The first flush analysis of stormwater runoff in a humid climate

This study focuses on the pollutants from urban runoff to Zarjoob River, which is one of the rivers leading to Anzali International Wetland, which was listed in the Montreux Record in 1993 as a site in need of priority conservation. Storm water runoff from a residential area in Rasht (the largest city on Iran’s Caspian Sea coast) was monitored in this study during thirteen rainfall events, with a total of 58 storm runoff samples collected from 2018 to 2019. In most rainfall events, the mean concentration of total suspended solids (TSS) and chemical oxygen demand (COD) were higher than the other pollutants. The event mean concentrations (EMC) of TSS loads ranged from 57.3 mg/L to 682.5 mg/L and from 46.7 mg/L to 590.4 mg/L for COD. The site mean concentrations (SMC) for TSS, COD, total phosphorus (Total P), nitrate-nitrogen (NO3-N), and total lead (Pb) were 219, 205, 1.91, 20.63, and 0.25 mg/L, respectively. The first flush coefficient (b) was used to evaluate the first flushing of various events. The results of the study confirmed that the first flush occurred in all events, and the average ranking of first flush strength among the pollutants was COD > NO3-N > TP > Pb > TSS. Controlling one-third of the initial runoff volume appeared to be critical for managing the quality of urban rivers in humid regions. The findings of this study can be applied to urban runoff management strategies in cities with similar climatic conditions

Post-Treatment of Reclaimed Municipal Wastewater through Unsaturated and Saturated Porous Media in a Large-Scale Experimental Model

In recent decades, groundwater overexploitation has caused an important aquifer level decline in arid zones each year. In addition to this issue, large volumes of effluent are produced each year in metropolitan areas of these regions. In this situation, an aquifer storage and recovery system (ASR) using the reclaimed domestic wastewater can be a local solution to these two challenges. In this research, a post-treatment of reclaimed municipal wastewater has been investigated through unsaturated–saturated porous media. A large-scale, L-shaped experimental model was set up near the second-stage wastewater treatment plant (WWTP) in the west of greater Tehran. The water, soil, and treated wastewater of the experimental model were supplied from the aquifer, site, and WWTP, respectively. The 13 physicochemical parameters, temperature and fecal coliform were analyzed every 10 days in seven points for a period of four months (two active periods of 40 days with a 12-h on–off rate (wet cycles) and a rest period of 40 days (dry cycle) between the two wet cycles). The results showed that the effects of the saturated zone were twice as great as those of the unsaturated zone and two-thirds of the total treatment efficiency. Furthermore, a discontinuous wet–dry–wet cycle had a significant effect on effluent treatment efficiency and contaminants’ reduction. In conclusion, an aquifer storage and recovery system using treated wastewater through the unsaturated–saturated zones is a sustainable water resource that can be used for agriculture, environmental and non-potable water demands

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