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We investigated a large-scale energy storage system based on reversible solid oxide cells, for a future Dutch electrical grid powered entirely by intermittent renewables. Three fuels — hydrogen, ammonia and methane — were investigated for such a system, to find the most suitable one in terms of minimizing the required fuel storage and renewable power generation capacity. The required sizes of fuel storage and power generation using each fuel were estimated using process models of rSOC systems, and a mathematical model of a storage-supported power grid. The results show that the use of hydrogen would lead to the smallest power generation requirement. It is found that the potential storage capacity in the Netherlands exceeds the requirement for storing any fuel, while the renewable power capacity planned for 2030 is insufficient to meet the demand. Under these conditions and assumptions, we find hydrogen to be the appropriate fuel for the Netherlands.

An increasing demand in the marine industry to reduce emissions led to investigations into more efficient power conversion using fuels with sustainable production pathways. Solid Oxide Fuel Cells (SOFCs) are under consideration for long-range shipping, because of its high efficiency, low pollutant emissions, and fuel flexibility. SOFC systems also have great potential to cater for the heat demand in ships, but the heat integration is not often considered when assessing its feasibility. This study evaluates the electrical and heat efficiency of a 100 kW SOFC system for marine applications fuelled with methane, methanol, diesel, ammonia, or hydrogen. In addition, cathode off-gas recirculation (COGR) is investigated to tackle low oxygen utilisation and thus improve heat regeneration. The software Cycle Tempo is used to simulate the power plant, which uses a 1D model for the SOFCs. At nominal conditions, the highest net electrical efficiency (LHV) was found for methane (58.1%), followed by diesel (57.6%), and ammonia (55.1%). The highest heat efficiency was found for ammonia (27.4%), followed by hydrogen (25.6%). COGR resulted in similar electrical efficiencies, but increased the heat efficiency by 11.9% to 105.0% for the different fuels. The model was verified with a sensitivity analysis and validated by comparison with similar studies. It is concluded that COGR is a promising method to increase the heat efficiency of marine SOFC systems.

Isolated tricuspid regurgitation is an egregious finding in patients with valvular disease( Rana and et al., 1 Feb. 2019) .11 Severe tricuspid regurgitation has been associated with hepatic congestion and can progress to hepatic cirrhosis( Rana and et al., 1 Feb. 2019; Fender et al., 2018) .1,21,2 However, isolated tricuspid valve surgery is done occasionally and is associated with the highest mortality among all valve interventions( Baumgartner et al., 2017) .33 Options for percutaneous interventions are still at an nascent/investigational stage. We report one such successful tricuspid valve intervention..

BackgroundSystematic studies to estimate the disease burden of typhoid and paratyphoid in India are limited. Therefore, a multicenter study on the Surveillance of Enteric Fever in India was carried out to estimate the incidence, clinical presentation, and antimicrobial resistance (AMR) trend. The data presented here represent the national burden of AMR in Salmonella Typhi and Salmonella Paratyphi A.MethodsAntimicrobial susceptibility testing was performed for S. Typhi and S. Paratyphi A (n = 2373) isolates collected prospectively during a 2-year period from November 2017 to January 2020.ResultsOf 2373 Salmonella isolates, 2032 (85.6%) were identified as S. Typhi and 341 (14.4%) were S. Paratyphi A. Approximately 2% of S. Typhi were multidrug-resistant (MDR), whereas all 341 (100%) of S. Paratyphi A isolates were sensitive to the first-line antimicrobials. Among 98% of ciprofloxacin nonsusceptible isolates, resistance (minimum inhibitory concentration [MIC] >0.5 µg/mL) was higher in S. Typhi (37%) compared with S. Paratyphi A (20%). Azithromycin susceptibility was 99.9% and 100% with a mean MIC of 4.98 μg/mL for S. Typhi and 7.39 μg/mL for S. Paratyphi A respectively. Ceftriaxone was the only agent that retained 100% susceptibility. Moreover, beta-lactam/beta-lactamase inhibitors showed potent in vitro activity against the study isolates.ConclusionsData obtained from this systematic surveillance study confirms the declining trend of MDR Salmonella isolates from India. The higher prevalence of ciprofloxacin nonsusceptibility enforces to limit its use and adhere to the judicious usage of azithromycin and ceftriaxone for enteric fever management.

Elizabethkingia anophelis is an emerging pathogen causing neonatal meningitis. Here, we describe the challenging course and necessity of a long 14-week duration of antibiotics in a 12-day-old male neonate with E. anophelis septicemia and meningitis. He developed ventriculitis and hydrocephalus, and needed a ventriculoperitoneal shunt. At 5-month follow-up he had developmental delay.

ST772-SCCmec V is a multi-drug resistant and highly virulent MRSA lineage. The complete genome of VB9352 S. aureus genome was generated using hybrid assembly of ion Torrent reads overlayed with the long reads of minIon. VB9352 was identified with the sequence type ST772 and carried SCCmec V element in the chromosome. The complete genome analysis showed the presence of mosaic integrated resistance plasmid (IRP) element contained loci for beta-lactam resistance operon (blaZ, blaI, blaR), aminoglycosides resistance (aphA3-sat-aadE), macrolide resistance (msrA, mphC), and bacitracin resistant genes (bcrA/B). A prophage Φ-IND772PVL co-carrying PVL and sea was also identified In the isolate VB9352, three distinct pathogenicity islands were identified. This includes vSaα carrying both toxins and superantigens, vSaβ carrying enterotoxin gene cluster (egc) and vSaγ containing super-antigen like protein, alpha hemolysin and exfoliative (eta) toxin. ST772 MRSA genomes carried two copies of blaZ and dfrG genes encoding for beta-lactam and trimethoprim resistance respectively.

The present study explores a hybrid energy storage system (HESS) for a microgrid, with Li-ion batteries for short-term storage coupled with a reversible solid oxide cell (rSOC) system for seasonal energy storage in hydrogen. A comparison of system size and capital cost shows that using a HESS leads to significant savings compared to a system with only batteries, with a capital cost reduction of up to 75 %. The study also reveals that Jodhpur (India) has greater needs for seasonal storage, and sees greater benefits from the use of a HESS than a temperate region like Groningen (Netherlands), due to the very high variability of wind energy, combined with the high share of wind energy in India. This shows that reversible solid oxide cell systems are a serious contender for energy storage in different climatic regions.

Objectives Elizabethkingia spp. are Gram-negative, glucose-non-fermenting bacilli that are ubiquitous in natural environments such as soil, plant and water sources. Besides environmental sources, the bacterium can be found in hospital environments, particularly medical equipment and reagents. Here we report the draft genome sequence of an Elizabethkingia anophelis isolate from a blood culture. Methods Genomic DNA of E. anophelis strain BP8467 was sequenced on an Ion Torrent PGM platform and the reads were assembled de novo using SPAdes v.5.0.0. The draft genome was annotated using the Prokaryotic Genome Annotation Pipeline (PGAP) v.4.9. Genetic determinants of antimicrobial resistance as well as virulence factors were identified using computational tools. Results The assembled draft genome is 3 859 105 bp in length with a G + C content of 35.62% distributed in 30 contigs. Presence of the blaBlaB and blaGOB-4 genes associated with resistance to carbapenems was identified. In addition, genes conferring resistance to other β-lactams (blaCME-1), aminoglycosides [ant(6)-I] and chloramphenicol (catB) were also detected. Antimicrobial susceptibility testing showed that the isolate was susceptible to levofloxacin, trimethoprim/sulfamethoxazole, tetracycline and rifampicin. Conclusion The presence of a multidrug-resistant isolate harbouring diverse antimicrobial resistance genes along with numerous virulence factors suggests the risk associated with Elizabethkingia spp. infections. This genome analysis provides insights into the antimicrobial resistance and pathogenicity mechanisms of multidrug-resistant E. anophelis that can help in the management of Elizabethkingia spp. infections in the future.

Chronic otitis media is a common disease of the developing world with persistent ear discharge, leading to major complications. This study describes the microorganisms isolated from the middle ear and nasopharynx of children with chronically discharging ears. Middle ear and nasopharyngeal swabs from 89 children were studied, and the microorganisms isolated were assessed for biofilm-forming ability. Methicillin-susceptible Staphylococcus aureus was common in the nasopharynx, while the middle ear showed predominantly pseudomonas and Methicillin-resistant S. aureus. Pseudomonas aeruginosa showed strong biofilm formation, whereas Escherichia coli, Proteus sp. and Providentia sp. were weak biofilm producers. S. aureus isolates were negative for biofilm formation.

Tigecycline is a reserve antibiotic increasingly used for the treatment of multidrug-resistant bacteria, especially Klebsiella pneumoniae and Acinetobacter baumannii. At present, there are concerns regarding the testing and interpretation of tigecycline susceptibility to bugs such as K. pneumoniae and A. baumannii, which limit clinicians in appropriate usage. Use of appropriate method for testing such as broth microdilution is essential. In addition, tigecycline susceptibility testing is a challenge due to inconsistent results from various antimicrobial susceptibility testing automated platforms. There is a great need to define a suitable methodology along with interpretive criteria, especially for K. pneumoniae and A. baumannii. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Food and Drug Administration (FDA) breakpoints show wide variation and are defined for different set of organisms. Non-species-related pharmacokinetic/pharmacodynamic (PK/PD) breakpoints defined by the EUCAST can be used for organisms such as K. pneumoniae and A. baumannii.

Negative emission technologies have recently received increasing attention due to climate change and global warming. One among them is bioenergy with carbon capture and storage (BECCS), but the capture process is very energy intensive. Here, a novel pathway is introduced, based on second-generation biofuels followed by carbon circulation in an indefinitely closed chain, effectively resulting in a sink. Instead of using an energy-intensive conventional CCS process, the application of an on-board solid oxide fuel cell (SOFC) running on biofuels in an electric vehicle (FCEV) could result in negative emissions by capturing a concentrated stream of CO2, which is readily stored in a second tank. A CO2 recovery system at the fuel station then takes the CO2 from the tank to be transported to storage locations or to be used for local applications such as CO2-based concrete curing and synthesis of e-fuels. Incorporating CO2 utilization technologies into the FCEVs-SOFC system can close the carbon loop, achieving carbon neutrality through feeding the CO2 in a reverse-logistic to a methanol plant. The methanol produced is also used in SOFCs, leading to an infinite repetition of this carbon cycle till a saturation stage is reached. It is determined this pathway will reach typical Cradle-to-Grave negative emissions of 0.515 ton CO2 per vehicle, and total negative CO2 emission of 138 Mt for all passenger cars in the EU is potentially achievable. All steps comprise known technologies with medium to high technology readiness level (TRL) levels, so principally this system can readily be applied in the mid-term.

Aim: To determine the presence of vancomycin heteroresistance in Staphylococcus haemolyticus. Materials & methods: A total of 48 rifampicin-resistant S. haemolyticus isolates from bloodstream infections were included. Vancomycin heteroresistance was determined using the population analysis profile-area under curve (PAP-AUC) method. All the isolates were screened for the presence of mecA gene, mutations in the rpoB gene, staphylococcal cassette chromosome mec and multilocus sequence types. Results: Fifteen isolates were identified as heteroresistant vancomycin-intermediate S. haemolyticus using PAP-AUC method. Dual rpoB mutations (D471E and I527M) contributed for the rifampicin resistance. The sequence types of heteroresistant vancomycin-intermediate S. haemolyticus were highly diverse. Conclusion: These findings illustrate the potential of S. haemolyticus to develop heteroresistance, which emphasizes the need for routine surveillance of S. haemolyticus isolated from intensive care units for infection control practices., Lay abstract The problem of vancomycin-resistant subpopulations of coagulase-negative Staphylococci is rising worldwide; and may adversely affect the response to treatment. This study was conducted to characterize the resistant subpopulations of Staphylococcus haemolyticus that cause bloodstream infection, which is largely unexplored. We observed the presence of vancomycin-resistant subpopulations of S. haemoltyicus, which are not tested routinely yet should be monitored regularly to potentially improve clinical outcomes.

Objective Factitious disorders are known to exist in the medical community but are not commonly diagnosed in clinical practice. The majority of the literature on factitious disorder comes from case reports or case series. This particular case is unusual because it describes a patient who initially presented with purely physical complaints, but over time, the symptoms transitioned into predominantly psychiatric concerns. This case describes the patient's unique presentation and is followed by a discussion of the management of factitious disorder. Methods The patient was seen during the course of an inpatient psychiatric hospitalization. Electronic chart review was conducted, and information from each prior hospitalization was gathered between the dates of first initial documented presentation available in the electronic record in 1995 to most recent hospitalization in 2017. Results The patient still continues to present to the emergency department. Upon each presentation, staff work to objectively assess his complaints to be sure that there is no true underlying medical emergency. There is also a focus on providing non-judgmental, supportive, and compassionate care. Conclusion This case highlights the importance of corroborating objective findings with the patient's subjective reports gathered during a history and physical, and to recognize that patients with this disorder can present to any specialty. Thus, the collaboration between specialties is critical in the care of these patients to minimize unnecessary, costly, and sometimes dangerous interventions.