Search

Municipal wastewater treatment plants (WWTPs) are crucial for maintaining good quality of surface water, limiting environmental pollution. However, during wet-weather events, WWTPs become an important point-source discharge due to the activation of the bypass, which releases a mix of untreated wastewater and stormwater. This work aims to assess how the WWTP discharges (effluent and bypass) impact on the receiving surface water body during dry- and wet-weather, monitoring 78 pollutants (7 conventional pollutants, 19 heavy metals, and 52 micropollutants) in each stream (effluent during dry-weather, effluent and bypass during wet-weather), including the influent in dry-weather for comparison. The occurrence, concentration levels and variability, and environmental risk were addressed, with a specific focus on high-resolution (up to 20-min) sampling of the bypass, based on the expected relevant temporal dynamicity. A wider range of pollutants occurred in the bypass, included undetected compounds in the dry-weather influent. Besides, a greater inter-events variability in bypass concentrations was observed, but smaller intra-event variability, with only some pollutants exhibiting a distinct first-flush effect. To address the challenge of a cost-effective bypass monitoring, we explored the applicability of readily measurable water quality parameters (total suspended solids and electrical conductivity) as proxies for micropollutants. Correlations between these parameters and specific pollutant groups suggest a promising path for further investigation and broader application. The magnitude of the rain event also affected concentration levels, with event volume clearly affecting pollutants dilution. The environmental risk assessment revealed a significantly higher risk associated to bypass discharge compared to the effluent, especially for conventional pollutants, metals, and terbutryn, highlighting the urgency of improved bypass management strategies. Overall, this study highlights the contribution of wet-weather discharges from WWTPs, emphasizing the importance of high-frequency bypass monitoring to capture peak pollutant concentrations and accurately assess the environmental risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The reuse of reclaimed wastewater is increasingly recognized as a viable alternative water source for irrigation. Its application, whether direct or indirect, impacts several interconnected compartments, including groundwater, surface water, soil, crops, and humans. Reclaimed wastewater provides essential resources for crops, like water and nutrients. However, it also introduces pathogens, and contaminants of emerging concern (CECs), defined as chemicals that may pose risks to human health and ecosystems but are not yet fully regulated, such as pharmaceuticals and personal care products, among others. Additionally, reclaimed wastewater may contain antibiotic-resistant bacteria (ARBs) and disinfection by-products (DBPs), all of which present potential health and environmental risks. Therefore, regulatory bodies stress the need for preventive risk assessments to ensure safe reuse. This paper critically reviews available models for assessing the impacts of reclaimed wastewater reuse in agriculture. It identifies gaps in current modelling approaches and outlines future research directions. Key areas requiring further investigation include the fate and transfer of CECs, ARBs and DBPs, and the co-occurrence of multiple risks in such interconnected systems, especially in the indirect reuse. To address these gaps, we proposed a simplified approach to integrate three types of risk associated with CECs in indirect reuse, focusing on risks posed by antibiotics and other pharmaceuticals: human health risk, environmental risk and risk from antibiotic resistance development. This approach aids in identifying the most critical endpoints within the One Health approach, supporting (i) CECs prioritization in regulations based on their critical endpoints and (ii) the adoption of CEC-specific mitigation measures., Competing Interests: Declaration of competing interest All authors confirm the absence of any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The presence of Contaminants of Emerging Concern (CECs) in drinking water is raising concern for potential negative effects on human health. Ozonation and adsorption on activated carbon are the most suitable processes for CECs removal in drinking water treatment plants (DWTPs). This study aims at evaluating the performance of ozonation and adsorption as in-series processes compared to those of the stand-alone processes, focusing on 18 compounds representative of various CECs families. No CECs spike was performed to evaluate the effectiveness of these processes towards CECs at their environmental concentrations. Adsorption isotherms were performed on water samples collected before and after the full-scale ozonation in a DWTP, testing different combinations of ozone and activated carbon doses. Generally, the combination of the two processes was beneficial (83% average removal) compared to adsorption and ozonation alone (71% and 34% average removal respectively). The effect of ozonation on adsorption depends on CECs reactivity with ozone, since ozonation improves the adsorption performance of poorly-oxidizable CECs, but worsens that of well-oxidizable compounds. The removal of organic matter, investigated by absorbance at 254 nm and fluorescence, by ozonation reduces competition for the subsequent CECs removal by adsorption (up to 20% increase of total CECs adsorption). Finally, the removal of both absorbance and fluorescence seems to be a good proxy variables for total CECs adsorption, with different relationships depending on the presence of ozonation. Conversely, it is not effective for ozonation, since the relationship depends on the reactivity of the specific CEC with ozone., Competing Interests: Declaration of competing interest All authors confirm the absence of any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The increasing overexploitation and pollution of freshater resources are potential threats for public health, causing cross-contamination among the interconnected environmental compartments (freshwater, soil, crops). In particular, contaminants of emerging concern (CECs) originating from anthropic activities are not completely removed by wastewater treatments plants. This leads to their presence in drinking water (DW) sources, soil and crops intended for human consumption due to discharges of treated wastewater in surface waters and direct wastewater reuse practices. Currently, health risk assessments are limited to single exposure sources without considering the multiple exposure routes to which humans are subjected. For instance, among CECs, bisphenol A (BPA) and nonylphenol (NP), respectively, adversely affect immune and renal systems and have been frequently detected in DW and food, their major exposure sources for humans. Here, an integrated procedure is proposed to quantitatively assess health risk from CECs due to multiple exposure from the consumption of both DW and food, considering the relevant inter-connected environmental compartments. This procedure was applied to BPA and NP to calculate their probabilistic Benchmark Quotient (BQ), showing its potential in quantitatively apportioning the risk between contaminants and exposure sources, and its use as a decision support tool for prioritizing mitigation measures. Our results indicate that, even though the human health risk due to NP is not negligible, the estimated risk due to BPA is significantly higher, and the consumption of food from edible crops determines a higher risk compared to tap water. Hence, BPA is undoubtedly a contaminant to be prioritized, especially through mitigation actions aimed at its prevention and removal from food., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Unfounded concerns regarding fever are increasingly observed among nurses worldwide. However, no study has so far explored the preferred approach towards pediatric fever among nursing students. Therefore, we aimed to investigate the attitude towards pediatric fever among final-year nursing students., Methods: Between February and June 2022, final-year nursing students of 5 Italian university hospitals were asked to answer an online survey on their approach to fever in children. Both quantitative and qualitative methods were utilized. Multiple regression models were employed to explore the existence of moderators on fever conceptions., Results: The survey was filled in by 121 nursing students (response rate 50%). Although most students (98%) do not consider discomfort to treat fever in children, only a minority would administer a second dose of the same antipyretic in nonresponsive cases (5.8%) or would alternate antipyretic drugs (13%). Most students would use physical methods to decrease fever (84%) and do not think that fever has mainly beneficial effects in children (72%). The own know-how adequacy on fever was inversely associated (OR 0.33, 95% CI 0.13-0.81) with the beliefs that high fever might lead to brain damage. No further predictive variable was significantly associated with the concern that fever might be associated with brain damage, the advice of physical methods use, and the assumption that fever has mostly positive effects., Discussion: This study shows for the first time that misconceptions and inappropriate attitudes towards fever in children are common among final-year nursing students. Nursing students could potentially be ideal candidates for improving fever management within clinical practice and amongst caregivers., (© 2023. The Author(s).)

The occurrence and hazard risks of mixtures of Contaminants of Emerging Concern (CECs) in drinking water (DW) lead to serious consideration regarding the possible impacts on public health. Consequently, there is ongoing research, development and empowerment of risk assessment procedures to get more toxicological insight. For instance, alkylphenols and phthalates have been frequently reported to be present both in bottled and tap water, affecting different human endpoints. Currently, deterministic chemical risk assessment (CRA) is used to evaluate the compounds' mixture health risk. However, CRA deals just qualitatively with sources of uncertainty, which may lead to erroneous assessment of risks. Here, a new procedure for quantitative chemical risk assessment of CEC mixtures (QCRA MIX ) is proposed. Its potential is illustrated by a case study where the risks related to the presence of mixtures of alkylphenols or phthalates in tap versus bottled DW are compared. Uncertainties in both exposure and hazard assessment steps of the procedure are included to calculate a probabilistic mixture Benchmark Quotient (BQ MIX ). The QCRA MIX procedure highlighted the non-negligible health risks posed by those compounds in both DW sources based on overall water consumption. In fact, DW consumers' behaviour in 13 different countries, in terms of total DW consumption and fraction of bottled and tap water consumed, were considered to evaluate the influence on health risk. For alkylphenols, the total water consumption was found to be the most relevant factor in increasing the health risk, while for phthalates the risk was found to be mainly influenced by the percentage of bottled water consumed. Hence, the proposed QCRA MIX procedure can be a valuable tool for prioritization of CECs to be included in DW regulations which aim to minimize the overall risk, accounting for actual DW consumption., (Copyright © 2022. Published by Elsevier Ltd.)

Background: To measure patient flow at our Pediatric Emergency Department (PED) during the Italian lockdown, with particular care in terms of otolaryngological (ENT)-related diagnoses., Methods: A retrospective evaluation of electronic charts of children admitted to our PED in the City Center of Milan (Italy) for any disease. The outcome was to compare distribution of diagnoses performed at our PED during 21 February-3 May 2019 (period 1) to 21 February-3 May 2020 (period 2)., Results: A total of 4538 children were evaluated during period 1 compared to 1310 during period 2. A statistically significant overall effect on diagnosis between the study periods was attested ( p -value < 0.001; pseudo R2 = 0.010), ENT-related diagnoses being more frequently documented in period 1 (80.4% vs. 19.5%; p -value < 0.001), as well as those related to middle ear infections (92.8% vs. 7.2%; p -value < 0.001). Non-complicated acute otitis media more frequently occurred in period 1 (92.0% vs. 8.0%; p -value < 0.001); no significant difference in the number of complicated middle ear infections occurred (95.8% vs. 4.2%)., Conclusions: The exceptional circumstances of the Italian lockdown resulted in a significant decrease in patients' attendance to our PED, especially when considering diagnoses related to any ENT disorder, middle ear disease, and non-complicated middle ear infection.

The second epicenter of the global COVID-19 epidemic following Wuhan, and the first in the Western world, occurred unexpectedly in the Lombardy region of Italy, whose capital city is Milan. The aggressive nature of the outbreak in the region was dramatic, leading to a 2-month period of lockdown. Within the Policlinico, the historic hospital in the center of Milan, many units were rapidly converted into intensive care units or semi-intensive units for adult patients. During lockdown, the pediatric inpatient units had to face daily reorganization caused by the necessary logistic and structural transformations, thus restricting routine care pathways for chronic patients, while the Pediatric Emergency Unit had to develop a system able to effectively separate the children and caregivers infected with COVID-19 from those who were not affected. These 2 months enhanced resilience among both doctors and nurses, and facilitated the transversal transmission of data aimed at helping colleagues and patients in any way possible, in spite of the restrictive measures limiting the rate of activity in pediatric care. The reorganization of the current phase of decreasing epidemic activity still leaves us with unanswered questions regarding the further possible changes to implement in the event of a potential reoccurrence of epidemic peaks.

In recent years, the presence of micropollutants in drinking water has become an issue of growing global concern. Due to their low concentrations, monitoring databases are usually rich in censored data (e.g. samples with concentrations reported below the limit of quantification, LOQ) which are typically eliminated or replaced with a value arbitrarily chosen between 0 and LOQ. These conventional methods have some limitations and can lead to erroneous conclusions on: presence of micropollutants in the source water, treatment efficiencies, produced water quality and associated human health risk. In this work, an advanced approach, based on Maximum Likelihood Estimation method for left-censored data (MLE LC ), was applied on monitoring data of 19 contaminants (metals, volatile organic compounds, pesticides and perfluorinated compounds) in 5362 groundwater (GW) and 12,344 drinking water (DW) samples, collected from 2012 to 2017 in 28 drinking water treatment plants in an urbanized area. This study demonstrates the benefits of MLE LC method, especially for high percentages of censored data. Data are used to build statistical distributions which can be effectively used for several applications, such as the time trend evaluation of GW micropollutant concentrations and the estimation of treatment removal efficiency, highlighting the adequacy or the need for an upgrade. Moreover, the MLE LC method has been applied to assess the human health risk associated with micropollutants, indicating the high discrepancy in the estimations obtained with conventional methods, whose results do not follow precautionary or sustainability criteria., Competing Interests: Declaration of competing interest All authors confirm the absence of any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work., (Copyright © 2020 Elsevier Ltd. All rights reserved.)