Enhanced treatment of sludge drying condensate by A/O-MBR process: Microbial activity and community structure.

With the rapid increase of sludge production from sewage treatment plants, the treatment of sludge drying condensate rich in a large amount of pollutants urgently needs to be addressed. Due to the unique characteristics of sludge drying condensate (high ammonia nitrogen and COD concentration), there are almost no reports on biological treatment methods specifically targeting sludge drying condensate. In this study, A/O-MBR process was proposed for sludge drying condensate treatment and the effects of ammonia nitrogen loads, alkalinity and aeration intensity were explored. Experimental results show that under the ammonia nitrogen load of 0.35 kg NH4+-N/(m3·d) and the aeration intensity of 0.5 m3/(m2·min), the removal rate of COD and NH4+-N could reach 94% and 99.86% with the addition of alkalinity (m(NaHCO3): m(NH4+-N) = 7:1), respectively. The distribution of living and dead microbial cells in the activated sludge of three reactors also proved that the supplement of alkalinity in the influent can ensure the feasible living conditions for microorganisms. In addition to traditional nitrifying bacteria, through the supplementation of alkalinity and the reduction of aeration intensity, the system had also domesticated high abundance heterogeneous nitrification aerobic denitrification (HN-AD) and aerobic denitrification bacteria (both more than 10% of the total bacterial count). The denitrification process of sludge drying condensate was simplified and the denitrification efficiency was greatly improved. The findings of this study could provide important theoretical guidance for the biological treatment process of sludge drying condensate.

High quality, patient centred and coordinated care for Alstrom syndrome: a model of care for an ultra-rare disease.

BACKGROUND: Patients with rare and ultra-rare diseases make heavy demands on the resources of both health and social services, but these resources are often used inefficiently due to delays in diagnosis, poor and fragmented care. We analysed the national service for an ultra-rare disease, Alstrom syndrome, and compared the outcome and cost of the service to the standard care. METHODS: Between the 9th and 26th of March 2014 we undertook a cross-sectional study of the UK Alstrom syndrome patients and their carers. We developed a semi-structured questionnaire to assess our rare patient need, quality of care and costs incurred to patients and their careers. In the UK all Alstrom syndrome patients are seen in two centres, based in Birmingham, and we systematically evaluated the national service and compared the quality and cost of care with patients' previous standard of care. RESULTS: One quarter of genetically confirmed Alstrom syndrome UK patients were enrolled in this study. Patients that have access to a highly specialised clinical service reported that their care is well organised, personalised, holistic, and that they have a say in their care. All patients reported high level of satisfaction in their care. Patient treatment compliance and clinic attendance was better in multidisciplinary clinic than the usual standard of NHS care. Following a variable costing approach based on personnel and consumables' cost, our valuation of the clinics was just under £700/patient/annum compared to the standard care of £960/patient/annum. Real savings, however, came in terms of patients' quality of life. Furthermore there was found to have been a significant reduction in frequency of clinic visits and ordering of investigations since the establishment of the national service. CONCLUSIONS: Our study has shown that organised, multidisciplinary "one stop" clinics are patient centred and individually tailored to the patient need with a better outcome and comparable cost compared with the current standard of care for rare disease. Our proposed care model can be adapted to several other rare and ultra-rare diseases.