Continuous Family Access to the Intensive Care Unit: A Mixed Method Exploratory Study.

INTRODUCTION: Intensive care unit (ICU) visitation has traditionally been restrictive, primarily due to septic considerations and staff apprehension towards unrestricted visitation policy. However, ICU admission is stressful for patients and their families and the presence of family relatives at ICU patients' bedside may help alleviate the same. The present study compares the viewpoints of healthcare workers (HCW) and patients' family members regarding these two types of visitation policies. MATERIALS AND METHODS: The initial assessment involved a qualitative investigation, based on an inductive grounded theory approach. Participant interviews were audiotaped, transcribed, manually coded, themes analyzed, and aggregate dimensions unfolded. Subsequently, a structured proforma filled by stakeholders and responses were coded as categorical variables (quantitative investigation). Their association with a continuous presence of family members was seen using univariate analysis (Chi-square test) and p <0.05 was considered significant. Satisfaction levels were rated on a Likert scale. RESULTS: Eighty-six stakeholders [group A: HCWs (15 doctors, 29 nurses), group B: patients (n = 18), and their relatives (n = 24)] were interviewed. While group A preferred restricted visitation policy (RVP), group B preferred unrestricted visitation policy (UVP). Quantitative data confirmed that HCWs (92.8% nurses and 85.7% doctors) were more satisfied with RVP and group B (92.3% relatives and 87.5% patients) with UVP. Group A (75.9% nurses and 93.3% doctors) therefore preferred RVP and group B (75% families and 66.6% patients) preferred UVP. CONCLUSION: The patients and their families were more satisfied with UVP contrary to HCWs who were skeptical towards UVP and preferred RVP. HOW TO CITE THIS ARTICLE: Mahajan RK, Gupta S, Singh G, Mahajan R, Gautam PL. Continuous Family Access to the Intensive Care Unit: A Mixed Method Exploratory Study. Indian J Crit Care Med 2021;25(5):540-550.

Current practices and challenges in using microalgae for treatment of nutrient rich wastewater from agro-based industries.

Considerable research activities are underway involving microalgae species in order to treat industrial wastewater to address the waste-to-bioenergy economy. Several studies of wastewater treatment using microalgae have been primarily focused on removal of key nutrients such as nitrogen and phosphorus. Although the use of wastewater would provide nutrients and water for microalgae growth, the whole process is even more complex than the conventional microalgae cultivation on freshwater media. The former one adds several gridlocks to the system. These gridlocks are surplus organic and inorganic nutrients concentration, pH of wastewater, wastewater color, total dissolved solids (TDS), microbial contaminants, the scale of photobioreactor, batch versus continuous system, harvesting of microalgae biomass etc. The present review discusses, analyses, and summarizes key aspects involved in the treatment of wastewaters from distillery, food/snacks product processing, and dairy processing industry using microalgae along with sustainable production of its biomass. This review further evaluates the bottlenecks for individual steps involved in the process such as pretreatment of wastewater for contaminants removal, concentration tolerance/dilutions, harvesting of microalgae biomass, and outdoor scale-up. The review also describes various strategies to optimize algal biomass and lipid productivities for various wastewater and photobioreactor type. Moreover, the review emphasizes the potential of co-cultivation of microorganism such as yeast and bacteria along with microalgae in the treatment of industrial wastewater.

Outdoor microalgae cultivation in airlift photobioreactor at high irradiance and temperature conditions: effect of batch and fed-batch strategies, photoinhibition, and temperature stress.

The microalgae Scenedesmus abundans cultivated in five identical airlift photobioreactors (PBRs) in batch and fed-batch modes at the outdoor tropical condition. The microalgae strain S. abundans was found to tolerate high temperature (35-45 °C) and high light intensity (770-1690 µmol m- 2 s- 1). The highest biomass productivities were 152.5-162.5 mg L- 1 day- 1 for fed-batch strategy. The biomass productivity was drastically reduced due to photoinhibition effect at a culture temperature of > 45 °C. The lipid compositions showed fatty acids mainly in the form of saturated and monounsaturated fatty acids (> 80%) in all PBRs with Cetane number more than 51. The fed-batch strategies efficiently produced higher biomass and lipid productivities at harsh outdoor conditions. Furthermore, the microalgae also accumulated omega-3 fatty acid (C18:3) up to 14% (w/w) of total fatty acid at given outdoor condition.

An integrated approach for microalgae cultivation using raw and anaerobic digested wastewaters from food processing industry.

An integrated approach has been proposed to produce microalgal biodiesel using both raw wastewater (RW) and anaerobically digested wastewater (ADW) of food processing industry without addition of extra nutrients or carbon source for cultivation besides obtaining effluent discharge permissible limits of TN, TP, and COD. Three microalgae species cultivated with following different combinations: RW, ADW, RW + ADW, and glucose + ADW. Results indicated that the addition of RW as a carbon source in ADW significantly enhanced BP, LP, and TN removal as compared to the ADW alone. The runs with RW + ADW removed COD, TN, and TP by 89%, 84%, and 70%, respectively. Sc. obliquus showed highest biomass and lipid productivities (211 and 27.5 mg L-1 d-1) for RW + ADW. The addition of RW or glucose in ADW significantly lowered PUFA contents to 5-15% CDW (as against 35-50% with ADW) for Chl. sorokiniana and Sc. obliquus.

Mixotrophic cultivation of microalgae to enhance the quality of lipid for biodiesel application: effects of scale of cultivation and light spectrum on reduction of α-linolenic acid.

The research on microalgal biodiesel is focused not only on getting the highest lipid productivity but also desired quality of lipid. The experiments were initially conducted on flask scale (1L) using acetate carbon source at different concentrations viz. 0.5, 2, 3 and 4 g L-1. The optimum concentration of acetate was considered for further experiments in two airlift photobioreactors (10 L) equipped separately with red and white LED lights. The Feasibility Index (FI) was derived to analyze the scalability of mixotrophic cultivation based on net carbon fixation in biomass per consumption of total organic carbon. The experimental strategy under mixotrophic mode of cultivation lowered the α-linolenic acid content of lipid by 60-80% as compared to autotrophic cultivation for Scenedesmus abundans species and yielded the highest biomass and lipid productivities, 59 ± 2 and 17 ± 1.8 mg L-1 day-1, respectively. The TOC, nitrate, and phosphate reduction rates were 74.6 ± 3.0, 11.5 ± 1.4, 9.6 ± 2.4 mg L-1 day-1, respectively. The significant change was observed in lipid compositions due to the scale, mode of cultivation, and light spectra. As compared to phototrophic cultivation, biodiesel obtained under mixotrophic cultivation only met standard biodiesel properties. The FI data showed that the mixotrophic cultivation was feasible on moderate concentrations of acetate (2-3 g L-1).