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Purpose Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation. Methods This retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36 ± 17 years with a range of 3–89 years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18 years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization. Results A total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤ 250 ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (P = 0.40) as was the mean APERP (303 ± 68 ms vs. 307 ± 75) (P = 0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (P Conclusion The results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.

Biofouling triggers a chain of events that are deleterious to engineered systems providing safe water to the population and industry. The frequent use of dissolved biocides to combat biofilm growth has its own drawbacks, including the formation of noxious substances (e.g., organochlorinated compounds) and the discharge of significant amounts of nonspent biocides in the aquatic environment. This paper proposes affordable and robust approaches for water pretreatment to reduce organic (bio) and inorganic fouling to be implemented in developing rural areas. The pretreatment follows a sequential step strategy that includes particulate matter removal through optimized coagulation, phosphorus removal by iron oxide sorption using recovered inexpensive waste materials and, finally, an innovative biocidal treatment with functionalized particles. The following main experimental results were obtained: (1) coagulation treatment with aluminum sulfate at 0.03 mg L-1 led to the elimination of particulate matter fouling, as confirmed by the improved performance of a downstream membrane separation system; (2) in the sorption step, iron-covered waste sand taken from filter backwash water allowed a reduction of microbial available phosphorous to levels where biofilm growth is highly limited; and (3) the novel bactericidal process, using inexpensive commercial alumina particles functionalized with benzalkonium chloride, was able to reduce to zero the microbial load of a contaminated water stream within 1 h of residence time, without leaching the biocide to the water. Implementation of this concept represents an affordable and environmentally sustainable treatment system because the basic materials used have low cost and are easily available. (C) 2021 American Society of Civil Engineers.

Operations research can be used to apply analytical methods that help make precise and reasonable decisions. In road maintenance, basic principles of operations research are used to create model formulation that could help lower costs in case of an inaccurately made decision. First, the paper provides a literature review on different model formulations. Afterward, hypotheses are proposed regarding the model formulation, and then the model that minimises total generalised costs from wrong duty orders for road maintenance is offered. In conclusion, the paper evaluates the hypotheses and the process of improving the mathematical model.

The presence of excess water in centralized sewerage systems is known to have a multitude of unfavorable effects on the daily operation of the wastewater infrastructure. The additional volume of I/I-water decreases the hydraulic capacity of wastewater collection networks, reduces the efficiency of wastewater treatment processes, and increases the costs of transporting and treating the wastewater. Currently, most I/I studies in Latvia are conducted on the scale of the wastewater treatment plant service area and determine only the common performance indicators for a given year. However, data of such resolution are not sufficient to identify problem areas within the networks and to introduce cost-effective measures. The contribution of private sewer laterals to the overall I/I volume is an area of particular interest. Although it is possible to locate and quantify I/I from individual house connections, in practice, given the financial and time constraints, it is not feasible to apply a case-by-case approach. Thus, a simple method to predetermine the problematic parts of the system before conducting on-site inspections is needed. This study investigates the link between groundwater levels and observed night-time wastewater flows on a sub-catchment scale by performing a linear regression analysis (940 data points in total). The results show a direct correlation (R > 0.70 in all cases) between said parameters and highlight the impacts of poorly built and ill-maintained house connections. The presented approach can be widely adopted by system operators to help identify potential sources of diluted wastewater and to aid in the development of priority-based renovation plans.

Hydrolysis of the lignocellulosic biomass results in the release of high-value chemicals that during industrial processing can be recovered with membrane technologies. To maintain an effective performance of the membranes used in the technological processing of biomass, their regular cleaning is essential. Although several guidelines may be found for membrane cleaning in the cases of organic fouling, the data for cleaning membranes fouled by hydrolyzed lignocellulosic biomass is limited. Current research is aimed to evaluate physical (air backpulse) and common cheap chemical membrane cleaning methods. The results showed that air backpulse alone had a minor (9%) effect on the membrane cleaning. The alternation of NaOH (1 %) solution with the NaClO (200 mg/L of Free chlorine) was the most effective approach for membrane cleaning. The cleaning effectiveness was 95.1 % for 50 nm membrane and 89 % for 200 nm membrane, indicating that membranes used for hydrolyzed lignocellulosic biomass filtration can be effectively cleaned using affordable and accessible chemicals.

Highlights • Assessing the relationship between atrial fibrillation and quality of life. • Implantable loop recorders assessed rhythm continuously in symptomatic patients. • Atrial fibrillation burden, episode duration and frequency were included. • Higher atrial fibrillation burden was associated with impaired quality of life., Aims To assess the relation between atrial fibrillation (AF) characteristics and health-related quality of life (QoL), and which AF characteristic had the greatest impact. Method The AF characteristics burden (percentage of time in AF), duration and number of AF episodes/month were obtained from implantable cardiac monitors during the 2-month run-in period in 150 patients included in the randomized CAPTAF trial comparing early ablation and antiarrhythmic drug therapy. The QoL was measured by the General Health and Vitality dimensions of the 36-Item Short-Form Health Survey. AF characteristics were analysed continuously and in quartiles (Q1-Q4). Results Greater AF burden (p = 0.003) and longer AF episodes (p = 0.013) were associated with impaired QoL (Vitality score only) in simple linear regression analyses. Greater AF burden was, however, the only AF characteristic associated with lower QoL, when adjusted for sex, type of AF, hypertension, heart rate above 110 beats per minute during AF, and beta-blocker use in multiple linear regression analyses. For every 10% increase in AF burden there was a 1.34-point decrease of Vitality score (95% confidence interval (CI) −2.67 to −0.02, p = 0.047). The Vitality score was 12 points lower (95% CI −22.73 to −1.27, p = 0.03) in patients with an AF burden > 33% (Q4) versus those with

Biogas is a common source of renewable energy. But biogas plants also produce a by-product which is at least as valuable as renewable energy, because of its nutrients and organic matter content – digestate. Digestate is an excellent fertilizer containing many different nutrients and micronutrients necessary for agriculture, including nitrogen, phosphorus and potassium. Digestate can be characterized based on the feedstock used to produce biogas. Latvia’s biogas plants produce digestate from: manure and agricultural sludge (85 %), sewage sludge (5 %) and municipal waste (10 %). However, digestate misuse can cause a serious threat to the environment. This study gathered information and proposes recommendations on the use of digestate in Latvia from nutrient perspective.

Background Idiopathic ventricular fibrillation (IVF) is a rare cause of sudden cardiac arrest which may pose therapeutic and prognostic challenges. To date, the only effective treatment for survivors of cardiac arrest is the insertion of an implantable cardioverter-defibrillator (ICD). We sought to review the long-term outcome of a Swedish cohort with IVF. Methods and results Fifty patients with IVF diagnosis between 1988 and 2016 (mean age at index 34.3, 56% male), were followed for a median 13.8 years in this retrospective multicenter observational study. No cardiac mortality was reported. 32% (n = 16) of patients had recurrence of ventricular fibrillation or sustained ventricular tachycardia, requiring ICD therapy, at a median time of 1.9 years (range 0.1–20.3) from the index event. Annual incidence rate of ventricular tachyarrhythmia was 3.1%. Abnormal ECG at baseline did not predict appropriate ICD therapy (p = 0.56). During the follow-up period, 14% (n = 7) patients received a cardiac diagnosis. Follow-up genetic testing was low (26%), however did confirm pathogenic mutations in three cases. Conclusion Idiopathic VF is a rare diagnosis with a relatively good prognosis provided ICD therapy is initiated. Routine clinical follow-up is recommended due to potential late emerging cardiac pathology. ECG changes are common, but have no prognostic value in determining the risk of ventricular arrhythmias recurrence. Screening for genetic diseases has previously been low, and this calls for improvement, especially since cheaper and more comprehensive genetic panels are now readily available.

Phosphorus (P) is among the most important nutrients required for bacterial growth. It has a great influence on microbial activity even at very small concentrations. Existing chemical methods are not able to determine P at low enough concentrations and to quantify biologically available phosphorus fractions. Therefore, a method of microbially available phosphorus (MAP) determination is used to quantify the amount of P at concentrations below 20 µg/l. Additionally, this method determines the amount of P that can be directly used by microorganisms. Originally it was determined by inoculating sample by Pseudomonas fluorescens (now Ps. brenneri) P17 strain and spread-plated on R2A agar for enumeration. Further, a more rapid method was developed by replacing heterotrophic plate count (HPC) by flow cytometry (FCM). In this paper the use of FCM for MAP determination is validated and compared with HPC method. The results of calibration are presented. The original pure P17 strain was used as inoculum and standards with different PO4-P concentrations were inoculated at 30°C. The gained yield factor by FCM was 1.59x108. FCM results showed strong correlation (R2=0.99) with HPC results, as pure culture was used. Therefore, flow cytometry is a rapid alternative to heterotrophic plate count method for microbially available phosphorus determination.

To study effects of ischemia-reperfusion on ventricular electrophysiology in humans by three-dimensional electrocardiography.Fifty-seven patients with first-time acute anterior ST elevation myocardial infarction were monitored from admission and24h after symptom onset with continuous vectorcardiography (VCG; modified Frank orthogonal leads). Global ventricular depolarization and repolarization (VR) measures were compared at maximum vs. minimum ST vector magnitude (STVM) (median 208; 111-303 vs. 362; 165-1359min after symptom onset).At maximum vs. minimum STVM the Tarea (overall VR dispersion) almost tripled (118 vs. 41μVs; p0.0001), the T-loop bulginess was 90% greater (Tavplan 0.91 vs 0.48μV; p0.0001), and Tpeak-end/QT was 39% larger (0.32 vs 0.23; p0.0001). QRSarea (overall dispersion of depolarization) was 12% larger at maximum STVM, while QRS duration was 10% longer at minimum STVM.Ischemia-reperfusion was accompanied by profound and transient alterations of VR dispersion, while changes in depolarization were modest and delayed.

By using industrial aluminium recycling waste, recycled silicate glass from outworn fluorescence lamp recycling plant, calcined kaolinite clay supplemented with alkali activator with different silicate modulus the new type of porous material for biotechnologic processes without the need for additional equipment for pH control was researched. This controlled-release system contains an alkali activated matrix in which NaOH crystals are encased. In this study ability to release NaOH per time in water according to material composition and structure were investigated. Three alkaline activated materials AAM 7.5, 10 and 12.5, with different alkali activator content were characterized.

Importance Quality of life is not a standard primary outcome in ablation trials, even though symptoms drive the indication. Objective To assess quality of life with catheter ablation vs antiarrhythmic medication at 12 months in patients with atrial fibrillation. Design, Setting, and Participants Randomized clinical trial at 4 university hospitals in Sweden and 1 in Finland of 155 patients aged 30-70 years with more than 6 months of atrial fibrillation and treatment failure with 1 antiarrhythmic drug or β-blocker, with 4-year follow-up. Study dates were July 2008–September 2017. Major exclusions were ejection fraction 60 mm, ventricular pacing dependency, and previous ablation. Interventions Pulmonary vein isolation ablation (n = 79) or previously untested antiarrhythmic drugs (n = 76). Main Outcomes and Measures Primary outcome was the General Health subscale score (Medical Outcomes Study 36-Item Short-Form Health Survey) at baseline and 12 months, assessed unblinded (range, 0 [worst] to 100 [best]). There were 26 secondary outcomes, including atrial fibrillation burden (% of time) from baseline to 12 months, measured by implantable cardiac monitors. The first 3 months were excluded from rhythm analysis. Results Among 155 randomized patients (mean age, 56.1 years; 22.6% women), 97% completed the trial. Of 79 patients randomized to receive ablation, 75 underwent ablation, including 2 who crossed over to medication and 14 who underwent repeated ablation procedures. Of 76 patients randomized to receive antiarrhythmic medication, 74 received it, including 8 who crossed over to ablation and 43 for whom the first drug used failed. General Health score increased from 61.8 to 73.9 points in the ablation group vs 62.7 to 65.4 points in the medication group (between-group difference, 8.9 points; 95% CI, 3.1-14.7;P = .003). Of 26 secondary end points, 5 were analyzed; 2 were null and 2 were statistically significant, including decrease in atrial fibrillation burden (from 24.9% to 5.5% in the ablation group vs 23.3% to 11.5% in the medication group; difference –6.8% [95% CI, –12.9% to –0.7%];P = .03). Of the Health Survey subscales, 5 of 7 improved significantly. Most common adverse events were urosepsis (5.1%) in the ablation group and atrial tachycardia (3.9%) in the medication group. Conclusions and Relevance Among patients with symptomatic atrial fibrillation despite use of antiarrhythmic medication, the improvement in quality of life at 12 months was greater for those treated with catheter ablation compared with antiarrhythmic medication. Although the study was limited by absence of blinding, catheter ablation may offer an advantage for quality of life. Trial Registration clinicaltrialsregister.eu Identifier:2008-001384-11