Advance Aerobic Granular Sludge Development for the Treatment of Low Strength Wastewater

The aim of the present study was to assess the start-up performance of aerobic granular sludge for the treatment of low-strength (COD <200 mg L−1) domestic wastewater by the application of a diatomite carrier. The feasibility was evaluated in terms of the start-up period and stability of the aerobic granules as well as COD and phosphate removal efficiencies. A single pilot-scale Sequencing Batch Reactor (SBR) was used and operated separately for the control granulation and granulation with diatomite. Complete granulation (granulation rate ≥ 90%) was achieved within 20 days for the case of diatomite with an average influent COD concentration of 184 mg L−1. In comparison, control granulation required 85 days to accomplish the same feat with a higher average influent COD concentration (253 mg L−1). The presence of diatomite solidifies the core of the granules and enhances physical stability. Diatomite granules recorded the strength and SVI of 18 IC and 53 mL/g SS which clearly superior to control granulation (19.3 IC, 81 mL/g SS). Quick start-up and achievement of stable granules lead to an efficient COD (89%) and phosphate removal (74%) in 50 days of bioreactor operation. Interestingly, this study revealed that diatomite has some special mechanism in enhancing the removal of both COD and phosphate. The result of this research implies that the advanced development of granular sludge by using diatomite can provide a promising low-strength wastewater treatment.

Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions

Importance: Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. Objective: In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. Data Sources: We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings: We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.

Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions

Importance: Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. Objective: In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. Data Sources: We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings: We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.