The MobiSan approach: informal settlements of Cape Town, South Africa.

Pook se Bos informal settlement and the Cape Town Water & Sanitation Services Department are partnering on an urban sanitation project with a Dutch Consortium consisting of Lettinga Associates Foundation (LeAF), Landustrie Sneek and Vitens-Evides International. The aim of the project is to improve the basic sanitation services provided in informal settlements through the implementation of the MobiSan approach. The approach consists of a communal Urine-Diversion and Dehydration Toilet (UDDT) built in a former sea shipping container. The system is independent of water, electricity or sewerage connection and it is maintained by full-time community caretakers who also act as hygiene promoters. The project seeks to link sanitation services with hygiene promotion in informal settlements while enhancing user satisfaction and reducing costs in providing basic sanitation services. This paper describes the preliminary experiences and lessons learnt during the implementation and evaluation of the MobiSan prototype and discusses its potential for replication. The MobiSan has proved to be an appropriate option by means of dealing successfully with shallow groundwater table, land availability and high settlement densities. In addition it has been demonstrated to be cost-competitive in terms of operating cost compared to chemical toilets.

Technology selection and comparative performance of source-separating wastewater management systems in Sweden and The Netherlands.

The research described in this paper has evaluated five demonstration projects with source-separating sanitation at neighbourhood scale, 10 years or more after their establishment. It presents the results of two systems with local grey water treatment in The Netherlands and three sites with urine separation in Sweden. The study has focused on (1) the drivers and barriers of the stakeholders that were responsible for project implementation and (2) the comparative performance of the source separation systems after their establishment. In The Netherlands the main drivers were water use reduction, combating sewer overflows and reduction of emissions. For the Swedish cases the main drivers of the involved actors were nutrient recycling, emission reduction and an active policy of the local government. The main barriers in all cases were higher investment costs and low experience with new sanitation approaches systems compared with the conventional system. Three of the sites showed a lower performance with respect to public health because effluent monitoring protocols for the grey water treatment systems were not in place or people could have direct contact with faeces. Lack of operation and maintenance is a cause of occasional failure for the grey water treatment systems, while the dominant failure reason for the urine separation systems was pipe clogging. The inventory showed that source-separating sanitation systems have a high potential to save or recover resources (water and nutrients).

Perioperative IFN-alpha to avoid surgically induced immune suppression in colorectal cancer patients.

Surgical treatment of colorectal cancer is associated with postoperative immunosuppression, which might facilitate dissemination of tumor cells and outgrowth of minimal residual disease/(micro) metastases. Minimal residual disease has been shown to be of prognostic relevance in colorectal cancer. Therefore, stimulation of (anti-tumor) immune responses may be beneficial in the prevention of metastases formation. Important anti-tumor effector cells, which serve this function, are natural killer (NK) cells, CD8+ lymphocytes (CTL), dendritic cells (DC) and macrophages. In this review the immunomodulating properties of IFN-alpha are discussed, with a particular focus on perioperative stimulation of immune function in cancer patients. IFN-alpha is known to enhance innate immune functions such as stimulation of NK cells, transition from innate to adaptive responses (activation of DC) and regulating of CD8+ CTL activity and memory. Moreover, it exerts direct antitumor effects by regulating apoptosis and cell cycle. In several clinical trials, perioperative administration of IFN-alpha has indeed been shown to improve T cell responsiveness, prevent impairment of NK cell cytotoxicity and increase expression of activation markers on NK, T and NKT cells. In a clinical pilot study we showed in colorectal cancer patients that received perioperative IFN-alpha enhanced activation markers on T cells and NK cells, combined with better-preserved T cell function as indicated by phytohemaggluttinin skin tests. In the liver of these patients significantly more CD8+ T cells were found. In conclusion, IFN-alpha provides an effective adjuvant in several forms of cancer and improves several postoperative immune functions in perioperative administration. However, larger clinical trials are necessary to investigate effects on disease-free and overall survival.

Evaluation of wastewater characterization methods.

Wastewater contains various organic components with different physical and biochemical characteristics. ASM No. 1 distinguishes two categories of biodegradable organic matter in wastewater, rapidly and slowly biodegradable. In general there are two methods for wastewater characterization: based on filtration in combination with a long-term BOD test or based on a respirogram. By comparing both approaches, we showed that in wastewater three categories of organic compounds with different biodegradation rates can be distinguished. These categories are referred to as readily biodegradable, rapidly hydrolysable and slowly hydrolysable organic matter. The total biodegradable COD can be found from a long-term BOD-test combined with a curve-fit and the readily biodegradable and rapidly hydrolysable from a respirogram. The slowly hydrolysable is the difference between total biodegradable COD and the sum of readily biodegradable and rapidly hydrolysable COD. Simulation with characterization based on filtration for a pre-anoxic reactor with a certain N-removal compared with the N-removal of the same plant with wastewater according to the modified characterization shows different results of each wastewater, especially with regard to the effluent nitrate concentration.

Turbidity-based monitoring of particle concentrations and flocculant requirement in wastewater pre-treatment.

The removal of particulate organic material in the first step of wastewater treatment may result in significant savings of reactor volume and energy at wastewater treatment plants, because the organic loading to pursuing unit operations can be reduced. This article describes experiments into the possibility of using turbidity measurements as a tool to quantify the concentration of particles in raw wastewater and, based on the result, assess the organic polymer requirement. A feed forward polymer dosing strategy based on a fixed polymer to influent-turbidity ratio was developed and tested. The experimental work confirms that turbidity measurements can be used to quantify particulate COD. For the investigated wastewater (both untreated and flocculated samples) a linear relationship was found in a wide range of particulate COD (100-900 mg O2 x l(-1)) and turbidity (50-450 NTU). On-line turbidity measurements showed that the particle concentrations in the tested municipal wastewater varied significantly. During dry weather conditions the turbidity fluctuated from 100 to 400 NTU, while in rainy periods fluctuations of 100 to >1,000 NTU were measured. The tested turbidity-related polymer dosing method could be used to create different, constant levels of particle removal, despite large particle concentration variations in the influent. Moreover, it resulted in higher removal efficiencies and a more stable operation compared to the dosing of fixed polymer dose per unit of volume.

Particle related fractionation and characterisation of municipal wastewater.

Several studies show that a more detailed characterisation of the particulate matter in municipal wastewater gives a better understanding and prediction of removal efficiencies of physical-chemical treatment techniques and the application of optimal chemical dosages. Such a characterisation should include the distribution of contaminants over various particle sizes. This article describes a method and results of experimental and full-scale investigations, conducted to determine how contaminants in wastewater are distributed over different particle sizes. For this purpose, particle size fractionations of wastewater influents originating from more than thirteen WWTP were carried out. One of these fractionations (WWTP Venray) is shown and interpreted in this article. First, the wastewaters were fractionated into 5 to 6 particle fractions (45, 5.0, 1.0/1.2, 0.45 and 0.1 microm) after which the fractions were analyzed for various water quality parameters like organic components, nutrients, salts, solids and turbidity. Based on the results the effects of removal of the different size fractions on design of the biological treatment and energy balance of a wastewater treatment plant can be assessed. The method also indicates whether a certain wastewater is efficiently treatable with physical-chemical pre-treatment methods. It is concluded wastewater fractionation on particle size is very useful, but that wastewater characteristics and particle size distributions should not be generalised, but have to be interpreted as indications for a certain average wastewater composition. To give more insight into the distribution of contaminants over particle size and the particle removal potential, a specific wastewater fractionation has to be carried out per WWTP.

Flotation with polyelectrolytes as a first step of a more sustainable wastewater treatment system.

Within the framework of a research programme into more sustainable wastewater treatment systems based on physical-chemical pretreatment the application of dissolved air flotation (DAF) with polyelectrolytes as a primary treatment was investigated. Experiments with municipal wastewater were carried out in 2.5 I flotation batches and in a 100 I DAF pilot reactor. Two cationic polyelectrolytes (PEs) with molecular weights of 4 x 10(6) g/mol and 8 x 10(6) g/mol, were tested. The higher weight PE was more effective in removing turbidity and was used in the pilot experiments for coagulation/flocculation. Within the pilot system experiments the dry solids concentration of the float layer as well as the removal efficiencies of turbidity, CODparticulate, CODdissolved and nutrients, were studied. Typical results were that the obtained dry solids concentration of the floated sludge was 10%, when the float layer was removed after several hours. By using polyelectrolytes it was possible to remove more than 80% of CODparticulate and turbidity at dosages of 7-8 mg/g influent COD (i.e. 5 mg PE/100 NTU). The removal efficiency of CODdissolved was low. There was a proportional relationship between CODparticulate and turbidity. This led to the conclusions that by introducing a dosing control strategy based on continuous turbidity measurements a constant CODparticulate removal efficiency can be obtained.

Direct influent filtration as a pretreatment step for more sustainable wastewater treatment systems.

Within the scope of a research programme into wastewater treatment scenarios based on physical-chemical pretreatment, the application of direct influent filtration (DIF) as a first treatment step in a wastewater treatment system was investigated. The aim of the experimental research was to investigate the feasibility of DIF as a pretreatment step for advanced particle removal. With a large scale pilot-plant filter at WWTP Leiden-Noord, The Netherlands the removal characteristics for suspended and colloidal material were investigated as well as operational conditions of eight different filter configurations. From the experimental research it was concluded that filtration of raw wastewater is possible, notwithstanding the relatively short run-times due to clogging. In general, the filters produced a filtrate with a constant quality with low concentrations of solids and low turbidity. Without addition of chemicals hardly any colloids and solubles were retained, but only suspended particulates were removed. After dosage of iron or polymer, it was possible to remove more suspended matter and a high proportion of colloidal material. Finally it was concluded that DIF could be applied as a compact treatment system to produce a high quality primary effluent with a constant composition, but for practical application further research has to be done.

Immune-stimulating effects of low-dose perioperative recombinant granulocyte-macrophage colony-stimulating factor in patients operated on for primary colorectal carcinoma.

BACKGROUND: Surgery induces a postoperative immunosuppression, thereby possibly facilitating the outgrowth of pre-existing occult metastases or the seeding of disseminated tumour cells in patients with primary colorectal carcinoma operated on with curative intent. The hypothesis that adjuvant therapy with perioperative recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) would minimize postoperative immunosuppression was investigated in this pilot study. METHODS: Patients were allocated randomly to receive daily subcutaneous injections with either saline (n = 8) or rhGM-CSF 2.8 microg per kg body-weight (n = 8) from 3 days before operation until 4 days afterwards. Phytohaemagglutinin (PHA) skin test reactivity, monocyte human leucocyte antigen (HLA) DR expression and the extent of the acute-phase response, by determination of white blood cell count and differentiation, plasma interleukin (IL) 6 levels and body temperature in the perioperative period, were examined. RESULTS: rhGM-CSF treatment minimized postoperative suppression in PHA skin test reactivity and increased the numbers of neutrophils and monocytes while enhancing the expression of HLA-DR in the postoperative period. Additionally, both postoperative plasma IL-6 levels and the incidence of fever tended to be higher in the rhGM-CSF group. CONCLUSION: In this pilot study, perioperative administration of low-dose rhGM-CSF stimulated certain immune functions that are normally depressed after operation. The implications for the antitumour responses directly after operation and the formation of liver metastases are currently under investigation.