In 2020, the European Union published ordinance EU 2020/741, establishing minimum requirements for water reuse in agriculture. The ordinance differentiates between several water quality classes. For the highest water quality class (Class A), the ordinance mandates analytical validation of the treatment performance of new water reuse treatment plants (WRTP) related to the removal of microbial indicators for viral, bacterial, and parasitic pathogens. While the ordinance clearly defines the numeric target values for the required log-reduction values (LRV), it provides limited to no guidance on the necessary sample sizes and statistical evaluation approaches. The main requirement is that at least 90 % of the validation samples should meet the requirements. However, the interpretation of this 90 % validation target can significantly impact the required sample size, efforts necessary, and the risk of misclassifying WRTPs in practice. The present study compares different statistical evaluation approaches that might be considered applicable for LRV validation monitoring. Special emphasis is placed on the use of tolerance intervals, which combine percentile estimations with sample size-based uncertainty and confidence regions. Tolerance interval-based approaches are compared with alternative methods, including a) a binomial evaluation and b) the calculation of empirical percentiles. The latter are already used in existing European and U.S. regulations for bathing water and irrigation water quality. Our study demonstrates that using tolerance intervals allows for the reliable validation of WRTPs that achieve high LRVs relative to regulatory targets with comparatively smaller sample sizes compared to the other two approaches, while reducing the risk of misclassification. Additionally, we show that simplified approaches, such as a "9 out of 10" approach, pose a substantial risk of misclassification and should not be applied. We illustrate the behavior of these different approaches through simulation experiments and application to real data collected in 2022 and 2023 at a large WRTP in Germany.
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http://dx.doi.org/10.1016/j.scitotenv.2025.178573 | DOI Listing |
J Ultrasound
January 2025
Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy.
Introduction: Post-stroke cognitive impairment (PSCI) and dementia affect short- and long-term outcome after stroke and can persist even after recover from a physical handicap. The process underlying PSCI is not yet fully understood. Transcranial Doppler ultrasound (TCD) is a feasible method to investigate cerebrovascular aging or dementia, through the pulsatility index (PI), the cerebrovascular reactivity (e.
View Article and Find Full Text PDFEndocrine
January 2025
Department of Endocrinology and Metabolic Diseases, Manisa Celal Bayar University Hospital, Manisa, Turkey.
Purpose: Our study evaluated skeletal muscle mass, function and quality among mild autonomous cortisol secretion (MACS) patients and non-functioning adrenal incidentaloma (NFAI) patients in comparison with the control group without adrenal mass.
Methods: 63 NFAI (49 female, 14 male) and 31 MACS (24 female, 7 male) patients were included in the study. As the control group, 44 patients (31 women, 13 men) who were known to have no radiological adrenal pathology on computed tomography or magnetic resonance imaging performed for other reasons were selected.
Radiol Med
January 2025
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Purpose: To develop an artificial intelligence (AI) algorithm for automated measurements of spinopelvic parameters on lateral radiographs and compare its performance to multiple experienced radiologists and surgeons.
Methods: On lateral full-spine radiographs of 295 consecutive patients, a two-staged region-based convolutional neural network (R-CNN) was trained to detect anatomical landmarks and calculate thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), and sagittal vertical axis (SVA). Performance was evaluated on 65 radiographs not used for training, which were measured independently by 6 readers (3 radiologists, 3 surgeons), and the median per measurement was set as the reference standard.
J Adolesc Health
January 2025
The National Alliance to Advance Adolescent Health/Got Transition, Washington, D.C.
Purpose: There is a paucity of evidence examining clinician experiences with structured health-care transition (HCT) programs. Among HCT Learning Collaborative participants, this study describes clinician experiences with implementation of a structured HCT process: Got Transition's 6 Core Elements.
Methods: Representative members from 6 health systems designed a survey to collect clinician feedback regarding HCT and demographic and practice information.
J Perianesth Nurs
January 2025
Medical Faculty, Department of Anesthesia and Reanimation, Giresun Üniversitesi, Giresun, Türkiye. Electronic address:
Purpose: The aim in the present study was to evaluate the effects of chewing postoperative xylitol gum on gastrointestinal functional recovery after laparoscopic cholecystectomy.
Design: A three-arm randomized controlled trial.
Methods: After a baseline assessment, participants were randomly assigned in three groups.
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