Comparative Assessment of Pharmaceutical Removal from Wastewater by the Microalgae Chlorella sorokiniana, Chlorella vulgaris and Scenedesmus obliquus

In view of risks associated with the discharge of pharmaceuticals in the aquatic environment, the objective of this work was to assess the removal of paracetamol, salicylic acid and diclofenac from water by a microalgae‐based treatment. For a comparison purpose, the growth and kinetic parameters for the removal of drugs were determined for three different microalgae strains, namely Chlorella sorokiniana, Chlorella vulgaris and Scenedesmus obliquus. It was found that the drugs removal efficiency by these strains was related to their growth. Comparing the three pharmaceuticals, the salicylic acid was the most efficiently removed, especially by S. obliquus (>93% batch culture, >99% semicontinuous culture) and C. sorokiniana (>73% batch culture, >93% semicontinuous culture). Contrarily, paracetamol was the most poorly removed, the maximum efficiencies being those attained by C. sorokiniana (>67% batch culture, >41% semicontinuous culture). On the other hand, diclofenac was efficiently removed only by S. obliquus (>98% batch culture, >79% semicontinuous culture). For the three considered drugs, C. vulgaris was the strain showing the lowest removal capacity. The large differences here revealed between microalgae strains regarding their removal capacity of pharmaceuticals, pointed to the strain selection as a key issue for a successful application in wastewater treatment

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Tratamiento térmico de lodos de la industria papelera: utilización de subproductos para la adsorción de contaminantes emergentes del agua = Thermal treatment of sludge from the paper industry: utilization of byproducts for the adsorption of emerging contaminants from water

135 p.La industria de la pasta y del papel es un sector estratégico para la economía de la Unión Europea, con una importante contribución al crecimiento financiero y la creación de empleo. Sin embargo, los procesos de producción de pasta y de papel requieren altos consumos de energía y agua, siendo esta industria altamente contaminante. Como consecuencia del elevado consumo de agua, se generan grandes volúmenes de aguas residuales, cuyo tratamiento da lugar a la producción de lodos primarios (L1) y secundarios (L2). La práctica más habitual en la industria papelera es mezclar L1 y L2, para después gestionar esa mezcla (lodos mixtos). En media se generan un total de 50 kg de lodos mixtos por cada tonelada de papel que se produce, siendo el 70% de L1 y el 30% L2. En este contexto, y en el ámbito de la economía circular, esta tesis se centra en el aprovechamiento energético y valorización de estos lodos, y tiene por objetivo determinar las características del procesamiento térmico (combustión y pirolisis) de L1 y L2 así como de su co-procesamiento con carbón (C). Además, se pretende también estudiar la utilización del carbonizado residual de la pirólisis de los lodos para la adsorción de fármacos en aguas residuales. Los resultados obtenidos mostraron que las propiedades térmicas de los L1 utilizados en este trabajo fueron muy diferentes de las de los L2 y de las de C. Mediante análisis térmico simultáneo (STA, del inglés Simultaneous Thermal Analysis) fueron determinadas las curvas de termogravimetría derivada (DTG, del inglés Differential Thermogravimetry) y de calorimetría diferencial de barrido (DSC, del inglés Differential Thermogravimetry) para la combustión y pirólisis de L1, L2, C y sus respectivas mezclas, CL1 y CL2 (con un 10% en masa de L1 o L2, respectivamente). Las curvas DTG y DSC de la combustión de C mostraron perfiles típicos de carbones bituminosos, con una única etapa de pérdida de masa y liberación de calor. En el caso de L1, la pérdida de masa durante la combustión ocurrió en dos etapas: la primera y exotérmica, asociada al contenido volátil de la celulosa; y la segunda, sin desprendimiento de calor asociado, a la descomposición del carbonato cálcico. En el caso de L2, las curvas DTG y DSC revelaron tres etapas exotérmicas (desvolatilización de la celulosa; combustión de la materia orgánica biodegradable; combustión del carbono fijo), seguidas de la descomposición del carbonato cálcico (sin desprendimiento de calor). A pesar de las grandes diferencias entre C y los lodos de papelera, la combustión a temperatura programada de CL1 y CL2 fue bastante similar a la de C, especialmente en el caso de CL2. Para la pirólisis, las curvas DTG de L1 y L2, al contrario de las de C, mostraron una pérdida de masa apreciable y reflejaron bastantes semejanzas con las respectivas curvas de combustión. Por otro lado, la mezcla de L1 y L2 con C supuso un incremento de la reactividad de C durante la pirólisis de CL1 y CL2. Por último, los parámetros característicos de las curvas DTG apuntaron para la existencia de interacciones entre C, L1 y L2 durante la combustión y la pirólisis de sus mezclas. Esto fue confirmado a través de los valores de energía de activación (E) determinados mediante análisis cinético no-isotérmico. Estas E fueron inferiores a las calculadas a partir de la composición de dichas mezclas. Del mismo modo, las curvas DTG calculadas para combustión y pirólisis de CL1 y CL2 mostraron pérdidas de masa inferiores a las experimentales, permitiendo inferir efectos sinérgicos negativos. Con base a los resultados anteriores, se recomienda la gestión de L1 y L2 por separado. Para L2 se considera la co-combustión con carbón (con un 10% en masa de L2) como una alternativa factible, mientras que, para L1 y debido a su alto contenido en volátiles, la pirólisis es una opción adecuada. Como residuo de esa pirólisis se obtiene un carbonizado, cuya valorización como adsorbente se plantea en esta tesis como una alternativa de gestión. En este sentido y después de optimizar las condiciones de pirólisis para desarrollar la porosidad, el carbonizado (PS800-150) fue utilizado en el estudio cinético y de equilibrio de la adsorción de cuatro fármacos (diclofenaco, ácido salicílico, ibuprofeno y acetaminofén). Este estudio se realizó tanto en agua ultrapura (AUP) como en el efluente secundario de una estación depuradora de aguas residuales urbanas (ES-EDAR)). La capacidad de adsorción de los fármacos fue similar en AUP y en ES-EDAR, disminuyendo en el sentido diclofenaco > ibuprofeno ≈ acetaminofén > ácido salicílico. Una vez que el diclofenaco fue el fármaco para el que PS800-150 mostró una mayor capacidad, se estudió la cinética y el equilibrio de adsorción de este contaminante emergente por parte de dos carbones activados (WP270 y GPP20) y una resina polimérica (SP207) comerciales con el propósito de comparar los resultados en términos de adsorción. La capacidad de adsorción de diclofenaco por parte de los carbones activados fue un orden de magnitud superior a la de PS800-150. Sin embargo, PS800-150 no sólo mostró una capacidad similar a la de la resina SP207 sino que su cinética de adsorción fue más rápida, lo que apunta a su posible aplicación para el tratamiento terciario de aguas residuale

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used