Oxidative treatment of micropollutants present in wastewater: A special emphasis on transformation products, their toxicity, detection, and field-scale investigations.

Micropollutants have become ubiquitous in aqueous environments due to the increased use of pharmaceuticals, personal care products, pesticides, and other compounds. In this review, the removal of micropollutants from aqueous matrices using various advanced oxidation processes (AOPs), such as photocatalysis, electrocatalysis, sulfate radical-based AOPs, ozonation, and Fenton-based processes has been comprehensively discussed. Most of the compounds were successfully degraded with an efficiency of more than 90%, resulting in the formation of transformation products (TPs). In this respect, degradation pathways with multiple mechanisms, including decarboxylation, hydroxylation, and halogenation, have been illustrated. Various techniques for the analysis of micropollutants and their TPs have been discussed. Additionally, the ecotoxicity posed by these TPs was determined using the toxicity estimation software tool (T.E.S.T.). Finally, the performance and cost-effectiveness of the AOPs at the pilot scale have been reviewed. The current review will help in understanding the treatment efficacy of different AOPs, degradation pathways, and ecotoxicity of TPs so formed.

Combination of advanced biological systems and photocatalysis for the treatment of real hospital wastewater spiked with carbamazepine: A pilot-scale study.

Over the past few decades, the increase in dependency on healthcare facilities has led to the generation of large quantities of hospital wastewater (HWW) rich in chemical oxygen demand (COD), total suspended solids (TSS), ammonia, recalcitrant pharmaceutically active compounds (PhACs), and other disease-causing microorganisms. Conventional treatment methods often cannot effectively remove the PhACs present in wastewater. Hence, hybrid processes comprising of biological treatment and advanced oxidation processes have been used recently to treat complex wastewater. The current study explores the performance of pilot-scale treatment of real HWW (3000 L/d) spiked with carbamazepine (CBZ) using combinations of moving and stationary bed bio-reactor-sedimentation tank (MBSST), aerated horizontal flow constructed wetland (AHFCW), and photocatalysis. The combination of MBSST and AHFCW could remove 85% COD, 93% TSS, 99% ammonia, and 30% CBZ. However, when the effluent of the AHFCW was subjected to photocatalysis, an enhanced CBZ removal of around 85% was observed. Furthermore, the intermediate products (IPs) formed after the photocatalysis was also less toxic than the IPs formed during the biological processes. The results of this study indicated that the developed pilot-scale treatment unit supplemented with photocatalysis could be used effectively to treat HWW.

Visible Light-Assisted Degradation of Sulfamethoxazole on 2D/0D Sulfur-Doped Bi2O3/MnO2 Z-Scheme Heterojunction Immobilized Photocatalysts.

Retrieving the spent photocatalysts from the reaction system is always a challenging task. Therefore, the present work is focused on immobilizing sulfur-doped-Bi2O3/MnO2 (S-BOMO) heterojunction photocatalysts over different support matrices and evaluating their performance for the removal of sulfamethoxazole (SMX) in water under visible light. Our findings revealed S-BOMO coated clay beads (S-BOMO CCB) achieving more than 86% (240 min) SMX degradation ∼3, ∼1.3, and ∼2 times higher compared to S-BOMO coated on the different substrates, including glass beads, floating stones, and polymer material substrates, respectively. Mott-Schottky measurements confirmed the construction of the Z-scheme heterojunction involving MnO2 and 2S-Bi2O3. This Z-scheme mechanism, along with its narrow band gap of 1.58 eV, resulted in a rapid spatial transfer of the photogenerated charge carriers between the semiconductors and is believed to enhance the overall photocatalytic activity of the nanocomposite. Radical trapping and electron paramagnetic resonance results clearly established the active role of hydroxyl radicals and hydrogen peroxide in the degradation of SMX. Further, the 2S-BOMO CCB demonstrated excellent stability and photocatalytic activity over multiple runs. According to the sensitivity analysis and the results of anion effect experiments, phosphate and sulfate ions exhibit a significant impact on sulfamethoxazole degradation. Toxicity analysis revealed that 2S-BOMO CCB and sulfamethoxazole degradation byproducts were apparently innocuous. Additionally, the practical applicability of 2S-BOMO CCB was examined in various real water matrices, with the degradation efficiency followed the order: tap water < groundwater < surface water < hospital wastewater < municipal wastewater < pharmaceutical industry wastewater. The economic assessment revealed the reduction in the overall cost of the immobilized 2S-BOMO following the recovery process. Overall, the findings of this work provided critical insights into the synthesis and performance of incredibly effective and stable immobilized photocatalysts for the degradation of pharmaceutical pollutants.

The spatio-temporal dynamics of suspended sediment sources based on a novel indexing approach combining Bayesian geochemical fingerprinting with physically-based modelling.

Applications of sediment source fingerprinting continue to increase globally as the need for information to support improved management of the sediment problem persists. In our novel research, a Bayesian fingerprinting approach using MixSIAR was used with geochemical signatures, both without and with informative priors based on particle size and slope. The source estimates were compared with a newly proposed Source Sensitivity Index (SSI) and outputs from the INVEST-SDR model. MixSIAR results with informative priors indicated that agricultural and barren lands are the principal sediment sources (contributing ∼5-85% and ∼5-80% respectively during two sampling periods i.e. 2018-2019 and 2021-2022) with forests being less important. The SSI spatial maps (using % clay and slope as informative priors) showed >78% agreement with the spatial map derived using the INVEST-SDR model in terms of sub-catchment prioritization for spatial sediment source contributions. This study demonstrates the benefits of combining geochemical sediment source fingerprinting with SSI indices in larger catchments where the spatial prioritization of soil and water conservation is both challenging but warranted.

Development of microbial fuel cell integrated constructed wetland (CMFC) for removal of paracetamol and diclofenac in hospital wastewater.

Hospital wastewater management has become a significant concern across the globe due to the presence of pharmaceutically active compounds (PhACs) and other toxic substances, which can potentially disrupt ecosystems. The presence of recalcitrant PhACs in hospital wastewater increases the difficulty level for conventional wastewater treatment systems. Furthermore, incorporating advanced oxidation-based treatment systems increase capital and operation costs. To reduce treatment costs, low-cost innovative technology, i.e., composite constructed wetland and microbial fuel cell system (CMFC), has been developed for higher treatment efficiency of PhACs in hospital wastewater along with simultaneous bioelectricity generation as an additional outcome. In this study, influencing operating parameters, such as initial chemical oxygen demand (COD), electrode spacing, and substrate-to-water-depth ratio, were optimized for two plant species: water hyacinth (WH) and duckweed (DW). The optimized systems were run in batch and continuous mode for WH-CMFC and DW-CMFC to treat synthetic hospital wastewater with paracetamol and diclofenac, and the bioelectricity generation was monitored. DW-CMFC system depicted better treatment efficiency and voltage generation as compared to WH-CMFC. In continuous mode, the DW-CMFC system exhibited a removal of 95.3% COD, 97.1% paracetamol, and 87.5% diclofenac. WH-CMFC and DW-CMFC achieved power densities of around 21.26 mW/m2 and 42.93 mW/m2, respectively. The fate of PhACs during and after treatment and toxicity analysis of the transformation products formed were also carried out. Higher bio-electricity generation and efficient wastewater treatment of the DW-CMFC make it a sustainable option for hospital wastewater management.

Application of a new baffled horizontal flow constructed wetland-filter unit (BHFCW-FU) for treatment and reuse of petrochemical industry wastewater.

The shortage of water resources and generation of large quantum of wastewater has posed a significant concern to the environment and public health. Recent research on wastewater treatment has started to focus on reusing wastewater for different activities to reduce the stress on natural water resources. Constructed wetland (CWs) is a low-cost wastewater treatment option. However, some drawbacks include large areal requirements and the need for tertiary treatment units for reusable effluent. In this study, a novel composite baffled horizontal flow CW filter unit (BHFCW-FU) was developed to overcome the drawbacks of the conventional CW. The BHFCW-FU planted with Chrysopogon zizanioides provided a nine times longer flow path, and the adjoined variable depth dual media filter reduced the total area requirement and served as a polishing unit. On average, the BHFCW-FU with horizontal sub-surface flow regime could efficiently remove around 93.93%, 87.20%, and 66.25% of turbidity, phenol, and COD, respectively, from real petrochemical wastewater (initial turbidity: 29.6 NTU, phenol: 4.52 mg/L, and COD: 381 mg/L) and rendered the effluent quality reusable for irrigation, industrial, and other environmental purposes. In synthetic wastewater (initial turbidity: 754 NTU, phenol: 10.87 mg/L, and COD: 1691 mg/L), the removal efficiency of turbidity, phenol, and COD were 99.50%, 93.73%, and 87.05%, respectively. In-depth substrate characterization was done to study the removal mechanism. The developed BHFCW-FU required less space and maintenance, provided reusable effluent, and overcame the drawbacks of conventional CWs. Hence, it may show immense potential as an effective wastewater treatment.

Bioavailability of acalabrutinib suspension delivered via nasogastric tube in the presence or absence of a proton pump inhibitor in healthy subjects.

AIMS: Acalabrutinib, a selective Bruton tyrosine kinase inhibitor, is approved for the treatment of mantle cell lymphoma and chronic lymphocytic leukaemia. Many critically ill patients are unable to swallow and need oral medications to be delivered via a nasogastric (NG) tube. Furthermore, critically ill patients are typically administered proton-pump inhibitors (PPIs) to prevent stress ulcers. Concomitant administration with PPIs reduces acalabrutinib exposure and is not currently recommended. To evaluate acalabrutinib in subjects co-administered with PPIs who require NG delivery, a phase 1, open-label, randomized, crossover, single-dose study was conducted in healthy subjects. METHODS: The study assessed the relative bioavailability of an acalabrutinib suspension-in regular, degassed Coca-Cola-administered via NG tube (Acala-NG) versus the pharmacokinetics (PK) of an acalabrutinib capsule administered orally with water. In addition, the PPI effect was evaluated by comparing the PK following Acala-NG in the presence or absence of rabeprazole. RESULTS: Exposure of acalabrutinib and its active metabolite (ACP-5862) were comparable following administration of Acala-NG versus the oral capsule (Geo mean ratio, % ref [90% confidence interval, CI]: acalabrutinib AUCinf : 103 [93-113]; Cmax : 144 [120-173]). In addition, exposure was similar following administration of Acala-NG with and without a PPI (Geo mean ratio, % ref [90% CI]: acalabrutinib AUCinf : 105 [79-138]; Cmax : 95 [66-137]). No safety or tolerability concerns were observed, and all adverse events were mild and resolved without treatment. CONCLUSIONS: Acala-NG with or without a PPI is safe and well-tolerated without impeding bioavailability.

Enhancement of wastewater treatment performance using 3D printed structures: A major focus on material composition, performance, challenges, and sustainable assessment.

In order to enhance the performance and sustainability of wastewater treatment technologies, researchers are showing keen interest in the development of novel materials which can overcome the drawbacks associated with conventional materials. In this context, 3D printing gained significant attention due to its capability of fabricating complex geometrics using different material compositions. The present review focuses on recent advancements of 3D printing applications in various physicochemical and biological wastewater treatment techniques. In physicochemical treatment methods, substantial research has been aimed at fabricating feed spacers and other membrane parts, photocatalytic feed spacers, catalysts, scaffolds, monoliths, and capsules. Several advantages, such as membrane fouling mitigation, enhanced degradation efficiency, and recovery and reusability potential, have been associated with the aforementioned 3D printed materials. While in biofilm-based biological treatment methods, the use of 3D printed bio-carriers has led to enhanced mass transfer efficiency and microbial activities. Moreover, the application of these bio-carriers has shown better removal efficiency of chemical oxygen demand (∼90%), total nitrogen (∼73%), ammonia nitrogen (95%), and total phosphorous (∼100%). Although the removal efficiencies were comparable with conventional carriers, 3D printed carriers led to ∼40% reduction in hydraulic retention time, which could significantly save capital and operational expenditures. This review also emphasizes the challenges and sustainability aspects of 3D printing technology and outlines future recommendations which could be vital for further research in this field.

Advancements of sequencing batch reactor for industrial wastewater treatment: Major focus on modifications, critical operational parameters, and future perspectives.

Industrial wastewater discharge has increased manifolds over the last few decades. Efficient industrial wastewater treatment is mandatory to meet stringent discharge regulations. Biological treatment systems, such as the sequencing batch reactor (SBR) are generally employed for domestic wastewater treatment. However, low infrastructure and energy requirements, as well as low footprint, make SBR a prominent technique to treat industrial wastewater. In the present review, the feasibility of SBR to treat wastewater generated from industries, such as textile, pulp and paper, pharmaceutical, tannery, etc., has been discussed. The factors affecting the treatment efficacy of the SBR in terms of organics and nutrient removal have also been investigated. It has been observed that the SBR system is effective for industrial wastewater treatment as it is easy to operate, resistant to shock loads, and can retain high biomass concentrations. The modifications to the conventional SBR, such as sludge granulation, the addition of bio-film carriers, and the incorporation of adsorbents, salt-tolerant microbes, and coagulants have been discussed. Further, various novel combinations of SBR with the other advanced treatment technologies, such as Fenton, membrane-based process, and electrochemical process have shown enhanced removal of various conventional and recalcitrant pollutants. The current review also accentuates the sustainability aspects of SBR technology to treat industrial wastewater which may be beneficial for researchers and engineers working in this field.

A review on the treatment of septage and faecal sludge management: A special emphasis on constructed wetlands.

The global concern of the pollution of freshwater resources is associated with faecal sludge (FS) disposal, which is an inevitable component of onsite wastewater management mostly in developing countries. The difficulties with its treatment facilities lies in its higher organic content and low dewaterability of various available treatment systems. Moreover, the higher variability in characteristics and quantity of FS generated at different locations creates hindrances in designing the treatment system. Among the several treatment options, the constructed wetlands (CW) are an organic/green approach towards sanitation of FS with low cost and higher efficiency. The present study is an in-depth literature review on the quality and quantity of FS and septage (stabilized FS) in different regions attributed to the wide variability of its characteristics. This paper highlights the treatment of FS in different systems with a special emphasis on CW systems. Different mechanisms and factors affecting the FS treatment efficacy in CW, such as DO/aeration, macrophytes, substrate, CW configuration, and other environmental parameters, have been studied meticulously. The cost analysis revealed CW to be an economic system, and it can enable hybridization with other technologies to develop a complete treatment system with pronounced efficiencies. Several process modifications, such as augmentation with aeration, recirculation, micro-organisms, and earthworms, can enhance the treatment efficacies of CWs. The present review exhibited that the widely used plant species is Phragmites, and the optimum solid loading rate (SLR) range is 50-250 kg TS/m2/yr. The various factors to construct an optimized CW system for FS treatment were attempted, which may bolster the necessary guidelines for field-scale applications.

An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19.

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%-70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, ß-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly.

Robust sensor placement for sustainable leakage management in water distribution networks of developing economies: A hybrid decision support framework.

Urban water distribution networks (WDNs) in developing economies often refrain from investing in sensor-based leakage management technologies due to financial constraints and other techno-managerial issues. Thus, this study proposes a generalized decision support framework based on network sensitivity analysis (NSA) and multi-criteria decision-making (MCDM) to assess the prospect of effective leakage control through robust sensor placement in existing deficient WDNs. Four sensitivity parameters are formulated for NSA to ascertain the pressure response of the potential sensor positions for diverse hydraulic and leak scenarios. Subsequently, selecting the optimal number of sensors and their relative positions within the WDN is framed as an MCDM problem that entails the simultaneous maximization of Euclidean distances among the potential sensor positions and the leak-induced pressure residuals obtained at these sensors. The proposed methodology is developed on a numerical benchmark network assuming ideal conditions, and its applicability is verified on a sensor-equipped experimental network considering realistic system uncertainties. The outcome of this study aims to provide an insightful understanding of the system behavior that governs its leak localization potential and ascertain the practical challenges of sensor-based leakage monitoring in existing WDNs. Decision-makers of resource-strained utilities can beneficially utilize the proposed framework to assess the environmental and cost trade-offs of employing sensor-based technologies for leakage management and proactive decision-making before its actual implementation.

Modeling defluoridation of real-life groundwater by a green adsorbent aluminum/olivine composite: Isotherm, kinetics, thermodynamics and novel framework based on artificial neural network and support vector machine.

The kinetic, isotherm, and thermodynamics of adsorptive removal of fluoride from the real-life groundwater was evaluated to assess the applicability of a green adsorbent, aluminum/olivine composite (AOC). The isotherm and kinetics were demonstrated by the Freundlich and Elovich model indicating significant surface heterogeneity of AOC in favouring the fluoride sorption. The fluoride removal efficiency of AOC was achieved as 87.5% after 240 min of contact time. The diffusion kinetic model exhibited that both the intra-particle and film diffusion together control the rate-limiting step of fluoride adsorption. A negative value of ΔG0 (-19.919 kJ/mol) at 303 K confirmed the spontaneous adsorption reaction of fluoride, and its endothermic nature was supported by the negative value of ΔH0 (39.504 kJ/mol). A novel framework for a predictive model by artificial neural network (ANN), and support vector machine (SVM) considering the real and synthetic fluoride-containing water was developed to assess the efficiency of adsorbent under different scenarios. ANN model was observed to be statistically significant (RMSE: 1.0955 and R2: 0.9982) and the proposed method may be instrumental in a similar area for benchmarking the synthetic and real-life samples. The low desorption potential of the spent adsorbent exhibited safe disposal of sludge and the secondary-pollutant-free treated water by the efficient and green adsorbent AOC enhanced the field-scale applicability of the green technology.

A multivariate modeling and experimental realization of photocatalytic system of engineered S-C3N4/ZnO hybrid for ciprofloxacin removal: Influencing factors and degradation pathways.

Ciprofloxacin, a pharmaceutically active compound, is present as a micropollutant in wastewater, which cannot be removed by conventional techniques due to its recalcitrant nature. Therefore, in the present study, the photocatalytic degradation of this bio-toxic compound was demonstrated using a three-dimensional sulfur-doped graphitic-carbon nitride/zinc oxide hybrid, with enriched oxygen vacancies. The influence of various water matrices and experimental conditions on the ciprofloxacin degradation was optimized. The hybrid material showed 98.8% and 75.8% degradation efficiency under optimum experimental conditions (i.e., catalyst dose: 1 g/L; pH: 5; initial ciprofloxacin concentration: 20 mg/L; temperature: 27 °C) under ultraviolet (UV) and visible light, respectively. A neural-network-based multivariate approach was used to predict a significant model considering the experimental conditions that showed adequate statistical significance (R2: 0.992 and F-value: 8707.1). The relative significance of the experimental conditions was assessed, suggesting that the initial ciprofloxacin concentration has a more significant effect on the degradation efficiency than the other factors. The rate kinetics and reaction mechanisms for ciprofloxacin degradation were demonstrated, and the driving radicals involved were identified. A higher rate of reaction was found under UV irradiation (0.01702 min-1) than under visible light (0.00802 min-1). Superoxide radicals were identified as the main driving radicals, which caused substantial photocatalytic reactions among the hybrid and ciprofloxacin molecules. Microscopic and macroscopic analyses of the used hybrid were conducted, which confirmed the presence of higher defect concentrations, crystallinity, and interlinked stacked structure in the hybrid. Hence, the 3D hybrid can be efficiently used and reused for ciprofloxacin degradation. This advanced photocatalytic system can be widely used to remediate emerging contaminants in wastewater treatment.

Analysis of Clinical Trial Registry of India for Evidence of Anti-Arthritic Properties of Withania somnifera (Ashwagandha).

BACKGROUND: Withania somnifera (Ashwagandha) is an herb with anti-inflammatory properties used in managing arthritis. There is significant clinical data in the public domain on the effects of Ashwagandha and this study was aimed at compiling and analysing these data in a structured manner. The major sources of evidence data were clinical trials and systematic review of extant literature. METHODOLOGY: Retrospective database search was conducted in the Clinical Trial Registry of India for trials registered from April 2008 to March 2020, and published literature related to the anti-arthritic effects of Withania somnifera were reviewed. RESULTS: In all, 77 registered clinical trials were analysed and common among them were interventional, single-centre, randomized, double-blind, two-arm studies with Placebo being the comparator. Similar findings were observed in the 10 published clinical trials on arthritis evaluated for this study. While industry- and government-sponsored trials were identified, government funded sites with approvals from Institutional Ethics Committees were preferred. Most trials were registered as Phase 2 with the highest number of sites in the state of Maharashtra. The solid dosage form was most preferred. CONCLUSION: While the effects of Withania somnifera on various disorders are being investigated by several clinical trials, the ones evaluated for this study provide insight on its potential in managing arthritis when given for a specific duration. Evidence shows a dosage of 6 gm in powder form or extracts in tablets, or 500 -1000 mg capsule consumed for a duration of 8 - 12 weeks may be useful in managing symptoms of arthritis in patients.

Predicting the trend and utility of different photocatalysts for degradation of pharmaceutically active compounds: A special emphasis on photocatalytic materials, modifications, and performance comparison.

The rapid rise in the healthcare sector has led to an increase in pharmaceutically active compounds (PhACs) in different aqueous bodies. The toxicity of the PhACs and their ability to persist after conventional treatment processes have escalated research in the field of photocatalytic treatment. Although different photocatalysts have been successful in degrading PhACs, their inherent drawbacks have severely limited their application on a large scale. A substantial amount of research has been aimed at overcoming the high cost of the photocatalytic material, low quantum yield, the formation of toxic end products, etc. Hence, to further research in this field, researchers must have a fair idea of the current trends in the application of different photocatalysts. In this article, the trends in the use of various photocatalysts for the removal of different PhACs have been circumscribed. The performance of different groups of photocatalysts to degrade PhACs from synthetic and real wastewater has been addressed. The drawbacks and advantages of these materials have been compared, and their future in the field of PhACs removal has been predicted using S-curve analysis. Zinc and titanium-based photocatalysts were efficient under UV irradiation, while bismuth and graphene-based materials exhibited exemplary performance in visible light. However, iron-based compounds were found to have the most promising future, which may be because of their magnetic properties, easy availability, low bandgap, etc. Different modification techniques, such as morphology modification, doping, heterojunction formation, etc., have also been discussed. This study may help researchers to clarify the current research status in the field of photocatalytic treatment of PhACs and provide valuable information for future research.

Hydraulic performance benchmarking for effective management of water distribution networks: An innovative composite index-based approach.

Hydraulic performance assessment and benchmarking of water distribution networks (WDNs) impose a major challenge to water utilities worldwide. Presently, benchmarking strategies for WDNs are not fully developed, especially for analyzing intermittent systems commonly encountered in non-developed nations. To overcome these limitations, this paper proposes an index-based benchmarking strategy for WDNs, comparing their actual hydraulic performance and expected serviceability. A robust Hydraulic Performance Index (HPI) is developed as a global metric to account for the combined impact of multiple hydraulic outputs, concerning their benchmark values. The applicability of this index is verified on a numerical benchmark network, and its usefulness is demonstrated on a real-world intermittent WDN located in Kolkata (India) by coupling the HPI-based framework with hydraulic models using the EPANET-MATLAB programmer's toolkit. A scenario-based analysis is conducted using extended-period simulation to obtain the HPI for diverse service levels and leakage conditions of the WDN models. The HPI is designed to effectively capture the localized pressure reduction during peak flow, prioritize hydraulic outputs based on regional constraints, and penalize systems with unsustainably high hydraulic output. The developed strategy is also effective in performance benchmarking of WDNs of different nations with diverse serviceability and threshold parameters on a common platform. Finally, the practical efficacy and generalizability of the HPI-based results in the context of case-specific performance management of WDNs, along with limitations, recommendations and future perspectives are elucidated upon.

Surgical anatomy of basal turn in relation to middle cranial fossa and round window as pertaining to middle fossa cochlear implant technique.

PURPOSE: The purpose of this investigation was to evaluate the relation of the basal turn of cochlea with middle cranial fossa and round window as pertaining to middle cranial fossa cochlear implant technique. METHODS: Fifty-four formalin preserved temporal bones were micro-dissected to expose the basal turn. The point (f) was marked on the basal turn of cochlea where there was minimum distance of basal turn of cochlea from the floor of middle cranial fossa (f1). The f-f1 distance, the angle (∠smf) and distance of point "f" from the round window (s-f) was measured. RESULTS: The mean minimum distance between basal turn of cochlea and floor of middle cranial fossa (f-f1) was 2.0 ± 0.7 mm.The point f was at mean distance (s-f) and angle (∠smf) of 14.7 ± 1.6 mm and 217° ± 13.7° from round window, respectively. CONCLUSIONS: The information may be helpful for designing appropriate electrode array for middle fossa technique especially for deciding the length of electrode array towards round window, as otherwise electrode may extend into vestibule of inner ear. In the cases where bone thickness between superior part of basal turn of cochlea and middle cranial fossa is < 1.5 mm, surgeon should be extra cautious.

Effect of coexisting ions on adsorptive removal of arsenate by Mg-Fe-(CO3) LDH: multi-component adsorption and ANN-based multivariate modeling.

The adsorptive removal of a pollutant from water is significantly affected by the presence of coexisting ions with various concentrations. Here, we have studied adsorption of arsenate [As(V)] by calcined Mg-Fe-(CO3)-LDH in the presence of different cations (Mg2+, Na+, K+, Ca2+, and Fe3+) and anions (CO32‒, Cl‒, PO43‒, SO42‒, and NO3‒) with their different concentrations to simulate the field condition. The experimental results indicated that Ca2+, Mg2+, and Fe3+ have a synergistic effect on removal efficiency of As(V), whereas PO43‒ and CO32‒ ions have a significant antagonistic impact. Overall, the order of inhibiting effect of coexisting anions on adsorption of As(V) was arrived as NO3-˂Cl-

Durvalumab alone and durvalumab plus tremelimumab versus chemotherapy in previously untreated patients with unresectable, locally advanced or metastatic urothelial carcinoma (DANUBE): a randomised, open-label, multicentre, phase 3 trial.

BACKGROUND: Survival outcomes are poor for patients with metastatic urothelial carcinoma who receive standard, first-line, platinum-based chemotherapy. We assessed the overall survival of patients who received durvalumab (a PD-L1 inhibitor), with or without tremelimumab (a CTLA-4 inhibitor), as a first-line treatment for metastatic urothelial carcinoma. METHODS: DANUBE is an open-label, randomised, controlled, phase 3 trial in patients with untreated, unresectable, locally advanced or metastatic urothelial carcinoma, conducted at 224 academic research centres, hospitals, and oncology clinics in 23 countries. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1. We randomly assigned patients (1:1:1) to receive durvalumab monotherapy (1500 mg) administered intravenously every 4 weeks; durvalumab (1500 mg) plus tremelimumab (75 mg) administered intravenously every 4 weeks for up to four doses, followed by durvalumab maintenance (1500 mg) every 4 weeks; or standard-of-care chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin, depending on cisplatin eligibility) administered intravenously for up to six cycles. Randomisation was done through an interactive voice-web response system, with stratification by cisplatin eligibility, PD-L1 status, and presence or absence of liver metastases, lung metastases, or both. The coprimary endpoints were overall survival compared between the durvalumab monotherapy versus chemotherapy groups in the population of patients with high PD-L1 expression (the high PD-L1 population) and between the durvalumab plus tremelimumab versus chemotherapy groups in the intention-to-treat population (all randomly assigned patients). The study has completed enrolment and the final analysis of overall survival is reported. The trial is registered with ClinicalTrials.gov, NCT02516241, and the EU Clinical Trials Register, EudraCT number 2015-001633-24. FINDINGS: Between Nov 24, 2015, and March 21, 2017, we randomly assigned 1032 patients to receive durvalumab (n=346), durvalumab plus tremelimumab (n=342), or chemotherapy (n=344). At data cutoff (Jan 27, 2020), median follow-up for survival was 41·2 months (IQR 37·9-43·2) for all patients. In the high PD-L1 population, median overall survival was 14·4 months (95% CI 10·4-17·3) in the durvalumab monotherapy group (n=209) versus 12·1 months (10·4-15·0) in the chemotherapy group (n=207; hazard ratio 0·89, 95% CI 0·71-1·11; p=0·30). In the intention-to-treat population, median overall survival was 15·1 months (13·1-18·0) in the durvalumab plus tremelimumab group versus 12·1 months (10·9-14·0) in the chemotherapy group (0·85, 95% CI 0·72-1·02; p=0·075). In the safety population, grade 3 or 4 treatment-related adverse events occurred in 47 (14%) of 345 patients in the durvalumab group, 93 (27%) of 340 patients in the durvalumab plus tremelimumab group, and in 188 (60%) of 313 patients in the chemotherapy group. The most common grade 3 or 4 treatment-related adverse event was increased lipase in the durvalumab group (seven [2%] of 345 patients) and in the durvalumab plus tremelimumab group (16 [5%] of 340 patients), and neutropenia in the chemotherapy group (66 [21%] of 313 patients). Serious treatment-related adverse events occurred in 30 (9%) of 345 patients in the durvalumab group, 78 (23%) of 340 patients in the durvalumab plus tremelimumab group, and 50 (16%) of 313 patients in the chemotherapy group. Deaths due to study drug toxicity were reported in two (1%) patients in the durvalumab group (acute hepatic failure and hepatitis), two (1%) patients in the durvalumab plus tremelimumab group (septic shock and pneumonitis), and one (<1%) patient in the chemotherapy group (acute kidney injury). INTERPRETATION: This study did not meet either of its coprimary endpoints. Further research to identify the patients with previously untreated metastatic urothelial carcinoma who benefit from treatment with immune checkpoint inhibitors, either alone or in combination regimens, is warranted. FUNDING: AstraZeneca.