Improved nitrogen removal efficiency by implementation of intermittent aeration.

The aim of the paper was to verify the possibility of using intermittent aeration to decrease outflow total nitrogen concentrations in municipal WWTPs of different capacities (15,780, 23,000 and 806,250 PE). A simple time-based intermittent aeration control was used in the experimental work. The results of WWTPs are compared with each other and with literature sources. The use of intermittent aeration led to a significant decrease of outflow total nitrogen concentration by up to 57% without the need of additional investment costs or the increase of operating costs. Nitrification kinetic tests and fluorescence in-situ hybridization observations proved that intermittent aeration has no negative impact on nitrifiers. The results proved that it is possible to utilize intermittent aeration for treatment plants initially designed with permanent aeration of nitrification sections if the current load is lower than the designed capacity. A necessary prerequisite for successful implementation of intermittent aeration is sufficient blower power. Although the time-based control is very simple and inexpensive to implement, the results are comparable to more complex systems such as systems based on rule-based systems for N-NH4+ and N-NO3- concentrations, on fuzzy logic or on mathematical models.

Commissioning of the new water line of the Central wastewater treatment plant in Prague and its impact on the operation of the existing water line.

This paper describes the commissioning of the new water line (NWL) of the Central wastewater treatment plant in Prague and also the gradual reduction of the existing water line (EWL) loading. Concerning the NWL, the gradual start-up of the process without inoculation will be described. As to the EWL, the presentation describes the adaptation of the EWL operation to the relatively quick reduction of loading to approximately 35%.

[Diagnosis of sleep apnea syndromes at the Medical School Hospital in Hradec Kralove]. / Diagnostika syndromu spánkové apnoe ve Fakultní nemocnici v Hradci Králové.

The authors present a short review of complex diagnostic procedure of sleep apnea syndrome in Hradec Králové Faculty Hospital.

Shame and suicide in Sophocles' Ajax.

This paper explores the vicissitudes of shame and its relation to narcissistic rage and escalation of conflict in Sophocles' Ajax. The plot is set in motion by Ajax's shame over losing the competition with Odysseus for Achilles' armor. His shame leads to narcissistic, rage and propels him to vengeance against the social order. Misidentification, an aspect of narcissistic rage, compounds his disgrace by escalating his shame to suicidal proportions when his madness leaves him. His defenses all fail, and his suicide becomes inevitable. Forces that bind him to the social order lose out to those that make of him a humiliated outcast and drive him to kill himself.

Nightmares of a hospitalized rape victim.

The author presents case material, including nightmares, of a recently raped female psychiatric inpatient. The material shows dream dynamics that include latent content, dreamwork, secondary revision, and unconscious wishes that attempted to deal with this woman's sense of fragility, guilt, and especially shame. The author suggests that such dreams deal not simply with the trauma of forced sexual contact, but also with the coexisting fear and humiliation related to the risk of being murdered; with preexisting trauma that amplifies the shame and guilt; and with the anticipation of retraumatization during heightened posttraumatic vulnerability. Although conclusions from a single case cannot be generalized to all rape victims, a close examination of the clinical data suggests that treatment needs go far beyond consideration of the traumatic event in isolation.

Quality improvement programs: alternative rewards.

As the trend continues toward pay for quality in the health care arena, interested organizations will doubtless recognize that pay-for-quality programs reinforce quality values, clarify communications in the organization, and generally support the culture's expectation of compensation for excellence. However, various stakeholders in the industry may have some skepticism, which will be overcome only through careful education and communication of the plan. An overview of the intrinsic issues and opportunities for alternative means to compensate and reward health care professionals and a case study of one hospital's implementation illustrate the typical benefits of quality-based pay for health care institutions and their nursing professionals.

The transformation of affect in posttraumatic nightmares.

The author questions the classical psychoanalytic assumptions that anxiety in posttraumatic nightmares arises from the same conflict represented in the manifest content of the nightmare, that such nightmares have no latent content, and that the day residue is insignificant. Such assumptions obscure the function of these nightmares, in which the dreamwork transforms shame into fear. Case material from two patients highlights the instigating role of posttraumatic dissociative states and shame in the day residue of posttraumatic nightmare sufferers. The author also emphasizes that conflict in the latent dream thoughts differs from that represented in the manifest content.

Flashback as screen memory.

The authors report a series of flashbacks of a combat patient's experience 18 years earlier. The flashback episodes occurred immediately after the patient's humiliating job loss. The man had no symptoms of delayed stress and no history of drug or alcohol abuse. The wartime memory served an obvious screening function by diminishing the impact of the patient's narcissistic injury just preceding the onset of the flashback sequence. The flashbacks also screened childhood and adolescent conflicts activated by the job loss.

Exploration of nightmares in hospital treatment of borderline patients.

A clinical investigation of nightmares enhanced the psychotherapy of many hospitalized borderline patients. Early familial trauma, prominent in the latent content of the nightmares, predisposed these patients to adult dysfunction or to a maladaptive response to subsequent trauma. The hospital ward's emphasis on intergenerational family therapy and the well-integrated holding environment helped offset distress in patients resulting from the upsurgence of conflictual material latent in their nightmares, whether or not they were posttraumatic. The authors present illustrative cases.

Post-traumatic nightmares and the family.

The authors conducted a systematic investigation of nightmares in consecutive admissions to an inpatient unit at a Veteran Administration hospital for a six-month period. Fifteen of the 41 nightmare sufferers identified their nightmares as post-traumatic. Examination of the nightmares in the light of family histories revealed that familial dysfunction from many points in the nightmare sufferers' life histories found clear-cut representation in the nightmare scenario. In this sample, post-traumatic nightmares dealt not only with the identified trauma, but also with a lifelong continuum of family stresses for which the traumatic scene served as a screen.

The subacute hospital treatment of the borderline patient: III. Management of suicidal crisis by family intervention.

A family approach to suicidal crises in hospitalized borderline patients is described. The approach is aimed not only at the acute crises, but at the likelihood that repetitive, panic-inducing suicidal episodes provoke shame-producing over-regulation in the short run or exhaustion of support systems (family and treatment team) in the long run. An emergency family session with a hospitalized patient in acute suicidal crisis is presented. Subacute hospital treatment must respond to these crises mindful of long-term as well as acute risks. Subacute hospitalization allows for family intervention to buttress support systems for the long term task of caring for the suicidal borderline patient.

The subacute hospital treatment of the borderline patient. II: An integrated focus on splitting.

A psychiatric inpatient unit with expertise in family treatment has developed an integrated effort to provide a one to three month treatment program for hospitalized borderline patients. Treatment goals are more ambitious than those obtainable by simple crisis intervention. Appreciation of staff splitting is enhanced by an intergenerational family systems approach. Early and sustained focus on splitting is aided by the use of a 15 minute educational tape and a weekly therapy group required for all nonpsychotic patients and recommended for their families. Cases illustrating the family perspective and a group therapy session are presented in detail. The therapy group, run by an interdisciplinary team (the authors) requires active staff initiative and confrontation to avoid responsibility-evading patient coalitions. Diagnostic considerations and impact of the program on patients and on staff are discussed.

The subacute hospital treatment of the borderline patient--I: An educational component.

Failure to begin the hospital treatment of the "borderline" patient with a formulation of the problems requiring hospitalization is an indication of a lack of integration in the staff's view of the patient's pathology. This failure may dovetail with a basic lack of integration in the patient's personality and recapitulate similar confusion and inconsistency within that patient's family. A 15-minute educational tape about "borderline" illness has been used to enhance integration and formulation of problems by staff and patients in a hospital setting in which stay is limited to one or two months. The program is described, and the taped programs included. "Self-regulatory disorder" is preferred to "borderline personality disorder." After one year's experience with the program, the staff has been better able to formulate difficulties in clinical discussions with patients and their families. The staff has noted a clearcut reduction of disruptive impulsive action in this population of hospitalized nonpsychotic patients.

Right on the money: disability forms and the hospitalized borderline patient.

Handling of the hospitalized borderline patient's request for disability compensation reflects the therapists's success or failure in keeping a sustained focus on splitting. This focus is crucial to the subacute hospital treatment of borderline psychopathology. Overprotectiveness or withholding of appropriate support results from countertransference reactions. Splitting is reinforced rather than minimized if the therapist fails to focus both on the damaged and overwhelmed aspect of the personality (how the patient feels) and on the irresponsible and manipulative aspect (what the patient does). The therapist who fails to respond to the disparate aspects in an integrated way risks acting out key aspects of the clinical picture to the detriment of successful subacute hospital treatment. The therapist's awareness of typical patterns of splitting can be enhanced by considering the patient's developmental history; current familial and vocational relations (or lack of them); and the patient's relation to the hospital staff.

Preoccupation as a mode of pathologic distance regulation.

This paper describes a defensive pattern, pathologic preoccupation, that is used to hide emotional absence under a mask of rationalization, in regard to loyalties outside the family. Observations and clinical data drawn from both individuals and families are used. The emphasis is on preoccupation as a transpersonal process of defense and on the resistances to treatment that result. The patient's struggle with the past against identification derives from representations of the family of origin in which the same-sex parent figures as an object of contempt or shame. Pathologic distance regulation must be understood through the manifest defensive operation of narcissistically vulnerable persons, that is, by the nature of binding and unbinding that occurs among real people, not just in fantasy.

Priapism associated with trazodone therapy: case report.

A case of priapism associated with trazodone is described. Erection subsided spontaneously after 4 hours, with subsequent potency unimpaired. No published reports of priapism with antidepressants were located, but 11 cases have been reported to the manufacturers.