Microbially-enhanced composting of olive mill solid waste (wet husk): bacterial and fungal community dynamics at industrial pilot and farm level.

Bacterial and fungal community dynamics during microbially-enhanced composting of olive mill solid waste (wet husk), used as a sole raw material, were analysed in a process carried out at industrial pilot and at farm level by the PCR-DGGE profiling of the 16 and 26S rRNA genes. The use of microbial starters enhanced the biotransformation process leading to an earlier and increased level of bacterial diversity. The bacterial community showed a change within 15 days during the first phases of composting. Without microbial starters bacterial biodiversity increased within 60 days. Moreover, the thermophilic phase was characterized by the highest bacterial biodiversity. By contrast, the biodiversity of fungal communities in the piles composted with the starters decreased during the thermophilic phase. The biodiversity of the microbial populations, along with physico-chemical traits, evolved similarly at industrial pilot and farm level, showing different maturation times.

Microbially-enhanced composting of wet olive husks.

The production of a compost from olive wet husks is described. The process is enhanced through the use of starters prepared with virgin husks enriched with selected microbial cultures. This approach, with respect to composting without the use of starters, allows to achieve faster start of the process (10 vs. 45 days), deeper humification (humification rate 19.2 vs. 12.2), shorter maturation time (2 vs. 4-5 months) and better detoxification of the starting material. Furthermore, the compost produced can effectively substitute for turf as a cultivation substrate in horticulture at greenhouse level, with beneficial effects on nutraceutical traits of tomato fruits.

Refusal to donate after brain death.

Quality control of the donation process with the use of appropriate validated indicators is fundamental to detect criticalities and plan corrective measures. We report the results of a retrospective study on the quality of interviews with brain-dead donor (BDD) families to obtain consent for organ and tissue donation. Between January 2001 and December 2009, we performed 260 interviews to explore willingness of BDD family members for organ and/or tissue donation. Refusal of donation occurred in 26.5% (69/260) of cases with no significant difference according to the type of intensive care unit or the cause of death. However, the analysis revealed a reduction in refusal rates over the study period from 46.4% in 2001 to 19.5% in 2009. Based on our study, the presence of experienced, committed health care personnel is necessary to reduce refusal rates and increase the available organ donor pool.

Efficiency of the tissue procurement process: what evaluation tools?

Evaluation of the efficiency of tissue procurement (TP) requires appropriate indicators. We report the results of a survey on all in-hospital deaths in Tuscany performed to identify potential indicators of efficiency with regard to donor identification and evaluation. In January 2004, we established a regional, compulsory, prospective program to monitor all in-hospital deaths in Tuscany. Currently, in Tuscany TP is performed if donors are < or =75 years without evidence of infectious or malignant diseases. Between January 2004 and December 2008, we analyzed data on 75,921 in-hospital deaths, including 50,001 (66.9%) in subjects older than 75 years, while 25,920 (33.1%) were < or =75 years and thus considered for TP. Among the latter cohort, 11,657 (15.3%) presented with clinical contraindication(s), while 14,263 (18.8%) were fit for tissue donation. Of the latter population, tissue donation occurred in 3083 cases (ie, 4% of in-hospital deaths or 11.8% of potential tissue donors). Contraindications to tissue donation were identified in 9861 cases (12.9%) based on clinical files, and in 1796 (2.4%) after interview with the family. There was a great variability by regional hospital in the percent of contraindications identified after the family interview, from a low of 4% to a high of 45%. Based on our experience, implementation of efficiency parameters and improvement of the efficiency of the entire TP process requires compulsory reporting of in-hospital deaths by local transplant coordinators.

The role of nurses in the risk management of organ and tissue donation.

In the setting of organ and tissue procurement, lack of transplantation and the resulting missed opportunity for wait-listed patients might be considered as an untoward effect, since it results in longer wait-list times, higher mortality rates for potential candidates, and harm to the entire society. Beyond the classical definition holding that an adverse event is the inadvertent transmission of disease from a donor to a recipient, we advocate it should also include nonreporting of potential deceased donors; unsuccessful donor management; failure in organ/tissue procurement as the result of impossibility to assess brain death, lack of clinical data, or technical problems during surgical procedures. Based on their education, experience, and competencies, nurses share the responsibility to participate in the evaluation of risks and in the implementation of appropriate strategies for error prevention during the entire procurement process.

The epidemiology of brain death in Tuscany: is there need for novel indicators?

Quality monitoring of the donation process requires appropriate indicators. We performed a retrospective review of all patients with encephalic lesions (ELs) reported to the Tuscany Quality Program of Donation during 2003 to 2007, seeking to assess whether there were differences in the brain-death-to-patients-with-encephalic-lesions (BD/EL) ratio, which is a current indicator of the efficiency of the donation process. The theoretical framework was that the type of disease may influence the probability of BD, and the subsequent donation process. During the study period 2555 patients were reported to display ELs. The overall BD/EL ratio was 48.1%, that is, 1229 patients were reported to be BD donors to the regional coordinating center at a later time point during patient hospitalization. With regard to the etiology, 1374 (53.8%) patients suffered cerebrovascular (CV disease); 514 (20.1%) traumatic (T); 397 (15.5%) postanoxic (PA); 55 (2.1%) neurological neoplasms (NN); and 215 (8.4%) other diseases (O). The BD/EL ratio by disease type was 57.2% for CV (786/1374); 58% for T (298/514); 19.4% for PA (77/397); 36.4% for NN (20/55); and 22.3% for O subjects (48/215). Despite its limitations, the current analysis advocates stratification of deceased donors by type of disease to allow better understanding and monitoring of the donation process.

Tissue procurement and transplantation: a Tuscany perspective.

Tissue procurement and transplantation are rarely taken into account as indicators of the efficiency of a regional donor procurement network. We present herein a retrospective review on Tuscany tissue procurement activities from 2004 until 2006. In 2003 the Tuscan Regional Government appointed a transplantation service authority to reorganize all regional donation and transplantation activities: the Organizzazione Toscana Trapianti (OTT). The regional tissue procurement network was based on either brain death (BD) and cardiac death (CD) donors under the responsibility of in-hospital transplantation coordinators (IHTCs). From 2004 to 2006, a total of 397 tissue donors were procured in Tuscany, and 4151 tissue transplantations were performed: 2909 skin grafts, 1209 bone grafts, and 33 heart valves. Over the same period, a total of 2116 cornea donors were procured; 4117 corneas were retrieved; 1779 were fit for transplantation, and 1418 were transplanted. Based on our experience, implementation of tissue procurement requires use of BD donors and paramount organizational efforts from IHTCs.

The quality assurance program of organ donation in Tuscany.

Constant monitoring is paramount in order to detect the criticalities and improve the results of the deceased donation process. Concomitant with the institution of a regional transplantation service authority--Organizzazione Toscana Trapianti--in 2003, Tuscany adopted a program of quality assurance of the deceased donation process by compulsory reporting of all encephalic deaths from local intensive care units to the regional transplant office in Florence. The indicators we adopted were the efficiency of deceased donor (DD) identification, expressed as the ratio of encephalic deaths (ED) to total deaths with encephalic lesions (EL) (ie, ED/EL); the efficiency of DD reporting, expressed as the ratio of reported potential DD (RPDD) to total ED (ie, RPDD/ED); the efficacy of the DD process, as the ratio between actual DD (ADD) to total ED (ie, ADD/ED); the conversion rate; the percent of opposition to donation; and the incidence of DD maintenance failures. Data were collected prospectively, stratified by regional hospital consortia (Aziende Sanitarie Locali) and compared with international benchmarks. In the period 2003-2006 the mean efficiency of DD identification was 48.3%+/-4.4% (range 42.6%-53.2%); the mean efficiency of DD reporting was 95.2%+/-2.5% (range 92.5%-98.5%); the mean efficacy of the deceased donation process was 51.8%+/-2.4% (range 48.6%-54.4%); the mean conversion rate was 59.6%+/-2.2% (range 57.6%-62.7%); the mean opposition rate was 31.9%+/-1.1% (range 30.6%-33.2%); and the incidence of DD maintenance failure was 5%+/-2.9% (range 2.2%-8.7%). The breakdown analysis revealed wide interhospital variability in terms of efficiency of DD identification (from a low of 25% to a high of 80%); efficacy of the donation process (from a low of 22% to a high of 79%); and conversion rate (from a low of 29% to a high of 79%). Our results highlight that the donation process gets started in about 50% of eligible cases. Further strategies are favored to address this critical area.

How to evaluate organ donation: the quality programme in Tuscany.

The shortage of cadaveric organ donors imposes a severe limit on the number of patients who can benefit from transplantation. This paper describes a programme for evaluation and improvement of the organ donation process, which has been implemented in the hospitals of the Tuscany region, Italy. After analysing the first results it was found that there was great potential for growth, especially in those hospitals with neurosurgery where the weakest points of the process were detected The development of a quality improvement programme in cadaveric organ donation is an adequate and scientific method to detect where the problems in the process of organ donation lie. Ideally, the comparison of these data with those of other Italian or European regions should be very useful to plan adequate strategies to improve cadaveric organ donation.

Summary: the quality improvement program in organ donation of the Tuscany region.

Since October 2002, after a pilot period, a quality improvement program in organ donation has been underway in Tuscany. This program is based on a database elaborated by the Transplant Coordination Office of the Pisa University, according to the Spanish program of the National Transplant Organization. All encephalic deaths occurring in intensive care units beds during mechanical ventilation are registered in the database. Encephalic deaths were evaluated by local transplant coordinators and an esthesiologists after review of the clinical records. The data are sent every month to the Central Unit located in the Santa Chiara Hospital of Pisa. Every 3 and 12 months, we calculate the indices to evaluate organ donation activity in every hospital. The preliminary results show that: (1) the program is a useful tool to evaluate the organ donation process; (2) the experience is limited, but has shown the potential of the program to increase organ donation activity in Tuscany.

Corneal explantation activity in 2002: an analysis of the modified operational schedule.

After data have been gathered about corneal explants performed within the AOP health-care web throughout 2001, the resulting findings were used to update the selection system for donation fitness and operational procedures. The rejection of anti-HBc-positive grafts and tissues coming from subjects more than 79 years old resulted in decreased donations (256 donations, that is 492 corneal explants in 2001 vs 140, that is 273 in 2002), although the number of deaths was unchanged (1298 in 2001 vs 1294 in 2002). Corneas fit for transplantation did not change in number-126 (25.6% of the total available) in 2001 and 113 (41.4%) in 2002-while the instances of rejected corneas occurred 56.3% less frequently, allowing a savings of great deal of human and money resources. After activity schedules were modified, the results analysis confirmed the expected improvement in 2001.

The influence of metam sodium on soil respiration.

A laboratory experiment was performed in order to evaluate the extent to which metam sodium (MS) applied at two different recommended rates and its degradation product, methyl isothiocyanate (MITC), affect soil respiration. Results suggest that MS degradation to MITC was complete within 4 hours and that MITC decomposed quickly in a few days, except in the soil containing high organic matter where it was still present after 15 days. Following the addition of MS, a lag phase appeared in CO2-C evolution in the soil. It was longer for the higher dose of MS added and for the two soils with low organic C content. The dynamics of the process was described by the Bonde and Rosswall model and by the Gompertz RS E model for the untreated and the MS-treated soils, respectively.