Search results for: Hamadi Kallali

Authors: Kraiem Khadija, Hamadi Kallali, Naceur Jedidi

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Constructed wetland systems are eco-technology recognized as environmentally friendly and emerging innovative solutions remediation as these systems are cost-effective and sustainable wastewater treatment systems. The performance of these biological system is affected by various factors such as plant, substrate, wastewater type, hydraulic loading rate, hydraulic retention time, water depth, and operation mood. The objective of this study was to to assess the alters of plant species on pollutants reduction and enrichment of anammox and nitrifing denitrifing bacteria in a modified vertical flow (VFCW) constructed wetland. This tests were carried out using three modified vertical constructed wetlands with a surface of 0.23 m² and depth 80 cm. It was a saturated vertical constructed wetland at the bottom. The saturation zone is maintained by the siphon structure at the outlet. The VFCW (₁) system was unplanted, VFCW (₂) planted with Typha angustofolia, and VFCW(₃) planted with Phragmites australis. The experimental units were fed with domestic wastewater and were operated by batch mode during 8 months at an average hydraulic loading rate around 20 cm day− 1. The operation cycle was two days feeding and five days rest. Results indicated that plants presence improved the removal efficiency; the removal rates of organic matter (85.1–90.9%; COD and 81.8–88.9%; BOD5), nitrogen (54.2–73%; NTK and 66–77%; NH4 -N) were higher by 10.7–30.1% compared to the unplanted vertical constructed wetland. On the other hand, the plant species had no significant effect on removal efficiency of COD, The removal of COD was similar in VFCW (₂) and VFCW (₃) (p > 0.05), attaining average removal efficiencies of 88.7% and 85.2%, respectively. Whereas it had a significant effect on NTK removal (p > 0.05), with an average removal rate of 72% versus 51% for VFCW (₂) and VFCW (₃), respectively. Among the three sets of vertical flow constructed wetlands, the VFCW(₂) removed the highest percent of total streptococcus, fecal streptococcus total coliforms, fecal coliforms, E. coli as 59, 62, 52, 63, and 58%, respectively. The presence and the plant species alters the community composition and abundance of the bacteria. The abundance of bacteria in the planted wetland was much higher than that in the unplanted one. VFCW(₃) had the highest relative abundance of nitrifying bacteria such as Nitrosospira (18%), Nitrosospira (12%), and Nitrobacter (8%). Whereas the vertical constructed wetland planted with typha had larger number of denitrifying species, with relative abundances of Aeromonas (13%), Paracoccus (11%), Thauera (7%), and Thiobacillus (6%). However, the abundance of nitrifying bacteria was very lower in this system than VFCW(₂). Interestingly, the presence of Thypha angustofolia species favored the enrichment of anammox bacteria compared to unplanted system and system planted with phragmites australis. The results showed that the middle layer had the most accumulation of anammox bacteria, which the anaerobic condition is better and the root system is moderate. Vegetation has several characteristics that make it an essential component of wetlands, but its exact effects are complex and debated.

Keywords: wastawater, constructed wetland, anammox, removal

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Authors: Hamadi Djamal, Labiodh Bachir, Ounis Abdelhafid, Chaalane Mourad

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The objective of this work is setting numerically operational finite element CAXI_L for the axisymmetric and nonaxisymmetric shells. This element is based on the Reissner-Mindlin theory and mixed model formulation. The MATLAB language is used for the programming. In order to test the elaborated program, some applications are carried out.

Keywords: axisymmetric shells, nonaxisymmetric behaviour, finite element, MATLAB programming

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Authors: Khlif Hamadi

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The principal aim of our research is to analyze the impact of the adoption of e-management approach on the performance of Tunisian firms. The method of structural equation was adopted to conduct our exploratory and confirmatory analysis. The results arising from the questionnaire sent to 155 E-managers affirm that the adoption of e-management approach influences the performance of Tunisian firms. The results of the questionnaire show that e-management favors the deployment of ICT usage and contributes enormously to the performance of the modern enterprise. The theoretical and practical implications of the study, as well as directions for future research, are discussed.

Keywords: e-management, ICT Deployment, organizational performance, e-manager

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Authors: Hamadi Khlif

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This paper deals with the understanding of the concept of e-management and the development of a measuring instrument adapted to the new problems encountered during the application of this new practice within the modern enterprise. Two principal e-management factors have been isolated in an exploratory study carried out among 260 participants. A confirmatory study applied to a second sample of 270 participants has been established in a cross-validation of the scale of measurement. The study presents the literature review specifically dedicated to e-management and the results of the exploratory and confirmatory phase of the development of this scale, which demonstrates satisfactory psychometric qualities. The e-management has two dimensions: a managerial dimension and a technological dimension.

Keywords: e-management, management, ICT deployment, mode of management

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Authors: Michael Heuer, Ayoub Al-Hamadi, Alexander Rain, Marc-Michael Meinecke

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Vulnerable road users, e.g. pedestrians, have a high impact on fatal accident numbers. To reduce these statistics, car manufactures are intensively developing suitable safety systems. Hereby, fast and reliable environment recognition is a major challenge. In this paper we describe a tracking approach that is only based on a 24 GHz radar sensor. While common radar signal processing loses much information, we make use of a track-before-detect filter to incorporate raw measurements. It is explained how the Range-Doppler spectrum can help to indicated pedestrians and stabilize tracking even in occultation scenarios compared to sensors in series.

Keywords: radar, pedestrian detection, active safety, sensor

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Authors: Djamal Hamadi, Ashraf Ayoub, Ounis Abdelhafid, Chebili Rachid

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In this paper, a new computationally-efficient rectangular flat shell finite element named 'ACM_RSBEC' is presented. The formulated element is obtained by superposition of a new rectangular membrane element 'RSBEC' based on the strain approach and the well known plate bending element 'ACM'. This element can be used for the analysis of thin shell structures, no matter how the geometrical shape might be. Tests on standard problems have been examined. The convergence of the new formulated element is also compared to other types of quadrilateral shell elements. The presented shell element ‘ACM_RSBEC’ has been demonstrated to be effective and useful in analysing thin shell structures.

Keywords: finite element, flat shell element, strain based approach, static condensation

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Authors: Khlif Hamadi

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Supply chain integration has become a potentially valuable way of securing shared information and improving supply chain performance since competition is no longer between organizations but among supply chains. This research conceptualizes and develops three dimensions of supply chain integration (integration with customers, integration with suppliers, and the interorganizational integration) and tests the relationships between supply chain integration, information sharing, and supply chain performance. Furthermore, the four types of information sharing namely; information sharing with customers, information sharing with suppliers, inter-functional information sharing, and intra-organizational information sharing; and the four constructs of Supply Chain Performance represents expenses of costs, asset utilization, supply chain reliability, and supply chain flexibility and responsiveness. The theoretical and practical implications of the study, as well as directions for future research, are discussed.

Keywords: supply chain integration, supply chain management, information sharing, supply chain performance

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Authors: Khlif Hamadi

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Customer Relationship Management has become the main interest of researchers and practitioners especially in the domains of Management and Information Systems (IS). This paper is an overview of success factors that could facilitate successful adoption of CRM. There are 2 factors: the organizational climate and the capacity for innovation. The survey was developed with 200 CRM users. Empirical research is in the positivist paradigm based on the hypothetico-deductive method. Indeed, the approach adopted is the quantitative approach based on a questionnaire complied by Tunisian companies operating in different sectors of activity. For the data analyses, the structural equations method was used to conduct our exploratory and confirmatory analysis. The results revealed that the creative organizational climate and high innovation capacity positively influence the success of CRM practice.

Keywords: CRM practices, innovation capacity, organizational climate, the structural equation

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Authors: Djamal Hamadi, Oussama Temami, Abdallah Zatar, Sifeddine Abderrahmani

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The analysis and design of thin shell structures is a topic of interest in a variety of engineering applications. In structural mechanics problems the analyst seeks to determine the distribution of stresses throughout the structure to be designed. It is also necessary to calculate the displacements of certain points of the structure to ensure that specified allowable values are not exceeded. In this paper a comparative study between displacement and strain based finite elements applied to the analysis of some thin shell structures is presented. The results obtained from some examples show the efficiency and the performance of the strain based approach compared to the well known displacement formulation.

Keywords: displacement formulation, finite elements, strain based approach, shell structures

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Authors: Fahrudin Nugroho, Halim Hamadi, Yusril Yusuf, Pekik Nurwantoro, Ari Setiawan, Yoshiki Hidaka

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We investigate the Nikolaevskiy equation numerically using exponential time differencing method and pseudo-spectral method. This equation develops a long-wavelength modulation that behaves as a Nambu–Goldstone mode, and short-wavelength instability and exhibit turbulence. Using the autocorrelation analysis, the statistical properties of the turbulence governed by the equation are investigated. The autocorrelation then has been fitted with The Kohlrausch– Williams–Watts (KWW) expression. By varying the control parameter, we show a transition from compressed to stretched exponential for the auto-correlation function of Nikolaevskiy turbulence. The compressed exponential is an indicator of the existence of dynamical heterogeneity while the stretched indicates aging process. Thereby, we revealed the existence of dynamical heterogeneity and aging in the turbulence governed by Nikolaevskiy equation.

Keywords: compressed exponential, dynamical heterogeneity, Nikolaevskiy equation, stretched exponential, turbulence

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Authors: Temami Oussama, Bessais Lakhdar, Hamadi Djamal, Abderrahmani Sifeddine

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The analysis of complex structures encourages the engineer to make simplifying assumptions, sometimes attempting the analysis of the whole structure as complex as it is, and it can be done using the finite element method (FEM). In the modeling of complex structures by finite elements, various elements can be used: beam element, membrane element, solid element, plates and shells elements. These elements formulated according to the classical formulation and do not generally share the same nodal degrees of freedom, which complicates the development of a compatible model. The compatibility of the elements with each other is often a difficult problem for modeling complicated structure. This compatibility is necessary to ensure the convergence. To overcome this problem, we have proposed finite elements with a rotational degree of freedom. The study used is based on the strain approach formulation with 2D and 3D formulation with different degrees of freedom at each node. For the comparison and confrontation of results; the finite elements available in ABAQUS/Standard are used.

Keywords: compatibility requirement, complex structures, finite elements, modeling, strain approach

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Authors: Djamal Hamadi, Sifeddine Abderrahmani, Toufik Maalem, Oussama Temami

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In recent years many finite elements have been developed for plate bending analysis. The formulated elements are based on the strain based approach. This approach leads to the representation of the displacements by higher order polynomial terms without the need for the introduction of additional internal and unnecessary degrees of freedom. Good convergence can also be obtained when the results are compared with those obtained from the corresponding displacement based elements, having the same total number of degrees of freedom. Furthermore, the plate bending elements are free from any shear locking since they converge to the Kirchhoff solution for thin plates contrarily for the corresponding displacement based elements. In this paper the efficiency of the strain based approach compared to well known displacement formulation is presented. The results obtained by a new formulated plate bending element based on the strain approach and Kirchhoff theory are compared with some others elements. The good convergence of the new formulated element is confirmed.

Keywords: displacement fields, finite elements, plate bending, Kirchhoff theory, strain based approach

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Authors: Dicko Ali Hamadi, Tong-Yette Nicolas, Gilles Benjamin, Faure Francois, Palombi Olivier

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A novel hybrid model of the lumbar spine, allowing fast static and dynamic simulations of the disc pressure and the spine mobility, is introduced in this work. Our contribution is to combine rigid bodies, deformable finite elements, articular constraints, and springs into a unique model of the spine. Each vertebra is represented by a rigid body controlling a surface mesh to model contacts on the facet joints and the spinous process. The discs are modeled using a heterogeneous tetrahedral finite element model. The facet joints are represented as elastic joints with six degrees of freedom, while the ligaments are modeled using non-linear one-dimensional elastic elements. The challenge we tackle is to make these different models efficiently interact while respecting the principles of Anatomy and Mechanics. The mobility, the intradiscal pressure, the facet joint force and the instantaneous center of rotation of the lumbar spine are validated against the experimental and theoretical results of the literature on flexion, extension, lateral bending as well as axial rotation. Our hybrid model greatly simplifies the modeling task and dramatically accelerates the simulation of pressure within the discs, as well as the evaluation of the range of motion and the instantaneous centers of rotation, without penalizing precision. These results suggest that for some types of biomechanical simulations, simplified models allow far easier modeling and faster simulations compared to usual full-FEM approaches without any loss of accuracy.

Keywords: hybrid, modeling, fast simulation, lumbar spine

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Authors: Syeda Sahra, Abdullah Jahangir, Rachelle Hamadi, Ahmad Jahangir, Allison Glaser

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Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (H.A.B.P.), and ventilator-associated bacterial pneumonia (V.A.B.P.). Objective: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. Search Strategy: We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. Selection Criteria: We included randomized clinical trials (R.C.T.s) with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. Analysis: For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A p-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, H.A.B.P., V.A.B.P.).

Keywords: bacterial pneumonia, complicated intra-abdominal infections, complicated urinary tract infection, Imipenem, cilastatin, relebactam

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Authors: M. A. Ashour

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As it is known Egypt is one of the countries having oldest sugarcane industry, which goes back to the year 710 AD. Cane plantations are the main agricultural product in five governorates in Upper Egypt (El-Menia, Sohag, Qena, Luxor, and Aswan), producing not less than 16 million tons a year. Eight factories (Abou-korkas, Gena, Nagaa-Hamadi, Deshna, Kous, Armant, Edfuo, and Komombo), located in such upper Egypt governorates generates huge amount of wastes during the manufacturing stage, the so called bagasse which is the fibrous, and cellulosic materials remaining after the era of the sugarcane and the juice extraction, presents about 30% of such wastes. The amount of bagasse generated yearly through the manufacturing stage of the above mentioned 8 factories is approximately about 2.8 million tons, getting red safely of such huge amount, presents a serious environmental problem. Storage of that material openly in the so hot climate in upper Egypt, may cause its self-ignition under air temperature reaches 50 degrees centigrade in summer, due to the remained residual content of sugar. At the same time preparing places for safely storage for such amount is very expensive with respect to the valueless of it. So the best way for getting rid of bagasse is converting it into an added value environmentally friendly material, especially till now the utilization of it is so limited. Since oil pollution became a serious concern, the issue of environmental cleaning arises. With the structure of sugarcane bagasse, which contains fiber and high content of carbon, it can be an adsorbent to adsorb the oil contamination from the water. The present study is a trail to introduce a new material for the purification of water systems to score two goals at once, the first is getting rid of that harmful waste safely, the second is converting it to a commercial valuable material for cleaning, and purifying the water from oil spills, and petroleum pollution. Introduced the new material proved very good performance, and higher efficiency than other similar materials available in the local market, in both closed and open systems. The introduced modified material can absorb 10 times its weight of oil, while don't absorb any water.

Keywords: environment, water resources, agricultural wastes, oil pollution control, sugarcane

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

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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: Ben Cheikh Asma, Bouafia Nabiha, Ammar Asma, Ezzi Olfa, Meddeb Khaoula, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Hospital Acquired Infection (HAI) constitutes an important worldwide health problem. It was associated with high mortality rate in intensive care units (ICU). This study aimed to determine HAI mortality rate in Tunisian intensive care units and identify its risk factors. Methods: We conducted a prospective observational cohort study over a 12 months period (September 15th 2015 to September 15 th 2016) in the adult medical ICU of University Hospital-Farhat Hached (Sousse-Tunisia). All patients admitted in the ICU for more than 48 hours were included in the study. We used an anonymous standardized survey record form to collect data by a medical hygienist assisted by an intensivist. We adopted definitions of Center for Diseases Control and prevention of Atlanta to detect HAI, Kaplan Meier survival analysis and Cox proportional hazard regression to identify independent risk factor of HAI mortality. Results: Of 171 patients, 67 developed ICU-acquired infection (global incidence rate=39.2%). The mean age of patients was 59 ± 21.2 years and 60.8% were male. The most frequently identified infections were pulmonary acquired infection (ventilator associated pneumonia (VAP) and infected atelectasis with density rates 21.4 VAP/1000 days of mechanical ventilation and 9.4 infected atelectasis /1000 days of mechanical ventilation; respectively) and central venous catheter associated infection (CVC - AI) with density rate 28.4 CVC-AI / 1000 CVC-days). HAI mortality rate was 66.7% (n=44). The median survival was 20 days 3.36, 95% Confidential Interval [13.39 – 26.60]. Specific mortality rates according to infectious site were 65.5%, 36.4% and 4.5% respectively for VAP, CVC associated infection and infected atelectasis. In univariate analysis, a significant associations between mortality and cardiovascular history (p=0.04) tracheotomy (p=0.00), peripheral venous catheterization (p=0.04), VAP (p=0.04) and infected atelectasis (p=0.04) were detected. Independent risk factors for HAI mortality were VAP with Hazard Ratio = 3.14, 95% Confidential Interval [1.63 – 6.05] (p=0.001) and tracheotomy (Hazard Ratio=0.22, 95% Confidential Interval [0.10 – 0.44], p=0.000). Conclusions: In the present study, hospital acquired infection mortality rate was relatively high. We need to intensify the fight against these infections especially ventilator-associated pneumonia that is associated with higher risk of mortality in many studies. Thus, more effective infection control interventions were necessary in our hospital.

Keywords: hospital acquired infection, intensive care unit, mortality, risk factors

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Authors: Nabiha Bouafia, Asma Ben Cheikh, Asma Ammar, Olfa Ezzi, Mohamed Mahjoub, Khaoula Meddeb, Imed Chouchene, Hamadi Boussarsar, Mansour Njah

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Background: Hospital acquired infections (HAI) cause significant morbidity, mortality, length of stay and hospital costs, especially in the intensive care unit (ICU), because of the debilitated immune systems of their patients and exposure to invasive devices. The aims of this study were to determine the rate and the risk factors of HAI in an ICU of a university hospital in Tunisia. Materials/Methods: A prospective study was conducted in the 8-bed adult medical ICU of a University Hospital (Sousse Tunisia) during 14 months from September 15th, 2015 to November 15th, 2016. Patients admitted for more than 48h were included. Their surveillance was stopped after the discharge from ICU or death. HAIs were defined according to standard Centers for Disease Control and Prevention criteria. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: During the study, 192 patients had admitted for more than 48 hours. Their mean age was 59.3± 18.20 years and 57.1% were male. Acute respiratory failure was the main reason of admission (72%). The mean SAPS II score calculated at admission was 32.5 ± 14 (range: 6 - 78). The exposure to the mechanical ventilation (MV) and the central venous catheter were observed in 169 (88 %) and 144 (75 %) patients, respectively. Seventy-three patients (38.02%) developed 94 HAIs. The incidence density of HAIs was 41.53 per 1000 patient day. Mortality rate in patients with HAIs was 65.8 %( n= 48). Regarding the type of infection, Ventilator Associated Pneumoniae (VAP) and central venous catheter Associated Infections (CVC AI) were the most frequent with Incidence density: 14.88/1000 days of MV for VAP and 20.02/1000 CVC days for CVC AI. There were 5 Peripheral Venous Catheter Associated Infections, 2 urinary tract infections, and 21 other HAIs. Gram-negative bacteria were the most common germs identified in HAIs: Multidrug resistant Acinetobacter Baumanii (45%) and Klebsiella pneumoniae (10.96%) were the most frequently isolated. Univariate analysis showed that transfer from another hospital department (p= 0.001), intubation (p < 10-4), tracheostomy (p < 10-4), age (p=0.028), grade of acute respiratory failure (p=0.01), duration of sedation (p < 10-4), number of CVC (p < 10-4), length of mechanical ventilation (p < 10-4) and length of stay (p < 10-4), were associated to high risk of HAIS in ICU. Multivariate analysis reveals that independent risk factors for HAIs are: transfer from another hospital department: OR=13.44, IC 95% [3.9, 44.2], p < 10-4, duration of sedation: OR= 1.18, IC 95% [1.049, 1.325], p=0.006, high number of CVC: OR=2.78, IC 95% [1.73, 4.487], p < 10-4, and length of stay in ICU: OR= 1.14, IC 95% [1.066,1.22], p < 10-4. Conclusion: Prevention of nosocomial infections in ICUs is a priority of health care systems all around the world. Yet, their control requires an understanding of epidemiological data collected in these units.

Keywords: healthcare associated infections, incidence, intensive care unit, risk factors

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

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Background: Ventilator-associated pneumonia (VAP) is currently recognized as one of the most relevant causes of morbidity and mortality among intensive care unit (ICU) patients worldwide. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP. The purposes of this study were to determine the incidence and risk factors for VAP in in a Tunisian medical ICU. Materials / Methods: A retrospective case-control study design based on the prospective database collected over a 14-month period from September 15th, 2015 through November 15th, 2016 in an 8-bed medical ICU. Patients under ventilation for over 48 h were included. The number of cases was estimated by Epi-info Software with the power of statistical test equal to 90 %. Each case patient was successfully matched to two controls according to the length of mechanical ventilation (MV) before VAP for cases and the total length of MV in controls. VAP in the ICU was defined according to American Thoracic Society; Infectious Diseases Society of America guidelines. Early onset or late-onset VAP were defined whether the infectious process occurred within or after 96 h of ICU admission. Patients’ risk factors, causes of admission, comorbidities and respiratory specimens collected were reviewed. Univariate and multivariate analyses were performed to determine variables associated with VAP with a p-value < 0.05. Results: During the period study, a total of 169 patients under mechanical ventilation were considered, 34 patients (20.11%) developed at least one episode of VAP in the ICU. The incidence rate for VAP was 14.88/1000 ventilation days. Among these cases, 9 (26.5 %) were early-onset VAP and 25 (73.5 %) were late-onset VAP. It was a certain diagnosis in 66.7% of cases. Tracheal aspiration was positive in 80% of cases. Multi-drug resistant Acinerobacter baumanii was the most common species detected in cases; 67.64% (n=23). The rate of mortality out of cases was 88.23% (n= 30). In univariate analysis, the patients with VAP were statistically more likely to suffer from cardiovascular diseases (p=0.035) and prolonged duration of sedation (p=0.009) and tracheostomy (p=0.001), they also had a higher number of re-intubation (p=0.017) and a longer total time of intubation (p=0.012). Multivariate analysis showed that cardiovascular diseases (OR= 4.44; 95% IC= [1.3 - 14]; p=0.016), tracheostomy (OR= 4.2; 95% IC= [1.16 -15.12]; p= 0.028) and prolonged duration of sedation (OR=1.21; 95% IC= [1.07, 1.36]; p=0.002) were independent risk factors for the development of VAP. Conclusion: VAP constitutes a therapeutic challenge in an ICU setting, therefore; strategies that effectively prevent VAP are needed. An infection control-training program intended to all professional heath care in this unit insisting on bundles and elaboration of procedures are planned to reduce effectively incidence rate of VAP.

Keywords: case control study, intensive care unit, risk factors, ventilator associated pneumonia

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Authors: Hamadi Cherif, Christophe Coquelet, Paolo Stringari, Denis Clodic, Laura Pellegrini, Stefania Moioli, Stefano Langè

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Biogas is a promising technology which can be used as a vehicle fuel, for heat and electricity production, or injected in the national gas grid. It is storable, transportable, not intermittent and substitutable for fossil fuels. This gas produced from the wastewater treatment by degradation of organic matter under anaerobic conditions is mainly composed of methane and carbon dioxide. To be used as a renewable fuel, biogas, whose energy comes only from methane, must be purified from carbon dioxide and other impurities such as water vapor, siloxanes and hydrogen sulfide. Purification of biogas for this application particularly requires the removal of hydrogen sulfide, which negatively affects the operation and viability of equipment especially pumps, heat exchangers and pipes, causing their corrosion. Several methods are available to eliminate hydrogen sulfide from biogas. Herein, reactive absorption in structured packed column by means of chemical absorption in aqueous sodium hydroxide solutions is considered. This study is based on simulations using Aspen Plus™ V8.0, and comparisons are done with data from an industrial pilot plant treating 85 Nm3/h of biogas which contains about 30 ppm of hydrogen sulfide. The rate-based model approach has been used for simulations in order to determine the efficiencies of separation for different operating conditions. To describe vapor-liquid equilibrium, a γ/ϕ approach has been considered: the Electrolyte NRTL model has been adopted to represent non-idealities in the liquid phase, while the Redlich-Kwong equation of state has been used for the vapor phase. In order to validate the thermodynamic model, Henry’s law constants of each compound in water have been verified against experimental data. Default values available in Aspen Plus™ V8.0 for the properties of pure components properties as heat capacity, density, viscosity and surface tension have also been verified. The obtained results for physical and chemical properties are in a good agreement with experimental data. Reactions involved in the process have been studied rigorously. Equilibrium constants for equilibrium reactions and the reaction rate constant for the kinetically controlled reaction between carbon dioxide and the hydroxide ion have been checked. Results of simulations of the pilot plant purification section show the influence of low temperatures, concentration of sodium hydroxide and hydrodynamic parameters on the selective absorption of hydrogen sulfide. These results show an acceptable degree of accuracy when compared with the experimental data obtained from the pilot plant. Results show also the great efficiency of sodium hydroxide for the removal of hydrogen sulfide. The content of this compound in the gas leaving the column is under 1 ppm.

Keywords: biogas, hydrogen sulfide, reactive absorption, sodium hydroxide, structured packed column

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