Treating wastewater by indigenous microalgae strain in pilot platform located inside a municipal wastewater treatment plant.

Various resources from a municipal wastewater treatment plant (MWTP) are available for microalgae cultivation plants, suggesting that a combination of these technologies can be used to produce microalgae biomass and remove contaminants at a low cost. In this study, the growth performance and nutrient removal efficiency of an indigenous Scenedesmus sp. in various wastewater media with different exchange patterns were investigated firstly, then transferred to a pilot-scale photobioreactor (located inside a MWTP) for bioremediation use. The temperature and pH of the platform were maintained at 15-30°C and 7.6, respectively. The N H 4 + -   N , N O 3 - -   N , and P O 4 3 - -   P of the wastewater could be reduced to below 0.05, 0.40, and 0.175 mg L-1, respectively. Our results indicate that microalgae cultivation using the resources of a MWTP can achieve high algal biomass productivity and nutrient removal rate. Our study also suggests that efficient technology for controlling zooplankton needs to be developed.

Towards optimized drum composting: evaluation of the radial mixing performance of a model substrate on the laboratory scale.

The rotating drum composter (RDC) is one of the most widespread reactor systems for biowaste treatment, worldwide. Nevertheless, knowledge on optimum operating conditions including, e.g. fill level, turning frequency, and mixing tool configuration is sparse. This study investigated the effect of static mixing tools (SMTs) on mixing in a rotating drum at high fill levels (60-80%). The methodological approach encompassed mixing experiments in a laboratory RDC using soaked wheat grains as a model material. The temporal course of material blending was quantified in terms of the entropy of mixing using digital image analysis. Experiments without SMTs showed the evolution of unmixed cores. With a single SMT, mixing was superior even at fill levels >70% while peripheral unmixed zones persisted when overly long SMTs were used. The results of this study may help to derive optimal process conditions for RDCs operated at high fill levels.

Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings.

AIM OF THE STUDY: The introduction of a paediatric Medical Emergency Team (pMET) was accompanied by weekly in-situ simulation team training. Key ward staff participated in team training, focusing on recognition of the deteriorating child, teamwork and early involvement of senior staff. Following an earlier study [1], this investigation aimed to evaluate the long-term impact of ongoing regular team training on hospital response to deteriorating ward patients, patient outcome and financial implications. METHODS: Prospective cohort study of all deteriorating in-patients in a tertiary paediatric hospital requiring admission to paediatric intensive care (PICU) the year before, 1year after and 3 years after the introduction of pMET and team training. RESULTS: Deteriorating patients were recognised more promptly (before/1year after/3years after pMET; median time 4/1.5/0.5h, p<0.001), more often reviewed by consultants (45%/76%/81%, p<0.001) and more rapidly escalated to PICU (median time 10.5/5/3.5h, p=0.02). There was a significant reduction in associated PICU admissions (56/51/32, p=0.02) and PICU bed days (527/336/193, p<0.001). The total annual cost of training (£74,250) was more than offset by savings from reduced PICU bed days (£801,600 per annum). Introduction of pMET coincided with significantly reduced hospital mortality (p<0.001). CONCLUSION: These results indicate that lessons learnt by ward staff during team training led to sustained improvements in the hospital response to critically deteriorating in-patients, significantly improved patient outcomes and substantial savings. Integration of regular in-situ simulation training of medical emergency teams, including key ward staff, in routine clinical care has potential application in all acute specialties.

Differential lower airway dendritic cell patterns may reveal distinct endotypes of RSV bronchiolitis.

RATIONALE: The pathogenesis of respiratory syncytial virus (RSV) bronchiolitis in infants remains poorly understood. Mouse models implicate pulmonary T cells in the development of RSV disease. T cell responses are initiated by dendritic cells (DCs), which accumulate in lungs of RSV-infected mice. In infants with RSV bronchiolitis, previous reports have shown that DCs are mobilised to the nasal mucosa, but data on lower airway DC responses are lacking. OBJECTIVE: To determine the presence and phenotype of DCs and associated immune cells in bronchoalveolar lavage (BAL) and peripheral blood samples from infants with RSV bronchiolitis. METHODS: Infants intubated and ventilated due to severe RSV bronchiolitis or for planned surgery (controls with healthy lungs) underwent non-bronchoscopic BAL. Immune cells in BAL and blood samples were characterised by flow cytometry and cytokines measured by Human V-Plex Pro-inflammatory Panel 1 MSD kit. MEASUREMENTS AND MAIN RESULTS: In RSV cases, BAL conventional DCs (cDCs), NK T cells, NK cells and pro-inflammatory cytokines accumulated, plasmacytoid DCs (pDCs) and T cells were present, and blood cDCs increased activation marker expression. When stratifying RSV cases by risk group, preterm and older (≥4 months) infants had fewer BAL pDCs than term born and younger (<4 months) infants, respectively. CONCLUSIONS: cDCs accumulate in the lower airways during RSV bronchiolitis, are activated systemically and may, through activation of T cells, NK T cells and NK cells, contribute to RSV-induced inflammation and disease. In addition, the small population of airway pDCs in preterm and older infants may reveal a distinct endotype of RSV bronchiolitis with weak antiviral pDC responses.

Fatal and near-fatal grape aspiration in children.

Choking remains an important cause of morbidity and mortality in young children. Whole seedless grapes are a popular fruit snack to give to young children.We present 3 cases of grape aspiration, discussing the emergency care from basic life support to specialist treatment.The lessons learned will be applicable to a wide range of health professionals from frontline emergency medical service personnel to physicians and nurses working in a hospital.

Sildenafil prevents rebound pulmonary hypertension after withdrawal of nitric oxide in children.

RATIONALE: Rebound pulmonary hypertension (PHT) can complicate the weaning of nitric oxide (NO), and is in part related to transient depletion of intrinsic cyclic guanosine monophosphate. Rebound is characterized by increased pulmonary arterial (PA) pressure, cardiopulmonary instability, and in some cases, the need to continue NO beyond the intended period of use. There is anecdotal evidence that sildenafil, a phosphodiesterase-5 inhibitor, may prevent recurrence of rebound. OBJECTIVES: We investigated the role of sildenafil in preventing rebound (an increase in PA pressure of 20% or greater, or failure to discontinue NO) in patients in whom previous attempts had not been made to wean from NO. METHODS: Thirty ventilated infants and children, receiving 10 ppm or greater inhaled NO, were randomized to receive 0.4 mg/kg of sildenafil, or placebo, 1 h before discontinuing NO. Twenty-nine patients completed the study. MEASUREMENTS: PA pressures and blood gases were measured before the study drug, and 1 and 4 h after stopping NO. MAIN RESULTS: Rebound occurred in 10 of 14 placebo patients, and 0 of 15 sildenafil patients (p < 0.001). PA pressure increased by 25% (14-67) in placebo patients, and by 1%(-9-5) in sildenafil patients (p < 0.001). Four placebo patients could not be weaned from NO due to severe cardiovascular instability, whereas all sildenafil patients were weaned (p = 0.042). Duration of ventilation after study was 98.0 (47.0-223.5) h for placebo patients and 28.2 (15.7-54.6) h for sildenafil patients (p = 0.024). CONCLUSION: A single dose of sildenafil prevented rebound after withdrawal of NO, and reduced the duration of mechanical ventilation. Prophylaxis with sildenafil should be considered when weaning patients from inhaled NO.