Treatment Facilities Research Articles

Combat-Relevant Anesthesia Fellowships Help Sustain the Army’s Multidomain Medical Force

ABSTRACT In the community of Army Nurse Anesthetists, there is an underutilized potential for Combat-Relevant Fellowship training that, if enthusiastically encouraged and taken advantage of, would proffer many benefits to the Military Health System and the beneficiaries of its care. Most importantly, increased access to and encouragement for participation in these fellowships for Nurse Anesthetists would act as a tool for skill sustainment, denying any potential for skill degradation or readiness gaps in preparation for the next-generation war. These fellowships would also augment the already robust breadth, quality, and safety of Army Nurse Anesthetists’ combat and noncombat anesthesia care, potentially increase Return-To-Duty rates, potentially expedite casualty clearance of the battlefield, increase the often-limited access to advanced pain management care for chronic pain patients in Military Treatment Facilities, increase the retention rates of Nurse Anesthetists, augment the military anesthesia community’s knowledge-base, and help to advance the art of anesthesia as a whole. To triumph against the anticipated rigors of the future war’s multidomain operational environment, we are duty bound to continually improve and strive to be the best versions of ourselves as soldiers, as professionals, and as communities. This paper will explore the untapped utility of Combat-Relevant Fellowships for Army Nurse Anesthetists.

Design and computational analysis of a novel Azurin-BR2 chimeric protein against breast cancer.

Cancer is one of most lethal diseases worldwide. Chemotherapeutics and surgeries are among the treatment facilities available for curing cancer. However due to their negative impact on normal cells and drug resistance development, new treatment strategies have yet to be developed. Some microbial products exhibit therapeutic potential for treating cancer. Pseudomonas aeruginosa Azurins have shown anticancer effects against breast cancer without affecting normal cells. To enhance its cytotoxic effect and targeted delivery, we fused Azurin with a cell-penetrating peptide (BR2) through a rigid linker and evaluated its anticancer potential via in silico analysis. The prediction of the secondary and the tertiary structures and analysis of physiochemical properties of chimeric proteins were computationally performed. The Azurin-BR2 chimeric protein has a basic nature with a molecular weight of 16.8kDa. The quality indices and validation of chimeric proteins were performed with ERRAT2 and Ramachandran plot values, respectively. The quality index of the chimeric protein was predicted to be 81% to 84.6%, and residues residing in the most favoured region were identified. The HDOCK bioinformatics tool was used for docking a chimeric protein with a cancer suppressor protein p53. The results of the current study support that an Azurin-BR2 fusion protein has a high binding affinity for p53 can induce apoptosis in cancerous cells, and can be used in tumor-targeting therapy.

An Optimization Framework for Waste Treatment Center Site Selection Considering Nighttime Light Remote Sensing Data and Waste Production Fluctuations

As urbanization accelerates, the management of urban solid waste poses increasingly intricate challenges. Traditional urban metrics, such as GDP and per capita consumption rates, have become inadequate for accurately reflecting the realities of waste generation; moreover, the linear correlation between these metrics and waste production is progressively diminishing. Consequently, this study introduces a novel methodology leveraging nighttime light remote sensing data to enhance the precision of urban solid waste production forecasts. By processing remote sensing data to mitigate noise and integrating it with conventional urban datasets, an innovative index system and predictive model were developed. Using Beijing as a case study, the gradient boosting regression algorithm yielded a prediction accuracy of 92%. Furthermore, in light of the substantial costs associated with waste recovery route planning and site selection for treatment facilities, this research further devised a location and distribution framework for waste treatment centers based on high-precision predictions of waste production while employing multi-objective evolutionary algorithms (MOEAs) alongside the non-dominated sorting genetic algorithm II (NSGA-II) for optimization. Distinct from prior studies, this study suggests that service point waste quantities are not fixed values but rather adhere to a normal distribution within specified ranges and thus provides a more realistic simulation of fluctuations in waste production while enhancing both the robustness and predictive accuracy of the model. In conclusion, by incorporating nighttime light remote sensing data along with advanced machine learning techniques, this study markedly improves forecasting accuracy for waste production while offering effective optimization strategies for site selection and recovery route planning—thereby establishing a robust data foundation aimed at refining urban solid waste management systems.

Clinic-Level Predictors of Psychotherapy Dosage in the Military Health System.

This study aimed to describe the demand for, supply of, and clinic processes associated with behavioral health care delivery in the Military Health System and to examine the clinic-level factors associated with receipt of a minimally adequate dosage of psychotherapy. This retrospective study used administrative behavioral health data from eight military treatment facilities (N=25,433 patients; N=241,028 encounters) that were participating in a larger implementation study of evidence-based psychotherapy for posttraumatic stress disorder. Minimally adequate dosage of psychotherapy was defined in two ways: at least three sessions within a 90-day period and at least six sessions within a 90-day period. The authors then used a path model to examine clinic-level factors hypothesized to predict psychotherapy dosage, including care demand, supply, and processes. Patients had an average of 2.5 psychotherapy appointments per quarter. Wait times for intake, between intake and the first psychotherapy session, and between follow-up sessions all averaged 17 days or longer. Path modeling showed that a higher patient-to-encounter ratio was associated with a longer wait time between follow-up psychotherapy appointments. In turn, a longer wait time between appointments was associated with a lower probability of receiving an adequate dosage of psychotherapy. However, a greater proportion of care delivered in groups was associated with a greater probability of receiving at least six sessions of psychotherapy. Receipt of a minimally adequate dosage of psychotherapy in the Military Health System is hindered by clinic staffing and workflows that increase wait times between follow-up psychotherapy appointments.

Enhancing Expert Decision-Making for Wastewater Treatment Plants with Seidel Laplacian Energy and Cosine Similarity Measure in Intuitionistic Fuzzy Graphs

Wastewater treatment facilities’ main goal is to protect the public and environment from the hazardous and poisonous materials found in wastewater. Water treatment facilities were developed to speed up the natural process of cleansing water. A novel cosine similarity measure across intuitionistic fuzzy graphs has been proven to be more effective than certain present ones in group decision-making issues using example verification. This paper provides a unique approach for calculating expert-certified, well-known scores by finding the ambiguous information of intuitionistic fuzzy preference relations as well as the regular cosine similarity grades from one separable intuitionistic fuzzy preference relation to another. The new technique considers both "objective" and "subjective" information provided by experts. Using intuitionistic fuzzy preference relations, we provide workable techniques for judging experts’ eligible reputational ratings. This can be used to raise or decrease the relevance of the stated criteria in an evaluation that takes into account several competing elements. We give a solution to a decisional problem by using two effective methods: the newly constructed cosine similarity measure and the Seidel Laplacian energy (SLe+) of an intuitionistic fuzzy graph. Finally, two working procedures and circumstances are offered to show the effectiveness and superiority of the proposed techniques.

Regulated 1-2 Carbon Disinfection Byproducts do not Correlate with Cytotoxicity with Increasing Disinfectant Contact Time During Chlorination, Chlorination Followed by Chloramination or Granular Activated Carbon Followed by Chlorination.

Regulations typically use four trihalomethanes (THM4) and five haloacetic acids (HAA5) as metrics of consumer exposure to disinfection byproducts (DBPs) and their chronic health risks. Their use as exposure metrics assumes that their concentrations correlate with DBP-associated toxicity. For a chlorine-disinfected surface water, this study demonstrates that increasing chlorine contact time from 1 to 7 days was associated with a 62-76% increase in THM4 and HAA5 but a 40-47% decrease in total cytotoxicity. Thus, the use of THM4 and HAA5 may divert regulatory attention away from the low water age sections of distribution systems near treatment facilities that may feature the highest cytotoxicity but lowest THM4/HAA5 concentrations. Among common options to reduce THM4/HAA5, this study also shows that chlorine disinfection followed by chloramines for maintaining a distribution system residual did not substantially reduce cytotoxicity. Granular activated carbon followed by chlorine reduced cytotoxicity by 28-80%, even at the lowest water ages where cytotoxicity was maximized. These findings highlight the need to identify DBPs that better correlate with toxicity than THM4/HAA5 to serve as metrics of exposure. These metrics could help identify distribution system locations exhibiting higher consumer risk and develop modifications to disinfection systems that effectively reduce consumer risk.

Prevalence of diarrhoea and treatment-seeking practices among children

Estimating the proportion of children with diarrhoea and those who are taken in as inpatients or outpatients is important for policy planning, resource allocation, and to evaluate the effectiveness of diarrhoea prevention and control interventions. We aimed to estimate the proportion of children <2 years of age with diarrhoea, explore their treatment-seeking practices, and identify factors associated with both diarrhoea and treatment seeking. We designed a longitudinal study based on a sample of children <2 years of age in the Birhan field site from September 2018 to September 2019. The study site collected data on child mortality and morbidity and treatment-seeking practice for those with a history of illness every three months. Mothers/caregivers were asked about signs or symptoms of illnesses for a two-week period prior to each study visit. We estimated the proportion of children <2 years of age with diarrhoea and treatment-seeking practices for each of the four rounds of data collection and identified associated factors through bivariable and multivariable logistic regression. We enrolled 4678 children <2 years of age. The proportion of children with diarrhoea was the highest from 11 September 2018 to 9 December 2018 (4.47%; 95% confidence interval (CI) = 3.70-5.35) and the lowest from 10 December 2018 to 9 March 2019 (2.48%; 95% CI = 1.90-3.19). Children from households with chlorinated drinking water had a 50% (adjusted odds ratio (aOR) = 0.50; 95% CI = 0.28-0.88) lower odds of developing diarrhoea compared to those who did not. Among 339 children with diarrhoea, 275 (81.12%; 95% CI = 76.54-85.15) were taken to health facilities for treatment. Female children had lower odds of being taken to health facilities for treatment (aOR = 0.37; 95% CI = 0.17-0.80) compared to males. While the proportion of children with diarrhoea in our study was lower than that observed in prior research conducted in Ethiopia, treatment-seeking practices were higher. Female children and children from the poorest families had lower odds of treatment. We recommend more studies to explore gender-based and socioeconomic differences affecting treatment-seeking practices.

Environmental Protection for Bureaucratic Promotion: Water Quality Performance Review of Provincial Governors in China

We show including quantitative environmental targets for bureaucratic promotion incentivizes government officials to enforce environmental regulation but at significant economic costs. Taking advantage of the gradual expansion of China’s water quality performance review (WQPR) over time and space, we find that WQPR significantly reduced ambient concentrations of criteria pollutants, digestive cancer mortality, and GDP growth rate. WQPR’s effects are more pronounced along provincial borders, which are targeted by WQPR, and when provincial governors have more promotion potential. An important mechanism is investment in wastewater treatment facilities. There is evidence that WQPR passed the benefit-cost test, especially in rural areas.

Environmental and economic assessment of urban wastewater reclamation from ultrafiltration membrane-based tertiary treatment: Effect of seasonal dynamic

This study aimed to assess the environmental and economic performance of an ultrafiltration (UF) tertiary treatment of effluent from an urban wastewater treatment facility. Data from a UF demonstration plant composed of commercially available equipment, including industrial hollow-fiber membranes was used to project a full-scale facility. The results from the demonstration plant recommended different ranges of transmembrane fluxes and sparging air demands under summer and winter conditions to prevent excessive fouling. The energy balance of the full-scale facility would be 0.308 ± 0.112 kWh·m−3 in summer and 0.140 ± 0.040 kWh·m−3 in winter, with blowers' being the main consumers (86–93 %). CAPEX accounted for €0.030 ± 0.002·m−3 in summer and €0.027 ± 0.002·m−3 in winter and membrane acquisition represented 66–69 % of the investment cost. Energy expenditure was the major OPEX cost (66–79 %), with a total operating cost of €0.077 ± 0.023·m−3 and €0.042 ± 0.008·m−3 in summer and winter, respectively. The final average value obtained for the TAC was €0.107 m−3 in summer and €0.068 m−3 in winter. The environmental assessment confirmed optimizing energy consumption and membrane requirements as the main factors influencing environmental sustainability. Specifically, summer and winter emissions of 0.079–0.175 and 0.043–0.079 kgCO2eq·m−3 (Global warming potential); 8.1 · 10−4–1.7 · 10−3 and 4.8 · 10−3–8.1 · 10−3 m3·m−3 (water consumption); 0.019–0.041 and 0.010–0.019 kg oileq·m−3 (fossil fuel scarcity); and 1.4 · 10−4–2.9 · 10−4 and 7.7 · 10−4–1.4 · 10−4 kg Cueq·m−3 (mineral resource scarcity) were calculated, respectively. The obtained permeate quality complied with the most stringent Spanish and EU regulations.

Dynamics of soluble salts in cooling systems of circulating water supply

A model of the dynamics of soluble salts in the water of cooling systems of circulating water supply was developed based on mass balance principles. The proposed model is expressed in a general form under the assumption of a constant volume of circulating water and non-stationary input and output flows. The model accounts for scenarios where the concentration of soluble salts exceeds their concentration in the circulating water, thereby considering the technological necessity to change the system's power source in the event of an emergency at the feedwater treatment facilities. The developed model enables accurate prediction of the water-chemical regime in both existing and new recirculating cooling systems, sufficient for engineering calculations. It also facilitates the selection of optimal management strategies for such systems, including stabilization methods for recirculating water, feedwater preparation, blowdown volumes, etc. The model was validated under laboratory conditions for cases of concentration and dilution of highly soluble NaCl salt, with an observed error margin not exceeding 2%, attributed to experimental and instrumental factors. The variation in the concentration factor was analyzed for different blowdown rates, assuming initial equality of soluble salt concentrations in feedwater and circulation water. It was shown that establishing dynamic equilibrium between the circulation and feed waters can require dozens or even hundreds of circulation cycles for blowdown rates of 1–4%, and this system inertia must be considered during operation and when forecasting the performance of cooling systems with circulating water supply.

Medicaid expansion and medications to treat opioid use disorder in outpatient specialty care from 2010 to 2020

IntroductionMedications for opioid use disorder (MOUD) are considered the first line treatment for opioid use disorder. As states expanded Medicaid beginning in 2014 under the Affordable Care Act, policymakers and public health officials were interested in the potential for expansion to increase access to MOUD. This study examined whether there were changes in MOUD use within outpatient admissions to specialty treatment facilities in Medicaid expansion states beyond the initial expansion period. MethodsAnalyses were conducted using 2010–2020 data from the Treatment Episode Data Set – Admissions. For states that expanded Medicaid prior to 2015, a difference-in-differences analysis was conducted to evaluate whether expansion was associated with an increased proportion of MOUD treatment comparing the initial 2014–2017 period and the 2018–2020 period to 2010–2013. We then conducted a difference-in-differences analysis to examine the overall effect of Medicaid expansion on outpatient MOUD using all states that passed expansion at any point during the study period. ResultsAmong outpatient treatment episodes for OUD in states that expanded Medicaid in 2014, there was a 9.5 percentage point (95 % CI: 0.7–18.2) increase in the probability of receiving MOUD during the initial expansion period from 2014 to 2017 compared to 2010–2013 period, and a 7.5 percentage point (95 % CI: −8.1 –23.1) increase in 2018–2020 (compared to the 2010–2013 period) after adjusting for individual-level covariates. After incorporating states that expanded Medicaid between 2015 and 2020, there was a 6.4 percentage point (95 % CI: −0.01–13.0) increase in the probability of receiving MOUD among individuals receiving care after expansion (compared to the pre-expansion period). During the study period, there was variability among states in the change in probability of receiving MOUD from prior to after Medicaid expansion from an almost 30 percentage point increase in New York to an almost 20 percentage point decrease in Washington, DC. ConclusionsMedicaid expansion increased the probability of receiving MOUD in outpatient settings across states from initial expansion through 2020. However, these results were not statistically significant. Additionally, significant variability between states warrants further study and suggests that improving access to MOUD will require additional state and local strategies.

Disparities in Receipt of Adjuvant Immunotherapy among Stage III Melanoma Patients.

Melanoma survival has greatly improved with the advent of immunotherapy, but unequal access to these medications may exist due to nonmedical patient factors such as insurance status, educational background, and geographic proximity to treatment. We used the National Cancer Database to assess patients with nonmetastatic cutaneous melanoma who underwent surgical resection and sentinel lymph node biopsy (SLNB) with tumor involvement from 2015 to 2020. We evaluated rates of adjuvant immunotherapy among this patient population based on patient, tumor, and facility variables, including insurance status, socioeconomic status, pathologic stage (IIIA-IIID), and treatment facility type and volume. Adjuvant immunotherapy was associated with improved survival for stage III melanoma, with a slight increase in 5-year OS for stage IIIA (87.9% vs. 85.9%, P=0.044) and a higher increase in stages IIIB-D disease (70.3% vs. 59.6%, P<0.001). Receipt of adjuvant immunotherapy was less likely for patients who were older, low socioeconomic status, or uninsured. Low-volume and community cancer centers had higher rates of adjuvant immunotherapy overall for all stage III patients, whereas high-volume and academic centers used adjuvant immunotherapy much less often for stage IIIA patients compared with those in stages IIIB-D. Our results demonstrate inconsistent use of adjuvant immunotherapy among patients with stage III melanoma despite a significant association with improved survival. Notably, there was a lower use of adjuvant immunotherapy in patients of lower SES and those treated at high-volume centers. Equity in access to novel standards of care represents an opportunity to improve outcomes for patients with melanoma.

Sludge dewaterability improvement in microbial fuel cell powered electro-Fenton system (MFCⓅEFs) coupled with chitosan quaternary ammonium salt

As improved and expanded wastewater treatment facilities, sludge dewatering is the essential process and major challenge due to the complex and abundant organic matter. Microbial fuel cell powered electro-Fenton system (MFCⓅEFs) has been demonstrated to generate •OH and destroy hydrophilic extracellular polymeric substances (EPS) as an improved method of high efficiency and low energy consumption. Nevertheless, the smaller particle size of the treated sludge and the release of partial organic matter into the supernatant can affect the sludge-water separation process. Chitosan quaternary ammonium salt (CQAS) as a renewable and biodegradability cationic coagulant can be involved in the follow-up treatment. The sludge after combined treatment exhibited better dewaterability, where the water content of sludge cake (WCSC), capillary suction time (CST), and specific resistance filtration (SRF) were 61.21%, 15.6 s, and 1.02×1012 m/kg (26.47%, 80.72% and 84.28% reduction), respectively. The oxidation of the MFCⓅEFs destroyed the cellular and EPS structure and the bridging flocculation and charge neutralization of CQAS caused the fine particles to squeeze each other. The combined treatment fully reduced the content of negative charge and hydrophilic substances on the surface, which affected the intensity change of N-H bond and altered the protein secondary structure to make it looser, thus releasing more bound water while improving aggregation characteristics. Overall, combined treatment can significantly improve sludge dewaterability and owns operational advantages of high efficiency, low energy and consumption, safety, and non-toxicity.

Sanitary sewer overflows, household sewage backups, and antibiotic-resistant bacteria: the new frontier of environmental health risks and disasters

Abstract Untreated sewage discharges leading to environmental contamination are increasingly common in communities across the globe. The cause of these discharges range from sewer lines in disrepair, blockages, and in the era of more extreme wet weather events, the infiltration of stormwater into the system during heavy downpours. Regardless of the driver of these events, the aftermath results in raw sewage spilling into local waterways, city streets, and commercial and residential structures. Historical research in public health has thoroughly documented the connection between exposure to untreated sewage and waterborne disease. Recent research has detected antibiotic-resistant bacteria at wastewater treatment facilities at a time when deaths by antibiotic-resistant infections are on the rise. However, no research has explored the exposure pathways of antibiotic resistant bacteria during sanitary sewer overflows and household-level sewage backups. In this commentary, we aim to introduce this new frontier of environmental health risks and disasters. To do this we describe the history of modern sanitation and sewer infrastructure with a particular focus on wastewater infrastructure in the U.S. We also explore emerging risks and current methods for identifying antibiotic-resistant bacteria in the environment. We end with future directions for interdisciplinary scholarship at the nexus of urban planning, engineering, and public health by introducing the Water Emergency Team (WET) Project. WET is a community-based multi-method effort to identify environmental risks in the aftermath of household backups through 1) residential surveys, 2) indoor visual inspections, 3) environmental sampling, and 4) laboratory processing and reporting. Our hope is that by introducing this comprehensive approach to environmental risks analysis, other scholars will join us in this effort and ultimately towards addressing this grand challenge of our time.

Multilevel analysis of factors affecting the interhospital transfer of high-acuity pediatric patients: a focus on severe pediatric emergency patients

Purpose: The authors aimed to identify the factors affecting interhospital transfer (“transfer”) of severe pediatric patients who visited to an emergency department (ED).Methods: Using the Korean National ED Information System, we analyzed high-acuity patients aged 18 years or younger who visited EDs of local or regional emergency centers nationwide. The high acuity was defined as a Korean Triage and Acuity Scale 1-2. To investigate the factors associated with transfer, a multilevel modeling was selected, examining independent variables at both individual- and hospital-levels with transfer as a dependent variable.Results: A model consisting of variables at individual- and hospital-levels showed the factors as follows: mode of arrival(self-transport: odds ratio, 0.48 [95% confidence interval, 0.38-0.61]; other ambulances: 0.41 [0.24-0.71]; compared with firehouse ambulance), visit at 18:00-07:59 (0.75 [0.64-0.88]), intentional injury (1.59 [1.03-2.47]; compared with non-injury), decreased level of consciousness (drowsy: 1.94 [1.33-2.84]; stupor: 4.08 [2.99-5.57]; coma: 1.81 [1.26-2.60]; compared with alert), severe illness diagnosis (1.49 [1.12-1.98]), the number of all beds in EDs (1.02 [1.01-1.04]), and acceptance for treatment (0.92 [0.87-0.98]; with increment of 1%).Conclusion: This study confirms that both individual-level and hospital-level factors affect the transfer risk of severe pediatric patients in EDs. The study suggests the needs for direct transportation to specialized pediatric treatment facilities, and concentrated support for the pediatric emergency medical centers and pediatric trauma centers.

Evaluating the Diagnostic Inter-rater Reliability Between Virtual and In-person Sick-call Examinations at a Military Dental Treatment Facility.

Teledentistry, also known as "virtual" dental examinations, is an innovative approach to increasing access to care. The objective of this study was to evaluate the diagnostic inter-rater reliability between virtual and in-person examinations for patients seeking emergency dental care (sick call) at a military dental treatment facility. One hundred subjects received both virtual and in-person examinations on the same day, in random order. The virtual examiner and subject were stationed in separate rooms and used only a laptop equipped with a camera, microphone, and speaker to complete the virtual exam. In contrast, the in-person examiner had access to all standard care modalities in a dental treatment room. After the first encounter, the subject proceeded to the corresponding virtual or in-person exam, and both examiners determined a diagnosis. Inter-rater agreement was determined between the two encounters for both diagnosis specialty category and diagnostic code using the Kappa coefficient. The results of the inter-rater analyses showed a Kappa score of 0.644 for the diagnosis specialty category (P < .001) and a Kappa score of 0.714 for diagnostic codes (P < .001). Both analyses indicated "substantial" agreement. We conclude that teledentistry can be an effective tool for determining a diagnosis and improving access to care for dental emergencies at military dental treatment facilities.

Innovations in residential treatment that promote multi-drug addiction recovery

Abstract Background As the drug addiction crisis deepens in many countries across the globe, governments are rapidly expanding publicly funded treatment facilities. At the same time, the illicit drug market has evolved with many substances now containing multiple addictive drugs that complicate recovery. The evidence base for treatment remains primarily focused on single substances. The purpose of this study was to examine the lived experience of adults who attended in-patient treatment centres for multi-drug addiction in Canada. Methods This qualitative study was conducted in 2022 with 32 adults who voluntarily attended an in-patient treatment centre for drug addiction (44% female, 23-53 years). All had been addicted to multiple substances including opioids, crack and methamphetamines. Most (70%) were homeless before treatment. In 1-hour semi-structured interviews adults described the structures and programming that helped them recover in these facilities. Many tried multiple facilities and thus had a rich history of lived experience to draw from. Narrative inquiry was used to characterize qualitative themes across interviews using a phenomenological lens. Results Seven qualitative themes emerged from the data. Residential treatment centres that were effective at helping adults recover from multi-drug addiction: (1) provided flexible stays up to 100 days; (2) felt like a home not a prison; (3) permitted opioid replacement therapies; (4) provided a variety of recovery tools (e.g., cognitive behavioural therapy, Narcotics Anonymous, cultural supports); (5) helped adults reunite with family, find a safe place to stay, and find work before discharge; (6) provided transitional housing after discharge if needed; and (7) provided free long-term recovery support and check-ins after discharge. Conclusions The findings of this study highlight 7 actions that treatment facilities can adopt and test with their own clients in an effort to better support multi-drug addiction recovery. Key messages • A stronger evidence base is needed to inform in-patient multi-drug addiction treatment. • Findings underline 7 actions treatment facilities can take to promote multi-drug addiction recovery.

Monitoring and maintaining quality in the paediatric haemodialysis unit.

Chronic kidney disease in children is being increasingly recognised and reported worldwide, and the focus of paediatric dialysis planning has changed from acute care alone to encompass chronic care. In many parts of the world, haemodialysis for children is performed in adult units and is based on standards established for adults. This review proposes standards for paediatric haemodialysis, incorporating special requirements for children while simultaneously drawing from the adult experience. We discuss the optimum requirements, including space utilisation, equipment needed, water treatment facilities, disposables, safety standards, staffing needs, monitoring and maintenance, infection prevention, waste disposal and quality indicators. We also review recent advancements in the field that should be incorporated into future dialysis units and the steps required for achieving carbon neutrality and protecting the environment.

Boron nitride: Novel ceramic reductant for low‐activity waste vitrification

AbstractDuring vitrification of radioactive wastes, excessive foaming reduces processing rates within melters by hindering heat transfer from the molten glass pool to the reacting melter feed. Formulations of low‐activity waste (LAW) melter feeds, for vitrification at the Waste Treatment and Immobilization Plant at the Hanford Site, conventionally include the addition of sucrose to mitigate excessive foaming by hastening the denitration process. However, incomplete combustion of sucrose produces organics such as acetonitrile (C2H3N) that may exceed bounding limits of downstream effluent treatment facilities. Using boron nitride (BN) as an alternate reductant to sucrose, in a representative LAW melter feed reduced C2H3N production by 90% by preventing the low‐temperature sucrose–nitrate reactions. Furthermore, foaming was suppressed due to the higher decomposition temperature of BN than H3BO3 meaning a delayed reaction of a large fraction of boron with the transient glass‐forming melt until above the foam onset temperature, thus reducing the quantity and viscosity of the connected melt and trapping less gas in the foam layer.

A Review of Sanitation Options and Programming in Ghana, West Africa

This review examines Ghana’s progress in sanitation. These efforts include the containment, transport, treatment, and disposal or reuse of human waste. This research specifically examined the current sanitation processes and programming efforts within Ghana, West Africa. Some reports indicate that Ghana is the second dirtiest country in Africa and the seventh dirtiest country in the world. A review of the current water, sanitation, and hygiene (WASH) options within the country indicates that significant efforts need to be undertaken. There are multiple toilet options and current practices within the country for the disposal of excrement. Unfortunately, the municipal sewer systems and wastewater treatment facilities within the country are either broken down or severely inadequate compared to their surrounding population. Current WASH programming, extension efforts, and key factors affecting the uptake of sanitation investment are reviewed. The price point where consumers would utilize sanitation products and services was analyzed, as well as the cost-to-benefit ratio of specific technologies for community members. This review demonstrated that initiatives should be undertaken to provide more sanitation professionals, renovate and expand urban municipal sewerage systems, and provide basic access to rural community areas. It was recommended that future programming, extension, and policy efforts be intentional and include relevant stakeholders and community members to provide a greater opportunity for establishing successful and substantial efforts.