On-site Treatment Research Articles

Towards a generic solution to onsite wastewater treatment

Decentralized wastewater treatment, specifically onsite treatment, is fundamental to recent wastewater management paradigms. However, onsite solutions often produce inadequate effluent quality for reuse and are ineffective in removing organic micropollutants (OMPs). This study suggests a multistep onsite system for treating wastewater in varying conditions. The system comprises biological treatment in a recirculating vertical-flow bioreactor (RVFB) followed by ozonation and ultrafiltration. The system was constructed on a farm in the Israeli Negev desert and tested year-round for its effluent quality and removal of two model OMPs. Additionally, laboratory-scale experiments were conducted to understand the field data. The system has demonstrated stable performance over varying climate conditions and wastewater qualities during one year of operation. The RVFB reduced the total suspended solid (TSS) concentration by up to 96 %, the dissolved organic carbon by up to 88 %, and the biodegradable OMP, Ibuprofen, by approximately 82 %. Ozonation had limited impact on effluent quality, most likely due to low ozone concentrations, but interestingly efficiently reduced Carbamazepine, a recalcitrant OMP, by around 87 %. Additionally, the laboratory experiments using the farm's wastewater demonstrated the ozone's potential efficiency in improving effluent quality. The final membrane filtration treatment step fully removed the residual TSS and E. coli, achieving effluent quality that meets the standards for wastewater reuse. The membrane exhibited stable performance over one month without chemical cleaning, probably due to the pre-ozonation step. Overall, this study highlights the potential of the suggested system to effectively treat diverse wastewater types and produce high-quality effluent suitable for reuse.

Determination and implementation of an onsite management system for motor-vehicle wash effluents: A field-scale commercial application toward sector sustainability

The global upsurge of vehicle wash enterprises is allied to the production of large wastewater volumes. This effluent contains organic and inorganic compounds which can cause environmental pollution. Upscaling the laboratory-scale systems for motor-vehicle wash wastewater (MVWW) treatment to field-scale commercial application is essential for enabling the circular economy framework, meeting the United Nations' 2030 Agenda. In this study, 98 research publications on MVWW treatment technologies were scrutinized for bibliometric-meta analysis. After, a practical treatment option was identified and designed for implementation in a Ugandan motor-vehicle wash station and a comprehensive economic evaluation was performed. A continental outlook on MVWW quality showed that its major pollutants include oil-greasy compounds, surfactants, and suspended solids. Results showed that a hybrid system consisting of coagulation/flocculation/sedimentation and sand/gravel filtration was identified as the most practical treatment method for implementation in motor-vehicle washing stations. The final effluent of the field-scale integrated treatment system contained turbidity = 2 ± 0.0 NTU, chemical oxygen demand (COD) = 18.9 ± 0.6 mg/L, surfactants = 3.2 ± 0.3 mg/L, supporting onsite recyclability in motor-vehicle washing activities. The integrated system demonstrated a profitability scenario with a benefit-cost ratio (B/C) > 1 and a payback period of 2.7 years. Implementing the hybrid system for onsite MVWW treatment could fulfil targets of sustainable development goals related to; water conservation, water recycling and reuse, and environmental protection.

Leachate management in medium- and small-sized sanitary landfills: a Greek case study

The sustainable management of landfill leachates remains a matter of important concern in many countries. We used as case study a medium-sized Greek landfill, and we initially investigated the performance of the existing secondary leachate treatment system. The activated sludge process removed chemical oxygen demand (COD), biochemical oxygen demand (BOD), NH4-N, and PO4-P by 55%, 84%, 94%, and 14%, respectively, but the effluents did not meet the legislation requirements for discharge or reuse. Afterwards, different management options of these effluents (co-treatment with sewage in the centralized treatment plant, onsite tertiary treatment with reverse osmosis, granular activated carbon (GAC), ozonation, photo-Fenton, or constructed wetlands) were evaluated regarding their operational costs and environmental footprint. The use of constructed wetlands presented the lower operational cost, energy requirements, and greenhouse gas (GHG) emissions, not exceeding 21.5 kg CO2eq/day. On the other hand, the power consumption and the GHG emissions of the other on-site technologies ranged from 0.37 kWh/m3 and 5.56 kg CO2eq/day (use of GAC) to 39.19 kWh/m3 and 588.6 kg CO2eq/day (use of ozonation), respectively. The co-treatment of the leachates with municipal wastewater required 0.6 kWh/m3 and emitted 30.18 kg CO2eq/day. For achieving zero-discharge of the treated leachates, a system consisting of constructed wetlands and evaporation ponds in series was designed.

Role of emergency teleradiology in a mass motorcycle event: the experience of the 2021 International Six Days of Enduro (ISDE).

Provision of healthcare support at mass gathering sporting events is of paramount importance for the success of the event. Many of such events, like motorsports, have been increasingly taking place in remote and austere environments. In these settings, the use of first-line diagnostic tools, such as point of care ultrasound and portable X-ray, could aid in definitive care on the field for patients with minor trauma while also ensuring fast access to the appropriate level of care for patients requiring hospitalization. As part of the ISDE 2021 medical response plan, a field hospital equipped with portable digital X-ray and telemedicine was established. Data on patient admission, triage, treatments, diagnostics, and outcomes were collected for analysis. During the 6-day competition, 79 patients sought medical care at the field hospital, with traumatic injuries accounting for 77% of cases. Of these, 47 were athletes and 32 were non-athletes. The majority (91%) arrived spontaneously, while 9% were transported directly. Upon admission, 68 patients were triaged as non-urgent (code 3) and 11 as urgent (code 2). Of those admitted, 69 received treatment and were discharged at the field hospital, while 10 were transferred elsewhere. Notably, four patients had major trauma, two had isolated fractures, and one needed a CT scan after losing consciousness. Overall, 29 missions were conducted on the race field, including 13 primary transports to local hospitals and 6 to the field hospital. Primary transport was primarily due to major trauma. Among 31 patients who had radiological exams, 11 (35.5%) had traumatic injuries. Of these, 5 were treated with braces and casts and discharged without hospitalization, 3 were advised for post-event care, and 3 were hospitalized. In contrast, patients with negative X-rays received on-site treatment, with 7 able to continue competing. In summary, the successful implementation of portable X-ray machines and teleradiology at remote and austere high-risk sporting events holds great promise for enhancing on-site medical capabilities, allowing clinicians informed decisions, avoiding unnecessary hospitalization, and allowing athletes to continue with their competition. Provided that challenges related to cost, safety, connectivity, and power supply are effectively addressed.

The use of sterol profiles, supported with other faecal source tracking methods, to apportion septic tanks contamination in rural catchments

Identifying the origin of faecal pollution in water is needed for effective water management decisions to protect both human health and aquatic ecosystems. Traditionally used indicators of faecal contamination, such as E. coli, only indicate pollution from warm-blooded animals and not the specific source of contamination; hence, more source specific tracers are required. The study has focussed on separating the two main sources of contaminants within rural catchments in Ireland, agriculture and on-site wastewater treatment systems (predominantly septic tanks). While human-specific effluent tracers may assist in identifying potential pathways from individual septic tanks to surface waters, it is difficult to quantify the cumulative impact of such systems at a catchment scale. This study has investigated faecal sterols as a method to quantify such an impact on four small catchments in areas of low subsoil permeability with high densities of septic tanks. The results demonstrate the usefulness of faecal sterols which provide a quantitative evaluation of the respective impact between agricultural pasture inputs and on-site effluent showing differences between the four catchments. The study also highlights the need to derive more specific local reference sterol profile databases for specific countries or regions, using local source material of animal faeces and effluent. Two intensive sampling campaigns on the four catchments then used faecal sterols in parallel to fluorescent whitening compounds (FWCs), caffeine, artificial sweeteners and selected pharmaceuticals to gain further insights and confirmation about contamination hotspots as well as providing comparison between the different parameters. The combination of sterols, FWCs, caffeine, acesulfame and cyclamate has proven suitable to provide an estimate of the extent of human contamination in these rural catchments and has yielded additional information about potential pollution pathways and proximity of contamination. Overall, this methodology can help to facilitate a targeted and effective water management in such catchments.

Interdisciplinary rendez-vous approach in endovascular stroke treatment a new concept to accelerate mechanical thrombectomy in primary stroke centers

Abstract Background/Introduction Prompt endovascular treatment of patients with stroke due to intracranial Large Vessel Occlusion (LVO) is a major challenge especially in rural areas because neurointerventionalists are usually not available. As a result, treatment is delayed, and clinical outcomes are worse compared with patients primarily treated in comprehensive stroke centers (CSC). Purpose To address this problem, we present a new concept in which interdisciplinary, on-site endovascular treatment is performed in a Primary Stroke Center (PSC) by a team of interventional cardiologists and neuroradiologists: the Rendez-Vous approach. Methods Twenty-seven patients with LVO who underwent interdisciplinary thrombectomy on-site at the PSC as part of the Rendez-Vous concept were compared with 72 patients who were transferred from a PSCs to the CSC for thrombectomy when diagnosed with LVO in terms of temporal sequences and clinical outcomes. The crucial aspect of the concept is that the patient is not transferred for the intervention but is treated on site and the cardiologist actively starts the intervention while the neurointerventionalist rushes to the site as soon as possible. Results Patients treated on-site at the PSC as part of the Rendez-Vous approach were managed as successfully and without an increase in complication rates compared with patients treated secondarily at a CSC (91.7% successful interventions in Rendez-Vous vs. 87.3% in control group, p=0.57). The time from diagnosis of LVO to groin puncture was reduced by 68.3 minutes with the Rendez-Vous concept (p<0.01). Regarding the clinical outcome, a functionally independent status was achieved in 37.0 % in the Rendez-Vous group and in 19.4% in the control group (p=0.012). Conclusion Interdisciplinary teamwork between cardiology and interventional neuroradiology in rural PSCs leads to shorter times to successful reperfusion in patients with severe ischemic stroke due to LVO. This has a potentially positive impact on the clinical outcome of stroke patients and should be considered as a possible care concept in similar stroke networks.Rendez-Vous concept in stroke management

Patient-centered and integrated outreach care for chronic hepatitis C patients with serious mental illness in Taiwan.

Patients with serious mental illness have a higher risk of hepatitis C virus (HCV) infection but suboptimal HCV care. The current study aimed to facilitate HCV treatment uptake by implementing an integrated outreach care model. Multidisciplinary outreach screening followed by HCV reflex testing and onsite treatment for schizophrenia patients was accomplished through the coordination of nongovernmental organizations, remote specialists, and local care providers. The objective was microelimination effectiveness, defined as the multiplication of the rates of anti-HCV antibodies screening, accurate HCV RNA diagnosis, treatment allocation, treatment completion, and sustained virological response (SVR12; no detectable HCV RNA throughout 12 weeks in the post-treatment follow-up period). A total of 1478 of the 2300 (64.3%) psychiatric patients received HCV mass screening. Seventy-three (4.9%) individuals were seropositive for anti-HCV antibodies. Of the 73 anti-HCV seropositive patients, all (100%) received HCV reflex testing, and 29 (37.7%) patients had HCV viremia. Eight patients (34.8%) had advanced liver disease, including 3 with liver cirrhosis and 2 with newly diagnosed hepatocellular carcinoma. Twenty-three of the 24 (95.8%) patients who stayed in the healthcare system received and completed 8 weeks of glecaprevir/pibrentasvir treatment and post-treatment follow-up without significant DDIs or adverse events. The SVR12 rate was 100%. The microelimination effectiveness in the current study was 61.6%. Individuals with serious mental illness are underserved and suffer from diagnostic delays. This patient-centered and integrated outreach program facilitated HCV care in this marginalized population.

Insights into the adsorption of perfluoroalkyl substances (PFASs) on excess sludge from an on-site leachate treatment plant

The disposal and reduction of excess sludge is one of the most challenging aspects of wastewater treatment. Recycling excess sludge as functional materials is an innovative approach that has garnered broad attention, as it can address environmental concerns and reduce the consumption of valuable materials. However, this approach is still challenging due to the low mixed liquor suspended solids in sewage treatment plants and the high synthesis costs involved. In this study, we proposed the application of excess sludge from an on-site leachate treatment plant for the efficient removal of perfluoroalkyl substances (PFASs) from wastewater. A simple thermal treatment was conducted and the obtained sludge-based adsorbents enable effective PFASs removal. Through the use of low field nuclear magnetic resonance and structural characterizations, results demonstrated that denitrifying sludge had higher hydrophobicity and specific surface area (30.85 m2/g) than nitrifying sludge, resulting in enhanced PFASs adsorption capacity and initial adsorption rates. Kinetic and isotherm simulations indicated that the adsorption was efficient and controlled by surface and intraparticle diffusion. Characterization and regulation results showed that the adsorption was dominated by hydrophobic and electrostatic interactions. These findings suggest a promising recycling approach of excess sludge while elucidating the dominant mechanisms involved.

Evaluation of ecotechnology performance in treating textile wastewater: constructed treatment wetlands and natural adsorbents

The development of environmentally friendly technology for water ecosystem rehabilitation has become a challenge in solving pollution control problems in water bodies. Ecotechnology is a technology to improve water quality using an ecosystem approach, including the technology of constructed treatment wetlands and natural adsorbents. This study aims to produce an alternative ecotechnology for textile industrial waste remediation, on-site treatment of water bodies contaminated with textile waste, using a constructed treatment wetlands system and natural adsorbents. The result was conducted for 6 months using a reactor on a pilot scale with a continuous system. The result showed that CTWs’ ability effectively reduced ammonia in textile wastewater with a 20% dilution of up to > 80% and > 90% respectively using plants Vetiveria zizanioides and Heliconia psittacorum. Meanwhile, at 50% textile wastewater dilution, CTW with Heliconia psittacorum was more effective in reducing ammonia (> 80%) than CTW with Vetiveria zizanioides (> 60%). CTW with Vetiveria zizanioides and Heliconia psittacorum was able to reduce the dye content up to < 69.68% and < 54.39%, respectively. The natural adsorbent ability of bentonite has a higher ability to reduce dyes and ammonia, which is up to < 64.84% and < 91.12%. Good performance in these two eco-technology systems will result in better waste disposal by combining these two systems into one ecotechnology system.

Development of data-driven models for the optimal design of multilayer sand filters for on-site treatment of greywater

Greywater, with limited content of pathogens, makes up more than half of the produced wastewater in urban areas. Given the high cost of wastewater management and treatment, it causes sense to collect greywater separately at the source and employ an on-site treatment system to increase opportunities for on-site water reuse. For this purpose, this paper aims to propose a multilayer granular filter as an inexpensive and simple on-site treatment method for greywater reuse. Furthermore, as determining the optimal structure of multilayer filters is a serious challenge, a simulation-optimization model is developed for determining the best filter configuration. An Artificial Neural Network (ANN) is trained based on experimental results to simulate the filter performance with different combinations of layers and the Genetic Algorithm (GA) is used to find the optimal thickness of different layers based on ANN simulation results. The proposed filter in this paper for greywater treatment consists of silica sand (in three different gradings) and activated carbon (with fixed grading) and treatment measures for evaluation of filter performance are considered as Chemical Oxygen Demand (COD) and Electrical Conductivity (EC). Due to difficulties in collecting, transferring, and storing the real greywater, synthetic greywater was used in this study. 49 experiments with different combinations of filter media thicknesses were performed and the performance of the filter was analyzed. Generally, three-layer filters perform better in COD and EC reduction, however, the average COD and EC elimination equals 36.3% and 15.1%, respectively, which indicates more efficiency of filter in COD reduction in comparison with EC. Based on the optimization-simulation model and experimental results, a filter consisting of 33 cm of fine sand, 20 cm of activated carbon, and 7 cm of medium sand results in the maximum efficiency and can reduce the COD and EC of greywater by 72% and 30%, simultaneously. According to the optimization outputs, the ideal filter can treat greywater up to having EC of 1000 μS/cm and COD of 321 mg/L, which is generally suitable for irrigation purposes.

Modeling the effect of improved sewage disposal rates on ecological status for aquatic organisms in Japan

Improving sewage disposal rates is an important policy for maintaining the health of aquatic organisms in river environments. In Japan, the rate is not yet 100 %. Two measures are necessary to eliminate the discharge of untreated greywater: (1) increase the number of households connected to sewage lines in areas with sewage systems, and (2) replace single-type household onsite wastewater treatment systems (OWTSs) with combined-type systems. To estimate the effect of improving the disposal rate on river water quality, we developed a hydrology-based organic pollution assessment model with a gridded spatial resolution of 250 m to estimate the biochemical oxygen demand (BOD) in rivers in Gunma Prefecture, Japan. We considered three scenarios based on the sewage disposal rate of 70.5 % in 2015. In Scenario A, the disposal rate is increased to 75.2 % in 2030 by increasing the connection rate to sewage lines. In Scenario B, the rate is increased to 88.2 % in 2030 through additional progress in converting from single-to combined-type OWTSs. In Scenario C, the rate reaches 100 % by 2040. The ecological status of rivers was evaluated using taxon richness of Ephemeroptera, Plecoptera, and Trichoptera estimated from its reported relationship to BOD. The number of sites in Gunma Prefecture polluted by organic waste classified as III (poor) and IV (very poor) was estimated to be 1610 under the present state (2015) and decreased to 1212 (25 % reduction) in Scenario A, 619 (62 % reduction) in Scenario B, and 50 (97 % reduction) in Scenario C, with the improvements mainly in small branch rivers. The effects of improved disposal rates were mainly evident in areas with relative high population densities using single-type OWTSs outside of areas with a sewage system, and measures taken in these areas were shown to be effective.

Evaluation of newly designed flushing techniques for on-site remediation of arsenic-contaminated excavated debris.

Excavated debris (soil and rock) contaminated with geogenic arsenic (As) is an increasing concern for regulatory organizations and construction stakeholders. Chelator-assisted soil flushing is a promising method for practical on-site remediation of As-contaminated soil, offering technical, economic, and environmental benefits. Ethylenediaminetetraacetic acid (EDTA) is the most prevalent chelator used for remediating As-contaminated soil. However, the extensive environmental persistence and potential toxicity of EDTA necessitate the exploration of eco-compliant alternatives. In this study, the feasibility of the conventional flushing method pump-and-treat and two newly designed immersion and sprinkling techniques were evaluated at the laboratory scale (small-scale laboratory experiments) for the on-site treatment of As-contaminated excavated debris. Two biodegradable chelators, L-glutamic acid-N,N'-diacetic acid (GLDA) and 3-hydroxy-2,2'-iminodisuccinic acid (HIDS), were examined as eco-friendly substitutes for EDTA. Additionally, this study highlights a useful post-treatment measure to ensure minimal mobility of residual As in the chelator-treated debris residues. The pump-and-treat method displayed rapid As-remediation (t, 3h), but it required a substantial volume of washing solution (100mLg-1). Conversely, the immersion technique demonstrated an excellent As-extraction rate using a relatively smaller washing solution (0.33mLg-1) and shorter immersion time (t, 3h). In contrast, the sprinkling technique showed an increased As-extraction rate over an extended period (t, 48h). Among the chelators employed, the biodegradable chelator HIDS (10mmol L-1; pH, 3) exhibited the highest As-extraction efficiency. Furthermore, the post-treatment of chelator-treated debris with FeCl3 and CaO successfully reduced the leachable As content below the permissible limit.

Model parameter sensitivity and identifiability for urban river water quality: impact of domestic wastewater discharges from on-site treatment facilities

Abstract River water quality degradation is a risk to human health. Hence, many water quality models have been developed to predict the future states of water bodies and understand how the current water treatment systems will respond to future pollution loads and climatic drivers. A Japanese river was evaluated with the River Water Quality Model No.1 (RWQM1), and parameter sensitivity and identifiability analyses were executed on the model output using parameter sensitivity ranking, collinearity index, and Fisher Information Matrix-derived criterion. Among RWQM1 kinetic parameters, those related to hydrolysis, growth of aerobicheterotrophs, and first-stage nitrifiers were the most influential. Reactive soluble organic substances included in untreated gray waters, in addition to a prevalence ratio of the most advanced on-site treatment facility, strongly contributed to the model output variability. A remediation analysis revealed that a renewal to the most advanced on-site treatment facility by 20% increment was almost equivalent to the 70% decrease in the effluent concentration from an on-site treatment facility producing the highest pollutant load in terms of a BOD concentration decrease in the stream. This study provided baseline data assisting in policy implementation regarding the management of effluents from on-site treatment facilities.

Effect of slaughterhouse waste on sewage channel

The meat producing sector are among primary users of global freshwater resources within the sector of agriculture and livestock. Processing of meat facilities known as MPP’s generate substantial volumes of wastewater during both the slaughtering process and facility cleaning. This wastewater, referred to as slaughterhouse wastewater (SWW), requires substantial treatment to ensure safe and environmentally friendly discharge because it contains high levels of organic materials and proteins. As a result, SWW treatment and disposal are crucial for maintaining public health. In that chapter, we study about the regulatory system pertinent management of slaughterhouse wastewater (SWW), its environmental ramifications, health implications, and the distinctive attributes of slaughterhouse waste. Due to the varying pollutant levels resulting from the type and quantity of killed flora and fauna, which can change within the meat industry, SWWs are typically assessed through bulk parameters. The characteristics of SWW, such as Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD), and Total Suspended Solids (TSS), are key pollutant affecting sewage system. When SWW combines with the sewage system, it adds to the burden on both the sewage network and sewage treatment plants (STP). Therefore, employing on-site treatment utilizing integrated processes emerges as the optimal approach for treating and disinfecting slaughterhouse effluents, ensuring their safe discharge into receiving waters.

Vertical flow constructed wetlands as green facades and gardens for on-site greywater treatment in buildings: Two-year mesocosm study on removal performance

This study focuses on the performance and clogging of vertical flow constructed wetlands (VFCWs) planted with climbing ornamentals and ornamental plants for greywater treatment, after two years of operation at mesocosm level. Different substrate (sand, vermiculite) and vegetation (Trachelospermum jasminoides, Lonicera japonica, Callistemon laevis) types were evaluated to determine the optimal removal of pollutants. Results revealed that, during the second year of operation, removal efficiencies of turbidity and COD were significantly higher (1st year: 54–94 %; 71–89 %, 2nd year: 82–98 %; 86–95 %, respectively) for both studied planted substrates, compared to the first year. Moreover, it was found that sand systems from each studied plant as well as from the unplanted systems, were more effective compared to vermiculite for most of the studied parameters (turbidity, TSS, COD, anionic surfactants, pathogens). Sand systems were also quite effective in removing total coliforms (5 log reduction) and Escherichia coli (4 log reduction). At the end of the two-year experiment, all planted systems with sand had significantly higher hydraulic conductivity than the unplanted ones. With reference to evapotranspiration, even though planted systems had significantly higher losses, C. laevis systems demonstrated less water losses than the other vegetated systems. According to the findings, the studied plants managed to continue growing without facing added stress. Therefore, the application of climbing and ornamental plants in VFCWs for greywater treatment in buildings seems a promising option for developing green infrastructures in urban areas and enhancing the removal efficiency of such systems.

Therapeutic potential of traditional Chinese medicine on heat stroke.

As global warming progresses, heat waves are becoming increasingly frequent and intense, meanwhile the incidence of heat stroke (HS) has increased sharply during the past decades. HS is typically associated with significant morbidity and mortality, and there is an urgent need for further research to solve this difficult issue. There currently exists difficulties regarding on-site emergency treatment methods and limited in-hospital treatment approaches, and better treatments are required as soon as possible. Theories and therapies from various traditional Chinese medicine (TCM) academic groups have been widely reported. Therefore, an exploration of prevention and protection methods should consider TCM experiences as an alternative. This article primarily reviews TCM herbal therapies and external therapies that have been described in various clinical reports and demonstrated in relevant studies. Herbal therapies, including herbal formulas, Chinese patent medicines (CPMs), single Chinese herbs, and associated extracts or monomers, are summarized based on the shared perspectives of the underlying mechanisms from TCM. In addition, external therapies including acupuncture, bloodletting, cupping, Gua sha and Tui na that have rarely been rarely mentioned and considered in most cases, are introduced and discussed to offer a unique perspective in the search for novel interventions for HS. In summary, TCM may provide abundant potential clinical benefits and research directions in the fight against HS.

Impact of an Interprofessional HIV Quality Improvement Team on Patient Care and Resident Learning Opportunities.

Although human immunodeficiency virus (HIV) care is a recommended competency for family medicine training, many programs report a lack of HIV expertise among faculty. After the departure of faculty with HIV care experience, an interprofessional HIV quality improvement team (HIV-QIT) of physicians and pharmacists aimed to maintain on-site HIV care and retain learning opportunities for residents, using process improvement and panel reviews with a remote HIV specialist faculty member. This study reports on a multicycle quality improvement pilot project with pre- and postintervention chart reviews between December 2019 and May 2021. All patients received primary care and HIV-QIT chart reviews on-site. We compared patients with integrated HIV care on-site to those receiving external HIV specialty care. Primary outcomes included virologic suppression, CD4 count ≥200 cells/mm3, and adherence to guideline-recommended HIV care. In cycle 1 (January-June 2020), the HIV-QIT reviewed patient charts and sent guideline-based recommendations to physicians. In cycle 2 (July 2020-May 2021), the HIV-QIT implemented several HIV-specific processes, including decision support updates, note templates, order sets, and reference materials. Sustained process improvements included HIV panel chart audits every 3 to 6 months and subsequent provider education. Of 29 patients, more than half (55%, n=16) received integrated HIV care at the primary care site. We found no significant difference in care quality measures between primary and specialty care. Barriers to care completion included missed or canceled follow-up visits, on-site phlebotomy service closures, and declined HIV services. The HIV-QIT maintained on-site HIV treatment and retained experiential learning opportunities through process improvement and specialist-supported care recommendations to primary care physicians.

Onsite treatment of wastes in municipal waste incinerator: Co-sintering of fly ash and leachate sludge into value-added ceramic granule

The leachate sludge (LS) and fly ash (FA) are the foci of hazardous wastes which generated from the municipal solid waste incineration (MSWI). The current work developed a new way to use energy from MSWI process for the on-site sintering of LS and FA at a relatively low temperature. With the assistance of CaF2, granule of LS and MSWI FA were co-sintered. The influence of temperature, the mass of CaF2, and the mass ratio of LS/MSWI FA were investigated. As a result, heavy metals volatilization and leaching in the form of chlorinated salts were controlled. In addition, CaF2 improved the compressive strength of the granule under low-temperature sintering. Moreover, the scale-up co-sintering test was achieved in an MSWI chamber. The results showed that the optimum condition was sintering at 973K for 1 h. The compressive strength of sintered product reached 4.25 MPa, which met the standard of ceramic granule. Moreover, with the addition of CaF2, the volatilization rate of Pb, Zn, and Cd decreased by 6%, 7%, and 6%, respectively. This method can be a promising technique for the utilization of solid wastes.

Microbial hazards in real-world alternating dual-pit latrines treated with storage and lime in rural Cambodia

Abstract Achieving safely managed sanitation (SMS) in rural areas has spurred innovation in toilet designs that provide on-site treatment of fecal sludge (FS), including the development of International Development Enterprise (iDE)’s alternating dual-pit latrine upgrade (ADP). ADPs treat FS by inactivating pathogens using storage treatment with lime; however, ADPs’ reduction in pathogenicity (and thus their associated public health benefit) has not yet been described in real-world pits at scale. We thus enumerate the fecal indicator bacteria Escherichia coli (E. coli) and fecal coliforms in 147 pits after two years of storage treatment with lime and compare detected concentrations to relevant standards. E. coli and fecal coliform concentrations indicated a risk to human health in 31% and 42% of sampled pits, respectively. Regression models described relationships between fecal indicator bacteria concentrations and measured factors (e.g., sludge pH, temperature) but did not reveal any meaningful associations. High rates of pit ineligibility also indicate that many ADPs are not operated as recommended. Results indicate a one-in-three chance that a household emptying their own pit would be exposed to health hazards and call into question the effectiveness of the standard two-year storage treatment in real-world applications. To improve rural SMS, various evidence-based recommendations are made.

Free-floating extracellular DNA (exDNA) in different wastewaters: Status quo on exDNA-associated antimicrobial resistance genes

Wastewater treatment plants (WWTPs) have been reported as major anthropogenic reservoirs for the spread of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) into the environment, worldwide. While most studies mainly focus on the intracellular DNA (iDNA), extracellular DNA (exDNA) accounting for a significant proportion of the total DNA in wastewater, was usually neglected. Following the One Health approach, this study focuses on wastewaters of municipal, clinical, and livestock origins (n = 45) that undergo different treatment processes (i.e., conventional activated sludge, ultrafiltration, and ozonation). Water samples were analysed for 12 ARGs as indicators of the different compartments associated with iDNA and exDNA by quantitative real-time PCR (qPCR). Taxonomic profiling of exDNA-fractions, obtained using nucleic acid adsorption particles, was conducted by sequencing the V3–V4 hypervariable regions of the 16S rRNA gene. Notified exDNA concentrations varied between on-site WWTPs and treatment stages, and ranged from 314.0 ± 70.2 ng/mL in untreated livestock wastewater down to 0.7 ± 0.1 ng/mL in effluents after ultrafiltration. In general, influents exhibited higher concentrations compared to effluents, while wastewater treated by advanced treatment processes (i.e., ultrafiltration and ozonation) showed the lowest exDNA concentrations. Despite the lower concentrations, free-floating exDNA accounted for up to 80.0 ± 5.8% of the total DNA in effluents. Target ARGs were more common in the iDNA (100%, n = 45/45), compared to the exDNA-fractions (51.1%, n = 23/45), whereas exDNA-ARGs were mostly detected in clinical and slaughterhouse wastewaters as well as in the municipal influents. Compared to the iDNA-ARGs, the concentrations of exDNA-ARGs were in general lower. Nevertheless, significant higher concentrations for exDNA-associated genes were measured in clinical wastewaters for blaNDM (4.07 ± 0.15 log gene copies (GC)/L) and blaVIM-2 (6.0 ± 0.2 log GC/L). Overall, our results suggest that depending on the origin of wastewater and its treatment methods, exDNA represents an important reservoir for ARGs, particularly in clinical wastewater.