Methodology for a preliminary assessment of water use sustainability in industries at sub-basin level.

The sustainability of industrial production, especially for highly water-demanding processes, is strictly related to water resource availability and to the dynamic interactions between natural and anthropogenic requirements over the spatial and temporal scales. The increase in industrial water demand raises the need to assess the related environmental sustainability, facing the occurrence of global and local water stress issues. The identification of reliable methodologies, based on simple indices and able to consider the impact on local water basins, may play a basilar role in water sustainability diagnosis and decision-making processes for water management and land use planning. The present work focalized on the definition of a methodology based on the calculation of indicators and indices in the view of providing a synthetic, simple, and site-specific assessment tool for industrial water cycle sustainability. The methodology was built starting from geo-referenced data on water availability and sectorial uses derived for Italian sub-basins. According to the data monthly time scale, the proposed indices allowed for an industrial water-related impacts assessment, able to take into account the seasonal variability of local resources. Three industrial factories, located in northern (SB1, SB2) and central (SB3) Italian sub-basins, were selected as case studies (CS1, CS2, CS3) to validate the methodology. The companies were directly involved and asked to provide some input data. The methodology is based on the calculation of three synthetic indexes: the Withdrawal and Consumption water Stress Index (WCSI) allowed for deriving a synthetic water stress level assessment at the sub-basin scale, also considering the spatial and temporal variations; the industrial water use sustainability assessment was achieved by calculating the Overall Factory-to-Basin Impact (OFBI) and the Internal Water Reuse (IWR) indices, which allowed a preliminary evaluation of the factories' impacts on the sub-basin water status, considering the related water uses and the overall pressures on the reference territorial context. The WCSI values highlighted significant differences between the northern sub-basins, characterised by limited water stress (WCSISB1 = 0.221; WCSISB2 = 0.047), and the central ones, more subjected to high stress (WCSISB3 = 0.413). The case studies CS1 and CS3 showed to exert a more significant impact on the local water resource (OFBICS1 = 0.18%; OFBICS2 = 0.192%) with respect to CS2 (OFBI = 0.002%), whereas the IWR index revealed the different company's attitude in implementing water reuse practices (IWRCS1 = 40%; IWRCS1 = 27%; IWRCS1 = 99%). The proposed methodology and the indices may also contribute to assessing the effectiveness of river basin management actions to pursue sustainable development goals.

Evaluation of the aerobic biodegradability of process water produced by hydrothermal carbonization and inhibition effects on the heterotrophic biomass of an activated sludge system.

In this work, the aerobic biodegradability of the process water (PW) produced by hydrothermal carbonization (HTC) of dewatered anaerobic digested sludge and the toxicity assessment in regard to the heterotrophic activated biomass of a conventional activated sludge systems, are described. Such assessments are not yet reported in other scientific papers, so this paper seeks to contribute to the increase of knowledge regarding the valorization of the HTC process applied in a wastewater treatment plant (WWTP). For such purpose, two different respirometric techniques were applied - multi-OUR respirometry and manometric respirometry. PW resulted highly biodegradable: 83% of total COD was biodegradable, with a 58% of readily biodegradable (rbCOD) fraction. The BOD5/COD ratio was 0.42. Further, it was characterized by a high concentration of volatile fatty acids (VFAs) (i.e. 2031 mg/L), of which the major constituent was acetic acid (i.e. 80%), an easily degradable intermediate of many biological processes. Both the respirometric techniques showed that the assessed PW, after being diluted accordingly with the WWTP real operational conditions, did not imply short-term toxic effects on the activated sludge, neither using fresh biomass nor keeping the same one. According to these results, the recirculation of PW at the water line of WWTPs represents a promising approach not affected by specific toxicity issues, especially when the HTC process is integrated into a WWTP scheme.

SARS-CoV-2 in water services: Presence and impacts.

The occurrence of human pathogenic viruses in aquatic ecosystems and, in particular, in internal water bodies (i.e., river, lakes, groundwater, drinking water reservoirs, recreational water utilities, and wastewater), raises concerns regarding the related impacts on environment and human health, especially in relation to the possibility of human exposure and waterborne infections. This paper reviews the current state of knowledge regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presence and persistence in human excreta, wastewaters, sewage sludge as well as in natural water bodies, and the possible implications for water services in terms of fecal transmission, public health, and workers' risk. Furthermore, the impacts related to the adopted containment and emergency management measures on household water consumptions are also discussed, together with the potential use of wastewater-based epidemiology (WBE) assessment as a monitoring and early warning tool, to be applied in case of infectious disease outbreaks. The knowledge and tools summarized in this paper provide a basic information reference, supporting decisions makers in the definition of suitable measures able to pursue an efficient water and wastewater management and a reduction of health risks. Furthermore, research questions are provided, in order to direct technical and public health communities towards a sustainable water service management in the event of a SARS-CoV-2 re-emergence, as well as a future deadly outbreak or pandemic.

A diagnostic flowchart, including TCD, Xe-CT and angiography, to improve the diagnosis of vasospasm critically affecting cerebral blood flow in patients with subarachnoid haemorrhage, sedated and ventilated.

The aim of this study was to prospectively evaluate a clinical protocol including transcranial doppler (TCD), Xenon-CT (Xe-CT) and angiography, for the detection of vasospasm leading to critical reductions of regional cerebral blood flow (rCBF) in both ventilated and sedated SAH patients, i.e. patients in whom clinical evaluation was not possible. Seventy-six patients were prospectively included in a surveillance protocol for daily TCD vasospasm monitoring. When TCD showed a V(mean) above 120 cm/sec in the middle cerebral artery (MCA), patients underwent Xe-CT study. If rCBF in the MCA was reduced to below 20 ml/100 g/min or if there was a reduction in the rCBF with significant asymmetry between the two MCAs, angiography was performed. Conversely, further Xe-CT and angiography were not obtained unless the TCD V(mean) values reached values above 160 cm/sec. In 35 patients, V(mean) attained values above 120 cm/sec, but only in five of them, rCBF was suggestive of vasospasm, and angiography confirmed the diagnosis in four. The protocol suggests that in sedated and ventilated patients, detection of a critical rCBF reduction due to vasospasm is possible to allow for more specific treatment and to reduce undue medical complications.

Prognosis of isolated acute post-traumatic subdural haematoma.

AIM: Acute subdural haematoma (ASDH) is seldom an isolated lesion and it is difficult to understand the mechanisms which determine the poor prognosis associated to this occurrence. Aim of this study was estimating the outcome of patients with ASDH without any companion lesions by analysing the haematoma volume, its thickness and midline shift. METHODS: Twenty-eight severely head injured patients (Glasgow Coma Scale, GCS =/<8) with isolated unilateral ASDH admitted in intensive care unit (ICU) were retrospectively studied. The haematoma thickness, the midline shift, the ASDH volume were obtained from the first emergency computerized tomography (CT) scan and analysed by a computer assisted programme (Osiris). Patients' outcome was scored according to the Glasgow Outcome Scale (GOS) 6 months after the event. According to their GOS the patients were further divided in 2 groups (favourable outcome: GOS 4-5, poor outcome: GOS 1-2-3). RESULTS: Midline shift ranged from 0 to 19.2 mm; we found a larger midline shift in those patients who died and in patients with severe disability or vegetative state 6 months after the trauma. CONCLUSION: The presence and size of midline shift was a more important determinant of outcome than ASDH volume or its thickness.

Induced acute arterial hypertension and regional cerebral flow in intracontusional low density area.

Traumatic brain contusions have been associated with regional ischemia. We aimed to measure the effect of induced supra-normal values of cerebral perfusion pressure (CPP) on regional cerebral blood flow (rCBF) in the intracontusional low density area surrounding the contusional hemorrhagic core. In 7 severely head injured patients (GCS < or = 8) harbouring a contusion larger than 2 cm, the rCBF levels were measured, by means of Xenon-enhanced CT, in: 1) the intracontusional low density area: 2) contralaterally, in a normal brain symmetric area. CBF studies were performed at a baseline CPP of 65.3 mmHg +/- 7 and after 20 minutes of norepinephrine-induced CPP supernormal values (88.3 mmHg +/- 10.5) (p = 0.0013). A "paradoxical" reduction of rCBF levels was observed in both the intracontusional low density area (p = 0.07) and the contralateral "normal" area (p = 0.08). In particular, this decrease of rCBF in the intracontusional low density area (-25.7 + 10 ml/100gr/min) (p = 0.0009) was present in only 4 cases, having a mean rCBF at baseline of 25 +/- 16 ml/100gr/min. In the remaining 3 cases in which rCBF at baseline was abnormally low (12 +/- 7 ml/ 100gr/min), rCBF values improved slightly (3.6 +/- 2 ml/100gr/min) (p = 0.61). An acute increase of CPP seems to marginally affect rCBF in the intracontusional low density area having critically reduced initial values, but may greatly reduce rCBF in subjects starting from non-critical baseline values.

[Selection and effects of sedation in intensive care]. / Scelta ed effetti della sedazione in Terapia Intensiva.

The importance of sedation in the ICU. The authors shortly describe the use of sedation as useful tool to reduce patient discomfort and to modulate stress response, in critically ill patients.