Starting treatment: caring for patients and their families

The standards presented in this section focus on providing physical, social and psychological care for the patient at the point he or she is diagnosed with tuberculosis (TB) and starts treatment. Detailed guidance is included with regard to organising directly observed treatment (DOT) safely and acceptably for both the patient and the management unit. The aim is to give the patient the best possible chance of successfully completing treatment according to a regimen recommended by the World Health Organization. If the health service where the patient is diagnosed cannot offer ongoing treatment and care due to a lack of facilities, overcrowding or inaccessibility, the patient needs to be referred to a designated TB management unit (BMU) elsewhere. The patient may also receive treatment from a facility outside a BMU. However care is organised, it is essential for all patients who are diagnosed with TB to be registered at an appropriate BMU so that their progress can be routinely monitored and programme performance can be assessed. To avoid the risk of losing contact with the patient at any stage of their care, good communication is essential between all parties involved, from the patient him/herself to the person supervising their DOT to the BMU.

Alcohol Dependence: Analysis of Factors Associated with Retention of Patients in Outpatient Treatment

Aims: To identify factors associated with retention in treatment of alcohol-dependent individuals and to compare treatment retention between men and women. Methods: Analysis of the treatment attendance records and baseline characteristics of 833 men and 218 women who undertook to attend follow-up treatment in an alcoholism treatment centre. Results: Retention after 4 weeks of treatment is more likely to occur among those using adjuvant medication (the most frequent of which was disulfiram), those presenting severe alcoholism and those who are older and tend to be frequent drinkers. There was no gender difference regarding treatment retention. Conclusion: Such results suggest possibilities for developing specific strategies to reduce the risk of early dropout from treatment.

Analysis of Bacteria, Parasites, and Heavy Metals in Lettuce (Lactuca sativa) and Rocket Salad (Eruca sativa L.) Irrigated with Treated Effluent from a Biological Wastewater Treatment Plant

This study aimed to evaluate the viability of using treated residuary water from the Biological Wastewater Treatment Plant of Ribeiro Preto to grow vegetables, through the characterization and quantification of parasites, coliforms, and heavy metals. Three equal cultivation areas were prepared. The first was irrigated with treated/chlorinated (0.2 mg L(-1)) wastewater, the second one with treated wastewater without chlorination, and the third site with potable water, which was the control group. The presence of Hymenolepis nana, Enterobius vermicularis, nematode larvae, and Entamoeba coli was verified in lettuce (Lactuca sativa) samples. Although nematode larvae were observed in rocket salad (Eruca sativa L.), no significant differences were found between the number of parasites and type of irrigation water used. No significant differences were found between the number of fecal coliforms in vegetables and the different types of irrigation. However, the vegetables irrigated with treated effluent without chlorination showed higher levels of fecal coliforms. The risk of pathogens is reduced with bleach addition to the treated effluent at 0.2 mg/L. Concentration of heavy metals in vegetables does not mean significant risks to human health, according with the parameters recommended by the World Health Organization.

Thermal diffusivity of polymers by modified angstrom method

The nature of the molecular structure of plastics makes the properties of such materials markedly temperature dependent. In addition, the continuous increase in the utilization of polymeric materials in many specific applications has demanded knowledge of their physical properties, both during their processing as raw material, as well as over the working temperature range of the final polymer product. Thermal conductivity, thermal diffusivity and specific heat, namely the thermal properties, are the three most important physical properties of a material that are needed for heat transfer calculations. Recently, among several different methods for the determination of the thermal diffusivity and thermal conductivity, transient techniques have become the preferable way for measuring thermal properties of materials. In this work, a very simple and low cost variation of the well known Angstrom method is employed in the experimental determination of the thermal diffusivity of some selected polymers. Cylindrical shaped samples 3 cm diameter and 7 cm high were prepared by cutting from long cylindrical commercial bars. The reproducibility is very good, and the results obtained were checked against results obtained by the hot wire technique, laser flash technique, and when possible, they were also compared with data found in the literature. Thermal conductivity may be then derived from the thermal diffusivity with the knowledge of the bulk density and the specific heat, easily obtained by differential scanning calorimetry. (C) 2009 Elsevier Ltd. All rights reserved.

Thermal characterization of a cross-flow heat exchanger with a new flow arrangement

The objective of the present paper is to thermally characterize a cross-flow heat exchanger featuring a new cross-flow arrangement, which may find application in contemporary refrigeration and automobile industries. The new flow arrangement is peculiar in the sense that it possesses two fluid circuits extending in the form of two tube rows, each with two tube lines. To assess the heat exchanger performance, it is compared against that for the standard two-pass counter-cross-flow arrangement. The two-part comparison is based on the thermal effectiveness and the heat exchanger efficiency for several combinations of the heat capacity rate ratio, C*, and the number of transfer units, NTU. In addition, a third comparison is made in terms of the so-called ""heat exchanger reversibility norm"" (HERN) through the influence of various parameters such as the inlet temperature ratio, T, and the heat capacity rate ratio, C*, for several fixed NTU values. The proposed new flow arrangement delivers higher thermal effectiveness and higher heat exchanger efficiency, resulting in lesser entropy generation over a wide range of C* and NTU values. These metrics are quantified with respect to the arrangement widely used in refrigeration industry due to its high effectiveness, namely, the standard two-pass counter-cross-flow heat exchanger. The new flow arrangement seems to be a promising avenue in situations where cross-flow heat exchangers for single-phase fluid have to be used in refrigeration units. (c) 2009 Elsevier Masson SAS. All rights reserved.

Thermal error evaluation and modelling of a CNC cylindrical grinding machine

With the relentless quest for improved performance driving ever tighter tolerances for manufacturing, machine tools are sometimes unable to meet the desired requirements. One option to improve the tolerances of machine tools is to compensate for their errors. Among all possible sources of machine tool error, thermally induced errors are, in general for newer machines, the most important. The present work demonstrates the evaluation and modelling of the behaviour of the thermal errors of a CNC cylindrical grinding machine during its warm-up period.

INFLUENCE OF ROOF MATERIAL ON THERMAL COMFORT IN BROILER HOUSINGS IN THE STATE OF SAO PAULO

This paper presents a different roof tiles influence study on the thermal comfort for broiler housings. The research was conducted at UNESP`s Experimental Campus at Dracena, state of Sao Paulo, Brazil. Four prototypes in real scale were built, each with an area of 28 m(2). The prototype was covered with roof tiles made of recycled long-life packing material, ceramic tiles, ceramic tiles painted with white coating, and fiber/cement tiles. Temperatures inside the structures were recorded in the winter 2007 over a 90-day period. The results obtained indicated that recycled tile thermal behavior was similar to ceramic tiles. However for the winter period all the prototypes had presented comfort thermal index not in the broilers thermo neutral zone.

Theoretical and experimental study of the thermal degradation of Eucalyptus timber

Thermal action on timber causes it to degrade through combustion of its chemical components, which leads to the release of vapors, combustible gases and surface char. This diminishes its load capacity, due to the reduction of its cross section by charring and to changes in its mechanical properties of strength and stiffness as a function of its exposure to high temperatures. This paper reports the charring rates observed on Eucalyptus structural beams and presents a numerical and experimental study of the behavior of these beams when exposed to fire, in which the properties of strength and stiffness were evaluated as a function of rising temperatures, allowing an analysis of the effect of the section factor on the internal rise in temperature of structural Eucalyptus beams.

Study of soils by thermal analysis

The study of soils is very important in the geological and geological engineering researches. A study of ten samples of soils was carried out by thermal analysis, and X-Ray Fluorescence Spectrometry to understand soil evolution in Angra dos Reis region, Rio de Janeiro State, Brazil. The sample collection sites were chosen based on geological characteristics, the soil layer thickness, the soil composition pattern, and whether or not it was moved either by erosion or by gravitational shifts. Because of the humid tropical climatic condition, natural soils tend to show great thickness of weathered mantles with formation of saprolites and saprolite soils. Kaolinite is an important secondary mineral which can be formed from many different minerals, like k-mica and k-feldspar and can be weathered to gibbsite. The results from TG/DTG and DTA indicated which soils had more weathering, and the same results were obtained by XRF, when silica/aluminum ratios from samples are compared with thermal analysis results.

AnSBBR Applied to a Personal Care Industry Wastewater Treatment: Effects of Fill Time, Volume Treated Per Cycle, and Organic Load

A study was performed regarding the effect of the relation between fill time, volume treated per cycle, and influent concentration at different applied organic loadings on the stability and efficiency of an anaerobic sequencing batch reactor containing immobilized biomass on polyurethane foam with recirculation of the liquid phase (AnSBBR) applied to the treatment of wastewater from a personal care industry. Total cycle length of the reactor was 8 h (480 min). Fill times were 10 min in the batch operation, 4 h in the fed-batch operation, and a 10-min batch followed by a 4-h fed batch in the mixed operation. Settling time was not necessary since the biomass was immobilized and decant time was 10 min. Volume of liquid medium in the reactor was 2.5 L, whereas volume treated per cycle ranged from 0.88 to 2.5 L in accordance with fill time. Influent concentration varied from 300 to 1,425 mg COD/L, resulting in an applied volumetric organic load of 0.9 and 1.5 g COD/L.d. Recirculation flow rate was 20 L/h, and the reactor was maintained at 30 A degrees C. Values of organic matter removal efficiency of filtered effluent samples were below 71% in the batch operations and above 74% in the operations of fed batch followed by batch. Feeding wastewater during part of the operational cycle was beneficial to the system, as it resulted in indirect control over the conversion of substrate into intermediates that would negatively interfere with the biochemical reactions regarding the degradation of organic matter. As a result, the average substrate consumption increased, leading to higher organic removal efficiencies in the fed-batch operations.

Effect of impeller type and stirring frequency on the behavior of an AnSBBR in the treatment of low-strength wastewater

The influence of impeller type and stirring frequency on the performance of a mechanically stirred anaerobic sequencing batch reactor containing immobilized biomass on an inert support (AnSBBR - Anaerobic Sequencing Batch Biofilm Reactor) was evaluated. The biomass was immobilized on polyurethane foam cubes placed in a stainless-steel basket inside a glass cylinder. Each 8-h batch run consisted of three stages: feed (10 min), reaction (460 min) and discharge (10 min) at 30 degrees C. Experiments were performed with four impeller types, i.e., helical, flat-blade, inclined-blade and curved-blade turbines, at stirring frequencies ranging from 100 to 1100 rpm. Synthetic wastewater was used in all experiments with an organic-matter concentration of 530 +/- 37 mg/L measured as chemical oxygen demand (COD). The reactor achieved an organic-matter removal efficiency of around 87% under all investigated conditions. Analysis of the four impeller types and the investigated stirring frequencies showed that mass transfer in the liquid phase was affected not only by the applied stirring frequency but also by the agitation mode imposed by each impeller type. The best reactor performance at all stirring frequencies was obtained when agitation was provided by the flat-blade turbine impeller. (C) 2010 Elsevier Ltd. All rights reserved.

Full-scale anaerobic sequencing batch biofilm reactor for sulfate-rich wastewater treatment

This paper describes the performance and biofilm characteristics of a full-scale anaerobic sequencing batch biofilm reactor (ASBBR; 20 m(3)) containing biomass immobilized on an inert support (mineral coal) for the treatment of industrial wastewater containing a high sulfate concentration. The ASBBR reactor was operated during 110 cycles (48 h each) at sulfate loading rates ranging from 6.9 to 62.4 kgSO(4)(2-)/cycle corresponding to sulfate concentrations of 0.58-5.2 gSO(4)(2-)/L. Domestic sewage and ethanol were utilized as electron donors for sulfate reduction. After 71 cycles the mean sulfate removal efficiency was 99%, demonstrating a high potential for biological sulfate reduction. The biofilm formed in the reactor occurred in two different patterns, one at the beginning of the colonization and the other of a mature biofilm. These different colonization patterns are due to the low adhesion of the microorganisms on the inert support in the start-up period. The biofilm population is mainly made up of syntrophic consortia among sulfate-reducing bacteria and methanogenic archaea such as Methanosaeta spp.

AnSBBR Applied to the Treatment of Metalworking Fluid Wastewater: Effect of Organic and Shock Load

An investigation was performed regarding the application of a mechanically stirred anaerobic sequencing batch biofilm reactor containing immobilized biomass on inert polyurethane foam (AnSBBR) to the treatment of soluble metalworking fluids to remove organic matter and produce methane. The effect of increasing organic matter and reactor fill time, as well as shock load, on reactor stability and efficiency have been analyzed. The 5-L AnSBBR was operated at 30 A degrees C in 8-h cycles, agitation of 400 rpm, and treated 2.0 L effluent per cycle. Organic matter was increased by increasing the influent concentration (500, 1,000, 2,000, and 3,000 mg chemical oxygen demand (COD)/L). Fill times investigated were in the batch mode (fill time 10 min) and fed-batch followed by batch (fill time 4 h). In the batch mode, organic matter removal efficiencies were 87%, 86%, and 80% for influent concentrations of 500, 1,000, and 2,000 mgCOD/L (1.50, 3.12, and 6.08 gCOD/L.d), respectively. At 3,000 mgCOD/L (9.38 gCOD/L.d), operational stability could not be achieved. The reactor managed to maintain stability when a shock load twice as high the feed concentration was applied, evidencing the robustness of the reactor to potential concentration variations in the wastewater being treated. Increasing the fill time to 4 h did not improve removal efficiency, which was 72% for 2,000 mgCOD/L. Thus, gradual feeding did not improve organic matter removal. The concentration of methane formed at 6.08 gCOD/L was 5.20 mmolCH(4), which corresponded to 78% of the biogas composition. The behavior of the reactor during batch and fed-batch feeding could be explained by a kinetic model that considers organic matter consumption, production, and consumption of total volatile acids and methane production.

Effect of Fill Time on the Performance of Pilot-scale ASBR and AnSBBR Applied to Sanitary Wastewater Treatment

Many lab-scale studies have been carried out regarding the effect of feed strategy on the performance of anaerobic sequencing batch reactors (ASBR); however, more detailed pilot-scale studies should be performed to assess the real applicability of this type of operation. Therefore, the objective of this work was to assess the effect of feed strategy or fill time in a 1-m(3) mechanically stirred pilot-scale sequencing batch reactor, treating 0.65 m(3) sanitary wastewater in 8-h cycles at ambient temperature. Two reactor configurations were used: one containing granular biomass (denominated ASBR) and the other immobilized biomass on polyurethane foam as inert support (denominated anaerobic sequencing batch biofilm reactor (AnSBBR)). The reactors were operated under five distinct feed strategies, namely: typical batch and fed-batch for 25%, 50%, 75%, and 100% of the cycle length. Stirring frequency in the ASBR was 40 rpm with two flat-blade turbine impellers and 80 rpm in the AnSBBR with two helix impellers. The results showed that both the ASBR and AnSBBR when operated under typical batch, fed-batch for 50% and 75% of the cycle length, presented improved organic matter removal efficiencies, without significant differences in performance, thus showing important operational flexibility. In addition, the reactors presented operation stability under all conditions.

Microbial processes and bacterial populations associated to anaerobic treatment of sulfate-rich wastewater

A pilot-scale (1.2 m(3)) anaerobic sequencing batch biofilm reactor (ASBBR) containing mineral coal for biomass attachment was fed with sulfate-rich wastewater at increasing sulfate concentrations. Ethanol was used as the main organic source. Tested COD/sulfate ratios were of 1.8 and 1.5 for sulfate loading rates of 0.65-1.90 kgSO(4)(2-)/cycle (48 h-cycle) or of 1.0 in the trial with 3.0 gSO(4)(2-) l(-1). Sulfate removal efficiencies observed in all trials were as high as 99%. Molecular inventories indicated a shift on the microbial composition and a decrease on species diversity with the increase of sulfate concentration. Beta-proteobacteria species affiliated with Aminomonas spp. and Thermanaerovibrio spp. predominated at 1.0 gSO(4)(2-) l(-1). At higher sulfate concentrations the predominant bacterial group was Delta-proteobacteria mainly Desulfovibrio spp. and Desulfomicrobium spp. at 2.0 gSO(4)(2-) l(-1), whereas Desulfurella spp. and Coprothermobacter spp. predominated at 3.0 gSO(4)(2-) l(-1). These organisms have been commonly associated with sulfate reduction producing acetate, sulfide and sulfur. Methanogenic archaea(Methanosaeta spp.)was found at 1.0 and 2.0 gSO(4)(2-) l(-1). Additionally, a simplified mathematical model was used to infer on metabolic pathways of the biomass involved in sulfate reduction. (C) 2009 Elsevier Ltd. All rights reserved.