Spa Pools Research Articles

The effectiveness of balneotherapy and thermal aquatic exercise in postoperative persistent lumbar pain syndrome.

In our study, we aimed to investigate the effectiveness of balneotherapy and aquatic exercises in patients with postoperative chronic low back pain. Forty-three patients over the age of 18 who had been operated on for herniated disc and who had at least 6months of back and/or leg pain were included in the study. The patients have been distributed randomly into 2 groups prior to the treatment. The program comprising aquatic exercises distributed into 5days a week for 2weeks and 20min (min) a day, in a 33°C spa pool was applied to the first group. After the first group's treatment was completed, a program consisting of walking out of the pool and strengthening and stretching exercises for the hip, abdominal, back, and waist muscles was distributed into 5days a week for 2weeks for a total duration of 20min per day was applied to both groups. The patients subjected to the study were evaluated before treatment, after treatment (2nd week), and at 1st and 6th months after treatment. The Visual Analogue Scale, Modified Schober Test, Finger-to-Floor Distance, Sorensen Test, Progressive Iso-inertial Lifting Evaluation, Rolland Morris Disability Index, Leeds Disability Scale, Beck Depression Inventory, Nottingham Health Profile, and Short Form 36 Health Survey parameters were evaluated. We detected a significant improvement in all parameters except for the Sorensen test, in both groups. We observed that the changes in VAS, Sorensen, NHP, and SF 36 tests in the aquatic exercise group were significantly better than those in the non-aquatic exercise group.

COVID-19: Research Directions for Non-Clinical Aerosol-Generating Facilities in the Built Environment

Physical contact and respiratory droplet transmission have been widely regarded as the main routes of COVID-19 infection. However, mounting evidence has unveiled the risk of aerosol transmission of the virus. Whereas caution has been taken to avoid this risk in association with clinical facilities, facilities such as spa pools and Jacuzzis, which are characterized by bubble-aerosol generation, high bather loads, and limited turnover rates, may promote aerosol transmission. Focusing on these non-clinical facilities in the built environment, a review study was undertaken. First, the typical water disinfection and ventilation-aided operations for the facilities were illustrated. Second, cross comparisons were made between the applicable standards and guidelines of the World Health Organization and countries including Australia, Canada, China, the United Kingdom, and the United States. The similarities and differences in their water quality specifications, ventilation requirements, and air quality enhancement measures were identified; there were no specific regulations for preventing aerosol transmission at those aerosol-generating facilities. Third, a qualitative review of research publications revealed the emergence of studies on potential air-borne transmission of COVID-19, but research on built facilities posing high risks of aerosol transmission remains scant. This study’s results inform key directions for future research on abating aerosol transmission of COVID-19: the development of bespoke personal protective equipment and engineering and management controls on water quality, ventilation, and air quality.

Legionellosis incidents associated with spa pools, England, 2002–2018

BackgroundSpa pools (SPs) pose risks of Legionella infection for users and bystanders. MethodsWe searched the National Enhanced Legionella Surveillance System for reported SP-associated legionellosis incidents in England between 2002 and 2018 involving at least two cases. ResultsFor seven legionellosis SP-associated incidents, six were in commercial settings such as hotels. The median number of cases per outbreak was four (range 2–115). ConclusionSP-associated legionellosis incidents were mainly located in commercial settings with a wider range of cases than those recognised in previous publications, reinforcing the need for effective environmental controls for SPs in a range of settings.

The microbiota as a candidate biomarker for SPA pools and SPA thermal spring stability after seismic events

Worldwide, the location of thermal springs overlaps seismic areas, and the higher occurrence of earthquakes may impact on water stability and safety. The hydrogeological perturbations pose environmental and public health risks that can be monitored by well-established chemical, physical and biological parameters. Specific health concerns involve the exposure of the population to the medical or wellness uses of SPA thermal waters, e.g. in respiratory or hydropinic treatments as well as during rehabilitative or recreational activities in pools. Since SPA waters are characterized by their own microbiota, we analysed by 16S amplicon sequencing the dynamics of water microbial communities after the August 2017 Ischia island earthquake. For the first time, we report the impact of a seismic event on a thermal spring water, whose microbiota was deeply characterized before and immediately after the natural disaster. The biodiversity stability of the water underwent a dramatic disturbance following the earthquake, as summarized by a Shannon index moving from 1.300 during May 2016-July 2017, up to 1.600 during the first 20–70 h after the event and slightly slowing down to 1.500 after 30 days and to 1.400 after 6 months. Microbiota analysis showed a sudden reduction of the relative abundance of autochthone thermophilic species within the first 20 h and a parallel increase of other thermophilic species as well as of ectopic bacteria from soil, sediments, sea, freshwater and wastewaters. Cultivable mesophilic bacteria were observed only in the first 20 h sample (7 × 103/L), even if the presence of faecal contamination traces was detected by Real Time PCR also up to 70 h after the disaster. OTUs analysis of putative metabolic functions showed several changes between pre and post event, such as in the distribution of Sulphur metabolizing and Carbon fixation species. The restoration of the original pattern followed a slow trend, requiring over six months. The observed results confirm the impact of the earthquake on the microbiota structure of the underground thermal spring water, suggesting further perspectives for monitoring water stability and safety issues by a metagenomic approach.

Dispersion of Legionella bacteria in atmosphere: A practical source location estimation method.

Legionnaires’ disease, a form of pneumonia which can be fatal, is transmitted via the inhalation of water droplets containing Legionella bacteria. These droplets can be dispersed in the atmosphere several kilometers from their source. The most common such sources are contaminated water within cooling towers and other air-conditioning systems but other sources such as ornamental fountains and spa pools have also caused outbreaks of the disease in the past. There is an obvious need to locate and eliminate any such sources as quickly as possible. Here a maximum likelihood model estimating the source of an outbreak from case location data has been developed and implemented. Unlike previous models, the average dose exposure sub-model is formulated using a atmospheric dispersion model. How the uncertainty in inferred parameters can be estimated is discussed. The model is applied to the 2012 Edinburgh Legionnaires’ disease outbreak.

Utilization indicators of balneotherapy in Hungary

The role of spa therapy is well defined and its importance has significantly increased in the healthcare but the utilization indicators of the implemented treatments are less known. The objective of our study was to analyze the utilization and the social insurance indicators of the healthcare publicly financed by health insurance in spa institutions. The data used for the analysis were derived from the funding database of the National Health Insurance Fund of Hungary. The period examined covered the years between 2009 and 2016. The spa treatment counts, social insurance expenses, the territorial inequalities in utilization, sex and age distribution of the treatments were examined. The treatment counts were the highest (7349587) in 2009 and they gradually decreased with 6558 204 treatments by 2012. 'Spa pool of medicinal water' treatment was the most common care in each year which incidence showed a downward trend during the past years: 2544 617 treatments were performed in 2009 but 2016 showed only 1898 338 treatments. We found the highest health insurance expenditures in 2016: 4.261 billion HUF or 13.8 EUR. In the previous years, there was a lower health insurance expenditure: in 2010 3.928 billion HUF (14.3 million EUR), in 2011 3.921 billion HUF (14.0 million EUR) and in 2012 3.875 billion HUF (13.4 million EUR). The utilization made the highest incidence of treatments in Csongrád county with 13174/10000 inhabitants and 8160 thousand HUF/10000 inhabitants of social security subsidy in 2016. The lowest utilization counts for treatments were found in Nógrád county with 3233/10000 inhabitants and 2192 thousand HUF/10000 inhabitants of social security subsidy. The highest utilization indicators were found in the age group between 60 and 69 in the distribution of population and genders. In the utilization of spa therapy funded by health insurance fund, no significant change has occurred during the past years but territorial discrepancies can be seen in sex, age, and county breakdown. Orv Hetil. 2019; 160(Suppl 1): 22-28.

Legionellosis Associated with Recreational Waters: A Systematic Review of Cases and Outbreaks in Swimming Pools, Spa Pools, and Similar Environments.

Legionella spp. is widespread in many natural and artificial water systems, such as hot water distribution networks, cooling towers, and spas. A particular risk factor has been identified in the use of whirlpools and hot tubs in spa facilities and public baths. However, there has been no systematic synthesis of the published literature reporting legionellosis cases or outbreaks related to swimming/spa pools or similar environments used for recreational purposes (hot springs, hot tubs, whirlpools, natural spas). This study presents the results of a systematic review of the literature on cases and outbreaks associated with these environments. Data were extracted from 47 articles, including 42 events (17 sporadic cases and 25 outbreaks) and 1079 cases, 57.5% of which were diagnosed as Pontiac fever, without any deaths, and 42.5% were of Legionnaires’ disease, with a fatality rate of 6.3%. The results are presented in relation to the distribution of Legionella species involved in the events, clinical manifestations and diagnosis, predisposing conditions in the patients, favourable environmental factors, and quality of the epidemiological investigation, as well as in relation to the different types of recreational water sources involved. Based on the epidemiological and microbiological criteria, the strength of evidence linking a case/outbreak of legionellosis with a recreational water system was classified as strong, probable, and possible; in more than half of the events the resulting association was strong.

Formation of trihalomethanes as disinfection byproducts in herbal spa pools

Herbal spa treatments are favorite recreational activities throughout the world. The water in spas is often disinfected to control pathogenic microorganisms and guarantee hygiene. However, chlorinated water may cause the formation of disinfection byproducts (DBPs). Although there have been many studies on DBP formation in swimming pools, the role of organic matter derived from herbal medicines applied in herbal spa water has been largely neglected. Accordingly, the present study investigated the effect of herbal medicines on the formation of trihalomethanes (THMs) in simulated herbal spa water. Water samples were collected from a spa pool, and then, disinfection and herbal addition experiments were performed in a laboratory. The results showed that the organic molecules introduced by the herbal medicines are significant precursors to the formation of THMs in spa pool water. Since at least 50% of THMs were produced within the first six hours of the reaction time, the presence of herbal medicines in spa water could present a parallel route for THM exposure. Therefore, despite the undeniable benefits of herbal spas, the effect of applied herbs on DBP formation in chlorinated water should be considered to improve the water quality and health benefits of spa facilities.

Legionella spp. Risk Assessment in Recreational and Garden Areas of Hotels.

Several Travel-associated Legionnaires’ disease (TALD) cases occur annually in Europe. Except from the most obvious sites (cooling towers and hot water systems), infections can also be associated with recreational, water feature, and garden areas of hotels. This argument is of great interest to better comprehend the colonization and to calculate the risk to human health of these sites. From July 2000–November 2017, the public health authorities of the Island of Crete (Greece) inspected 119 hotels associated with TALD, as reported through the European Legionnaires’ Disease Surveillance Network. Five hundred and eighteen samples were collected from decorative fountain ponds, showers near pools and spas, swimming pools, spa pools, garden sprinklers, drip irrigation systems (reclaimed water) and soil. Of those, 67 (12.93%), originating from 43 (35.83%) hotels, tested positive for Legionella (Legionella pneumophila serogroups 1, 2, 3, 6, 7, 8, 13, 14, 15 and non-pneumophila species (L. anisa, L. erythra, L. taurinensis, L. birminghamensis, L. rubrilucens). A Relative Risk (R.R.) > 1 (p < 0.0001) was calculated for chlorine concentrations of less than 0.2 mg/L (R.R.: 54.78), star classification (<4) (R.R.: 4.75) and absence of Water Safety Plan implementation (R.R.: 3.96). High risk (≥104 CFU/L) was estimated for pool showers (16.42%), garden sprinklers (7.46%) and pool water (5.97%).

Antimycobacterial potential of the juniper berry essential oil in tap water.

Mycobacterium avium complex-related diseases are often associated with poorly maintained hot water systems. This calls for the development of new control strategies. The aim of this study was to investigate the activity of essential oils (EOs) from the Mediterranean plants, common juniper, immortelle, sage, lavandin, laurel, and white cedar against Mycobacterium avium ssp. avium, Mycobacterium intracellulare, and Mycobacterium gordonae in culturing broth and freshwater as their most common habitat. To do that, we developed a new method of water microdilution to determine their minimal effective concentrations (MEC). The most active EO was the one from the common juniper with the MEC of 1.6 mg mL-1. Gas chromatography / mass spectrometry the juniper EO identified monoterpenes (70.54 %) and sesquiterpenes (25.9 %) as dominant component groups. The main monoterpene hydrocarbons were α-pinene, sabinene, and β-pinene. The juniper EO significantly reduced the cell viability of M. intracellulare and M. gordonae at MEC, and of M. avium at 2xMEC. Microscopic analysis confirmed its inhibitory effect by revealing significant morphological changes in the cell membrane and cytoplasm of all three bacteria. The mode of action of the juniper EO on the cell membrane was confirmed by a marked leakage of intracellular material. Juniper EO has a great practical potential as a complementary or alternative water disinfectant in hot water systems such as baths, swimming pools, spa pools, hot tubs, or even foot baths/whirlpools.

Presence and select determinants of organophosphate flame retardants in public swimming pools

The occurrence of five organophosphate flame retardants (PFRs) consisting of tributyl phosphate (TNBP), tris(2-chloroethyl) phosphate (TCEP), tris(1-chloro-2-propyl) phosphate (TCIPP), tris(1.3-dichloro-2-propyl) phosphate (TDCIPP) and triphenyl phosphate (TPHP) in swimming pools were investigated. Fifteen chlorinated public swimming pools were sampled, including indoor pools, outdoor pools and spa pools. The analyses were carried out using isotope dilution gas chromatography tandem mass spectrometry. All five PFRs were detected in swimming pool waters with concentrations ranging from 5–27ng/L (TNBP), 7–293ng/L (TCEP), 62–1180ng/L (TCIPP), 10–670ng/L (TDCIPP) and 8–132ng/L (TPHP). The concentrations of PFRs were generally higher in indoor swimming pools compared to outdoor swimming pools. In municipal water supplies, used to fill the swimming pools in three of the sampling locations, the five PFRs were all below the limit of quantifications, eliminating this as the source. Potential leaching of PFRs from commonly used swimming equipment, including newly purchased kickboards and swimsuits was investigated. These experiments revealed that PFRs leached from swimsuits, and may be a source of PFRs in swimming pools. A quantitative risk assessment revealed that the health risk to PFRs via swimming pools was generally low and below commonly applied health risk benchmarks.

Genomic Investigation of a Legionellosis Outbreak in a Persistently Colonized Hotel.

Objectives: A long-lasting legionellosis outbreak was reported between November 2011 and July 2012 in a hotel in Calpe (Spain) affecting 44 patients including six deaths. Intensive epidemiological and microbiological investigations were performed in order to detect the reservoirs.Methods: Clinical and environmental samples were tested for the presence and genetic characterization of Legionella pneumophila. Six of the isolates were subjected to whole-genome sequencing.Results: Sequencing of 14 clinical and 260 environmental samples revealed sequence type (ST) 23 as the main responsible strain for the infections. This ST was found in the spa pool, from where it spread to other hotel public spaces, explaining the ST23 clinical cases, including guests who had not visited the spa. Uncultured clinical specimens showed profiles compatible with ST23, ST578, and mixed patterns. Profiles compatible with ST578 were obtained by direct sequencing from biofilm samples collected from the domestic water system, which provided evidence for the source of infection for non ST23 patients. Whole genome data from five ST23 strains and the identification of different STs and Legionella species showed that different hotel premises were likely colonized since the hotel opening thus explaining how different patients had been infected by distinct STs.Conclusions: Both epidemiological and molecular data are essential in the investigation of legionellosis outbreaks. Whole-genome sequencing data revealed significant intra-ST variability and allowed to make further inference on the short-term evolution of a local colonization of L. pneumophila.

Occurrence and daily variability of pharmaceuticals and personal care products in swimming pools.

The aim of this research was to investigate the presence and daily variability of pharmaceuticals and personal care products (PPCPs) in public swimming pools. Various types of public swimming pool water were analysed, taken from freshwater indoor swimming pools, outdoor swimming pools, spa pools and seawater swimming pools. Swimming pool water samples were analysed for 30 PPCPs using solid phase extraction (SPE) followed by isotope dilution liquid chromatography tandem mass spectrometry (LC-MS/MS). All PPCPs were below quantification limits in seawater pools. However, caffeine was detected in 12 chlorinated swimming pools at concentrations up to 1540 ng/L and ibuprofen was observed in 7 chlorinated pools at concentrations up to 83 ng/L. Caffeine and ibuprofen concentrations were below quantification limits in all fill water samples, eliminating this as their source in swimming pools. High variations in caffeine concentrations monitored throughout the day roughly reflect bather loads in swimming pools. Future monitoring of these compounds may assist in evaluating what portion of organic matter measured in swimming pools may come from human excretions.

RADON AND PROGENY SOURCED DOSE ASSESSMENT OF SPA EMPLOYEES IN BALNEOLOGICAL SITES.

This study was conducted in the scope of IAEA project with the name 'Establishing a Systematic Radioactivity Survey and Total Effective Dose Assessment in Natural Balneological Sites' (TUR/9/018), at the Health Physics department of Sarayköy Nuclear Research and Training Center (SANAEM). The aim of this study is estimation of radon and progeny sourced effective dose for the people who are working at the spa facilities by measuring radon activity concentration (RAC) at the ambient air of indoor spa pools and dressing rooms. As it is known, the source of the radon gas is the radium content of the earth crust. Therefore, thermal waters coming from ground may contain dissolved radon and the radon can diffuse water to air. So the ambient air of spa pools can contain serious RAC that depends on a lot of parameters. In this regard, RAC measurements were executed at the 70 spa facilities in Turkey. The measurements were done with both active and passive methods at ambient air of spa pools and dressing rooms. Thus, active measurements were carried out by using the Alphaguard(®) with diffusion mode during half an hour, and passive measurements were carried out by using the humidity resistive CR-39 radon detectors during 2 months. Results show that RAC values at ambient air of spa pools varies between 13 Bq m(-3) and 10 kBq m(-3) Because long-term measurements are more reliable, if it is available, for dose calculations passive radon measurements (with CR-39 detectors) at ambient air of spa pools and dressing rooms were used, otherwise active measurement results were used. With the measurement by the conversion coefficients of ICRP 65 and occupational data of the employees has got from questionary forms, effective dose values were calculated. According to the calculations, spa employees are exposed to annual average dose between 0.05 and 29 mSv because of radon and progeny.

Evaluation of the Pseudalert®/Quanti-Tray® MPN Test for the Rapid Enumeration of Pseudomonas aeruginosa in Swimming Pool and Spa Pool Waters

This study assessed the performance of a new most probable number test (Pseudalert/Quanti-Tray) for the enumeration of Pseudomonas aeruginosa from swimming pool and spa pool waters by comparing it to the international and national membrane filtration-based culture methods for P. aeruginosa: ISO 16266:2006 and UK The Microbiology of Drinking Water-Part 8 (MoDW Part 8) which both use Pseudomonas CN agar. The comparison was based on the calculation of mean relative differences between the two methods conducted according to ISO 17994:2014. Using both routine pool water samples (149 from 8 laboratories) and artificially contaminated samples (309 from 7 laboratories), paired counts from each sample and enumeration method were analysed. For routine samples, there were insufficient data for a conclusive assessment, but the data do indicate at least equivalent performance of Pseudalert/Quanti-Tray to the reference methods. For the artificially contaminated samples, the data also did not result in a statistically conclusive assessment but did indicate potentially better performance of Pseudalert/Quanti-Tray. Combining the data from the routine samples and artificially contaminated samples resulted in an ISO 17994 outcome that the two methods were not statistically significantly different. Thus, the Pseudalert/Quanti-Tray method is an acceptable alternative to ISO 16266 and MoDW Part 8. The Pseudalert/Quanti-Tray method has the advantage in that it does not require confirmation testing, and of providing confirmed counts within 24-28 h incubation compared to 40-48 h or longer for the ISO 16266 and MoDW Part 8 methods.

The metal–organic framework HKUST-1 as efficient sorbent in a vortex-assisted dispersive micro solid-phase extraction of parabens from environmental waters, cosmetic creams, and human urine

Three metal–organic frameworks (MOFs), specifically HKUST-1, MOF-5, and MIL-53(Al), have been synthetized, characterized, studied and compared in a vortex-assisted dispersive micro-solid-phase extraction (VA-D-µ-SPE) procedure in combination with high-performance liquid chromatography (HPLC) with diode-array detection (DAD) for determining seven parabens in environmental waters (tap water, swimming pool water, and water coming from a spa pool), human urine (from two volunteers), and cosmetic creams (two commercial brands). Experimental parameters, such as nature and amount of MOF, sample volume, nature of elution solvent and its amount, vortex and centrifugation time, among others, were properly optimized. HKUST-1 was the most adequate MOF to work with. Detection limits for the overall method down to 0.1μgL−1 for butylparaben (BPB) and benzylparaben (BzPB) were obtained, with determination coefficients (R2) higher than 0.9966 for a range of 0.5–147μgL−1 (depending on the paraben), average relative recoveries (RR, in %) of 80.3% at the low spiked level (7μgL−1), and relative standard deviation (RSD) values below 10% also at the low spiked level. The strength of the affinity between HKUST-1 and parabens was evaluated, and it ranged from 33.5% for isopropylparaben (iPPB) to 77.0% for isobutylparaben (iBPB). When analyzing complex environmental waters, RR values of 78%, inter-day precision values (as RSD) lower than 15%, and intra-day precision values lower than 7.8% were obtained, despite the observed matrix effect. When analyzing cosmetic creams, parabens were detected, with contents ranging from 0.14±0.01μgg−1 for EPB in the healing cream analyzed to 1.12±0.07mgg−1 for MPB in the mask cream analyzed, with precision values (RSD) lower than 12% and RR values from 63.7% for propylparaben (PPB) to 121% for iPPB. When analyzing human urine, no parabens were detected but the method could be performed with RSD values lower than 19%. These results show the adequateness of MOFs as sorbents in VA-D-µ-SPE procedures despite sample complexity.

Prevalence of Simkania negevensis in chlorinated water from spa swimming pools and domestic supplies.

This study aimed to investigate the prevalence of Simkania negevensis in the chlorinated water of spa swimming pools and domestic network systems. A total of 10 and 36 samples were collected from two domestic water supplies and four spa facilities, respectively. Simkania negevensis was isolated in Acanthamoeba castellanii monolayers and detected by Gimenez staining and immunofluorescence test. Simkania negevensis DNA, extracted from the positive samples, was confirmed by a nested PCR assay followed by sequencing. Simkania negevensis was detected in 41·3% of samples (domestic water: 50%; untreated spa supply water: 25%; chlorinated spa pool water: 42·9%) from all the examined water systems in successive samplings performed in 1 year. The presence of S. negevensis was not correlated with the counts of Heterotrophic Bacteria and Pseudomonas aeruginosa. Unlike Legionella spp., which were never isolated from the swimming-pool water samples, S. negevensis was also detected in chlorinated spa water. This investigation shows that Simkania is widespread in natural and man-made aquatic environments, which may represent possible sources of infection: in the swimming pools, in particular, the aerosol generated by the water movement could increase the risk of inhalation of infected particles. This study represents the first evidence of the presence of S. negevensis in spa pool water. Sero-epidemiological surveys on spa users could help to clarify its transmission in this environment.

Disinfection of herbal spa pool using combined chlorine dioxide and sodium hypochlorite treatment.

The presence of pathogenic microorganisms in public spa pools poses a serious threat to human health. The problem is particularly acute in herbal spas, in which the herbs and microorganisms may interact and produce undesirable consequences. Accordingly, the present study investigated the effectiveness of a combined disinfectant containing chlorine dioxide and sodium hypochlorite in improving the water quality of a public herbal spa in Taiwan. Water samples were collected from the spa pool and laboratory tests were then performed to measure the variation over time of the microorganism content (total CFU and total coliforms) and residual disinfectant content given a single disinfection mode (SDM) with disinfectant concentrations of 5.2 × 10, 6.29 × 10, 7.4 × 10, and 11.4 × 10(-5) N, respectively. Utilizing the experience gained from the laboratory tests, a further series of on-site investigations was performed using three different disinfection modes, namely SDM, 3DM (once every 3 h disinfection mode), and 2DM (once every 2 h disinfection mode). The laboratory results showed that for all four disinfectant concentrations, the CFU concentration reduced for the first 6 h following SDM treatment, but then increased. Moreover, the ANOVA results showed that the sample treated with the highest disinfectant concentration (11.4 × 10(-5) N) exhibited the lowest rate of increase in the CFU concentration. In addition, the on-site test results showed that 3DM and 2DM treatments with disinfectant concentrations in excess of 9.3 × 10 and 5.5 × 10(-5) N, respectively, provided an effective reduction in the total CFU concentration. In conclusion, the experimental results presented in this study provide a useful source of reference for spa businesses seeking to improve the water quality of their spa pools.

Geothermal energy

Geothermal technologies use renewable energy resources to generate electricity and direct use of heat while producing very low levels of greenhouse-gas (GHG) emissions. Geothermal energy is stored in rocks and in fluids circulating in the underground. Electricity generation usually requires geothermal resources temperatures of over 100°C. For heating, geothermal resources spanning a wider range of temperatures can be used in applications such as space and district heating (and cooling, with proper technology), spa and swimming pool heating, greenhouse and soil heating, aquaculture pond heating, industrial process heating and snow melting. Geothermal technology, which has focused so far on extracting naturally heated steam or hot water from natural hydrothermal reservoirs, is developing to more advanced techniques to exploit the heat also where underground fluids are scarce and to use the Earth as a potential energy battery, by storing heat. The success of the research will enable energy recovery and utilization from a much larger fraction of the accessible thermal energy in the Earth’s crust.

Aerosolization of respirable droplets from a domestic spa pool and the use of MS-2 coliphage and Pseudomonas aeruginosa as markers for Legionella pneumophila.

Legionnaires' disease can result when droplets or aerosols containing legionella bacteria are inhaled and deposited in the lungs. A number of outbreaks have been associated with the use of a spa pool where aeration, a high water temperature, and a large and variable organic load make disinfectant levels difficult to maintain. Spa pool ownership is increasing, and the aim of this study, using two surrogate organisms (MS-2 coliphage and Pseudomonas aeruginosa [a natural contaminant]), was to assess the potential risk to domestic users when disinfection fails. A representative "entry level" domestic spa pool was installed in an outdoor courtyard. The manufacturer's instructions for spa pool maintenance were not followed. A cyclone sampler was used to sample the aerosols released from the spa pool with and without activation of the air injection system. Samples were taken at increasing heights and distances from the pool. An aerodynamic particle sizer was used to measure the water droplet size distribution at each sample point. When the air injection system was inactivated, neither surrogate organism was recovered from the air. On activation of the air injection system, the mean mass of droplets within the respirable range (10 cm above the water line) was 36.8 μg cm(-3). This corresponded to a mean air concentration of P. aeruginosa of 350 CFU m(-3). From extrapolation from animal data, the estimated risk of infection from aerosols contaminated with similar concentrations of Legionella pneumophila was 0.76 (males) and 0.65 (females). At 1 m above and/or beyond the pool, the mean aerosol mass decreased to 0.04 μg cm(-3) and corresponded to a 100-fold reduction in mean microbial air concentration. The estimated risk of infection at this distance was negligible.