Evaluating drained water quality in a pilot worm-sludge treatment reed bed planted with Arundo donnas in the Mediterranean climate

This study evaluated the impact of incorporating earthworms (Eisenia fetida) on the drained water quality from a sludge treatment reed bed. The experiment encompassed four setups of treatment beds in two replicates: planted with Arundo donax and addition of earthworms, planted without earthworms, unplanted with earthworms, and treatment bed without plants nor earthworms as control. The units were fed every two weeks with mixed sewage sludge, a blend of primary and secondary sludge over 24 cycles. The mixed sewage sludge had mean dry and volatile solid contents of 24.71 g.DS.L-1 (± 13.67) and 19.14 g.VS.L-1 (± 10.29) resulting a sludge loading rate of 43.59 kg.DS.m-2.year-1 (± 14.49). The inclusion of earthworms in the planted unit reduced release masses of total suspended solids, chemical oxygen demand, nitrate and phosphorous by 43, 45, 75 and 45 % compared to the planted unit. Plant biomass production increased by 43 % with the earthworm presence. The removal efficiency of the units improved after a ramp-up phase (after six months feeding) of which the concentration of TSS, COD and Escherichia coli met limits for water reuse while nitrogen components and phosphorous surpassed the limits. The planted unit with earthworms removed 99 and 99 % of TSS and COD, respectively. Overall, water loss namely through evapotranspiration and earthworm hydration need, positively correlated with pollutant concentration, and earthworm-planted unit had 46 % higher water loss compared to control unit.

Water balance analysis in a novel pilot-scale of the Worm-sludge treatment reed bed (W-STRB) planted with Arundo donax

A one-year study of sludge treatment reed bed assisted with earthworms (W-STRB) was conducted in a temperate climate. The effects of using Eisenia fetid and Arundo donax on W-STRB water balance (WB) and dewatering efficiency (DE) were investigated. Four different bed configurations were tested: worm-planted (WP), planted (P), worm-control (W), and control (C), duplicated resulting in a total of eight units. The beds received a total of 24 cycles of mixed sewage sludge twice per month (average loading rate: 43.59 kg.DS. m-2.year-1). It was found seasonal variation played a significant role in WB and DE. During the dry season, the thickness of the residual sludge (RS) layer was less than 1 cm, with a dry solid (DS) content of over 80%, in contrast, the wet season indicated an increase in RS thickness to nearly 30 cm (DS < 15 % for all units). The WP unit exhibited the lowest RS accumulation, 22% less than the P, W, and C units. The subsurface layer had a 5% lower volatile solids (VS) content compared to the surface layers. After 132 days of a final resting, WP unit had the highest RS volume reduction of 65 % (DS = 71 % and VS = 53 %) and a RS thickness of 6 cm indicating a 10 % higher stabilization compared to P unit. The population of earthworms was 30% higher in the WP unit compared to the W unit. As the subsurface DS exceeded 20 % during the dry season, the population increased. The WP unit showed a 43% higher above-ground plant biomass compared to the P unit. In WB analysis, evapotranspiration (ET) was 46% higher in the WP unit (average daily ET = 5.44 mm in the dry season). The main process of water loss was through drainage and Awhile water content in RS layer was 57 % during feeding period. The water percolation rate of all units decreased by 99%, particularly during the wet season, reaching less than 0.1 m.day-1.

Mango Peel Nanofiltration Concentrates to Enhance Anaerobic Digestion of Slurry from Piglets Fed with Laminaria

The environmental impact of biowaste generated during animal production can be mitigated by applying a circular economy model: recycling, reinventing the life cycle of biowaste, and developing it for a new use. The aim of this study was to evaluate the effect of adding sugar concentrate solutions obtained from the nanofiltration of fruit biowaste (mango peel) to slurry from piglets fed with diets incorporating macroalgae on biogas production performance. The nanofiltration of ultrafiltration permeates from aqueous extracts of mango peel was carried out using membranes with a molecular weight cut-off of 130 Da until a volume concentration factor of 2.0 was reached. A slurry resulting from piglets fed with an alternative diet with the incorporation of 10% Laminaria was used as a substrate. Three different trials were performed sequentially: (i) a control trial (AD₀) with faeces resulting from a cereal and soybean-meal-based diet (S0); (ii) a trial with S₁ (10% L. digitata) (AD₁), and (iii) an AcoD trial to assess the effect of the addition of a co-substrate (20%) to S1 (80%). The trials were performed in a continuous-stirred tank reactor (CSTR) under mesophilic conditions (37.0 ± 0.4 °C), with a hydraulic retention time (HRT) of 13 days. The specific methane production (SMP) increased by 29% during the anaerobic co-digestion process. These results can support the design of alternative valorisation routes for these biowastes, contributing to sustainable development goals.

Moringa as a household water purification method - community perception and pilot study in Guinea-Bissau

Background

Public perceptions of water-related issues are still under-researched topics. The current paper intends to explore a local community’s perceptions regarding household water purification (HWP) strategies, namely before and after trying a new method: moringa seeds powder (moringa-teabag).

Methods

In September 2020, six focus group discussions (N = 65) assessing perceptions about the usefulness of Moringa oleifera Lam (Moringaceae) as a HWP method (before moringa-based HWP trials), and questionnaires (N = 104) evaluating successes and identifying difficulties (after one week of moringa-based HWP trials). Participants were all women aged over 18 years, living in Ondame, Biombo region, Guinea-Bissau. Data were analyzed using qualitative and quantitative approaches.

Results

The focus group discussions revealed that people are aware of the fact that water can transmit diseases. Although certain persons showed concern about shallow well water safety, people generally underestimate the risk, as they trust tubewell water. Not everyone had an understanding of what water contamination is, or the concept of medical importance. Some respondents declared they use traditional methods such as boiling and bleach to treat water before drinking. However, those who reported no kind of treatment indicated reasons such as lack of time, cost, and bleach’s taste and smell. In the questionnaire, more than half of the participants (68%) reported treating water before consumption. Nevertheless, these results are not consistent with our field notes. Participants demonstrated a strong belief in the capacity of moringa-teabags to purify water and even consider them better or much better (81%) than other methods. Participants asked for more information on moringa-teabag for household water purification.

Conclusion

More information on water treatment and water safety would help to raise public awareness about waterborne diseases. These findings could be used to promote greater adherence to moringa-based HWP as an alternative to household water treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14344-w.

Sludge Treatment Reed Bed under different climates: A review using meta-analysis

Sludge Treatment Reed Beds (STRBs) have been used worldwide over the past few decades. This review aims to overarchingly identify and appraise the currently available knowledge of STRB technology and discern climatic patterns through Meta-Analysis (MA). We systematically searched Google Scholar, Scopus, and Web of Science databases (up to Dec 2021) via a combination of keywords to identify English-language studies published in peer-reviewed journals. Of 142 potential articles, 73 studies met the present review objectives and inclusion criteria. Four STRB classifications including typical STRB, earthworm STRB, Sludge Treatment Electro Wetland (STEW), and earthworm STEW were found since 1990. The data and information on STRBs' configuration, operational parameters in terms of location, type of sewage sludge, study scale, Sludge Loading Rate (SLR), Dry Solid (DS), the proportion of Volatile Solid to DS (VS/DS), and their association with the feeding and resting modes were extracted from the selected articles. The analysis was focused on the interconnections between operational parameters and system efficiency for Temperate type 1 (low intensity of solar radiation), Temperate type 2 (high intensity of solar radiation), and Tropical climates. Based on MA, we found the average SLRs of 50, 70, and 101 Kg.DM.m^-2.year^-1 for Temperate type 1, Temperate type 2, and Tropical climates respectively, and DS during the feeding of 33 %, 35 %, and 40 %. A qualitative comparison of Arid and Polar climates was also performed given the reduced number of studies available in these climates. The volume of the sludge reduced was 60 % higher and the height of accumulated sludge was annually 2 cm in the earthworm STRBs, and STEWs compared to typical STRBs, which was 6 cm annually in Tropical climates. Correlation analysis, media characterization, list of plant species, and the removal efficiency of STRBs in the residual sludge and leachate are mentioned as well.

Enhanced biomethane production by co-digestion of mixed sewage sludge and dephenolised two-phase olive pomace

In this study, co-digestion of mixed sewage sludge from a wastewater treatment plant (WWTP) and partially dephenolised two-phase olive pomace (DOP) as a co-substrate was addressed with the aim of improving the biodigestibility of both substrates. The introduction of DOP into WWTP anaerobic digester facilities could significantly increase biomethane production and enhance the sustainability of both activities. An improvement in the system's performance was supported by stability parameters: total alkalinity increased and stabilised with the addition of 5% v/v DOP, and the specific energy loading rate was maintained at 0.177 ± 0.03 d^-1, which indicated better buffer capacity and stability in the bioreactor, and the possibility of enhancing the organic loading rate. In terms of average daily biogas production rate, an increase of 39% was achieved, up to 0.39 ± 0.11 L L^-1d^-1. Moreover, there was a 40% and 37% improvement in specific methane production and methane production rate, respectively, up to 0.28 ± 0.02 L CH₄ g _TVS^-1 and 0.26 ± 0.08 L L^-1d^-1. In addition, the proposed strategy leads to an energy saving of 20,328.6 kWh year^-1 at the WWTP as a result of the electric energy production surplus, corresponding to an annual saving of €3293.23.

Dual-pool, three-phase kinetic model of anaerobic digestion in batch mode

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Original model based on the kinetics of the digestion process.

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Better performance than current empirical approaches.

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Interesting tool to reduce the duration of batch tests.

The ability of anaerobic digestion to create value from waste gives it an important role in reducing greenhouse gas emissions and in the transition to a circular economy. For a better understanding of the digestion process and in order to reduce the number of time-consuming batch tests, an analytical model was developed to describe the kinetics of biogas production. Assuming that the organic fraction of the substrate has different degradation rates, the whole process was modelled as two groups of 1^st order reactions.

The model was tested with published data and showed an excellent performance in reproducing the experimental information. Moreover, its kinetic constants provided a useful insight into the internal processes of anaerobic digestion and the substrate characteristics. Given its accuracy in fitting the data, the model can be used as an auxiliary tool to determine the biogas potential, presenting itself as the most complete empirical model currently available.

'La Vida Normal': Young people adapting to Type 1 diabetes in Bolivia

OBJECTIVES

To identify challenges and coping strategies of young people with Type 1 diabetes (T1D) and their families in Bolivia through qualitative analysis of interviews with beneficiaries of Centro Vivir con Diabetes (CVCD), a diabetes health center supported by the International Diabetes Federation Life for a Child (LFAC) program.

METHODS

Eighteen young people aged 14-33 and at least one caregiver participated in semi-structured interviews in five cities in Bolivia from May to June 2016. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis.

RESULTS

Participants described needing guidance at diagnosis and facing stigma in communities. Young people expressed that life with T1D was 'la vida normal' (a normal life), although interpretations of normalcy varied. For some, 'la vida normal' meant resistance to T1D; for others it indicated acceptance.

DISCUSSION

Access to interdependent spheres of support allowed young people to form a new normal around T1D. Receiving supplies through the CVCD/LFAC partnership maintained family connection to clinical care, CVCD education helped families share in T1D management, and peer support mitigated stigma for young people. Programs like CVCD that combine supply-based aid with clinical education for whole families, create effective support for young people with T1D in low- and middle-income countries.

Integration of Membrane Processes for By-Product Valorization to Improve the Eco-Efficiency of Small/Medium Size Cheese Dairy Plants

Goat and second cheese whey from sheep’s milk are by-products of the manufacture of goat cheeses and whey cheeses from sheep. Due to their composition which, apart from water—about 92%—includes lactose, proteins, fat, and minerals, and the elevated volumes generated, these by-products constitute one of the main problems facing to cheese producers. Aiming to add value to those by-products, this study evaluates the efficiency of ultrafiltration/diafiltration (UF/DF) for the recovery of protein fraction, the most valuable component. For a daily production of 3500 and using the experimental results obtained in the UF/DF tests, a membrane installation was designed for valorization of protein fraction, which currently have no commercial value. A Cost–Benefit Analysis (CBA) and Sensitivity Analysis (SA) were performed to evaluate the profitability of installing that membrane unit to produce three new innovative products from the liquid whey protein concentrates (LWPC), namely food gels, protein concentrates in powder and whey cheeses with probiotics. It was possible to obtain LWPC of around 80% and 64% of crude protein, from second sheep cheese whey and goat cheese whey, respectively. From a survey of commercial values for the intended applications, the results of CBA and SA show that this system is economically viable in small/medium sized cheese dairies.

A pig slurry feast/famine feeding regime strategy to improve mesophilic anaerobic digestion efficiency and digestate hygienisation

The increasing concentration of livestock farms results in large amounts of waste production and the need for their management. The study of anaerobic digestion (AD) technology, under mesophilic conditions, applied to pig slurry is of the upmost importance for biogas recovery and sanitised digestate, contributing to a circular economy. The assessment of the effects of a feast/famine regime on biogas and biomethane (bio-CH₄) yield with different feeding frequencies was performed. The evaluation was made in regards to three scenarios: the first is based on daily feeding (FR1); in the second, the feeding occurs once every two days (FR2); and in the third, the feeding happens once every three days (FR3). The results demonstrate that the biogas and methane yield increased by 34% and 37% between FR1 and FR3. The stability inside the reactor was maintained since specific loading energetic rate values did not exceed the recommended limit (0.4 d^-1). It was also possible to conclude that the AD technology was efficient to sanitise the pig slurry, with the count of Escherichia coli going from 1 × 10⁵ colony-forming units (CFU) g^-1 to less than 100 CFU g^-1, meeting the legal requirements for agricultural valorisation. The total anaerobic mesophile plate counts were significantly (p < 0.1) reduced from feeding to digestate, and the plate counts of Clostridia were significantly (p < 0.05) increased, reflecting the changes in the composition of the microbiota. The increasing yield in bio-CH₄ in accordance with Clostridium counts suggests this genus as a positive microbiological key indicator of the AD performance.

Valorization of Goat Cheese Whey through an Integrated Process of Ultrafiltration and Nanofiltration

Goat cheese whey is a co-product that comes from goat cheese manufacture. Due to its high organic load, adequate treatment is necessary before its disposal. Additionally, the recent growing interest in caprine products, attributed to their specific nutritional and nutraceutical characteristics, such as the lower allergenicity of their proteins and higher content of oligosaccharides, compared with bovine products, made the recovery of goat cheese whey a challenge. In this study, an integrated process for the recovery of sweet goat whey components was carried out. It includes filtration, centrifugation and pasteurization, followed by sequential membrane processes, ultrafiltration/dilution, nanofiltration of ultrafiltration permeates in dilution mode and the concentration/dilution of nanofiltration retentates. Ultrafiltration was performed with membranes of 10 and 1 kDa. Membranes of 10 kDa have higher permeate fluxes and, in a single stage of dilution, allowed for better protein retention and higher lactose purity, with a separation factor of 14. The concentration of lactose by nanofiltration/dilution led to the retention of almost all the lactose in retentates and to a final permeate, whose application in cheese dairy plants will allow for the total recovery of whey. The application of this integrated process in small- or medium-sized goat cheese dairies can represent an important contribution to their sustainability.

The Retornus-2 study: impact of respiratory muscle training in subacute stroke patients with dysphagia, study protocol of a double-blind randomized controlled trial

Background

Stroke can lead to varying degrees of oropharyngeal dysphagia, respiratory muscle dysfunction and even increase medical complications such as aspiration, malnutrition and death. Recent studies suggest that inspiratory and expiratory respiratory muscle training (IEMT) can improve swallowing efficacy and may reduce aspiration events. The main purpose of this study is to examine whether an 8-week IEMT programme can improve respiratory muscle strength and swallow dysfunction severity in subacute stroke patients with dysphagia.

Methods

Retornus-2 is a two-arm, prospectively registered, randomized controlled study with blinded assessors and the participation of fifty individuals who have suffered a stroke. The intervention group undergoes IEMT training consisting of 5 sets of 10 repetitions, three times a day for 8 weeks. Training loads increase weekly. The control group undergoes a sham-IEMT protocol. The primary outcome examines the efficacy of the IEMT protocol to increase respiratory muscle strength and reduce dysphagia severity. The secondary outcome assesses the longitudinal impact of dysphagia on body composition and nutritional assessment over a 6-month follow-up.

Discussion

IEMT induces an improvement in respiratory muscle strength and might be associated with relevant benefits in dysphagia patterns, as well as a reduction in the number of aspiration events confirmed by videofluoroscopy or fiberoptic endoscopic evaluation of swallowing. The description of the impact of swallowing impairment on nutritional status will help develop new strategies to face this known side-effect.

Trial registration

Clinicaltrials.gov NCT03021252. Registered on 10 January 2017. https://clinicaltrials.gov/ct2/results?cond=retornus+2&term=&cntry=ES&state=&city=&dist=

WHO trial Registration data set: Due to heavy traffic generated by the COVID-19 outbreak, the ICTRP Search Portal does not respond. The portal recommends other registries such as clinicaltrials.gov. Protocol version: RETORNUS 2_ PROTOCOL_2.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05353-y.

[Cooperation between the department of ophthalmology at the University of Düsseldorf (Germany) and the Fundación Visión in Asunción (Paraguay) as an example of the German hospital partnerships programm]

BACKGROUND

A hospital partnership between the University Eye Hospital Düsseldorf (UAK Düsseldorf) and Fundación Visión in Asunción has existed since 2014 based on a memorandum of understanding. Fundación Visión plays a leading role in ophthalmological treatment and prevention of blindness in Paraguay. Since 2016 a program for the promotion of international hospital partnerships of the German government has been in place.

MATERIAL AND METHODS

Following a written application in 2016 the hospital partnership Düsseldorf-Asunción is funded by the Federal Ministry for Economic Cooperation in Germany. The aim of the project was to establish modern minimally invasive corneal transplantation techniques with faster postoperative rehabilitation and less follow-up in Paraguay with the help of several activities within a defined schedule. Secondary aims were to obtain first data on the prevalence of eye diseases in a typical patient cohort of the Fundación Visión and to establish an infrastructure for modern eye banking techniques in Paraguay.

RESULTS

First a Paraguayan surgeon was trained to carry out Descemet membrane endothelial keratoplasty (DMEK) transplantations in Germany. At the same time, the surgical instruments required for the DMEK technique were purchased and delivered to the Fundación Visión. In September 2018 the first lamellar corneal transplantations were successfully performed in Paraguay by the team from the Fundación Visión under the supervision of an experienced surgical team from Düsseldorf. Subsequently, the split cornea approach using a donor cornea for a posterior and an anterior lamellar keratoplasty (DMEK and DALK) was also implemented in Asunción. In November 2019 epidemiological data on eye diseases were collected during a field campaign of the Fundación Visión in a rural region of Paraguay. In the course of data collection an employee of the University Eye Hospital Düsseldorf learned small incision cataract surgery. In March 2019, a technician from the Fundación Visión was trained in Düsseldorf in corneal tissue culture techniques and preparation of amniotic membrane transplants in the Lions eye bank North-Rhine/Westfalia.

CONCLUSION

With the aid of a supported hospital partnership modern minimally invasive corneal transplantation techniques can be successfully transferred to the eye hospital of a developing country and in return surgical skills can be taught to surgeons from Germany who are in training. Therefore, an efficient hospital partnership is the basis for a mutual exchange and is not purely one-way traffic.

[Long-term cognitive and functional status in survivors of an aneurysmal subarachnoid hemorrhage: Analysis of a retrospective cohort]

OBJECTIVE

Little data is available on long-term functional and cognitive outcomes in patients with aneurysmal subarachnoid hemorrhage (ASH). The main objective of this study was to assess cognition, functional state, mood disorders, and quality of life in patients with SAH at least six months following the ASH.

PATIENTS AND METHODS

Cross-sectional study of 40 patients (aged 58.2 [SD 9.9] years) with ASH, discharged from a Neurologic Rehabilitation unit between January 2010 and July 2017.

MAIN OUTCOME VARIABLES

functional status (Barthel index), cognition (Pfeiffer questionnaire), depression (Hamilton scale), and health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), as well as type and duration of therapeutic rehabilitation procedures after discharge.

RESULTS

From 35 patients with cognitive disorders, only 12 received cognitive therapy at hospital discharge. In the long-term follow-up, cognitive impairment persisted in 22 patients. When compared with those without cognitive impairment, they presented significantly worse mean differences in the Barthel index (15.5 [95% CI: 1.2-29.7]), Hamilton scale (-0.8 [95% CI: -1.27 to -0.37]), and EQ-5D (27.6 [95% CI: 12.4-19]).

CONCLUSION

The prevalence of long-term cognitive impairments in survivors of a SAH episode is high, and their presence is associated with worse functional status, more depression and worse quality of life. The low percentage of subjects who received cognitive therapies through their recovery process and the clinical implications observed, support the need of including neuropsychological therapies in the rehabilitation programs after an SAH event.

Energetic Valorization of Cereal and Exhausted Coffee Wastes Through Anaerobic Co-digestion With Pig Slurry

In the past years, there has been steady growth in work relating to improve resource efficiency through waste minimization and bioenergy recovery to mitigate climate change. Agro-food industries produce large amounts of bio-waste, challenging innovative energetic valorization strategies in the framework of circular economy principles. Anaerobic digestion (AD) technology is an interesting route to stabilize organic matter and produce biogas as a renewable energy source. This study involves continuous co-digestion of pig slurry (PS), cereal and exhausted coffee wastes (CECW) performed in a continuously stirred tank reactor, with a hydraulic retention time (HRT) of 16 days under at mesophilic conditions (36.9 ± 0.3°C). The experimental trials, were designed to include different cereal and exhausted coffee liquor (CECL) shares in the feeding mixture, corresponding to different PS to CECL ratios (PS:CECL), respectively: 100:0 (T0), 90:10 (T1), 80:20 (T2), and 70:30 (T3), in terms of percentage of inlet feeding rate (v:v). The results obtained for the feeding rate (70:30) yield to the highest specific methane production (SMP = 341 ml.gVS−1) led to a 3.5-fold improvement in comparison with the reference scenario. The synergetic effect between the microbial consortia of PS and the high carbon to nitrogen ratio (C/N) of CECL explain the improvements achieved. The maximum soluble chemical oxygen demand (SCOD) reduction (84.0%) due to the high content and soluble chemical oxygen demand to total chemical oxygen demand ratio (SCOD/TCOD) corroborate the results achieved. The digester stability, evaluated by specific energetic loading rate, was below the limit (0.4 d−1). Results from ANOVA showed a significant effect of CECL on the resulting GPR and SMP values. Additionally, Tukey's “Honest Significant Difference” method, confirmed statistically significant differences between the trials T3-T0, T3-T1, T3-T2, and T2-T0. Thus, co-digestion of PS and of CECL seems to be a promising approach for bioenergy recovery and promoting biowastes circularity.

Avaliação do ponto de congelamento do leite cru por espectroscopia de infravermelho com transformada de Fourier como método de triagem

RESUMO O objetivo deste estudo foi investigar a interferência do teor de gordura do leite no ponto de congelamento (PC) obtido pelo infravermelho com transformada de Fourier (FTIR). Uma fração de leite cru foi desnatada, obtendo-se creme e leite desnatado. O leite integral e o desnatado foram adicionados com água (0%, 2%, 5%, 10%, 15% e 20%). O leite desnatado remanescente foi adicionado com creme (5%, 10%, 15%, 20%) e água (0%, 2%, 5%, 10%, 15% e 20%). As amostras foram analisadas para PC (crioscópio eletrônico e FTIR) e composição (FTIR). O PC medido por FTIR foi altamente correlacionado com o método do crioscópio eletrônico (acima de 98,5%) e, como esperado, a adição de água foi significativa (P≤0,001) ao aumentar o PC do leite em ambos os métodos. No entanto, o alto teor de gordura no leite cru resultou na redução do PC ao se utilizar o FTIR, enquanto o baixo teor de gordura resultou em aumento do PC (P≤0,001). Uma vez que a adição de água causou o efeito inverso do alto teor de gordura no PC medido por FTIR, é importante considerar o teor de gordura do leite para evitar interpretações erradas do PC quando se utiliza o método FTIR.

Quality Assessment of Three Types of Drinking Water Sources in Guinea-Bissau

The lack of access to safe drinking water causes important health problems, mainly in developing countries. In the West African country Guinea-Bissau, waterborne diseases are recognised by WHO as major infectious diseases. This study analysed the microbiological and physicochemical parameters of drinking water in the capital Bissau and its surroundings. Twenty-two sites belonging to different water sources (piped water, tubewells and shallow wells) were surveyed twice a day for three weeks, in both dry and wet seasons. Most of the microbiological parameters were out of the acceptable ranges in all types of water and both seasons and tended to worsen in the wet season. Moreover, in Bissau, the levels of faecal contamination in piped water increased from the holes to the consumer (tap/fountain). Several physicochemical variables showed values out of the internationally accepted ranges. Both well sources showed low-pH water (4.87–5.59), with high nitrite and iron levels in the wet season and high hexavalent chromium concentration in the dry season. The residual chlorine never reached the minimum recommended level in any of the water sources or seasons, suggesting a high risk of contamination. Results reveal a lack of quality in the three water sources analysed, coherent with the high number of diarrheal cases in the country. There is an urgent need to improve sanitarian conditions to reduce the disease burden caused by these waterborne illnesses.

Performance of Iris pseudacorus and Typha domingensis for furosemide removal in a hydroponic system

The potential of Iris pseudacorus and Typha domingensis to remove the pharmaceutical active compound (PhAC) Furosemide from a nutrient solution was assessed. Both plants were exposed to 2 mg L^-1 of furosemide during 21 days and the removal of furosemide was monitored. Vessels without furosemide were also implemented as control systems for plants development. Likewise, unplanted vessels with furosemide were employed to assess abiotic removal mechanisms. All vessels were covered with aluminum foil to avoid photodegradation of the compound. Both plants showed potential to remove Furosemide, attaining, at the end of the experiment, a removal of 42.0-66.9% and 40.5-57.8%, for Typha and Iris, respectively. The plants do not presented a visible negative stress response to the exposure to furosemide, having a positive growth rate at the end of the experiment. Biodegradation seems to play an important role in furosemide removal, being enhanced by the presence of the plants. The two macrophytes presented different removal behaviors, particularly in the first 48 h of contact time. FUR removal by Iris follows a pseudo-first order while by Typha is divide in different phases. These results indicate that different plants species seem to have different mechanisms to remove pollutants from water.HighlightsPhACs removal potential of Iris pseudacorus and Typha domingensis was assessed.Plants were exposed to 2 mg L^-1 of furosemide during 21 days.Both macrophytes showed good removal efficiencies.Biodegradation of furosemide seems to be the main removal mechanism.Plants demonstrated different removal behavior along the experiment.Removal mechanisms of plants seem to differ between species.

Enhanced biogas production from anaerobic co-digestion of pig slurry and horse manure with mechanical pre-treatment

Enhanced biogas production from anaerobic co-digestion of pig slurry and horse manure with mechanical pre-treatment. In this study, co-digestion of horse manure and pig slurry was investigated in a continuously stirred tank reactor, with a mechanical pre-treatment. Experiments were conducted at 37°C, with hydraulic retention times of 23 days and increasing shares of horse manure, corresponding to different horse manure to pig slurry ratios (HM:PS) equal to 0:100, 10:90, 13:87 and 20:80, in terms of percentage of inlet volatile solids (%VS inlet). The results show that the best synergetic effect between the microbial consortia of pig slurry and the high Carbon to Nitrogen ratio (C/N) of horse manure is obtained for the mixture of 20:80%VS inlet, yielding the highest specific methane production (SMP = 142.6 L kg_TCOD^-1) and the highest soluble chemical oxygen demand (SCOD) reduction (68.5%), due to the high volatile dissolved solids content and soluble chemical oxygen demand to total chemical oxygen demand ratio (SCOD/TCOD). Thus, co-digestion of horse manure and pig slurry is shown to be a promising approach for biogas production and as a waste treatment solution. Furthermore, the analysis provides a methodology for the pre-treatment of these substrates and to investigate into the best combination for improved biogas production.

Translation and Validation of the Spanish Version of the SARC-F Questionnaire to Assess Sarcopenia in Older People

OBJECTIVES

The revised European consensus on sarcopenia definition and diagnosis (EWGSOP2) includes the SARC-F questionnaire, the most valid and consistent sarcopenia screening tool, as the mandatory first step. Our aim was the translation, cross-cultural adaptation, and validation of the SARC-F questionnaire as a culturally-responsive Spanish-language version for the European population.

STUDY DESIGN

Cross-sectional descriptive study, applying the two-step WHO methodology for translation and cross-cultural adaptation of health questionnaires, and harmonization with the Mexican-Spanish version. European Union Geriatric Medicine Society recommendations for SARC-F validation in European languages were considered.

PARTICIPANTS

Outpatient clinics of a university hospital.

INCLUSION CRITERIA

stable, ambulatory (including aids), community-dwelling population ≥65 years old.

MAIN OUTCOME MEASURES

The self-reported 5-item SARC-F questionnaire was administered; scores ≥4 indicated sarcopenia. Sensitivity, specificity, accuracy-likelihood ratios, predictive values, and kappa statistics were calculated and consecutively compared with European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2 criteria.

RESULTS

This Spanish version, administered in an average 70s, has adequate internal consistency (Cronbach alpha=0.779). For the validation study, 90 (43.3%) of 208 potentially eligible subjects (81.4 ± 5.9 years old, 75.6% women) were included. SARC-F identified 51 (56.7%) subjects with sarcopenia and 39 (43.3%) without the disease. Prevalence was 17.8% per EWGSOP and 25.6% per EWGSOP2 (58% accuracy and fair agreement: sensitivity, 78.3%; specificity, 50.8%).

CONCLUSIONS

SARC-F is a feasible tool, suitable for bedside assessment in community-dwelling older patients. Wide diffusion of this culturally-responsible SARC-F Spanish version is expected as EWGSOP2 is adopted and sarcopenia assessment is broadly implemented in Spain.

Furosemide removal in constructed wetlands: Comparative efficiency of LECA and Cork granulates as support matrix

The removal efficiency of LECA and cork granulates as support matrix for pharmaceuticals active compounds in a constructed wetland system was investigated using the diuretic drug Furosemide. Kinetics studies were performed testing three different concentrations of Furosemide in an ultrapure water matrix, along seven days. LECA achieved higher removal values compared to cork granulates. However, cork granulates presented a higher removal in the first 24 h of contact time compared to the other adsorbent. The kinetic studies showed that LECA and cork granulates have different adsorption behaviours for Furosemide which is controlled by different adsorption mechanisms. Both materials showed good removal efficiencies and a combination of the two should be further explored in order to applied both materials as support matrix to cope with different furosemide concentrations.

Overview of the state of the art of constructed wetlands for decentralized wastewater management in Brazil

Conventional wastewater treatment plants (WWTPs) commonly require large capital investments as well as operation and maintenance costs. Constructed wetlands (CWs) appear as a cost-effective treatment, since they can remove a broad range of contaminants by a combination of physical, chemical and biological processes with a low cost. Therefore, CWs can be successfully applied for decentralized wastewater treatment in regions with low population density and/or with large land availability as Brazil. The present work provides a review of thirty nine studies developed on CWs implemented in Brazil to remove wastewater contaminants. Brazil current sanitation data is also considered to evaluate the potential role of CWs as decentralized wastewater treatment. Performance of CWs was evaluated according to (i) type of wetland system, (ii) different support matrix (iii) vegetation species and (iv) removal efficiency of chemical oxygen demand (COD), biological oxygen demand (BOD₅), nitrogen (N), and phosphorus (P). The reviewed CWs in overall presented good efficiencies, whereas H-CWs achieved the highest removals for P, while the higher results for N were attained on VF-CW and for COD and BOD₅ on HF-CW. Therefore, was concluded that CWs are an interesting solution for decentralized wastewater treatment in Brazil since it has warm temperatures, extensive radiation hours and available land. Additionally, the low percentage of population with access to the sewage network in the North and Northeast regions makes these systems especially suitable. Hence, the further implementation of CW is encouraged by the authors in regions with similar characteristics as Brazil.

[Early pharmacologic treatment with botulinum toxin A in post-stroke spasticity: consensus evidence-based recommendations]

Spasticity is a common complication that occurs in those patients that have suffered a stroke. To identify those patients at high risk of having post-stroke spasticity and to start treatment at early stages would probably benefit the patient. The key aspects in the early management of post-stroke spasticity were review and the clinical implications and strength of evidences were also considered. The document drafted by the study coordinators was subsequently reviewed and then a validated document was developed. The experts recommend defining early treatment of spasticity as one that begins before the first three months after stroke. The panel considers very important to identify the risk factors associated with the onset of spasticity, since this might reduce its impact. Additionally, the most common conditions subsidiaries of early treatment of both upper and lower limb are defined. The panel recommends that the treatment with botulinum toxin A must only be given by specialists with experience in diagnosis and management of spasticity. In conclusion, the treatment of focal spasticity in the first three months after stroke is indicated in certain situations. These recommendations help to standardize the early management of post-stroke spasticity, with the consequent support to clinicians and patients.

Water-energy nexus: Anaerobic co-digestion with elephant grass hydrolyzate

The anaerobic co-digestion process in a continuous stirred-tank reactor (CSTR) was carried out under mesophilic conditions (37 ± 0.2 °C). All the trials were performed at a hydraulic retention time (HRT) of 15 days and the AD reactor was daily fed with a mixture of sewage sludge (SS) and elephant grass hydrolyzate (EGH). In this study, three different trials were assessed, with different mixture proportions of SSSS and EGH: F0 (100:0,v/v), F1 (75:25, v/v) and F2 (50:50, v/v), during 90 days each trial, keeping the organic loading rate (OLR) in a range of 0.94-1.16 g VS L(-1) day(-1). The experimental results obtained showed that the soluble chemical oxygen demand (SCOD) removal efficiency was around 77% and 86% for trials F1 and F2, respectively. SS co-digestion with EGH enhanced methane yield, leading to an increment between 23% and 38%, in comparison with the reference scenario (F0).

Use of simulations to enhance knowledge integration and livestock producers’ adaptation to variability in the climate in northern Uruguay

Basaltic soils have an extremely reduced capacity to accumulate water in Uruguay where they occupy 3.5 m ha (25% of the area of Uruguay) and are mainly exploited by extensive cattle production systems. Drought can have a negative effect on forage growth and cattle production and can have a devastating impact on the economy of livestock producers, and damage the entire beef-supply chain. To improve the livestock producers ability to adapt to climate variability, the past effects of droughts were modelled to understand the dynamics of droughts at the level of the production unit through the development of an interactive agent-based simulation model. The simulator was constructed in four steps by simulating: (i) forage growth using a logistic growth equation calibrated with data originated from the Moderate resolution imaging spectroradiometer (MODIS) satellite, (ii) the life cycle of livestock, (iii) the interaction between forage and livestock, and (iv) different strategies of management. Outputs of simulations were explored in five workshops with 82 livestock farmers and development actors. In these workshops, both biophysical models and those related to farm management were recognised as valid, and the typologies used were identified as realistic. Through the workshops and discussions about the models, the producers’ understanding of droughts was investigated. It was found that two types of information were important in encouraging better adaptation: (i) information that allowed a better understanding of the complex system and (ii) information that supported action. The workshops were found to valuable in generating a motivation to analyse and discuss climate variability.

Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients

Background

Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients.

Methods

A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer) and comorbidity (abbreviated Charlson index) were considered to be confounding variables.

Statistical analysis

Simple comparisons and mixed models of multiple ordinal regression.

Results

The sample presented generalized weakness in scapular (mean 4.22) and pelvic (mean 3.82) muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001), pelvic waist strength (P=0.005) and walking ability (P=0.001). A statistically significant relationship in the regression analysis was found between the grip (right and left hands) and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale). The confounding variables showed no statistical significance in the results.

Conclusion

Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful.

Anaerobic co-digestion of dairy cattle manure and pear waste

Anaerobic co-digestion of pre-treated dairy cattle manure (LCM) with pear waste after a storage period (PLF) was tested at four inclusion levels: 0%, 25%, 75% and 100%. Inclusion levels consisted in the replacement of the volatile solids (VS) from the LCM with the VS from PLF keeping the organic loading rate around 1.1 ± 0.4 g SVL(-1)d(-1). The introduction of the co-substrate clearly enhanced methane production rate (MPR) in comparison to single substrate (phase I) as phases II and III, respectively, achieving values 1.3 and 2.8 times higher than phase I. The overall performance was optimized for the mixture 25:75 (LCM:PLF; v:v). Moreover, storage of pear waste did not compromise its use in AD. This fact is important once it can improve waste management from pear production through its valorisation as co-substrate in AD process.

Sports injuries in Brazilian blind footballers

The purpose of this study was to assess the characteristics and prevalence of sports-related injuries in visually disabled athletes of the Brazilian football 5-a-side team. The participants were 13 male athletes, all classified as B1 visual class, members of the Brazilian team, who played in five consecutive international competitions. Data were collected using the Brazilian Paralympic Committee and the Brazilian Confederation of Sports for the Blind report form. From the total of 13 athletes, 11 succumbed to some form of injury during the 5 competitions, which incorporated 23 matches, representing a prevalence of 84.6%. A total of 35 sports injuries were recorded, giving a clinical incidence of 2.7 injuries per athlete and an injury risk of 0.85 and an incidence rate of 0.12 injuries per match. Traumatic injuries (80%) were more common than overuse injuries (20%) (p<0.05). The highest distribution of injury was in the lower limbs (80%), followed by the head (8.6%), spine (5.7%) and upper limbs (5.7%). The body regions most affected were the knee (28.6%), feet (17.1%), ankle (11.4%) and thigh (11.4%). Contusions (31.4%), sprains (25.7%) and tendinopathy (8.6%) were the most frequent diagnoses. This is the first study to describe the nature and prevalence of sports-related injuries in 5-a-side football in blind athletes. The results are important in guiding strategies to inform the implementation of preventive pathways and provide a strong rationale for the compulsory use of additional protective equipment.

Utilization of wasted sardine oil as co-substrate with pig slurry for biogas production--a pilot experience of decentralized industrial organic waste management in a Portuguese pig farm

This work aimed to demonstrate in a pig farm and in real conditions, the possibilities to co-digest wasted sardine oil (WSO) and pig slurry (PS) at farm scale. A biogas mobile pilot plant, was set up in the farm and operated in real conditions during 4 months. Dynamic mesophilic (35-37 °C) continuous pilot trials were performed during four different periods of time. In each period a different organic loading rate (OLR) based on the chemical oxygen demand (COD) was operated sequentially, with pig slurry (PS) (OLR = 1.6 kg COD/m(3) d(-1)) and with mixtures of WSO:PS with a volumetric composition (% v/v) of 2:98 (OLR = 3.0 kg COD/m(3) d(-1)), 3:97 (OLR = 3.7 kg COD/m(3) d(-1)) and 5:95 (OLR = 5.2 kg COD/m(3) d(-1)). Biomass adapted very fast in metabolise the WSO and biogas productivity was raised substantially for different compositions of WSO:PS. Process stability indicators pH and Total volatile fatty acids/bicarbonate alkalinity (T-VFA/BA) ratio, suggests that the co-digestion process was robust. It was concluded that WSO could be easily co-digested in farm scale biogas plants.

Reuse of treated wastewater and sewage sludge for fertilization and irrigation

The objective of the present work was to assess the short-term potential of treated wastewater and sewage sludge for ornamental lawn fertilization and irrigation. A field experiment was performed and the following treatments were considered: sewage sludge application + irrigation with public water; sewage sludge application + irrigation with treated wastewater; irrigation with public water; irrigation with treated wastewater (TW). Irrigation with treated wastewater showed a positive effect on lawn installation through higher growth of grass (1,667 cm) and higher dry matter yield (18,147 g m(-2)). These results represent a significant increase in the grass yield compared with public water irrigation. The grass height (2,606 cm) and dry matter yield (23,177 g m(-2)) increased even more, when sewage sludge produced in the wastewater treatment plant (WWTP) was applied to soil, which proves once more its benefits as an organic fertilizer. At the end of the experiment, an increase of some soil parameters (pH, electrical conductivity, organic matter, Ca2+, Na+, K+, Mg2+ and NH4+) was observed, indicating that treated wastewater irrigation can cause a soil sodization. This short-term study indicated that use of treated wastewater and sewage sludge for ornamental lawn fertilization and irrigation is an environmentally sustainable option for re-use of the WWTP by-products.

[Trunk control test: early predictor of gait balance and capacity at 6 months of the stroke]

INTRODUCTION

It has been challenging to establish a prognostic tool in the acute period following stroke to predict gait outcomes. The purpose of this study is to determine the relationship between trunk control and other early functional prognostic measures with equilibrium and the capacity to ambulate at six months following acute stroke.

METHODS

Sixty-eight patients with stoke admitted consecutively to the Physical Medicine and Rehabilitation unit were followed prospectively. At one and two weeks following admission, the following data were collected: sex, age, type of stroke, urinary incontinence, National Institutes of Health Stroke Scale (NIHSS) and the Trunk Control Test (TCT). At six months following acute stroke, balance was assessed with the Berg Balance score, baropodometry, and computerized posturography as well as gait capacity (measured as velocity and gait ability and limits)

RESULTS

This study found a significant correlation between age, sex, urinary incontinence, TCT and NIHSS at one and two weeks from onset of stroke and the results of equilibrium and gait capacity at six months (p<0.05). When the TCT is <37 in the second week following acute stroke, the Berg Balance score was found to be lower, and with worse gait characteristics (<0.001). The TCT score in the second week is predictive of the achieving functional gait at the six month endpoint (area beneath the curve 0.920).

CONCLUSIONS

The TCT is a simple and quick test which may be considered as an early prognostic indicator for functional motor endpoints in the patient with stroke.

Reclamation of a mine contaminated soil using biologically reactive organic matrices

Organic residues such as sewage sludge, biowastes and composts are increasingly used in land rehabilitation because they can improve the physical, chemical and biochemical properties of soil, and reduce the need for inorganic fertilization. Furthermore, their use contributes to an integrated approach to waste management by promoting recycling of nutrients and minimizing final disposal, especially of organic residues that, due to their composition, can pose problems to agricultural soils. In the present study, three different types of organic residues were considered as amendments to be used in the reclamation of a metal-contaminated mine soil from the Aljustrel mining area (a pyrite mine located in the SW Portugal in the Iberian Pyrite Belt), with high Cu, Pb and Zn total contents: sewage sludge from a municipal wastewater treatment plant (SS), compost from the organic fraction of unsorted municipal solid waste (MSWC), and garden waste compost (GWC), applied at 100 and 200 Mg ha(-1) . The soil and mixtures of soil and amendments were adjusted to 70% of the maximum water-holding capacity determined for each type of sample and incubated in a controlled-temperature room at 20 +/- 1 degrees C. Sub-samples were taken prior to wetting (time zero), and after 7, 14, 21 and 28 days of incubation, and analysed for pH, electrical conductivity, organic matter content, effectively bioavailable Cu, Zn and Pb (extracted with 0.01 mol L(- 1) calcium chloride) and potentially bioavailable metals (extracted with 0.5 mol L(-1) ammonium acetate, 0.5 mol L( -1) acetic acid and 0.01 mol L(- 1) EDTA, pH 4.7). In general, organic residues corrected soil acidity, and increased the total organic matter content of the soil. The SS and the MSWC amendments were roughly equivalent in their ability to correct soil acidity whereas the GWC had the smallest liming capacity and only with 200 Mg ha(-1) GWC did the soil pH reach acceptable values. As expected, all the tested organic residues, at both application rates, were effective in reducing the effectively bioavailable metals in the soil. The Zn bioavailability was the most affected by the addition of organic residues, whereas Pb bioavailability was small even in the unamended soil and was the least affected by treatments. Potentially bioavailable metals increased with SS and MSWC application and the opposite was true following amendment with GWC.

Organic residues as immobilizing agents in aided phytostabilization: (II) effects on soil biochemical and ecotoxicological characteristics

Sewage sludge (SS), municipal solid waste compost, and garden waste compost (GWC) were used as immobilizing agents in aided phytostabilization of an acid metal-contaminated soil affected by mining activities. The organic residues were applied at 25, 50 and 100 Mg ha(-1) (dry weight basis) and perennial ryegrass (Lolium perenne L.) was used as a "green cover". We studied the effects of the treatments on soil phytotoxicity and enzymatic activities, and on the composition and toxicity of the soil leachate towards Vibrio fischeri and Daphnia magna. Application of SS led to the greatest values of dehydrogenase, acid phosphatase, beta-glucosidase, protease and urease activities, corresponding to the greatest overall microbial and biochemical activity in amended soils. Conversely, GWC did not increase these enzymatic activities, relative to the unamended soil, or enhance ryegrass growth. Cellulase activity increased with increasing application rates of the amendments tested, but decreased at the highest SS application rate. The organic amendments were able to suppress soil toxicity to levels that did not affect D. magna, when applied at 50 and 100 Mg ha(-1), but SS, at the same application rates, increased the soil leachate toxicity towards V. fischeri. Moreover, ryegrass showed some phytotoxic symptoms when 100 Mg ha(-1) of SS were applied. This study showed the importance of an integrated evaluation of soil quality on remediation processes. Although SS immobilized trace metals and corrected soil acidity, improving soil biochemical status, when used at high application rates it led to toxicity of soil leachate towards V. fischeri, decreased soil cellulase activity and impaired ryegrass growth.

Organic residues as immobilizing agents in aided phytostabilization: (I) effects on soil chemical characteristics

A greenhouse experiment was conducted to evaluate the effect of three different organic residues, sewage sludge (SS), municipal solid waste compost (MSWC), and garden waste compost (GWC), as immobilizing agents in aided phytostabilization of a highly acidic metal-contaminated soil, affected by mining activities, using perennial ryegrass (Lolium perenne L.). The organic residues were applied at 25, 50 and 100 Mg ha(-1) (dry weight basis), and their effects on soil chemical characteristics and on relative plant growth and metal concentrations were assessed. All the organic residues tested immobilized Cu, Pb and Zn, decreasing their mobile fractions. This was corroborated by negative correlations obtained between mobile Cu, Pb and Zn and other soil chemical characteristics, which rose as a consequence of the amendments applied (i.e., pH, electrical conductivity, organic matter, nitrogen content, available P and available K), and by the multivariate exploratory techniques performed that showed an inverse correlation between these groups of variables. The greatest increase in ryegrass relative growth (more than three times) was obtained in the presence of 50 MgMS WC ha(-1), followed by SS at the same application dosage. GWC did not contribute to an increase in shoot growth, due to its small capacity to correct soil acidity and to supply essential macronutrients (N, P, K). No extractant was able of demonstrating by a linear correlation the uptake of Cu, Pb and Zn by ryegrass. This plant was therefore not a good "indicator" of Cu, Pb and Zn availability in the soil. The results obtained in this study suggest that ryegrass can be used in aided phytostabilization for this type of mine contaminated soils and that MSWC, and to a minor extent SS, applied at 50Mg ha(-1), were effective in the in situ immobilization of metals, improving soil chemical properties and leading to a large increase in plant biomass.