Multi-year diagnosis of unpredictable fouling occurrences in a full-scale membrane bioreactor

The membrane bioreactor (MBR) at the Traverse City Regional Wastewater Treatment Plant has experienced sudden and unpredictable periods of substantial permeability decline since 2011. Early observations detected irregularly-shaped gram-positive bacteria that correlated with plant upsets. Use of biomolecular techniques, such as DNA sequencing of laboratory isolates and the mixed liquor microbial community, and fluorescent in situ hybridization, identified the dispersed organisms as members of the genus Staphylococcus. However, Staphylococcus species were consistently present during normal operation and therefore were more likely to be an indicator of the upset, not the cause. The results suggest that these microorganisms are responding to specific influent wastewater constituents. We chemically analysed seven mixed liquor samples from periods of permeability decline in 2017 and 2018, and four samples from a period of normal operation. During upset conditions, the total carbohydrate content exceeded that of normal operation by 40%. Additionally, mixed liquor calcium concentrations were 65% above normal during the upset in 2017. It is hypothesized and supported through multivariate statistical analysis and estimation of specific resistance to filtration values that a calcium-intermediated polymer bridging mechanism with extracellular polymeric substance constituents is a major contributor to fouling and permeability disruptions in the Traverse City MBR.

Tele Hematology/Hemostasis Clinics: Delivering Hematology/Oncology and Hemophilia Comprehensive Services To Remote Pediatric Patients In Michigan

Introduction Telemedicine is the delivery of health services to patients through interactive video and /or audio who otherwise have difficulty in accessing services. Often these patients reside in remote areas and distance and cost of travel to access specialty services are limited. In addition, inclement weather often results in cancellation of these clinics. Beside diagnostic and comprehensive clinical services, teleclinics could also offer access to clinical trials for children in remote areas. Methods Records of patient visits seen at Marquette General Hospital (MGH) in the Michigan Upper Peninsula MI UP) and Traverse City (TC) by Michigan State University (MSU) pediatric hematologists. The types of patients and distance traveled by patients, satisfaction survey by patients regarding their telemedicine visit versus field clinic were recorded. Personnel, equipment type and cost as well as the cost savings of travel will be discussed. Results Since 1994, MSU hematologists have been conducting field clinics at MGH for pediatric hematology oncology services. Field clinics in TC were conducted in the 1990s but were then discontinued. The need for telehematology services arose because of distance, inclement weather and cost of travel. Since 2011, using real time telemedicine, 26 patients, ages 2- 24 years with various hematologic/hemostatic and oncologic diseases were seen at MGH. At Traverse City, primarily, patients with various bleeding disorders such as hemophilia, von Willebrand Disease, FVII deficiency and platelet function disorders were seen via telemedicine and included 11 patients, ages newborn – 23 years. Besides physicians, physician assistants, nurse practitioner, social worker, nurse, clinic staff and participated in the delivery of services such as consultations, treatment planning, disease monitoring and education. For those patients eligible for clinical trials, consent was obtained via telemedicine visit. Besides savings in costs of travel, there was considerable time savings for the health team, patients and their families. Conclusion Telehematology and hemostasis clinics allow comprehensive specialty services to be delivered in a cost effective manner to remote patients. Future research in telehematology is needed to measure improvement in health outcomes, including quality of life, access to state of the art and preventive therapies, and participation in disease surveillance and clinical trials. Disclosures: No relevant conflicts of interest to declare.