Boosting nutrient recovery from AnMBR effluent by means of electrodialysis technology: Operating parameters assessing.

This work describes a comprehensive assessment of operating parameters of a bench-scale electrodialysis (ED) plant for nutrient concentration from an Anaerobic Membrane BioReactor (AnMBR) effluent. The ED bench-scale plant serves a dual purpose. Firstly, to generate a concentrated stream with a high nutrient content, and secondly, to produce high-quality reclaimed water in the diluted stream, both sourced from real wastewater coming from the effluent of an AnMBR. Two sets of experiments were conducted: 1) short-term experiments to study the effect of some parameters such as the applied current and the type of anionic exchange membrane (AEM), among others, and 2) a long-term experiment to verify the feasibility of the process using the selected parameters. The results showed that ED produced concentrated ammonium and phosphate streams using a 10-cell pair stack with 64 cm2 of unitary effective membrane area, working in galvanostatic mode at 0.24 A, and operating with an Acid-100-OT anionic exchange membrane. Concentrations up to 740 mg/L and 50 mg/L for NH4-N and PO4-P, respectively, were achieved in the concentrated stream along with removal efficiencies of 70% for ammonium and 60% for phosphate in the diluted stream. The average energy consumption was around 0.47 kWh·m-3.

Maximising resource recovery from wastewater grown microalgae and primary sludge in an anaerobic membrane co-digestion pilot plant coupled to a composting process.

A pilot-scale microalgae (Chlorella spp.) and primary sludge anaerobic co-digestion (ACoD) plant was run for one year in an anaerobic membrane bioreactor (AnMBR) at 35 °C, 70 d solids retention time and 30 d hydraulic retention time, showing high stability in terms of pH and VFA concentration. The plant achieved a high degree of microalgae and primary sludge substrate degradation, resulting in a methane yield of 370 mLCH4·gVSinf-1. Nutrient-rich effluent streams (685 mgN·L-1 and 145 mgP·L-1 in digestate and 395 mgNH4-N·L-1 and 37 mgPO4-P·L-1 in permeate) were obtained, allowing posterior nutrient recovery. Ammonium was recovered from the permeate as ammonia sulphate through a hydrophobic polypropylene hollow fibre membrane contactor, achieving 99% nitrogen recovery efficiency. However, phosphorus recovery through processes such as struvite precipitation was not applied since only 26% of the phosphate was available in the effluent. Composting process of the digestate coming from the ACoD pilot plant was assessed on laboratory-scale Dewar reactors, as was the conventional sludge compost from an industrial WWTP digestion process, obtaining similar values from both. Sanitised (free of Escherichia coli and Salmonella spp.) and stable compost (respirometric index at 37 °C below 0.5 mgO 2 g organic matter-1·h-1) was obtained from both sludges.

At 10 years of chlormadinone use in Latin America: a review.

Chlormadinone acetate (CMA) is a progesterone derivative (17α-acetoxy-6-chloro-4,6-pregnadiene-3,20-dione), first synthesized in 1961. It was used as progestin-based hormone replacement therapy; since 1999 it was first used for oral contraception combined with ethinyl estradiol (EE). CMA exerts a potent progestagenic effect, about one third higher than that observed with endogenous progesterone. CMA is also an anti-estrogen, showing no androgenic effects (at birth control dose). Unlike progesterone, it has a mild glucosteroidal effect with no anti-mineralocorticoid effect at all. These biological actions have allowed CMA to have a role for therapeutic use in dysmenorrhea, hyperandrogenism, and as a contraceptive agent. In addition, CMA has exhibited beneficial neuroendocrine effects on women's mood. CMA-EE combination has shown excellent contraceptive efficacy, high tolerability, and compliance due to its risk-benefit profile, having additional benefits on skin and hair, such as reduction of seborrhea and acne. Metabolic tolerance of CMA has been demonstrated in several clinical studies. Currently, CMA is formulated to be taken as oral caplets in a 21 caplets package containing 0.03 mg/EE and 2 mg CMA per pill with/without seven placebo additional pills. Another presentation has 24 caplets containing 0.02 mg/EE and 2 mg CMA plus four placebo pills.

An upper limit on the stochastic gravitational-wave background of cosmological origin.

A stochastic background of gravitational waves is expected to arise from a superposition of a large number of unresolved gravitational-wave sources of astrophysical and cosmological origin. It should carry unique signatures from the earliest epochs in the evolution of the Universe, inaccessible to standard astrophysical observations. Direct measurements of the amplitude of this background are therefore of fundamental importance for understanding the evolution of the Universe when it was younger than one minute. Here we report limits on the amplitude of the stochastic gravitational-wave background using the data from a two-year science run of the Laser Interferometer Gravitational-wave Observatory (LIGO). Our result constrains the energy density of the stochastic gravitational-wave background normalized by the critical energy density of the Universe, in the frequency band around 100 Hz, to be <6.9 x 10(-6) at 95% confidence. The data rule out models of early Universe evolution with relatively large equation-of-state parameter, as well as cosmic (super)string models with relatively small string tension that are favoured in some string theory models. This search for the stochastic background improves on the indirect limits from Big Bang nucleosynthesis and cosmic microwave background at 100 Hz.

Directional limits on persistent gravitational waves using LIGO S5 science data.

The gravitational-wave (GW) sky may include nearby pointlike sources as well as stochastic backgrounds. We perform two directional searches for persistent GWs using data from the LIGO S5 science run: one optimized for pointlike sources and one for arbitrary extended sources. Finding no evidence to support the detection of GWs, we present 90% confidence level (C.L.) upper-limit maps of GW strain power with typical values between 2-20×10(-50) strain(2) Hz(-1) and 5-35×10(-49) strain(2) Hz(-1) sr(-1) for pointlike and extended sources, respectively. The latter result is the first of its kind. We also set 90% C.L. limits on the narrow-band root-mean-square GW strain from interesting targets including Sco X-1, SN 1987A and the Galactic center as low as ≈7×10(-25) in the most sensitive frequency range near 160 Hz.

Obstructive sleep apnoea and its association with gestational hypertension.

Hypertension develops in 10% of pregnancies. Snoring, a marker of obstructive sleep apnoea, is a newly identified risk factor for gestational hypertension. Moreover, obstructive sleep apnoea is an independent risk factor for incident hypertension in the non-pregnant population. The aim of the present study was to test the hypothesis that obstructive sleep apnoea is associated with new onset of hypertension among pregnant females. A case-control study was performed involving 17 pregnant females with gestational hypertension and 33 pregnant females without hypertension. Subjects were frequency-matched for gestational age and recruited in a tertiary obstetrical centre. Obstructive sleep apnoea was ascertained by polysomnography and defined by an apnoea/hypopnoea index (AHI) of >or=15 events x h(-1), without requirement for desaturation. The mean+/-sd AHI for normotensive pregnant females was 18.2+/-12.2 events x h(-1) compared with 38.6+/-36.7 events x h(-1) for females with hypertensive pregnancies. The crude odds ratio for the presence of obstructive sleep apnoea given the presence of gestational hypertension was 5.6. The odds ratio was 7.5 (95% confidence interval 3.5-16.2), based on a logistic regression model with adjustment for maternal age, gestational age, pre-pregnancy body mass index, prior pregnancies, and previous live births. In conclusion, gestational hypertension appears to be strongly associated with the presence of obstructive sleep apnoea.

Insuficiencia ovárica primaria en adolescentes: revisión de la literatura a propósito de un caso clínico / Primary ovarian insufficiency in adolescents: review of the literature regarding a clinical case

El objetivo de este manuscrito es realizar una revisión y actualización de la literatura de la insuficiencia ovárica primaria (IOP) en población adolescente, a partir del diagnóstico, manejo y seguimiento de un caso clínico. La insuficiencia ovárica primaria se define como la menopausia en una mujer antes de los 40 años, acompañada de amenorrea, hipogonadismo hipergonadotrópico e infertilidad. Su prevalencia varía entre 1 a 2%, y en mujeres menores de 20 años su prevalencia es un caso de cada 10,000. Aunque se sabe que muchas afecciones pueden llevar a una IOP, la más común es la causa idiopática. La presentación clínica es diversa, y varios trastornos diferentes pueden también, llevar a esta condición. CASO CLÍNICO: Se presenta el caso de una adolescente de 17 años, previamente sana, con historia de amenorrea secundaria, no embarazada, con examen físico general y ginecológico normal. Se solicita estudio analítico complementario resultando con niveles de hormona folículo estimulante (FHS), estradiol (E2) y hormona antimülleriana (AMH) compatibles con una insuficiencia ovárica como la observada en la posmenopausia. Se inicia terapia hormonal (TH) clásica con estradiol y progesterona, siendo posteriormente reemplazada por anticoncepción hormonal combinada (AHC) oral, coincidente con el inicio de vida sexual, con respuesta favorable y sangrados regulares. La IOP tiene graves consecuencias para la salud incluyendo trastornos psicológicos como angustia, síntomas depresivos o depresión, infertilidad, osteoporosis, trastornos autoinmunes, cardiopatía isquémica, y un mayor riesgo de mortalidad. La enfermedad de Hashimoto es el trastorno autoinmune más frecuente asociado a la IOP. Su tratamiento y diagnóstico deben establecerse de forma precoz para evitar consecuencias a largo plazo. La terapia con estrógenos es la base del tratamiento para eliminar los síntomas de la deficiencia de estrógenos, además de evitar las consecuencias futuras del hipogonadismo no tratado. También el manejo debe incluir los siguientes dominios: fertilidad y anticoncepción, salud ósea, problemas cardiovasculares, función psicosexual, psicológica y neurológica, informando a los familiares y a la paciente sobre la dimensión real de la IOP y la necesidad de tratamiento multidisciplinario en muchos casos. CONCLUSIÓN: El caso presentado, pese a ser infrecuente, permite abordar de manera sistematizada el diagnostico de IOP y evaluar alternativas de manejo plausibles para evitar graves consecuencias en la salud, así como conocer respuesta clínica y de satisfacción de la adolescente.

The objective of this manuscript is to review and update the literature on primary ovarian insufficiency (POI) in an adolescent population, based on the diagnosis, management and follow-up of a clinical case. Primary ovarian insufficiency is defined as menopause in a woman before the age of 40, accompanied by amenorrhea, hypergonadotropic hypogonadism, and infertility. Its prevalence varies between 1 to 2%, and in women under 20 years of age its prevalence is one case in every 10,000. Although it is known that many conditions can lead to POI, the most common is the idiopathic cause. The clinical presentation is diverse, and several different disorders can also lead to this condition. CLINICAL CASE: The case of a 17-year-old adolescent, previously healthy, with a history of secondary amenorrhea, not pregnant, with a normal general physical and gynecological examination is presented. A complementary analytical study is requested, resulting in levels of follicle stimulating hormone (FHS), estradiol (E2) and anti-müllerian hormone (AMH) compatible with ovarian insufficiency such as that observed in postmenopause. Classic hormonal therapy (HT) with estradiol and progesterone was started, later being replaced by combined hormonal contraception (CHC), coinciding with the beginning of sexual life, with a favorable response and regular bleeding. POI has serious health consequences including psychological disorders such as distress, depressive symptoms or depression, infertility, osteoporosis, autoimmune disorders, ischemic heart disease, and an increased risk of mortality. Hashimoto's disease is the most common autoimmune disorder associated with POI. Its treatment and diagnosis must be established early to avoid long-term consequences. Estrogen therapy is the mainstay of treatment to eliminate the symptoms of estrogen deficiency, in addition to avoiding the future consequences of untreated hypogonadism. Management should also include the following domains: fertility and contraception, bone health, cardiovascular problems, psychosexual, psychological and neurological function, informing family members and the patient about the real dimension of POI and the need for multidisciplinary treatment in many cases. CONCLUSION: The case, although infrequent, allows a systematic approach to the diagnosis of POI and evaluate plausible management alternatives to avoid serious health consequences, as well as to know the clinical response and satisfaction of the adolescent.

Renin-secreting tumor. Case report.

Renin-secreting tumor, though rare, should be considered in assessing severe hyperreninemic, hypertensive patients. We studied an 18-year-old girl with hypokalemic hyperreninemic hyperaldosteronism. No angiographic lesion could be detected. The plasma renin activity (PRA) of the right/left renal vein was 7.3. With a presumptive diagnosis of renin-secreting tumor (RST), the patient was operated on, and a cortical nodule was found on the right lower pole. Partial nephrectomy was followed by a rapid fall in PRA (half-life, 33-44 min) and normalization of blood pressure (BP). At 3 1/2 months postoperatively, the patient showed normotension, normokalemia, normal aldosterone, and slightly elevated PRA unresponsive to postural changes and furosemide treatment. Tumoral PRA secretion responded to postural stimulus, spironolactone use, and nitroprusside-induced hypotension. Neither the high aldosterone excretion nor hyperreninemia decreased after 3 days of DOCA; this agrees with a previously reported case suggesting the usefulness of this test in the diagnosis of RST.

Detection and localization of intra-abdominal abscesses by diagnostic ultrasound.

In four patients, intra-abdominal abscesses were identified by ultrasonic technique: a right lower quadrant abscess in Crohn disease, a pyogenic liver abscess, a pelvic abscess following rejection and removal of a transplanted kidney, and a perinephric abscess. In all four the establishment by ultrasound that the mass was filled with fluid was critical in guiding drainage. Diagnostic ultrasound is a safe and effective means for the detection, localization, and characterization of retroperitoneal, intraperitoneal, or intraparenchymal inflammatory masses.

Menopausia y terapia hormonal de la menopausia. Las recomendaciones 2018 de la Unidad de Endocrinología Ginecológica de Clínica Alemana de Santiago -Sociedad Italiana de la Menopausia y la Sociedad Chilena de Endocrinología Ginecológica / Menopause and menopausal hormone therapy. The 2018 recommendations of the Gynecological Endocrinology Unit of Clínica Alemana de Santiago -Italian Society of Menopause and the Chilean Society of Gynecological Endocrinology

ABSTRACT In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these Recommendations is to provide a simple and updated reference on postmenopausal MHT. The term MHT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential (Seq) when progestogen is added to ERT for 10-14 days a month, or continuous combined (CC) when progestogen is administered continuously every day along with a fixed amount of estrogen. MHT also includes Tibolone and the Tissue Selective Estrogen Complex (TSEC).

Compact vibration isolation and suspension for Australian International Gravitational Observatory: performance in a 72 m Fabry Perot cavity.

This paper describes the first demonstration of vibration isolation and suspension systems, which have been developed with view to application in the proposed Australian International Gravitational Observatory. In order to achieve optimal performance at low frequencies new components and techniques have been combined to create a compact advanced vibration isolator structure. The design includes two stages of horizontal preisolation and one stage of vertical preisolation with resonant frequencies approximately 100 mHz. The nested structure facilitates a compact design and enables horizontal preisolation stages to be configured to create a superspring configuration, where active feedback can enable performance close to the limit set by seismic tilt coupling. The preisolation stages are combined with multistage three-dimensional (3D) pendulums. Two isolators suspending mirror test masses have been developed to form a 72 m optical cavity with finesse approximately 700 in order to test their performance. The suitability of the isolators for use in suspended optical cavities is demonstrated through their ease of locking, long term stability, and low residual motion. An accompanying paper presents the local control system and shows how simple upgrades can substantially improve residual motion performance.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data.

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

Search for gravitational-wave bursts from soft gamma repeaters.

We present a LIGO search for short-duration gravitational waves (GWs) associated with soft gamma ray repeater (SGR) bursts. This is the first search sensitive to neutron star f modes, usually considered the most efficient GW emitting modes. We find no evidence of GWs associated with any SGR burst in a sample consisting of the 27 Dec. 2004 giant flare from SGR 1806-20 and 190 lesser events from SGR 1806-20 and SGR 1900+14. The unprecedented sensitivity of the detectors allows us to set the most stringent limits on transient GW amplitudes published to date. We find upper limit estimates on the model-dependent isotropic GW emission energies (at a nominal distance of 10 kpc) between 3x10;{45} and 9x10;{52} erg depending on waveform type, detector antenna factors and noise characteristics at the time of the burst. These upper limits are within the theoretically predicted range of some SGR models.

Ultrasonography in the detection of intra-abdominal retained surgical sponges.

Six cases of confirmed retained surgical sponges are reviewed. In five patients a clean, clear-cut acoustic shadow could be identified in relation to a palpable mass. In four of these patients the sponges were identified preoperatively by their ultrasonographic appearance. Abdominal radiographs were usually obtained afterwards, to confirm the diagnostic impression or to rule out bowel gas or calcifications. Since this ultrasonographic finding has not been described previously, the authors call attention to it in order to prevent misdiagnosis.

Specimen processing and concentration of Chlamydia trachomatis added can influence false-negative rates in the LCx assay but not in the APTIMA Combo 2 assay when testing for inhibitors.

Inhibitors in clinical specimens can be detected by adding the target of nucleic acid amplification to the sample. Introduction of a Chlamydia trachomatis L2 434 preparation containing 12 elementary bodies (EBs) into first-void urine (FVU) from 225 nonpregnant women and 190 pregnant women before specimen processing by the assays produced false-negative rates of 0.48% (2 of 415 specimens) and 13% (44 of 338 specimens) by the APTIMA Combo 2 and the Chlamydia LCx tests, respectively. Reducing the amount of C. trachomatis added to one EB, a concentration closer to the APTIMA Combo 2 test cutoff, for a subset of 244 FVU specimens increased the number of specimens with false-negative results by the APTIMA Combo 2 assay to 7 (2.9%), suggesting that the strength of the input C. trachomatis per specimen has an influence on the number of specimens with false-negative results. Repeat testing after overnight storage and dilution decreased the APTIMA Combo 2 test false-negative rates to 0% (0 of 415 specimens) with the stronger inoculum and 0.8% (2 of 244 specimens) with the weaker inoculum; the false-negative rate of the LCx assay was reduced to 5.4% (18 of 334 specimens). When an additional 70 FVU specimens from women to which 12 EBs were added before specimen processing were tested by the LCx assay, 34 specimens had false-negative results, whereas 21 specimens had false-negative results when the C. trachomatis EBs were introduced after processing. Nine of the 21 specimens to which EBs were added after processing and all of the 34 urine specimens to which the target was added before processing remained falsely negative on repeat testing at a 1:2 dilution, suggesting that input C. trachomatis DNA was lost during processing by the LCx assay. In contrast, the APTIMA Combo 2 assay appears to have a higher sensitivity and either lost little nucleic acid during processing or demonstrated few problems with inhibitors of transcription-mediated amplification.

[Honduran experience with the control of acute infantile respiratory infections]. / Experiencia hondureña en el control de las infecciones respiratorias agudas infantiles.

The Honduran Ministry of Public Health and Social Welfare, in consultation with the HEALTHCOM Project of the Academy for Educational Development, conducted a national study that examined the characteristic patterns of acute respiratory infections (ARI) in children, as well as the measures being used to control them. Following an ethnographic analysis of the entire population, a pilot intervention program was developed to teach mothers how to recognize ARI symptoms and take appropriate measures in the case of mild, moderate, and severe episodes. The intervention consisted of teaching health workers (HW) in eight rural towns the most important aspects of ARI control and instructing them in a methodology for transmitting these concepts to the community through oral presentations in local health centers. The methodology included behavior modification techniques and incentives. Three observation instruments were used to compare the effectiveness of the health workers' presentations before and after their training, as well as the knowledge acquired by those who attended the presentations and the community at large. The results indicated that the techniques used both to train the HW and by them in their presentations helped the mothers and other members of the community to respond more effectively when children came down with acute respiratory infections of varying degrees of severity.

Radiology of the Mirizzi syndrome: diagnostic importance of the transhepatic cholangiogram.

The essential feature of the MIrizzi syndrome is partial common hepatic duct obstruction due to an impacted cystic duct stone. This entity has rarely been reported but is apparently more common than previously thought. Our review of the world literature shows 42 proven cases in 18 publications from 7 different countries. We are adding 11 further cases with surgical proof. The preoperative x-ray diagnosis of the Mirizzi syndrome was established in 10 of the 42 previously reported cases. This diagnostic problem was probably due to limitations of plain film and intravenous cholangiography techniques. The preoperative diagnosis was possible in 8 of our 11 cases, primarily with the use of transhepatic cholangiography. The preoperative diagnosis is important and can lead to a decrease in surgical complications, particularly if stone penetration, fistula formation, and adjacent inflammatory masses are demonstrated.

Doppler ultrasound evaluation of extracranial cerebrovascular disease.

Carotid Doppler examination was compared with arteriographic findings in 125 patients. The results demonstrated exact correlation in 87% of vessels studied. Clinically significant errors occurred at a rate of 4.5%. Clinically insignificant errors (8.5%) were usually the result of wall disease being mistaken for nonhemodynamically significant stenosis.

Food of the gods: cure for humanity? A cultural history of the medicinal and ritual use of chocolate.

The medicinal use of cacao, or chocolate, both as a primary remedy and as a vehicle to deliver other medicines, originated in the New World and diffused to Europe in the mid 1500s. These practices originated among the Olmec, Maya and Mexica (Aztec). The word cacao is derived from Olmec and the subsequent Mayan languages (kakaw); the chocolate-related term cacahuatl is Nahuatl (Aztec language), derived from Olmec/Mayan etymology. Early colonial era documents included instructions for the medicinal use of cacao. The Badianus Codex (1552) noted the use of cacao flowers to treat fatigue, whereas the Florentine Codex (1590) offered a prescription of cacao beans, maize and the herb tlacoxochitl (Calliandra anomala) to alleviate fever and panting of breath and to treat the faint of heart. Subsequent 16th to early 20th century manuscripts produced in Europe and New Spain revealed >100 medicinal uses for cacao/chocolate. Three consistent roles can be identified: 1) to treat emaciated patients to gain weight; 2) to stimulate nervous systems of apathetic, exhausted or feeble patients; and 3) to improve digestion and elimination where cacao/chocolate countered the effects of stagnant or weak stomachs, stimulated kidneys and improved bowel function. Additional medical complaints treated with chocolate/cacao have included anemia, poor appetite, mental fatigue, poor breast milk production, consumption/tuberculosis, fever, gout, kidney stones, reduced longevity and poor sexual appetite/low virility. Chocolate paste was a medium used to administer drugs and to counter the taste of bitter pharmacological additives. In addition to cacao beans, preparations of cacao bark, oil (cacao butter), leaves and flowers have been used to treat burns, bowel dysfunction, cuts and skin irritations.

Doppler evaluation of extracranial cerebrovascular disease.

The carotid Doppler examination is an accurate means of screening the extracranial carotid system for stenotic lesions. Comparison of 100 patients (200 vessels) examined by the Doppler method and arteriography showed agreement in 90% of the vessels and a significant error rate in only 3.5%.