTIs) have been reported in children with nephrotic syndrome. However, the only causes for the infection reported to date are bacteria, but not many prior reported occurrences of fungi or yeast as causative organisms. Hence, the present study aimed to describe the epidemiology of urinary tract fungal infections in a tertiary care pediatric. A single-center cross-sectional study was conducted at the nephrology ward of Aboozar Pediatric Hospital between March 21, 2021, and April 28, 2022. Urine was collected aseptically from children, inoculated onto culture media, and incubated at 37 °C for 18–48 hours. Yeast was identified following standard procedures. Antifungal susceptibility testing was determined by the disk diffusion method according to the CLSI guideline. Descriptive statistics and logistical regressions were used to estimate the crude ratio with a 95% confidence interval. P-value < 0.05 was considered significant. Among 68 individuals referred to the mycology lab, the result of direct examination and culture of all patients approved for C.albicans. Of these, 38 individuals (55.8%) were male, and 30 (44.2%) were female. The patients' age ranges were between one month and an 18-year-old. In the study of infection intensity, the patients were classified into three levels such as few (73.5%), moderate (20.6%), and many (5.9%). In the present study, all the patients were sensitive to Posaconazole. Also, the eagle effect was found in Amphotericin B, Voriconazole, and Fluconazole with frequencies of 91.7%, 91.7%, and 83%, respectively. In addition, just 8.3% of isolates were resistant to Itraconazole. It has not shown resistance in other mentioned medicine. The patients showed an intermediate response to Itraconazole (91.7%), Fluconazole (17%), Voriconazole (8.3%), and Amphotericin B (8.3%). There is a high prevalence of yeast infections in children with suspected UTIs. Also, boys are more likely to get yeast infections, and the severity of the infection is higher than girls. The present study demonstrated the importance of diagnosing and selecting the appropriate drug for urinary tract fungal infections in hospitalized children.

Keywords: urinary tract infections, children, fungal infections, yeast, antifungal susceptibility

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Authors: Tomasz Smolinski, Irena Herdzik-Koniecko, Marta Pyszynska, M. Rogowski

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Old electronic components can be easily found nowadays. Significant quantities of valuable metals such as gold, silver or copper are used for the production of advanced electronic devices. Old useless electronic device slowly became a new source of precious metals, very often more efficient than natural. For example, it is possible to recover more gold from 1-ton personal computers than seventeen tons of gold ore. It makes urban mining industry very profitable and necessary for sustainable development. For the recovery of metals from waste of electronic equipment, various treatment options based on conventional physical, hydrometallurgical and pyrometallurgical processes are available. In this group hydrometallurgy processes with their relatively low capital cost, low environmental impact, potential for high metal recoveries and suitability for small scale applications, are very promising options. Institute of Nuclear Chemistry and Technology has great experience in hydrometallurgy processes especially focused on recovery metals from industrial and agricultural wastes. At the moment, urban mining project is carried out. The method of effective recovery of valuable metals from central processing units (CPU) components has been developed. The principal processes such as acidic leaching and solvent extraction were used for precious metals recovery from old processors and graphic cards. Electronic components were treated by acidic solution at various conditions. Optimal acid concentration, time of the process and temperature were selected. Precious metals have been extracted to the aqueous phase. At the next step, metals were selectively extracted by organic solvents such as oximes or tributyl phosphate (TBP) etc. Multistage mixer-settler equipment was used. The process was optimized.

Keywords: electronic waste, leaching, hydrometallurgy, metal recovery, solvent extraction

Procedia PDF Downloads 137

Authors: Parvin Berenjkar, Qiuyan Yuan, Richard Sparling, Stan Lozecznik

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Landfills highly contribute to anthropological global warming through CH₄ emissions. Landfills are usually capped by a conventional soil cover to control the migration of gases. Methane is consumed by CH₄-oxidizing microorganisms known as methanotrophs that naturally exist in the landfill soil cover. The growth of methanotrophs can be optimized in a bio-cover that typically consists of a gas distribution layer (GDL) to homogenize landfill gas fluxes and an overlying oxidation layer composed of suitable materials that support methanotrophic populations. Materials such as mature yard waste composts can provide an inexpensive and favourable porous support for the growth and activity of methanotrophs. In areas with seasonal cold climates, it is valuable to know if methanotrophs in a bio-cover can survive in winter until the next spring, and how deep they are active in the bio-cover to mitigate CH₄. In this study, a pilot bio-cover was constructed in a closed landfill cell in Winnipeg that has a very cold climate in Canada. The bio-cover has a surface area of 2.5 m x 3.5 m and 1.5 m of depth, filled with 50 cm of gravel as a GDL and 70 cm of biosolids compost amended with yard and leaf waste compost. The observed in situ potential of methanotrophs for CH₄ oxidation was investigated at a specific period of time from December 2016 to April 2017 as well as November 2017 to April 2018, when the transition to surface frost and thawing happens in the bio-cover. Compost samples taken from different depths of the bio-cover were incubated in the laboratory under standardized conditions; an optimal air: methane atmosphere, at 22ºC, but at in situ moisture content. Results showed that the methanotrophs were alive oxidizing methane without a lag, indicating that there was the potential for methanotrophic activity at some depths of the bio-cover.

Keywords: bio-cover, global warming, landfill, methanotrophic activity

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Authors: I. N. Nwafia, U. C. Ozumba, M. E. Ohanu, S. O. Ebede

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Antibiotic resistance is increasing globally and has become a major health challenge. Extended-spectrum beta-lactamase is clinically important because the ESBL gene are mostly plasmid encoded and these plasmids frequently carry genes encoding resistance to other classes of antimicrobials thereby limiting antibiotic options in the treatment of infections caused by these organisms. The specific objectives of this study were to determine the prevalence of ESBLs production in Escherichia coli, to determine the antibiotic susceptibility pattern of ESBLs producing Escherichia coli, to detect TEM, SHV and CTX-M genes and the risk factors to acquisition of ESBL producing Escherichia coli. The protocol of the study was approved by Health Research and Ethics committee of the University of Nigeria Teaching Hospital (UNTH), Enugu. It was a descriptive cross-sectional study that involved all hospitalized patients in UNTH from whose specimens Escherichia coli was isolated during the period of the study. The samples analysed were urine, wound swabs, blood and cerebrospinal fluid. These samples were cultured in 5% sheep Blood agar and MacConkey agar (Oxoid Laboratories, Cambridge UK) and incubated at 35-370C for 24 hours. Escherichia coli was identified with standard biochemical tests and confirmed using API 20E auxanogram (bioMerieux, Marcy 1'Etoile, France). The antibiotic susceptibility testing was done by disc diffusion method and interpreted according to the Clinical and Laboratory Standard Institute guideline. ESBL production was confirmed using ESBL Epsilometer test strips (Liofilchem srl, Italy). The ESBL bla genes were detected with polymerase chain reaction, after extraction of DNA with plasmid mini-prep kit (Jena Bioscience, Jena, Germany). Data analysis was with appropriate descriptive and inferential statistics. One hundred and six isolates (53.00%) out of the 200 were from urine, followed by isolates from different swabs specimens 53(26.50%) and the least number of the isolates 4(2.00) were from blood (P value = 0.096). Seventy (35.00%) out of the 200 isolates, were confirmed positive for ESBL production. Forty-two (60.00%) of the isolates were from female patients while 28(40.00%) were from male patients (P value = 0.13). Sixty-eight (97.14%) of the isolates were susceptible to imipenem while all of the isolates were resistant to ampicillin, chloramphenicol and tetracycline. From the 70 positive isolates the ESBL genes detected with polymerase chain reaction were blaCTX-M (n=26; 37.14%), blaTEM (n=7; 10.00%), blaSHV (n=2; 2.86%), blaCTX-M/TEM (n=7; 10.0%), blaCTX-M/SHV (n=14; 20.0%) and blaCTX-M/TEM/SHV (n=10; 14.29%). There was no gene detected in 4(5.71%) of the isolates. The most associated risk factors to infections caused by ESBL producing Escherichia coli was previous antibiotics use for the past 3 months followed by admission in the intensive care unit, recent surgery, and urinary catheterization. In conclusion, ESBLs was detected in 4 of every 10 Escherichia coli with the predominant gene detected being CTX-M. This knowledge will enable appropriate measures towards improvement of patient health care, antibiotic stewardship, research and infection control in the hospital.

Keywords: antimicrobial, Escherichia coli, extended spectrum beta lactamase, resistance

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Authors: Lokvendra S. Budania, Yogesh K Gaude, Vamsidhar Chamala

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Introduction: Congenitally corrected transposition of great arteries (CCTGA) is a complex congenital heart disease where there are both atrioventricular and ventriculoarterial discordances, usually accompanied by other cardiovascular malformations. Case Report: A 24-year-old primigravida known case of CCTGA at 37 weeks of gestation was referred to our hospital for safe delivery. Her electrocardiogram showed HR-40/pm, echocardiography showed Ejection Fraction of 65% and CCTGA. Temporary pacemaker was inserted by cardiologist in catheterization laboratory, before giving trial of labour in view of complete heart block. She was planned for normal delivery, but emergency Caesarean section was planned due to non-reassuring foetal Cardiotocography Pre-op vitals showed PR-50 bpm with temporary pacemaker, Blood pressure-110/70 mmHg, SpO2-99% on room air. Nil per oral was inadequate. Patency of two peripheral IV cannula checked and left radial arterial line secured. Epidural Anaesthesia was planned, and catheter was placed at L2-L3. Test dose was given, Anaesthesia was provided with 5ml + 5ml of 2% Lignocaine with 25 mcg Fentanyl and further 2.5Ml of 0.5% Bupivacaine was given to achieve a sensory level of T6. Cesarean section was performed and baby was delivered. Cautery was avoided during this procedure. IV Oxytocin (15U) was added to 500 mL of ringer’s lactate. Hypotension was treated with phenylephrine boluses. Patient was shifted to post-operative care unit and later to high dependency unit for monitoring. Post op vitals remained stable. Temporary pacemaker was removed after 24 hours of surgery. Her post-operative period was uneventful and discharged from hospital. Conclusion: Rare congenital cardiac disorders require detail knowledge of pathophysiology and associated comorbidities with the disease. Meticulously planned and carefully titrated neuraxial techniques will be beneficial for such cases.

Keywords: congenitally corrected transposition of great arteries, complete heart block, emergency LSCS, epidural anaesthesia

Procedia PDF Downloads 131

Authors: Elisa Esposito, Johannes C. Jansen, Loredana Dellamuzia, Ugo Moretti, Lidietta Giorno

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The reduction of CO₂ emission into the atmosphere as a result of human activity is one of the most important environmental challenges to face in the next decennia. Emission of CO₂, related to the use of fossil fuels, is believed to be one of the main causes of global warming and climate change. In this scenario, the production of biomethane from organic waste, as a renewable energy source, is one of the most promising strategies to reduce fossil fuel consumption and greenhouse gas emission. Unfortunately, biogas upgrading still produces the greenhouse gas CO₂ as a waste product. Therefore, this work presents a case study on biogas upgrading, aimed at the simultaneous purification of methane and CO₂ via different steps, including CO₂/methane separation by polymeric membranes. The original objective of the project was the biogas upgrading to distribution grid quality methane, but the innovative aspect of this case study is the further purification of the captured CO₂, transforming it from a useless by-product to a pure gas with food-grade quality, suitable for commercial application in the food and beverage industry. The study was performed on a pilot plant constructed by Tecno Project Industriale Srl (TPI) Italy. This is a model of one of the largest biogas production and purification plants. The full-scale anaerobic digestion plant (Montello Spa, North Italy), has a digestive capacity of 400.000 ton of biomass/year and can treat 6.250 m3/hour of biogas from FORSU (organic fraction of solid urban waste). The entire upgrading process consists of a number of purifications steps: 1. Dehydration of the raw biogas by condensation. 2. Removal of trace impurities such as H₂S via absorption. 3.Separation of CO₂ and methane via a membrane separation process. 4. Removal of trace impurities from CO₂. The gas separation with polymeric membranes guarantees complete simultaneous removal of microorganisms. The chemical purity of the different process streams was analysed by a certified laboratory and was compared with the guidelines of the European Industrial Gases Association and the International Society of Beverage Technologists (EIGA/ISBT) for CO₂ used in the food industry. The microbiological purity was compared with the limit values defined in the European Collaborative Action. With a purity of 96-99 vol%, the purified methane respects the legal requirements for the household network. At the same time, the CO₂ reaches a purity of > 98.1% before, and 99.9% after the final distillation process. According to the EIGA/ISBT guidelines, the CO₂ proves to be chemically and microbiologically sufficiently pure to be suitable for food-grade applications.

Keywords: biogas, CO₂ separation, CO2 utilization, CO₂ food grade

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Authors: Arnold S. Freitas Neto, Rodrigo E. Coelho, Erick S. Mendonça

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The study aims to assess if high-purity iron powder in iron-aluminum alloys can be replaced by SAE 1020 steel chips with an atomicity proportion of 50% for each element. Chips of SAE 1020 are rejected in industrial processes. Thus, the use of SAE 1020 as a replaceable composite for iron increase the sustainability of ferrous alloys by recycling industrial waste. The alloys were processed by high energy milling, of which the main advantage is the minimal loss of raw material. The raw material for three of the six samples were high purity iron powder and recyclable aluminum cans. For the other three samples, the high purity iron powder has been replaced with chips of SAE 1020 steel. The process started with the separate milling of chips of aluminum and SAE 1020 steel to obtain the powder. Subsequently, the raw material was mixed in the pre-defined proportions, milled together for five hours and then underwent a closed-die hot compaction at the temperature of 500 °C. Thereafter, the compacted samples underwent heat treatments known as sintering and solubilization. All samples were sintered one hour, and 4 samples were solubilized for either 4 or 10 hours under well-controlled atmosphere conditions. Lastly, the composition and the mechanical properties of their hardness were analyzed. The samples were analyzed by optical microscopy, scanning electron microscopy and hardness testing. The results of the analysis showed a similar chemical composition and interesting hardness levels with low standard deviations. This verified that the use of SAE 1020 steel chips can be a low-cost alternative for high-purity iron powder and could possibly replace high-purity Iron in industrial applications.

Keywords: Fe-Al alloys, high energy milling, iron-aluminum alloys, metallography characterization, powder metallurgy, recycling ferrous alloy, SAE 1020 steel recycling

Procedia PDF Downloads 359

Authors: A. Sathish, N. N. Lingaraju, K. N. Geetha, C. A. Srinivasamurthy, S. Bhaskar

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Under dryland conditions, it is observed that the soil organic matter is low due to low organic carbon content due to poor management with less use of inputs. On the other hand, disposal of sugar industry waste, i.e., spentwash is a major concern with limited space for land based treatment and disposal which causes environmental pollution. Spentwash is also a resource that can be applied for productive uses since it contains nutrients that have the potential for use in agriculture. The disposal of spent wash may lead to environmental pollution. Hence as an alternative mechanism, it was applied once to dry lands, and the experiments were conducted from 2012-13 to 2016-17 in kharif season in Maddur Taluk, Mandya District, Karnataka State, India. The study conducted was in 93 different farmers field (maize-11, finger millet-80 & horsegram-14). Spentwash was applied at the rate of 100 m³ ha⁻¹ before sowing of the crops. The results showed that yield of dryland crops like finger millet, horse gram and maize was recorded 14.75 q ha⁻¹, 6 q ha⁻¹ and 31.00 q ha⁻¹, respectively and the yield increase to an extent of 10-25 per cent with one time application of spentwash to dry lands compared to farmers practice, i.e., chemical fertilizer application. The higher yield may be attributed to slow and steady release of nutrients by spentwash throughout the crop growth period. In addition, the growth promoting and other beneficial substances present in spentwash might have also helped in better plant growth and yield. The soil sample analysis after harvest of the crops indicate acidic to neutral pH, EC of 0.11 dSm⁻¹ and Na of 0.20 C mol (P⁺) kg⁻¹ in the normal range which are not harmful. Hence, it can be applied to drylands at least once in 3 years which enhances yield as well as reduces environmental pollution.

Keywords: dryland crops, pollution, sugar industry waste, spentwash

Procedia PDF Downloads 238

Authors: Rouzbeh Jafari, Joe Nava

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This study includes learnings from an engineering practice normally performed on large scale biohydrogen processes. If properly scale-up is done, biohydrogen can be a reliable pathway for biowaste valorization. Most of the studies on biohydrogen process development have used model feedstock to investigate process key performance indicators (KPIs). This study does not intend to compare different technologies with model feedstock. However, it reports economic drivers and technical challenges which help in developing a road map for expanding biohydrogen economy deployment in Canada. BBA is a consulting firm responsible for the design of hydrogen production projects. Through executing these projects, activity has been performed to identify, register and mitigate technical drawbacks of large-scale hydrogen production. Those learnings, in this study, have been applied to the biohydrogen process. Through data collected by a comprehensive literature review, a base case has been considered as a reference, and several case studies have been performed. Critical parameters of the process were identified and through common engineering practice (process design, simulation, cost estimate, and life cycle assessment) impact of these parameters on the commercialization risk matrix and class 5 cost estimations were reported. The process considered in this study is food waste and woody biomass dark fermentation. To propose a reliable road map to develop a sustainable biohydrogen production process impact of critical parameters was studied on the end-to-end process. These parameters were 1) feedstock composition, 2) feedstock pre-treatment, 3) unit operation selection, and 4) multi-product concept. A couple of emerging technologies also were assessed such as photo-fermentation, integrated dark fermentation, and using ultrasound and microwave to break-down feedstock`s complex matrix and increase overall hydrogen yield. To properly report the impact of each parameter KPIs were identified as 1) Hydrogen yield, 2) energy consumption, 3) secondary waste generated, 4) CO2 footprint, 5) Product profile, 6) $/kg-H2 and 5) environmental impact. The feedstock is the main parameter defining the economic viability of biohydrogen production. Through parametric studies, it was found that biohydrogen production favors feedstock with higher carbohydrates. The feedstock composition was varied, by increasing one critical element (such as carbohydrate) and monitoring KPIs evolution. Different cases were studied with diverse feedstock, such as energy crops, wastewater slug, and lignocellulosic waste. The base case process was applied to have reference KPIs values and modifications such as pretreatment and feedstock mix-and-match were implemented to investigate KPIs changes. The complexity of the feedstock is the main bottleneck in the successful commercial deployment of the biohydrogen process as a reliable pathway for waste valorization. Hydrogen yield, reaction kinetics, and performance of key unit operations highly impacted as feedstock composition fluctuates during the lifetime of the process or from one case to another. In this case, concept of multi-product becomes more reliable. In this concept, the process is not designed to produce only one target product such as biohydrogen but will have two or multiple products (biohydrogen and biomethane or biochemicals). This new approach is being investigated by the BBA team and the results will be shared in another scientific contribution.

Keywords: biohydrogen, process scale-up, economic evaluation, commercialization uncertainties, hydrogen economy

Procedia PDF Downloads 110

Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

Abstract:

Background: Central venous catheter associated infections (CVC-AI) are among the serious hospital-acquired infections. The aims of this study are to determine the incidence of CVC-AI, and their risk factors among patients followed in a Tunisian medical intensive care unit (ICU). Materials / Methods: A prospective cohort study conducted between September 15th, 2015 and November 15th, 2016 in an 8-bed medical ICU including all patients admitted for more than 48h. CVC-AI were defined according to CDC of ATLANTA criteria. The enrollment was based on clinical and laboratory diagnosis of CVC-AI. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, exposure to CVC (number of CVC placed, site of insertion and duration catheterization) were recorded. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: Among 192 eligible patients, 144 patients (75%) had a central venous catheter. Twenty-eight patients (19.4%) had developed CVC-AI with density rate incidence 20.02/1000 CVC-days. Among these infections, 60.7% (n=17) were systemic CVC-AI (with negative blood culture), and 35.7% (n=10) were bloodstream CVC-AI. The mean SAPS II of patients with CVC-AI was 32.76 14.48; their mean Charlson index was 1.77 1.55, their mean duration of catheterization was 15.46 10.81 days and the mean duration of one central line was 5.8+/-3.72 days. Gram-negative bacteria was determined in 53.5 % of CVC-AI (n= 15) dominated by multi-drug resistant Acinetobacter baumani (n=7). Staphylococci were isolated in 3 CVC-AI. Fourteen (50%) patients with CVC-AI died. Univariate analysis identified men (p=0.034), the referral from another hospital department (p=0.03), tobacco (p=0.006), duration of sedation (p=0.003) and the duration of catheterization (p=0), as possible risk factors of CVC-AI. Multivariate analysis showed that independent factors of CVC-AI were, male sex; OR= 5.73, IC 95% [2; 16.46], p=0.001, Ramsay score; OR= 1.57, IC 95% [1.036; 2.38], p=0.033, and duration of catheterization; OR=1.093, IC 95% [1.035; 1.15], p=0.001. Conclusion: In a monocenter cohort, CVC-AI had a high density and is associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.

Keywords: central venous catheter associated infection, intensive care unit, prospective cohort studies, risk factors

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Authors: A. Abubakar, A. Parsa, S. Walker

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Despite advances made in the diagnosis and management of drug-sensitive tuberculosis (TB) over the past decades, treatment of multidrug-resistant tuberculosis (MDR-TB) remains challenging and complex particularly in high burden countries including Nigeria. Treatment of MDR-TB is cost-prohibitive with success rate generally lower compared to drug-sensitive TB and if care is not taken it may become the dominant form of TB in future with many treatment uncertainties and substantial morbidity and mortality. Addressing these challenges requires collaborative efforts thorough sustained researches to evaluate the current treatment guidelines, particularly in high burden countries and prevent progression of resistance. To our best knowledge, there has been no research exploring the acceptability, effectiveness, and cost-effectiveness of community-based-MDR-TB treatment model in Nigeria, which is among the high burden countries. The previous similar qualitative study looks at the home-based management of MDR-TB in rural Uganda. This research aimed to explore patient’s views and acceptability of community-based-MDR-TB treatment model and to evaluate and compare the effectiveness and cost-effectiveness of community-based versus hospital-based MDR-TB treatment model of care from the Nigerian perspective. Knowledge of patient’s views and acceptability of community-based-MDR-TB treatment approach would help in designing future treatment recommendations and in health policymaking. Accordingly, knowledge of effectiveness and cost-effectiveness are part of the evidence needed to inform a decision about whether and how to scale up MDR-TB treatment, particularly in a poor resource setting with limited knowledge of TB. Mixed methods using qualitative and quantitative approach were employed. Qualitative data were obtained using in-depth semi-structured interviews with 21 MDR-TB patients in Nigeria to explore their views and acceptability of community-based MDR-TB treatment model. Qualitative data collection followed an iterative process which allowed adaptation of topic guides until data saturation. In-depth interviews were analyzed using thematic analysis. Quantitative data on treatment outcomes were obtained from medical records of MDR-TB patients to determine the effectiveness and direct and indirect costs were obtained from the patients using validated questionnaire and health system costs from the donor agencies to determine the cost-effectiveness difference between community and hospital-based model from the Nigerian perspective. Findings: Some themes have emerged from the patient’s perspectives indicating preference and high acceptability of community-based-MDR-TB treatment model by the patients and mixed feelings about the risk of MDR-TB transmission within the community due to poor infection control. The result of the modeling from the quantitative data is still on course. Community-based MDR-TB care was seen as the acceptable and most preferred model of care by the majority of the participants because of its convenience which in turn enhanced recovery, enables social interaction and offer more psychosocial benefits as well as averted productivity loss. However, there is a need to strengthen this model of care thorough enhanced strategies that ensure guidelines compliance and infection control in order to prevent the progression of resistance and curtail community transmission.

Keywords: acceptability, cost-effectiveness, multidrug-resistant TB treatment, community and hospital approach

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