Efficiency of blue-green stormwater retrofits for flood mitigation - Conclusions drawn from a case study in Malmö, Sweden.

Coupled one-dimensional (1D) sewer and two-dimensional (2D) overland flow hydrodynamic models were constructed to evaluate the flood mitigation efficiency of a renowned blue-green stormwater retrofit, i.e. Augustenborg, in Malmö, Sweden. Simulation results showed that the blue-green stormwater systems were effective in controlling local surface flooding in inner-city catchments, having reduced the total flooded surfaces by about 70%. However, basement flooding could still be a potential problem depending on the magnitude of the inflows through combined sewer from upstream areas. Moreover, interactions between blue-green retrofits and the surrounding pipe-system were studied. It was observed that the blue-green retrofits reduced the peak flows by approximately 80% and levelled out the runoff. This is a substantial advantage for downstream pipe-bound catchments, as they do not receive a cloudburst-equivalent runoff from the retrofitted catchment, but a reduced flow corresponding to a much milder rainfall. Blue-green retrofits are more effective if primarily implemented in the upstream areas of a pipe-bound catchment since the resulting reduced runoff and levelled out discharge would benefit the entire network lying downstream. Implementing blue-green retrofits from upstream towards downstream can be considered as a sustainable approach.

Fat intake and breast milk fatty acid composition in farming and nonfarming women and allergy development in the offspring.

BACKGROUND: Children growing up on small family farms are at much lower risk of developing allergy than other children. We hypothesized that low intake of margarine and polyunsaturated fats among farming families could contribute to this protection. METHODS: Twenty-eight mother-infant pairs living on small dairy farms and 37 nonfarm rural resident pairs were recruited in the FARMFLORA birth cohort. Food items expected to affect dietary fat composition were recorded by food frequency questionnaires during pregnancy and by 24-h recalls followed by 24-h food diaries during lactation. Allergy was diagnosed by doctors, using strict predefined criteria. Maternal diet and breast milk fat composition were compared between farming and nonfarming mothers and related to children's allergy at age 3 y. RESULTS: Farming mothers consumed more butter, whole milk, saturated fat, and total fat than nonfarming mothers, who consumed more margarine, oils, and low-fat milk. Farming mothers' breast milk contained higher proportions of saturated and lower proportions of polyunsaturated fat. Allergy was eight times more common in nonfarm children. Mothers of allergic children consumed more margarine and oils than mothers of nonallergic children. CONCLUSION: Low maternal consumption of margarine and vegetable oils might contribute to the allergy-preventive effect of growing up on small dairy farms.

Serum fatty acids in infants, reflecting family fish consumption, were inversely associated with allergy development but not related to farm residence.

AIM: In this study, differences in serum fatty acid patterns between farm and nonfarm infants were investigated and related to subsequent allergy development. We also related allergy-related serum fatty acids to maternal diet and breast milk fatty acids. METHODS: The FARMFLORA birth cohort included 28 farm and 37 nonfarm infants. Serum was obtained from 21 farm infants and 29 controls at four months post-partum and analysed for phospholipid fatty acids. Allergy was diagnosed by paediatricians at three years of age. RESULTS: Serum fatty acid patterns were similar in farm and control infants, although farm infants had lower 18:1 omega-7 proportions. Serum proportions of eicosapentaenoic acid (EPA) were unrelated to farming status, but lower in children who subsequently developed allergy, with an odds ratio of 0.47 and 95% confidence interval of 0.27-0.83 (p = 0.01) for every 0.1% EPA increase. The infants' serum EPA proportions correlated with breast milk EPA proportions, which, in turn, correlated with maternal oily fish intake during lactation. CONCLUSION: The allergy-protective effect of farming was not linked to infant serum fatty acid composition. However, healthy infants had higher proportions of EPA in their sera, probably reflecting a family diet rich in fish, compared to subsequently allergic children.

No association between allergy and current 25-hydroxy vitamin D in serum or vitamin D intake.

AIM: Vitamin D may be involved in allergy development, but there is conflicting evidence. We investigated if dietary intake of vitamin D and levels of 25OHD in serum differed between allergic and nonallergic adolescents and if serum 25OHD correlated with dietary intake of vitamin D or season of blood sampling. METHODS: Serum 25-hydroxy vitamin D (25OHD) levels were analysed in 13-year-old subjects with atopic eczema (n = 55), respiratory allergy (n = 55) or no allergy (n = 55). Intake of fat-containing foods was assessed by food-frequency questionnaires, and total daily vitamin D intake was calculated. Logistic regression was used to adjust for gender, parental allergy and time of blood sampling. RESULTS: Subjects with atopic eczema or respiratory allergy did not differ from nonallergic controls regarding serum 25OHD levels or calculated vitamin D intake. Subjects sampled in the autumn had significantly higher levels of serum 25OHD than subjects sampled in the winter or spring. Serum 25OHD levels correlated to consumption of vitamin D-fortified lean milk (p = 0.001). CONCLUSION: The findings suggest no association between allergy and 25OHD levels in serum or vitamin D intake in adolescents. Serum 25OHD levels correlated to intake of vitamin D-fortified lean milk.

Serum fatty acid profile does not reflect seafood intake in adolescents with atopic eczema.

AIM: Long-chain polyunsaturated fatty acids (LCPUFAs) are immunomodulatory, but their role in allergy development is controversial. We investigated whether proportions of LCPUFAs in serum phospholipids were related to allergic diagnosis, seafood intake and LCPUFA proportions in cord blood. METHODS: Serum was obtained from 148 birth cohort children at 13 years of age. Forty had atopic eczema, 53 had respiratory allergy, and 55 were nonallergic. Proportions of LCPUFAs were determined in serum phospholipids; cord blood from 128 of the individuals was previously analysed. Seafood intake was estimated using questionnaires. RESULTS: Allergic and nonallergic individuals did not differ significantly regarding individual LCPUFAs. However, arachidonic acid over docosahexaenoic acid (DHA) ratio was higher in allergic, compared with nonallergic, adolescents. In nonallergic individuals, LCPUFA proportions in cord serum and adolescent serum correlated weakly. In individuals with atopic eczema and respiratory allergy, these correlations were weak or absent. A moderate correlation between seafood intake and serum DHA was seen in nonallergic individuals and those with respiratory allergy, but not in those with atopic eczema. CONCLUSION: Serum LCPUFA pattern was similar in allergic and nonallergic adolescents. Fatty acid metabolism may be altered in atopic eczema subjects, suggested by poor correlations between fatty acid intake and serum levels.

Organic removal activity in biofilm and suspended biomass fractions of MBBR systems.

The moving bed biofilm reactor (MBBR) wastewater treatment process is usually designed based on the assumption that all activity in the process occurs in the biofilm on the MBBR carriers, although there is always some active biomass in the bulk liquid due to biofilm sloughing and, sometimes, free-growing bacteria. In this study the removal of organic matter is evaluated in laboratory-scale MBBR reactors under varying load, hydraulic retention time (HRT), oxygen concentration and volumetric filling degree of carriers in order to determine the heterotrophic activity in the different fractions of the MBBR biomass. The results showed that the heterotrophic conversions in an MBBR can show the same type of diffusion limited dependency on oxygen as nitrification, even for easily degradable substrates such as acetate. The contribution to the removal from the suspended biomass is shown to vary depending on HRT, as the amount of suspended solids changes. The developed method in this report is a useful tool for determining heterotrophic activity in the separate fractions of biomass in MBBRs.

Determining short chain fatty acids in sewage sludge hydrolysate: a comparison of three analytical methods and investigation of sample storage effects.

In anaerobic digestion, the production of short-chain fatty acids (SCFAs) can be beneficial or harmful to the overall process, depending on the concentration of accumulated acids. Therefore, the accurate determination of the SCFA concentration in both fresh and stored sludge hydrolysates is important. To select a suitable method for monitoring SCFAs during the anaerobic digestion of sewage sludge, the accuracy of three available analytical methods, including 5 pH point acid titration (TITRA5), gas chromatography (GC), and spectrophotometry, were compared in the present study. The results revealed that TITRA5 and GC displayed better agreement in the achieved measurements and higher precision and accuracy than the spectrophotometric assay, as supported by the application of different statistical models. TITRA5 excelled in titrating unfiltered hydrolysate while simultaneously measuring the alkalinity, whereas the GC method provided detailed information on the contribution of different fatty acids to the total acidity. In contrast, the spectrophotometric assay suffered from many forms of interference, depending on the sample's matrix. SCFA production followed the pattern of enzymatic reactions and fitted the Michaelis-Menten model. In addition to promoting TITRA5 as an accurate and robust analytical tool for routine SCFA analyses, this comparative study also demonstrated the possibility of storing hydrolysate samples at different temperatures and durations without altering the SCFA measurements.

Adolescents' attitudes, preferences and perceived behaviours regarding healthy eating and whole grains from a gender and health interest perspective.

Background: A healthy diet is important not only for the growth and development of the human body but also for the prevention of chronic diseases. However, most Swedish adolescents do not follow dietary recommendations, especially the intake of whole grain is very low. To create targeted conditions for healthy food choices amongst adolescents, comprehensive knowledge of factors related to adolescents' unhealthy and healthy eating is needed. Objective: To investigate adolescents' attitudes, preferences and perceived behaviours regarding healthy eating, with a specific focus on whole grains and to evaluate differences between genders and between adolescents with higher versus lower health interest. Design: A total of 1,178 Swedish adolescents responded to a questionnaire about their attitudes, preferences and perceived behabviours towards healthy eating and whole grains, and their general interest in nutrition and health. Results of girls and boys were compared, as well as adolescents with a higher versus lower health interest. Results: Displays information about healthy eating among adolescents and a comprehensive set of factors that may affect their ability to eat healthier. Overall, adolescents had a positive attitude towards food and health, but less than half felt that they managed to eat healthy. The consumption of different whole grain products was low, although the willingness to eat healthier and more whole grain was high. The most reported barrier to healthy eating, as well as increasing whole grain intake, was the unavailability of tasty healthy products, taste being even more important for adolescents with a low health interest than those with a high interest. Whole grain consumption and factors increasing the willingness of whole grain consumption were most prominent not only in adolescents with high health interest but also in girls compared with boys. Conclusion: The results show good potential to improve dietary habits amongst adolescents. Taste and availability of healthy products were rated the most important, whilst knowledge about the products' healthiness was rated the least important, especially amongst those with low health interest. By focusing on the attitudes and preferences of adolescents, the effectiveness may increase of initiatives to improve their dietary habits.

Reliability and validity testing of team emergency assessment measure in a distributed team context.

Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74-0.92 on the TEAM instrument's three domains of leadership, teamwork, and task management. Internal consistency (Cronbach's alpha) ranged between 0.89-0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams' overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.

Pain associated with the chronic pelvic pain syndrome is strongly related to the ambient temperature.

OBJECTIVE: There are indications suggesting that the pain associated with the chronic pelvic pain syndrome (CPPS) may be related to cold. The purpose of the present study was to evaluate how the symptom intensity reported by the patient relates to the time of the year in a temperate climate, i.e. to the ambient temperature and to weather changes. MATERIAL AND METHODS: Thirty-one patients, mean age 51 years (range 35-66 years), with CPPS for 17 ± 10 years (3-42 years) were asked to complete a set of questionnaires including questions concerning how they experienced their symptom intensity during the different seasons using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire. RESULTS: The total NIH-CPSI score was 22.2 ± 8.2. There was a highly marked relationship between season and pain intensity as reported by the informants: it was experienced to be three times more intense during the winter months. All subjects reported that a temperature drop was associated with deterioration. CONCLUSION: The strong relationship between the ambient temperature, a drop in temperature and the pain experienced by men with CPPS confirms the association between cold and symptom intensity in the Scandinavian countries, where the seasonal temperature variation spans a long range and the winters are long. The cause of this relationship is still to be established. Muscular spasm/stiffness is a possibility that remains to be explored.

Full-scale in-line hydrolysis and simulation for potential energy and resource savings in activated sludge--a case study.

The potential effects of altering primary settlers during biological in-line hydrolysis and converting a nitrifying activated sludge process into a partial pre-denitrification process for the purpose of resource conservation were evaluated. A full-scale primary sludge hydrolysis experiment was performed at a wastewater treatment plant and implemented in a dynamic modelling tool based on ASM2d. The full-scale hydrolysis experiment achieved a volatile fatty acid (VFA) production of 43 g COD(HAc) x m(-3) with no release of ammonium. Additional nitrogen removal of 44 t N x a(-1) was simulated, and the produced hydrolysate was able to replace 50% of the annual ethanol usage. Furthermore, 196 MWh of electricity per annum could be saved through the reduction of ethanol production and the optimization of the operation strategy of the activated sludge tank by operating a different number of anoxic zones.

The Effect of Rye-Based Foods on Postprandial Plasma Insulin Concentration: The Rye Factor.

Consumption of whole grain has been associated with lower incidence of type-2 diabetes, cardiovascular disease and their risk factors including improved glycemic control. In comparison with other whole grain products, rye bread has been shown to induce lower insulin response in the postprandial phase, without affecting the glucose response. This phenomenon has been referred to as the "rye factor" and is being explored in this review where we summarize the findings from meal and extended meal studies including rye-based foods. Overall, results from intervention studies showed that rye-based foods vs. (wheat) control foods had positive effect on both insulin and glucose responses in the postprandial phase, rather than on insulin alone. Mechanistic studies have shown that the rye factor phenomenon might be due to slowing of the glucose uptake in the intestine. However, this has also been shown for wheat-based bread and is likely an effect of structural properties of the investigated foods rather than the rye per se. More carefully controlled studies where standardized structural properties of different cereals are linked to the postprandial response are needed to further elucidate the underlying mechanisms and determinants for the effect of specific cereals and product traits on postprandial glycemic control.

Urine cultures from indwelling bladder catheters in nursing home patients: a point prevalence study in a Swedish county.

OBJECTIVES: To survey the bacterial flora and antibiotic resistance in urinary strains from patients with indwelling bladder catheters residing in nursing homes within a geographically defined region. MATERIAL AND METHODS: Urine was sampled for culture from 163 catheter patients (126 men and 37 women) during a 2 week period in March 2010. Susceptibility testing of the isolated bacteria was compared with all urinary strains (n = 9994) from hospitals and primary healthcare in the same geographical area cultured during the first 6 months of 2010 (control group). RESULTS: Bacteriuria was found in 159 of 163 urine samples (98%). Enterococcus faecalis and Escherichia coli were the most common species, one or both being detected in 72% of the urine samples, while Proteus species were found in10% and a single isolate of Providentia species was seen.Strains in the study patients were more resistant to antibiotics than in the control group. Particularly large differences were noted for ciprofloxacinin in E. coli (16.9% vs 7.9%) and for trimethoprim-sulfamethoxazole in E. faecalis (39.1% vs 24.8%). One extended spectrum ß-lactamase (ESBL)-producing E. coli was cultured (1.3%), compared with 1.6% in the control group. No vancomycin-resistant enterococci (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) were detected. CONCLUSIONS: Proteus mirabilis and Providentia species were rarely isolated, in sharp contrast to previous studies from geriatric hospital wards where they have often been in the majority. The limited incidence of ESBL and the absence of VRE and MRSA is gratifying, but the high resistance to antibiotics needs to be assessed on a continuous basis.

A prospective registration of catheter life and catheter interventions in patients with long-term indwelling urinary catheters.

OBJECTIVE: The aims of this study were to register the incidence of scheduled and acute urinary catheter changes and rinses (acute interventions) among nursing home patients, to relate the incidence of acute interventions to catheter material and time of catheterization, and to register the use of antibiotics for catheter-associated urinary tract infections. MATERIAL AND METHODS: Catheter life and catheter-related interventions were followed prospectively for 1 year in all patients with long-term indwelling catheters in all 78 nursing homes in a county in western Sweden. RESULTS: Altogether, 366 patients were followed: 117 (32%) women and 249 (68%) men. Acute changes (n = 718) were more common than scheduled ones (n = 519). The rate of acute interventions was not related to catheter material and was significantly lower in patients with a catheter for over 2 years. In 25% of the patients, acute interventions were virtually never necessary, in contrast to 10% where acute interventions were registered nearly every month. Antibiotic treatment for reasons assumed to be related to the urinary tract was instituted on 170 occasions among 85 men (34%) and 20 women (17%), a significant difference between the genders (p < 0.01). CONCLUSIONS; No catheter material appeared to be superior. The surprising finding that acute interventions were less common after 2 years' catheterization needs further study to be verified and explained. Only 10-25% had a more frequent need for acute interventions and are candidates for future interventional studies.

Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario.

INTRODUCTION: Healthcare teams and their performance in a complex environment such as that of intensive care units (ICUs) are influenced by several factors. This study investigates the relationship between team background characteristics and team as well as task performance. METHODS: This study included 105 professionals (26 teams), working at the ICUs of 2 hospitals in Northern Sweden. The team-based simulation training sessions were video recorded, and thereafter, team performance and task performance were analyzed based on ratings of the TEAM instrument and the ABCDE checklist. RESULTS: The final analyses showed that a higher age was significantly associated with better total team performance (ß = 0.35, P = 0.04), teamwork (ß = 0.04, P = 0.04), and task management (ß = 0.04, P = 0.05) and with a higher overall rating for global team performance (ß = 0.09, P = 0.02). The same pattern was found for the association between age and task performance (ß = 0.02, P = 0.04). In addition, prior team training without video-facilitated reflection was significantly associated with better task performance (ß = 0.35, P = 0.04). On the other hand, prior team training in communication was significantly associated with worse (ß = -1.30, P = 0.02) leadership performance. CONCLUSIONS: This study reveals that a higher age is important for better team performance when caring for a severely ill patient in a simulation setting in the ICU. In addition, prior team training had a positive impact on task performance. Therefore, on a team level, this study indicates that age and, to some extent, prior team training without video-facilitated reflection have an impact on team performance in the care of critically ill patients.

Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams.

BACKGROUND: When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes. METHOD: Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2. RESULTS: Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist. CONCLUSIONS: This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs. TRIAL REGISTRATION: This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.

Urine bladder catheters in nursing home patients: a one-day point prevalence study in a Swedish county.

OBJECTIVE: The aim of this study was to register the use of long-term indwelling catheters in nursing homes in a defined geographical region, and present the indications for and duration of catheterization, catheter material and size, the time between the regular catheter changes and the number of patients with regular catheter rinses. MATERIAL AND METHODS: On 16 February 2009, the 78 nursing homes in a county in western Sweden with 260 000 inhabitants reported the required information to the study centre. RESULTS: Of the 2625 nursing home patients (1781 women and 844 men), 50 (3%) of the women (mean age 88 years) and 135 (16%) of the men (mean age 85 years) had indwelling catheters. Urine retention and high residual urine were the most common indications (79%). Incontinence (6%) was rarely the reason. The men had been catheterized much longer (mean ± SD 32 ± 29 months) than the women (20 ± 19 months). Regular bladder catheter rinses were used in 51 patients (28%). CONCLUSION: Seven per cent of nursing home patients in the region had an indwelling catheter, the men five times more often than the women. The main indication for both genders was insufficient bladder emptying, and rarely incontinence. The men had been catheterized for much longer periods than the women and more often arrived at the nursing home with a long-term indwelling catheter.

Side-stream products of malting: a neglected source of phytochemicals.

Whole grain consumption reduces the risk of several chronic diseases. A major contributor to the effect is the synergistic and additive effect of phytochemicals. Malting is an important technological method to process whole grains; the main product, malted grain, is used mainly for brewing, but the process also yields high amounts of side-stream products, such as rootlet. In this study, we comprehensively determined the phytochemical profile of barley, oats, rye, and wheat in different stages of malting and the subsequent extraction phases to assess the potential of malted products and side-streams as a dietary source of bioactive compounds. Utilizing semi-quantitative LC-MS metabolomics, we annotated 285 phytochemicals from the samples, belonging to more than 13 chemical classes. Malting significantly altered the levels of the compounds, many of which were highly increased in the rootlet. Whole grain cereals and the malting products were found to be a diverse and rich source of phytochemicals, highlighting the value of these whole foods as a staple. The characterization of phytochemicals from the 24 different sample types revealed previously unknown existence of some of the compound classes in certain species. The rootlet deserves more attention in human nutrition, rather than its current use mainly as feed, to benefit from its high content of bioactive components.

Fecal short chain fatty acids in children living on farms and a link between valeric acid and protection from eczema.

Children growing up on farms have low rates of allergy, but the mechanism for this protective effect has not been fully elucidated. Short chain fatty acids (SCFAs) produced by the gut microbiota may play a role in protection from allergy. We measured fecal SCFA levels in samples collected from 28 farming and 37 control children over the first 3 years of life using gas chromatography. Data on diet and other host factors were recorded and allergy was diagnosed at 8 years of age. Among all children, median propionic and butyric acid concentration increased over the first 3 years, and longer SCFAs typically appeared by 1 year of age. Farm children had higher levels of iso-butyric, iso-valeric and valeric acid at 3 years of age than rural controls. In addition, children with elder siblings had higher levels of valeric acid at 3 years of age, and dietary factors also affected SCFA pattern. High levels of valeric acid at 3 years of age were associated with low rate of eczema at 8 years of age. The fecal SCFA pattern in farm children suggests a more rapid maturation of the gut microbiota. Valeric acid or associated microbes may have protective potential against eczema.