Effects of interventions on trajectories of health-related quality of life among older patients with hip fracture: a prospective randomized controlled trial.

BACKGROUND: Health-related quality of life (HRQoL) has been used to assess subjects' prognosis and recovery following hip fracture. However, evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture. The purposes of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery. METHODS: For this secondary analysis, data came from a randomized controlled trial of subjects with hip fracture receiving three treatment care models: interdisciplinary care (n = 97), comprehensive care (n = 91), and usual care (n = 93). Interdisciplinary care consisted of geriatric consultation, discharge planning, and 4 months of in-home rehabilitation. Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms, fall prevention, and 12 months of in-home rehabilitation. Usual care included only in-hospital rehabilitation and occasional discharge planning, without geriatric consultation and in-home rehabilitation. Mental and physical HRQoL were measured at 1, 3, 6, and 12 months after discharge by the physical component summary scale (PCS) and mental component summary scale (MCS), respectively, of the Medical Outcomes Study Short Form 36, Taiwan version. Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models. RESULTS: We identified three quadratic PCS trajectories: poor PCS (n = 103, 36.6 %), moderate PCS (n = 96, 34.2 %), and good PCS (n = 82, 29.2 %). In contrast, we found three linear MCS trajectories: poor MCS (n = 39, 13.9 %), moderate MCS (n = 84, 29.9 %), and good MCS (n = 158, 56.2 %). Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory (b = 0.99, odds ratio [OR] = 2.69, confidence interval [CI] = 7.24-1.00, p = 0.049, and b = 1.32, OR = 3.75, CI = 10.53-1.33, p = 0.012, respectively) than those who received usual care. However, neither care model improved MCS. CONCLUSIONS: The interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects' odds for following a trajectory of good physical functioning after hospitalization. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01350557 ).

[Formation and characterization of aerobic granules in a pilot-scale reactor for real wastewater treatment].

Microbial granules were successfully developed in a pilot-scale sequencing batch reactor (SBR) for the treatment of real municipal wastewater. The aerobic granules developed had good settleability with a settling velocity of > 21 mh-1. The mature granular sludge was capable of simultaneous removal of chemical oxygen demand (COD), nitrogen (N) and phosphorus (P). With the cycle of 3 h, the effluent COD, ammonium nitrogen (NH+4 -N) and total nitrogen (TN) concentrations were <50 mg L-1, <5. 0 mg L-1, and <15 mgL-1, respectively. The removal efficiency for TN and total phosphorus (TP) was about 50%. Examinations by confocallaser scanning microscopy (CLSM) showed that extracellular polymeric substances (EPS) were uniformly distributed throughout the granules, forming the granule structure matrix. X-ray diffraction (XRD) analysis indicated the presence of SiO2 and other metal oxides inside aerobic granules, implying that minerals in real wastewater might function as the seed in the initial stage of aerobic granulation.

[Treatment of municipal wastewater using the combined reversed A2/O-MBR process].

For the treatment of municipal wastewater, the effects of the reversed A2/O-MBR system on COD, NH4+ -N, TN, TP, SS and transmembrane pressure (TMP) were investigated through two-point feeding. The results indicated that the removal efficiencies for COD and NH4+ -N were high in the system, the effluent met the requirements of the Class A in first grade discharge standard of GB 18918-2002. The effluent TN was < 15 mg x L(-1) when the reflux ratio of nitrification was 200%, whereas the average TP removal rate was 90% after the excessive sludge was removed. The effluent SS was < 10 mg x L(-1) before the large-scale breakage of membrane. The TMP increased gradually with the operation of the system, if the way of aeration was not correct, the TMP would increase quickly. Efficient separation by the membrane contributed to the removal of COD, TP and SS. Because there was no sludge washout in the system, SRT could be properly controlled, it was good for the ammonia-oxidizing bacteria and denitrifying bacteria which both have long life-cycle. Even if the inflow was increased to 1.5 fold, the effluent quality was good when the sludge concentration was increased to 6500 mg x L(-1).