Demographic Study of Hip Fractures in the Maltese Islands.

INTRODUCTION: Despite hip fractures being a great public health burden, only few studies have analyzed the relationship between hip fracture incidence and socioeconomic status. Many studies found an association; however, results are in part conflicting. OBJECTIVE: To analyze the impact of regional-level socioeconomic status on the incidence of hip fractures in the Maltese Islands. METHOD: All individuals older than 50 years who presented to the acute care hospitals in Malta and Gozo with low-energy hip fractures between December 1, 2015, and November 30, 2016, were selected. Data on individual demographics, hip fracture type, surgical intervention, and hospital stay were collected. The percentage of hip fracture and socioeconomic status of each region in the Maltese Islands were calculated. These were then analyzed for any statistical association. RESULTS: A moderate negative correlation (r = -0.5987, N = 454, P < .05) was found between the socioeconomic status and the incidence of hip fracture in each region. There was 5.9% (n = 27) mortality rate posed by these hip fractures. The average duration of hospital stay was 14 days, with an average delay to surgical intervention of 2 days. CONCLUSION: Despite the Maltese Islands having a small population (429 344 people) and a free universal national health service, our results show that districts with low socioeconomic status had a higher incidence of hip fracture. Further studies using individual socioeconomic data and longer duration are required.

Chronic kidney disease referral practices among non-nephrology specialists: A single-centre experience.

BACKGROUND: Early referral of CKD patients to nephrology teams (NT) is vital to identify patients most likely to progress, delay decline of excretory function, and provide planned RRT. Unfortunately, many are still being referred late. METHODS: We conducted a retrospective analysis to investigate referral rates, predictors of non-referral, and performed urine investigations in hospitalised CKD patients. RESULTS: Out of 388 patients studied, 5.6%, 11.4%, and 16.4% in CKD3A, 3B, and 4+5, respectively, were referred to an NT upon discharge (CKD3A vs. CKD4+5, p=0.016). For every additional year of age, the odds of being referred decreased by 5% (OR: 0.95, CI: 0.92-0.98, p=0.003). Patients were more likely to be referred to an NT if they were males (OR: 2.31, CI: 1.09-4.90, p=0.029) and having reached CKD 4+5 (OR: 3.99, CI: 1.58-10.10, p=0.003). Only 28.8%, 43.9%, and 50.7% of patients with CKD3A, 3B, and 4+5 were followed up with urine investigations after discharge (p=0.001). CKD stage 3B (OR: 3.54, CI: 1.23-10.19, p=0.019), CKD stage 4+5 (OR: 6.06, CI: 1.69-21.67, p=0.006), DM (OR: 6.28, CI: 2.38-16.58, p<0.0001), and having been referred to a NT (OR: 20.95, CI: 3.54-123.92, p=0.001) were independent predictors for having urine investigations. CONCLUSION: The highest rate of referral was achieved in males, younger age group, and those who have reached CKD stage 4+5. Urine tests remain largely underutilised and only a minority (16.4%) of patients with an eGFR <30mL/min/1.73m(2) were referred to a NT.

Development and Implementation of a Novel Sulfur Removal Process from H2S Containing Wastewaters.

A novel process for removing sulfur from wastewater containing dissolved sulfide has been developed and implemented in a membrane bioreactor (MBR) process treating anaerobically pretreated industrial (pulp and paper) wastewater at the Gippsland Water Factory. Controlled oxygen addition to the first bioreactor zone (constituting 27.7% of the total bioreactor volume) to create oxygen-limiting conditions, followed by oxygen-sufficient conditions in the remaining zones of the bioreactor, provide the necessary conditions. Dissolved sulfide is oxidized to elemental sulfur in the first zone, and the accumulated sulfur is retained in the bioreactor mixed liquor suspended solids (MLSS) in the remaining zones. Accumulated sulfur is removed from the process in the waste activated sludge (WAS). Oxidation of dissolved sulfide to elemental sulfur reduces the associated process oxygen requirement by 75% compared to oxidation to sulfate. Microscopic examinations confirm that biological accumulation of elemental sulfur occurs. Process performance was analyzed during a nearly 2-year commissioning and optimization period. Addition of air in proportion to the process influent dissolved sulfide loading proved the most effective process control approach, followed by the maintenance of dissolved oxygen concentrations of 1.0 and 1.5 mg/L in the two downstream bioreactor zones. Sufficient oxygen is added for the stoichiometric conversion of dissolved sulfide to elemental sulfur. Enhanced biological phosphorus removal also occurred under these conditions, thereby simplifying supplemental phosphorus addition. These operating conditions also appear to lead to low and stable capillary suction time values for the MBR mixed liquor.

Diagnosis of dissolved organic matter removal by GAC treatment in biologically treated papermill effluents using advanced organic characterisation techniques.

Granular activated carbon (GAC) exhaustion rates on pulp and paper effluent from South East Australia were found to be a factor of three higher (3.62cf. 1.47kgm(-3)) on Kraft mills compared to mills using Thermomechanical pulping supplemented by Recycled Fibre (TMP/RCF). Biological waste treatment at both mills resulted in a final effluent COD of 240mgL(-1). The dissolved organic carbon (DOC) was only 1.2 times higher in the Kraft effluent (70 vs. 58mgL(-1)), however, GAC treatment of Kraft and TMP/RCF effluent was largely different on the DOC persisted after biological treatment. The molecular mass (636 vs. 534gmol(-1)) and aromaticity (5.35 vs. 4.67Lmg(-1)m(-1)) of humic substances (HS) were slightly higher in the Kraft effluent. The HS aromaticity was decreased by a factor of 1.0Lmg(-1)m(-1) in both Kraft and TMP/RCF effluent. The molecular mass of the Kraft effluent increased by 50gmol(-1) while the molecular mass of the TMP/RCF effluent was essentially unchanged after GAC treatment; the DOC removal efficiency of the GAC on Kraft effluent was biased towards the low molecular weight humic compounds. The rapid adsorption of this fraction, coupled with the slightly higher aromaticity of the humic components resulted in early breakthrough on the Kraft effluent. Fluorescence excitation-emission matrix analysis of the each GAC treated effluent indicated that the refractory components were higher molecular weight humics on the Kraft effluent and protein-like compounds on the TMP/RCF effluent. Although the GAC exhaustion rates are too high for an effective DOC removal option for biologically treated pulp and paper mill effluents, the study indicates that advanced organic characterisation techniques can be used to diagnose GAC performance on complex effluents with comparable bulk DOC and COD loads.