The potential impact of an implementation of microalgae-based wastewater treatment on the energy balance of a municipal wastewater treatment plant in Central europe.

Integration of a photobioreactor for WWT by microalgae is calculated as a future alternative for cost-efficient and environmentally-friendly nutrient removal for municipal WWTPs. High growth rates and higher biogas yields (compared to conventional sewage sludge) of algal biomass can significantly improve WWTP energy balances. This study focuses on temperate climate zones with changing seasons and discusses energy potential of microalgae-enhanced wastewater treatment for an existing WWTP (32,000 PE) in Central Germany. For WWTP-dimensioning and determination of energy-rich biomasses for anaerobic digestion and CHP, actual influent load data was used and calculation was carried out according to valid regulations. Algae growth figures are based on pilot-scale test series from Germany and correspond to the relevant climatic and local process conditions. Computed results show a shift in the energy balance from a current energy demand of 662,173kWh a-1 to an energy production of approx. 1,9MWhel. a-1 and 1 MWhth. a-1.

Regular in situ simulation training of paediatric medical emergency team improves hospital response to deteriorating patients.

AIM OF THE STUDY: The introduction of a paediatric medical emergency team (pMET) was accompanied by integration of weekly in situ simulation team training into routine clinical practice. On a rotational basis, all key ward staff participated in team training, which focused on recognition of the deteriorating child, teamwork and early consultant review of patients with evolving critical illness. This study aimed to evaluate the impact of regular team training on the hospital response to deteriorating in-patients and subsequent patient outcome. METHODS: Prospective cohort study of all deteriorating in-patients of a tertiary paediatric hospital requiring admission to paediatric intensive care (PICU) the year before, and after, the introduction of pMET and concurrent team training. RESULTS: Deteriorating patients were: recognised more promptly (before/after pMET: median time 4/1.5 h, p<0.001), more often reviewed by consultants (45%/76%, p=0.004), more often transferred to high dependency care (18%/37%, p=0.021) and more rapidly escalated to intensive care (median time 10.5/5 h, p=0.024). These improved responses by ward staff extended beyond direct involvement of pMET. There was a trend towards fewer PICU admissions, reduced level of sickness at the time of PICU admission, reduced length of PICU stay and reduced PICU mortality. Introduction of pMET coincided with significantly reduced hospital mortality (p<0.001). CONCLUSIONS: These results indicate that lessons learnt by ward staff during regular in situ team training led to significantly improved recognition and management of deteriorating in-patients with evolving critical illness. Integration of in situ simulation team training in clinical care has potential applications beyond paediatrics.

The intensive care of infants with hypoplastic left heart syndrome.

Until a little over two decades ago, hypoplastic left heart syndrome was considered an inoperable and fatal condition, with most deaths occurring in early infancy, and almost all of those affected dying before their first birthday. However, the advent of surgical palliation and advances in peri-operative care, have offered hope to these patients and their families.

Infection with Ureaplasma urealyticum: is there a specific clinical and radiological course in the preterm infant?

BACKGROUND: Despite having mild early respiratory disease, many preterm babies develop chronic lung disease (CLD). Intrauterine infection with Ureaplasma urealyticum has been associated with preterm labour and CLD. OBJECTIVE: To test the hypothesis that infection with U urealyticum results in a specific clinical and radiological picture in the first 10 days of life. METHODS: Retrospective study of 60 ventilated babies < 30 weeks gestation, who had tracheal secretions tested for U urealyticum. Placental histology was reviewed by a paediatric pathologist for signs of chorioamnionitis. Chest radiographs were independently reviewed by two paediatric radiologists according to previously agreed criteria. All reviewers were blinded to the infection status of the babies. RESULTS: Twenty five babies were U urealyticum positive. These were more likely to experience chorioamnionitis (p = 0.004), premature rupture of membranes (p = 0.01), and spontaneous vaginal delivery (p = 0.09). U urealyticum positive babies had fewer signs of respiratory distress syndrome on early chest radiographs (p = 0.038), and they could be weaned from their ventilation settings (fraction of inspired oxygen (FIO(2)) and mean airway pressure) more quickly in the first few days. Subsequently U urealyticum positive babies deteriorated clinically and radiologically. More often they required ventilation to be restarted (p = 0.051), a higher proportion being ventilated on day 10 (p = 0.027) with higher FIO(2) (p = 0.001) and mean airway pressure (p = 0.002). Their chest radiographs showed more emphysematous changes as early as day 5 (p = 0.045), with a pronounced difference by day 10 (p = 0.009). CONCLUSIONS: Preterm ventilated babies with U urealyticum in their tracheal secretions have a different clinical and radiological course, with less acute lung disease but early onset of CLD, compared with those with negative cultures.

Questionnaire for teachers changes the outcome of school entrance medical examinations.

OBJECTIVE: To evaluate the impact of a teachers' questionnaire on the outcome of school entrance medical examinations (SEMs). METHODOLOGY: Retrospective audit. Routine SEMs in 17 primary schools before and after the introduction of the questionnaire. RESULTS: Primary outcome was teachers' concerns known to school doctors, which increased from 2% of pupils to 27% (P < 0.001). Secondary outcome measures increased significantly: new diagnoses made by school doctors (22-31%, P = 0.038) and follow-ups arranged (8-15%, P = 0.034). Medical or educational intervention was required in 17% of pupils identified by teachers' concerns over the subsequent 3 years. Used as an adjunct for selection for SEMs, the questionnaire would have reduced the number of children with problems overlooked by 60%. CONCLUSIONS: The questionnaire improves communication between teachers and school doctors. It significantly changed the short- and longer-term outcome of SEMs. The teachers' questionnaire provides a useful adjunct for selection for SEMs.

[Aerosol disinfection of bacterial spores]. / Untersuchungen zur Aerosoldesinfektion bakterieller Sporen.

The present investigations are divided into two parts. First it is tested which commercial disinfectants are efficient in aerosol disinfection of bacterial spores. This part is carried out in an aerosol chamber with airborne spores (laboratory experiments). The best results are obtained with peracetic acid, hydrogen peroxide and formaldehyde are effective with some restrictions. With these disinfectants it is tested in the second part if the aerosol disinfecting-method is capable for disinfecting rooms with electronic equipment. This part is carried out in a vessel under open air conditions (field experiments). Bacterial spores dried on germ carriers of limewood, aluminium and rusty iron are exposed to disinfectant aerosols under those temperature and relative humidity conditions which are representative for the four seasons in Germany. In these investigations there are also included germ carriers with spores, that have been lyophilized without any protective substances respectively with Bentonite, Mixtura desiccans and Silicagel + Serum as protective substances. To check the corrosive effect of disinfectant aerosols electronic pocket calculators and pocket transistor receivers have been exposed to the aerosols. The best results are obtained with formaldehyde at temperatures above 10 degrees C and relative humidities within 65% to 95%. At temperatures and relative humidity conditions outside of this optimal range the effectiveness of formaldehyde tends to zero. Hydrogen peroxide is capable for disinfecting spores on germ carriers of limewood and aluminium at all temperature and relative humidity conditions; on germ carriers of rusty iron the effectiveness is reduced strongly. Same results could be obtained with peracetic acid respectively a mixture of peracetic acid and hydrogen peroxide. With these disinfectants a decontamination of rusty iron surfaces is impossible too except the germ concentration on the surface is below 10(4) CFU/cm2. As to the protective substances used in the lyophilization process Bentonite and Mixtura desiccans cause hardly any change in the disinfectant resistance of bacterial spores. Silicagel + Serum in comparison to that protects the imbedded spores that far, that no disinfection of these germ carriers was achieved with the oxidizing agents. As about 15 disinfection runs with each disinfectant did not cause permanent damages to the pocket calculators and transistor receivers it can be emphasized as result of these investigations that aerosol disinfection is an effective method in disinfecting rooms with electronic equipment under middle European climate conditions.(ABSTRACT TRUNCATED AT 400 WORDS)

[The mechanism of action of aerosol disinfection]. / Die Wirkungsmechanismen bei der Aerosoldesinfektion.

It is drawn up a list of physical laws describing the behavior of an aerosol system. First the influence of sedimentation, diffusion, coagulation and impaction is described. In the second part the evaporation and the condensation from droplets in relation to the vapor tension of disinfectants is regarded. Finally the circumstances under which the vaporized disinfectants will reach the microorganisms by diffusion are described. It is demonstrated, that the terminus technicus "aerosol disinfection" should be restricted to systems, that operate with drop diameters less than or equal to 10 microns.

[Effect of the addition of DMSO and EDTA on the activity of formaldehyde and hydrogen peroxide against Bacillus cereus spores]. / Untersuchungen über den Einfluss der Zusätze DMSO und EDTA auf die Wirkung von Formaldehyd und Wasserstoffperoxid gegen Sporen von Bac. cereus.

The question was investigated if DMSO in concentrations between 1 and 6% and 0.1% EDTA could improve the effect of the sporocidal disinfectants formaldehyde and hydrogen-peroxide. In suspension-tests with spores of Bac. cereus it was found, that the sporocidal activity of a 1.2 and 3% formaldehyde solution did not increase, in contrary it decreased significantly if EDTA or DMSO were present in the solution. The same effect could be found with 0.8-5% hydrogenperoxide in combination with the above mentioned substances. These results are not in agreement with the observations of other authors working with vegetative bacteria. It is supposed that DMSO rather reactivates injured spores than that it acts as a carrier for the respective disinfectant. This effect seems to mask a relatively faint increase of the permeability for the disinfectants. Concerning EDTA it could be possible, that it did not succeed in removing the Ca++ from the cortex, in contrary it seems, that it binds itself to the calciumdipicolinate thus stabilizing the spore structure.

On two-dimensional passive random walk in lipid bilayers and fluid pathways in biomembranes.

The lateral mobility of pyrene, pyrene decanoic acid, and 1-palmitoyl-2-pyrene decanoyl-phosphatidyl choline (pyrene lecithin) in lipid bilayers is determined by the excimer formation technique. This method is applied to vesicles of lecithins differing in chain length and in the degree of saturation of the hydrocarbon chains. These values are compared with results in cephalins of different chain length and in dipalmitoyl phosphatidic acid at variable pH. The influence of cholesterol is investigated. The results are analyzed in terms of the Montroll model of two-dimensional random walk. The jump frequency of the probe molecule within the lipid lattice is obtained. The advantage of this measure of transport in lipid layers is that it does not involve lipid lattice parameters. The main results of the present work are: (i) The lateral mobility of a given solute molecule in lamellae of saturated lecithins is independent of hydrocarbon chain length and rather a universal function of temperature. (ii) In unsaturated dioleyl lecithin the amphiphatic molecules have lateral mobilities of the same size as in saturated lipids. The jump frequency of pyrene, however, is by a factor of two larger in the unsaturated lecithin. (iii) The jump frequencies in phosphatidyl ethanolamines are about equal to those in lecithins. (iv) In phosphatidic acid layers the hopping frequencies depend on the charges of the head groups of both the lipids and the probes. (v) Cholesterol strongly reduces the jump frequency in fluid layers. (vi) The lateral mobility in biological membranes is comparable to that in artificial lipid bilayers. The experimental results are discussed in terms of the free volume model of diffusion in fluids. Good agreement with the predictions made from this model is found. A striking result is the observation of a tilt in dioleyl-lecithin bilayer membranes from the hopping frequencies of pyrene and pyrene lecithin. A tilt angle of phi = 17 degrees is estimated.