A Novel Plenoptic Camera-Based Measurement System for the Investigation into Flight and Combustion Behavior of Refuse-Derived Fuel Particles

In the past several decades, refuse-derived fuels (RDFs) have been widely applied in industrial combustion processes, for instance, in cement production. Since RDF is composed of various waste fractions with complex shapes, its flight and combustion behaviors can be relatively complicated. In this paper, we present a novel plenoptic camera-based spatial measurement system that uses image processing approaches to determine the dwell time, the space-sliced velocity in the depth direction, and the ignition time of various applied RDF fractions based on the obtained images. The image processing approach follows the concept of tracking-by-detection and includes a novel combined detection method, a 2.5D multiple particle tracking algorithm, and a postprocessing framework to tackle the issues in the initial tracking results. The thereby obtained complete spatial fuel trajectories enable the analysis of the flight behaviors elaborated in the paper. The acquired particles' properties (duration, velocity, and ignition time) reversely prove the availability and applicability of the developed measurement system. The adequacy and accuracy of the proposed novel measurement system are validated by the experiments of detecting and tracking burning and nonburning fuel particles in a rotary kiln. This new measurement system and the provided experimental results can benefit a better understanding of the RDF's combustion for future research.

The influence of obstructive sleep apnea and continuous positive airway pressure on the nasal microbiome

OBJECTIVE

The aim of this study was to investigate the influence of obstructive sleep apnea and continuous positive airway pressure on the nasal microbiome.

PATIENTS AND METHODS

Endonasal swabs from the olfactory groove of 22 patients with moderate and severe obstructive sleep apnea (OSA) and a control group of 17 healthy controls were obtained at the Department of Otorhinolaryngology of the Friedrich-Alexander-Universität Erlangen-Nürnberg. 16S rRNA gene sequencing was performed to further evaluate the endonasal microbiome. In a second step, the longitudinal influence of continuous positive airway pressure (CPAP) therapy on the nasal microbiome was investigated (3-6 and 6-9 months).

RESULTS

Analysis of the bacterial load and β-diversity showed no significant differences between the groups, although patients with severe OSA showed increased α-diversity compared to the control group, while those with moderate OSA showed decreased α-diversity. The evaluation of longitudinal changes in the nasal microbiota during CPAP treatment showed no significant difference in α- or β-diversity. However, the number of bacteria for which a significant difference between moderate and severe OSA was found in the linear discriminant analysis decreased during CPAP treatment.

CONCLUSIONS

Long-term CPAP treatment showed an alignment of the composition of the nasal microbiome in patients with moderate and severe OSA as well as an alignment of biodiversity with that of the healthy control group. This change in the composition of the microbiome could be both part of the therapeutic effect in CPAP therapy and a promoting factor of the adverse side effects of the therapy. Further studies are needed to investigate whether the endonasal microbiome is related to CPAP compliance and whether CPAP compliance can be positively influenced in the future by therapeutic modification of the microbiome.

Defining patients needs and expectations for eHealth-based cardiac rehabilitation in Germany and Spain: living lab data from the TIMELY study

Background

eHealth innovations have set the stage to optimize personalized care and provide assistance for disease control to patients with CAD. TIMELY is the first artificial intelligence (AI)-driven eHealth approach that employs internet of things devices and is based on cardiac rehabilitation (CR) components. To guarantee acceptance and usability of eHealth solutions, patients are actively participating in development through a Living Lab approach.

Purpose

To define patients' needs for an eHealth-based lifestyle intervention and self-care support.

Methods

The Living Lab approach included a guided survey conducted among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to current use of technology and patients' opinion on the usefulness of suggested features of a future eHealth application. Ratings for usefulness/importance were recorded on a 5-point Likert scale reported as median score.

Results

79 patients (20% female) were interviewed (DE, n=49; ES, n=30). Patients' mean age was 57 years (range 37–79), educational level was 87% ≤ high school and 13% > high school. All patients owned a smartphone that they also used for information (76%) and documentation (43%). Patients rated the importance of all CR components (regular exercise, healthy diet, stress management, smoking cessation, risk factor reduction) along the continuum of care as “very high” (5/5). Individual need for regular exercise support after structured CR was rated “high” (4/5). Exercise reminders, suggestions on activities, update of recommended training heart rate, evaluation of training progress, and achieved goals were rated “useful” (4/5) to “very useful” (5/5). The importance of support for diet, stress management, overall risk factor management, and medication was rated 3/5. Usefulness of a learning/education tool was rated 4/5, while motivational messages scored 3/5 and individual feedback of a person or virtual agent scored 4/5 and 3/5, respectively. The availability of electronic health records was evaluated as “very useful” (5/5) remote ECG monitoring and blood pressure management were rated as “useful” (4/5). The range of all items accessed was 1–5, indicating large interindividual differences. No significant differences existed between female and male patients or German and Spanish patients, though the importance of sharing training progress with family/ friends was rated higher by men (3/5) compared to women (1/5) and higher by Spanish (4/5) compared to German patients (2/5).

Conclusions

CR patients expressed a strong need for individual support of regular physical exercise and updated training recommendations. The observed inter-individual differences regarding usefulness and acceptance indicate the need for a highly adaptive system to prevent exclusion from eHealth access. CR patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Commission Horizon 2020

Participation of the intestinal microbiota in the mechanism of beneficial effect of treatment with synbiotic Syngut on experimental colitis under stress conditions

Gut-brain axis plays a central role in the regulation of stress related diseases such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). It is increasingly recognized that stress modulates gut microbiota community structure and activity and represents an important causal factor in dysbiosis. This study was designed to determine the effect of daily treatment with synbiotic (Syngut) containing inulin, Lactobacillus acidophilus, Bifidobacterium lactis W51, Lactobacillus plantarum W21 and Lactococcus lactis applied i.g. at a dose of 50 mg/kg i.g. on the colonic damage and colonic mucosal blood flow in rats with experimentally induced TNBS-colitis that were additionally exposed or not to acute stress (episodes of cold restraint stress every other day before colitis induction). Control rats received daily treatment with vehicle (saline, i.g.) or mesalazine (50 mg/kg-d i.g.), the standard drug recommended in therapy of IBD. At the termination of TNBS colitis, the histologic evaluation of colonic mucosa, mucosal malonyldialdehyde (MDA) level and plasma concentrations of proinflammatory cytokines (TNF-α, IL-1β) and adipokine adiponectin were assessed. the samples of colonic mucosa not involving colonic lesions and surrounding the flared mucosa were excised for the determination of mRNA expression for proinflammatory biomarkers TNF-α, IL-1β, IL-10 and COX-2 as well as antioxidazing factors SOD-1 and SOD-2. Finally, the gut microbial profiles were analyzed by 16S rRNA sequencing at phylum, family and genus level. Episodes of cold stress significantly aggravated the course of TNBS colitis, and significantly increased the release of proinflammatory cytokines as well as the significant increase in the MDA concentration has been observed as compared with non-stressed TNBS rats. These changes were followed by the significant fall in the CBF and plasma adiponectin levels and by the overexpression of mRNA of proinflammatory biomarkers. Synbiotic treatment with Syngut significantly reduced the area of colonic lesions observed macroscopically and microscopically in rats with TNBS colitis with or without exposure to cold stress, significantly increased the CBF, normalized plasma adiponectin levels and significantly attenuated the release and colonic expression of proinflammatory cytokines and biomarkers. the analysis of the gut microbiota showed a significant reduction of microbial diversity (Shannon index) in rats with TNBS colitis with or without exposure to stress. The therapy with Syngut failed to significantly affect the alpha diversity. At the phylum level, the significant rise in Proteobacteria has been observed in stressed rats with TNBS colitis and this effects was attenuated by treatment with Syngut. At family level, TNBS colitis alone or in combination with stress led to a significant decrease of SCFA producing bacterial taxa such as Ruminococaceae and Lachnospiraceae and Syngut counteracted this effect. We conclude that: 1) cold stress exacerbates the gastrointestinal inflammation in experimental colitis; 2) the synbiotic therapy with Syngut ameliorates the gut inflammation in rats with TNBS colitis combined with cold stress; 3) the beneficial effect of Syngut is accompanied by increase of anti-inflammatory taxa such as Ruminococaceae and Lachnospiraceae, and 4) the modulation of gut microbiota with Syngut alleviates stress-related intestinal inflammation suggesting a potential usefulness of synbiotic therapy in intestinal disorders accompanied by stress in patients with IBD.

[Emergency physician training-survey of course participants regarding training conditions and motivation]

INTRODUCTION

Qualification is the basis to prevent a shortage of emergency medicine service (EMS) physicians. To find out more about the motivation and training conditions young doctors attending EMS medicine courses were questioned.

MATERIALS AND METHODS

33 planned courses were identified and participants from 19 courses were asked to fill out the questionnaires. The questionnaires contained 22 questions on person, motivation, support by the employer and individual aims of course attendance.

RESULTS

2,050 questionnaires were distributed, 970 (47.3%) were returned. Participants were 31.8 ± 5.2 years old (mean) and attended the course after 3.7 ± 4.3 years of clinical experience. 907 were in specialist training (237 surgery, 320 internal medicine, 269 anaesthesia). 751 participants planned to work as emergency physician in the future (196 possibly), 213 in urgent care centres. For 309 participants attendance was an employer requirement. Attendance was on educational leave (489), paid leave (258), annual leave (112) or free time (85). The course was fully (493) or partially (177) paid by the employer. Accommodation was paid for by physicians (525) or employers (287). Practical training on the ambulance was planned in free time or during annual leave (582), on paid leave (204) or during regular shifts (119). 682 participants hoped to gain more safety with in-hospital emergencies, 560 planned shifts on the ambulance of the own hospital and 511 planned to work on a free-lance basis. 388 physicians planned to use the services of an agency for free-lance work.

CONCLUSION

While employers supported course attendance in more than 50%, the majority of the participants had to organise the practical training on the ambulance during free time. Only 58% planned to work on the ambulance as part of their regular job or 53% on a free-lance basis. Other participants attended in preparation for work in urgent-care or to gain competence in handling in-hospital emergencies.

Microbial patterns in patients with histamine intolerance

Histamine intolerance represents a controversially discussed disorder. Besides an impaired degradation of orally supplied histamine due to diamine oxidase (DAO) deficiency, a deranged gut flora may also contribute to elevated histamine levels. Our aim was to determine the intestinal bacterial composition in patients with proven histamine intolerance in comparison to other food intolerances and healthy controls. A total of 64 participants were included in the study, encompassing 8 patients with histamine intolerance (HIT), 25 with food hypersensitivity (FH), 21 with food allergy and 10 healthy controls (HC). All participants underwent blood testing for total and food-specific immunoglobulin E, plasma histamine and DAO serum activity. Stool samples were used to analyze stool histamine and zonulin levels and bacterial composition by 16s rRNA sequencing. No significant differences in stool histamine levels were observed, but HIT patients showed elevated levels of stool zonulin. Microbiota analysis revealed increased levels of Proteobacteria (5.4%) and a significantly reduced alpha-diversity in the HIT group (P = 0.019). On family level, HC showed a significantly higher abundance of Bifidobacteriaceae compared to other study groups (P = 0.005), with lowest levels in the HIT group (P = 0.036). Also significantly reduced abundances of the genera Butyricimonas (P = 0.026) and Hespellia (P = 0.025) were observed in the HIT patients, whereas Roseburia were significantly elevated (P = 0.021). We concluded that the altered occurrence of Proteobacteria and Bifidobacteriaceae, reduced alpha-diversity as well as elevated stool zonulin levels suggest a dysbiosis and intestinal barrier dysfunction in histamine intolerant patients, which in turn may play an important role in driving disease pathogenesis.

Constitutive and inducible in vivo protein-DNA interactions at the tumor necrosis factor-alpha promoter in primary human T lymphocytes

Tumor necrosis factor-alpha (TNF-alpha) is a key cytokine of lymphocytes with major regulatory functions in immunomodulation, chronic inflammation, and septic shock. However, only limited information on TNF promoter regulation in vivo in primary lymphocytes is available. To determine and compare protein-DNA interactions at the native TNF locus in primary lymphocytes, we analyzed the human TNF-alpha promoter by ligation-mediated polymerase chain reaction (LM-PCR) techniques. Accordingly, primary CD4+ T lymphocytes from peripheral blood were cultured in the presence of various stimuli and analyzed by LM-PCR. Inducible in vivo protein-DNA interactions at the TNF promoter were detected between -120 and -70 bp of the human TNF promoter relative to the transcriptional start site. This area includes binding sites for transcription factors such as ETS-1, NFAT, ATF-2/c-jun, SP-1/Egr-1, and NF-kappaB. In contrast, no protein-DNA interactions were observed at various binding sites with reported regulatory function in tumor cell lines such as the k2 element, the NFAT site at -160, the AP1 site at -50, and the SP1 site at -65. Additional mutagenesis and transfection studies demonstrated that NF-kappaB and CREB/AP-1 are important regulators of inducible TNF promoter activity in primary human T lymphocytes. These results provide novel insights into the complex regulation of TNF gene transcription in primary T lymphocytes in vivo by constitutive and inducible protein-DNA interactions that appear to be at least partially different compared to previously characterized tumor cell lines.

[Use of cognitive aids in pediatric emergency care : Interdisciplinary consensus statement]

Preclinical pediatric emergencies are rare events and are therefore often associated with stress and uncertainty for emergency medical service personnel. To ensure adequate treatment of pediatric patients a variety of different cognitive aids exist (e.g. books, apps, rulers, weight-adapted bag systems). Especially the size specifications of the medical equipment and the dosage of emergency medication are individually very different in children and are dependent on parameters, such as body height and weight. Therefore, cognitive aids often enable length measurement whereby it is possible to draw conclusions on body weight for calculating the child's medication dosage. These aids may help to avoid the wrong medication dose or the wrong therapy of children but uncritical and untrained usage of these aids carries a potential risk of mistakes. This recommendation gives an overview of the general requirements and different problems of cognitive aids and should help improve the general framework and the rational basis for the use and further development of cognitive aids in emergency medicine.

Successful therapy of Clostridium difficile infection with fecal microbiota transplantation

Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea and represents an important burden for healthcare worldwide. Symptoms of severe CDI include watery, foul-smelling diarrhea, peripheral leucocytosis, increased C-reactive protein (CRP), acute renal failure, hypotension and pseudomembranous colitis. Recent studies indicate that the main cause of CDI is dysbiosis, an imbalance in the normal gut microbiota. The restoration of a healthy gut microbiota composition via fecal microbiota transplantation (FMT) recently became more popular. The aim of the present study was to assess the effect of FMT on the healing of CDI and to analyze the changes in the level of pro-inflammatory markers (C-reactive protein, fecal calprotectin) and pro-inflammatory cytokines. Eighteen patients with CDI were included in our study (6 males and 12 females) with recurrent and/or severe CDI. The FMT was performed in 17 patients using colonoscopy, including 16 patients receiving a one-time FMT and 1 patient who needed 2 additional FMTs. One patient was treated with a single round of FMT using push-and-pull enteroscopy. In all CDI patients, before and 3 weeks after FMT, the following parameters were analyzed: C-reactive protein, fecal calprotectin, and plasma interleukin (IL)-6, IL-8 and IL-12, and tumor necrosis factor-alpha (TNF-α). In addition, the plasma level of LL-37, a cathelicidine peptide was assessed by fluorescence-activated cell sorting (FACS) before and 3 months after FMT. Finally, in 7 patients a microbiome analysis was performed by sequencing of 16SrRNA in stool probes obtained before and 3 weeks after FMT. The healing rate of CDI was 94%. In all successfully treated patients no recurrent CDI was observed during follow-up (16 months). The serum level of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8 and IL-12) significantly decreased after FMT. Similarly, CRP and fecal calprotectin normalized after FMT. 3 months after FMT a significant increase of LL-37 in the plasma of successfully treated patients was monitored. The sequencing analysis demonstrated an elevated abundance of beneficial bacterial species such as Lactobacillaceae, Ruminococcaceae, Desulfovibrionaceae, Sutterellaceae and Porphyromonodacea after FMT. No serious side effects were observed. We concluded that FMT represented a very effective and safe treatment of recurrent and/or severe CDI and led to favorable shifts in the composition of gut microbiome.

IL-27 suppresses type 2 immune responses in vivo via direct effects on group 2 innate lymphoid cells

Group 2 innate lymphoid cells (ILC2) were recently characterized by their ability to produce significant amounts of type-2 signature cytokines and drive central beneficial and pathological features of type-2 immune responses. Although factors such as IL-33 and IL-25 were shown to have ILC2 activating capacity, it is not well understood, how ILC2 responses are regulated in vivo. Here we provide compelling evidence that IL-27-signalling directly inhibits ILC2 responses and reveal a novel mechanism for negative regulation of the innate arm of type-2 immunity. We demonstrate that IL-27-deficiency is linked to increased mucosal presence of ILC2 in a model of inflammatory lung disease. Moreover, IL-27-treatment inhibited ILC2 proliferation and cytokine production and significantly reduced their accumulation in vivo. During helminth infection, regulation of ILC2 by IL-27 directly impacted anti-parasitic immunity. Thus, therapeutic modulation of the IL-27/IL-27R axis may be relevant in a number of inflammatory conditions associated with dysregulated type-2 responses.

Transient receptor potential melastatin 8 ion channel in macrophages modulates colitis through a balance-shift in TNF-alpha and interleukin-10 production

The transient receptor potential (TRP) ion channel family is well characterized in sensory neurons; however, little is known about its role in the immune system. Here we show that the cold-sensing TRPM8 has an unexpected role in innate immunity. TRPM8 expression and function in macrophages were demonstrated in vitro using molecular techniques and calcium imaging. In addition, adoptive macrophage transfer and systemic interleukin (IL)-10 overexpression were performed in experimental colitis. TRPM8 activation induced calcium-transients in murine peritoneal macrophages (PM) and bone marrow-derived macrophages of wild-type (WT) but not TRPM8-deficient mice. TRPM8-deficient PM exhibited defective phagocytosis and increased motility compared with those in WT, whereas the opposite effects of TRPM8 activation were induced in WT PM. TRPM8 activation or blockage/genetic deletion induced a anti- or pro-inflammatory macrophage cytokine profile, respectively. WT mice treated with repeated menthol (TRPM8 agonist) enemas were consistently protected from experimental colitis, whereas TRPM8-deficient mice showed increased colitis susceptibility. Adoptive transfer of TRPM8-deficient macrophages aggravated colitis, whereas systemic IL-10 overexpression rescued this phenotype. TRPM8 activation in peptidergic sensory neurons did not affect neuropeptide release from the inflamed colon. TRPM8 in macrophages determines pro- or anti-inflammatory actions by regulating tumor necrosis factor-α and interleukin-10 production. These findings suggest novel TRPM8-based options for immunomodulatory intervention.

[Mass maritime casualty incidents in German waters: structures and resources]

The Central Command for Maritime Emergencies was founded in Germany in 2003 triggered by the fire on board of the cargo ship "Pallas" in 1998. Its mission is to coordinate and direct measures at or above state level in maritime emergency situations in the North Sea and the Baltic Sea. A special task in this case is to provide firefighting and medical care. To face these challenges at sea emergency doctors and firemen have been specially trained. This form of organization provides a concept to counter mass casualty incidents and peril situations at sea. Since the foundation of the Central Command for Maritime Emergencies there have been 5 operations for firefighting units and 4 for medical response teams. Assignments and structure of the Central Command for Maritime Emergencies are unique in Europe.

Separation of harmful impurities from refuse derived fuels (RDF) by a fluidized bed

In firing systems of cement production plants and coal-fired power plants, regular fossil fuels are increasingly substituted by alternative fuels. Rising energy prices and ambitious CO2-reduction goals promote the use of alternative fuels as a significant contribution to efficient energy recovery. One possibility to protect energy resources are refuse-derived fuels (RDF), which are produced during the treatment of municipal solid, commercial and industrial waste. The waste fractions suitable for RDF have a high calorific value and are often not suitable for material recycling. With current treatment processes, RDF still contains components which impede the utilization in firing systems or limit the degree of substitution. The content of these undesired components may amount to 4 wt%. These, in most cases incombustible particles which consist of mineral, ceramic and metallic materials can cause damages in the conveying systems (e. g. rotary feeder) or result in contaminations of the products (e. g. cement, chalk). Up-to-date separation processes (sieve machine, magnet separator or air classifier) have individual weaknesses that could hamper a secure separation of these particles. This article describes a new technology for the separation of impurities from refuse derived fuels based on a rotating fluidized bed. In this concept a rotating motion of the particle bed is obtained by the tangential injection of the fluidization gas in a static geometry. The RDF-particles experience a centrifugal force which fluidized the bed radially. The technical principle allows tearing up of particle clusters to single particles. Radially inwards the vertical velocity is much lower thus particles of every description can fall down there. For the subsequent separation of the particles by form and density an additionally cone shaped plate was installed in the centre. Impurities have a higher density and a compact form compared to combustible particles and can be separated with a high efficiency. The new technology was experimentally investigated and proven using model-RDF, actual-RDF and impurities of different densities. In addition, numerical simulations were also done. The fluidization chamber was operated in batch mode. The article describes experiences and difficulties in using rotating fluidized bed systems.

[Relevance of parents as source for contamination of neonates with multiresistant Gram-negative pathogens (MRGN)]

BACKGROUND

There is an increase in nosocomial contamination and infection with multi-resistant bacteria among NICU patients. In 2011 we had to deal with an outbreak from multi-resistant Klebsiella pneumoniae in our NICU. Analysing the situation, we found 3 different clonal tribes. We presume that there are different sources for the contamination with multiresistant Gram-negative pathogens (MRGN) and we suspect that parents of NICU children may be of some importance. We studied in a one-year setting whether the incidence of nosocomial contaminations and infections may be prevented in a setting of barrier nursing and surveillance of the NICU patients and their parents. Our study was prospective and justified by a vote of support from the ethics committee of the 'Hamburger Ärztekammer' as well as additional funding from the Asklepios-Hamburg Pro-Research for the laboratory expenses.

MATERIAL AND METHODS

In a one-year study we undertook a programme of barrier nursing for all children admitted to our NICU with bacteriological surveillance on their entry into the NICU for children and their parents with anal and pharyngeal-nasal swabs. As long as there were no results, barrier-nursing for the children, their parents and staff was maintained. Where negative results were found, barrier-nursing was interrupted and children were nursed under normal hygienic conditions. Surveillance cultures from the children were taken once a week until being released. In cases of detection of MRGN bacteria, barrier-nursing was implemented together with room isolation.

RESULTS

We detected 23 families carrying MRGN bacteria pre-existent before hospitalisation. In cases of MRGN findings, barrier-nursing and room isolation were maintained. Under these circumstances, there were 6 cases of contamination of NICU children, 4 after vaginal delivery and secondary admittance in the NICU. The circumstances for the 2 others are discussed.

CONCLUSION

Parents are an important source for MRGN bacteria in the NICU. The early detection of those carriers is important for the avoidance of outbreaks in an NICU. In most cases, contamination and infection can be prevented.

Soil Erosion on Abandoned Land in Andalusia: A Comparison of Interrill- and Rill Erosion Rates

The present paper is based on several field investigations (monitoring soil and rill erosion by aerial photography, rainfall simulations with portable rainfall simulators, and manmade rill flooding) in southern Spain. Experiments lead now to a closer understanding of the dynamics and power of different soil erosion processes in a gully catchment area. The test site Freila (Andalusia, Spain) covers an area of 10.01 ha with a rill density of 169 m ha−1, corresponding to a total rill length of 1694 m. Assuming an average rill width of 0.15 m, the total rill surface can be calculated at 250 m2 (0.025 ha). Given that, the surface covered by rills makes up only 0.25% of the total test site. Since the rill network drains 1.98 ha, 20% of the total runoff comes from rills. The rills’ sediment erosion was measured and the total soil loss was then calculated for detachment rates between 1685 g m−2 and 3018 g m−2. The interrill areas (99.75% of the test site) show values between 29 and 143 g m−2. This suggests an important role of rill erosion concerning runoff and soil detachment.