Removal of pharmaceutical residues using ozonation as intermediate process step at Linköping WWTP, Sweden.

Pilot tests as basis for the design, implementation and operation of a future full-scale oxidation plant completing the existing sewage treatment in Linköping, Sweden, were performed. Using an ozonation step between bio-sedimentation and post-denitrification processes, the primary goal was the removal of the highest priority substances to effluent water levels that will not cause adverse effects in the recipient considering the natural dilution. The study included initial emission screenings, dose control trials, treatment performance studies and eco-toxicity studies. At an ozone dose of 5 mg O3/L, most substances could be removed. Ecotoxicological tests showed no negative effect for the tested ozone doses. High levels of oxygen into the denitrification could be rapidly reduced in the biology. The number of bacteria in the treated water could be significantly reduced even at relatively low ozone doses. Based on these results, the planning for the full-scale implementation of the treatment system was initiated in 2015.

Efficiency of an emissions payment system for nitrogen in sewage treatment plants - a case study.

An emissions payment system for nitrogen in Swedish sewage treatment plants (STPs) was evaluated using a semi-empirical approach. The system was based on a tariff levied on each unit of nitrogen emitted by STPs, and profitable measures to reduce nitrogen emissions were identified for twenty municipal STPs. This was done through direct involvement with the plant personnel and the results were scaled up to cover all treatment plants larger than 2000 person equivalents in the Swedish tributary areas of the Kattegat and the Baltic Proper. The sum of costs and nitrogen reductions were compared with an assumed command-and-control regulation requiring all STPs to obtain 80% total nitrogen reduction in their effluents. Costs for the latter case were estimated using a database containing standard estimates for reduction costs by six specified measures. For both cases a total reduction target of 3000 tonnes of nitrogen was set. We did not find that the emissions payment system was more efficient in terms of total reduction costs, although some practical and administrative advantages could be identified. Our results emphasize the need to evaluate the performance of policy instruments on a case-by-case basis since the theoretical efficiency is not always reflected in practice.

Activated carbon for the removal of pharmaceutical residues from treated wastewater.

Pharmaceutical residues, which pass naturally through the human body into sewage, are in many cases virtually unaffected by conventional wastewater treatment. Accumulated in the environment, however, they can significantly impact aquatic life. The present study indicates that many pharmaceutical residues found in wastewater can be removed with activated carbon in a cost-efficient system that delivers higher resource utilisation and security than other carbon systems. The experiment revealed a substantial separation of the analysed compounds, notwithstanding their relatively high solubility in water and dissimilar chemical structures. This implies that beds of activated carbon may be a competitive alternative to treatment with ozone. The effluent water used for the tests, performed over 20 months, originated from Stockholm's largest sewage treatment plant. Passing through a number of different filters with activated carbon removed 90-98% of the pharmaceutical residues from the water. This paper describes pilot-scale tests performed by IVL and the implications for an actual treatment plant that has to treat up to several thousand litres of wastewater per second. In addition, the advantages, disadvantages and costs of the method are discussed. This includes, for example, the clogging of carbon filters and the associated hydraulic capacity limits of the activated carbon.

Advancing paternal age and schizophrenia: the impact of delayed fatherhood.

OBJECTIVE: It is well known that advancing paternal age is associated with an increased risk of schizophrenia in offspring, but the mechanism behind this association remains unknown. This study investigates if delayed fatherhood rather than advancing paternal age per se might explain the increased risk of schizophrenia in offspring associated with advancing paternal age. METHODS: This is a register-based study of the Swedish population looking at people born 1955-1985 who have 1 or 2 siblings (n = 2 589 502). The main analysis investigated whether the association between advancing paternal age and schizophrenia was explained by delayed fatherhood. Possible confounding factors were taken into account. Cox regression was used throughout. RESULTS: In the main analysis the association between advancing paternal age and increased risk of schizophrenia in offspring disappeared after controlling for delayed fatherhood (hazard ratio [HR] = 0.93, 95% CI = 0.72-1.21 comparing 45+ years old fathers to those 25-29), whereas delayed fatherhood showed an association with increased risk of schizophrenia in offspring comparing 35-39 and 40-44 years old fathers to 25-29 year olds (HR = 1.37, 95% CI = 1.18-1.58; HR = 1.81, 95% CI = 1.44-2.28, respectively). The results remained when controlling for possible confounders. CONCLUSIONS: This study suggests that the association between paternal age and schizophrenia is not due to paternal age per se, but rather to an unknown factor associated with both delayed fatherhood and schizophrenia.

[National respiration center support patients with tracheostomy tubes. Outpatient clinic for respiratory support in the home]. / Nationellt respirationscentrum stöttar patienter med trakealkanyl - Öppenvårdsmottagning för andningsstöd i hemmet.

It is now 60 years since the polio epidemic in Copenhagen and the first use of prolonged invasive positive pressure ventilation. After this pioneer work positive pressure ventilation rapidly became well established. Intubation/tracheostomy and mechanical ventilation are now standard in Intensive Care Units. In the late 1970 Gillis Andersson was the first in Sweden to discharge patients home with invasive mechanical ventilator support. His pioneer work included the development of a dedicated practical and technical support organization at National Respiration Centre at Danderyds Hospital. This unit developed skills in patient customized tracheostomy tube construction and home invasive ventilation supportive care. Tracheostomy tubes and home ventilators have since then developed rapidly. Some patients still need customized tracheostomy tubes, which the NRC supplies. The production is certified by the Swedish Medicinal Product Agency. Today invasive home ventilation is standard care. Invasive mechanical home ventilation when instituted as a life-saving therapy in, for example, progressive ALS patients is complex and resource-intensive. New aspects such as training and education in order to secure quality of care in the home environment is one of many challenges. When commencing invasive ventilation in patients with progressive neurological disease ethical considerations must also be acknowledged, e.g. aspects such as patients' perhaps changing wishes during the course of illness regarding cessation of life support.

Removal of estrogenicity in Swedish municipal sewage treatment plants.

The human estrogen receptor alpha-test, hosted in a yeast strain, was used to quantify estrogenicity in three-week composite samples of untreated and treated effluents from 20 Swedish municipal sewage treatment plants. The treatment plants were selected to represent different treatment processes regarding chemical precipitation and microbial procedures. The discharge from Swedish domestic sewage treatment plants contained estrogenic compounds corresponding to <0.1-15 ng estradiol equivalents/L. Low levels of estrogenic activity were also found in a river receiving municipal effluents, 3.5-35 km downstream the outlet from a sewage treatment works. The range of estrogenicity in untreated, raw sewage effluents was found to be 1-30 ng estradiol equivalents/L. Generally, wastewater treatment reduced the estrogenicity and extended biological treatment was most effective in its removal. Activated sludge treatment tended to be more effective than trickling filters, whereas chemical precipitation using iron or aluminium salts without biological treatment showed little effectivity. The study showed that treatment methods in current use are able to eliminate or largely reduce estrogenicity in domestic wastewater.

Parental age and the risk of autism spectrum disorders: findings from a Swedish population-based cohort.

BACKGROUND: The objectives of this study were to examine the independent and dependent associations of maternal and paternal age and risk of offspring autism spectrum disorders (ASD), with and without intellectual disability (ID). METHODS: The sample consisted of 417 303 Swedish children born 1984-2003. ASD case status (N = 4746) was ascertained using national and regional registers. Smoothing splines in generalized additive models were used to estimate associations of parental age with ASD. RESULTS: Whereas advancing parental age increased the risk of child ASD, maternal age effects were non-linear and paternal age effects were linear. Compared with mothers at the median age 29 years, those <29 had similar risk, whereas risk increased after age 30, with an odds ratio (OR) of 1.75 [95% (CI): 1.63-1.89] at ages 40-45. For fathers, compared with the median age of 32 years, the OR for ages 55-59 was 1.39 (1.29-1.50). The risk of ASD was greater for older mothers as compared with older fathers. For example, mothers aged 40-45 (≥97.2th percentile) had an estimated 18.63 (95% CI: 17.25-20.01) ASD cases per 1000 births, whereas fathers aged 55-59 (≥99.7th percentile) had 16.35 (95% CI: 15.11-17.58) ASD cases per 1000 births. In analyses stratified by co-parental age, increased risk due to advancing paternal age was evident only with mothers ≤35 years. In contrast, advancing maternal age increased risk regardless of paternal age. Advancing parental age was more strongly associated with ASD with ID, compared with ASD without ID. CONCLUSIONS: We confirm prior findings that advancing parental age increases risk of ASD, particularly for ASD with ID, in a manner dependent on co-parental age. Although recent attention has emphasized the effects of older fathers on ASD risk, an increase of n years in maternal age has greater implications for ASD risk than a similar increase in paternal age.

Adoptive paternal age and risk of psychosis in adoptees: a register based cohort study.

The association between advancing paternal age and increased risk of schizophrenia in the off-spring is well established. The underlying mechanisms are unknown. In order to investigate whether the psychosocial environment associated with growing up with an aged father explains the increased risk we conducted a study of all adoptive children in Sweden from 1955-1985 (n =31 188). Their risk of developing schizophrenia or non-affective psychosis in relation to advancing age of their adoptive fathers' was examined. We found no association between risk of psychoses and advancing adoptive paternal age. There was no support of psychosocial environmental factors explaining the "paternal age effect".

Assessment of androgenicity in leachates from Swedish landfills and treatments for its elimination.

An in vitro recombinant yeast strain, transfected with the human androgen receptor was used to assess androgenic hormone disrupting potencies in leachates from Swedish landfills. It was shown that components in extracts of these affected the androgenic receptor and promoted a response in the beta-galactosidase marker system. Levels were within the range of those determined for domestic sewage effluents but lower than the highest levels found in an industrial effluent. These leachates finally enter receiving waters with or without wastewater treatment. Evidence was found for transformation during some of the wastewater treatments.

Nonsteroidal anti-inflammatory drugs for the prevention of Alzheimer's disease: a systematic review.

OBJECTIVE: Alzheimer's disease, the most prevalent dementia, is a prominent source of chronic illness in the elderly. Laboratory evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) might prevent the onset of Alzheimer's disease. Since the early 1990s numerous observational epidemiological studies have also investigated this possibility. The purpose of this meta-analysis is to summarize and evaluate available evidence regarding exposure to nonaspirin NSAIDs and risk of Alzheimer's disease using meta-analyses of published studies. METHODS: A systematic search was conducted using Medline, Biological Abstracts, and the Cochrane Library for publications 1960 onwards. All cross-sectional, retrospective, or prospective observational studies of Alzheimer's disease in relation to NSAID exposure were included in the analysis. At least 2 of 4 independent reviewers characterized each study by source of data and design, including method of classifying exposure and outcome, and evaluated the studies for eligibility. Discrepancies were resolved by consensus of all 4 reviewers. RESULTS: Of 38 publications, 11 met the qualitative criteria for inclusion in the meta-analysis. For the 3 case-control and 4 cross-sectional studies, the combined risk estimate for development of Alzheimer's disease was 0.51 (95% Cl=0.40-0.66) for NSAID exposure. In the prospective studies, the estimate was 0.74 (95% Cl=0.62-0.89) for 4 studies reporting lifetime NSAID exposure and it was 0.42 (95% Cl=0.26-0.66) for the 3 studies reporting a duration of use of 2 or more years. CONCLUSIONS: Based on analysis of prospective and nonprospective studies, NSAID exposure was associated with decreased risk of Alzheimer's disease. An issue that requires further exploration in future trials or observational studies is the temporal relationship between NSAID exposure and protection against Alzheimer's disease.