Life cycle energy and GHG emission within the Turin metropolitan area urban water cycle

The aim of this study is to analyze the urban water cycle in the Turin Metropolitan Area (Northwestern Italy), with a focus on quantifying the annual life cycle energy consumption and greenhouse gas emissions. The study made use Material Flow Analysis and Life Cycle Assessment methods for a defined urban water cycle system (ATO3) operated by one water utility (SMAT S.p.A.), and examines all main sub-systems of the entire urban water cycle. The study quantified the annual direct and indirect energy consumption and the direct and indirect greenhouse gas emissions related to system-wide energy consumption and the production and transportation of chemicals used in water treatment and wastewater treatment plants. It is found that the wastewater treatment consumes the biggest share of the total energy (44%), but a significant part of this energy demand is provided by the energy in biogas produced from wastewater sludge. On the basis of this study it was possible to provide strategic recommendations to the water utility on how to improve the water/energy/carbon nexus and contribute better to sustainability performance of urban water cycle systems

Urban water system metabolism assessment using WaterMet2 model

12th International Conference on Computing and Control for the Water Industry, CCWI2013, 2013-09-06, 2013-09-09, Perugia, ItalyThis paper presents a new "WaterMet2" model for integrated modelling of an urban water system (UWS). The model is able to quantify the principal water flows and other main fluxes in the UWS. The UWS in WaterMet2 is characterised using four different spatial scales (indoor area, local area, subcatchment and system area) and a daily temporal resolution. The main subsystems in WaterMet2 include water supply, water demand, wastewater and cyclic water recovery. The WaterMet2 is demonstrated here through modelling of the urban water system of Oslo city in Norway. Given a fast population growth, WaterMet2 analyses a range of alternative intervention strategies including 'business as usual', addition of new water resources, increased rehabilitation rates and water demand schemes to improve the performance of the Oslo UWS. The resulting five intervention strategies were compared with respect to some major UWS performance profiles quantified by the WaterMet2 model and expert's opinions. The results demonstrate how an integrated modelling approach can assist planners in defining a better intervention strategy in the future.This work was carried out as part of the ‘TRansition to Urban water Services of Tomorrow’ (TRUST) project. The authors wish to acknowledge the European Commission for funding TRUST project in the 7th Framework Programme under Grant Agreement No. 265122

Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomes

Background Triage and interhospital transfer are central to trauma systems. Few studies have addressed transferred trauma patients. This study investigated transfers of variable distances to OUH (Oslo University Hospital, Ullevål), one of the largest trauma centres in Europe. Methods Patients included in the OUH trauma registry from 2001 to 2008 were included in the study. Demographic, injury, management and outcome data were abstracted. Patients were grouped according to transfer distance: ≤20 km, 21-100 km and > 100 km. Results Of the 7.353 included patients, 5.803 were admitted directly, and 1.550 were transferred. The number of transfers per year increased, and there was no reduction in injury severity during the study period. Seventy-six per cent of the transferred patients were severely injured. With greater transfer distances, injury severity increased, and there were larger proportions of traffic injuries, polytrauma and hypotensive patients. With shorter distances, patients were older, and head injuries and injuries after falls were more common. The shorter transfers less often activated the trauma team: ≤20 km -34%; 21-100 km -51%; > 100 km -61%, compared to 92% of all directly admitted patients. The mortality for all transferred patients was 11%, but was unequally distributed according to transfer distance. Conclusion This study shows heterogeneous characteristics and high injury severity among interhospital transfers. The rate of trauma team assessment was low and should be further examined. The mortality differences should be interpreted with caution as patients were in different phases of management. The descriptive characteristics outlined may be employed in the development of triage protocols and transfer guidelines

Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit(*)



Problem: Need for improved sedation strategy for adults receiving ventilator support. Design: Observational study of effect of introduction of guidelines to improve the doctors' and nurses' performance. The project was a prospective improvement and was part of a national quality improvement collaborative. Background and setting: A general mixed surgical intensive care unit in a university hospital; all doctors and nurses in the unit; all adult patients (>18 years) treated by intermittent positive pressure ventilation for more than 24 hours. Key measures for improvement: Reduction in patients' mean time on a ventilator and length of stay in intensive care over a period of 11 months; anonymous reporting of critical incidents; staff perceptions of ease and of consequences of changes. Strategies for change: Multiple measures (protocol development, educational presentations, written guidelines, posters, flyers, emails, personal discussions, and continuous feedback) were tested, rapidly assessed, and adopted if beneficial. Effects of change: Mean ventilator time decreased by 2.1 days (95% confidence interval 0.7 to 3.6 days) from 7.4 days before intervention to 5.3 days after. Mean stay decreased by 1.0 day (–0.9 to 2.9 days) from 9.3 days to 8.3 days. No accidental extubations or other incidents were identified. Lessons learnt: Relatively simple changes in sedation practice had significant effects on length of ventilator support. The change process was well received by the staff and increased their interest in identifying other areas for improvement

The European trauma course: trauma teaching goes European

status: publishe