Standard Treatment Process Research Articles

Graph neural collaborative filtering with medical content-aware pre-training for treatment pattern recommendation

Recently, considering the advancement of information technology in healthcare, electronic medical records (EMRs) have become the repository of patients’ treatment processes in hospitals, including the patient’s treatment pattern (standard treatment process), the patient’s medical history, the patient’s admission diagnosis, etc. In particular, EMRs-based treatment recommendation systems have become critical for optimizing clinical decision-making. EMRs contain complex relationships between patients and treatment patterns. Recent studies have shown that graph neural collaborative filtering can effectively capture the complex relationships in EMRs. However, none of the existing methods take into account the impact of medical content such as the patient’s admission diagnosis, and medical history on treatment recommendations. In this work, we propose a graph neural collaborative filtering model with medical content-aware pre-training (CAPRec) for learning initial embeddings with medical content to improve recommendation performance. First the model constructs a patient-treatment pattern interaction graph from EMRs data. Then we attempt to use the medical content for pre-training learning and transfer the learned embeddings to a graph neural collaborative filtering model. Finally, the learned initial embedding can support the downstream task of graph collaborative filtering. Extensive experiments on real world datasets have consistently demonstrated the effectiveness of the medical content-aware training framework in improving treatment recommendations.

Structure and properties of samples made from XH50BMTJuB-VI (EP648-VI) alloy produced by using selective laser melting process

The paper presented examines the composition, the structure and properties of samples made from the XH50VMTJuB-VI (hereinafter EP648-VI) alloy obtained by using the selective laser melting process (the SLM-process) in relation to manufacturing parts for aviation purposes. The authors carried out a comparative study of the samples’ structure and properties upon conducting such operations as depositing in two directions (horizontal and vertical), separate heat treatment and after hot isostatic pressing (HIP) followed by a standard heat treatment process applied for deformable semi-finished products made from the XH50VMTJuB-VI(EP648-VI) alloy. The authors inform that the manufacturing of samples by means of the SLM-process involved powders obtained through the technology of the vacuum-induction spraying of the molten metal jet with an inert gas (argon). The paper has established that samples obtained by using the HIP process with the application of the heat treatment (a vacuum high-temperature homogenization followed by a long-term aging) demonstrated the best set of mechanical properties, since the implemented complex process ensured the “healing” of pores and discontinuities in the structure, and strengthening by means of the intermetallic g¢-phase, while separations of the excess, needle-shaped a -Cr phase are fine and evenly distributed in the material structure. The authors noted that mechanical properties of samples under analysis were generally in compliance with the requirements set forth in the regulatory documentation for deformable semi-finished products made from the XH50VMTJuB-VI (EP648-VI) alloy, while underlining the increase in the level of impact strength of samples that underwent the HIP process, and the long-term strength of samples manufactured in the vertical direction compared to other options studied. Following the results of the analysis, the authors established that the SLM-process made it possible to manufacture products whose level of mechanical properties was close to the level of the deformable material, and even exceeded it in some cases.

Effectiveness of an online management platform (Joint Cloud) versus standard process for patients undergoing total knee arthroplasty: study protocol for a prospective randomised controlled trial

IntroductionOsteoarthritis (OA) is one of the main causes of mobility impairment in the elderly worldwide. Therefore, total knee arthroplasty (TKA) is often performed and is one of the most successful...

Enhanced strength-ductility synergy of laser powder bed fused Inconel 718 via tailoring grain structure and precipitates

Inconel 718 fabricated by laser-powder bed fusion (L-PBF) exhibits a hierarchical microstructure, rendering traditional standard heat treatment processes not entirely suitable. To enhance the tensile properties, a novel heat treatment strategy to simultaneously tailor the grain structure and precipitates of L-PBFed Inconel 718 is proposed. This study aims to investigate the effects of homogenization time, coupled with water cooling, on grain structure, precipitation, and room-temperature tensile properties. The results demonstrate that increasing the homogenization time from 1 h to 4 h results in a significant improvement of tensile ductility by 33.7%, while maintaining higher tensile strength compared to the wrought counterparts. The utilization of water cooling following homogenization effectively suppresses the formation of undesirable δ phases and promotes the precipitation of γ′′ phases during subsequent aging treatment, leading to exceptional tensile strength. Furthermore, the prolonged homogenization time facilitates recrystallization and promotes uniform deformation between adjacent grains, thereby enhancing the material's ductility. This study provides theoretical guidance for the development of customized heat treatment processes to achieve superior mechanical properties in additive-manufactured metallic materials.

Microstructure, Mechanical and Wear Behaviour of Deep Cryogenically Treated EN 52 Silchrome Valve Steel.

This study has compared the performance of cryogenically processed EN 52 Silchrome valve steel with untreated material. After completing the standard heat treatment process, EN 52 steel material specimens are subjected to a deep cryogenic process with varying soaking temperatures. The parameters of the deep cryogenic procedure were changed to find the best wear qualities. The key features of valve steel, such as microstructure, mechanical, and wear behaviour are evaluated by conducting a test study. The evolution of wear mechanisms after enhancing qualities of EN 52 steel is studied using scanning electron microscopy. The mechanical and wear behaviour improved due to factors such as fine carbide precipitation, conversion of residual austenite, and carbide refining formed after cryogenic treatment. With a maximum reduction in wear rate of up to 45%, the deep cryogenic treatment of EN 52 steel with a soaking temperature of −140 °C was the ideal parameter. All three cryo-treated samples had better properties than the untreated EN 52 valve steel.

Stereotactic irradiation on linear accelerator - ultrasound versus MRI in choroidal melanoma volume calculation

BackgroundStereotactic irradiation is one of the treatment modalities for intraocular uveal melanoma. The study’s purpose was to describe the background of stereotactic one-day session radiosurgery, how the comparison in the difference between the tumor volume measured values from the magnetic resonance imaging (MRI) method and the ultrasound method was related to it, and which method was more precise to be used for tumor regression after irradiation.MethodsThe group of 147 patients with choroidal melanoma was treated by stereotactic irradiation on the linear accelerator with a single dose of 35.0 Gy. During the standard treatment process the uveal melanoma volumes, needed for dose calculation, were obtained using MRI from the individual stereotactic planning scheme and by ultrasound from the ultrasound device. All volumes were statistically compared using the paired t-test, and for the visualization purpose, the Bland-Altman plot was used.ResultsIn the group of patients, it was 70 (47.6%) males and 77 (52.4%) females. The tumor volume median was from MRI equal to 0.44 cm3 and from ultrasound equal to 0.53 cm3. The difference between the ultrasound and the MRI volume measured values was statistically significant. However, the Bland-Altman plot clearly documents that the two methods are in agreement and can be used interchangeably. In most of the cases, the measured values of the ultrasound-calculated volume achieved slightly higher measured values.ConclusionsThe calculation of the intraocular uveal tumor volume is a crucial part of the stereotactic irradiation treatment. The ultrasound volume measured values were in most of the cases higher than the measured values from the MRI. Although the methods are comparable and can be used interchangeably, we are recommending using the more precise MRI method not only during the treatment but also on later regular medical checks of tumor regression or progression.

D-shape optical fiber probe dimension optimization for LSPR based bio-sensor

The evanescent wave absorption based photonic sensing platform has been developed using D-shaped fiber optic probes for refractive index (RI) mediated bio-sensors. The RI sensitivity of this bare probe was established using different sucrose solutions by optimizing the active de-cladded surface area of the fiber. A linear correlation between probe sensing area and RI sensitivity was observed for different probe lengths. Further, these bare probes have been functionalized using amine (–NH2) functional groups on the air-exposed core using the standard silane treatment process. This probe was demonstrated as a localized surface plasmon resonance (LSPR) monitoring platform by immobilizing the spherical gold nanoparticles (AuNPs). The effect of D-shaped length/area on absorption sensitivity was compared with bare and LSPR probes. The biosensing property of this LSPR probe was tested using Immunoglobulin antibody (HIgG). An exponential bimolecular binding kinetic has been observed during this antigen–antibody conjugation and the limit of detection was measured (0.6 µg/mL) by varying concentrations of antigen (GaHIgG). These fiber optic LSPR probes can be integrated into an optical system to develop an evanescent wave absorption-based biosensor.

Identification of a VHL gene mutation in atypical Von Hippel-Lindau syndrome: genotype\u2013phenotype correlation and gene therapy perspective

BackgroundClassical von Hippel Lindau (VHL) disease/syndrome includes CNS hemangioblastoma, renal or pancreatic cysts, pheochromocytoma, renal carcinoma and exodermic cystadenoma. The syndrome is caused by mutation of VHL tumor suppressor gene. The most prevalent mutations are present in VHL syndrome. To date, > 500 mutations of gene related to the progression of VHL syndrome have been reported. VHL gene mutation presented in single lung or pancreatic tumor has been reported occasionally, but there is no report of both.MethodsIn this paper, we used CT scan, pathological and genetic examination methods to diagnose a rare atypical VHL syndrome.ResultsWe reported a rare case of atypical VHL syndrome with authenticated VHL mutation at p.Arg167Gln, that was associated with not only bilateral pheochromocytoma but also lung carcinoid and neuroendocrine tumor of pancreas. Based on literature reviews, the patient was recommended to be further subjected to octreotide-based radionuclide therapy.ConclusionsCombined with gene detection and clinical diagnosis, we found the inherent relationship between VHL genotype and phenotype, and constructed the standard diagnosis and treatment process of disease with rare VHL mutation from the perspective of gene therapy.

Endovascular repair of ruptured abdominal aortic aneurysms assisted by double balloon occlusion technique combined with intra-aneurysm fibrin binder injection technique

Objective: To investigate the long-term efficacy and safety of alternating double balloon occlusion combined with intra-aneurysm injection of human fibrin binder in the endovascular repair of ruptured abdominal aortic aneurysm (rAAA). Methods: The clinical data of 28 patients with rAAA admitted to Department of Vascular Surgery, the Fourth Affiliated Hospital of Guangxi Medical University from January 2015 to December 2019 were retrospectively analyzed. There were 23 males and 5 females, aged (62±5) years (range: 46 to 88 years).The maximum diameter of the tumors was (65.2±10.5) mm (range: 47.3 to 100.5 mm), all of which were subrenal rAAA. The intraoperative EVAR for abdominal aortic aneurysm was successfully performed under the emergency green channel procedure, and this surgery was assisted used the double balloon occlusion technique in aorta of inferior renal and superior renalcombined with intraoperative human fibrin binder injection technique. Observation indexes included: patients with preoperative preparation, operation time, hospitalization days, surgical treatment success rate and the incidence of postoperative complications, and aortic stent form during the follow-up period, the incidence of leakage, branch stents patency rate and infection rates. Results: The preoperative preparation time of 28 patients was (45.5±8.5) minutes (range:20 to 100 minutes). The operation time was (100.0±15.5) minutes (range:85 to 210 minutes), the ICU stay time was (7±2) days(range:1 to 17 days). The length of hospitalization was (13.5±2.5) days(range:5 to 43 days). The success rate of surgical treatment was 92.9% (26/28). Two patients died, 1 case died of postoperative multifocal lacunar cerebral infarction and massive gastrointestinal hemorrhage, and another elderly patient (84 years old) died of massive abdominal fluid due to preoperative abdominal aortic aneurysm rupture, postoperative complicated with significant abdominal compartment syndrome, and secondary multiple organ failure. Balloon occlusion of the upper renal aorta took (13±2)minutes (range:12 to 30 minutes). The intraoperative injection of fibrin adhesive was (14±2) ml(range:6 to 28 ml) in 22 cases. The incidence of major postoperative complications was 57.1% (16/28). Among the 26 patients who survived the surgery, 69.2% (18/26) completed the 3-year follow-up, and the follow-up time was (30±3) months(range:13 to 36 months). During the follow-up, the aortic stent was in good shape without obvious displacement. The incidence of leakage within 6 months after the operation was 10.7% (3/28), and there was no internal leakage in the patients who were followed up for 36 months after the operation. The patency rate of renal artery and iliac artery branch stents was 16/18. The incidence of stent infection was 7.7% (2/26), 1 case occurred at 1 month and another case at 6 months, respectively. All patients recovered after prolonged intensive anti-infection therapy. Conclusions: Under the standard emergency treatment process, the double balloon alternating occlusion technique combined with the intra-aneurysm injection of human fibrin adhesive technique can assist the successful completion of the endovascular repair of rAAA, effectively improve the success rate of treatment for patients, and reduce the incidence of postoperative leakage and serious complications. The mid-term and long-term results of EVAR for rAAA are good, safe and reliable.

Understanding whether chronic lower back pain patients with lumbar spinal stenosis benefit from multiple epidural steroid injections prior to the mild® Procedure.

Originally published in Pain Management, this article is a summary of a study performed to look at the benefit, if any, of more than one epidural steroid injection in the spine before the mild® Procedure. Minimally invasive lumbar decompression (commonly known as the mild Procedure) and epidural steroid injections are both common treatment options for lumbar spinal stenosis (commonly referred to as LSS), a condition that causes chronic lower back pain in older adults. To determine how to best treat LSS patients, healthcare professionals use a guide to help with the decision-making process (called an algorithm) to pass through non-medical to more invasive therapies that often includes one or more epidural steroid injections. An epidural steroid injection is medication inserted in the lower back to reduce swelling and provide relief from pain. Researchers wanted to look at a change to when in the treatment process the mild Procedure is carried out. In the study, researchers compared the medical records of participants who had received either just one or no steroid injection prior to the mild Procedure, to participants who received two or more epidural steroid injections prior to the mild Procedure. Similar outcomes in both treatment groups in this study proved that giving more than one epidural steroid injection prior to the mild Procedure did not improve how well patients did and may have delayed patient care. Based on the results of the study, it is recommended that the standard treatment process for LSS patients be changed to give the mild Procedure either as soon as LSS is diagnosed or after the failure of the first epidural steroid injection.

Resource recovery from liquid digestate of swine wastewater by an ultrafiltration membrane bioreactor (UF-MBR) and reverse osmosis (RO) process

Biogas production is an important method for treating manure and wastewater produced in swine farms, but the liquid digestate generated by this process poses an issue due to the high costs of both in-situ standard treatment for discharge and off-site transportation for fertilizer. Membrane technology plays an important role in combining the standard treatment process with resource recovery from liquid digestate. In this study, an ultrafiltration membrane bioreactor (UF-MBR) and reverse osmosis (RO) system was used to treat and reuse the liquid digestate produced from swine wastewater. The bioreactor component of the system was able to reduce the pH of the liquid digestate to 6.5. A dissolved oxygen (DO) concentration of 4.0 mg/L was found to lead to the highest quality of effluent. The UF component of the MBR had an obvious effect on removing suspended solids and reducing turbidity, protecting the subsequent RO membrane. Under 90% water recovery, RO permeate water was found to meet the standard requirements for discharge and reuse of the water. Higher concentrations of nutrients and humic acid were found in the RO concentrate; the fate analysis of the substances showed that the UF-MBR and RO system was not conducive to the recovery of N and P, but could be used for recovering K, Ca, Mg, and humic acid for the production of water-soluble fertilizers.

P–142 Comparison of the IVF outcome in the course of ICSI vs PICSI treatment continuation in exactly the same group of HBA abnormal patients

Abstract Study question Does the PICSI have a beneficial effect for men with abnormal HBA on the fertilization rate, blastocysts number and clinical pregnancies in the next attempt? Summary answer Patients with HBA <80% choosing to undergo PICSI after ICSI failure see an increase in blastocyst and pregnancy rates. What is known already Hyaluronic acid (HA) is a main component of cervical mucus and the extracellular matrix of cumulus cells. The formation of HA-binding sites in sperm cell membranes is one of the markers of sperm maturation indicating completion the spermatogenic process of remodelling the plasmatic membrane, cytoplasmic extrusion and nuclear maturity. Spermatozoa selected by the HA-binding technique (the physiologically selected intracytoplasmic sperm injection – PICSI) have a potentially reduced risk of chromosomal aneuploidy or DNA fragmentation. Recent evidence do not show significant benefits in using PICSI. However, it has not been analysed in the course of treatment continuation in the same patients. Study design, size, duration This was a retrospective case-control study. It included exactly the same 58 patients with abnormal HBA, who underwent IVF treatment with ICSI initially and later with PICSI, between January 2014 and October 2020 at INVICTA Fertility Centre, Poland. Median female partner age in PICSI group was 36,2±5,34, without PICSI 35,8 ±5,28. Participants/materials, setting, methods 275 cycles (130 ICSI and 145 PICSI) resulted in 793 and 897 MII respectively. Patients were also divided into two groups <80% and ≥80% depending on the obtained HBA score expressed as the percentage of sperm bound with hyaluronan. The analysis covered the fertilization rate (FR), TQ and total blastocyst rate on day 5 and clinical pregnancy rate. Patients with poor response to stimulation were excluded from the study. Main results and the role of chance FR in ICSI and PICSI groups was not significantly difference (57.00%±31.2 vs 59.87%±30.8) even when taking into account the division of patients according to the obtained HBA score. In the <80% group the FR was 57.04%±29.3 vs 59.54%±30.8 in ICSI vs PICSI group respectively. There were no significant differences when comparing the under HBA ≥80% subgroups for all analysed outcomes. Fertilization rate ​​was 56.88% in the ICSI group vs 61.03% in the PICSI group. The percentage of blastocysts was 28.61% vs 34.45% and the percentage of TQ blastocysts on day 5 was 15.32% vs 16.81% with ICSI and PICSI respectively, in the group consisting of the same patients. In the HBA <80% group significant differences were observed in the percentage of obtained blastocysts 37.81% vs 47.61% by comparing the ICSI and PICSI approaches (p < 0.05). Also, percentage of TQ blastocyst on day 5 also was higher in patients with <80% HBA score after PICSI and was statistically significant (17.07% ICSI vs 23.92% PICSI, p < 0.05). We saw statistically significant (p < 0.01) increase in percentage of clinical pregnancies from 29.03% without PICSI to 69.44% in patient’s subsequent procedures involving PICSI. Limitations, reasons for caution More data is required to confirm that improved results of PICSI procedure are consistent and possible to reproduce in a larger group – and as a result could be included as part of the standard treatment process. Wider implications of the findings: The presented results show that in patients with normal HBA score, PICSI does not bring a measurable benefit and this may be important factor to consider in decision-making for couples seeking assistance. Trial registration number Not applicable

Experimental investigation on post-processed NiCr thermal barrier coating and its sliding wear behaviour

NiCr metal is deposited on martensitic stainless steel using an atmospheric plasma spray method. To enrich the metallurgical properties of the NiCr metallic coating, a standard heat treatment process is adopted. From the investigation, it has been shown that the voids and porosity developed during the thermal spray have been controlled through heat treatment. Electron image analysis reveals that the coating has reduced porosity with strong and dense bonding strength. With reference to the surface hardness, the post-processed coating yields a maximum of 140 Hv compared with the coated (129 Hv) and base metal (115 Hv). Subsequently, the sliding wear behaviour of post-processed NiCr coating has a minimum wear of 25 μm for an applied load of 5 N and 57 μm for an applied load of 15 N. Owing to the high metallurgical bonding, the coating has sustained the heavy loads, and the wear formation is controlled. However, the base metal has an adhesive wear mechanism caused by the high frictional force on the sliding friction. Therefore, it is recommended that post-processed thermal barrier coatings possess good metallurgical bonding and withstand heavy load causing minimum wear.

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

Background: Most severe substance use disorders (SUDs) are connected with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Therapeutic communities (TCs) provide a suitable option for the treatment of severe SUDs. The relationship between ADHD, the severity of the SUD, and other comorbidities in residential TCs is unknown. Objective: To estimate the prevalence of ADHD among clients with an SUD in residential rehab, and to compare the mental health of clients with and without ADHD. Methods: A cohort study was conducted in 5 residential TCs (N = 180, 76.7% male, 53.9% 25–34 years, 79.2% diagnosed with methamphetamine use disorder). We assessed ADHD symptoms, substance use, mental health problems, and psychiatric symptoms. Results: ADHD was found in 51% of the clients who showed significantly higher scores for their psychiatric status composite score (ASI-PSY) (F = 9.08, p < 0.001; t = 5.05, p < 0.001), the positive psychiatric symptoms total (SCL-PST) (F = 3.36, p < 0.05; t = 3.15, p < 0.01), and the global severity index (SCL-GSI) (F = 3.27, p < 0.05; t = 3.18, p < 0.01). The ASI-PSY and SCL correlated significantly with the symptoms of attention deficit disorder (Pearson’s r’s = 0.30–0.42, p’s < 0.001) and the symptoms of hyperactivity disorder (r’s = 0.24–0.30, p’s < 0.01). Even when severity of substance use was accounted for, ADHD was confirmed as a significant predictor of ASI-PSY (B= 0.14, p < 0.001 for combined disorder; B = 0.20, p < 0.001 for attention disorder) and partially of SCL-PST (B = 8.12, p < 0.05 for attention disorder). Conclusions: The ADHD prevalence in TCs was nearly 10-fold compared to the globally recorded values. ADHD diagnostic procedures and interventions should become an integral part of the standard diagnostic and treatment process.

Assessment of Pain, Acceptance of Illness, Adjustment to Life, and Strategies of Coping with Illness among Patients with Gastric Cancer

Gastric cancer is the fourth leading cause of deaths in Poland. The standard treatment for non-advanced gastric cancer is surgery, which significantly reduces the quality of life of patients. The objective of the study was to evaluate the strategy of coping with pain and its control, acceptance of illness, and adjustment to living with cancer in patients suffering from gastric cancer. The analysis of the impact of socio-economic factors on the above-mentioned problems was also analyzed. The study was conducted among 93 patients diagnosed with gastric cancer, treated on an outpatient basis at the Oncology Center—Maria Skłodowska—Curie Institute in Warsaw in 2017–2018. The PAPI (paper and pencil interview) technique was used. The questionnaire interview included metric questions (socio-economic variables) and four psychometric tests: BPCQ (the Beliefs about Pain Control Questionnaire), CSQ (the Pain Coping Strategies Questionnaire), AIS (Acceptance of Illness Scale), and Mini-MAC (Mental Adjustment to Cancer) test. In the area of pain control, patients with gastric cancer assign the greatest role to internal factors (M = 16.34, SD = 4.93), although women obtained the highest value in the impact of physicians. In the area of coping with pain, patients most likely select the strategy of praying/hoping (M = 22.19, SD = 9.36). The mean value of acceptance of illness for patients with gastric cancer is M = 24.02, SD = 7.69, and it is not conditioned by any socio-economic variable. In the area of mental adjustment to illness, the highest values were obtained by positive reevaluation (M = 20.73, SD = 3.35) and fighting spirit (M = 20.68, SD = 3.98). Patients with gastric cancer control pain mainly through internal factors. The most frequently chosen strategy for coping with pain is praying/hoping, and positive reevaluation prevails in the field of mental adjustment. The results point to specific factors that can affect the patient’s pain, quality of life, and treatment outcomes. Knowing the diversity of these factors, it is possible to plan specific psychotherapeutic activities for specific groups of people that could be a supplement to the standard treatment process.

Characterization of Disinfection By-Products Levels at an Emergency Surface Water Treatment Plant in a Refugee Settlement in Northern Uganda

The reliance on chlorination in humanitarian operations has raised concerns among practitioners about possible health risks associated with disinfection by-products; however, to date, there has not been an evaluation of disinfection by-product (DBP) levels in an emergency water supply intervention. This study aimed to investigate DBP levels at a surface-water treatment plant serving a refugee settlement in northern Uganda using the colorimetric Hach THM Plus Method. The plant had two treatment processes: (1) Simultaneous clarification–chlorination (“rapid treatment”); and (2) pre-clarification and chlorination in separate tanks (“standard treatment”). For both standard (n = 17) and rapid (n = 3) treatment processes, DBP levels in unique parcels of water were tested at 30 min post-chlorination and after 24 h of storage (to simulate what refugees actually consume). DBP levels after 24 h did not exceed the World Health Organization (WHO) guideline limit of 300 ppb equivalent chloroform, either for standard treatment (mean: 85.1 ppb; 95% confidence interval (C.I.): 71.0–99.1 ppb; maximum: 133.7 ppb) or for rapid treatment (mean: 218.0 ppb; 95% C.I.: 151.2–284.8; maximum: 249.0 ppb). Observed DBPs levels do not appear to be problematic with respect to the general population, but may pose sub-chronic exposure risks to specifically vulnerable populations that warrant further investigation.

Performance Evaluation of Gravity-Fed Water Treatment Systems in Rural Honduras: Verifying Robust Reduction of Turbidity and Escherichia coli during Wet and Dry Weather.

.This is the first study to document the reduction of turbidity and Escherichia coli throughout the processes of full-scale gravity-fed drinking water plants (GFWTPs) and their downstream distribution systems in rural Honduras. The GFWTPs, which in these cases were designed by AguaClara, use standard treatment processes: coagulation, sedimentation, filtration, and chlorination. During the dry season, we measured E. coli, turbidity, and chlorine residual at five GFWTPs with < 1,000 connections and at three alternative piped-water systems in neighboring communities. Samples were evaluated from the raw water, settled water, filtered water, post-chlorination in the distribution tank, and at a distant-piped household connection. During the dry season, the treated water and household connections serviced by the GFWTPs met World Health Organization (WHO) recommendations for E. coli (< 1 most probable number [MPN]/100 mL). Alternative plants with the same water sources had comparable or higher E. coli and turbidity measurements posttreatment. We examined the performance robustness of two GFWTPs during the transition into the rainy season. The turbidity of the filtered water met WHO recommendations (< 1 nephelometric turbidity units). Escherichia coli was not detected in treated water, indicating that the two GFWTPs can consistently remove particulates and E. coli from source waters containing varying levels of turbidity. During two sampling events during the rainy season, E. coli was detected at the household connection of a GFWTP system with intermittent service and a substandard chlorine residual (geometric mean = 1.0 MPN/100 mL). Strategies to avoid contamination or inactivate E. coli in the distribution system are needed to ensure safe drinking water at the points of delivery, especially for systems with intermittent service.

Concentrations of disinfection by-products in swimming pool following modifications of the water treatment process: An exploratory study

The formation and concentration of disinfection by-products (DBPs) in pool water and the ambient air vary according to the type of water treatment process used. This exploratory study was aimed at investigating the short-term impact of modifications of the water treatment process on traditional DBP levels (e.g., trihalomethanes (THMs), chloramines) and emerging DBPs (e.g., Halonitromethanes, Haloketones, NDMA) in swimming pool water and/or air. A sampling program was carried to understand the impact of the following changes made successively to the standard water treatment process: activation of ultraviolet (UV) photoreactor, halt of air stripping with continuation of air extraction from the buffer tank, halt of air stripping and suppression of air extraction from the buffer tank, suppression of the polyaluminium silicate sulfate (PASS) coagulant. UV caused a high increase of Halonitromethanes (8.4 fold), Haloketones (2.1 fold), and THMs in the water (1.7 fold) and, of THMs in the air (1.6 fold) and contributed to reducing the level of chloramines in the air (1.6 fold) and NDMA in the water (2.1 fold). The results highlight the positive impact of air stripping in reducing volatile contaminants. The PASS did not change the presence of DBPs, except for the THMs, which decrease slightly with the use of this coagulant. This study shows that modifications affecting the water treatment process can rapidly produce important and variable impacts on DBP levels in water and air and suggests that implementation of any water treatment process to reduce DBP levels should take into account the specific context of each swimming pool.

The progression of parenteral and enteral nutrition based on new guidelines

As people are getting a better understanding of organism's metabolism and the concept of disease treatment is being continuously updated, parenteral and enteral nutrition become an inter discipline subject that serves for the clinic and involves a number of disciplines. Just in the past five years, related guidelines at home and abroad have been published as much as more than 40. In order to better serve the clinical decision making, this text attempts to give a carding and interpretation from the three aspects of nutrition screening and assessment, the implementing of nutritional intervention and the progress of special nutrition support. It is observed that the standard clinical nutrition diagnosis and treatment process has been formed consensus. But in the practical application, there are still many details need to confirm and further study.

Strategies on surgical treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common disease with contents of upper gastrointestinal tract reflux into esophagus. GERD is a frequently encountered problem in Western populations. Now, GERD is also common in China. Although the effect of proton pump inhibitor acid suppression was significant, there were complex pathogenesis of GERD and many risk factors, and patients need to increase the dose of the drug or in combination with other drugs. So more patients need surgical treatment to avoid or reduce the dose of drug treatment. Surgeons performing operation of the standardization should comprehensively understand the indications of surgery and pathogenesis of GERD, meanwhile, the standard treatment process, multidisciplinary team, follow-up and database should be built or strengthened in order to guide the treatment of GERD. Key words: Gastroesophageal reflux disease; Esophageal hiatus hernia; Fundoplication; Herniorrhaphy; Pathogenesis