Metal removal processes in a pilot hybrid constructed wetland for the treatment of semi-synthetic stormwater.

This study investigates the reliability of a pilot hybrid constructed wetland (H-CW), located in Eastern Sicily (Italy). To address the uncertainty associated with implementing representative monitoring during highly variable storm events, unique to Mediterranean conditions, a recipe for semi-synthetic stormwater was used to evaluate the removal efficiency of the system. This was characterised by metals (Cd, Cr, Fe, Pb, Cu, Zn) and relative concentrations typically found in urban stormwater runoff (SR). Approximately one month of intensive monitoring activities were carried out and quality analyses were conducted on three matrices comprising the pilot H-CW: water, biomass (Canna indica, Typha latifolia), and volcanic gravel substrate. Metal retention in early clogging matter (SS) was also examined. The results showed a significantly high H-CW efficiency for the removal of all metals (70-98%) already at the horizontal flow unit outflow, confirming its strategic role. A metal mass balance analysis was also conducted to describe the retention capacity and influence of each system component on the overall efficiency (ranging from 87.8% for Cr to 99.2% for Pb). Metal removal was mostly related to sediment and substrate processes, while plants exhibited root bioaccumulation and phytostabilisation capacity even with a limited impact on overall system retention. The pilot H-CW exhibits characteristics suitable for the treatment of metal-enriched stormwater runoff and validates the useful application of decentralised natural systems for water resource management.

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.

Assessment of clogging in constructed wetlands by saturated hydraulic conductivity measurements.

This study aims at defining a methodology to evaluate Ks reductions of gravel material constituting constructed wetland (CW) bed matrices. Several schemes and equations for the Lefranc's test were compared by using different gravel sizes and at multiple spatial scales. The falling-head test method was implemented by using two steel permeameters: one impervious (IMP) and one pervious (P) on one side. At laboratory scale, mean K values for a small size gravel (8-15 × 10-2 m) measured by the IMP and the P permeameters were equal to 19,466 m/d and 30,662 m/d, respectively. Mean Ks values for a big size gravel (10-25 × 10-2 m) measured by the IMP and the P permeameters were equal to 12,135 m/d and 20,866 m/d, respectively. Comparison of Ks values obtained by the two permeameters at laboratory scale as well as a sensitivity analysis and a calibration, lead to the modification of the standpipe equation, to evaluate also the temporal variation of the horizontal Ks. In particular, both permeameters allow the evaluation of the Ks decreasing after 4 years-operation and 1-1.5 years' operation of the plants at full scale (filled with the small size gravel) and at pilot scale (filled with the big size gravel), respectively.

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.

Economic feasibility study for intensive and extensive wastewater treatment considering greenhouse gases emissions.

Economic feasibility assessments represent a key issue for selecting which wastewater treatment processes should be implemented. The few applications that exist focus on the positive economic value of externalities, overlooking the existence of negative externalities. However, wastewater treatment plants (WWTPs) consume a significant amount of energy, contributing to climate change. In this context, as a pioneering approach, greenhouse gas emissions (GHG) have been incorporated as a negative externality of wastewater treatment. Within this framework, this study aims to compare the economic feasibility of five technologies, both intensive and extensive, for small communities. The results show that both the investment and operation costs are higher for intensive than for extensive technologies. Moreover, significant differences in the value of negative externalities were observed. This study demonstrates that from an economic perspective, constructed wetland is the most suitable option for treating wastewater in small agglomerations.

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.

Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is often associated with other chronic diseases. These patients are often admitted to hospital based rehabilitation programmes. OBJECTIVES: To determine the prevalence of chronic comorbidities in patients with COPD undergoing pulmonary rehabilitation and to assess their influence on outcome. DESIGN: Observational retrospective cohort study. SETTING: A single rehabilitation centre. PATIENTS: 2962 inpatients and outpatients with COPD (73% male, aged 71 (SD 8) years, forced expiratory volume in 1 s (FEV(1)) 49.3 (SD 14.8)% of predicted), graded 0, 1 or >/=2 according to the comorbidity categories and included in a pulmonary rehabilitation programme. MEASUREMENTS: The authors analysed the number of self-reported comorbidities and recorded the Charlson Index. They then calculated the percentage of patients with a predefined positive response to pulmonary rehabilitation (minimum clinically important difference (MCID)), as measured by improvement in exercise tolerance (6 min walking distance test (6MWD)), dyspnoea (Medical Research Council scale) and/or health related quality of life (St George's Respiratory Questionnaire (SGRQ)). RESULTS: 51% of the patients reported at least one chronic comorbidity added to COPD. Metabolic (systemic hypertension, diabetes and/or dyslipidaemia) and heart diseases (chronic heart failure and/or coronary heart disease) were the most frequently reported comorbid combinations (61% and 24%, respectively) among the overall diseases associated with COPD. The prevalence of patients with MCID was different across the comorbidity categories and outcomes. In a multiple categorical logistic regression model, the Charlson Index (OR 0.72 (96% CI 0.54 to 0.98) and 0.51 (96% CI 0.38 to 0.68) vs 6MWD and SGRQ, respectively), metabolic diseases (OR 0.57 (96% CI 0.49 to 0.67) vs 6MWD) and heart diseases (OR 0.67 (96% CI 0.55 to 0.83) vs SGRQ) reduced the probability to improve outcomes of rehabilitation. CONCLUSIONS: Most patients with COPD undergoing pulmonary rehabilitation have one or more comorbidities. Despite the fact that the presence of comorbidities does not preclude access to rehabilitation, the improvement in exercise tolerance and quality of life after rehabilitation may be reduced depending on the comorbidity.

Subsurface constructed wetlands for wastewater treatment and reuse in agriculture: five years of experiences in Sicily, Italy.

The paper reports the results of an investigation on a H-SSF constructed wetland for tertiary treatment in a small community located in eastern Sicily, Italy. The system is designed to reuse wastewater for the irrigation of olive orchards covering about 150 hectares. From March 2001 to September 2005, wastewater samples were collected and the following chemical-physical parameters were determined according to Standard Methods: temperature, pH, EC, DO, TSS (105degrees C), BOD5, COD, TN, TP. The following microbiological parameters were also evaluated: total coliforms, faecal coliforms, Escherichia coli, faecal streptococci, Salmonella, helminth eggs. Mean removal efficiencies ranged from 77 to 92% (TSS), 37 to 72% (BOD5), 51 to 79% (COD), 97 to 99.5% (E. coli). Removal efficiency of Salmonella and helminth eggs was always 100% in all samples; however, only 150% of total samples matched the limit of E. coli (< 50 CFU/100 mL) fixed by Italian legislation for wastewater reuse.

Second-line therapy of advanced ovarian cancer with GnRH analogs.

Ovarian cancer is still the first cause of death among female malignancies. The standard treatment adopted in ovarian cancer is a radical surgical treatment or cytoreduction, followed by six courses of platinum-based chemotherapy; second-line regimens are associated with severe side effects. GnRH analogs could represent an alternative therapeutical approach. The aim of our study was to evaluate the role of GnRH analogs in the management of platinum-resistant ovarian cancers. We enrolled 12 patients affected by advanced ovarian cancer, previously treated with six courses of platinum-paclitaxel. In second-line therapy, we used leuprolide on 1, 8, and 28 days of treatment. CA 125 levels were recorded for each patient. One case of clinical partial response was obtained (8.3%). Stable disease was diagnosed in three patients (25%). Progression was recorded in eight cases (66.7%). Progression-free survival was 6 months. The treatment was well tolerated by patients. The high tolerability and the results obtained with leuprolide versus platinum in second-line therapy might permit a better use of the analogs for advanced ovarian cancer.

Impact of comprehensive pulmonary rehabilitation on anxiety and depression in hospitalized COPD patients.

To prospectively evaluate the effect of inpatient pulmonary rehabilitation (iPR) on anxiety and depression as outcome measures in patients with COPD, we studied 149 consecutive adults COPD referred to our iPR after an exacerbation. Patients were divided according to the GOLD staging into: Group 1 (stage 2a, n = 48, FEV1 63 +/- 9% pred.), Group 2 (stage 2b, n = 53, FEV1 42 +/- 6% pred.) and Group 3 (stage 3, n = 48, FEV1 25 +/- 7% pred.). The iPR consisted of twelve 3-hours daily sessions. Hospital Anxiety Depression (HAD) Scale as well as 6-minute walk (6MWD) with evaluation of dyspnea (D) and leg fatigue (F) at rest and end of effort, and health related quality of life by means of St. George Respiratory Questionnaire (SGRQ) were assessed before (T0) and after (T1) the iPR. 6MWD, D and F at end of effort and SGRQ total score similarly improved (p < 0.001) in all groups after iPR. The mean level of HAD-anxiety (from 9.1 +/- 4.0 to 7.7 +/- 3.5, from 9.0 +/- 4.6 to 7.2 +/- 4.6 and from 8.1 +/- 4.1 to 6.7 +/- 4.3 in group 1,2 and 3 respectively) and HAD-depression (from 9.4 +/- 3.5 to 8.2 +/- 3.5, from 9.1 +/- 4.2 to 8.2 +/- 4.5 and from 9.0 +/- 4.0 to 7.4 +/- 4.5 respectively) similarly changed (p < 0.0001) over time in all groups. The total percentage of patients with abnormal score (> 10) of HAD-anxiety (from 31% to 21%) and HAD-depression (from 30% to 22%) significantly decreased (p < 0.05) after the iPR. Inpatient pulmonary rehabilitation may improve levels of anxiety and depression as well as symptoms, exercise capacity and health related quality of life in moderate to severe COPD patients after an acute exacerbation.

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.

[Role of the occupational physician in the management of the emergency of SARS]. / Ruolo del medico competente nella gestione dell'emergenza SARS.

The recent epidemic event related to SARS has focused the attention on an important role that the occupational doctor should play in prevention, protection and information of the workers. We would like to introduce some advices to resolve some problems that could happen in every business activity.

[Role of intestinal resection in primary cytoreduction of ovarian cancer]. / Il ruolo della resezione intestinale nella citoriduzione primaria del cancro dell'ovaio.

BACKGROUND: The aim of this study is to define the role of the intestinal removal for the therapy of ovarian cancer in advanced stadium. METHODS: We have examined 247 females with epithelial ovarian cancer in advanced stadium, that had intestinal removal. RESULTS: The survival in the females that had a very good intestinal removal is greatest than in the females that hadn't a very good intestinal removal.

[Cytoreductive surgery in patients with stage IV ovarian carcinoma]. / La chirurgia citoriduttiva nelle pazienti con carcinoma dell'ovaio allo stadio IV.

BACKGROUND: The aim of this study is to evaluate the efficacy of cytoriductive surgical in females with ovarian carcinoma in advanced stadium, and to define the role of this surgical for the survival of females with hepatic metastases. METHODS: This is a retrospective study. 164 females with ovarian cancer in IV stadium was examined. 64 females had hepatic metastasis. All patients had cytoriductive surgical. RESULTS: The survival in the patients without hepatic metastasis was 38 months if the cytoreduction was very good; it was 18.3 months if there is residual disease. The survival in the patients with hepatic metastasis was 50.1 months if the cytoreduction was very good; it was 27 months if there is residual disease. CONCLUSIONS: A very good surgical is very important for the survival of patients with ovarian cancer in advanced stadium. This is true also in the patients with hepatic metastases.

[Meigs' syndrome and "Meigs' pseudo-syndrome." Report of 2 cases]. / Sindrome di Meigs e "pseudo-sindrome di Meigs". Descrizione di due casi.

BACKGROUND: The aim of this study is to investigate similitudis and differences between the Meigs' syndrome and Meigs' pseudosyndrom. The Meigs' syndrome is an uncommon disease that is characterized by benign ovarian tumor, ascites and pleural effusion. The Meigs' pseudosyndrom is a serious disease that is characterized by malignant ovarian tumor, ascites, pleural effusion. METHODS: We have examined two cases: a case of Meigs' syndrome that is characterized by vomit, abdominal pain, ascites, height serum Ca 125 level; a case of Meigs' pseudosyndrom that is characterized by ovarian adenocarcinoma that is diagnosticated owing to ascites and pleural effusion. CONCLUSIONS: This study suggest that the surgical therapy have a very important role for the complete remission of the disease in the Meigs' syndrome and for the remission of ascites and pleural effusion in the Meigs' pseudosyndrom.

[Second-look in ovarian cancer: laparoscopy or laparotomy?]. / Second-look per cancro dell'ovaio: laparoscopia o laparotomia?

BACKGROUND: The aim of the present study was to compare the laparoscopic second-look with laparotomic second-look as regards the consistency of diagnosis of residual tumoral disease after first step treatment in patients affected by ovarian cancer, and to evaluate the feasibility of the laparoscopic second-look. METHODS: Twenty-one patients affected by ovarian cancer underwent laparoscopic second-look followed by laparotomic second-look. Six months after the first surgical intervention all the patients showed no contraindications to laparoscopic second-look. All the surgeries were performed with the same procedure: after the introduction of the trocars the lysis of adherences was carried out, the whole abdominal cavity was explored, 18 abdominal-pelvic sites were examined, direct biopsies were performed and samples for the cyto- and histological analysis were obtained. RESULTS: Positive predictive value for laparoscopy was 100% (6 out of 6 cases), while negative predictive value was 84% (2 false negative cases out of 12). The complete abdominal-pelvic examination was possible in 95% of cases with laparotomy while in 41% of cases with laparoscopy, because of post-operative severe adherences. CONCLUSIONS: Laparoscopic second-look has a good consistency as regards the diagnosis of residual tumoral disease, but its feasibility is lower than laparotomy owing to the presence of severe adherences and the high risk of intra- and post-operative compliances.