Integrated use of real-time sensors and process modelling to optimize wastewater disinfection by peracetic acid

Disinfection plays a key role in complying with microbiological quality standards in case of wastewater reuse. Among chemical disinfectants, peracetic acid (PAA) is a valid alternative to the commonly-used chlorine, thanks to its high spectrum of biocidal activity, the absence of halogenated disinfection by-product (DBPs) and the easy retrofitting of existing structures [1]. Anyway, it is affected by strong decay during the disinfection contact time which significantly depends on water quality [2]. The presence of suspended solids (SS) has proved to influence PAA disinfection in different ways: (i) enhancing PAA decay rate and (ii) promoting protection mechanism to bacteria [3]. The quantification of SS and microbiological enumeration by laboratory procedures requires many hours, consequently the development of real-time monitoring sensors is spreading in wastewater treatment plant (WWTP). In the present research, a modelling framework for describing involved phenomena (PAA decay, bacterial inactivation) and accounting for system uncertainty by stochastic tools is developed and adapted to process real-time water quality monitoring data. The final goal is to assess the efficacy of recently developed sensors to evaluate the effect of SS on PAA decay and, consequently, on the overall performance of PAA on E. coli inactivation, in the view of real-time control

Indirect methods based on stochastical modelling for peracetic acid decay estimation in wastewater

Optimal control of wastewater disinfection, aimed at ensuring system reliability to minimize microbial risk, is essential in case of wastewater reuse. When peracetic acid (PAA) is used as disinfectant, natural loss of reactant occurs, with dependence on the wastewater matrix characteristics [1,2]. An accurate description of PAA decay in a specific wastewater matrix is usually carried out by laboratory experiments. In the present work, two indirect methods based on stochastical modelling for PAA decay estimation are explored, as effective, simple and fast alternatives to direct characterization. Both methods are based on monitoring data collected from the disinfection reactor. The final goal is to provide proper tools for real-time control

Dealing with uncertainty in modelling of wastewater disinfection by peracetic acid

Disinfection is fundamental in wastewater treatment plants (WWTPs) for matching the microbiological standards on treated wastewater, especially in case of water reuse. In recent years, the modelling of disinfection is receiving increasing interest due to the need for supporting tools for the operation of reactors. In particular, when dealing with chemical disinfectants, the main goal is the optimization of dosage for providing the requested dose for microbial inactivation while minimizing the cost of reagents, the generation of disinfection by-products (DBPs) and the discharged residual disinfectant, having ecotoxicological implications on the aquatic ecosystem. Peracetic acid (PAA) is an emerging disinfectant whose dosage in disinfection reactors must account for PAA strong decay in wastewater. Moreover, even if PAA is not quoted for the generation of DBPs, the discharge in surface water of residual components of commercial solutions (PAA, hydrogen peroxide) can result in the occurrence of ecotoxicity phenomena. Several attempts were reported in the past about the modelling of PAA disinfection, based on deterministic and non-deterministic approaches, also aimed at developing a control system for optimal dosing of the disinfectant. However, no research work included the modelling of uncertainty related to the process so far. Uncertainty is a key aspect of many engineering processes, possibly resulting in significant effects on process performance. In the present work, a modelling framework accounting for uncertainty is defined and discussed, based on stochastical techniques to estimate the uncertainty related to each part of process and to propagate it. The behaviour of a full-scale disinfection reactor was evaluated as a function of operating conditions, identifying the potential non-compliance and proposing operational practices for maximizing performance while satisfying different process goals, while relevant indications for the optimization of a full-scale disinfection reactors were determined. The proposed approach can be easily adapted to other WWTPs and disinfectants

Complications and mortality in a cohort of patients undergoing emergency and elective surgery with perioperative SARS-CoV-2 infection: an Italian multicenter study. Teachings of Phase 1 to be brought in Phase 2 pandemic

Since the beginning of the pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its related disease, coronavirus disease 2019 (COVID-19), several articles reported negative outcomes in surgery of infected patients. Aim of this study is to report results of patients with COVID-19-positive swab, in the perioperative period after surgery. Data of COVID-19-positive patients undergoing emergent or oncological surgery, were collected in a retrospective, multicenter study, which involved 20 Italian institutions. Collected parameters were age, sex, body mass index, COVID-19-related symptoms, patients' comorbidities, surgical procedure, personal protection equipment (PPE) used in operating rooms, rate of postoperative infection among healthcare staff and complications, within 30-postoperative days. 68 patients, who underwent surgery, resulted COVID-19-positive in the perioperative period. Symptomatic patients were 63 (92.5%). Fever was the main symptom in 36 (52.9%) patients, followed by dyspnoea (26.5%) and cough (13.2%). We recorded 22 (32%) intensive care unit admissions, 23 (33.8%) postoperative pulmonary complications and 15 (22%) acute respiratory distress syndromes. As regards the ten postoperative deaths (14.7%), 6 cases were related to surgical complications. One surgeon, one scrub nurse and two circulating nurses were infected after surgery due to the lack of specific PPE. We reported less surgery-related pulmonary complications and mortality in Sars-CoV-2-infected patients, than in literature. Emergent and oncological surgery should not be postponed, but it is mandatory to use full PPE, and to adopt preoperative screenings and strategies that mitigate the detrimental effect of pulmonary complications, mostly responsible for mortality

Adjunctive Brivaracetam in Older Patients with Focal Seizures: Evidence from the BRIVAracetam add‑on First Italian netwoRk Study (BRIVAFIRST)

BACKGROUND: The management of epilepsy in older adults has become part of daily practice because of an aging population. Older patients with epilepsy represent a distinct and more vulnerable clinical group as compared with younger patients, and they are generally under-represented in randomized placebo-controlled trials. Real-world studies can therefore be a useful complement to characterize the drug's profile. Brivaracetam is a rationally developed compound characterized by high-affinity binding to synaptic vesicle protein 2A and approved as adjunctive therapy for focal seizures in adults with epilepsy. OBJECTIVE: The aim of this study was to assess the 12-month effectiveness and tolerability of adjunctive brivaracetam in older patients (≥65 years of age) with epilepsy treated in a real-world setting. METHODS: The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a 12-month retrospective multicenter study including adult patients prescribed adjunctive brivaracetam. Effectiveness outcomes included the rates of seizure response (≥50% reduction in baseline seizure frequency), seizure freedom, and treatment discontinuation. Safety and tolerability outcomes included the rate of treatment discontinuation due to adverse events and the incidence of adverse events. Data were compared for patients aged ≥65 years of age ('older') vs those aged <65 years ('younger'). RESULTS: There were 1029 patients with focal epilepsy included in the study, of whom 111 (10.8%) were aged ≥65 years. The median daily dose of brivaracetam at 3 months was 100 [interquartile range, 100-175] mg in the older group and 100 [100-200] mg in the younger group (p = 0.036); it was 150 [100-200] mg in both groups either at 6 months (p = 0.095) or 12 months (p = 0.140). At 12 months, 49 (44.1%) older and 334 (36.4%) younger patients had a reduction in their baseline seizure frequency by at least 50% (p = 0.110), and the seizure freedom rates were 35/111 (31.5%) and 134/918 (14.6%) in older and younger groups, respectively (p < 0.001). During the 1-year study period, 20 (18.0%) patients in the older group and 245 (26.7%) patients in the younger group discontinued brivaracetam (p = 0.048). Treatment withdrawal because of insufficient efficacy was less common in older than younger patients [older: n = 7 (6.3%), younger: n = 152 (16.6%); p = 0.005]. Adverse events were reported by 24.2% of older patients and 30.8% of younger patients (p = 0.185); the most common adverse events were somnolence, nervousness and/or agitation, vertigo, and fatigue in both study groups. CONCLUSIONS: Adjunctive brivaracetam was efficacious, had good tolerability, and no new or unexpected safety signals emerged when used to treat older patients with uncontrolled focal seizures in clinical practice. Adjunctive brivaracetam can be a suitable therapeutic option in this special population

Sustained seizure freedom with adjunctive brivaracetam in patients with focal onset seizures

The maintenance of seizure control over time is a clinical priority in patients with epilepsy. The aim of this study was to assess the sustained seizure frequency reduction with adjunctive brivaracetam (BRV) in real-world practice. Patients with focal epilepsy prescribed add-on BRV were identified. Study outcomes included sustained seizure freedom and sustained seizure response, defined as a 100% and a >= 50% reduction in baseline seizure frequency that continued without interruption and without BRV withdrawal through the 12-month follow-up. Nine hundred ninety-four patients with a median age of 45 (interquartile range = 32-56) years were included. During the 1-year study period, sustained seizure freedom was achieved by 142 (14.3%) patients, of whom 72 (50.7%) were seizure-free from Day 1 of BRV treatment. Sustained seizure freedom was maintained for >= 6, >= 9, and 12 months by 14.3%, 11.9%, and 7.2% of patients from the study cohort. Sustained seizure response was reached by 383 (38.5%) patients; 236 of 383 (61.6%) achieved sustained >= 50% reduction in seizure frequency by Day 1, 94 of 383 (24.5%) by Month 4, and 53 of 383 (13.8%) by Month 7 up to Month 12. Adjunctive BRV was associated with sustained seizure frequency reduction from the first day of treatment in a subset of patients with uncontrolled focal epilepsy