Wastewater treatment plants (WWTPs) are energy-intensive facilities. Thus, reducing their carbon footprint is particularly important, both economically and environmentally. Knowing the real operating ...energy efficiency of WWTPs is the starting point for any energy-saving initiative. In this article, we applied a non-radial Data Envelopment Analysis (DEA) methodology to calculate energy efficiency indices for sampling of WWTPs located in Spain. In a second stage analysis, we examined the operating variables contributing to differences in energy efficiency among plants. It is verified that energy efficiencies of the analyzed WWTPs were quite low, with only 10% of them being efficient. We found that plant size, quantity of organic matter removed, and type of bioreactor aeration were significant variables in explaining energy efficiency differences. In contrast, age of the plant was not a determining factor in energy consumption. Lastly, we quantified the potential savings, both in economic terms and in terms of CO
2 emissions, that could be expected from an improvement in energy efficiency of WWTPs.
► Non radial Data Envelopment Analysis methodology to obtain an efficiency indicator for each of the variables in the process. ► Operating energy efficiency of WWTPs as the starting point for any energy-saving initiative. ► Assessment of energy efficiency as a measure to reduce the carbon footprint of the WWTPs. ► The role of internal and external factors in WWTP energy efficiency. ► Potential savings of CO
2 emissions and economic costs as a result of efficiency improvements.
There are no evidence‐based guidelines on pain management in people with haemophilia (PWH), who may suffer acute, disabling pain from haemarthroses and chronic arthropathic pain. To review evidence ...and to investigate current clinical practice in pain assessment and management in PWH the European Haemophilia Therapy Standardisation Board undertook a literature review and a survey in 22 Haemophilia Treatment Centres (HTC), using a questionnaire and seven clinical scenarios. Consensus was sought on pain assessment and management in PWH. Few clinical studies on pain management in PWH were identified. The HTCs care for 1678 children (47% severe haemophilia, 84% on prophylaxis, 17% with arthropathy and 8% with chronic pain) and 5103 adults (44% severe haemophilia, 40% on prophylaxis, 67% with arthropathy and 35% with chronic pain). Analgesics are prescribed by HTCs in 80% of cases (median; range 0–100%) and in 10% (median; range 0–80%) are bought over the counter. Pain and analgesic use are assessed when reported by patients and at check‐ups. Only eight centres use a specific pain scale and/or have specific pain guidelines. Two HTCs arrange regular consultations with pain specialists. For acute pain, the preferred first‐line drug is paracetamol for children, and paracetamol or non‐steroidal anti‐inflammatory drugs (NSAIDs) for adults. Children with chronic pain are treated with paracetamol or NSAIDs, whereas adults usually receive Cox‐2 inhibitors. Second‐line therapy is heterogeneous. There is little published evidence to guide pain assessment and management in PWH, and clinical practice varies considerably across Europe. General and specific recommendations are needed.
A study is made to evaluate the bioaccessibility of heavy metals in contaminated soils through a simple bioaccessibility extraction test (SBET), applied to the analysis of both the gastric and ...intestinal phases. Soils with high metal content of the Mapocho, Cachapoal, and Rancagua series were studied; they are located in suburban areas of large cities in the central valley of Chile. The bioaccessible concentrations of Cd, Cr, Cu, Ni, Pb, and Zn were related to the main physicochemical characteristics of the soils and to the chemical forms obtained by sequential extraction.
The elements Cd, Cu, Ni, and Zn are distributed in the soils between the exchangeable fractions, bound to oxides, to organic matter, and in the residual fraction. On the other hand, Cr and Pb are found mainly in the fractions bound to organic matter and in the residual fraction. The three soils have a high Cu content, (640–2060 mg/kg), in the order Cachapoal > Rancagua > Mapocho. The SBET test allowed establishing a different bioaccessibility for the elements in the soil. Cu was notoriously bioaccessible in both the gastric and intestinal phases in the three soils, reaching more than 50% in the Cachapoal and Rancagua soils. The other elements, regardless of the soil, were bioaccessible only in one of the phases, more frequently in the gastric phase. The multiple correlation study indicates that the metal forms have a higher incidence than the soil’s physicochemical factors on the extractability to evaluate the human oral bioaccessibility of the metals.
•SBET allows evaluating the gastric and intestinal bioaccessibility of metal in soils.•Copper is highly bioaccessible in gastric and intestinal phase of contaminated soils.•Chemical form of the metal has a remarkable impact on the bioaccessibility in soils.
ABSTRACT
Stellar pulsation is a common phenomenon and is sustained because of coherent driving mechanisms. When pulsations are driven by heat or convective mechanisms, it is usual to observe ...combination frequencies in the power spectra of the stellar light-curves. These combination frequencies are not solutions of the perturbed stellar structure equations. In dense power spectra from a light-curve of a given multiperiodic pulsating star, they can compromise the mode identification in asteroseismic analyses, and hence they must be treated as spurious frequencies and removed. In this paper, a method based on fitting the set of frequencies that best describes a general non-linear model, like the Volterra series, is presented. The method allows these frequencies to be extracted from the power spectrum, thereby improving the frequency analysis and enabling hidden frequencies to emerge from what was initially considered as noise. Moreover, the method yields frequencies with uncertainties several orders of magnitude smaller than the Rayleigh dispersion, which is sometimes used as if it were an error when identifying combination frequencies. Furthermore, it is compatible with the classical counting cycles method, the so-called O-C method, which is valid only for mono-periodic stars. The method creates the possibility of characterizing the non-linear behaviour of a given pulsating star by studying in detail the complex generalized transfer functions on which the model is based.
In this study, the effect of a partial substitution of peat for compost on the growth and nutrition of a native shrub (
Pistacia lentiscus L.) was tested. Composts were prepared from pruning and ...municipal solid wastes or pruning waste and sewage sludge. For preparing growing media each compost was added at a rate of 40%, fresh pine bark at 20% or 40% and peat at 20%, 40% or 60%. Aqueous extracts from the substrates did not impair germination of cress (germination bioassay). In relation to plants growing in peat-based substrate (used as a control), plants of the compost-based substrates reached better growth and nutrition, especially when using the sewage sludge-based compost, and the P uptake was notably enhanced. The concentrations of trace elements were far lower than the ranges considered phytotoxic for vascular plants. Detrimental effect derived from using fresh pine bark was not observed.
Bloodstream infection (BSI) is a serious complication in immunocompromised hosts. This study compares epidemiological, clinical and microbiological characteristics of BSI among children with ...haematological malignancies (HM) and solid tumours (ST). The study was conducted from October 2012 through to November 2015 at a referral hospital for cancer care and included the first BSI episode detected in 210 patients aged 18 years or less. BSI cases were prospectively detected by daily laboratory-based surveillance. The Centers for Disease Control and Prevention definitions for primary or secondary BSI were used. A higher proportion of use of corticosteroids (P = 0.02), chemotherapy (P = 0.01) and antibiotics (P = 0.05) before the BSI diagnosis; as well as of neutropenia (P < 0.001) and mucositis (P < 0.001) at the time of BSI diagnosis was observed in patients with HM than with ST. Previous surgical procedures (P = 0.03), mechanical ventilation (P = 0.01) and bed confinement (P < 0.001) were more frequent among children with ST. The frequency of use of temporary (P = 0.01) and implanted vascular lines (P < 0.01) was significantly higher in children with ST than with HM while the tunnelled line (P = 0.01) use was more frequent in children with HM as compared to ST. Most (n = 181) BSI cases were primary BSI. BSI associated with a tunnelled catheter was more frequent in children with HM (P < 0.01), whereas BSI associated with an implanted (P < 0.01) or temporary central line (P < 0.02) was more common in patients with ST. BSI associated with mucosal barrier injury was more frequent (P = 0.01) in children with HM. Indication for intensive care was more frequent in children (P = 0.05) with ST. Mortality ratio was similar in children with ST and HM, and length of hospital stay after BSI was higher in patients with HM than with ST (median of 19 vs. 13 days; P = 0.02). Infection caused by Gram-negative bacteria (P = 0.04) and polymicrobial infections (P = 0.05) due to Gram-positive cocci plus fungus was more common in patients with HM. These findings suggest that the characteristics of BSI acquisition and mortality can be cancer-specific.
Objective
This study was undertaken to report clinical presentations and outcomes of CASPR2‐IgG‐associated seizures.
Methods
Mayo Clinic Neuroimmunology database was queried to identify ...CASPR2‐IgG‐seropositive (CASPR2‐IgG+) patients evaluated at our institution (2009–2019).
Results
Of the 53 CASPR2‐IgG+ patients (titer ≥ 1:10), 20 had seizures (38%). All seizure patients were male, with median onset age of 68 years. Eighteen (90%) had seizures at initial presentation. One patient was found to have malignancy (colon adenocarcinoma). Two patients had coexisting LGI1‐IgG. Twelve patients had archived sera, which on titration had CASPR2‐IgG titers ≥ 1:100. Fifteen patients (75%) met criteria for autoimmune encephalitis. Patients most commonly presented with focal onset, nonmotor seizures with impaired awareness (n = 14, 70%). Eleven patients also had focal motor and/or sensory seizures as one of the seizure semiologies. The majority of patients (n = 11, 55%) developed generalized tonic–clonic seizures during their disease course. Seizure clusters occurred in 12 patients. In addition to seizures, patients developed cognitive disturbance (n = 16, 80%), episodic emotional lability (n = 13, 65%), paroxysmal dizziness (n = 9, 45%), episodic ataxia (n = 6, 30%), and chronic ataxia (n = 9, 45%). Only three patients (15%) had coexisting peripheral nervous system involvement. Frontotemporal or temporal ictal and/or interictal electroencephalographic abnormalities were present among nine patients, and three had multifocal epileptiform abnormalities. Eight patients (40%) had medial temporal T2/fluid‐attenuated inversion recovery hyperintensity on brain magnetic resonance imaging. Elevated cerebrospinal fluid protein and/or lymphocytic pleocytosis was present in most cases (13/14, 93%). Thirteen patients reached seizure freedom following initiation of antiseizure medication (ASM; n = 4) or a combination of immunotherapy and ASM (n = 9). Median duration of follow‐up was 25 months (range = 2–136 months).
Significance
CASPR2‐IgG evaluation should be considered among older male patients with new onset focal seizures and impaired awareness often occurring in clusters with/without features of encephalitis. Coexisting neurological manifestations, including episodic emotional lability, ataxia, and paroxysmal dizziness, also aid in the diagnosis.
The aim of this paper is to provide a methodology for a better understanding of the cost structure of wastewater treatment processes. This methodology may be useful in the planning of new facilities. ...The existing models in the literature are focused on the influence of the capacity of plant, expressed as inhabitants or flow rate, on the cost of treatment. We propose a new approach for the operating cost function that includes the most representative variables in the process. The idea is that the modelling of treatment costs enables us to understand the key role of the economies of scale in this context; and also the influence of other variables such as contaminants removed, or the age of the facility. The calculation of these extended cost functions also enables a detailed comparison to be made of the various treatment technologies from an economic point of view. In this sense, an extensive knowledge of the structure of the costs associated with each of the available treatment technologies is a basic issue in the planning of treatment processes and water reuse projects. This research applies a cost modelling methodology using statistical information from a sample of 341 wastewater treatment plants in Spain.
►Cost modeling provides a better understanding of the cost structure of WWTPs. ►This methodology is useful in the planning of new facilities. ►It enables to compare different treatment technologies from an economic point of view. ►A new approach including the most representative variables in the treatment process.
Water reuse is an emerging and promising non-conventional water resource. Feasibility studies are essential tools in the decision making process for the implementation of water-reuse projects. ...However, the methods used to assess economic feasibility tend to focus on internal costs, while external impacts are relegated to unsubstantiated statements about the advantages of water reuse. Using the concept of shadow prices for undesirable outputs of water reclamation, the current study developed a theoretical methodology to assess internal and external economic impacts. The proposed methodological approach is applied to 13 wastewater treatment plants in the Valencia region of Spain that reuse effluent for environmental purposes. Internal benefit analyses indicated that only a proportion of projects were economically viable, while when external benefits are incorporated all projects were economically viable. In conclusion, the economic feasibility assessments of water-reuse projects should quantitatively evaluate economic, environmental and resource availability.
► The shadow price methodology is a pioneering approach to quantify the environmental benefit associated with avoiding the discharge of pollutants. ► This approach is based on the directional distance functions and represents an alternative to conventional methods of economic valuation. ► The methodology proposed in this paper allows the assessment of external economic impacts of water-reuse projects. ► The economic valuation of externalities is a very relevant issue in order to carry out realistic feasibility studies of water-reuse projects.
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