Microbial conversion of organic residues into acid rich process liquids and their use in bio-electrochemical systems

In 2016, 2.01 billion tonnes of solid waste were generated worldwide. The volume of waste is expected to grow to 3.40 billion tonnes by 2050. Worldwide, most solid waste is disposed of in landfills or dumps. Due to improper treatment and disposal of solid waste, nearly 1.6 billion tonnes of CO2 equivalents of greenhouse gas emissions were generated worldwide in 2016. This amount is expected to rise to 2.6 billion tonnes of CO2 equivalents per year by 2050. It will therefore become increasingly important in the future not only to treat waste sustainably, but also to use it as an alternative to fossil fuels. Different waste-to-energy concepts are used, particularly for the treatment of OFMSW. As an alternative to the previously dominant biogas production, intensive research is currently being carried out into technologies for the recycling of organic residual materials, including so-called bio-electric systems (BES). In contrast to biogas production, this technology enables the treatment of a wide range of wastes to produce different end products, e.g. electrical energy, hydrogen or methane, can be preferred in BES depending on the selected process parameters. Despite numerous advances in research, considerable additional optimization is still required in order to be able to use the systems in large-scale power generation. In order to use solid organic waste in BES systems, fermentative digestion is required to convert the organic components into dissolved short-chain organic acids (Volatile Fatty Acids (VFA)) and alcohols. In the course of the investigations, the solid waste residues were first digested to acid-rich hydrolysate in a hydrolysis reactor at pH-values of 5.5 and 6.0. However, this hydrolysate also contains particles that are inert to a subsequent degradation step leading to technical process disturbances. These inert particles can be removed by means of a membrane filtration step; a particle-free permeate is produced, which can be fed to the BES reactors. Within the scope of the present work, the basics of the utilization of OFMSW via microbial digestion, membrane filtration and utilization in BES should be investigated. Lab-scale BES reactors were developed and batch tests were carried out. The vegetable waste residues from hydrolysis could be efficiently converted into hydrolysate. At a pH value of 6.0, higher organic acid concentrations were achieved than at pH 5.5. At pH 6.0, based on the added organic dry matter, these were approx. 350 g kg-1 (oDMadded) and at pH 5.5 approx. 215 g kg-1 oDMadded. Likewise, the concentration of chemical oxygen demand (COD) of the hydrolysate at pH 6.0 was 21.85 % higher than at pH 5.5. However, the COD degradation rates in the AF used were insufficient because the inert particles present in the hydrolysate could not be completely microbially degraded. The subsequent integration of ceramic cross-flow membrane filtration into the two-stage system produced a particle-free permeate and significantly the increased microbial degradability. Clear differences could be shown depending on the substrate used (plant waste and grass/maize silage). The filtration step resulted in a significant improvement of the specific methane yield of permeate by 40% (vegetable waste) and 24.5% (grass/maize silage) compared to hydrolysate; proof that inert particles were separated efficiently. Finally, the process liquids hydrolysate and permeate produced by the hydrolysis of maize silage and the subsequent membrane filtration were fed to the anode chamber of two mixed-culture BES reactors. The investigations showed that all organic acids in both process liquids could be completely degraded in the BES. The highest COD (87%) and TOC degradation rates (88%) were achieved with permeate. However, the hydrolysate with added acetic acid yielded the highest current density of 470 µA/cm². Increasing the pH-value of the process liquids from 5.75 to 6.8 also significantly improved the current production and degradation rates. In this batch studies, relatively low Coulomb efficiencies of less than 10% were achieved due to the use of a mixed cultures. The promising results show that at high pH-values (pH 6.0) in hydrolysis organic residues can be efficiently converted into a hydrolysate with high concentrations of organic acids and that the system can be further optimized by coupling membrane filtration. The utilization of the permeate in BES enables, a sustainable production of bioenergy and platform chemicals with permeate enables, depending on the BES reactor configuration. In summary, it was described for the first time that the combination of the fermentative biomass degradation process with filtration via ceramic membranes and the use of permeate in BES systems is possible.Im Jahr 2016 fielen weltweit 2,01 Milliarden Tonnen an festen Abfällen an. Es wird erwartet, dass das Abfallaufkommen bis 2050 auf 3,40 Milliarden Tonnen anwächst. Weltweit werden die festen Abfälle überwiegend über Deponien oder Müllhalden entsorgt. Aufgrund unsachgemäßer Behandlung und Entsorgung wurden weltweit in 2016 nahezu 1,6 Milliarden Tonnen CO2-Äquivalente an Treibhausgasemissionen verursacht, mit weiter steigender Tendenz. Die nachhaltige Verwertung der Abfälle und deren Nutzung zur Energiegewinnung wird in Zukunft weiter an Bedeutung gewinnen. Insbesondere zur Behandlung der organischen Bestandteile des Hausmülls (Organic Fraction of Municipal Solid Waste (OFMSW)) kommen unterschiedliche Waste-to-Energy-Konzepte zum Einsatz. Alternativ zur bisher dominierenden Biogasgewinnung wird derzeit intensiv an neuen Technologien geforscht, u.a. an sogenannten bio-elektrischen Systemen (BES). In BES interagieren exo-elektrogene Mikroorganismen, die als Biofilm auf Elektroden aufwachsen, mit diesen und ermöglichen die Konversion gelöster organischer Verbindungen zu unterschiedlichen Endprodukten, z.B. elektrische Energie, Wasserstoff oder Methan. Trotz zahlreicher Fortschritte in der Forschung besteht noch erheblicher zusätzlicher Optimierungsbedarf, um die Systeme im technischen Maßstab einsetzen zu können. Um feste organische Abfälle in BES-Systemen einsetzten zu können, bedarf es zunächst eines fermentativen Aufschlusses zur Überführung der organischen Bestandteile in gelöste kurzkettige organische Säuren (VFA) und Alkohole. Dieses Hydrolysat enthält jedoch auch Partikel, die gegen einen nachfolgenden Abbauschritt inert sind und zu technischen Prozessstörungen führen können. Diese inerten Partikel können mithilfe eines Membranfiltrationsschritts entfernt werden; es entsteht ein partikelfreies Permeat, welches den BES-Reaktoren zugeführt werden kann. Im Rahmen der vorliegenden Arbeit sollten die Grundlagen der Verwertung von OFMSW über mikrobiellen Aufschluss, Membranfiltration und Verwertung in BES untersucht werden. Dazu wurden BES-Reaktoren im Labormaßstab entwickelt und Batch-Tests durchgeführt. Die pflanzlichen Reststoffe konnten fermentativ effizient in Hydrolysat überführt werden. Bei einem pH-Wert von 6,0 wurde höhere organischen Säurekonzentrationen und -erträge erreicht als bei pH 5,5. Die gebildete Gesamtmasse der kurzkettigen organischen Säuren betrugen bei pH 6,0, bezogen auf die zugeführte organische Trockenmasse, ca. 350 g kg-1 (oDMadded) und bei pH 5,5 ca. 215 g kg-1 oDMadded. Ebenso war die Konzentration an Chemischem Sauerstoffbedarfs (CSB) des Hydrolysats bei pH 6,0 um 21,85 % höher als bei pH 5,5. Die CSB-Abbauraten im genutzten Festbettreaktor waren jedoch unzureichend, da die im Hydolysat enthaltenen inerten Partikel nicht vollständig mikrobiell abgebaut werden konnten. Durch die anschließende Integration einer keramischen Cross-Flow- Membranfiltration in das zweistufige System konnte ein partikelfreies Permeat erzeugt werden und die mikrobielle Abbaubarkeit erheblich gesteigert werden. Dabei konnten deutliche Unterschiede in Abhängigkeit des eingesetzten Substrats (Pflanzenabfälle und Gras-/Maissilage) aufgezeigt werden. Durch den Filtrationsschritt konnte eine signifikante Verbesserung der spezifischen Methanausbeute von Permeat um 40% (pflanzliche Abfälle) und 24,5% (Gras-/Maissilage) im Vergleich zu Hydrolysat erreicht werden; ein Beleg dafür, dass inerte Partikel effizient abgetrennt wurden. Schließlich wurden die aus Maissilage erzeugte Prozessflüssigkeit Hydrolysat und dass durch die Membranfiltration gewonnene Permeat der Anodenkammer zweier BES-Reaktoren, die mit einer Mischkultur angeimpft waren, zugeführt. Die Untersuchungen zeigten, dass alle organischen Säuren in beiden Prozessflüssigkeiten im BES vollständig abgebaut werden können. Die höchsten CSB- (87%) und TOC-Abbauraten (88%) wurden mit Permeat erreicht. Das Hydrolysat mit zugesetzter Essigsäure ergab hingegen die höchste Stromdichte von 470 µA/cm². Die Erhöhung des pH-Wertes der Prozessflüssigkeiten von 5,75 auf 6,8 verbesserte auch die Produktions- und Abbauraten deutlich. In diesen Batchstudien wurden aufgrund der Verwendung von Mischkulturen relativ niedrige Coulomb-Wirkungsgrade von weniger als 10% erreicht. Die vielversprechenden Ergebnisse zeigen, dass bei hohen pH-Werten von 6,0 in der Hydrolyse organische Reststoffe effizient in ein Hydrolysat mit hohen Konzentrationen an organischen Säuren überführt werden können und mit der Kopplung einer Membranfiltration das System weiter optimiert werden kann. Die Verwertung des Permeats in BES ermöglicht, je nach Konfiguration der Reaktoren, eine nachhaltige Erzeugung von Bioenergie- und Plattformchemikalien. Zusammenfassend wurde erstmalig beschrieben, dass die Kombination des fermentativen Biomasse-Abbauprozesses mit der Filtration über keramische Membranen und Nutzung des Permeats in BES-Systemen möglich ist

Development of a production chain from vegetable biowaste to platform chemicals

Abstract Background A future bioeconomy relies on the development of technologies to convert waste into valuable compounds. We present here an attempt to design a biotechnological cascade for the conversion of vegetable waste into acetoin and electrical energy. Results A vegetable waste dark fermentation effluent containing mainly acetate, butyrate and propionate was oxidized in a bioelectrochemical system. The achieved average current at a constant anode potential of 0 mV against standard hydrogen electrode was 177.5 ± 52.5 µA/cm2. During this step, acetate and butyrate were removed from the effluent while propionate was the major remaining component of the total organic carbon content comprising on average 75.6%. The key players with regard to carbon oxidation and electrode reduction were revealed using amplicon sequencing and metatranscriptomic analysis. Using nanofiltration, it was possible to concentrate the propionate in the effluent. The effluent was revealed to be a suitable medium for biotechnological production strains. As a proof of principle, the propionate in the effluent of the bioelectrochemical system was converted into the platform chemical acetoin with a carbon recovery of 86%. Conclusions To the best of our knowledge this is the first report on a full biotechnological production chain leading from vegetable waste to the production of a single valuable platform chemical that integrates carbon elimination steps leading to the production of the valuable side product electrical energy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Development of a production chain from vegetable biowaste to platform chemicals

Abstract Background A future bioeconomy relies on the development of technologies to convert waste into valuable compounds. We present here an attempt to design a biotechnological cascade for the conversion of vegetable waste into acetoin and electrical energy. Results A vegetable waste dark fermentation effluent containing mainly acetate, butyrate and propionate was oxidized in a bioelectrochemical system. The achieved average current at a constant anode potential of 0 mV against standard hydrogen electrode was 177.5 ± 52.5 µA/cm2. During this step, acetate and butyrate were removed from the effluent while propionate was the major remaining component of the total organic carbon content comprising on average 75.6%. The key players with regard to carbon oxidation and electrode reduction were revealed using amplicon sequencing and metatranscriptomic analysis. Using nanofiltration, it was possible to concentrate the propionate in the effluent. The effluent was revealed to be a suitable medium for biotechnological production strains. As a proof of principle, the propionate in the effluent of the bioelectrochemical system was converted into the platform chemical acetoin with a carbon recovery of 86%. Conclusions To the best of our knowledge this is the first report on a full biotechnological production chain leading from vegetable waste to the production of a single valuable platform chemical that integrates carbon elimination steps leading to the production of the valuable side product electrical energy

MOESM1 of Development of a production chain from vegetable biowaste to platform chemicals

Additional file 1: Table S1. Primer sequences and amplicon size for the 16S Illumina MiSeq

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally