On the performance of a pilot hybrid constructed wetland for stormwater recovery in Mediterranean climate.

The overall efficiency of a pilot-scale hybrid constructed wetland (H-CW), located on a retail store's parking area in Eastern Sicily, for alternative treatment of stormwater runoff and of sequential batch reactor (SBR) effluent was evaluated. Experimental activities were focused on system performances, including wastewater (WW) quality and hydraulic monitoring. System design, macrophyte growth and seasonal factors influenced the pilot plant performance. Very high removal efficiency for microbial indicators were reported within the subsurface horizontal flow unit (HF), playing a strategic role for Clostridium perfringens. The algal growth occurred in the free water surface (FWS) unit and inhibited removal efficiencies of total suspended solids (TSS), biochemical oxygen demand (BOD5) and chemical oxygen demand (COD), impairing water quality. The whole H-CW showed good efficiency in trace metals removal, especially for Pb, Zn, and Cu. Preliminary results suggested the reliability of the H-CW technology in decentralised water treatment facilities for enhancing water recovery and reuse.

Hydraulic reliability of a horizontal wetland for wastewater treatment in Sicily.

The purpose of this study was to evaluate how the hydraulic behavior of a horizontal subsurface wetland (HF), that is part of the hybrid wetland (hybrid-TW) of the IKEA® store in Eastern Sicily (Italy), influences the overall wastewater treatment performance. The HF unit experiences frequent overloading peaks due to the extreme variability in the number of visitors at the store, and after 2 years of operation it showed signals of partial clogging at the inlet area. The hydraulics of the HF unit has been monitored through measurements of hydraulic conductivity at saturation (Ks), tracer tests, and geophysical (i.e. electrical resistivity tomography-ERT) measurements carried out during the years 2016 and 2017. Results indicated a general good agreement between the performed measurement techniques, thus their combination, if adequately performed and calibrated, might be a reliable tool for detecting those wetland areas mainly affected by clogging conditions. The results also indicated that partial clogging had no significant effect on the quality of the discharged water.

Assessing environmental impacts of constructed wetland effluents for vegetable crop irrigation.

The objective of this study was to monitor and assess environmental impacts of reclaimed wastewater (RW), used for irrigation of vegetable crops, on soil, crop quality and irrigation equipment. During 2013, effluents of a horizontal sub-surface flow constructed treatment wetland (TW) system, used for tertiary treatment of sanitary wastewater from a small rural municipality located in Eastern Sicily (Italy), were reused by micro-irrigation techniques to irrigate vegetable crops. Monitoring programs, based on in situ and laboratory analyses were performed for assessing possible adverse effects on water-soil-plant systems caused by reclaimed wastewater reuse. In particular, experimental results evidenced that Escherichia coli content found in RW would not present a risk for rotavirus infection following WHO (2006) standards. Irrigated soil was characterized by a certain persistence of microbial contamination and among the studied vegetable crops, lettuce responds better, than zucchini and eggplants, to the irrigation with low quality water, evidencing a bettering of nutraceutical properties and production parameters.

Reuse of constructed wetland effluents for irrigation of energy crops.

The aim of this study was to evaluate biomass production of promising 'no-food' energy crops, Vetiveria zizanoides (L.) Nash, Miscanthus × giganteus Greef et Deu. and Arundo donax (L.), irrigated with low quality water at different evapotranspiration restitutions. Two horizontal subsurface flow (H-SSF) constructed wetland (CW) beds, with different operation life (12 and 6 years), were used to treat secondary municipal wastewaters for crop irrigation. Water chemical, physical and microbiological parameters as well as plant bio-agronomic characters were evaluated. The results confirm the high reliability of CWs for tertiary wastewater treatment given that the H-SSF1 treatment capacity remained largely unchanged after 12 years of operation. Average total suspended solids, chemical oxygen demand and total nitrogen removal for CWs were about 68, 58 and 71%, respectively. The Escherichia coli removal was satisfactory, about 3.3 log unit for both CW beds on average, but caution should be taken as this parameter did not achieve the restrictive Italian law limits for wastewater reuse. The average above-ground dry matter productions were 7 t ha⁻¹ for Vetiveria zizanoides, 24 t ha⁻¹ for Miscanthus × giganteus and 50 t ha⁻¹ for Arundo donax. These results highlight attractive biomass yield by using treated wastewater for irrigation with a complete restitution of evapotranspiration losses.

Hydraulic behaviour and removal efficiencies of two H-SSF constructed wetlands for wastewater reuse with different operational life.

This work focuses on the performance evaluation of two full-scale horizontal suburface flow constructed wetlands (H-SSF CWs) working in parallel, which have an almost equal surface area (about 2,000 m2) but with different operational lives: 8 and 3 years. Both H-SSF CWs, located in Southern Italy (Sicily), are used for tertiary treatment of the effluent of a conventional wastewater treatment plant. This study evaluates and compares H-SSF CW efficiency both in terms of water quality improvement (removal percentage) and achievement of Italian wastewater discharge and irrigation reuse limits. The mean removal percentage, for the overall operational life, of TSS, COD and BOD (80%, 63%, 58% obtained for H-SSF1 and 67%, 38%, 41% for H-SSF2), confirm the high reliability of CWs for wastewater treatment. However, despite the satisfactory removal of microbial indicators (the mean E. coli removal was up to 2.5 log unit for both beds), CWs didn't achieve the Italian limits for wastewater reuse. Information on hydraulic properties of the CWs were extracted from breakthrough curves of a non-reactive tracer (NaCl). By comparing the nominal (tau(n)) and actual residence time (tau), hydraulic behaviour was revealed.

[Forensic implications and stress ina group of anaestheticians: a cross sectional study]. / Contenzioso medico-legale e stress: indagine in un gruppo di anestesisti.

Aim of the study is the appraisal of stress in a group of the 500 anaestheticians and in a control group. Two anonymous self-administered questionnaires were utilized, one for the subjective appraisal of the perceived various risk related to job, and one for the subjective appraisal of stress: VRS questionnaire of Tarsitani and Biondi. The results of the study showed that all the anaestheticians identified the perception of the emotional aspects related to work as a risk factor. They put it mainly in relation with the forensic implications. The total score of scale VRS and the score for cluster depression, anxiety, aggressiveness are higher in the anesthetists than the control group.

Wastewater quality improvement through storage: a case study in Sicily.

This paper presents the results of a research aiming at evaluating the effects of storage on wastewater characteristics. Wastewater discharged from the Caltagirone (Eastern Sicily) plant after secondary treatment was stored in an earth reservoir with a capacity of about 25,000 m3 and a depth of 5 m. Wastewater inflow in the reservoir was continuous throughout the experimental activities, while discharge was discontinuous, depending on irrigation demand. Removal efficiency resulted highly influenced by the operation regime of the reservoir and by influent wastewater characteristics. BOD5 and COD removal efficiency was above 50%. Removal efficiency of faecal coliforms, faecal streptococci and Escherichia coli was between 2 and 5 log units. Single and multiple regressions were tested to determine the reservoir design characteristics and operation parameters that most significantly affected water quality changes.

Wastewater reuse in Italy.

In many parts of Italy, particularly in the South, it has become ever more difficult to meet the water demand. The recent years of drought and the constant increase of water demand for the civil sector have made irrigation supply more problematic. Wastewater reuse could represent a viable solution to meet water demand. The focus of this paper is on the regulation problems, hampering the development of wastewater reuse for irrigation, and on the potentials for reuse, particularly in Southern Italy. Planned exploitation of municipal wastewater could help meeting the irrigation water demand particularly in Southern Italy, where farmers have been practising uncontrolled wastewater reuse for a long time. In Northern and Central Italy, where available water resources generally meet water needs for different purposes, wastewater reuse could play an important role in controlling the pollution of water bodies. Despite the fact that Italian legislation is extremely strict and outdated, for several years in some regions, such as Sicily, wastewater reuse systems have been in operation; furthermore, several projects of wastewater reuse are currently in progress.

Biochemical, histomorphometric and densitometric changes in patients with multiple myeloma: effects of glucocorticoid therapy and disease activity.

It is unknown whether bone changes which can occur in multiple myeloma (MM) are due to cytokine-induced osteoclastic bone resorption from a clone of abnormal plasma cells or high-dose glucocorticoid therapy. We studied 25 MM patients treated for 1-12 years with combination chemotherapy, subdivided into two groups. Group 1 consisted of 12 patients with stage I and II myeloma and group 2 consisted of 13 patients with stage III MM. Their serum biochemistry, tetracycline-labelled bone histomorphometry and bone densitometry were compared to age- and sex-matched controls. Patients with MM demonstrated increased indices of bone resorption (P < 0.001 versus controls) and, to a lesser extent, increased indices of bone formation (P < 0.01 versus controls). No patient had evidence of a mineralization defect. Lumbar spine, femoral neck and total body bone mineral density measurements (BMD) were significantly lower in group 2 compared with group 1 (P < 0.05). Following 12 months of therapy, lumbar spine BMD decreased by 6.6% (95% CI, 2.7% to -9.3%) and femoral neck BMD decreased by 9.5% (95% CI, -3.2% to -15.9%). In a stepwise regression analysis, cumulative prednisolone dosage (B Coef. = -0.39; P = 0.03) and plasma cell infiltrate (B Coef. = -0.08; P = 0.05) were the most important predictors of lumbar spine bone loss, whereas serum paraprotein (B Coef.= -0.35; P = 0.02) and plasma cell infiltrate (B Coef. = -0.20; P = 0.04) were the most important predictors of femoral neck bone loss. We conclude that MM is characterized by high bone turnover with osteoblast-osteoclast uncoupling. Both disease activity and high-dose glucocorticoid therapy may be responsible for the ongoing bone loss seen with MM.

Measurement of periprosthetic bone density in hip arthroplasty using dual-energy x-ray absorptiometry. Reproducibility of measurements.

To define the precision (reproducibility) of measurement of periprosthetic bone mineral density and bone mineral content, dual-energy x-ray absorptiometry scans were obtained on 45 randomly selected patients who had had a unilateral total hip arthroplasty within the previous 3 years. The coefficients of variation of the bone mineral density in the proximal Gruen zones were 5.0 and 5.3%, corresponding to errors of 0.07 and 0.11 g/cm2. The coefficients of variation of the bone mineral density for the distal zones averaged 2.8%, with an error of 0.08 g/cm2. The coefficients of variation of the bone mineral content were 4.8 and 2.9% for the proximal and distal zones. The contralateral femur was also scanned in 32 of the patients. For the contralateral femur bone mineral density, the coefficients of variation were 5.0% for the proximal zones and 4.8% for the distal zones. The bone mineral content was 6.0% for the contralateral regions. These results imply that differences in bone mineral density greater than 0.16 g/cm2 (2 standard errors) can be reliably measured. Dual-energy x-ray absorptiometry therefore provides a highly reproducible technique for quantitatively monitoring the changes in bone density that occur after total hip arthroplasty.

Colon transit scintigraphy using oral indium-111-labeled DTPA. Can scan pattern predict final diagnosis?

Colon transit scintigraphy (CTS) was performed in 100 consecutive patients with idiopathic constipation using oral indium-111-labeled DTPA. Criteria were defined to allow classification of studies as normal, slow transit constipation (STC), or obstructed defecation (OD). Results were compared with final clinical diagnosis in 100 and findings of defecating proctography in 70. Of those with a scintigraphic diagnosis of STC, this was also the final diagnosis in 75% (33 of 44), and the scintigraphic diagnosis of OD was confirmed in 61% (17 of 28). Of 28 normal or equivocal scans, the final diagnosis was STC in only two (4%) but OD in 10 (21%). Fifty-four percent of patients with STC and 71% with OD had abnormal proctograms. The correlation between CTS and proctography was mediocre, occurring in 54% of patients. CTS has a valuable role in the diagnostic work-up of patients with idiopathic constipation.

Cyclical etidronate plus ergocalciferol prevents glucocorticoid-induced bone loss in postmenopausal women.

OBJECTIVE: To assess the benefit of cyclical etidronate plus ergocalciferol for the prevention of glucocorticoid-induced bone loss in a 2-year, prospective, open study based in an osteoporosis clinic. PATIENTS AND METHODS: Group 1 consisted of 15 postmenopausal women (mean age 62.6 +/- 3.3 years) who commenced glucocorticoid therapy and were treated with cyclical etidronate (400 mg/d for the first month; thereafter, 400 mg/d for 2 weeks of every 3-month period), elemental calcium (1 g/d), and ergocalciferol (0.5 mg/wk). Group 2 consisted of 11 postmenopausal women (mean age 60.2 +/- 4.7 years) with glucocorticoid-induced osteoporosis, who were attending the clinic at the same time and were treated with calcium supplements only (1 g/d). MEASUREMENTS: Lumbar spine and femoral neck bone mineral densities (BMD) were measured at baseline and after 12 and 24 months of glucocorticoid therapy using a dual energy x-ray absorptiometer. RESULTS: The two groups did not differ with respect to age, years since the menopause, mean daily glucocorticoid dose, and baseline BMD values. During the first year of therapy, mean lumbar spine BMD increased from an initial value of 0.88 g/cm2 to 0.94 g/cm2, an increase of 7% per year (95% confidence interval [CI] 3.7% to 10.2%; P < 0.001 compared with controls). Significant increases in BMD of 2.5% per year were also observed in the femoral neck (95% CI -1% to 6%; P < 0.01 compared with controls). After the second year of cyclical etidronate therapy, femoral neck BMD continued to increase (P < 0.05 compared with value at 12 months), while lumbar spine BMD remained stable. CONCLUSION: Chronic glucocorticoid therapy may result in bone loss at most skeletal sites. Therapy with cyclical etidronate plus ergocalciferol not only prevented glucocorticoid-induced bone loss, but even increased lumbar spine and femoral neck BMD in postmenopausal women commencing glucocorticoid therapy.

Oral colon transit scintigraphy using indium-111 DTPA: variability in healthy subjects.

Oral colon transit scintigraphy using indium-111 diethylene-triamine-pentaacetic acid was performed in 41 healthy subjects (22 females, 19 males) to determine variability with age and sex and to define normal ranges. Repeat studies were performed in 10 females and 9 males to assess intra-subject variability. Females showed slightly but significantly slower colonic transit than men and slightly greater intra-subject variability. There was no correlation between age and colonic transit. The results have implications for the definition of normal ranges.

Niacin-positive Mycobacterium kansasii isolated from immunocompromised patients.

Niacin-positive Mycobacterium kansasii was isolated from three patients, two with respiratory infections and one with a perirectal abscess. The isolates were phenotypically similar to other strains of M. kansasii, differing only in their ability to produce niacin. This phenotype has been reported only twice in the literature, during the 1960s.

Comparison of oral iodine-131-cellulose and indium-111-DTPA as tracers for colon transit scintigraphy: analysis by colon activity profiles.

In 11 normal subjects and 11 patients with a clinical diagnosis of constipation, oral 131I-cellulose and 111In-DTPA were compared simultaneously as tracers for radionuclide colon transit scintigraphy. Visual assessment of the images revealed no differences between tracers. Quantitation was performed using total and segmental percent retention and the derived value of clearance half-time. In addition, profiles of the activity distribution along the length of the colon were generated and the mean position of the activity in the colon calculated. For all indices, the results were similar in both normal subjects and constipated patients when comparing tracers, although marked differences were present between normal subjects and constipated patients for each tracer. Indium-111-DTPA was easy to administer and dosimetry was more acceptable than for 131I-cellulose, especially in constipated patients. It is concluded that 111In-DTPA is the preferred tracer for oral colon transit scintigraphy.

DNA probe culture confirmation assay for identification of thermophilic Campylobacter species.

We studied the ability of a new DNA probe-based assay system to correctly identify isolates of the thermophilic campylobacters Campylobacter jejuni, C. coli, and C. laridis grown in vitro. We examined 424 organisms, including 214 Campylobacter isolates and 210 other aerobic and anaerobic isolates. The probe assay, which uses a new homogeneous system in which all reactions take place within a single tube, demonstrated 100% accuracy, producing neither false-positive nor false-negative results. The assay does not, however, distinguish among C. jejuni, C. coli, and C. laridis.

Colon transit scintigraphy in health and constipation using oral iodine-131-cellulose.

The purpose of the study was to assess if a new scintigraphic method for noninvasive assessment of colonic transit could differentiate between subjects with normal bowel transit and those with constipation. Eleven normal subjects and 29 constipated patients were given 4 MBq iodine-131-cellulose (131I-cellulose) orally and sequential abdominal scans were performed at 6, 24, 48, 72, and 96 hr from which total and segmental percent retentions were calculated. There were clear differences between the normal subjects and the constipated patients for the total percent retention at all time intervals, on a segmental basis in the right colon at 24 hr, and in all segments at 48 and 72 hr. Three-day urinary excretion of radioiodine was minimal; 2.4% +/- 1.2% (mean +/- s.d.) in constipated patients and 3.1% +/- 0.8% in normals, with approximately 75% occurring in the first day. The use of oral radiotracers in the investigation of constipation appears promising.

Culture confirmation of Campylobacter spp. by latex agglutination.

A commercial latex agglutination test [Meritec-Campy (jcl), Meridian Diagnostics, Cincinnati, Ohio] was evaluated for identification of Campylobacter jejuni, C. coli, C. laridis, and other Campylobacter isolates. The test had 100% sensitivity in detecting C. jejuni and C. coli but low sensitivity with C. laridis isolates. C. upsaliensis strains reacted with the test. The test had 100% specificity for 101 non-Campylobacter organisms.

Detection of Neisseria gonorrhoeae in cervical swabs using the Gonozyme enzyme immunoassay. Clinical evaluation in a university family planning clinic.

The authors performed a prospective clinical evaluation of the Gonozyme (Abbott Laboratories, Chicago, IL) assay in a family planning clinic population. One thousand five hundred eighty-eight female patients were screened for gonococcal infection using culture and Gonozyme assay. One hundred nine patients were culture positive (6.9% disease prevalence). The sensitivity and specificity of the Gonozyme assay in this setting was 87.2% and 89.1%, respectively. The predictive value of a positive and negative test, given a disease prevalence of 6.9%, was 37.2% and 98.9%, respectively. The false-positive and false-negative rate was 10.9% and 12.8%, respectively. The authors prospectively followed patients with true-positive and false-positive Gonozyme results. The Gonozyme test showed a 83% correlation with test of cure cultures and, thus, should not be used for test cure analysis. False-positive Gonozyme tests could not be explained on the basis of cross-reacting bacteria or detection of vancomycin-sensitive gonococci. The authors' results suggest that the Gonozyme test should not be used in lieu of culture in a clinical setting with a similar population.

PIP: The authors performed a prospective, clinical evaluation of the Gonozyme assay in a family planning clinic population. 1588 female patients were screened for gonococcal infection using culture and Gonozyme assay. 109 patients were culture positive (6.9% disease prevalence). The sensitivity and specificity of the Gonozyme assay in this setting was 87.2% and 89.1% respectively. The predictive value of a positive and negative test, given a disease prevalence of 6.9%, was 37.2% and 98.9%, respectively. The false positive and false negative rate was 10.9% and 12.8% respectively. The authors prospectively followed patients with true positive and false positive Gonozyme results. The Gonozyme test showed an 83% correlation with test of cure cultures and, thus, should not be used for test of cure analysis. False positive Gonozyme tests could not be explained on the basis of cross-reacting bacteria or detection of vancomycin sensitive gonococci. Results suggest that the Gonozyme test should not be used in lieu of culture in a clinical setting with a similar population.