Optimizing ozone treatment for pathogen removal and disinfection by-product control for potable reuse at pilot-scale.

Reclaimed water poses environmental and human health risks due to residual organic micropollutants and pathogens. Ozonation of reclaimed water to control pathogens and trace organics is an important step in advanced water treatment systems for potable reuse of reclaimed water. Ensuring efficient pathogen reduction while controlling disinfection byproducts remains a significant challenge to implementing ozonation in reclaimed water reuse applications. This study aimed to investigate ozonation conditions using a plug flow reactor (PFR) to achieve effective pathogen removal/inactivation while minimizing bromate and N-Nitrosodimethylamine (NDMA) formation. The pilot scale study was conducted using three doses of ozone (0.7, 1.0 and 1.4 ozone/total organic carbon (O3/TOC) ratio) to determine the disinfection performance using actual reclaimed water. The disinfection efficiency was assessed by measuring total coliforms, Escherichia coli (E. coli), Pepper Mild Mottle Virus (PMMoV), Tomato Brown Rugose Fruit Virus (ToBRFV) and Norovirus (HNoV). The ozone CT values ranged from 1.60 to 13.62 mg min L-1, resulting in significant reductions in pathogens and indicators. Specifically, ozone treatment led to concentration reductions of 2.46-2.89, 2.03-2.18, 0.46-1.63, 2.23-2.64 and > 4 log for total coliforms, E. coli, PMMoV, ToBRFV, and HNoV, respectively. After ozonation, concentrations of bromate and NDMA increased, reaching levels between 2.8 and 12.0 µg L-1, and 28-40.0 ng L-1, respectively, for average feed water bromide levels of 86.7 ± 1.8 µg L-1 and TOC levels of 7.2 ± 0.1 mg L-1. The increases in DBP formation were pronounced with higher ozone dosages, possibly requiring removal/control in subsequent treatment steps in some potable reuse applications.

Evaluation of the therapeutic effect of very small stem cells from peripheral blood on the treatment of Premature Ovarian Failure: A pilot study.

OBJECTIVE: Premature ovary failure (POF) is a severe health condition with multiple negative outcomes, which deteriorate a patient's life. The current study aimed to evaluate the therapeutic effect of mesenchymal stem cells (MSCs) derived from peripheral blood in the treatment of women with the POF background. METHODS: The current study was a pilot study carried-out on women younger than 40 with premature ovarian failure. Study participants underwent 4-months cell therapy using Mesenchymal stem cells extracted from peripheral bloods. Serum level of Follicle-stimulating hormone (FSH), Estradiol (E2), Anti-mullerian hormone (AMH), and Antral follicle count (AFC) were the main investigated outcomes that were assessed at baseline, month two and month four of the very small stem cell intervention. RESULTS: Average serum level of FSH was 45.0 (12.1) mIU/mL at baseline and continually decreased during the study and reached 33.2 (12.4) mIU/mL in the fourth month. The average AMH level was 0.10 ng/mL prior to the intervention and increased to 0.13 ng/mL in the 2nd month and 0.15 ng/mL in the fourth month. The level E2 was 85.7 (23.6) pg/ml on average at baseline, while the average E2 reduced to 77.2 (25.6) pg/ml in the fourth month. Average number of AFC was 2.0 (0.8) at baseline. We observed a gradual increase in the second month (Mean AFC=2.2) and after four months it increased to 3.1 (1.8) as the highest menstrual restoration and pregnancy was observed in 10% of our study participants. CONCLUSIONS: MSCs could significantly improve hormone secretion in women with POF. Implantation of MSCs in women with POF background was associated with an increase in AMH and AFC, while it downed the serum level of E2 and FSH. MSCs could also lead to menstrual restoration and pregnancy in women with POF.

A pilot-scale study of a novel system for simultaneous nitrogen and carbon removal: technological advancement of a structured bed reactor with intermittent aeration (SBRIA) in real domestic sewage treatment.

This study outlines the development of an effective pilot-scale simultaneous denitrification and nitrification (SDN) system using intermittent aeration for the removal of carbon and nitrogen from real domestic sewage. Given the limited research in this area, the main objective was to evaluate the overall performance of the SBRIA system on a pilot scale and show its benefits in domestic wastewater treatment. The structured bed reactor with intermittent aeration (SBRIA) notably achieved 57% efficiency in removing total nitrogen without requiring external carbon sources. It also demonstrated impressive removal rates of 56% for total chemical oxygen demand (CODT) and 82% for biochemical oxygen demand (BOD5), indicating its effectiveness in degrading organic matter. In addition, the SBRIA showed high pH control and managed the consumption of alkalinity without the need for an alkalizer, maintaining consistent mean values of 7.7 ± 0.8 for pH and 166.8 ± 79.8 mg·L-1 for alkalinity. The system also proved resilient against toxic shocks caused by significant variations in influent characteristics. This study offers valuable insights and compelling results into a cost-effective and efficient treatment approach using an innovative technology not previously applied at the pilot scale. Its potential to remediate polluted water is substantial.

Wet anaerobic digestion of organic fraction of municipal solid waste: experience with long-term pilot plant operation and industrial scale-up.

This paper presents the analysis of a pilot anaerobic digestion plant that operates with organic fraction of municipal solid waste (OFMSW) from a wholesale market and can treat up to 500 kg d-1. The process was monitored for a period of 524 days during which the residue was characterized and the biogas production and methane content were recorded. The organic load rate (OLR) of volatile solids (VS) was 0.89 kg m-3 d-1 and the Hydraulic Retention Time (HRT) was 25 d during the process. The yield was 82 Nm3 tons OFMSW-1 biogas, equivalent to 586 Nm3 tons CH4 VS-1. The results obtained in the pilot plant were used to carry out a technical-economic evaluation of a plant that treats 50 tons of OFMSW from wholesale markets. A production of 3769 Nm3 d-1 of biogas and 2080 Nm3 d-1 of methane is estimated, generating 35.1 MWh d-1 when converted to electricity.

Study of sugarcane bagasse/straw combustion and its atmospheric emissions using a pilot-burner.

This work conducted experimental combustion on a closed chamber using two different materials: mixture (1:1) sugarcane bagasse/straw and pre-treated biomass. The sampling method was an Andersen cascade impactor with eight stages. Tests were carried out on untreated biomass varying the velocities observed in the sampling duct (4.18; 5.20, 6.85, and 8.21 m.s-1). Pre-treated biomass tests were performed at 4.19 m.s-1 because in this condition there is a higher speed stability inside the duct. During the combustion tests, the concentration of emitted particles was higher for the lower speed range, with an order of 4.19 > 5.40 > 6.85 > 8.21 m.s-1. The higher speeds observed inside the duct behaved as a dragging agent for particulate material. For the tests at the speed of 8.21 m.s-1 where the flow inside the duct was 0.088 m3s-1, this behavior is more evident. Considering the fine diameter particles (< 2.5 µm), they were emitted in a higher concentration, due to the biomass combustion process, which results in higher emission of ultrafine particles. The emission factors (EFs) obtained for PM10 for untreated biomass were in the range of 0.414 and 0.840. On the other hand, considering the pre-treated biomass, these factors were 0.70 and 1.51. The EFs of PM from the burning of the pre-treated biomass were higher when compared to untreated biomass, which is mainly due to the higher temperature of the process due to the higher HHV (higher heating value) of this material, caused by the removal of hemicellulose (4.71 times) and a proportional increase in lignin (1.52 times). Biomass combustion has the potential to partially replace fossil fuels in heat and energy generation. Nevertheless, more stringent and comprehensive legislation should be established to ensure that air quality is maintained. Furthermore, the emission factors obtained in this study might be useful as input data for air quality modeling in the context of sugarcane's burning biomass, thus, contributing to the generation of inventories that include emissions of this nature.

Rede nacional de testes moleculares para detecção de Chlamydia trachomatis e Neisseria gonorrhoeae: experiência de implantação-piloto no Brasil / A national network of molecular tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae: a pilot implementation experience in Brazil / Red nacional de pruebas moleculares para la detección de Chlamydia trachomatis y Neisseria gonorrhoeae: experiencia de implantación piloto en Brasil

Resumo: O objetivo deste estudo foi conhecer a opinião dos profissionais participantes da implantação-piloto de testes moleculares para detecção de Chlamydia trachomatis e Neisseria gonorrhoeae no Sistema Único de Saúde (SUS). Determinou-se a taxa de detecção de C. trachomatis e/ou N. gonorrhoeae e os fatores associados à infecção. A estratégia contou com laboratórios pertencentes à rede de carga viral de HIV e hepatites virais. A testagem teve como público-alvo pessoas mais vulnerabilizadas às infecções sexualmente transmissíveis, com coleta de amostras de urina e/ou swabs vaginal, endocervical e/ou uretral masculino. Questionários foram enviados aos gestores estaduais e profissionais de laboratório sobre a implantação-piloto. De maneira geral, as avaliações foram positivas. Entre as fraquezas, citou-se dificuldades na mudança do processo de trabalho, carência de recursos humanos, pouca sensibilidade de profissionais da assistência e ausência de tubo primário de urina, único insumo não fornecido. Como fortaleza, destaca-se aquisição centralizada de testes, compartilhamento de equipamentos e armazenamento de amostras à temperatura ambiente. Das 16.177 pessoas testadas, 1.004 (6,21%) foram positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae e 239 (1,48%) para C. trachomatis/N. gonorrhoeae. A detecção de infecção ocorreu mais em pessoas jovens (≤ 24 vs. > 24 anos) (aOR = 2,65; IC95%: 2,38-2,96), do sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), pardas/pretas (aOR = 1,06; IC95%: 1,05-1,11), na Região Sudeste (aOR = 1,08; IC95%: 1,02-1,13) e em amostras de secreção uretral (aOR = 1,46; IC95%: 1,41-1,52). Os resultados deste estudo demonstraram a importância da disponibilização da testagem em âmbito nacional, os quais subsidiaram a implantação da rede definitiva para detecção de C. trachomatis/N. gonorrhoeae no SUS.

Abstract: This study aimed to know the opinion of professionals participating in an experiment to implement a pilot for molecular tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae at the Brazilian Unified National Health System (SUS). The detection rate of C. trachomatis and/or N. gonorrhoeae and the factors associated with infection were determined. The strategy included laboratories belonging to the HIV and viral hepatitis viral load network. Testing targeted people who are more vulnerable to sexually transmitted infections and collected urine samples and/or vaginal, endocervical, and/or male urethral swabs. Questionnaires were sent to state managers and laboratory professionals about the implementation of the pilot. Reviews were overall positive. Weaknesses included difficulties changing work processes, lack of human resources, poorly sensitized care professionals, and absence of primary urine tubes, the only input not provided. Strengths included the centralized acquisition of tests, sharing of equipment, and storage of samples at room temperature. Of the 16,177 people who were tested, 1,004 (6.21%) were positive for C. trachomatis; 1,036 (6.4%), for N. gonorrhoeae; and 239 (1.48%), for C. trachomatis/N. gonorrhoeae . Detection of any infection occurred more frequently in young people (≤ 24 vs. > 24 years) (adjOR = 2.65; 95%CI: 2.38-2.96), men (adjOR = 1.95; 95%CI: 1.72-2.21), brown/black individuals (adjOR = 1.06; 95%CI: 1.05-1.11), those in Southeastern Brazil (adjOR = 1.08; 95%CI: 1.02-1.13), and in urethral secretion samples (adjOR = 1.46; 95%CI: 1.41-1.52). Results show the importance of making testing available nationwide, which supported the implementation of a definitive network to detection C. trachomatis/N. gonorrhoeae in SUS.

Resumen: El objetivo de este estudio fue conocer la opinión de los profesionales participantes de la implantación piloto de pruebas moleculares para la detección de Chlamydia trachomatis y Neisseria gonorrhoeae en el Sistema Único de Salud brasileño (SUS). Se determinó la tasa de detección de C. trachomatis y/o N. gonorrhoeae y los factores asociados con la infección. En la estrategia participaron laboratorios pertenecientes a la red de carga viral de VIH y hepatitis virales. La prueba tuvo como público objetivo a personas más vulnerables a las infecciones de transmisión sexual, con recolección de muestras de orina y/o swabs vaginal, endocervicales y/o uretral masculino. Se enviaron cuestionarios a los gestores estatales y a los profesionales de laboratorio sobre la implementación piloto. En general, las evaluaciones fueron positivas. Entre las debilidades, se citó las dificultades en el cambio del proceso de trabajo, la falta de recursos humanos, los profesionales de la asistencia poco sensibilizados y la ausencia del contenedor de orina primaria, el único insumo no suministrado. Como fortalezas, se destaca la adquisición centralizada de pruebas, el intercambio de equipos y el almacenamiento de muestras a temperatura ambiente. De las 16.177 personas evaluadas, 1.004 (6,21%) fueron positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae y 239 (1,48%) para C. trachomatis/N. gonorrhoeae. La detección de alguna infección ocurrió más en personas jóvenes (≤ 24 vs. > 24 años) (aOR = 2,65; IC95%: 2,38-2,96), del sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), parda/negra (aOR = 1,06; IC95%: 1,05-1,11), localizadas en la región Sudeste (aOR = 1,08; IC95%: 1,02-1,13) y en muestras de secreción uretral (aOR = 1,46; IC95%: 1,41-1,52). Los resultados de este estudio demostraron la importancia de la disponibilidad de la prueba a nivel nacional, los cuales subsidiaron la implantación de la red definitiva para detección de C. trachomatis/N. gonorrhoeae en el SUS.

Home-based self-management for sedentary individuals with mild walking disability after stroke: protocol for a randomised pilot study.

BACKGROUND: A Phase I study showed that it is feasible to implement a home-based self-management program aimed at increasing physical activity in individuals after stroke with mild walking disability in Brazil. The next step is to test this program against a control group in order to provide a power analysis for a fully-powered Phase III clinical trial. METHODS: A Phase II pilot randomised clinical trial with concealed allocation, blinded measurement, and intention-to-treat analyses will be carried out. The inclusion criteria will be individuals diagnosed with stroke, in the acute or subacute phase, with mild walking disability, sedentary, and no significant language impairment. The participants will be randomly allocated to the experimental or control group. The experimental group will receive six sessions of a home-based self-management program based on behaviour change techniques through the Social-Cognitive Theory and Control Theory over 11 weeks. The control group will receive one session of education about stroke (regarding the importance of practising physical activity after a stroke) and usual care. A total of 24 participants will be recruited. The primary outcome will be physical activity, measured through steps taken per day by an activity monitor (Actigraph wGT3X-BT, Pensacola, FL, USA). The mean of daily steps will be analysed to compare groups after intervention. Secondary outcomes will be cardiovascular risk (body mass index, waist circumference, and blood pressure), depressive symptoms (Geriatric Depression Scale), walking ability (6-Minute Walk Test and 10-Meter Walk Test), exercise self-efficacy (Self-Efficacy for Exercise scale), social participation (Stroke Impact Scale) and quality of life (EuroQual-5D). Two-way analyses of variance will be implemented for all parametric outcomes, and the Kruskal-Wallis test for non-parametric outcomes will be used to determine the statistical significance of the between-group differences and reported as mean differences between groups (95% CI). All analyses will be conducted intention-to-treat. All outcomes will be measured at baseline (Week 0), post-intervention (Week 12), and follow-up (Week 24). This pilot clinical trial was registered online at Clinical Trials under number NCT05461976 on 4th April 2022. DISCUSSION: If beneficial, this Phase II pilot randomised trial will provide data to plan a fully powered future Phase III clinical trial aimed at verifying the efficacy of this program to promote physical activity after stroke. TRIAL REGISTRATION: Clinical Trials NCT05461976 on 4th April 2022.

Radiosterilized Pig Skin, Silver Nanoparticles and Skin Cells as an Integral Dressing Treatment for Burns: Development, Pre-Clinical and Clinical Pilot Study.

Radiosterilized pig skin (RPS) has been used as a dressing for burns since the 1980s. Its similarity to human skin in terms of the extracellular matrix (ECM) allows the attachment of mesenchymal stem cells, making it ideal as a scaffold to create cellularized constructs. The use of silver nanoparticles (AgNPs) has been proven to be an appropriate alternative to the use of antibiotics and a potential solution against multidrug-resistant bacteria. RPS can be impregnated with AgNPs to develop nanomaterials capable of preventing wound infections. The main goal of this study was to assess the use of RPS as a scaffold for autologous fibroblasts (Fb), keratinocytes (Kc), and mesenchymal stem cells (MSC) in the treatment of second-degree burns (SDB). Additionally, independent RPS samples were impregnated with AgNPs to enhance their properties and further develop an antibacterial dressing that was initially tested using a burn mouse model. This protocol was approved by the Research and Ethics Committee of the INRLGII (INR 20/19 AC). Transmission electron microscopy (TEM) and dynamic light scattering (DLS) analysis of the synthesized AgNPs showed an average size of 10 nm and rounded morphology. Minimum inhibitory concentrations (MIC) and Kirby-Bauer assays indicated that AgNPs (in solution at a concentration of 125 ppm) exhibit antimicrobial activity against the planktonic form of S. aureus isolated from burned patients; moreover, a log reduction of 1.74 ± 0.24 was achieved against biofilm formation. The nanomaterial developed with RPS impregnated with AgNPs solution at 125 ppm (RPS-AgNPs125) facilitated wound healing in a burn mouse model and enhanced extracellular matrix (ECM) deposition, as analyzed by Masson's staining in histological samples. No silver was detected by energy-dispersive X-ray spectroscopy (EDS) in the skin, and neither by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in different organs of the mouse burn model. Calcein/ethidium homodimer (EthD-1), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT), and scanning electron microscopy (SEM) analysis demonstrated that Fb, Kc, and MSC could attach to RPS with over 95% cell viability. Kc were capable of releasing FGF at 0.5 pg above control levels, as analyzed by ELISA assays. An autologous RPS-Fb-Kc construct was implanted in a patient with SDB and compared to an autologous skin graft. The patient recovery was assessed seven days post-implantation, and the patient was followed up at one, two, and three months after the implantation, exhibiting favorable recovery compared to the gold standard, as measured by the cutometer. In conclusion, RPS effectively can be used as a scaffold for the culture of Fb, Kc, and MSC, facilitating the development of a cellularized construct that enhances wound healing in burn patients.

A complex intervention to support breastfeeding: A feasibility and acceptability study.

AIMS: The aims of this study are to assess the acceptability and feasibility of a multicomponent intervention to support breastfeeding women and their families and explore its effectiveness. METHODS: A pilot study with control and intervention groups was conducted using the complex intervention framework in two primary healthcare centres. Overall, 44 childbearing women, their partners/relatives and 20 healthcare professionals participated in the study. The intervention's feasibility and acceptability were measured. The percentage of exclusive breastfeeding rates and women's self-efficacy were measured at pre-intervention, at 10 days postpartum, and again at 2, 4 and 6 months postpartum. Postpartum depression risk was measured at 2 and 6 months postpartum. Professional self-efficacy was measured at pre-intervention and 3 months later. RESULTS: The intervention was feasible and acceptable. No difference in self-efficacy existed between the intervention and control groups. Preliminary effects of the intervention were found in exclusive breastfeeding percentage and postpartum depression risk in the intervention group. CONCLUSION: The intervention is feasible and acceptable. The results are promising not only for breastfeeding maintenance but also for preventing postpartum depression and recovering exclusive breastfeeding during pandemics. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03944642.

Warning labels on alcoholic beverage containers: a pilot randomized experiment among young adults in Mexico.

BACKGROUND: Little is known about the potential impacts of visible and up-to-date health warning labels on alcoholic beverage containers on a range of outcomes in low- and middle-income countries. We conducted an experimental study to test the potential impacts of visible health warning labels (on the principal panel of the package) on thinking about health risks, product attractiveness, visual avoidance, and intention to change alcohol use among students in Mexico aged 18-30 years. METHODS: A double-blind, parallel-group, online randomized trial was conducted from November 2021 to January 2022 in 11 states in Mexico. In the control group, participants were presented with the image of a conventional beer can with a fictional design and brand. In the intervention groups, the participants observed pictograms with a red font and white backgrounds (health warning label in red-HWL red) or with a black font and yellow backgrounds (health warning label in yellow-HWL yellow), located at the top, covering around one-third of the beer can. We used Poisson regression models -unadjusted and adjusted for covariates- to assess differences in the outcomes across study groups. RESULTS: Using intention-to-treat analysis (n = 610), we found more participants in groups HWL red and HWL yellow thought about the health risks from drinking beer compared to the control group [Prevalence Ratio (PR) = 1.43, CI95%:1.05,1.93 for HWL red; PR = 1.25, CI95%: 0.91, 1.71 for HWL yellow]. A lower percentage of young adults in the interventions vs control group considered the product attractive (PR 0.74, 95%CI 0.51, 1.06 for HWL red; PR 0.56, 95%CI 0.38, 0.83 for HWL yellow). Although not statistically significant, a lower percentage of participants in the intervention groups considered buying or consuming the product than the control group. Results were similar when models were adjusted for covariates. CONCLUSIONS: Visible health warning labels could lead individuals to think about the health risks of alcohol, reducing the attractiveness of the product and decreasing the intention to purchase and consume alcohol. Further studies will be required to determine which pictograms or images and legends are most contextually relevant for the country. TRIAL REGISTRATION: The protocol of this study was retrospectively registered on 03/01/2023: ISRCTN10494244.

Telemonitoreo y sistema de alerta en tiempo real en insuficiencia cardiaca: estudio piloto de factibilidad, aceptabilidad y eficacia / Telemonitoring and a real-time alert system in heart failure: a preliminary pilot study of feasibility, acceptability and efficacy

Resumen Introducción: Existe creciente evidencia que el telemonitoreo (TM) de pacientes con insuficiencia cardíaca (IC) parece mejorar su evolución. No se han diseñado y evaluado plataformas de TM en Argentina. El objetivo fue evaluar la factibilidad, aceptabilidad, usabilidad y eficacia preliminar de una plataforma de TM de IC. Métodos: Se realizó un ensayo piloto apareado abierto, con un modelo de intervención de un solo grupo. Los pacientes con IC fueron incluidos en una consulta ambulatoria en enero de 2021. Se diseñó una pla taforma de TM las 24 h y 7 días de la semana. El punto final primario a 30 días fue la factibilidad, aceptabilidad y usabilidad. Resultados: Se incluyeron 20 pacientes, con una media de edad 62 ± 10 años. Se analizaron 542 cargas de parámetros. La autopercepción relacionada al estado de salud en comparación al inicio fue "levemente" o "marcadamente mejor" en el 60% de los pacientes, y en 75% "de acuerdo" o "totalmente de acuerdo" que el TM mejora el cuidado de la IC. En el 80% la carga diaria de parámetros no interfirió en su vida cotidiana. La media total de adherencia farmacológica previa a la intervención de TM fue de 6.8 ± 1.3 y posterior 7.7 ± 0,4 (p = 0.019), sin encontrar diferencias en las escalas de autocuidado. Conclusión: El TM de pacientes con IC parece ser factible, con un adecuado grado de aceptabilidad. Se observó un aumento significativo en la tasa de total adherencia, plantea una hipótesis de potencial beneficio a evaluar en una muestra mayor.

Abstract Introduction: There is growing evidence that telemonitoring (TM) in heart failure (HF) seems to improve their outcome. TM platforms have not been designed and evaluated in Argentina. The objective was to evaluate the feasibility, acceptability, usability and preliminary efficacy of a HF TM platform. Methods: An open-label, paired pilot trial was conducted with a single-group intervention model. HF patients were included in an outpatient clinic in January 2021. A 24-hour*7-day TM platform was designed. The primary endpoint at 30 days was feasibility, acceptability, and usability. Results: Twenty patients were included, mean age 62 ± 10 years; 542 parameter loads were analyzed. Self-perception related to health status compared to baseline was "slightly" or "markedly better" in 60% of patients, and in 75% "agree" or "totally agree" that TM improves patient care. In 80%, the load ing of parameters did not interfere with their daily activities. The total mean pharmacological adherence prior to the TM intervention was 6.8 ± 1.3 and 7.7 ± 0.4 afterward (p = 0.019), with no differences found in the self-care scales. Conclusion: The TM of patients with HF seems to be feasible, with an adequate degree of acceptability. A significant increase in the total adherence rate was reduced, raising a hypothesis of potential benefit to be evaluated in a larger sample.

[Telemonitoring and a real-time alert system in heart failure: a preliminary pilot study of feasibility, acceptability and efficacy]. / Telemonitoreo y sistema de alerta en tiempo real en insuficiencia cardiaca: estudio piloto de factibilidad, aceptabilidad y eficacia.

INTRODUCTION: There is growing evidence that telemonitoring (TM) in heart failure (HF) seems to improve their outcome. TM platforms have not been designed and evaluated in Argentina. The objective was to evaluate the feasibility, acceptability, usability and preliminary efficacy of a HF TM platform. METHODS: An open-label, paired pilot trial was conducted with a single-group intervention model. HF patients were included in an outpatient clinic in January 2021. A 24-hour 7-day TM platform was designed. The primary endpoint at 30 days was feasibility, acceptability, and usability. RESULTS: Twenty patients were included, mean age 62 ± 10 years; 542 parameter loads were analyzed. Self-perception related to health status compared to baseline was "slightly" or "markedly better" in 60% of patients, and in 75% "agree" or "totally agree" that TM improves patient care. In 80%, the loading of parameters did not interfere with their daily activities. The total mean pharmacological adherence prior to the TM intervention was 6.8 ± 1.3 and 7.7 ± 0.4 afterward (p = 0.019), with no differences found in the self-care scales. CONCLUSION: The TM of patients with HF seems to be feasible, with an adequate degree of acceptability. A significant increase in the total adherence rate was reduced, raising a hypothesis of potential benefit to be evaluated in a larger sample.

Introducción: Existe creciente evidencia que el telemonitoreo (TM) de pacientes con insuficiencia cardíaca (IC) parece mejorar su evolución. No se han diseñado y evaluado plataformas de TM en Argentina. El objetivo fue evaluar la factibilidad, aceptabilidad, usabilidad y eficacia preliminar de una plataforma de TM de IC. Métodos: Se realizó un ensayo piloto apareado abierto, con un modelo de intervención de un solo grupo. Los pacientes con IC fueron incluidos en una consulta ambulatoria en enero de 2021. Se diseñó una plataforma de TM las 24 h y 7 días de la semana. El punto final primario a 30 días fue la factibilidad, aceptabilidad y usabilidad. Resultados: Se incluyeron 20 pacientes, con una media de edad 62 ± 10 años. Se analizaron 542 cargas de parámetros. La autopercepción relacionada al estado de salud en comparación al inicio fue "levemente" o "marcadamente mejor" en el 60% de los pacientes, y en 75% "de acuerdo" o "totalmente de acuerdo" que el TM mejora el cuidado de la IC. En el 80% la carga diaria de parámetros no interfirió en su vida cotidiana. La media total de adherencia farmacológica previa a la intervención de TM fue de 6.8 ± 1.3 y posterior 7.7 ± 0,4 (p = 0.019), sin encontrar diferencias en las escalas de autocuidado. Conclusión: El TM de pacientes con IC parece ser factible, con un adecuado grado de aceptabilidad. Se observó un aumento significativo en la tasa de total adherencia, plantea una hipótesis de potencial beneficio a evaluar en una muestra mayor.

User Experience Regarding Digital Primary Health Care in Santarém, Amazon: Evaluation of Patient Satisfaction and Doctor's Feedback.

BACKGROUND: With the arrival of the pandemic, telemedicine has been widely used to provide medical care and can be used to assist patients in regions far from urban centers that are difficult to access, such as riverside communities in the Brazilian Amazon region. A telemedicine project connecting São Paulo, a mega-metropolis, to Paysandú, a riverside district in the Amazon, was built to serve the local population where access to the nearest medical care is 6 hours away by speedboat. OBJECTIVE: This study aims to assess the feedback from patients and doctors regarding the use of telemedicine in outpatient care at Paysandú, a riverside district in the Amazon. METHODS: This is a single-center study following the guidelines "Evaluating digital health products" from Public Health England, with local adaptations for the project and the Brazilian reality, that was conducted between São Paulo and Santarém in Brazil. A survey was carried out with patients who were treated by a doctor in the city of São Paulo, about 2500 km from the local basic health unit, between September 27 to December 15, 2021. At the end of each teleconsultation, the attending physician answered an administrative survey form, and the patient answered a satisfaction survey. RESULTS: A total of 111 patients completed the satisfaction survey from a total of 220 consultations carried out during the period (95% CI margin error 0.22%). According to the survey, more than 95% of patients were satisfied with the service, 87.4% (n=97) had previous experience with videoconferencing, and 76.6% (n=85) reported that their demand was fully solved. Additionally, according to the hired doctor's feedback, the average duration of the consultations was between 15 and 20 minutes. Of the 220 teleconsultations performed, 90.9% (n=200) of the demands were solved with support from the local health team, and 99.1% (n=218) of the appointments had a problem with audio or video. CONCLUSIONS: This teleconsultation project between São Paulo and Paysandú showed that it is possible to offer medical care from more developed locations to communities far from urban centers, as is the case with Paysandú District. Beyond the feasibility of the infrastructure, acceptance and satisfaction among patients were high. This health care supply model has proven to be functional and should be expanded nationally or perhaps internationally to regions lacking medical assistance. Escalation of the project does not seem too difficult once infrastructure issues are solved.

Biological pilot treatment reduces physicochemical and microbiological parameters of dairy cattle wastewater.

The objectives of the present study were to characterize and evaluate a pilot treatment unit (PTU) for dairy cattle wastewater (DCW) in relation to its efficiency in reducing the physicochemical and microbiological parameters and possible application of this fertilizer in organic production. A PTU was set up, composed of the following elements: a dung pit of 7.8 m3, already in place; a septic tank; a set of anaerobic biological filters comprising an upflow filter and a downward-flow filter filled with fragments PVC corrugated conduit; and two constructed wetland systems (CWSs) of horizontal subsurface flow in two parallel routes (Routes 1 and 2), controlled by means of a flow rate divider box. Route 1 passed through CWS 1 cultivated with cattail (Typha domingensis) and Route 2 passed through CWS 2 cultivated with vetiver grass (Chrysopogon zizanioides). To evaluate the treatment stages, biweekly investigations were carried out to collect effluent samples. The results of monitoring, in absolute values, were evaluated by means of the medians and variation coefficients and compared by means of Kruskal-Wallis non-parametric test followed by the Student Newman Keuls test. The treatment efficiencies of Routes 1 and 2 were calculated. The influence of vetiver on the removal of nutrients from the DCW was analyzed and the productivity estimate (t.ha-1) was performed. CWS 1 was not able to reduce the organic load indices, but it was able to retain fatty material and sodium. CWS 2 showed a reduction in nitrogenous forms and also for other nutrients, achieving the greatest removal of sodium and greatest decay of fecal contamination indicators, thermotolerant coliforms (56.13%), and E. coli (46.82%).

Short-Finned Pilot Whale Strandings Associated with Pilot Whale Morbillivirus, Brazil.

Cetacean morbillivirus (CeMV) causes illness and death in cetaceans worldwide; the CeMV strains circulating in the Southern Hemisphere are poorly known. We detected a pilot whale CeMV strain in 3 short-finned pilot whales (Globicephala macrorhynchus) stranded in Brazil during July-October 2020. Our results confirm this virus circulates in this species.

Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial.

RATIONALE & OBJECTIVE: Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of S aureus. STUDY DESIGN: Randomized controlled pilot study. SETTING & PARTICIPANTS: 34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus. INTERVENTIONS: Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660nm, 400mW/cm2, 300 seconds, methylene blue 0.01%) or with a topical mupirocin regimen (twice a day for 5 days). OUTCOME: Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized. RESULTS: All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P=0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group. LIMITATIONS: Testing was restricted to assessing nasal colonization; infectious complications were not assessed. CONCLUSIONS: Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin. FUNDING: Government grant (National Council for Scientific and Technological Development process 3146682020-9). TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT04047914.

Instrumented open-source filament extruder for research and education.

Extruders are necessary equipment for 3D filament manufacturing, which is considered a clean technology because it has less scrap and can reuse materials, increasing its life cycle. Open source extruders are less expensive than industrial extruders. However, they have little instrumentation, which limits processing analysis and thus the development of new materials, screw design and process control. Therefore, this project aims to develop a low-cost extruder with a high degree of instrumentation for in-situ process analysis. To achieve this, equipment was developed with an integrated circuit board, both with modularity, machine and peripheral control, process stability, and data acquisition. To validate the equipment, processing was done at constant temperature and with flow variation. The data obtained were the temperatures at different points in the barrel, the rotation speed of the extruder motor, the current consumed by the motor and the resistances, and the speed of the extruder motor. Thermal images of the components were obtained during processing, validating the type of material used in the parts manufactured by additive manufacturing. The ABS filament produced was analyzed by flow and surface analysis using a confocal microscope. Higher flow rates had a better surface quality of the filament.

Development of an economically competitive Trichoderma-based platform for enzyme production: Bioprocess optimization, pilot plant scale-up, techno-economic analysis and life cycle assessment.

Despite decades of research and industrial applications of Trichoderma reesei, the development of industrially relevant strains for enzyme production including a low-cost and scalable bioprocess remains elusive. Herein, bioprocess optimization, pilot plant scale-up, techno-economic analysis and life-cycle assessment for enzyme production by an engineered T. reesei strain are reported. The developed bioprocess increased in âˆ¼ 2-fold protein productivity (0.39 g.L-1.h-1) and 1.6-fold FPase activity (196 FPU.L-1.h-1), reducing the fermentation in 4 days. Cultivation in a 65-L pilot plant bioreactor resulted in 54 g.L-1 protein in 7 days, highlighting the robustness and scalability of this bioprocess. Techno-economic analysis indicates an enzyme cost of âˆ¼ 3.2 USD.kg-1, which is below to the target proposed (4.24 USD.kg-1) in the NREL/TP-5100-47764 report, while life-cycle assessment shows a carbon footprint reduction of approximately 50% compared to a typical commercial enzyme. This study provides the fundamental knowledge for the design of economically competitive Trichoderma technologies for industrial use.

Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program.

BACKGROUND: Internet-based self-management programs and telerehabilitation initiatives have increased and have been extensively used for delivering health care in many areas. These programs overcome common barriers that patients face with traditional face-to-face health care, such as travel expenditures, lack of time, and high demand on the public health system. During the COVID-19 pandemic, this mode of web-based health care delivery had become more popular. However, there is still a lack of studies testing this mode of delivery in low- and middle-income countries. To gain a better understanding of the context, feasibility, and factors involved in the implementation of a web-based program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable, and adequate for its purposes and for optimizing resource allocation. OBJECTIVE: This study aims to evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education (ReabilitaDOR) in people with chronic musculoskeletal pain and to compare this program with a program using only a web-based self-management booklet. METHODS: The study design was a parallel pilot study of a prospectively registered, assessor-blinded, 2-arm randomized controlled trial with economic evaluation. This study was performed using waiting lists of physiotherapy and rehabilitation centers and advertisements on social media networks. The participants were 65 patients with chronic musculoskeletal pain aged between 18 and 60 years. The effects of an 8-week telerehabilitation program based on exercises and pain education (intervention group) were compared with those of a program based only on a web-based self-management booklet (control group). The main outcome measures were implementation outcomes of patients' perceptions of acceptability, appropriateness, feasibility, and usability of the program and the societal costs and feasibility of the main trial at 8-week posttreatment follow-up. Adverse events were also analyzed. RESULTS: In total, 56 participants were analyzed at the 8-week follow-up. The intervention group showed responses with a mean of 4.5 (SD 0.6) points for acceptability, 4.5 (SD 0.5) points for appropriateness, and 4.5 (SD 0.6) points for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. There is satisfactory evidence for the feasibility of the main trial. For costs related to the interventions, health care, patients, and loss of productivity at 8 weeks, we found a total expenditure of US $278.30 per patient in the intervention group and US $141.52 per patient in the control group. No adverse events were reported during the intervention period. CONCLUSIONS: We found that the ReabilitaDOR program is feasible, appropriate, and acceptable from the users' implementation perspective. This system was considered usable by all the participants, and the main trial seemed feasible. Cost data were viable to be collected, and the program is likely to be safe. TRIAL REGISTRATION: ClinicalTrials.gov NCT04274439; https://clinicaltrials.gov/ct2/show/NCT04274439.

QoS-Aware Resource Allocation with Pilot-Aided Channel Estimation for Heterogeneous Wireless Networks.

The deployment of heterogeneous networks (HetNets) is a way to increase the network capacity and release part of the traffic generated by users inside a cell to small-scale wireless networks for service. In this context, the main problem is managing the interference due to the coexistence of small cells and macro cells. In this paper, a QoS-aware Resource Allocation (RA) algorithm jointly working with admission control (AC) over a two-tier HetNet scenario is investigated in the presence of both the pilot-symbols for channel estimation and the channel estimation error. The RA algorithm allows two users, the macro cell user (CU) and small cell user (SU), to simultaneously share the same resource block. Moreover, system performance and fairness are improved by including adaptive power allocation to users over resource blocks. In the framework of RA with proportional rate constraints, a novel algorithm is designed by including the effects of pilot-aided channel estimation. The algorithm is able to distribute the same proportional rate to all CUs and SUs, even in the presence of channel estimation error. Relevant numerical results for the downlink of a two-tier HetNet with pilot-aided channel estimation show that the rate dispersion is driven to zero while the sum-rate is maximized, and the average user rate penalty with respect to a perfect-CSI scenario may rise to 20%.