Because of the recalcitrance of some micropollutants to conventional wastewater treatment systems, the occurrence of organic micropollutants in water has become a worldwide issue, and an increasing ...environmental concern. Their biodegradation during wastewater treatments could be an interesting and low cost alternative to conventional physical and chemical processes. This paper provides a review of the organic micropollutants removal efficiency from wastewaters. It analyses different biological processes, from conventional ones, to new hybrid ones. Micropollutant removals appear to be compound- and process- dependent, for all investigated processes. The influence of the main physico-chemical parameters is discussed, as well as the removal efficiency of different microorganisms such as bacteria or white rot fungi, and the role of their specific enzymes. Even though some hybrid processes show promising micropollutant removals, further studies are needed to optimize these water treatment processes, in particular in terms of technical and economical competitiveness.
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•Some micropollutants are recalcitrant to conventional wastewater treatment systems.•Micropollutant removal are compound- and process-specific.•Hybrid processes may achieve better micropollutant removal.•An environmentally and economically sustainable water treatment process is needed.
•The paper deals with the optimal control and design of activated sludge processes.•Studies on the topic are critically reviewed.•Focus is set on the problem formulation that allows one getting ...reliable solutions.•The selection of appropriate cost functions and constraints is discussed.•Aspects related to dealing with model mismatch are presented.
The activated sludge process (ASP) is the most commonly used process for wastewater treatment. Improving its performance is necessary from economic and environmental point of views. In this context, dynamic optimization is a powerful tool for assisting engineers in determining optimal operations and designs for ASPs.
However, the real optimality of the solution strongly depends on the optimization problem statement, for which unfortunately, there is no standard or commonly accepted formulation. In a hopeful attempt to provide a guideline for future works on the topic, this paper reviews the literature devoted to optimal control and design of ASPs. The main issues to be addressed in order to get reliable solutions are discussed, among which: (1) Managing the inevitable mismatch between the model predictions and the real ASP operation. (2) Dealing with the unpredictable variations in the wastewater characteristics. (3) Accounting for the slowest dynamic processes occurring in ASPs. (4) Appropriately selecting the decision variables and the flowsheet structure in order to simplify the problem formulation from a mathematical perspective. (5) Conveniently choosing the cost functions expressions/correlations. (6) Successfully selecting the mathematical constraints in order to guarantee physically relevant operations.
Pharmaceutical products have become a necessary part of life. Several studies have demonstrated that indirect exposure of humans to pharmaceuticals through the water could cause negative effects. Raw ...sewage and wastewater effluents are the major sources of pharmaceuticals found in surface waters and drinking water. Therefore, it is important to consider and characterize the efficiency of pharmaceutical removal during wastewater and drinking-water treatment processes. Various treatment options have been investigated for the removal/reduction of drugs (e.g., antibiotics, NSAIDs, analgesics) using conventional or biological treatments, such as activated sludge processes or bio-filtration, respectively. The efficiency of these processes ranges from 20–90%. Comparatively, advanced wastewater treatment processes, such as reverse osmosis, ozonation and advanced oxidation technologies, can achieve higher removal rates for drugs. Pharmaceuticals and their metabolites undergo natural attenuation by adsorption and solar oxidation. Therefore, pharmaceuticals in water sources even at trace concentrations would have undergone removal through biological processes and, if applicable, combined adsorption and photocatalytic degradation wastewater treatment processes. This review provides an overview of the conventional and advanced technologies for the removal of pharmaceutical compounds from water sources. It also sheds light on the key points behind adsorption and photocatalysis.
Most guidelines recommend either a long-acting beta-agonist (LABA) plus an inhaled glucocorticoid or a long-acting muscarinic antagonist (LAMA) as the first-choice treatment for patients with chronic ...obstructive pulmonary disease (COPD) who have a high risk of exacerbations. The role of treatment with a LABA-LAMA regimen in these patients is unclear.
We conducted a 52-week, randomized, double-blind, double-dummy, noninferiority trial. Patients who had COPD with a history of at least one exacerbation during the previous year were randomly assigned to receive, by inhalation, either the LABA indacaterol (110 μg) plus the LAMA glycopyrronium (50 μg) once daily or the LABA salmeterol (50 μg) plus the inhaled glucocorticoid fluticasone (500 μg) twice daily. The primary outcome was the annual rate of all COPD exacerbations.
A total of 1680 patients were assigned to the indacaterol-glycopyrronium group, and 1682 to the salmeterol-fluticasone group. Indacaterol-glycopyrronium showed not only noninferiority but also superiority to salmeterol-fluticasone in reducing the annual rate of all COPD exacerbations; the rate was 11% lower in the indacaterol-glycopyrronium group than in the salmeterol-fluticasone group (3.59 vs. 4.03; rate ratio, 0.89; 95% confidence interval CI, 0.83 to 0.96; P=0.003). The indacaterol-glycopyrronium group had a longer time to the first exacerbation than did the salmeterol-fluticasone group (71 days 95% CI, 60 to 82 vs. 51 days 95% CI, 46 to 57; hazard ratio, 0.84 95% CI, 0.78 to 0.91, representing a 16% lower risk; P<0.001). The annual rate of moderate or severe exacerbations was lower in the indacaterol-glycopyrronium group than in the salmeterol-fluticasone group (0.98 vs. 1.19; rate ratio, 0.83; 95% CI, 0.75 to 0.91; P<0.001), and the time to the first moderate or severe exacerbation was longer in the indacaterol-glycopyrronium group than in the salmeterol-fluticasone group (hazard ratio, 0.78; 95% CI, 0.70 to 0.86; P<0.001), as was the time to the first severe exacerbation (hazard ratio, 0.81; 95% CI, 0.66 to 1.00; P=0.046). The effect of indacaterol-glycopyrronium versus salmeterol-fluticasone on the rate of COPD exacerbations was independent of the baseline blood eosinophil count. The incidence of adverse events and deaths was similar in the two groups. The incidence of pneumonia was 3.2% in the indacaterol-glycopyrronium group and 4.8% in the salmeterol-fluticasone group (P=0.02).
Indacaterol-glycopyrronium was more effective than salmeterol-fluticasone in preventing COPD exacerbations in patients with a history of exacerbation during the previous year. (Funded by Novartis; FLAME ClinicalTrials.gov number, NCT01782326.).
Precision medicine is a patient-specific approach that integrates all relevant clinical, genetic and biological information in order to optimise the therapeutic benefit relative to the possibility of ...side-effects for each individual. Recent clinical trials have shown that higher blood eosinophil counts are associated with a greater efficacy of inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD) patients. Blood eosinophil counts are a biomarker with potential to be used in clinical practice, to help target ICS treatment with more precision in COPD patients with a history of exacerbations despite appropriate bronchodilator treatment.The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 pharmacological treatment algorithms, based on the ABCD assessment, can be applied relatively easily to treatment-naive individuals at initial presentation. However, their use is more problematic during follow-up in patients who are already on maintenance treatment. There is a need for a different system to guide COPD pharmacological management during follow-up.Recent large randomised controlled trials have provided important new information concerning the therapeutic effects of ICSs and long-acting bronchodilators on exacerbations. The new evidence regarding blood eosinophils and inhaled treatments, and the need to distinguish between initial and follow-up pharmacological management, led to changes in the GOLD pharmacological treatment recommendations. This article explains the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.
Summary Chronic obstructive pulmonary disease (COPD) is a common, complex, and heterogeneous disorder that is responsible for substantial and growing morbidity, mortality, and health-care expense ...worldwide. Of imperative importance to decipher the complexity of COPD is to identify groups of patients with similar clinical characteristics, prognosis, or therapeutic needs, the so-called clinical phenotypes. This strategy is logical for research but might be of little clinical value because clinical phenotypes can overlap in the same patient and the same clinical phenotype could result from different biological mechanisms. With the goal to match assessment with treatment choices, the latest iteration of guidelines from the Global Initiative for Chronic Obstructive Lung Disease reorganised treatment objectives into two categories: to improve symptoms (ie, dyspnoea and health status) and to decrease future risk (as predicted by forced expiratory volume in 1 s level and exacerbations history). This change thus moves treatment closer to individualised medicine with available bronchodilators and anti-inflammatory drugs. Yet, future treatment options are likely to include targeting endotypes that represent subtypes of patients defined by a distinct pathophysiological mechanism. Specific biomarkers of these endotypes would be particularly useful in clinical practice, especially in patients in which clinical phenotype alone is insufficient to identify the underlying endotype. A few series of potential COPD endotypes and biomarkers have been suggested. Empirical knowledge will be gained from proof-of-concept trials in COPD with emerging drugs that target specific inflammatory pathways. In every instance, specific endotype and biomarker efforts will probably be needed for the success of these trials, because the pathways are likely to be operative in only a subset of patients. Network analysis of human diseases offers the possibility to improve understanding of disease pathobiological complexity and to help with the development of new treatment alternatives and, importantly, a reclassification of complex diseases. All these developments should pave the way towards personalised treatment of patients with COPD in the clinic.
Using a laser-equivalent linear energy transfer (LET) approach, strong correlation is found for collected charge following heavy-ion and pulsed-laser excitation in a bulk diode device. By ...significantly modifying the size of the charge distribution generated by one- and two-photon absorption compared to the depth of the sensitive region, charge deposition in a large variety of device technologies is mimicked. Nearly one-to-one correlation is found with heavy-ion charge collection, independent of the laser focusing geometry or magnitude of LET. Finally, this approach is applied to the previous studies where empirical laser-ion correlations on highly scaled technologies were proposed. These correlations are reproduced through direct calculation of the laser-equivalent LET, and outstanding observations are explained despite the sensitive areas of these devices being up to 1000 times smaller than the laser-deposited charge profile. In total, these studies suggest that this quantitative methodology for laser-ion correlation is broadly applicable for a range of complex device technologies.
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most ...significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
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