Diagnosing and characterizing the mechanisms of biological phosphorus removal at the Great Lakes Water Authority (GLWA) water resource recovery facility (WRRF).

Previous research has demonstrated that biological phosphorus removal (bio-P) occurs in the Great Lakes Water Authority (GLWA) water resource recovery facility (WRRF) high purity oxygen activated sludge (HPO-AS) process, suggesting that sludge fermentation in the secondary clarifier sludge blanket is key to bio-P occurrence. This study, combining batch reactor testing, the development of a process model for the HPO-AS process using Sumo21 (Dynamita), and the analysis of eight and a half years of plant operating data, showed that bio-P consistently occurs at the GLWA WRRF. This occurrence is attributed to the unique configuration of the HPO-AS process, which has a relatively large secondary clarifier compared to the bioreactor, and the characteristics of the influent wastewater, primarily particulate matter with limited concentrations of dissolved biodegradable organic matter. The volatile fatty acids (VFAs) needed for polyphosphate accumulating organisms (PAOs) growth are produced in the secondary clarifier sludge blanket, which provides more than four times the anaerobic biomass inventory compared to the anaerobic zones in the bioreactor, thus facilitating bio-P in the current system. Opportunities exist to further optimize the phosphorus removal performance of the HPO-AS process and reduce the amount of ferric chloride used. These findings may be of interest to researchers investigating biological phosphorus removal in similar systems. PRACTITIONER POINTS: Fermentation in the clarifier sludge blanket an essential component of bio-P process at this facility. Results suggest simple adjustments to the system could lead to further improvements in bio-P. It is possible to decrease the use of chemical phosphorus removal methods (i.e., ferric chloride) while simultaneously increasing bio-P. Determining the phosphorus mass balance from sludge streams provides insight into evaluating the effectiveness of the phosphorus recovery system.

Randomized Trial of a Mobile App Introduced During Well-Visits to Enhance Guidance for Reading With Young Children.

OBJECTIVE: To estimate feasibility, usability and efficacy of a mobile parenting app (Rx for Success; RxS) to enhance reading guidance provided to parents of young children during well-visits. METHODS: This trial was conducted at a clinic serving primarily families of Hispanic ethnicity and low-socioeconomic status (SES) where Reach Out and Read (ROR) is standard practice. It involved 252 parent-child dyads in 2 age groups (~6-months old, ~18-months old) randomized during well-visits to receive RxS or a children's book modeling alternatives to screen time (Control) by research coordinators. RxS involves videos, activities and "push" messages. Follow-up assessments were conducted approximately 6 months later, including impression and use, shared reading behaviors, child language and screen time. RESULTS: A total of 217 dyads completed both visits (110 RxS, 107 Control). Time to introduce RxS was under 3 minutes and 32% of parents experienced largely minor performance issues. Parent impression of RxS was favorable for both age groups at baseline and follow-up, though use was infrequent, attributable to a desire for more relevant and updated content. Significant findings favoring RxS included shared reading as a favorite activity, more frequent shared reading reported at 12 months and higher language scores at 24 months. Screen time was equivalent between cohorts, exceeding American Academy of Pediatrics guidelines. CONCLUSIONS: A mobile app introduced to parents of young children from low-SES backgrounds was feasible during well-visits, rated as helpful, and effective to enhance shared reading at younger and language at older ages. While a potentially impactful enhancement to ROR, features needing improvement were identified.

Five-Year Secular Trends and Predictors of Nonconsent to Receive Donor Milk in the Neonatal Intensive Care Unit.

OBJECTIVE: To identify independent maternal and infant factors associated with donor milk nonconsent and to examine secular trends in nonconsent rates. MATERIALS AND METHODS: Mothers of infants eligible to receive donor milk (≤32 weeks of gestation or ≤1,800 g) born between August 2010 and 2015 were included. Multivariable logistic regression modeled odds of nonconsent. RESULTS: Of the 486 mother/infant dyads from the first 5 years of the donor milk program, nonwhite race (adjusted odds ratio [aOR] 1.69; 95% confidence interval [CI] 1.04-2.76) and increasing gestational age (aOR 1.11; 95% CI 1.03-1.21) independently predicted nonconsent. Each year the program existed, there was a 48% reduction in odds of nonconsent (aOR 0.52; 95% CI 0.43-0.62). The most common reason given for nonconsent was "it's someone else's milk." CONCLUSION: Program duration was associated with reduced nonconsent rates and may reflect increased exposure to information and acceptance of donor milk use among neonatal intensive care unit staff and parents. Despite overall improvements in consent rates, race-specific disparities in rates of nonconsent for donor milk persisted after 5 years of this donor milk program. Further research is warranted to clarify the basis for race-based disparities in donor milk nonconsent rates, with the goal of designing interventions to reduce donor milk refusal among minority mothers.

Immunizations: vaccinations in general.

The childhood immunization schedule is complex and nuanced. Although serious adverse reactions to immunizations are uncommon, clinicians must be well-versed in these reactions as well as the contraindications and precautions to each vaccine. • Conjugate vaccine technology links polysaccharide antigens to carrier proteins, triggering T-cell-dependent immunity to polysaccharides, thereby strengthening immune memory. • On the basis of some research evidence and consensus, live vaccines are generally contraindicated in immunocompromised patients and in pregnancy. Most live vaccines can be administered to household contacts of immunocompromised patients. • On the basis of some research and consensus, modified administration of meningococcal, pneumococcal, and less commonly, other vaccines may be indicated to protect immunocompromised patients. • On the basis of disease epidemiology and consensus, international travelers should be up-to-date with all routine immunizations; depending on destination, additional vaccines or immune globulin may be required.