scholarly journals How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Kidney360 ◽  
2020 ◽  
Vol 1 (10) ◽  
pp. 1163-1175
Author(s):  
Nilum Rajora ◽  
Shani Shastri ◽  
Gulzar Pirwani ◽  
Ramesh Saxena
Keyword(s):  
Peritoneal Dialysis ◽  
Cost Effective ◽  
Cost Of Care ◽  
Dialysis Initiation ◽  
High Rate ◽  
Center Staff ◽  
Effective Option ◽  
Poor Outcomes ◽  
Unplanned Dialysis ◽  
Improve Patient

In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter–related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.

Using automated peritoneal dialysis for unplanned dialysis initiation

2017 ◽  
Vol 2 (4) ◽  
pp. 194-199
Author(s):  
Venkat Rama Reddy Gangaram ◽  
Gerry Endall ◽  
Amanda Laird ◽  
Gary Leggatt ◽  
Anna Sampson ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Initiation ◽  
Automated Peritoneal Dialysis ◽  
Unplanned Dialysis

Sand Free Production Success Through Proven Technology Enabler from An Untapped Heterogeneous Reservoir Zone Utilizing Gravel Pack Replacement Methodology

2020 ◽  
Author(s):  
Y. Anggoro
Keyword(s):  
Oil And Gas ◽  
Erosion Resistance ◽  
Cost Effective ◽  
High Rate ◽  
Screen Design ◽  
Sand Control ◽  
Rules Of Thumb ◽  
Production Success ◽  
Control Technologies ◽  
Gravel Pack

The Belida field is an offshore field located in Block B of Indonesia’s South Natuna Sea. This field was discovered in 1989. Both oil and gas bearing reservoirs are present in the Belida field in the Miocene Arang, Udang and Intra Barat Formations. Within the middle Arang Formation, there are three gas pay zones informally referred to as Beta, Gamma and Delta. These sand zones are thin pay zones which need to be carefully planned and economically exploited. Due to the nature of the reservoir, sand production is a challenge and requires downhole sand control. A key challenge for sand control equipment in this application is erosion resistance without inhibiting productivity as high gas rates and associated high flow velocity is expected from the zones, which is known to have caused sand control failure. To help achieve a cost-effective and easily planned deployment solution to produce hydrocarbons, a rigless deployment is the preferred method to deploy downhole sand control. PSD analysis from the reservoir zone suggested from ‘Industry Rules of Thumb’ a conventional gravel pack deployment as a means of downhole sand control. However, based on review of newer globally proven sand control technologies since adoption of these ‘Industry Rules of Thumb’, a cost-effective solution could be considered and implemented utilizing Ceramic Sand Screen technology. This paper will discuss the successful application at Block B, Natuna Sea using Ceramic Sand Screens as a rigless intervention solution addressing the erosion / hot spotting challenges in these high rate production zones. The erosion resistance of the Ceramic Sand Screen design allows a deployment methodology directly adjacent to the perforated interval to resist against premature loss of sand control. The robust ceramic screen design gave the flexibility required to develop a cost-effective lower completion deployment methodology both from a challenging make up in the well due to a restrictive lubricator length to the tractor conveyancing in the well to land out at the desired set depth covering the producing zone. The paper will overview the success of multi-service and product supply co-operation adopting technology enablers to challenge ‘Industry Rules of Thumb’ replaced by rigless reasoning as a standard well intervention downhole sand control solution where Medco E&P Natuna Ltd. (Medco E&P) faces sand control challenges in their high deviation, sidetracked well stock. The paper draws final attention to the hydrocarbon performance gain resulting due to the ability for choke free production to allow drawing down the well at higher rates than initially expected from this zone.

An efficient biotreatment process for polyvinyl alcohol containing textile wastewater

2013 ◽  
Vol 8 (3-4) ◽  
pp. 469-478 ◽  
Author(s):  
Sandip S. Magdum ◽  
Gauri P. Minde ◽  
Upendra S. Adhyapak ◽  
V. Kalyanraman
Keyword(s):  
Polyvinyl Alcohol ◽  
Process Optimization ◽  
Textile Wastewater ◽  
Cost Effective ◽  
Chemical Oxidation ◽  
High Rate ◽  
Microbial Consortia ◽  
Environment Friendly ◽  
Candida Sp ◽  
Textile Wastewater Treatment

The aim of this work was to optimize the biodegradation of polyvinyl alcohol (PVA) containing actual textile wastewater for a sustainable treatment solution. The isolated microbial consortia of effective PVA degrader namely Candida Sp. and Pseudomonas Sp., which were responsible for symbiotic degradation of chemical oxidation demand (COD) and PVA from desizing wastewater. In the process optimization, the maximum aeration was essential to achieve a high degradation rate, where as stirring enhances further degradation and foam control. Batch experiments concluded with the need of 16 lpm/l and 150 rpm of air and stirring speed respectively for high rate of COD and PVA degradation. Optimized process leads to 2 days of hydraulic retention time (HRT) with 85–90% PVA degradation. Continuous study also confirmed above treatment process optimization with 85.02% of COD and 90.3% of PVA degradation of effluent with 2 days HRT. This study gives environment friendly and cost effective solution for PVA containing textile wastewater treatment.

scholarly journals ANN-Based Decision Making in Station Keeping for Geotechnical Drilling Vessel

2021 ◽  
Vol 9 (6) ◽  
pp. 596
Author(s):  
Murugan Ramasamy ◽  
Mohammed Abdul Hannan ◽  
Yaseen Adnan Ahmed ◽  
Arun Kr Dev
Keyword(s):  
Decision Making ◽  
Water Depth ◽  
Business Models ◽  
Cost Benefit ◽  
Cost Effective ◽  
Station Keeping ◽  
Operational Information ◽  
Effective Option ◽  
The Cost ◽  
Cost Factors

Offshore vessels (OVs) often require precise station-keeping and some vessels, for example, vessels involved in geotechnical drilling, generally use Spread Mooring (SM) or Dynamic Positioning (DP) systems. Most of these vessels are equipped with both systems to cover all ranges of water depths. However, determining which system to use for a particular operational scenario depends on many factors and requires significant balancing in terms of cost-benefit. Therefore, this research aims to develop a platform that will determine the cost factors for both the SM and DP station-keeping systems. Operational information and cost data are collected for several field operations, and Artificial Neural Networks (ANN) are trained using those data samples. After that, the trained ANN is used to predict the components of cost for any given environmental situation, fieldwork duration and water depth. Later, the total cost is investigated against water depth for both DP and SM systems to determine the most cost-effective option. The results are validated using two operational scenarios for a specific geotechnical vessel. This decision-making algorithm can be further developed by adding up more operational data for various vessels and can be applied in the development of sustainable decision-making business models for OVs operators.

Advances in high rate anaerobic treatment: staging of reactor systems

2001 ◽  
Vol 44 (8) ◽  
pp. 15-25 ◽  
Author(s):  
J.B. van Lier ◽  
F.P. van der Zee ◽  
N.C.G. Tan ◽  
S. Rebac ◽  
R. Kleerebezem
Keyword(s):  
Cost Effective ◽  
Anaerobic Treatment ◽  
High Rate ◽  
Extreme Conditions ◽  
Waste Streams ◽  
Textile Processing ◽  
Anaerobic Wastewater Treatment ◽  
Anaerobic Reactors ◽  
Wide Acceptance ◽  
Solids Retention

Anaerobic wastewater treatment (AnWT) is considered as the most cost-effective solution for organically polluted industrial waste streams. Particularly the development of high-rate systems, in which hydraulic retention times are uncoupled from solids retention times, has led to a world-wide acceptance of AnWT. In the last decade up to the present, the application potentials of AnWT are further explored. Research shows the feasibility of anaerobic reactors under extreme conditions, such as low and high temperatures. Also toxic and/or recalcitrant wastewaters, that were previously believed not to be suitable for anaerobic processes, are now effectively treated. The recent advances are made possible by adapting the conventional anaerobic high-rate concept to the more extreme conditions. Staged anaerobic reactor concepts show advantages under non-optimal temperature conditions as well as during the treatment of chemical wastewater. In other situations, a staged anaerobic - aerobic approach is required for biodegradation of specific pollutants, e.g. the removal of dyes from textile processing wastewaters. The current paper illustrates the benefits of reactor staging and the yet un-exploited potentials of high-rate AnWT.

scholarly journals Damping Pressure Pulsations in a Wave-Powered Desalination System

2014 ◽  
Vol 136 (2) ◽  
Author(s):  
Brandon J. Hopkins ◽  
Nikhil Padhye ◽  
Alison Greenlee ◽  
James Torres ◽  
Levon Thomas ◽  
...  
Keyword(s):  
Constant Pressure ◽  
Low Cost ◽  
Pressure Fluctuations ◽  
Cost Effective ◽  
Coastal Communities ◽  
Pressure Pulsations ◽  
Pressure Flow ◽  
Reliable Source ◽  
Effective Option ◽  
Elastic Pipes

Wave-driven reverse osmosis desalination systems can be a cost-effective option for providing a safe and reliable source of drinking water for large coastal communities. Such systems usually require the stabilization of pulsating pressures for desalination purposes. The key challenge is to convert a fluctuating pressure flow into a constant pressure flow. To address this task, stub-filters, accumulators, and radially elastic-pipes are considered for smoothing the pressure fluctuations in the flow. An analytical model for fluidic capacitance of accumulators and elastic pipes are derived and verified. Commercially available accumulators in combination with essentially rigid (and low cost) piping are found to be a cost-effective solution for this application, and a model for selecting accumulators with the required fluidic-capacitance for the intended system is thus presented.

scholarly journals Outcome of Acute Peritoneal Dialysis in Northern Tanzania

2012 ◽  
Vol 32 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Kajiru Gad Kilonzo ◽  
Sudakshina Ghosh ◽  
Siya Anaeli Temu ◽  
Venance Maro ◽  
John Callegari ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Outcomes ◽  
Kidney Injury ◽  
Cost Effective ◽  
High Morbidity ◽  
Poor Countries ◽  
Resource Limited ◽  
Northern Tanzania ◽  
Nephrology Care ◽  
Technical Simplicity

Data on the burden of acute kidney injury (AKI) in resource-poor countries such as Tanzania are minimal because of a lack of nephrology services and an inability to recognize and diagnose AKI with any certainty. In the few published studies, high morbidity and mortality are reported. Improved nephrology care and dialysis may lower the mortality from AKI in these settings. Hemodialysis is expensive and technically challenging in resource-limited settings. The technical simplicity of peritoneal dialysis and the potential to reduce costs if consumables can be made locally, present an opportunity to establish cost-effective programs for managing AKI. Here, we document patient outcomes in a pilot peritoneal dialysis program established in 2009 at a referral hospital in Northern Tanzania.

Addressing the Scottish burden of wounds through the Lens of Profound Knowledge

2021 ◽  
Vol 30 (Sup20) ◽  
pp. S34-S40
Author(s):  
Jenni MacDonald
Keyword(s):  
Patient Outcomes ◽  
Wound Care ◽  
Cost Effective ◽  
Theory Of Knowledge ◽  
Care Needs ◽  
Profound Knowledge ◽  
The Cost ◽  
Improve Patient ◽  
Growing Population

The prevalence of wounds and the cost of treating them are increasing year on year. Improving the quality of wound care will improve patient outcomes and is a financial necessity. The Lens of Profound Knowledge is a tool that can be used to support quality improvement and identify where action is needed. It allows exploration of an organisation through four aspects—appreciate the system, understanding variation, psychology, and theory of knowledge—and working on all four aspects simultaneously is believed to increase the likelihood of achieving improvement. Improvements at and between all levels—microsystem (such as frontline services), mesosystem (health boards) and macrosystem (NHS Scotland)—would reduce variation in practice and prove to be both clinically and cost-effective. Given the rapidly growing population of people with unhealed wounds, wound care needs to be valued at all system levels and be adequately resourced.

Anaerobic digestion for sustainable development: a natural approach

2002 ◽  
Vol 45 (10) ◽  
pp. 321-328 ◽  
Author(s):  
H.J. Gijzen
Keyword(s):  
Industrial Wastewater ◽  
Systems Approach ◽  
Cost Effective ◽  
Anaerobic Treatment ◽  
High Rate ◽  
Natural Ecosystems ◽  
Natural Systems ◽  
Anaerobic Reactors ◽  
Rural And Urban ◽  
Pre Treatment

After the discovery of methane gas by Alessandro Volta in 1776, it took about 100 years before anaerobic processes for the treatment of wastewater and sludges were introduced. The development of high rate anaerobic digesters for the treatment of sewage and industrial wastewater took until the nineteen-seventies and for solid waste even till the nineteen-eighties. All digesters have in common that they apply natural anaerobic consortia of microorganisms for degradation and transformation processes. In view of this, it could be rewarding to evaluate the efficiency of natural ecosystems for their possible application. Examples of high rate anaerobic natural systems include the forestomach of ruminants and the hindgut of certain insects, such as termites and cockroaches. These “natural reactors” exhibit volumetric methane production rates as high as 35 l/l.d. The development of anaerobic reactors based on such natural anaerobic systems could produce eco-technologies for the effective management of a wide variety of solid wastes and industrial wastewater. Important limitations of anaerobic treatment of domestic sewage relate to the absence of nutrient and pathogen removal. A combination of anaerobic pre-treatment followed by photosynthetic post-treatment is proposed for the effective recovery of energy and nutrients from sewage. This eco-technology approach is based on the recognition that the main nutrient assimilating capacity is housed in photosynthetic plants. The proposed anaerobic-photosynthetic process is energy efficient, cost effective and applicable under a wide variety of rural and urban conditions. In conclusion: a natural systems approach towards waste management could generate affordable eco-technologies for effective treatment and resource recovery.

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