A control problem arising in the process of waste water purification

AbstractIn this paper we state and solve an optimal control problem arisen from the management of the sewage disposal which is dumped into the sea through submarine outfalls. Firstly, we fix oxygen and amount of organic matter as water quality indicators and we state a partial differential equations model to simulate them in a domain occupied by shallow waters. Constraints about water quality and economic objectives lead us to a pointwise optimal control problem with state and control constraints. (The theoretical analysis of the problem has been developed by the authors in (Martinez et al., C. R. Acad. Sci. Paris, Serie I 328 (1999) 35.) (Martinez et al., Preprint, Dept. Matematica Aplicada, Univ. Santiago de Compostela, Spain, 1998.)). We deal with the problem by using time and space discretizations and we propose two algorithms for the numerical resolution of the discretized problem. Finally, we give numerical results obtained by applying the described techniques for a realistic problem posed in the rı́a of Vigo (Spain)

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Numerical optimization for the purification of polluted shallow waters

AbstractThe optimal control theory allows us to design a wastewater treatment system in order to control marine pollution in any open area of shallow waters, as was shown in previous works of the authors. However, there exist many closed areas (for instance, enclosed bays) which present a serious quality problem caused by domestic/industrial contaminants, due to the insufficient seawater exchange. In these areas it is necessary to consider a new technique in order to purify polluted waters: promoting seawater exchange by the injection of clear water from the outer sea. The aim of this paper is to determine the minimal quantity of injected water in order to purify the protected areas up to a fixed threshold. We present the mathematical formulation of the continuous and discretized control problems, and propose an algorithm for the numerical resolution. Finally, we present numerical results obtained in the study of a real-world problem

Numerical resolution of a shape optimization problem in hydraulic engineering

In this work, we take interest in hydraulic structures that enable fish to over- come stream obstructions (such as dams and weirs) to their spawning and other river migrations. Particularly, we study the design of a vertical slot fishway, that is, a rect- angular channel built on a side of the dam, with a sloping floor, that is divided into a number of pools by baffles with slots. We look for the location and length of the baffles separating the pools, in order to obtain a suitable water velocity: it has to be great enough to attract fish to the channel, but it cannot be so great as to wash fish back downstream or to exhaust them to the point where they cannot continue their journey upriver. First we pose the problem as a shape optimization problem, where the state system is given by the shallow water (Saint-Venant) equations, the design variables are the location and length of the baffles, and the objective function is related to obtaining a suitable water velocity. Next, by using the \u93domain derivative\u94 we give a detailed expression for the gradient of the objective function via the adjoint system. Following, we propose a characteristc-Galerkin method for solving the state system, and two algorithms to solve the optimization problem: a derivative-free algorithm, and a gradient-type method computing the cost gradient by solving the adjoint system with the characteristc-Galerkin method. Finally, we show numerical results obtained for a standard ten pools fishway