Godoy and Reif comment on a study by Jennings et al concerning the transcriptional response to toxic chemicals. The study gives a comprehensive overview of transcription factors relevant for ...responses to toxic compounds. The review is of high interest to anyone studying gene expression proles and transcriptional regulation.
Municipal wastewaters contain many organic compounds, among them active ingredients as pharmaceuticals and cosmetic products, which are used in large quantities throughout the world. Most of these ...compounds come either from domestic sewage or from hospital or industrial discharges and enter municipal sewage treatment plants (STPs). Modern STPs can effectively accomplish carbon and nitrogen removal, as well as microbial pollution control. However, these plants have not been specifically designed to remove these trace polluting compounds.
The dynamics of 12 micropollutants in a membrane bioreactor (MBR) have been studied when treating synthetic sewage. These selected substances correspond to different therapeutic groups such as antiepileptics (carbamazepine), tranquillisers (diazepam), analgesics (ibuprofen, naproxen, diclofenac), antibiotics (roxithromycin, erythromycin, sulfamethoxazole, trimethoprim) and three polycyclic musk fragrances (galaxolide, tonalide, celestolide). These micropollutants are spiked into the synthetic wastewater fed to the reactor at environmentally relevant concentrations ranging from 10 to 20 μg/L.
Taking into account previous researches, the MBR is operated at a sludge retention time (SRT) of 44–72 days, since a high value of this parameter is considered as crucial for the removal of these micropollutants. Under these conditions, different fates are observed depending on pharmaceutical and personal care products (PPCPs) characteristics. Hydrophobic organic substances, like musk fragrances, are partially sorbed onto the sludge. This explains the partial removal observed in the reactor, with an overall efficiency around 50%. Other substances, like the anti-inflammatories ibuprofen and naproxen, are not sorbed but they are eliminated almost completely (98% and 84% of removal, respectively). On the other hand, substances like carbamazepine or diclofenac show a recalcitrant character and their elimination from the effluent is very limited, below 9%.
Purpose
The aim of this project was to compare patient characteristics, overall efficacy, and readmission events following operative vs non-operative management modalities of non-elective patients ...presenting with symptomatic incisional hernias.
Methods
This study is a retrospective study of patients and patient demographics that presented as non-elective hospitalizations with symptomatic incisional hernia. Analysis of patients and characteristics utilized the National Readmission Database from 2010 to Q3 of 2015, delineating patient factors and outcomes following operative or non-operative management of hernias.
Results
A total of 14,137 patients met inclusion criteria for our study. The majority of patients were treated operatively rather than non-operatively (79 vs. 21%) on their non-elective admission for incisional hernia. Those undergoing surgical management were younger (56 vs 61 years,
p
< 0.01), we more often of male gender (69 vs 64%,
p
< 0.01), and had fewer comorbidities (1.92 vs 2.97,
p
< 0.01) and chronic conditions (0.45 vs 2.68,
p
< 0.01). Patients managed operatively had a significantly lower readmission rate when compared to patients managed non-operatively (6.6 vs 14.3%,
p
< 0.01). However, non-operative management was associated with a shorter length of stay (3 vs 4 days,
p
< 0.01). Of patients who were initially medically managed and had to be readmitted, a further 61% underwent surgical treatment on their readmission.
Conclusion
In this nationwide study, patients with non-elective admissions for incisional hernia were mostly managed surgically. Those managed operatively had lower rates of readmission when compared to non-operative management. Initial non-operative management was associated with a shorter length of stay and a lower cost to the patient. The results of this study support operative management of symptomatic incisional hernia.
Life Cycle Assessment (LCA) is a methodology to generate environmental impact estimates associated with the life cycle stages of a product or process. The approach facilitates a more comprehensive ...outlook of the end-of-pipe process impacts, in which wastewater treatment plants (WWTPs) are included. Here we describe the implementation of the LCA methodology within a knowledge-based Decision support system (DSS) in order to include the environmental criteria to the decision making process when selecting the most appropriate process flow diagrams for specific scenarios. A sample group of 22 actual operating facilities in Spain, corresponding to five different typologies were assessed by two relevant impact categories within the system: Eutrophication Potential (EP) and Global Warming Potential (GWP). DSS includes useful tools that support a user in choosing a consistent, near optimum solution for an environmental impact specific problem in a reduced time frame. The synergistic combination of the two methodologies to address the design and assessment of treatment facilities can serve to identify the most sustainable options, embracing simultaneously a wide variety of analysis criteria, and enhancing the calculation of environmental savings. Results of averaged paired-comparison ratios between DSS estimates and facilities operations empirical data showed up to 70% and 95% EP and GWP, respectively. Interestingly, when unbiased operational efficiencies for existing facilities were discarded, the matching ratios increased substantially, up to 99% in both cases. The in-depth analysis of different output data gathered during the conceptual design and simulation of operating facilities using DSS identified the best performing facilities; and was used to improve the environmental performance of WWTPs, even during preliminary design of new facilities. Results demonstrated that combined LCA and DSS implementation is a suitable tool to assess WWTP design during the decision-making process. Following this procedure, a reliable interpretation and discussion of the results can be performed.
Display omitted
•The integration of an LCA has been applied to 22 WWTPs.•WWTPs were evaluated using two LCA categories: Eutrophication and Global Warming.•Matching ratios increased when unbiased operational efficiencies were discarded.•The paired-comparison allows the identification of the best performing facilities.•Combining LCA and DSS is a suitable tool to improve the decision-making.
The preliminary design and economic assessment of small wastewater treatment plants (less than 2000 population equivalent) are issues of particular interest since wastewaters from most of these ...agglomerations are not covered yet. This work aims to assess nine different technologies set-up for the secondary treatment in such type of facilities embracing both economic and environmental parameters. The main novelty of this work is the combination of an innovative environmental decision support system (EDSS) with a pioneer approach based on the inclusion of the environmental benefits derived from wastewater treatment. The integration of methodologies based on cost–benefit analysis tools with the vast amount of knowledge from treatment technologies contained in the EDSS was applied in nine scenarios comprising different wastewater characteristics and reuse options. Hence, a useful economic feasibility indicator is obtained for each technology including internal and external costs and, for the first time, benefits associated with the environmental damage avoided. This new methodology proved to be crucial for supporting the decision process, contributing to improve the sustainability of new treatment facilities and allows the selection of the most feasible technologies of a wide set of possibilities.
► Environmental decision support system embracing environmental and economic aspects ► Ranking wastewater treatment technologies for small communities according to sustainability criteria ► Environmental benefit analysis of several wastewater treatment technologies under different scenarios ► Membrane bioreactor technology is the only one with the potential to produce an effluent suitable for all analyzed scenarios.
Twenty-first century opportunities for GSI will be governed in part by a hierarchy of physical limits on interconnects whose levels are codified as fundamental, material, device, circuit, and system. ...Fundamental limits are derived from the basic axioms of electromagnetic, communication, and thermodynamic theories, which immutably restrict interconnect performance, energy dissipation, and noise reduction. At the material level, the conductor resistivity increases substantially in sub-50-nm technology due to scattering mechanisms that are controlled by quantum mechanical phenomena and structural/morphological effects. At the device and circuit level, interconnect scaling significantly increases interconnect crosstalk and latency. Reverse scaling of global interconnects causes inductance to influence on-chip interconnect transients such that even with ideal return paths, mutual inductance increases crosstalk by up to 60% over that predicted by conventional RC models. At the system level, the number of metal levels explodes for highly connected 2-D logic megacells that double in size every two years such that by 2014 the number is significantly larger than ITRS projections. This result emphasizes that changes in design, technology, and architecture are needed to cope with the onslaught of wiring demands. One potential solution is 3-D integration of transistors, which is expected to significantly improve interconnect performance. Increasing the number of active layers, including the use of separate layers for repeaters, and optimizing the wiring network, yields an improvement in interconnect performance of up to 145% at the 50-nm node.
Introduction
Inguinal hernia repair is one of the most common surgical operations, yet the optimal treatment strategy remains undefined. Treatment of symptomatic inguinal hernias include both ...surgical and non-surgical approaches. The objective of this study was to determine differences in population, readmission rates, and costs between operative and non-operative approaches for patients admitted non-electively for an inguinal hernia in a national dataset. In addition, we sought to define the baseline characteristics of the two groups and identify potential predictive factors in the non-surgically managed subgroup who were readmitted and treated operatively within 90 days of their first visit.
Methods
This study was a retrospective review of data from the Nationwide Readmissions Database (NRD) from 2010 to 2014. Patients above age 18 who were admitted non-electively for a primary diagnosis of inguinal hernia were included. Patients whose length of stay was < 1% or > 95% percentile or died during the initial visit were excluded. Readmissions within 90 days of the initial visit were flagged. Patients were classified according to initial management strategy: operative versus non-operative. Demographic, clinical, and organizational characteristics were compared between the two cohorts.
Results
14,249 patients met inclusion criteria and were operative (
n
= 8996, 63.13%) and non-operative (
n
= 5255, 36.88%) cohorts. When comparing the two groups, readmission rate was lower (0.49% for surgical, 1.78% for non-surgical,
p
< 0.01), mean length of stay (LOS) longer (3.27 SE = 0.05 days for surgical, 2.76 days SE = 0.06 for non-surgical,
p
< 0.01), and mean total cost higher ($9597 for surgical, $7167 for non-surgical,
p
< 0.01) in surgically treated patients. The non-surgical population was on average older (63.05 years for surgical, 64.52 years for non-surgical,
p
< 0.01) with more chronic conditions (3.57 for surgical, 4.05 for non-surgical,
p
< 0.01). Of the patients initially managed non-surgically, 1.78% (
n
= 91) were readmitted, and of them, 62.63% (
n
= 57) were readmitted and managed surgically within 90 days of initial admission (i.e., crossed over from watchful waiting to surgical treatment). Average number of chronic conditions (3.79 versus 4.03,
p
= 0.74), average number of comorbidities (2.26 versus 2.18,
p
= 0.87), and average total number of ICD-9 discharge codes (7.44 versus 8.23
p
= 0.54 did not differ significantly between the operative versus non-operative sample of the readmitted population. The total cost ($5562.38 versus $8737.28,
p
= 0.01) was greater in the operative versus non-operative sample.
Conclusion
Watchful-waiting strategy is the most common treatment approach in patients admitted non-electively for symptomatic inguinal hernia. Readmission after non-elective hospitalization for inguinal hernia is rare, but surgical intervention decreased the likelihood of readmission compared to non-operative management, while also increasing LOS and cost of care. Our data supports a patient centric approach to the management; non-surgical treatment is a viable temporary option even in symptomatic inguinal hernias, while surgical treatment may reduce the likelihood of future readmission.
Although cultivated hepatocytes are widely used in the studies of drug metabolism, their application in toxicogenomics is considered as problematic, because previous studies have reported only little ...overlap between chemically induced gene expression alterations in liver in vivo and in cultivated hepatocytes. Here, we identified 22 genes that were altered in livers of rats after oral administration of the liver carcinogens aflatoxin B1 (AB1), 2-nitrofluorene (2-NF), methapyrilene (MP) or piperonyl-butoxide (PBO). The functions of the 22 genes have been classified into two groups. Genes related to stress response, DNA repair or metabolism and genes associated with cell proliferation, respectively. Next, rat hepatocyte sandwich cultures were exposed to AB1, 2-NF, MP or PBO for 24h and expression of the above mentioned genes was determined by RT-qPCR. Significant correlations between the degree of gene expression alterations in vivo and in vitro were obtained for the stress, DNA repair and metabolism associated genes at concentrations covering a range from cytotoxic concentrations to non-toxic/in vivo relevant concentrations. In contrast to the stress associated genes, no significant in vivo/in vitro correlation was obtained for the genes associated with cell proliferation. To understand the reason of this discrepancy, we compared replacement proliferation in vivo and in vitro. While hepatocytes in vivo, killed after administration of hepatotoxic compounds, are rapidly replaced by proliferating surviving cells, in vitro no replacement proliferation as evidenced by BrdU incorporation was observed after washing out hepatotoxic concentrations of MP. In conclusion, there is a good correlation between gene expression alterations induced by liver carcinogens in vivo and in cultivated hepatocytes. However, it should be considered that cultivated primary hepatocytes do not show replacement proliferation explaining the in vivo/in vitro discrepancy concerning proliferation associated genes.
PDF
