Assisted reverse electrodialysis : a novel technique to decrease reverse osmosis energy demand

Assisted reverse electrodialysis (ARED) was introduced as a pre-desalination technique for seawater reverse osmosis (RO) for drinking water production. ARED is comparable to an additional applied pressure along the osmotic pressure in pressure assisted osmosis; a small voltage is applied in the same direction as the open cell voltage to increase the desalination speed compared to reverse electrodialysis (RED). This decreases the required membrane area. The concentration of the dilute compartment increases significantly during ARED operation due to the increased speed of desalination. This results in an overall decrease in total cell resistance. Although the energy demand for ARED is higher than for RED, the ARED-RO process still achieves a decrease in overall energy requirements at higher RO recoveries when compared to stand-alone RO. However, ion-exchange membrane prices will have to come down to 1-10 €/m² for the ARED-RO hybrid to become economically viable at current energy prices

Alternate Americanisms

Architecture is actively crafting reality, culture, and identity. It is simultaneously constructed from and constructing meaning. Route 66 exists as an American invention, ruin, and manifestation of American Identity. The objects on the route sit innocently on the landscape, covering their complex histories and power networks that lead back to the dominant government administration. Alternate Americanisms shows the agency of architectural objects in creating new realities, identities, and histories. The game explores how every single decision changes the entire built landscape. It reflects and translates alternate histories to project alternate versions. It examines the relationship between meaning and architecture, identity and the built environment. It tells the history of objects in the built landscape and allows for understanding and speculation. Each game plays out differently and parallels the frameworks of our reality to create endless Alternate Americanisms

Alternative Americanisms

This project investigates the circular influence of architecture, meaning and place across the built American landscape of Route 66. It focuses on the route as an uniquely American invention, reflection, and now obsolete piece of cultural infrastructure

Assisted reverse electrodialysis : principles, mechanisms, and potential

Although seawater reverse osmosis (RO) is nearing its thermodynamic minimum energy limit, it is still an energy-intensive process, requiring 2–3 kWh/m³ at a recovery of 50%. Pre-desalination of the seawater by reverse electrodialysis (RED), using an impaired water source, can further decrease this energy demand by producing energy and reducing the seawater concentration. However, RED is hampered by the initial high resistance of the fresh water source, resulting in a high required membrane area (i.e., high investment costs). In this paper, a new process is presented that can overcome this initial resistance and decrease the RED investment cost without the need for additional infrastructure: assisted RED (ARED). In ARED, a small potential difference is applied in the direction of the natural salinity gradient, increasing the ionic transport rate and rapidly decreasing the initial diluate resistance. This decreasing resistance is shown to outweigh any negative effects caused by, for example, concentration polarization, resulting in a process that is more efficient than theoretically expected. As this effect is mainly important at low diluate concentrations (up to 0.1 M), ARED is proposed as a first step in an economic and energy efficient (A)RED-RO hybrid process

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Intern markedsorientering i offentlig sektor: En studie av somatiske sykehus

Denne masteroppgaven setter fokus på intern markedsorientering (IMO) og bidrar med ny teoretisk og praktisk kunnskap om årsaker til, og effekter av IMO i offentlig sektor. IMO blir sett på som en ledelsesfilosofi med formål om å forvalte førstelinjeansatte i tjenesteytende næringer slik at de bidrar til økt konkurransefortrinn. Etter det forfatterne til denne masteroppgaven kjenner til er IMO kun studert i privat sektor. Offentlig sektor blir i større grad utsatt for økt konkurranse. Et godt eksempel på det er somatiske sykehus som med fritt sykehusvalg konkurrerer med hverandre og samtidig møter utfordringer fra private helseinstitusjoner. Etter at Helseforetaksloven ble innført i 2002, ble somatiske sykehus tvunget til å se utover finansielle resultater med fokus på å levere tjenester av høy kvalitet. Dette har ført til at offentlige institusjoner i denne sektoren blir avhengig av å ha gode styringsmekanismer for å fremme sitt konkurransefortrinn. IMO er en markedsrettet ledelsespraksis som vil bidra til å øke konkurransefortrinnet. Med bakgrunn i dette ville vi sette IMO i en ny kontekst og studere den i offentlig sektor, som i denne masteroppgaven er representert ved somatiske sykehus. Det ble gjennomført en kvantitativ studie hvor vi har studert årsaker til IMO og effekter av IMO. Resultatene i denne studien er basert på 164 svarene vi mottok fra ansatte i førstelinjen ved fire somatiske sykehus i Norge. Toppledelse og organisasjonsdynamikk er årsaker til IMO og er studert i artikkel 1. Jobbtilfredshet, engasjement, ansattes opplevelse av tjenestekvalitet og turnover er effekter av IMO og studert i artikkel 2. De faktorene som er valgt for denne studien har ikke tidligere blitt studert i forhold til IMO i offentlig sektor. Resultatene fra studien viser at toppledelse og organisasjonsdynamikk har en positiv sammenheng med IMO, og toppledelsen er den årsaken som har størst betydning for IMO. Med dette indikerer resultatene fra studien at toppledelse i kraft av sin posisjon kan fremme IMO-filosofien i organisasjonen slik at det oppnår sine målsettinger. Videre finner studien at IMO har positiv sammenheng med jobbtilfredshet, engasjement og ansattes opplevelse av tjenestekvalitet, og negativ sammenheng med turnover. I følge funnene i studien har IMO størst påvirkning på jobbtilfredshet og turnover. Innen forvaltning av førstelinjeansatte er disse faktorene viktig å ta med seg videre for å oppnå ønskede målsetninger, høy standard på tjenestene og å ivareta oppbygd kompetanse som er avgjørende for vellykket drift. Med bakgrunn i funnene anbefaler vi toppledelsen ved somatiske sykehus om å vie oppmerksomhet mot IMO, ettersom dette vil bidra til å skape økt konkurransefortrinn gjennom førstelinjeansatte. Vi kommer med praktiske implikasjoner og forslag til implementering av IMO

Decision-making among adolescents prescribed antipsychotic medications: Interviews to gain perspectives of youth without psychosis or mania

OBJECTIVES: This study aimed to understand the experiences of youth who had been prescribed antipsychotics but did not have psychosis, mania, autism spectrum disorder, or developmental disability. METHODS: Twenty-three qualitative telephone interviews were conducted with youth aged 11-18 who had been prescribed an antipsychotic medication but did not have a diagnosis of psychotic disorder, bipolar disorder, autism spectrum disorder, or developmental disability. Participants were recruited from four U.S. healthcare systems participating in the pragmatic trial Safer Use of Antipsychotics in Youth (SUAY). Interviews were recorded, transcribed and analyzed using template analysis techniques. RESULTS: Prior to initiating an antipsychotic medication, most participants experienced behavioral health crises; many felt that they had no options other than to start the medication. Other core themes included: (1) antipsychotics had both positive psychosocial outcomes, such as improvement of family life, and adverse effects, such as drowsiness or weight gain, (2) antipsychotics were only one part of a broader treatment plan, (3) efforts were made to maximize benefits and minimize side effects through careful titration, (4) feedback from friends and family was important in the decision to continue. CONCLUSIONS: The findings provide valuable insights into how to engage youth in conversations around the use of antipsychotics

A feasibility study on express-o-wrack (100 Co.)

The feasibility study of 100% Co.\u27s Express-O-Wrack shall discuss the viability and marketability of the product. The Background of the Study discusses the relevance of the study in relation to components in the environment. It primarily relates how the product and the company came into existence. The features and benefits of Express-O-Wrack are part of the Market Study. This part determines the marketability of the product and how the proponents intend to market it. The analysis of the survey, which brings in the preferences, is also included in this chapter to give justification to the market survey, which brings in the preferences, is also included in this chapter to give justification to the market share. Technical Study includes the production process and description of materials and equipment used. Basically, it is all about the production plan and strategies of the company. As to the structure of the corporation, the Management and Legal Study discusses the job positions and description. Aside from this, it includes the legal matters and requirements in setting up the business. In terms of the financial aspects in the business, the Financial Study includes the assumptions and the budget. Justifications for such the allotment of budget are also illustrated through the tables and computations. The Socio-Economic Study discusses the significance of being civic-oriented, especially by businesses, such as what the proponents are to set up. The corporation\u27s responsibility to all its stakeholders is also discussed. The proponents of 100% Co. has proposed the operation of the business in the points that their product, Express-O-Wrack is feasible and viable. In the context that quantitative and qualitative facts can be presented, the company has the reassurance that the business would mean favorable results in the long run

Extracellular Matrix Profiling and Disease Modelling in Engineered Vascular Smooth Muscle Cell Tissues

Aortic smooth muscle cells (SMCs) have an intrinsic role in regulating vessel homeostasis and pathological remodelling. In two-dimensional (2D) cell culture formats, however, SMCs are not embedded in their physiological extracellular matrix (ECM) environment. To overcome the limitations of conventional 2D SMC cultures, we established a 3D in vitro model of engineered vascular smooth muscle cell tissues (EVTs). EVTs were casted from primary murine aortic SMCs by suspending a SMC-fibrin master mix between two flexible silicon-posts at day 0 before prolonged culture up to 14 days. Immunohistochemical analysis of EVT longitudinal sections demonstrated that SMCs were aligned, viable and secretory. Mass spectrometry-based proteomics analysis of murine EVT lysates was performed and identified 135 matrisome proteins. Proteoglycans, including the large aggregating proteoglycan versican, accumulated within EVTs by day 7 of culture. This was followed by the deposition of collagens, elastin-binding proteins and matrix regulators up to day 14 of culture. In contrast to 2D SMC controls, accumulation of versican occurred in parallel to an increase in versikine, a cleavage product mediated by proteases of the A Disintegrin and Metalloproteinase with Thrombospondin motifs (ADAMTS) family. Next, we tested the response of EVTs to stimulation with transforming growth factor beta-1 (TGFβ-1). EVTs contracted in response to TGFβ-1 stimulation with altered ECM composition. In contrast, treatment with the pharmacological activin-like kinase inhibitor (ALKi) SB 431542 suppressed ECM secretion. As a disease stimulus, we performed calcification assays. The ECM acts as a nidus for calcium phosphate deposition in the arterial wall. We compared the onset and extent of calcification in EVTs and 2D SMCs cultured under high calcium and phosphate conditions for 7 days. Calcified EVTs displayed increased tissue stiffness by up to 30 % compared to non-calcified controls. Unlike the rapid calcification of SMCs in 2D cultures, EVTs sustained expression of the calcification inhibitor matrix Gla protein and allowed for better discrimination of the calcification propensity between independent biological replicates. In summary, EVTs are an intuitive and versatile model to investigate ECM synthesis and turnover by SMCs in a 3D environment. Unlike conventional 2D cultures, EVTs provide a more relevant pathophysiological model for retention of the nascent ECM produced by SMCs