Identifying extreme COVID-19 mortality risks in English small areas: a disease cluster approach.

The COVID-19 pandemic is having a huge impact worldwide and has highlighted the extent of health inequalities between countries but also in small areas within a country. Identifying areas with high mortality is important both of public health mitigation in COVID-19 outbreaks, and of longer term efforts to tackle social inequalities in health. In this paper we consider different statistical models and an extension of a recent method to analyze COVID-19 related mortality in English small areas during the first wave of the epidemic in the first half of 2020. We seek to identify hotspots, and where they are most geographically concentrated, taking account of observed area factors as well as spatial correlation and clustering in regression residuals, while also allowing for spatial discontinuities. Results show an excess of COVID-19 mortality cases in small areas surrounding London and in other small areas in North-East and and North-West of England. Models alleviating spatial confounding show ethnic isolation, air quality and area morbidity covariates having a significant and broadly similar impact on COVID-19 mortality, whereas nursing home location seems to be slightly less important.

Flexible Bayesian P-splines for smoothing age-specific spatio-temporal mortality patterns.

In this paper age-space-time models based on one and two-dimensional P-splines with B-spline bases are proposed for smoothing mortality rates, where both fixed relative scale and scale invariant two-dimensional penalties are examined. Model fitting and inference are carried out using integrated nested Laplace approximations, a recent Bayesian technique that speeds up computations compared to McMC methods. The models will be illustrated with Spanish breast cancer mortality data during the period 1985-2010, where a general decline in breast cancer mortality has been observed in Spanish provinces in the last decades. The results reveal that mortality rates for the oldest age groups do not decrease in all provinces.

A two-stage approach to estimate spatial and spatio-temporal disease risks in the presence of local discontinuities and clusters.

Disease risk maps for areal unit data are often estimated from Poisson mixed models with local spatial smoothing, for example by incorporating random effects with a conditional autoregressive prior distribution. However, one of the limitations is that local discontinuities in the spatial pattern are not usually modelled, leading to over-smoothing of the risk maps and a masking of clusters of hot/coldspot areas. In this paper, we propose a novel two-stage approach to estimate and map disease risk in the presence of such local discontinuities and clusters. We propose approaches in both spatial and spatio-temporal domains, where for the latter the clusters can either be fixed or allowed to vary over time. In the first stage, we apply an agglomerative hierarchical clustering algorithm to training data to provide sets of potential clusters, and in the second stage, a two-level spatial or spatio-temporal model is applied to each potential cluster configuration. The superiority of the proposed approach with regard to a previous proposal is shown by simulation, and the methodology is applied to two important public health problems in Spain, namely stomach cancer mortality across Spain and brain cancer incidence in the Navarre and Basque Country regions of Spain.

A statistical algorithm showing coenzyme Q10 and citrate synthase as biomarkers for mitochondrial respiratory chain enzyme activities.

Laboratory data interpretation for the assessment of complex biological systems remains a great challenge, as occurs in mitochondrial function research studies. The classical biochemical data interpretation of patients versus reference values may be insufficient, and in fact the current classifications of mitochondrial patients are still done on basis of probability criteria. We have developed and applied a mathematic agglomerative algorithm to search for correlations among the different biochemical variables of the mitochondrial respiratory chain in order to identify populations displaying correlation coefficients >0.95. We demonstrated that coenzyme Q10 may be a better biomarker of mitochondrial respiratory chain enzyme activities than the citrate synthase activity. Furthermore, the application of this algorithm may be useful to re-classify mitochondrial patients or to explore associations among other biochemical variables from different biological systems.

Analyzing the evolution of young people's brain cancer mortality in Spanish provinces.

OBJECTIVES: To analyze the spatio-temporal evolution of brain cancer relative mortality risks in young population (under 20 years of age) in Spanish provinces during the period 1986-2010. METHODS: A new and flexible conditional autoregressive spatio-temporal model with two levels of spatial aggregation was used. RESULTS: Brain cancer relative mortality risks in young population in Spanish provinces decreased during the last years, although a clear increase was observed during the 1990s. The global geographical pattern emphasized a high relative mortality risk in Navarre and a low relative mortality risk in Madrid. Although there is a specific Autonomous Region-time interaction effect on the relative mortality risks this effect is weak in the final estimates when compared to the global spatial and temporal effects. CONCLUSIONS: Differences in mortality between regions and over time may be caused by the increase in survival rates, the differences in treatment or the availability of diagnostic tools. The increase in relative risks observed in the 1990s was probably due to improved diagnostics with computerized axial tomography and magnetic resonance imaging techniques.

Size and structure evolution of kaolin-Al(OH)3 flocs in the electroflocculation process: a study using static light scattering.

Electroflocculation (EF) is gaining recognition as an alternative process to conventional coagulation/flocculation. The electrical current applied in EF that generates the active coagulant species creates a unique chemical/physical environment in which competing redox reactions occur, primarily water electrolysis. This causes a transient rise in pH, due to cathodic formation of hydroxyl ions, which, in turn, causes a continuous shift in coagulation/flocculation mechanisms throughout the process. This highly impacts the formation of a sweep floc regime that relies on precipitation of metal hydroxide and its growth into floc. The size and structural evolution of kaolin-Al(OH)(3) flocs was examined using static light scattering techniques, in aim of elucidating kinetic aspects of the process. An EF cell was operated in batch mode and comprised of two concentric electrodes - a stainless steel cathode (inner electrode) and an aluminum anode (outer electrode). The cell was run at constant current between 0.042A and 0.22A, and analyses performed at pre-determined time intervals. The results demonstrate that EF is able to generate a range of flocs, exhibiting different growth rates and structural characteristics, depending on the conditions of operation. Growth patterns were sigmoidal and a linear correlation between growth rate and current applied was observed. The dependency of growth rate on current can be related to initial pH and aluminum dosing, with a stronger dependency apparent for initial optimal sweep floc regime. All flocs exhibited a fragile nature and undergo compaction and structural fluctuations during growth. This is the first time size and structural evolution of flocs formed in the EF process is reported.

Control of biofilm formation in water using molecularly capped silver nanoparticles.

Control of biofouling and its negative effects on process performance of water systems is a serious operational challenge in all of the water sectors. Molecularly capped silver nanoparticles (Ag-MCNPs) were used as a pretreatment strategy for controlling biofilm development in aqueous suspensions using the model organism Pseudomonas aeruginosa. Biofilm control was tested in a two-step procedure: planktonic P. aeruginosa was exposed to the Ag-MCNPs and then the adherent biofilm formed by the surviving cells was monitored by applying a model biofilm-formation assay. Under specific conditions, Ag-MCNPs retarded biofilm formation, even when high percentage of planktonic P. aeruginosa cells survived the treatment. For example, Ag-MCNPs (10 microg mL(-1)) retarded biofilm formation (>60%), when 50 percent of the planktonic P. aeruginosa cells survived the treatment. Moreover, stable low value of relative biomass has been formed in the presence of fixed Ag-MCNPs concentrations at various biofilm incubation times. Our results showed that Ag-MCNPs pretreated cells were able to produce EPS although they succeeded to form relatively low adherent biofilm. These pretreated cells appear well preserved and undamaged under TEM HPH/freeze micrographs, yet the intra cellular material seems to be pushed towards the peripheral parts of the cell, possibly indicating a survival strategy to the presence of Ag-MCNPs. The lower value of relative biomass formed in the presence of Ag-MCNPs could be associated with molecular mechanisms related to biofilm formation or continuous release of silver ions in the sample. However, further research is required to examine these factors.

Silver nanoparticle-E. coli colloidal interaction in water and effect on E. coli survival.

Silver nanoparticles exhibit antibacterial properties via bacterial inactivation and growth inhibition. The mechanism is not yet completely understood. This work was aimed at elucidating the effect of silver nanoparticles on inactivation of Escherichia coli, by studying particle-particle interactions in aqueous suspensions. Stable, molecularly capped, positively or negatively charged silver nanoparticles were mixed at 1 to 60microgmL(-1) with suspended E. coli cells to examine their effect on inactivation of the bacteria. Gold nanoparticles with the same surfactant were used as a control, being of similar size but made up of a presumably inert metal. Log reduction of 5log(10) and complete inactivation were obtained with the silver nanoparticles while the gold nanoparticles did not show any inactivation ability. The effect of molecularly capped nanoparticles on E. coli survival was dependent on particle number. Log reduction of E. coli was associated with the ratio between the number of nanoparticles and the initial bacterial cell count. Electrostatic attraction or repulsion mechanisms in silver nanoparticle-E. coli cell interactions did not contribute to the inactivation process.

Characteristics of aggregates formed by electroflocculation of a colloidal suspension.

Electroflocculation (EF) is becoming recognized as an alternative process to conventional coagulation/flocculation, although both are somewhat different. The electrical current applied in EF to generate the active coagulant species creates a unique chemical/physical environment which affects coagulation mechanisms and subsequent aggregate formation. The chemical and physical characteristics of an electroflocculated kaolin suspension and the morphology/fractal dimension of the resulting aggregates were examined. An EF cell was operated in batch mode and comprised of two concentric electrodes--a stainless steel cathode (outer electrode) and an aluminum anode (inner electrode). The cell was run at constant current between 0.05 and 0.3A, velocity gradients were 0-30s(-1). The results show that the simultaneous hydrolysis occurring has a profound effect on the final pH and consequently on the coagulation mechanisms as indicated by differences in zeta potential measured. Moreover, the electrical field induced by passage of a current has an apparent effect on particle transport. A linear correlation between floc size and current was observed and lower fractal dimensions were obtained for larger floc sizes. The fractal dimensions of the flocs obtained in EF are on average lower than those reported for conventional coagulation.

UV disinfection of wastewater effluents for unrestricted irrigation.

Wastewater reuse in arid regions is important for the production of a water resource to be utilised for non-potable purposes and to prevent the environmental transmission of disease-causing agents. This study was conducted to evaluate the effect of water quality on the comparative disinfection efficiency of viruses, bacteria and spores by UV irradiation. Furthermore, the microbial quality of effluent produced by coagulation, high rate filtration (HRF) and either UV irradiation or chlorination was determined. Using low pressure collimated beam, a UV dose of 80 mWs/cm2 was needed to achieve a 3-log10 inactivation of either rotavirus SA-11 or coliphage MS2, whereas over 5-log10 inactivation of E. coli was reached with a dose of only 20 mWs/cm2. B. subtilis inactivation was found to be linear up to a dose of 40 mWs/cm2 and then a tailing up to a UV dose of 120 mWs/cm2 was observed. It is worth noting that effluent turbidity of < 5 NTU did not influence the inactivation efficiency of UV irradiation. Operation of a pilot plant to treat secondary effluent by coagulation, HRF and UV disinfection at a UV dose of 80 mWs/cm2 resulted in the production of high quality effluent in compliance with the Israel standards for unrestricted irrigation (< 10 CFU/100 mL faecal coliform and turbidity of < 5 NTU). Sulphite reducing clostridia (SRC) were found to be more resistant than coliphages and F coliform for UV irradiation. The results of this study indicated that UV disinfection is suitable for the production of effluents for unrestricted irrigation of food crops.

Membrane fouling and selectivity mechanisms in effluent ultrafiltration coupled with flocculation.

Membrane filtration is adequate for producing disinfected clear water suitable for various kinds of applications. However, fouling of membranes is the main limitation. The scope of the present study is to examine the effect of iron coagulation of primary wastewater effluent on membrane filtration, in parallel to fouling characterization of the iron itself. The fouling of ultrafiltration membranes by colloidal iron hydroxide-oxide has been studied by measuring the pore streaming potential of PES UF membrane. pH 5.5 (charge neutralization zone) provided better removal and lower fouling intensity than pH 7.8 (sweep coagulation zone), but the internal clogging at acidic pH was higher. Fouling of the membrane as measured by flux reduction was usually accompanied by a positive change in zeta potential and iso-electric point (IEP) of the membrane. An initially large change in zeta potential (without charge reversal) was seen even after relatively small amounts of iron solution were filtered through the membrane. A control experiment showed this is not due to iron adsorption equilibrium, but should probably be attributed to fouling. Change in zeta potential, can be used as an indicator for commencement of fouling even for small flux reductions. UF membrane critical flux after iron filtration can be evaluated more accurately by zeta potential than pressure drop or change in iron concentration.

Genetic differentiation and trade among populations of peach palm ( Bactris gasipaes Kunth) in the Peruvian Amazon-implications for genetic resource management.

Peach palm ( Bactris gasipaes Kunth) is cultivated for fruit and 'heart of palm', and is an important component of agroforestry systems in the Peruvian Amazon. In this study, AFLP was used to compare genetic diversity among domesticated populations along the Paranapura and Cuiparillo rivers, which are managed by indigenous and colonist farming communities, respectively. Gene diversity was 0.2629 for the populations in indigenous communities and 0.2534 in colonist communities. Genetic differentiation among populations ( G(st)) was 0.0377-0.0416 ( P<0.01) among populations along both rivers. There was no relation between genetic differentiation and the geographical location of populations along the rivers. Since natural seed dispersal by birds and rodents is thought to occur only across relatively short distances (100-200 m), it is likely that exchange of material by farmers and commercial traders is responsible for most of the 'long-distance' (over more than 20 km) gene flow among populations along the two rivers studied. This exchange of material may be important to counteract the effects of selection as well as genetic drift in small groups of trees in farmers' fields, much as in a metapopulation, and may account for the weak genetic differentiation between the two rivers ( G(st)=0.0249, P<0.01). A comparison with samples from other landraces in Peru and Brazil showed the existence of an isolation-by-distance structure up to 3,000 km, consistent with gene flow on a regional scale, likely mediated by trade in the Amazon Basin. Results are discussed with regard to practical implications for the management of genetic resources with farming communities.

Particle count and size alteration for membrane fouling reduction in non-conventional water filtration.

If coagulation is not completely successful and produces aggregates which are too small, fouling may increase. In some cases, a deep-bed filter could perhaps provide a solution. The paper examines these effects using experimental results for different waters. Activated sludge effluents, stormy seawater containing microalgae and spent filter backwash water (SFBW) were coagulated by alum or ferric chloride. Sand filtration tests were carried out. Tests were performed in a membrane filtration stirred cell, filtration pilot plant equipped with SDI analyzer (seawater) and pilot UF plant (SFBW). For activated sludge effluent, alum residual ratio curves of turbidity and total particle count (TPC) followed one another. With ferric chloride, low coagulant dosage showed negative turbidity removal. Contact granular filtration reduced membrane fouling intensity. Increasing the dose resulted in higher improvement in membrane flux. For seawater, a filter run period under storm conditions reached 35 hours with satisfactory filtrate quality. An iron chloride dose of 0.3 mg/l during normal conditions and 0.5 mg/l for stormy condition should be injected, mixed well before the filters, while maintaining 10 m/hr filtration rate and pH 6.8 value. For SFBW, alum flocculation pretreatment of SFBW was effective in reducing turbidity, TPC, viruses and protozoa. SFBW settling prior to flocculation did not enhance turbidity and TPC removal. The largest remaining particle fraction after alum flocculation was 3-10 microm in size, both Cryptosporidium and Giardia are found in this size range. Coagulation enhanced the removal of small size particles, a positive impact on reducing membrane fouling potential.

Climbing the ladder: a step by step approach to international guidelines for water recycling.

Given the pressures on the world's freshwater resources, recycled water is a valuable resource. Recycled water can increase the reliability of water supply because it is an independent source of water. Water recycling requires effective measures to protect public health and the environment. In the absence of comprehensive international guidelines, different countries have developed different approaches to managing water recycling depending on the understanding of the health risks, their individual economic circumstances, and affordability. Approaches vary between high technology/high cost/low risk and low technology/low cost/controlled risk. Furthermore, differences occur between countries and within individual countries. Inconsistencies can often be traced to lack of a unified scientific position on health effects. These inconsistencies increase public concerns about health risks and may give rise to conservative controls on responses to water recycling projects that some countries may be unable to afford. In this paper, an international panel of authors discusses how the different water recycling approaches might be linked together into international water recycling guidelines. These guidelines would incorporate a uniform approach to assessing hazards and risks while providing flexibility for individual countries to vary requirements to suit local circumstances of affordability and risk. The authors propose a framework of guidelines in which individual countries can progressively improve recycled water quality as lower risk levels become more affordable. The authors argue that a uniform international approach will result in a number of benefits including a better focus on risk management, better targeted research and development efforts and greater public confidence in water recycling. The authors invite discussion on the concepts put forward in the paper.