Jan Hrdlička

ITAREPS: Information Technology Aided Relapse Prevention Programme in Schizophrenia

ITAREPS presents a mobile phone-based telemedicine solution for weekly remote patient monitoring and disease management in schizophrenia and psychotic disorders in general. The programme provides health professionals with home telemonitoring via a PC-to-phone SMS platform that identifies prodromal symptoms of relapse, to enable early intervention and prevent unnecessary hospitalizations. Its web-based interface offers the authorized physician a longitudinal analysis of the dynamics and development of possible prodromes. This work presents preliminary findings from a one-year mirror-design follow-up evaluation of the programmes clinical effectiveness in 45 patients with psychotic illness. There was a statistically significant 60% decrease in the number of hospitalizations during the mean 283.3+/-111.9 days of participation in the ITAREPS, compared to the same time period before the ITAREPS entry (sign test, p<0.004). Variables significantly influencing the number of hospitalizations after the ITAREPS entry (medication compliance along with factors intrinsic to the ITAREPS, i.e. adherence to the programme and involvement of a family member) suggest a critical role of the programme in controlling the number of relapses and subsequent hospitalizations in psychosis.

The Information Technology Aided Relapse Prevention Programme in Schizophrenia: an extension of a mirror-design follow-up

Aims:  Decreasing a number of hospital admissions is important for improving outcomes for people with schizophrenia. The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) programme enables early pharmacological intervention in psychosis by identification of prodromal symptoms of relapse using home telemonitoring via a phone‐to‐PC SMS platform.

Effectiveness of the information technology-aided program of relapse prevention in schizophrenia (ITAREPS): a randomized, controlled, double-blind study.

Purpose. To evaluate the effectiveness of the Information Technology-Aided Program of Re lapse Prevention in Schizophrenia (ITAREPS). Methods. Relapse-prone outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n=75) or control group (n=71). In the active arm, according to the protocol, investigators were prompted to increase the antipsychotic dose upon occurrence of a pharmacological inter vention requiring event (PIRE) detected by ITAREPS. Results. Intention-to-treat (ITT) analysis found no between-group difference in the hospitalization-free survival rate at 12 months. However, the trial suffered from high non-adherence of investigators in the active group, with no antipsychotic dose increase in 61% of PIREs. Furthermore, Cox regression analysis showed a 11-fold increased risk of hospitalization in the absence of pharmacological intervention following a PIRE (hazard ratio [HR]=10.8; 95% confidence interval [CI] 1.4–80.0; p=0.002). Therefore, a post-hoc as-treated analysis was performed, which demonstrated a nine-fold reduction in the risk of hospitalization in ITAREPS Algorithm-Adherers (IAAs, n=25) compared with the ITAREPS Non-interventional group (INIs, n=70; Kaplan-Meier survival analysis, HR=0.11, 95% CI 0.05–0.28, p=0.009; number needed to treat [NNT]=4, 95% CI 3–10). A significant difference in favor of the IAA group was seen in the number of inpatient days (p<0.05) and costs (p<0.05). Conclusion. Future ITAREPS trials should target the underlying mechanisms that cause low investigator adherence to the program. Trial registration: Clinical Trials NCT00712660 (Journal of Psychiatric Practice 2012;18:269–280)

Control for ecological improvement of small biomass boilers

Abstract The aim of this paper is to present various types of research on reducing emissions in the flue gases produced by low-power biomass boilers, especially when the boilers operate outside their nominal operating regime. This long-term investigation program is being carried out on a pilot boiler in the university laboratories. The program involves acquiring additional instrumentation for performing and evaluating present and future experiments, creating various types of models of the boiler for designing and testing the control algorithms using available data, and implementing and evaluating the algorithms in real operation. The pilot device enables us to experiment using non-standard instrumentation, but throughout our research it is necessary to strike a balance between ecological policy requirements and economic considerations.

Continuous Control Issues Concerning Operation Improvement of Small-Scale Biomass Boilers

Abstract To meet the increasing environmental and efficiency requirements, the possibilities to improve the performance of a 25 kWth wood pellet boiler by utilizing PLC and feedback control are investigated. The process is first stabilized by improving the grate sweeping sequence, which originally disturbs the process. Prior to continuous combustion control development, the process is analyzed and identified. After sequential control improvements the combustion behaves well but tends to drift. A PID controller was designed to enable drifting compensation. It is shown that improved grate sweeping sequence and continuous feedback control provide a major improvement for system performance cost effectively.

SPECIFIC EMISSIONS FROM BIOMASS COMBUSTION

This paper deals with determining the specific emissions from the combustion of two kinds of biomass fuels in a small-scale boiler. The tested fuels were pellets made of wood and pellets made of rape plant straw. In order to evaluate the specific emissions, several combustion experiments were carried out using a commercial 25 kW pellet-fired boiler. The specific emissions of CO, SO 2 and NO x were evaluated in relation to a unit of burned fuel, a unit of calorific value and a unit of produced heat. The specific emissions were compared with some data acquired from the reference literature, with relatively different results. The differences depend mainly on the procedure used for determining the values, and references provide no information about this. Although some of our experimental results may fit with one of the reference sources, they do not fit with the other. The reliability of the references is therefore disputable.

Optimal Combustion Conditions for a Small-scale Biomass Boiler

This paper reports on an attempt to achieve maximum efficiency and lowest possible emissions for a small-scale biomass boiler. This aim can be attained only by changing the control algorithm of the boiler, and in this way not raising the acquisition costs for the boiler. This paper describes the experimental facility, the problems that arose while establishing the facility, and how we have dealt with them. The focus is on discontinuities arising after periodic grate sweeping, and on finding the parameters of the PID control loops. Alongside these methods, which need a lambda probe signal for proper functionality, we inroduce another method, which is able to intercept the optimal combustion working point without the need to use a lambda sensor.

Relapse in schizophrenia: Definitively not a bolt from the blue

Detailed study of the period before schizophrenic relapse when early warning signs (EWS) are present is crucial to effective pre-emptive strategies. To investigate the temporal properties of EWS self-reported weekly via a telemedicine system. EWS history was obtained for 61 relapses resulting in hospitalization involving 51 patients with schizophrenia. Up to 20 weeks of EWS history per case were evaluated using a non-parametric bootstrap test and generalized mixed-effects model to test the significance and homogeneity of the findings. A statistically significant increase in EWS sum score was detectable 5 weeks before hospitalization. However, analysis of EWS dynamics revealed a gradual, monotonic increase in EWS score across during the 8 weeks before a relapse. The findings-in contrast to earlier studies-suggest that relapse is preceded by a lengthy period during which pathophysiological processes unfold; these changes are reflected in subjective EWS.

The Validation of a Calculation Model for Biomass Combustion Using CO2 Measurement

This paper presents a calculation model for obtaining specific volumes of flue gas and air from biomass combustion. The main goal of the presented work is the evaluation of the accuracy of the model in relation to the actual combustion process. Since the model allows calculation of concentrations of flue gas components, the validity of the model was evaluated by measuring the actual CO2 concentration. In total 10 various kinds of biomass fuels were used for combustion experiments, including wood, waste, and agricultural biomass. The tests were performed in a commercially available small-scale boiler which provided CO2 concentrations in precisely defined conditions. Generally, the measured and calculated concentrations differed approximately from −9% to +2% relatively. The performed correlation analysis shows that the calculated values correlate with the measured values with a 95% reliability. The analysis also shows a 65% correlation of the relative deviation of the calculated and measured concentrations with the carbon monoxide concentration as a measure of incompleteness of the combustion process. On the other hand, no correlation was found between the relative deviation between the CO2 concentrations and the operation mode of the boiler, represented by the percentage of the nominal capacity of the boiler. The last evaluation was focused on the influence of the excess air ratio on the relative deviation, in order to find a possible influence of flue gas dilution on model reliability. Also in this case no correlation was found.

NOx EMISSIONS FROM BUBBLING FLUIDIZED BED COMBUSTION OF LIGNITE COAL

This paper presents experimental results of NO x emission measurements for combustion of two kinds of coal in a bubbling fluidized bed combustor. The tested fuels were Czech brown coal (CBC) and German young brown coal (GYC). These fuels have different nitrogen contents. The experiments were performed in the pilot scale BFB experimental unit with power output of 500 kW. The influence of several parameters on NO x formation are investigated in this paper. The parameters studied here include the effect of the nitrogen content in the fuel, the effect of the oxygen concentration in the bed, the effect of bed temperature, the effect of air staging, and the effect of fluidization velocity. Significantly different behaviour of the fuels was found. Although GYC has a lower nitrogen content than CBC, it is more reactive and produces higher NO x emissions. The biggest dependence of NO x production for CBC was found for the effects of air staging and fluidization velocity. As the fluidization velocity increases and the amount of secondary air decreases, there is an increase in NOx emissions. The oxygen concentration in the bed has the strongest effect on the NO x production of GYCs. With increasing oxygen concentration, the production of NO x also increases. On the basis of the NO x measurements, the N-NO conversion factor was calculated and the effect of the operating parameters on this conversion factor was investigated.