A Two-Stage Aerobic/Anaerobic Denitrifying Horizontal Bioreactor Designed for Treating Ammonium and H2S Simultaneously

A two-stage bioreactor was operated for a period of 140 days in order to develop a post-treatment process based on anaerobic bioxidation of sulfite. This process was designed for simultaneously treating the effluent and biogas of a full-scale UASB reactor, containing significant concentrations of NH4 and H2S, respectively. The system comprised of two horizontal-flow bed-packed reactors operated with different oxygen concentrations. Ammonium present in the effluent was transformed into nitrates in the first aerobic stage. The second anaerobic stage combined the treatment of nitrates in the liquor with the hydrogen sulfide present in the UASB-reactor biogas. Nitrates were consumed with a significant production of sulfate, resulting in a nitrate removal rate of 0.43 kg N m(3) day(-1) and a parts per thousand yen92 % efficiency. Such a removal rate is comparable to those achieved by heterotrophic denitrifying systems. Polymeric forms of sulfur were not detected (elementary sulfur); sulfate was the main product of the sulfide-based denitrifying process. S-sulfate was produced at a rate of about 0.35 kg m(3) day(-1). Sulfur inputs as S-H2S were estimated at about 0.75 kg m(3) day(-1) and Chemical Oxygen Demand (COD) removal rates did not vary significantly during the process. DGGE profiling and 16S rRNA identified Halothiobacillus-like species as the key microorganism supporting this process; such a strain has not yet been previously associated with such bioengineered systems.

Hydrogen and Methane Production, Energy Recovery, and Organic Matter Removal from Effluents in a Two-Stage Fermentative Process

This study evaluates the potential for using different effluents for simultaneous H-2 and CH4 production in a two-stage batch fermentation process with mixed microflora. An appreciable amount of H-2 was produced from parboiled rice wastewater (23.9 mL g(-1) chemical oxygen demand [COD]) and vinasse (20.8 mL g(-1) COD), while other effluents supported CH4 generation. The amount of CH4 produced was minimum for sewage (46.3 mL g(-1) COD), followed by parboiled rice wastewater (115.5 mL g(-1) COD) and glycerol (180.1 mL g(-1) COD). The maximum amount of CH4 was observed for vinasse (255.4 mL g(-1) COD). The total energy recovery from vinasse (10.4 kJ g(-1) COD) corresponded to the maximum COD reduction (74.7 %), followed by glycerol (70.38 %, 7.20 kJ g(-1) COD), parboiled rice wastewater (63.91 %, 4.92 kJ g(-1) COD), and sewage (51.11 %, 1.85 kJ g(-1) COD). The relatively high performance of vinasse in such comparisons could be attributed to the elevated concentrations of macronutrients contained in raw vinasse. The observations are based on kinetic parameters of H-2 and CH4 production and global energy recovery of the process. These observations collectively suggest that organic-rich effluents can be deployed for energy recovery with sequential generation of H-2 and CH4.

A two-stage economic succession at the inception of farming in central Portugal. Preliminary examination of possible causes and consequences

[EN]Notwithstanding their scarcity and uneven distribution, zooarchaeological and stable isotope data sets on the Early and Middle Neolithic (5500–3200 cal BC) in the region of Estremadura in Central Portugal strongly suggest that two succeeding stages in subsistence strategies took place: sheep and goat itinerant pastoralism (across large areas) and/or renewed focus on wild food sources (cervid hunting, harvesting marine and freshwater food) which replaced livestock farming within smaller areas and less specialised hunting practices. This economic shift seems to have coincided with two other dramatic changes: the 5.9 kyr cal BP climate event and the onset of megalithism. Possible correlations between these past cultural and palaeoenvironmental phenomena are herein preliminarily outlined. [ES] A pesar de su escasez y distribución desigual, el conjunto de datos arqueozoológicos y de isótopos estables para el Neolítico Antiguo y Medio de la región de Estremadura en el centro de Portugal (5500-3200 a. C. cal), sugiere con claridad dos etapas sucesivas en las estrategias de subsistencia: pastoreo itinerante de ovejas y cabras (ocupando grandes territorios) y/o un renovado interés por los recursos alimenticios silvestres (caza de cérvidos, recolección de alimentos marinos y de agua dulce), que reemplazó otras formas de ganadería más confinadas en el espacio acciones con regímenes de mantenimiento reducidos y unas prácticas de caza menos especializadas. Este cambio económico parece haber ocurrido junto con otros dos cambios dramáticos, el evento climático 5.9 k BP (cal.) y el inicio del megalitismo. Aquí se esbozan de forma preliminar las posibles correlaciones entre estos fenómenos culturales y paleoambientales del pasado.

Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: a prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry

Background Total joint replacements represent a considerable part of day-to-day orthopaedic routine and a substantial proportion of patients undergoing unilateral total hip arthroplasty require a contralateral treatment after the first operation. This report compares complications and functional outcome of simultaneous versus early and delayed two-stage bilateral THA over a five-year follow-up period. Methods The study is a post hoc analysis of prospectively collected data in the framework of the European IDES hip registry. The database query resulted in 1819 patients with 5801 follow-ups treated with bilateral THA between 1965 and 2002. According to the timing of the two operations the sample was divided into three groups: I) 247 patients with simultaneous bilateral THA, II) 737 patients with two-stage bilateral THA within six months, III) 835 patients with two-stage bilateral THA between six months and five years. Results Whereas postoperative hip pain and flexion did not differ between the groups, the best walking capacity was observed in group I and the worst in group III. The rate of intraoperative complications in the first group was comparable to that of the second. The frequency of postoperative local and systemic complication in group I was the lowest of the three groups. The highest rate of complications was observed in group III. Conclusions From the point of view of possible intra- and postoperative complications, one-stage bilateral THA is equally safe or safer than two-stage interventions. Additionally, from an outcome perspective the one-stage procedure can be considered to be advantageous.

An intraoperatively moulded PMMA prostheses like spacer for two-stage revision of infected total knee arthroplasty

We report a series of 16 consecutive total knee arthroplasty (TKA) revision procedures for deep infection, treated with a newly developed intraoperatively moulded PMMA cement-prostheses-like spacer (CPLS). The standard treatment consisted of a two-stage protocol with initial explantation of the infected components combined with radical debridement, followed by implantation of a temporary cement spacer and final reimplantation of a new TKA. A sterilizeable Teflon tapered aluminium mould was developed for production of a custom made CPLS during the intervention. Stable implantation of the CPLS was achieved with a second cementation, allowing for correct alignment and ligament balancing. The spacer remained 3.5 months on average until reimplantation of a TKA occurred. At time of reimplantation, patients had an average KSS score of 84.44 points with an average flexion capacity of 102°. There was no recurrent infection during the study period of minimum 2 years. With this new technique, a low friction articulation with good stability, high comfort and a better range of motion compared to handcrafted spacers was achieved. The use of this spacer is a time sparing, cheap and convenient option in 2-stage TKA revision.

Response Bias Using Two-Stage Data Collection: A study of elderly participants in a program.

Researchers examining the effects of programs, in this case a state-level pharmaceutical assistance program for the elderly, sometimes must rely on multiple methods of data collection. Two-stage data collection (e.g., a telephone interview followed by a mail questionnaire) was used to obtain a full range of information. Older age groups were found to participate less frequently in the telephone interview, while certain demographic factors characterized mail questionnaire nonparticipants, all of which supports past research. Results also show that those in the poorest health are less likely to participate in the mail survey. Combining the two methods did not result in high attrition, suggesting that innovation can be successfully employed. Knowledge of the bias associated with each method will aid in targeting special groups.

"Rapid two-stage" Norwood operation in a child with multiorgan failure

The Norwood I operation continues to be a procedure with significant operative mortality. One well-accepted risk factor for death after the first step of the Norwood operation is critical preoperative status. We describe herein a new concept for the treatment of patients with hypoplastic left heart syndrome (HLHS) in very poor preoperative condition. This is a case report of a child who was born in a rural hospital. On the second day of life he was referred to our center in multiorgan failure. There were signs of liver dysfunction and the child was anuric. Therapy was started immediately with prostaglandin and vasodilators as well as diuretics, milrinone, and dobutamine. However, systemic perfusion continued to be insufficient. Finally, the child was placed on a ventilator. On the fourth day of life, bilateral pulmonary artery (PA) banding was performed and circulation stabilized immediately. Two hours after the operation urine output started. Liver function stabilized over the next couple of days. Two days after PA banding the child was weaned from the ventilator. On the 12th day of life a Norwood operation with PA debanding and a right ventricle-PA conduit was performed, and 2 days postoperatively the child was weaned from the ventilator. Twenty days after the operation he was discharged home. When the boy was 4 months old a bidirectional cavopulmonary anastomosis was performed. In selected cases of patients with HLHS with very poor hemodynamic conditions, a rapid two-stage approach with bilateral banding followed by a Norwood operation after cardiac stabilization can be recommended.

A TWO-STAGE MICROBIAL FUEL CELL SYSTEM TO CONVERT SOLID ORGANIC WASTE TO ELECTRICITY

Microbial fuel cell (MFC) research has focused mostly on producing electricity using soluble organic and inorganic substrates. This study focused on converting solid organic waste into electricity using a two-stage MFC process. In the first stage, a hydrolysis reactor produced soluble organic substrates from solid organic waste. The soluble substrates from the hydrolysis reactor were pumped to the second stage reactor: a continuous-flow, air-cathode MFC. Maximum power output (Pmax) of the MFC was 296 mW/m3 at a current density of 25.4 mA/m2 while being fed only leachate from the first stage reactor. Addition of phosphate buffer increased Pmax to 1,470 mW/m3 (89.4 mA/m2), although this result could not be duplicated with repeated polarization testing. The minimum internal resistance achieved was 77 Omega with leachate feed and 17 Omega with phosphate buffer. The low coulombic efficiency (

Screening for Rheumatic Heart Disease among Peruvian Children: A Two-Stage Sampling Observational Study.

BACKGROUND The objective of the study was to evaluate the implications of different classifications of rheumatic heart disease on estimated prevalence, and to systematically assess the importance of incidental findings from echocardiographic screening among schoolchildren in Peru. METHODS We performed a cluster randomized observational survey using portable echocardiography among schoolchildren aged 5 to 16 years from randomly selected public and private schools in Arequipa, Peru. Rheumatic heart disease was defined according to the modified World Health Organization (WHO) criteria and the World Heart Federation (WHF) criteria. FINDINGS Among 1395 eligible students from 40 classes and 20 schools, 1023 (73%) participated in the present survey. The median age of the children was 11 years (interquartile range [IQR] 8-13 years) and 50% were girls. Prevalence of possible, probable and definite rheumatic heart disease according to the modified WHO criteria amounted to 19.7/1000 children and ranged from 10.2/1000 among children 5 to 8 years of age to 39.8/1000 among children 13 to 16 years of age; the prevalence of borderline/definite rheumatic heart disease according to the WHF criteria was 3.9/1000 children. 21 children (2.1%) were found to have congenital heart disease, 8 of which were referred for percutaneous or surgical intervention. CONCLUSIONS Prevalence of RHD in Peru was considerably lower compared to endemic regions in sub-Saharan Africa, southeast Asia, and Oceania; and paralleled by a comparable number of undetected congenital heart disease. Strategies to address collateral findings from echocardiographic screening are necessary in the setup of active surveillance programs for RHD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02353663.

One-stage (Warsaw) and two-stage (Oslo) repair of unilateral cleft lip and palate: Craniofacial outcomes

The aim of this study was to compare facial development in subjects with complete unilateral cleft lip and palate (CUCLP) treated with two different surgical protocols. Lateral cephalometric radiographs of 61 patients (42 boys, 19 girls; mean age, 10.9 years; SD, 1) treated consecutively in Warsaw with one-stage repair and 61 age-matched and sex-matched patients treated in Oslo with two-stage surgery were selected to evaluate craniofacial morphology. On each radiograph 13 angular and two ratio variables were measured in order to describe hard and soft tissues of the facial region. The analysis showed that differences between the groups were limited to hard tissues – the maxillary prominence in subjects from the Warsaw group was decreased by almost 4° in comparison with the Oslo group (sella-nasion-A-point (SNA) = 75.3° and 79.1°, respectively) and maxillo-mandibular morphology was less favorable in the Warsaw group than the Oslo group (ANB angle = 0.8° and 2.8°, respectively). The soft tissue contour was comparable in both groups. In conclusion, inter-group differences suggest a more favorable outcome in the Oslo group. However, the distinctiveness of facial morphology in background populations (ie, in Poles and Norwegians) could have contributed to the observed results.

Assessment of the requirement management process using a two-stage questionnaire

This research advocates the idea that although requirements management process is not carried out in many organizations there is some people within the organization that perform some requirements management practices. However, these practices are usually not documented and as consequence are not spread across the organization. This paper proposes an assessment methodology based on a two-stage questionnaire to identify which practices of the requirements management process are performed but not documented, which practices require to be prioritized and which are not implemented due to bad management or unawareness. In order to validate the assessment methodology, the questionnaire was applied to an industrial case study.

Determining practices achievement in the requirement management process using a two-stage questionnaire

This paper aims to obtain a baseline snapshot of the requirement management process using a two-stage questionnaire to identify both performed and non-performed CMMI practices. The questionnaire proposed in this paper may help with the assessment of the requirement management process, provide useful information related to the current state of the process, and indicate those practices that require immediate attention with the aim of begin a Software Process Improvement program.