bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Child and Parent Mental Health in Primary Care: A Cluster-Randomized Trial of Communication Skills Training
Authors: Wissow Lawrence Sagin , Gadomski Anne , Roter Debra , Larson Susan , Brown Jonathan , Zachary Ciara , Bartlett Edward , Horn Ivor , Luo Xianghua , Wang Mei-Cheng
Published: February 2008

OBJECTIVE. We examined child and parent outcomes of training providers to engage families efficiently and to reduce common symptoms of a range of mental health problems and disorders.

METHODS. Training involved three 1-hour discussions structured around video examples of family/provider communication skills, each followed by practice with standardized patients and self-evaluation. Skills targeted eliciting parent and child concerns, partnering with families, and increasing expectations that treatment would be helpful. We tested the training with providers at 13 sites in rural New York, urban Maryland, and Washington, DC. Children (5–16 years of age) making routine visits were enrolled if they screened “possible” or “probable” for mental disorders with the Strengths and Difficulties Questionnaire or if their provider said they were likely to have an emotional or behavioral problem. Children and their parents were then monitored for 6 months, to assess changes in parent-rated symptoms and impairment and parent symptoms.

RESULTS. Fifty-eight providers (31 trained and 27 control) and 418 children (248 patients of trained providers and 170 patients of control providers) participated. Among the children, 72% were in the possible or probable categories. Approximately one half (54%) were white, 30% black, 12% Latino, and 4% other ethnicities. Eighty-eight percent (367 children) completed follow-up monitoring. At 6 months, minority children cared for by trained providers had greater reduction in impairment (−0.91 points) than did those cared for by control providers but no greater reduction in symptoms. Seeing a trained provider did not have an impact on symptoms or impairment among white children. Parents of children cared for by trained providers experienced greater reduction in symptoms (−1.7 points) than did those cared for by control providers.

CONCLUSION. Brief provider communication training had a positive impact on parent mental health symptoms and reduced minority children's impairment across a range of problems.
Trends in Acute Otitis Media-Related Health Care Utilization by Privately Insured Young Children in the United States, 1997–2004
Authors: Zhou Fangjun , Shefer Abigail , Kong Yuan , Nuorti J. Pekka
Published: February 2008

OBJECTIVE. The goal was to estimate the population effect of 7-valent pneumococcal conjugate vaccine on rates of acute otitis media-related ambulatory visits and antibiotic prescriptions for <2-year-old children enrolled in private insurance plans.

METHODS. We performed a retrospective analysis of a defined population by using the 1997–2004 MarketScan databases, which included an average of >500000 person-years of observations for children <2 years of age. Trends in rates of International Classification of Diseases, Ninth Revision-coded ambulatory visits and antibiotic prescriptions attributable to acute otitis media were evaluated, and the national direct medical expenditures for these outcomes were estimated.

RESULTS. In a comparison of 2004 with 1997–1999 (baseline period), rates of ambulatory visits and antibiotic prescriptions attributable to acute otitis media decreased from 2173 to 1244 visits per 1000 person-years (42.7% reduction) and from 1244 to 722 prescriptions per 1000 person-years (41.9% reduction), respectively. Total, estimated, national direct medical expenditures for acute otitis media-related ambulatory visits and antibiotic prescriptions for children <2 years of age decreased from an average of $1.41 billion during 1997 to 1999 to $0.95 billion in 2004 (32.3% reduction).

CONCLUSIONS. Acute otitis media-related health care utilization and associated antibiotic prescriptions for privately insured young children decreased more than expected (on the basis of efficacy estimates in prelicensure clinical trials) after the introduction of routine 7-valent pneumococcal conjugate vaccine immunization. Although other factors, such as clinical practice guidelines to reduce antibiotic use, might have contributed to the observed trend, 7-valent pneumococcal conjugate vaccine may play an important role in reducing the burden of acute otitis media, resulting in substantial savings in medical care costs.
Further Delineation of Deletion 1p36 Syndrome in 60 Patients: A Recognizable Phenotype and Common Cause of Developmental Delay and Mental Retardation
Authors: Battaglia Agatino , Hoyme H. Eugene , Dallapiccola Bruno , Zackai Elaine , Hudgins Louanne , McDonald-McGinn Donna , Bahi-Buisson Nadia , Romano Corrado , Williams Charles A. , Brailey Lisa L. , Zuberi Sameer M. , Carey John C.
Published: February 2008

OBJECTIVES. Deletion 1p36 syndrome is a recently delineated disorder, considered to be the most common subtelomeric microdeletion syndrome (1 in 5000 newborns). 1p36.3 deletions account for 0.5% to 1.2% of idiopathic mental retardation; thus, knowledge about the condition is important for pediatricians caring for such patients. Despite 100 reported cases, little is known about its natural history. Our aim was to delineate the natural history of deletion 1p36 and develop complete and accurate information with which to answer families' questions in the clinical setting.

PATIENTS AND METHODS. We evaluated 60 patients with the 1p36 deletion syndrome (41 female, 19 male). All underwent physical and neurologic assessments, and most received a psychological evaluation. Standard cytogenetics, fluorescence in situ hybridization of the subtelomeric regions, or array comparative genomic hybridization were used for diagnosis.

RESULTS. Fourteen cases were detected by standard cytogenetics, and 46 were detected by fluorescence in situ hybridization of the subtelomeric regions or array comparative genomic hybridization. Occipitofrontal circumference was at ≤2nd centile in 95%, and height and weight ranged between the <3rd and 90th centiles. All patients had straight eyebrows, deep-set eyes, midface hypoplasia, broad nasal root/bridge, long philtrum, and pointed chin. Other features included microbrachycephaly (65%), epicanthus (50%), large, late-closing anterior fontanel (77%), and posteriorly rotated, low-set, abnormal ears (40%). Brachy/camptodactyly and short feet were prominent. Seventy-one percent exhibited heart defects, including 23% with a “noncompaction cardiomyopathy.” Fifty-two percent had eye/visual abnormalities, and 64% had visual inattentiveness. Twenty-eight percent had sensorineural deafness, 41% had skeletal anomalies, 25% had abnormal genitalia, and 22% had renal abnormalities. Eighty-eight percent had central nervous system anomalies, and 44% had seizures. All patients demonstrated developmental delay with poor/absent speech; 95% had hypotonia. Twenty-six percent were able to walk alone, and 47% had a behavior disorder. Constant developmental progress was observed in all cases over time. Noncompaction cardiomyopathy and most seizures were controlled by pharmacotherapy.

CONCLUSIONS. These 60 patients with deletion 1p36 represent the largest clinical series to date and provide new information on several aspects of this disorder, which is characterized by neurodevelopmental disability and a recognizable pattern of malformation.
Effects of Basic Developmental Care on Neonatal Morbidity, Neuromotor Development, and Growth at Term Age of Infants Who Were Born at <32 Weeks
Authors: Maguire Celeste M. , Veen Sylvia , Sprij Arwen J. , Le Cessie Saskia , Wit Jan M. , Walther Frans J. ,   on behalf of the Leiden Developmental Care Project
Published: February 2008

OBJECTIVE. The goal of this study was to investigate the effect of basic elements of developmental care (incubator covers and positioning aids) on days of respiratory support and intensive care, growth, and neuromotor development at term age in infants who were born at <32 weeks’ gestation.

METHODS. Infants were randomly assigned within 48 hours of birth to the developmental care group or the standard care control group (no covers or nests). The intervention continued until the infant either was transferred to a regional hospital or was discharged from the hospital. Length, weight, and head circumference were measured (bi)weekly and at term age. Neuromotor development was defined as definitely abnormal (presence of a neonatal neurologic syndrome, such as apathy or hyperexcitability, hypotonia or hypertonia, hyporeflexia or hyperreflexia, hypokinesia or hyperkinesia, or a hemisyndrome), mildly abnormal (presence of only part of such a syndrome), or normal.

RESULTS. A total of 192 infants were included (developmental care: 98; control: 94). Thirteen infants (developmental care: 7; control: 6) were excluded according to protocol (admitted for less than or died within the first 5 days: n = 12; taken out at parents’ request: n = 1), which left a total of 179 infants who met inclusion criteria. In-hospital mortality was 12 (13.2%) of 91 in the developmental care group and 8 (9.1%) of 88 in the control group. There was no significant difference in the number of days of respiratory support, number of intensive care days, short-term growth, or neuromotor developmental outcome at term age between the developmental care and control groups. Duration of the intervention, whether only during the intensive care period or until hospital discharge, had no significant effect on outcome.

CONCLUSIONS. Providing basic developmental care in the NICU had no effect on short-term physical and neurologic outcomes in infants who were born at <32 weeks’ gestation.
Clinical Utility of Echocardiography for the Diagnosis and Management of Pulmonary Vascular Disease in Young Children With Chronic Lung Disease
Authors: Mourani Peter M. , Sontag Marci K. , Younoszai Adel , Ivy D. Dunbar , Abman Steven H.
Published: February 2008

OBJECTIVE. The goal was to determine the clinical utility of Doppler echocardiography in predicting the presence and severity of pulmonary hypertension in patients with chronic lung disease who subsequently underwent cardiac catheterization.

METHODS. A retrospective review of data for all patients <2 years of age with a diagnosis of bronchopulmonary dysplasia, congenital diaphragmatic hernia, or lung hypoplasia who underwent echocardiography and subsequently underwent cardiac catheterization for evaluation of pulmonary hypertension was performed. The accuracy of echocardiography in diagnosing pulmonary hypertension, on the basis of estimated systolic pulmonary artery pressure, was compared with the detection of pulmonary hypertension with the standard method of cardiac catheterization.

RESULTS. Thirty-one linked measurements for 25 children were analyzed. Systolic pulmonary artery pressure could be estimated in 61% of studies, but there was poor correlation between echocardiography and cardiac catheterization measures of systolic pulmonary artery pressure in these infants. Compared with cardiac catheterization measurements, echocardiographic estimates of systolic pulmonary artery pressure diagnosed correctly the presence or absence of pulmonary hypertension in 79% of the studies in which systolic pulmonary artery pressure was estimated but determined the severity of pulmonary hypertension (severe pulmonary hypertension was defined as pulmonary/systemic pressure ratio of ≥0.67) correctly in only 47% of those studies. Seven (58%) of 12 children without estimated systolic pulmonary artery pressure demonstrated pulmonary hypertension during subsequent cardiac catheterization. In the absence of estimated systolic pulmonary artery pressure, qualitative echocardiographic findings, either alone or in combination, had worse predictive value for the diagnosis of pulmonary hypertension.

CONCLUSION. As used in clinical practice, echocardiography often identifies pulmonary hypertension in young children with chronic lung disease; however, estimates of systolic pulmonary artery pressure were not obtained consistently and were not reliable for determining the severity of pulmonary hypertension.
Role of Environmental Factors in the Timing of Puberty
Authors: Euling Susan Y. , Selevan Sherry G. , Pescovitz Ora Hirsch , Skakkebaek Niels E.
Published: February 2008

Puberty-timing measures have historically been used as indicators of adequate nutrition and growth. More recently, these measures have been examined in relation to exposure to estrogenic or antiandrogenic agents, as well as other environmental factors. The scientific community has debated whether puberty timing is occurring earlier today than in the mid-1900s in the United States and, if so, whether environmental factors play a role; however, no one has asked a multidisciplinary panel to resolve this question. Thus, a multidisciplinary expert panel jointly sponsored by the US Environmental Protection Agency, the National Institute of Environmental Health Sciences, and Serono Symposia International was convened to examine the evidence of a secular trend, identify potential environmental factors of concern, and identify research needs regarding environmental factors and puberty timing at “The Role of Environmental Factors on the Timing and Progression of Puberty” workshop. The majority of the panelists concluded that the girls' data are sufficient to suggest a secular trend toward earlier breast development onset and menarche from 1940 to 1994 but that the boys' data are insufficient to suggest a trend during this same period. The weight-of-the-evidence evaluation of human and animal studies suggest that endocrine-disrupting chemicals, particularly the estrogen mimics and antiandrogens, and body fat are important factors associated in altered puberty timing. A change in the timing of puberty markers was considered adverse from a public health perspective. The panel recommended research areas to further our understanding of the relationships among environmental factors, puberty-timing outcomes, and other reproductive and adult disease at the individual and population levels.
Hospital-Based Influenza Vaccination of Children: An Opportunity to Prevent Subsequent Hospitalization
Authors: Zerr Danielle M. , Englund Janet A. , Robertson Andrea S. , Marcuse Edgar K. , Garrison Michelle M. , Christakis Dimitri A.
Published: February 2008

OBJECTIVE. We performed this study to determine the frequency of previous hospitalization among children hospitalized with influenza.

METHODS. The Pediatric Health Information System database (discharges that occurred between January 1, 2001, and December 31, 2006) was used to determine the proportion of children hospitalized with influenza or respiratory illness who had a previous hospitalization during the most recent influenza-vaccination season. Subjects included pediatric patients (through 18 years of age). The index hospitalization was defined as the first influenza or respiratory illness hospitalization for a child that occurred during the study period and between November 1 and April 30. A previous hospitalization during the most recent influenza-vaccination season was defined as a hospitalization for any reason in the 0.5 to 6 months before the index hospitalization but not before September 1 or on or after March 1.

RESULTS. Overall, 16% of children hospitalized with influenza and 12% of children hospitalized with influenza or a respiratory illness had a previous hospitalization during the most recent influenza-vaccination season. Approximately 23% of the children hospitalized with influenza and a comorbidity had a previous hospitalization during the most recent influenza-vaccination season.

CONCLUSION. Hospital-based programs for influenza vaccination have the potential to reach children at highest risk of influenza complications and to reduce the rates of pediatric hospitalization for treatment of influenza-related illness.
Principles for the Development and Use of Quality Measures
Authors:   Steering Committee on Quality Improvement and Management and Committee on Practice and Ambulatory Medicine
Published: February 2008

The American Academy of Pediatrics and its members are committed to improving the health care system to provide the highest-quality and safest health care for infants, children, adolescents, and young adults. This statement is intended as a guide for pediatricians and pediatric leadership on the appropriate uses of quality measures and the criteria on which they should be based. The statement summarizes the current national efforts on quality measurement and provides a set of principles for the development, use, and evaluation of quality measures for improving children's health and health care. The American Academy of Pediatrics recommends that these measures address important issues for children; be appropriate for children's health and health care, scientifically valid, and feasible; and focus on what can be improved. In addition, the American Academy of Pediatrics supports reasonable principles for the oversight and implementation of pay-for-performance programs.
Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate
Authors: Engle William A. ,   and the Committee on Fetus and Newborn
Published: February 2008

Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in preterm infants. Surfactant therapy substantially reduces mortality and respiratory morbidity for this population. Secondary surfactant deficiency also contributes to acute respiratory morbidity in late-preterm and term neonates with meconium aspiration syndrome, pneumonia/sepsis, and perhaps pulmonary hemorrhage; surfactant replacement may be beneficial for these infants. This statement summarizes indications, administration, formulations, and outcomes for surfactant-replacement therapy. The impact of antenatal steroids and continuous positive airway pressure on outcomes and surfactant use in preterm infants is reviewed. Because respiratory insufficiency may be a component of multiorgan dysfunction, preterm and term infants receiving surfactant-replacement therapy should be managed in facilities with technical and clinical expertise to administer surfactant and provide multisystem support.
Periodontal Ligament Stem Cell-Mediated Treatment for Periodontitis in Miniature Swine
Authors: Liu Yi , Zheng Ying , Ding Gang , Fang Dianji , Zhang Chunmei , Bartold Peter Mark , Gronthos Stan , Shi Songtao , Wang Songlin
Published: February 2008

Periodontitis is a periodontal tissue infectious disease and the most common cause for tooth loss in adults. It has been linked to many systemic disorders, such as coronary artery disease, stroke, and diabetes. At present, there is no ideal therapeutic approach to cure periodontitis and achieve optimal periodontal tissue regeneration. In this study, we explored the potential of using autologous periodontal ligament stem cells (PDLSCs) to treat periodontal defects in a porcine model of periodontitis. The periodontal lesion was generated in the first molars area of miniature pigs by the surgical removal of bone and subsequent silk ligament suture around the cervical portion of the tooth. Autologous PDLSCs were obtained from extracted teeth of the miniature pigs and then expanded ex vivo to enrich PDLSC numbers. When transplanted into the surgically created periodontal defect areas, PDLSCs were capable of regenerating periodontal tissues, leading to a favorable treatment for periodontitis. This study demonstrates the feasibility of using stem cell-mediated tissue engineering to treat periodontal diseases.

Disclosure of potential conflicts of interest is found at the end of this article.
RESPONSE INDUCTION DURING THE ACQUISITION AND MAINTENANCE OF LEVER PRESSING WITH DELAYED REINFORCEMENT
Authors: Escobar Rogelio , Bruner Carlos A.
Published: February 2008

The acquisition of lever pressing by rats and the occurrence of unreinforced presses at a location different from that of the reinforced response were studied using different delays of reinforcement. An experimental chamber containing seven identical adjoining levers was used. Only presses on the central (operative) lever produced food pellets. Groups of 3 rats were exposed to one of seven different tandem random‐interval (RI) fixed‐time (FT) schedules. The average RI duration was the complement of the FT duration such that their sum yielded a nominal 32‐s interreinforcement interval on average. Response rate on the operative lever decreased as the FT value was lengthened. The spatial distribution of responses on the seven levers converged on the operative lever when the FT was 0 or 2 s and spread across the seven levers as the FT value was lengthened to 16 or 32 s. Presses on the seven levers were infrequent during the FT schedule. Both operative‐ and inoperative‐lever pressing intertwined in repetitive patterns that were consistent within subjects but differed between subjects. These findings suggest that reinforcer delay determined the response‐induction gradient.
STOCHASTIC MATCHING AND THE VOLUNTARY NATURE OF CHOICE
Authors: Neuringer Allen , Jensen Greg , Piff Paul
Published: February 2008

Attempts to characterize voluntary behavior have been ongoing for thousands of years. We provide experimental evidence that judgments of volition are based upon distributions of responses in relation to obtained rewards. Participants watched as responses, said to be made by “actors,” appeared on a computer screen. The participant's task was to estimate how well each actor represented the voluntary choices emitted by a real person. In actuality, all actors' responses were generated by algorithms based on Baum's (1979) generalized matching function. We systematically varied the exponent values (sensitivity parameter) of these algorithms: some actors matched response proportions to received reinforcer proportions, others overmatched (predominantly chose the highest‐valued alternative), and yet others undermatched (chose relatively equally among the alternatives). In each of five experiments, we found that the matching actor's responses were judged most closely to approximate voluntary choice. We found also that judgments of high volition depended upon stochastic (or probabilistic) generation. Thus, stochastic responses that match reinforcer proportions best represent voluntary human choice.
CHOICE IN A SUCCESSIVE‐ENCOUNTERS PROCEDURE AND HYPERBOLIC DECAY OF REINFORCEMENT
Authors: Mazur James E.
Published: February 2008

Pigeons responded in a successive‐encounters procedure that consisted of a search state, a choice state, and a handling state. The search state was either a fixed‐interval or mixed‐interval schedule presented on the center key of a three‐key chamber. Upon completion of the search state, the choice state was presented, in which the center key was off and the two side keys were lit. A pigeon could either accept a delay followed by food (by pecking the right key) or reject this option and return to the search state (by pecking the left key). During the choice state, a red right key represented the long alternative (a long handling delay followed by food), and a green right key represented the short alternative (a short handling delay followed by food). In some conditions, both the short and long alternatives were fixed‐time schedules, and in other conditions both were mixed‐time schedules. Contrary to the predictions of both optimal foraging theory and delay‐reduction theory, the percentage of trials on which pigeons accepted the long alternative depended on whether the search and handling schedules were fixed or mixed. They were more likely to accept the long alternative when the search states were fixed‐interval rather than mixed‐interval schedules, and more likely to reject the long alternative when the handling states were fixed‐time rather than mixed‐time schedules. This pattern of results was in qualitative agreement with the predictions of the hyperbolic‐decay model, which states that the value of a reinforcer is inversely related to the delay between a choice response and reinforcer delivery.
Improved real-time PCR assays for the detection of fecal indicator bacteria in surface waters with different instrument and reagent systems
Authors: Siefring S. , Varma M. , Atikovic E. , Wymer L. , Haugland R. A.
Published: February 2008

Previously reported and redesigned primer and probe assays were evaluated for the quantitative analysis of the fecal indicator bacterial groups, Enterococcus and Bacteroidetes with three real-time PCR instrument and reagent systems. The efficiency and sensitivity of the original assays varied between systems in analyses of DNA extracts from pure cultures of Enterococcus faecalis and Bacteroides fragilis, whereas the modified assays gave more consistent results. Distinctions between original and modified assays also occurred in analyses of known spike levels of E. faecalis and B. fragilis cells on filters with diverse surface water retentates. Percentages of samples causing PCR failures due to inhibition were lower using the modified assays. The accuracy and precision of spiked bacteria measurements were also generally higher, although mean measurements of both target organisms were still significantly different between systems (p < 0.05). The accuracy and precision of spiked bacteria measurements by both modified assays were further improved using a new sample matrix control spike consisting of cultured Lactococcus lactis cells and a reference assay for this organism. Corrections provided by the L. lactis assay eliminated significant differences in E. faecalis measurements between all three systems and between two of the three systems in B. fragilis measurements.
Current status and future trends in Cryptosporidium and Giardia epidemiology in Malaysia
Authors: Lim Y. A. L. , Ahmad R. A. , Smith H. V.
Published: February 2008

Cryptosporidium and Giardia are major causes of diarrhoeal diseases of humans worldwide, and are included in the World Health Organisation's ‘Neglected Diseases Initiative’. Cryptosporidium and Giardia occur commonly in Malaysian human and non-human populations, but their impact on disease, morbidity and cost of illness is not known. The commonness of contributions from human (STW effluents, indiscriminate defaecation) and non-human (calving, lambing, muck spreading, slurry spraying, pasturing/grazing of domestic animals, infected wild animals) hosts indicate that many Malaysian environments, particularly water and soil, are sufficiently contaminated to act as potential vehicles for the transmission of disease. To gain insight into the morbidity and mortality caused by human cryptosporidiosis and giardiasis, they should be included into differential diagnoses, and routine laboratory testing should be performed and (as for many infectious diseases) reported to a centralised public health agency. To understand transmission routes and the significance of environmental contamination better will require further multidisciplinary approaches and shared resources, including raising national perceptions of the parasitological quality of drinking water. Here, the detection of Cryptosporidium and Giardia should be an integral part of the water quality requirement. A multidisciplinary approach among public health professionals in the water industry and other relevant health- and environment-associated agencies is also required in order to determine the significance of Cryptosporidium and Giardia contamination of Malaysian drinking water. Lastly, adoption of validated methods to determine the species, genotype and subgenotype of Cryptosporidium and Giardia present in Malaysia will assist in developing effective risk assessment, management and communication models.
The effect of wetland vegetation on the survival of Escherichia coli, Salmonella typhimurium, bacteriophage MS-2 and polio virus
Authors: Karim Mohammad R. , Glenn Edward P. , Gerba Charles P.
Published: February 2008

A study was conducted to examine the role of aquatic plants used in constructed wetlands on the survival of enteric bacteria and viruses. Four small-scale wetland systems, receiving fresh water and two other wetland systems, receiving secondary unchlorinated sewage were used in this study. Fresh water and secondary sewage without the presence of any aquatic plants were used as controls. Escherichia coli, Salmonella typhimurium, bacteriophage MS-2 and poliovirus were added to the waters collected from the wetlands and controls. The presence of aquatic plants significantly increased the die-off of both bacteria in fresh water and secondary sewage. No significant difference in the die-off of E. coli and S. typhimurium was observed in water from wetlands with different types of plants in freshwater. However, there was a significant difference in the die-off of E. coli in water with aquatic plants when sewage was used. The presence of the plants significantly increased the inactivation of MS-2 and poliovirus. Additional work on the survival of E. coli indicated that the plausible mechanism of bacterial die-off in constructed wetlands is through increased microbial competition or predation.
Exploring intra-household factors for diarrhoeal diseases: a study in slums of Delhi, India
Authors: Dasgupta Rajib
Published: February 2008

While infrastructure conditions constitute ‘primary routes’, contamination of water within households and other behavioural determinants are considered as ‘secondary routes’. However, recontaminated water has been considered not to constitute a serious risk though it occurs commonly in poorer societies. A study was conducted in Delhi where individual risk factors were located within a larger socio-economic, political and administrative framework, as they were often independent variables. This component of the larger study hypothesised that behavioural factors at individual household levels lose significance as major determinants of diarrhoeal diseases once they are analysed in a holistic epidemiology frame. Determinants at the household level were explored through a dataset based on a primary survey of 300 households in three slum clusters. Amongst households storing municipal water (proven to be safe at source), adhering to the best storage practices did not translate into lower incidence rates as compared to those with relatively unsafe practices. The explanation lay in factors which were external to the home and beyond the control of the affected household. Thus, household level behavioural factors such as storage practises should not be analysed in isolation as determinants of diarrhoeal illness particularly when pitted against stronger neighbourhood and external determinants.
Survival of enteric microorganisms on grass surfaces irrigated with treated effluent
Authors: Sidhu J. P. S. , Hanna J. , Toze S. G.
Published: February 2008

Treated effluent can be reused for the irrigation of parks and sports grounds but there is an associated potential public health risks from microbial pathogens present on the grass surface, particularly when used for contact sports. The main aim of this study was to investigate the survival of pathogenic and indicator microorganisms on the grass surface of a sports ground irrigated with treated effluent under differing climatic conditions. Results showed that Salmonella enterica serotype typhimurium, Escherichia coli, Enterococcus faecalis and Staphylococcus aureus decayed faster under direct sunlight than MS2 with one log10 reduction (T90) varying from 3 to 11 hours. Rapid decay (T90 3 to 4 hours) of bacterial pathogens occurred in both sunlight and shade during the summer. In contrast, T90 times for the bacteria during the winter varied from 6 to 11 hours in direct sunlight and from 23 to 38 hours in shade. No significant seasonal variation was observed in the inactivation of the bacteriophage MS2. Enteric viruses are expected to show inactivation rates similar to MS2. The results show that rapid inactivation of enteric bacteria can be expected on grass surface irrigated with treated effluent at higher ambient temperatures, in direct sunlight and low moisture content.
Long-term study of Cryptosporidium and Giardia occurrence and quantitative microbial risk assessment in surface waters of Arizona in the USA
Authors: Ryu Hodon , Abbaszadegan Morteza
Published: February 2008

A four-year systematic study of microbial water quality in the surface waters of central Arizona was performed. The objectives of this study were to investigate the occurrence of microbial pathogens and indicators in the waters. A total of 192 water samples from five sites were analyzed for Cryptosporidium, Giardia, and various microbial and physical indicators. Ten percent (16/162) of the samples collected using EnviroChek filters were positive for Cryptosporidium oocysts, whereas no oocysts (<1 in 5 L) were detected in the grab samples (0/30). Giardia cysts were detected in 10% (3/30) of the grab samples and in 27% (44/162) samples collected using EnviroChek filters. Mean concentrations of oocysts in the source waters at the treatment plants were lower than the Bin 1 category of the USEPA Long Term 2 Enhanced Surface Water Treatment Rule; therefore no additional treatment is required by the plants. The annual risks of infection from Cryptosporidium met the annual acceptable risk of 10−4 at all sampling sites, whereas the risks of Giardia infection at the Verde River and the Salt River were 5.70E-04 and 2.66E-04, respectively.
Experience in Wales (UK) of the optimisation of ortho-phosphate dosing for controlling lead in drinking water
Authors: Hayes C. R. , Incledion S. , Balch M.
Published: February 2008

Dwr Cymru Welsh Water supplies over three million people with drinking water throughout most of Wales (UK). Ortho-phosphate has increasingly been dosed at around 1 mg/L (P) to further reduce the corrosivity of supplies to the lead pipes which connect approximately 30% of houses to water mains in the company's area, additional to long-establish pH adjustment measures. The installation of new ortho-phosphate dosing schemes and the optimisation of these and existing dosing schemes, 29 schemes in total, were subject to a regulatory programme of work, agreed with the Drinking Water Inspectorate (DWI). Optimisation comprised (i) selection of appropriate ortho-phosphate doses by a procedure involving laboratory based plumbosolvency testing linked to zonal lead emission (compliance) modelling, (ii) tight dose control and (iii) extensive monitoring of lead in supply by random daytime (RDT) sampling and by the use of lead pipe test rigs. The successful outcome was confirmed by 99% of over 5,000 RDT samples complying with the future standard of 10 μg/L for lead in drinking water.
The application of waterworks sludge ash to stabilize the volume of cement paste
Authors: Luo H. L. , Kuo W. T. , Lin D. F.
Published: February 2008

In order to extend the recycling of waterworks sludge to engineering applications, this paper addresses the influence of nano-SiO2 on incinerated waterworks sludge ash (IWSA) cement paste attacked by sulfate. Tests were performed such as length measurement for volume change, compressive strength, weight loss, and micro-structural testing using scanning electron microscopy (SEM). The results indicate that when a portion of the cement in the paste was replaced by IWSA, the IWSA diluted the cementitious material C3A, and filled the capillary pores in the hardened paste. Moreover, since IWSA has potential pozzolanic activity, it can chemically react with Ca(OH)2 crystals in the paste and can consequently improve the resistance of the paste to sulfate attack. Test results also show that due to the fully developed pozzolanic effect of IWSA, the major reaction products of sulfate attack, gypsum and ettringite, were clearly reduced. Hence, the expansion rate in length decreased with the increase of IWSA replacement. Furthermore, the addition of nano-SiO2 to IWSA cement paste can also reduce the length expansion rate.
Fate of nonylphenol and 17β-estradiol contained in composted sewage sludge after land application
Authors: Minamiyama M. , Ochi S. , Suzuki Y.
Published: February 2008

Many environmental problems caused by endocrine disrupters (EDs) have been reported. Because little is known about the fate of EDs accumulated in sewage sludge, we carried out a study to clarify the fate of EDs in composted sludge after its application to soil. Nonylphenol (NP) and 17β-estradiol (E2) were measured for leachate and soil. High concentrations of NP and E2 were detected in the leachate at the early stage, but they decreased rapidly. Also, the high contents of NP and E2 in soil decreased significantly within 300 days. Because the decrease of NP and E2 in the soil was much larger than that of NP and E2 in the leachate, there must have been a physicochemical or biological decomposition mechanism in the soil layer. We also tried to clarify the transfer of NPs to plants from compost. In the experimental conditions of this study, the transfer of NPs to plants from compost was not observed.
Aeration of anaerobically digested sewage sludge for COD and nitrogen removal: optimization at large-scale
Authors: Parravicini V. , Svardal K. , Hornek R. , Kroiss H.
Published: February 2008

The paper will report about the experiences at an Austrian large wastewater treatment plant of 720,000 population equivalents, where anaerobically digested sewage sludge is further stabilised under aerobic conditions. Enhanced stabilisation of the anaerobically digested sludge was required at the plant in order to get a permit for landfill disposal of the dewatered stabilized sludge. By implementing a post-aeration treatment (SRT ∼ 6d; 36 °C) after anaerobic digestion the organic content of the anaerobically well digested sludge can be decreased by 16%. Investigations on site showed that during digested sludge post-aeration anoxic phases for denitrification are needed to provide stable process conditions. In this way the pH value can be kept in a more favourable range for micro-organisms and concrete structures. Additionally, inhibition of the biological process due to nitrite accumulation can be avoided. By optimising the aeration/pause ratio ∼ 45% of total nitrogen in digested sludge can be removed. This significantly improves nitrogen removal efficiency at the wastewater treatment plant. NH4-removal occurs mainly through nitritation and denitritation with an efficiency of 98%. The costs/benefit analysis shows that post-aeration of digested sludge results in an increase of total annual costs for wastewater treatment of only 0.84%, corresponding to 0.19 Euro/pe/a. Result of molecular biological analyses (DGGE) indicate that all four ammonium-oxidizing bacteria species present in activated sludge can survive anaerobic digestion, but only two of them can adapt in the digested sludge post-aeration tanks. Additionally, in the post-aerated digested sludge a further ammonium-oxidizing bacteria species was identified.
Biogas from waste materials as transportation fuel–benefits from an environmental point of view
Authors: Börjesson P.
Published: February 2008

In this paper various biogas systems based on waste materials have been analysed from an environmental point of view. The analyses are based on Swedish conditions using a systems analysis approach from an energy and life cycle perspective. The biogas produced is used as a transportation fuel replacing petrol in light-duty vehicles. The overall aims are to quantify the potential environmental effects when current waste handling and transportation fuel systems are replaced. A general conclusion is that the indirect environmental benefits (e.g. reduced emissions of ammonia and methane, and nitrogen leaching) from altered handling of organic waste materials and land-use may often significantly exceed the direct environmental benefits achieved when biogas replaces petrol (e.g. reduced emissions of carbon dioxide and air pollutants). Such indirect benefits are seldom considered when biogas is evaluated from an environmental point of view. However, the environmental impact from different biogas systems can vary significantly due to factors such as the waste materials utilised, different reference systems being replaced, and local conditions.
Modeling microbial diversity in anaerobic digestion
Authors: Ramirez I. , Steyer J. P.
Published: February 2008

The aim of this study is to develop a modeling approach able to handle microbial diversity both in normal and abnormal situations. Normal situations are defined as changing input characteristics that do not imply process imbalance while abnormal situations are illustrated by the presence of toxicant into the reactor. In both cases, modeling is performed by adding a stochastic term on top of a well defined and well structured model such as the IWA Anaerobic Digestion Model No1. Experimental data from a 1 m3 pilot scale anaerobic digester treating wine distillery wastewater are provided to demonstrate the applicability of this approach. Discussion also highlights that monitoring of digesters might receive a renewed consideration in the near future in order to handle explicitly microbial diversity within the control objectives.
Changes of microbial characteristics of retained sludge during low-temperature operation of an EGSB reactor for low-strength wastewater treatment
Authors: Syutsubo K. , Yoochatchaval W. , Yoshida H. , Nishiyama K. , Okawara M. , Sumino H. , Araki N. , Harada H. , Ohashi A.
Published: February 2008

In this study, a lab scale EGSB reactor was operated for 400 days to investigate the influence of temperature-decrease on the microbial characteristic of retained sludge. The EGSB reactor was started-up at 15°C seeding with 20°C-grown granular sludge. The influent COD of synthetic wastewater was set at 0.6–0.8 gCOD/L. The process-temperature was stepwise reduced from 15°C to 5°C during 400 days operation. Decrease of temperature of the reactor from 15°C to 10°C caused the decline of COD removal efficiency. However, continuous operation of the EGSB reactor led the efficient treatment of wastewater (70% of COD removal, 50% of methane recovery) at 10°C. We confirmed that the both acetate-fed and hydrogen-fed methanogenic activities of retained sludge clearly increased under 15 to 20°C. Changes of microbial profiles of methanogenic bacteria were analyzed by 16S rDNA-targeted DGGE analysis and cloning. It shows that genus Methanospirillum as hydrogen-utilizing methanogen proliferated due to low temperature operation of the reactor. On the other hand, genus Methanosaeta presented in abundance as acetoclastic-methanogen throughout the experiment.
Impact of dissolved oxygen concentration on membrane filtering resistance and soluble organic matter characteristics in membrane bioreactors
Authors: Min Kyung-Nan , Ergas Sarina J. , Mermelstein Anna
Published: February 2008

This study investigated the impact of dissolved oxygen (DO) concentration on membrane filtering resistance, soluble organic matter (SOM) and extracellular polymeric substance (EPS) characteristics in a membrane bioreactor (MBR). A laboratory-scale MBR was operated under DO limited (0.2 mg L−1 DO) and fully aerobic (3.7 and 5.4 mg L−1 DO) conditions. Membrane filtering resistance was determined for the mixed liquor suspended solids (MLSS) and for resuspended microbial biomass after removing SOM. Regardless of the DO concentration, the cake resistance (Rc) was approximately 95 percent of the total resistance (Rt). The membrane cake resistance was found to decrease significantly after removing the SOM. The total resistance caused by the resuspended biomass was 29 percent of that caused by the MLSS under DO limited conditions, while the total resistance caused by resuspended biomass was 41 to 48 percent of that caused by the MLSS under fully aerobic conditions. Under DO limited conditions, SOM in the MLSS contained a larger amount of high molecular weight compounds, leading to higher cake resistance than under fully aerobic conditions. There was significant variation in the molecular weight fractions of the EPS, with no clear relationship with DO concentration. There was also no distinct relationship between membrane filtering resistance and molecular weight fraction of the EPS.
Classification of the degradability of 30 pharmaceuticals in water with ozone, UV and H2O2
Authors: Kim I. H. , Tanaka H. , Iwasaki T. , Takubo T. , Morioka T. , Kato Y.
Published: February 2008

Experiments were conducted to assess the degradability of 30 PPCPs, selected on the basis of consumption and environmental relevance, by O3 process, UV process and AOPs consisting of UV/ H2O2, O3/UV and O3/H2O2. A batch reactor with volume of 22L of water including the PPCPs was used. For UV process, combination of UV and H2O2 or O3 that can generate OH radicals was capable of degrading the PPCPs faster than UV radiation alone. On the other hand, O3 process and O3-based/UV-based AOPs could remove a variety of the PPCPs effectively, while some PPCPs such as 2-QCA, DEET and cyclophosphamide showed a relatively low degradability compared with the other PPCPs. However, further evaluation on formation of intermediate products resulting from the degradation of the parent PPCPs will be needed because DOC concentration was not decreased with lowered concentrations of the PPCPs.
Decentralized collection of iodinated x-ray contrast media in hospitals–results of the feasibility study and the practice test phase
Authors: Heinzmann Bernd , Schwarz Rolf-Jürgen , Schuster Petra , Pineau Claire
Published: February 2008

Iodinated x-ray contrast media are unmetabolized and almost completely with the urine in 24 hours emitted in the wastewater after their application by human being. These very polar, hydrophilic and hardly biodegradable substances have already been detected in the water cycle. The objective of this R&D project is the collection of the x-ray contrast media already at the source in the hospital and so the avoidance of an emission in the water cycle.

Three concepts have been developed in the scope of this R&D project: a centralized collection concept with a no-mix toilet in the radiology unit, a decentralized collection concept featuring a no-mix toilet for every of the ward and another decentralized collection concept with mobile urine containers for the wards. The evaluation of the collection concepts has taken systematically into consideration costs, acceptance and a value benefit analysis. The feasibility study has shown that a separated collection of iodinated x-ray contrast media in hospitals is possible through the implementation of a decentralized urine collection concept using mobile urine containers.

This decentralised collection concept was tested in each case on one main focus ward of two representative German hospitals for 20 weeks. In both wards of the hospitals around 60% of patients with an examination of x-ray contrast media took part in the voluntary urine collection. The AOX arose from the iodinated x-ray contrast media in the collected urine. The averaged measured AOI concentration in the patient's urine was 18 g/l. The total costs, formed by the costs for staff, material and disposal, were estimated at 10 € per patient, 7 € per litre urine and approximate 380 € per kilogramme iodine for the separated urine collection in hospitals. The main part of the total costs is formed by the costs for staff with around 80%.

This R&D project has shown that the separated collection of the patients' urine with a simple and decentralised collection concept with mobile urine containers in hospitals can be carried out hygienically and safely. A transfer of this decentralised collection concept to pharmaceuticals which are excreted with urine is possible.