Practical experience with full-scale structured sheet media (SSM) integrated fixed-film activated sludge (IFAS) systems for nitrification.

Many wastewater treatment plants in the USA, which were originally designed as secondary treatment systems with no or partial nitrification requirements, are facing increased flows, loads, and more stringent ammonia discharge limits. Plant expansion is often not cost-effective due to either high construction costs or lack of land. Under these circumstances, integrated fixed-film activated sludge (IFAS) systems using both suspended growth and biofilms that grow attached to a fixed plastic structured sheet media are found to be a viable solution for solving the challenges.

Short-term mechanical management of cardiogenic shock.

Cardiogenic shock (CS), a state of cardiac dysfunction that results in systemic hypoperfusion and end-organ dysfunction, is associated with high in-hospital mortality. Various forms of mechanical circulatory support have been used to treat CS. First employed in the 1960s, the intra-aortic balloon pump (IABP) has been a mainstay in the treatment of acute CS.