A waste characterisation procedure for ADM1 implementation based on degradation kinetics.

In this study, a procedure accounting for degradation kinetics was developed to split the total COD of a substrate into each input state variable required for Anaerobic Digestion Model n°1. The procedure is based on the combination of batch experimental degradation tests ("anaerobic respirometry") and numerical interpretation of the results obtained (optimisation of the ADM1 input state variable set). The effects of the main operating parameters, such as the substrate to inoculum ratio in batch experiments and the origin of the inoculum, were investigated. Combined with biochemical fractionation of the total COD of substrates, this method enabled determination of an ADM1-consistent input state variable set for each substrate with affordable identifiability. The substrate to inoculum ratio in the batch experiments and the origin of the inoculum influenced input state variables. However, based on results modelled for a CSTR fed with the substrate concerned, these effects were not significant. Indeed, if the optimal ranges of these operational parameters are respected, uncertainty in COD fractionation is mainly limited to temporal variability of the properties of the substrates. As the method is based on kinetics and is easy to implement for a wide range of substrates, it is a very promising way to numerically predict the effect of design parameters on the efficiency of an anaerobic CSTR. This method thus promotes the use of modelling for the design and optimisation of anaerobic processes.

Modelling aerobic biodegradation in vertical flow sand filters: impact of operational considerations on oxygen transfer and bacterial activity.

Oxygen renewal, as a prominent phenomenon for aerobic bacterial activity, deeply impacts Vertical Flow Constructed Wetland (VFCW) treatment efficiency. We introduce a multiphase model able to simulate multi-component transfer in VFCWs. It is based on a two-phase flow module, and a transport module. The flow module can quantify both water and air velocities throughout the filter during operation. The reactive transport module follows dissolved and gaseous oxygen concentrations, and the transport of solutes such as ammonium and readily biodegradable COD (Chemical Oxygen Demand). The consumption of components is governed by Monod-type kinetics. Heterotrophic and autotrophic bacteria, which are responsible for COD and ammonium degradation respectively, are part of the model components. The kinetics are based on the Constructed Wetlands Model 1. The results from the simulation tool were compared with existing experimental data, and two kinds of operation with VFCWs were investigated. The authors show strong interplay between oxygen renewal and bacterial consumption in case of sequential batch feeding with transient flooding of surface. Oxygen renewal is essentially convection mediated in such operation, while convection is not significant in non-flooding operation. Simulated bacterial patterns are impacted by the operation, both quantitatively and spatially. From a modelling point of view, the authors highlight some limitations of the biological model: the description of bacterial lysis processes needs to be enhanced, as well as ammonium adsorption to organic matter.

Anaerobic co-digestion of waste activated sludge and greasy sludge from flotation process: batch versus CSTR experiments to investigate optimal design.

In this study, the maximum ratio of greasy sludge to incorporate with waste activated sludge was investigated in batch and CSTR experiments. In batch experiments, inhibition occurred with a greasy sludge ratio of more than 20-30% of the feed COD. In CSTR experiments, the optimal greasy sludge ratio was 60% of the feed COD and inhibition occurred above a ratio of 80%. Hence, batch experiments can predict the CSTR yield when the degradation phenomenon are additive but cannot be used to determine the maximum ratio to be used in a CSTR configuration. Additionally, when the ratio of greasy sludge increased from 0% to 60% of the feed COD, CSTR methane production increased by more than 60%. When the greasy sludge ratio increased from 60% to 90% of the feed COD, the reactor yield decreased by 75%.

Two-phase flow modelling for oxygen renewal estimation in vertical flow filter: luxury or necessity?

Scientists and practitioners exhibit an increasing interest on effluent transfer and degradation modelling in Vertical Flow Sand Filters (VFSF) and Vertical Flow Constructed Wetland (VFCW). Modelling software used to this purpose is mainly monophasic: in the unsaturated zone, only water flow is taken into account and air phase influence is assumed to be negligible. In hydrology, many studies have point out the limitations of this assumption in order to quantify air phase movement but little has been done in the modelling of vertical flow filter. Despite its complexity, two-phase flow modelling allows to overcome these difficulties. In this work, we describe the complex air and water flows in the particular case of vertical flow filter fed intermittently using both numerical and experimental results. Complete different behaviour is observed depending on ponding occurs or not. If it does, flow is clearly influenced by air entrapment which is responsible of a reduction of the infiltration speed and of the drainage of a part of the water kept at the interface between the sand and the drainage layer. Finally, we study the dependency of oxygen income by convection on hydraulic load and compare numerical results with experimental results obtained on oxygen consumption.

Use of 3D modelling and several ultrasound sensors to assess overflow rate.

A new instrumentation mode has been put in place in order to determine the overflow rate of five complex CSOs of the system in Sélestat (French), which are subject to self monitoring. 3D and 1D models have made it possible to predict the shapes of the water lines and suggest a location for the ultrasound sensors. In order to validate the instrumentation principle, three overhead sensors were placed on a weir. The overflow laws suggested are of the type Q(overflow) = a1h1b1 + a2h2b2 + a3h3b3. Early results of the overflow rate that have been obtained by applying the law are close to 10 % of the flow measured in the physical test bench. On the actual site, the ultrasound sensors were assembled on a rail covering the entire weir in order to be able to change their position in future after models calibration.

Activated sludge wastewater treatment plants optimisation to face pollution overloads during grape harvest periods.

The principal objective of our study was to optimise a municipal activated sludge wastewater treatment plant (WWTP) to face high organic flows due to viticulture effluents inputs. Treatment file optimization consisted in testing different treatment lines, changing the number and volume of biological basins and clarifiers, with or without a buffer basin upstream, with a view to achieving a better reduction of COD. The actual WWTP biological stage is composed of two aerated basins whose total volume is 1365 m3. The studied cases are successively, the installation of a single basin of 1365 m3, then of several basins whose total volume remains constant and equal to 1365 m3. Another case was also considered, that of an aerated basin followed by a first clarifier and then, by another aerated basin and a second clarifier. All scenarios presented below were evaluated, for standard dry weather conditions and for high organic load conditions, as encountered during the grape harvest period. The method used was to carry out various simulations, using numerical modelling, and to compare the impact of different process line scenarios and management strategies on the activated sludge WWTP efficiencies.

[The assessment of therapeutic effectiveness of paravertebral blockades in patients with painful radicular syndromes in discopathy and in lumbar spine spondylosis]. / Ocena efektywnosci terapeutycznej blokad przykregoslupowych u chorych z zespolami bólowo-korzeniowymi w przebiegu dyskopatii i zmian zwyrodnieniowych ledzwiowego odcinka kregoslupa.

A group of 103 patients were examined for radicular painful syndromes in lumbar discopathy and lumbar spondylosis. Fifty-eight were treated by placing them in spine-decompressing position, traction and therapeutic exercises. The group of 45 patients had additionally paravertebral blockade (steroid + a local anaesthetic). In the blockade group the therapeutic effects were better, with rapid reduction of acute pain, with wellbeing improvement and better comfort, which facilitated further stages of the treatment. This made possible shortening of hospital stay by 20%, on average, as compared with the group without blockade. In patients with shorter lasting radicular pains (below 2 months) the results after paravertebral blockade were significantly better than in cases with longer duration of pains (2-6 months).

Do-not-resuscitate practices in the chronically critically ill.

OBJECTIVES: To determine the frequency of do-not-resuscitate (DNR) orders in the chronically critically ill; to identify the differences in clinical and demographic characteristics of chronically critically ill patients who have DNR orders and those who do not; to identify the differences in the cost of care between patients with and without DNR orders; and to identify the differences in DNR practices between an experimental special care unit and the traditional intensive care unit (ICU). DESIGN: Randomized, prospective design with a block randomization scheme. SUBJECTS: Two hundred twenty patients who met the following eligibility criteria for enrollment in a parent study of the special care unit: an ICU stay of at least 5 days, an absence of pulmonary artery monitoring, an absence of frequent titration of intravenous vasopressors, an Acute Physiology and Chronic Health Evaluation II score of less than 18, and a Therapeutic Intervention Scoring System score of less than 39. SETTING: A large, urban academic medical center. MEASURES: Clinical and demographic variables describing the study populations, mental status, and timing of DNR orders, mortality rates, and cost of hospitalization. RESULTS: There was no difference in the frequency of DNR orders between the special care unit versus the intensive care unit--although patients in the special care unit had a longer interval between hospital admission and initiation of the DNR order. DNR patients differed from non-DNR in that they were older, less likely to be married, and had a higher Acute Physiology and Chronic Health Evaluation II score on admission to the study. The mortality rate in the DNR group was 71% versus 6% in the non-DNR group. There was no difference in total costs. DNR patients were also more likely to have an impaired mental status on admission, and more likely to have deterioration in mental status by the time of discharge than the non-DNR patients.

The hypertensive elder: a review for the primary care provider.

Hypertension, the most prevalent cardiovascular disorder in America, affects over 50% of the older adult population. Management of hypertension in the elder is influenced by numerous age-related factors, including physiological changes, co-morbid conditions, functional or cognitive impairments, and polypharmacy issues. As data on the damaging effects of untreated hypertension increase, practice guidelines are increasingly focused on early detection and successful management of blood pressure in the primary care setting. The primary health care provider, having an advanced knowledge base and excellent communication skills, can make effective management of hypertension a reality. This article presents a comprehensive review of assessment, diagnosis, and treatment of hypertension in the older adult. Lifestyle modification and pharmacologic therapy are discussed. Elements of patient education are described, with special emphasis on promoting adherence to a long-term treatment regimen.

[The attempt to define reciprocal relations between radicular and pseudoradicular syndrome in patients with lumbar disc herniation (1dh)]. / Próba okreslenia wzajemnej relacji zespolów korzeniowych i rzekomokorzeniowych u chorych na przepukliny ledzwiowych krazków miedzykregowych (plkm).

Based on history and clinical examination in 100 patients with Idh we selected four clinical features characteristic of radicular and pseudoradicular (spondylogenic) syndrome. The choice was based on data from review of literature. We confirmed that pseudoradicular syndrome features appeared in most of Idh patients. Of the 100 patients in 20% pseudoradicular syndrome features prevailed, 14% experienced mainly radicular syndrome features and 66% patients presented mixed clinical picture. We suggest that above relationships should be considered in clinical practice.

[On alleged radicular pain in patients with lumbar intervertebral disc hernias]. / O bólach rzekomokorzeniowych u chorych na przepukliny ledzwiowych krazków miedzykregowych [plkm].

A review is presented of opinions on the sources and mechanisms of pain in patients with hernias of the lumbar intervertebral discs in particular, on the pathogenesis and clinical characteristics of the so called pseudoradicular syndromes in discopathies. The diagnosis of pseudoradicular syndromes reflecting the degree of involvement by the disease process of the osteoarticular and ligamentous spinal structures and the condition of spinal muscles is of importance for the therapeutic management, providing information on the necessity of avoiding rehabilitation procedures contributing to destabilization of the segmental system of the spine (certain types of exercises, exercises in suspension with large amplitude of movements, certain manual procedures) and on the use of procedures reducing the stress on the spine and strengthening it (special positions in bed, isometric exercises, balneotherapy in later stage).

[Surgical treatment for mitral valve defects with preponderance of mitral stenosis and high pulmonary vascular resistance. Clinical and hemodynamic observations 6 months after valve replacement]. / Leczenie operacyjne wady mitralnej z przewaga zwezenia i wysokim naczyniowym oporem plucnym. Obserwacje kliniczne i hemodynamiczne w 6 miesiecy od wymiany zastawki.

10 patients with isolated or predominant mitral stenosis (mean mitral valve area 0.9 cm) and high preoperative values of pulmonary vascular resistance (mean 7.2 Wood units) were chosen for further hemodynamic postoperation evaluation. The patients had normal function of the aortic valve and no significant stenosis of coronary arteries. Hemodynamic evaluation was done by floating Swan-Ganz catheter preoperatively at rest and 6 months after mitral valve replacement at rest and during bicycle cycloergometer test in the supine position. Significant improvement in NYHA class was noted. Preoperatively 6 patients were in NYHA III class, 4 in NYHA IV class. After mitral valve replacement 4 patients were in class III and 6 in class II. Before mitral valve replacement only 3 patients were able to perform 25 Watt test. After surgery all except one performed at least 25 W. There was a significant decrease of pulmonary vascular resistance from 7.2 +/- 2.2 preoperatively to 3.1 +/- 1.9 Wood units at rest after the operation. Post operation during exercise pulmonary vascular resistance attained 4.2 +/- 1.9 Wood units. These changes were due to a fall in mean pulmonary artery pressure 49 +/- 13 at rest preoperatively to 25 +/- 6 mm Hg (rest) and 43 +/- 14 mm Hg (23 W) postoperatively and a rise in stroke volume index from 24 +/- 7 ml (m2) beat preoperatively to 32 +/- 9 at rest and 33 +/- 6 (25 W) postoperatively. Despite clinical and hemodynamic improvement there was no full recovery of pulmonary hemodynamics.

[Value of exercise test for assessment of hemodynamic efficiency of the heart]. / Wartosc próby wysilkowej dla oceny sprawnosci hemodynamicznej serca.

The purpose of the work was an attempt at determination of the value of exercise test for the assessment of haemodynamic heart effectiveness. The reaction of blood pressure and heart rate to exercise was accepted as the basis for analysis. The analysis was based on a material of 40 men aged 33-66 years (mean = 51 years) with a history of myocardial infarction in whom exercise tests were carried out one year after aortocoronary bypass graft implantation. The studied men were divided into two groups A abd B depending on the reaction of blood pressure and heart rate occurring during exercise. Group A consisted of persons who responded to exercise with blood pressure and heart rate in a physiological way. The patients in group B terminated the exercise test due to pathological response. The subject of the analysis were: ischaemic changes during exercise; duration of the exercise test; attained workload in Watts; heart rhythm disturbances in group A and B; segmental left ventricular contractility disturbances evaluated on the basis of echocardiography findings. Among the patients in group B a higher percent of positive tests was found as well as shorter duration of the test and lower mean workload in relation to the patients in group A. Contractility disturbances occurred significantly more frequently - 80% among the patients in group B with greater prevalence of more sever forms of akinesis and dyskinesis (p < 0.05). Hypokinesis was observed in 7 patients (35%), akinesis in 5 cases (25%), and dyskinesis in 4 cases (20%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of improper pulmonary venous compliance on clinical results of mitral valve replacement]. / Wplyw nieprawidlowej podatnosci zylnego systemu plucnego na kliniczne wyniki wymiany zastawki mitralnej.

The pulmonary venous vascular volume and its compliance (PVcomp) are important factors influencing filling of the left ventricle. It seems that a poor PVcomp effects the value and reversibility of secondary pulmonary hypertension. Basing on Hirakawa's method PVcomp (= 0.4'' x SV/V-d) was calculated in 34 patients with isolated mitral stenosis (SM). Basing on the mean value of PVcomp the group was divided into those with poor (< = 4.3 ml/mmHg) and good (4.4 and more ml/mmHg) PVcomp. Prior mitral valve replacement (MVR) the groups did not differ in values of PAP, PWP, SVI, PVR assessed at rest. During exercise (25 Watt) in the supine position significant higher values of PAP and PWP were observed in patients with poor compliance. Six months after MVR the PAP and PWP values normalized in all patients. In the patients with the initial good PVcomp values significantly higher values of SVI and a decrease in PVR was found. During exercise (25 Watts) significantly higher values of PAP and PVR were registered in patients with initial poor PVcomp values. Pulmonary venous compliance may be an independent factors influencing the clinical outcome of mitral valve replacement 6 months after the procedure.

[Factors influencing survival in patients with coronary disease. I. Characteristics of examined patients and survival curves]. / Czynniki wplywajace na przezywalnosc chorych z choroba wiencowa--Czesc I. Charakterystyka badanych chorych i krzywe przezycia.

The group of 683 patients with the significant narrowing (> 70%) of at least one coronary vessel diagnosed by coronarography performed between 1976-1988 in the Institute of Cardiology in Warsaw was followed during one to seven years. The number of patients with a poor left ventricular function was high in the group treated surgically and non surgically. Ejection fraction < 50% was found in 27% and 43% respectively, LVEDP > 12 mmHg (66% and 69%), EDVI > 100 ml/m2 (58% and 70%). Survival curves were calculated in the two different subsets of patients treated surgically and non surgically. Despite some favorite trend toward a better outcome for patients treated surgically the differences were not statistically significant for a whole group. However we showed a significantly higher probability of survival in the subgroup of the three vessel disease treated surgically compared to other treatment. There were no significant differences in survival in patients with one, two, or three vessel disease treated surgically (survival probability of 0.82; 0.78; 0.84 respectively after 7 years). In patients treated non surgically the growing number of diseased vessels worsened the prognosis (survival probability of 0.84; 0.78; 056 respectively). In our observation the differences for better outcome in patients with poor left ventricular function treated surgically did not reach a statistical significance.

[Factors influencing survival in patients with coronary heart disease. II. Multivariate logistic function analysis]. / Czynniki wplywajace na przezywalnosc chorych z choroba wiencowa--Czesc II--Analiza metoda funkcji logistycznej wielu zmiennych.

A group of 683 patients with the significant narrowing (> 70%) of at least one coronary vessel diagnosed by coronarography performed between 1976-1988 in the Institute of Cardiology in Warsaw was followed during one to seven years. Two hundred ninety of them were treated surgically, 393 non surgically. A multivariate logistic function (MLF) analysis of 10 variables is presented obtained from anamnesis and hemodynamic data and their significance upon survival after 2, 4 and 6 years. In the group treated non surgically the number of narrowed vessels was a factor independently significant after 2, 4 and 6 years. After 4 and 6 years the ejection fraction and the left ventricle end diastolic volume index were also significant. In the group treated surgically none of those were significant after 2 years. After 4 and 6 years anamnesis of arterial hypertonia was significant after 6 years also left ventricle end diastolic volume index. Coefficients calculated from multivariate logistic function analysis allow the calculation of probability of survival for an individual patient.

[Early and delayed repair of gynecological ureteral injuries]. / Wczesna i odroczona naprawa ginekologicznych uszkodzen moczowodów.

The report is based on a material of 45 patients with 54 ureteral damages after obstetric-gynaecological operations. In 30 cases nephrostomy was done and the operation on the ureter was delayed, while 24 ureters were operated on immediately after establishing of the diagnosis. The authors are proponents of early operations. The results of these operations are better, the patients recover earlier regaining fitness, and additional procedure, nephrostomy, is avoided.