29 research outputs found

    Assessment of a viral load result-triggered automated differentiated service delivery model for people taking ART in Lesotho (the VITAL study): study protocol of a cluster-randomized trial

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    INTRODUCTION: To sustainably provide good quality care to increasing numbers of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in resource-limited settings, care delivery must shift from a "one-size-fits-all" approach to differentiated service delivery models. Such models should reallocate resources from PLHIV who are doing well to groups of PLHIV who may need more attention, such as those with treatment failure. The VIral load Triggered ART care Lesotho (VITAL) trial assesses a viral load (VL)-, participant's preference-informed, electronic health (eHealth)-supported, automated differentiated service delivery model (VITAL model). With VITAL, we aim to assess if the VITAL model is at least non-inferior to the standard of care in the proportion of participants engaged in care with viral suppression at 24 months follow-up and if it is cost-saving. METHODS: The VITAL trial is a pragmatic, multicenter, cluster-randomized, non-blinded, non-inferiority trial with 1:1 allocation conducted at 18 nurse-led, rural health facilities in two districts of northern Lesotho, enrolling adult PLHIV taking ART. In intervention clinics, providers are trained to implement the VITAL model and are guided by a clinical decision support tool, the VITALapp. VITAL differentiates care according to VL results, clinical characteristics, sub-population and participants' and health care providers' preferences. EXPECTED OUTCOMES: Evidence on the effect of differentiated service delivery for PLHIV on treatment outcomes is still limited. This pragmatic cluster-randomized trial will assess if the VITAL model is at least non-inferior to the standard of care and if it is cost saving. TRIAL REGISTRATION: The study has been registered with clinicaltrials.gov (Registration number NCT04527874; August 27, 2020)

    Measurement of Organic Air Toxics Emissions from Coal Firing in a Laminar-Flow Reactor

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    Title III of 1990 Clean Air Ad Amendments (CAAA) addresses the emissions of 189 Hazardous Air Pollutants (HAPs), also referred to as "air toxics." Through this, Congress mandates the Environmental Protection Agency (EPA) to conduct risk assessment studies on the health hazards associated with HAPs before promulgating any legislation for their control. In order to meet the potential future needs of industry resulting from air toxics emissions regulation, Combustion Engineering, Inc. (ABS CE) has been conduding a multi-faceted R&D program aimed at clarifying the impads of fuel properties, fumace design and operating conditions on air toxies emissions. This paper presents some of the organic air toxies (Volatile OrganiC Compounds, Semi-Volatile Organic Compounds and Poly-cyclic Aromatic Hydrocarbons-VOCs, SVOCs and PAHs) results from combustion testing of a bituminous coal in a three-stage entrained flow reador. The reador is capable of heating readant particles to temperatures of up to 2650 OF and sustaining particle residence times of up to about 1.5 seconds to simulate the rapid suspension firing conditions encountered in pulverized-a>al fired boilers. The various measurement and analytical techniques used in the testing program are identified and the results obtained are discussed. Results obtained from this study indicate that coal combustion does result in the emissions of some organiC HAPs at low levels. Results also show that low NOx firing does not necessarily exacerbate the emissions of these micro-pollutants. Furthermore, the emissions levels determined were quite low as compared to US EPA's MACT stipulations. It should be borne in mind that metal emissions (Hg, Se, As, Pb, etc.), which are likely to be greater, were not part of this investigation. Lastly, testing in larger-scale facilities is essential so that linkages between field and laboratory results can be established

    GREENHOUSE GAS EMISSIONS CONTROL BY OXYGEN FIRING IN CIRCULATING FLUIDIZED BED BOILERS: PHASE II--PILOT SCALE TESTING AND UPDATED PERFORMANCE AND ECONOMICS FOR OXYGEN FIRED CFB WITH CO2 CAPTURE

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    Because fossil fuel fired power plants are among the largest and most concentrated producers of CO{sub 2} emissions, recovery and sequestration of CO{sub 2} from the flue gas of such plants has been identified as one of the primary means for reducing anthropogenic CO{sub 2} emissions. In this Phase II study, ALSTOM Power Inc. (ALSTOM) has investigated one promising near-term coal fired power plant configuration designed to capture CO{sub 2} from effluent gas streams for sequestration. Burning fossil fuels in mixtures of oxygen and recirculated flue gas (made principally of CO{sub 2}) essentially eliminates the presence of atmospheric nitrogen in the flue gas. The resulting flue gas is comprised primarily of CO{sub 2}, along with some moisture, nitrogen, oxygen, and trace gases like SO{sub 2} and NO{sub x}. Oxygen firing in utility scale Pulverized Coal (PC) fired boilers has been shown to be a more economical method for CO{sub 2} capture than amine scrubbing (Bozzuto, et al., 2001). Additionally, oxygen firing in Circulating Fluid Bed Boilers (CFB's) can be more economical than in PC or Stoker firing, because recirculated gas flow can be reduced significantly. Oxygen-fired PC and Stoker units require large quantities of recirculated flue gas to maintain acceptable furnace temperatures. Oxygen-fired CFB units, on the other hand, can accomplish this by additional cooling of recirculated solids. The reduced recirculated gas flow with CFB plants results in significant Boiler Island cost savings resulting from reduced component The overall objective of the Phase II workscope, which is the subject of this report, is to generate a refined technical and economic evaluation of the Oxygen fired CFB case (Case-2 from Phase I) utilizing the information learned from pilot-scale testing of this concept. The objective of the pilot-scale testing was to generate detailed technical data needed to establish advanced CFB design requirements and performance when firing coals and delayed petroleum coke in O{sub 2}/CO{sub 2} mixtures. Firing rates in the pilot test facility ranged from 2.2 to 7.9 MM-Btu/hr. Pilot-scale testing was performed at ALSTOM's Multi-use Test Facility (MTF), located in Windsor, Connecticut
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