Rapid and Efficient Arsenic Removal by Iron Electrocoagulation Enabled with in Situ Generation of Hydrogen Peroxide.

Millions of people are exposed to toxic levels of dissolved arsenic in groundwater used for drinking. Iron electrocoagulation (FeEC) has been demonstrated as an effective technology to remove arsenic at an affordable price. However, FeEC requires long operating times (∼hours) to remove dissolved arsenic due to inherent kinetics limitations. Air cathode Assisted Iron Electrocoagulation (ACAIE) overcomes this limitation by cathodically generating H2O2 in situ. In ACAIE operation, rapid oxidation of Fe(II) and complete oxidation and removal of As(III) are achieved. We compare FeEC and ACAIE for removing As(III) from an initial concentration of 1464 µg/L, aiming for a final concentration of less than 4 µg/L. We demonstrate that at short electrolysis times (0.5 min), i.e., high charge dosage rates (1200 C/L/min), ACAIE consistently outperformed FeEC in bringing arsenic levels to less than WHO-MCL of 10 µg/L. Using XRD and XAS data, we conclusively show that poor arsenic removal in FeEC arises from incomplete As(III) oxidation, ineffective Fe(II) oxidation and the formation of Fe(II-III) (hydr)oxides at short electrolysis times (<20 min). Finally, we report successful ACAIE performance (retention time 19 s) in removing dissolved arsenic from contaminated groundwater in rural California.

Optimization of Secondary Air Injection in a Wood-Burning Cookstove: An Experimental Study.

Nearly 40% of the world's population regularly cooks on inefficient biomass stoves that emit harmful airborne pollutants, such as particulate matter (PM). Secondary air injection can significantly reduce PM mass emissions to mitigate the health and climate impacts associated with biomass cookstoves. However, secondary air injection can also increase the number of ultrafine particles emitted, which may be more harmful to health. This research investigates the effect of secondary air injection on the mass and size distribution of PM emitted during solid biomass combustion. An experimental wood-burning cookstove platform and parametric testing approach are presented to identify and optimize secondary air injection parameters that reduce PM and other harmful pollutants. Size-resolved measurements of PM emissions were collected and analyzed as a function of parametric stove design settings. The results show that PM emissions are highly sensitive to secondary air injection flow rate and velocity. Although increasing turbulent mixing (through increased velocity) can promote more complete combustion, increasing the total flow rate of secondary air may cause localized flame quenching that increases particle emissions. Therefore, biomass cookstoves that implement secondary air injection should be carefully optimized and validated to ensure that PM emission reductions are achieved throughout the particle size range.

Effective Remediation of Groundwater Fluoride with Inexpensively Processed Indian Bauxite.

India represents one-third of the world's fluorosis burden and is the fifth global producer of bauxite ore, which has previously been identified as a potential resource for remediating fluoride-contaminated groundwater in impoverished communities. Here, we use thermal activation and/or groundwater acidification to enhance fluoride adsorption by Indian bauxite obtained from Visakhapatnam, an area proximate to endemic fluorosis regions. We compare combinatorial water treatment and bauxite-processing scenarios through batch adsorption experiments, material characterization, and detailed cost analyses. Heating Indian bauxite above 300 °C increases available surface area by > 15× (to ∼170 m2/g) through gibbsite dehydroxylation and reduces the bauxite dose for remediating 10 ppm F- to 1.5 ppm F- by ∼93% (to 21 g/L). Additionally, lowering groundwater pH to 6.0 with HCl or CO2 further reduces the average required bauxite doses by 43-73% for ores heated at 300 °C (∼12 g/L) and 100 °C (∼77 g/L). Product water in most examined treatment scenarios complies with EPA standards for drinking water (e.g., As, Cd, Pb, etc.) but potential leaching of Al, Mn, and Cr is of concern in some scenarios. Among the defluoridation options explored here, bauxite heated at 300 °C in acidified groundwater has the lowest direct costs ($6.86 per person per year) and material-intensity.

Factors Governing the Performance of Bauxite for Fluoride Remediation of Groundwater.

Globally, 200 million people drink groundwater contaminated with fluoride concentrations exceeding the World Health Organization's recommended level (WHO-MCL = 1.5 mg F-/L). This study investigates the use of minimally processed (dried/milled) bauxite ore as an inexpensive adsorbent for remediating fluoride-contaminated groundwater in resource-constrained areas. Adsorption experiments in synthetic groundwater using bauxites from Guinea, Ghana, U.S., and India as single-use batch dispersive media demonstrated that doses of ∼10-23 g/L could effectively remediate 10 mg F-/L. To elucidate factors governing fluoride removal, bauxites were characterized using X-ray fluorescence, X-ray diffraction, gas-sorption analysis, and adsorption isotherms/envelopes. All ores contained gibbsite, had comparable surface areas (∼14-17 m2/g), had similar intrinsic affinities and capacities for fluoride, and did not leach harmful ions into product water. Fluoride uptake on bauxite -primarily through ion-exchange- was strongly pH-dependent, with highest removal occurring at pH 5.0-6.0. Dissolution of CaCO3, present in trace amounts in India bauxite, significantly hindered fluoride removal by increasing solution pH. We also showed that fluoride remediation with the best-performing Guinea bauxite was ∼23-33 times less expensive than with activated alumina. Overall, our results suggest that bauxite could be an affordable fluoride-remediation adsorbent with the potential to improve access to drinking water for millions living in developing countries.

Determinants of the use of alternatives to arsenic-contaminated shallow groundwater: an exploratory study in rural West Bengal, India.

Shallow groundwater containing toxic concentrations of arsenic is the primary source of drinking water for millions of households in rural West Bengal, India. Often, this water also contains unpleasant levels of iron and non-negligible fecal contamination. Alternatives to shallow groundwater are increasingly available, including government-built deep tubewells, water purchased from independent providers, municipal piped water, and household filters. We conducted a survey of 501 households in Murshidabad district in 2014 to explore what influenced the use of available alternatives. Socioeconomic status and the perceived likelihood of gastrointestinal (GI) illness (which was associated with dissatisfaction with iron in groundwater) were the primary determinants of the use of alternatives. Arsenic knowledge was limited. The choice amongst alternatives was influenced by economic, social, and aesthetic factors, but not by health risk perceptions. The use of purchased water was rarely exclusive and was strongly associated with socioeconomic status, suggesting that this form of market-based water provision does not ensure universal access. Demand for purchased water appeared to decrease significantly shortly after free piped water became available at public taps. Our results suggest that arsenic mitigation interventions that also address co-occurring water problems (iron, GI illness) could be more effective than a focus on arsenic alone.

Reducing Ultrafine Particle Emissions Using Air Injection in Wood-Burning Cookstoves.

In order to address the health risks and climate impacts associated with pollution from cooking on biomass fires, researchers have focused on designing new cookstoves that improve cooking performance and reduce harmful emissions, specifically particulate matter (PM). One method for improving cooking performance and reducing emissions is using air injection to increase turbulence of unburned gases in the combustion zone. Although air injection reduces total PM mass emissions, the effect on PM size distribution and number concentration has not been thoroughly investigated. Using two new wood-burning cookstove designs from Lawrence Berkeley National Laboratory, this research explores the effect of air injection on cooking performance, PM and gaseous emissions, and PM size distribution and number concentration. Both cookstoves were created using the Berkeley-Darfur Stove as the base platform to isolate the effects of air injection. The thermal performance, gaseous emissions, PM mass emissions, and particle concentrations (ranging from 5 nm to 10 µm in diameter) of the cookstoves were measured during multiple high-power cooking tests. The results indicate that air injection improves cookstove performance and reduces total PM mass but increases total ultrafine (less than 100 nm in diameter) PM concentration over the course of high-power cooking.

Measuring and Increasing Adoption Rates of Cookstoves in a Humanitarian Crisis.

Traditional smoky cooking fires are one of today's greatest environmental threats to human life. These fires, used by 40% of the global population, cause 3.9 million annual premature deaths. "Clean cookstoves" have potential to improve this situation; however, most cookstove programs do not employ objective measurement of adoption to inform design, marketing, subsidies, finance, or dissemination practices. Lack of data prevents insights and may contribute to consistently low adoption rates. In this study, we used sensors and surveys to measure objective versus self-reported adoption of freely-distributed cookstoves in an internally displaced persons camp in Darfur, Sudan. Our data insights demonstrate how to effectively measure and promote adoption, especially in a humanitarian crisis. With sensors, we measured that 71% of participants were cookstove "users" compared to 95% of respondents reporting the improved cookstove was their "primary cookstove." No line of survey questioning, whether direct or indirect, predicted sensor-measured usage. For participants who rarely or never used their cookstoves after initial dissemination ("non-users"), we found significant increases in adoption after a simple followup survey (p = 0.001). The followup converted 83% of prior "non-users" to "users" with average daily adoption of 1.7 cooking hours over 2.2 meals. This increased adoption, which we posit resulted from cookstove familiarization and social conformity, was sustained for a 2-week observation period post intervention.

Production and transformation of mixed-valent nanoparticles generated by Fe(0) electrocoagulation.

Mixed-valent iron nanoparticles (NP) generated electrochemically by Fe(0) electrocoagulation (EC) show promise for on-demand industrial and drinking water treatment in engineered systems. This work applies multiple characterization techniques (in situ Raman spectroscopy, XRD, SEM, and cryo-TEM) to investigate the formation and persistence of magnetite and green rust (GR) NP phases produced via the Fe(0) EC process. Current density and background electrolyte composition were examined in a controlled anaerobic system to determine the initial Fe phases generated as well as transformation products with aging. Fe phases were characterized in an aerobic EC system with both simple model electrolytes and real groundwater to investigate the formation and aging of Fe phases produced in a system representing treatment of arsenic-contaminated ground waters in South Asia. Two central pathways for magnetite production via Fe(0) EC were identified: (i) as a primary product (formation within seconds when DO absent, no intermediates detected) and (ii) as a transformation product of GR (from minutes to days depending on pH, electrolyte composition, and aging conditions). This study provides a better understanding of the formation conditions of magnetite, GR, and ferric (oxyhydr)oxides in Fe EC, which is essential for process optimization for varying source waters.

Escherichia coli Attenuation by Fe Electrocoagulation in Synthetic Bengal Groundwater: Effect of pH and Natural Organic Matter.

Technologies addressing both arsenic and microbial contamination of Bengal groundwater are needed. Fe electrocoagulation (Fe-EC), a simple process relying on the dissolution of an Fe(0) anode to produce Fe(III) precipitates, has been shown to efficiently remove arsenic from groundwater at low cost. We investigated Escherichia coli (E. coli) attenuation by Fe-EC in synthetic Bengal groundwater as a function of Fe dosage rate, total Fe dosed, pH, and presence of natural organic matter (NOM). A 2.5 mM Fe dosage simultaneously achieved over 4-log E. coli attenuation and arsenic removal from 450 to below 10 µg/L. E. coli reduction was significantly enhanced at pH 6.6 compared to pH 7.5, which we linked to the decreased rate of Fe(II) oxidation at lower pH. 3 mg/L-C of NOM (Suwanee River fulvic acid) did not significantly affect E. coli attenuation. Live-dead staining and comparisons of Fe-EC with chemical coagulation controls showed that the primary mechanism of E. coli attenuation is physical removal with Fe(III) precipitates, with inactivation likely contributing as well at lower pH. Transmission electron microscopy showed that EC precipitates adhere to and bridge individual E. coli cells, resulting in large bacteria-Fe aggregates that can be removed by gravitational settling. Our results point to the promising ability of Fe-EC to treat arsenic and bacterial contamination simultaneously at low cost.

Fe(III) nucleation in the presence of bivalent cations and oxyanions leads to subnanoscale 7 Å polymers.

Highly disordered Fe(III) phases formed in the presence of bivalent cations and oxyanions represent important components of the global Fe cycle due to their potential for rapid turnover and their critical roles in controlling the speciation of major and trace elements. However, a poor understanding of the formation pathway and structure of these Fe phases has prevented assessments of their thermodynamic properties and biogeochemical reactivity. In this work, we derive structural models for the Fe(III)-As(V)-Ca and Fe(III)-P-Ca polymers formed from Fe(II) oxidation and Fe(III) polymerization in the presence of As(V)/P and Ca. The polymer phase consists of a less than 7 Å coherent network of As(V)/P coordinated to Fe(III) polyhedra, with varying amounts of Ca bound directly and indirectly to the oxyanion. This phase forms at the onset of Fe(II) oxidation and, because of its large oxyanion:Fe solids ratio, depletes the oxyanion concentration with only small amounts of Fe. Our results demonstrate that when a steady supply of Fe(III) is provided from an Fe(II) source, these Fe(III) polymers, which dominate oxyanion uptake, form with little dependence on the initial oxyanion concentration. The formation mechanisms and structures of the oxyanion-rich Fe(III) polymers determined in this study enable future thermodynamic investigations of these phases, which are required to model the interrelated biogeochemical cycles of Fe, As(V)/P, and Ca.

Emissions and climate-relevant optical properties of pollutants emitted from a three-stone fire and the Berkeley-Darfur stove tested under laboratory conditions.

Cooking in the developing world generates pollutants that endanger the health of billions of people and contribute to climate change. This study quantified pollutants emitted when cooking with a three-stone fire (TSF) and the Berkeley-Darfur Stove (BDS), the latter of which encloses the fire to increase fuel efficiency. The stoves were operated at the Lawrence Berkeley National Laboratory testing facility with a narrow range of fuel feed rates to minimize performance variability. Fast (1 Hz) measurements of pollutants enabled discrimination between the stoves' emission profiles and development of woodsmoke-specific calibrations for the aethalometer (black carbon, BC) and DustTrak (fine particles, PM2.5). The BDS used 65±5% (average±95% confidence interval) of the wood consumed by the TSF and emitted 50±5% of the carbon monoxide emitted by the TSF for an equivalent cooking task, indicating its higher thermal efficiency and a modest improvement in combustion efficiency. The BDS reduced total PM2.5 by 50% but achieved only a 30% reduction in BC emissions. The BDS-emitted particles were, therefore, more sunlight-absorbing: the average single scattering albedo at 532 nm was 0.36 for the BDS and 0.47 for the TSF. Mass emissions of PM2.5 and BC varied more than emissions of CO and wood consumption over all tests, and emissions and wood consumption varied more among TSF than BDS tests. The international community and the Global Alliance for Clean Cookstoves have proposed performance targets for the highest tier of cookstoves that correspond to greater reductions in fuel consumption and PM2.5 emissions of approximately 65% and 95%, respectively, compared to baseline cooking with the TSF. Given the accompanying decrease in BC emissions for stoves that achieve this stretch goal and BC's extremely high global warming potential, the short-term climate change mitigation from avoided BC emissions could exceed that from avoided CO2 emissions.

Low-cost, local production of a safe and effective disinfectant for resource-constrained communities.

Improved hygiene depends on the accessibility and availability of effective disinfectant solutions. These disinfectant solutions are unavailable to many communities worldwide due to resource limitations, among other constraints. Safe and effective chlorine-based disinfectants can be produced via simple electrolysis of salt water, providing a low-cost and reliable option for on-site, local production of disinfectant solutions to improve sanitation and hygiene. This study reports on a system (herein called "Electro-Clean") that can produce concentrated solutions of hypochlorous acid (HOCl) using readily available, low-cost materials. With just table salt, water, graphite welding rods, and a DC power supply, the Electro-Clean system can safely produce HOCl solutions (~1.5 liters) of up to 0.1% free chlorine (i.e.,1000 ppm) in less than two hours at low potential (5 V DC) and modest current (~5 A). Rigorous testing of free chlorine production and durability of the Electro-Clean system components, described here, has been verified to work in multiple locations around the world, including microbiological tests conducted in India and Mexico to confirm the biocidal efficacy of the Electro-Clean solution as a surface disinfectant. Cost estimates are provided for making HOCl locally with this method in the USA, India, and Mexico. Findings indicate that Electro-Clean is an affordable alternative to off-the-shelf commercial chlorinator systems in terms of first costs (or capital costs), and cost-competitive relative to the unit cost of the disinfectant produced. By minimizing dependence on supply chains and allowing for local production, the Electro-Clean system has the potential to improve public health by addressing the need for disinfectant solutions in resource-constrained communities.

Arsenic removal from groundwater using iron electrocoagulation: effect of charge dosage rate.

We demonstrate that electrocoagulation (EC) using iron electrodes can reduce arsenic below 10 µg/L in synthetic Bangladesh groundwater and in real groundwater from Bangladesh and Cambodia, while investigating the effect of operating parameters that are often overlooked, such as charge dosage rate. We measure arsenic removal performance over a larger range of current density than in any other single previous EC study (5000-fold: 0.02 - 100 mA/cm(2)) and over a wide range of charge dosage rates (0.060 - 18 Coulombs/L/min). We find that charge dosage rate has significant effects on both removal capacity (µg-As removed/Coulomb) and treatment time and is the appropriate parameter to maintain performance when scaling to different active areas and volumes. We estimate the operating costs of EC treatment in Bangladesh groundwater to be $0.22/m(3). Waste sludge (~80 - 120 mg/L), when tested with the Toxic Characteristic Leachate Protocol (TCLP), is characterized as non-hazardous. Although our focus is on developing a practical device, our results suggest that As[III] is mostly oxidized via a chemical pathway and does not rely on processes occurring at the anode. Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Environmental Science and Health, Part A, to view the free supplemental file.

Data-Sparse Prediction of High-Risk Schools for Lead Contamination in Drinking Water: Examples from Four U.S. States.

Childhood lead exposure through drinking water has long-term effects on cognition and development, and is a significant public health concern. The comprehensive lead testing of public schools entails high expense and time. In prior work, random forest modeling was used successfully to predict the likelihood of lead contamination in the drinking water from schools in the states of California and Massachusetts. In those studies, data from 70% of the schools was used to predict the probability of unsafe water lead levels (WLLs) in the remaining 30%. This study explores how the model predictions degrade, as the training dataset forms a progressively smaller proportion of schools. The size of the training set was varied from 80% to 10% of the total samples in four US states: California, Massachusetts, New York, and New Hampshire. The models were evaluated using the precision-recall area under curve (PR AUC) and area under the receiver operating characteristic curve (ROC AUC). While some states required as few as 10% of the schools to be included in the training set for an acceptable ROC AUC, all four states performed within an acceptable ROC AUC range when at least 50% of the schools were included. The results in New York and New Hampshire were consistent with the prior work that found the most significant predictor in the modeling to be the Euclidean distance to the closest school in the training set demonstrating unsafe WLLs. This study further supports the efficacy of predictive modeling in identifying the schools at a high risk of lead contamination in their drinking water supply, even when the survey data is incomplete on WLLs in all schools.

Community Perceptions of Arsenic Contaminated Drinking Water and Preferences for Risk Communication in California's San Joaquin Valley.

Due to chronic exposure to elevated levels of arsenic in drinking water, thousands of Californians have increased risk for internal cancers and other adverse health effects. The mortality risk of cancer is 1 in 400 people exposed to above 10 µg/L of arsenic in their drinking water. The purpose of this community assessment was to understand the perceptions and awareness of the residents and public water representatives in rural, unincorporated farming communities of color in San Joaquin Valley, California. In our research, we asked 27 community informants about their (1) available water sources, (2) knowledge about the health impacts of arsenic, and (3) preferences for risk communication and education regarding the health impacts of arsenic-contaminated drinking water. Through our qualitative coding and analysis, we found that most community informants indicated that there was limited community awareness about the health effects of drinking water with elevated arsenic levels. Preferences for risk communication included using in-language, culturally relevant, and health literate health promotion strategies and teaching these topics through the local K-8 schools' science curriculum with a language brokerage approach to transfer student knowledge to family members. Key recommendations include implementing these communication preferences to increase community-wide knowledge about safe drinking water.

Removing arsenic from synthetic groundwater with iron electrocoagulation: an Fe and As K-edge EXAFS study.

Electrocoagulation (EC) using iron electrodes is a promising arsenic removal strategy for Bangladesh groundwater drinking supplies. EC is based on the rapid in situ dissolution of a sacrificial Fe(0) anode to generate iron precipitates with a high arsenic sorption affinity. We used X-ray absorption spectroscopy (XAS) to investigate the local coordination environment (<4.0 Å) of Fe and As in EC precipitates generated in synthetic Bangladesh groundwater (SBGW). Fe and As K-edge EXAFS spectra were found to be similar between samples regardless of the large range of current density (0.02, 1.1, 5.0, 100 mA/cm(2)) used to generate samples. Shell-by-shell fits of the Fe K-edge EXAFS spectra indicated that EC precipitates consist of primarily edge-sharing FeO(6) octahedra. The absence of corner-sharing FeO(6) octahedra implies that EC precipitates resemble nanoscale clusters (polymers) of edge-sharing octahedra that efficiently bind arsenic. Shell-by-shell fits of As K-edge EXAFS spectra show that arsenic, initially present as a mixture of As(III) and As(V), forms primarily binuclear, corner-sharing As(V) surface complexes on EC precipitates. This specific coordination geometry prevents the formation of FeO(6) corner-sharing linkages. Phosphate and silicate, abundant in SBGW, likely influence the structure of EC precipitates in a similar way by preventing FeO(6) corner-sharing linkages. This study provides a better understanding of the structure, reactivity, and colloidal stability of EC precipitates and the behavior of arsenic during EC. The results also offer useful constraints for predicting arsenic remobilization during the long-term disposal of EC sludge.

Modeling As(III) oxidation and removal with iron electrocoagulation in groundwater.

Understanding the chemical kinetics of arsenic during electrocoagulation (EC) treatment is essential for a deeper understanding of arsenic removal using EC under a variety of operating conditions and solution compositions. We describe a highly constrained, simple chemical dynamic model of As(III) oxidation and As(III,V), Si, and P sorption for the EC system using model parameters extracted from some of our experimental results and previous studies. Our model predictions agree well with both data extracted from previous studies and our observed experimental data over a broad range of operating conditions (charge dosage rate) and solution chemistry (pH, co-occurring ions) without free model parameters. Our model provides insights into why higher pH and lower charge dosage rate (Coulombs/L/min) facilitate As(III) removal by EC and sheds light on the debate in the recent published literature regarding the mechanism of As(III) oxidation during EC. Our model also provides practically useful estimates of the minimum amount of iron required to remove 500 µg/L As(III) to <50 µg/L. Parameters measured in this work include the ratio of rate constants for Fe(II) and As(III) reactions with Fe(IV) in synthetic groundwater (k(1)/k(2) = 1.07) and the apparent rate constant of Fe(II) oxidation with dissolved oxygen at pH 7 (k(app) = 10(0.22) M(-1)s(-1)).

Superior removal of As(III) and As(V) from water with Mn-doped ß-FeOOH nanospindles on carbon foam.

Arsenic pollution of water is one of the severest environmental challenges threatening human health. Iron-based nanomaterials have been demonstrated effective in arsenic removal. However, they generally suffer from low removal efficiency towards highly toxic As(III), loss of active sites owing to agglomeration, and poor reusability. Herein, we report a carbonized melamine foam supported Mn(IV)-doped ß-FeOOH nanospindles(CF@Mn-FeOOH NSp) for tackling the technical hurdles. The designed CF@Mn-FeOOH NSp appears as a free-standing monolith through a low-cost and straightforward hydrothermal method. The atomic-scale integration of Mn(IV) into ß-FeOOH enables an oxidation-adsorption bifunctionality, where Mn(IV) serves as oxidizer for As(III) and Fe(III) acts as adsorber for As(V). The maximal adsorption capacity for As(V) and As(III) can reach 152 and 107 mg g-1, respectively. Meanwhile, As in simulated high arsenic groundwater can be decreased to below 10 µg L-1 within 24 h. By simple "filtrating-washing", 85% and 82% of its initial adsorption capacity for As(V) and As(III) can be easily recovered even after 5-cycles reuse. Kinetics and isotherm adsorption study indicate that the arsenic adsorption behavior is mainly through chemical bonding during single-layer adsorbing process. The as-prepared CF@Mn-FeOOH offers a scalable, efficient, and recyclable solution for arsenic removal in groundwater and wastewater from mines and industry.

Adapting a drinking water treatment technology for arsenic removal to the context of a small, low-income California community.

Small, low-income, and rural communities across the United States are disproportionately exposed to arsenic contaminated drinking water because existing treatment solutions are too expensive and difficult to operate. This paper describes efforts to overcome some barriers and limitations of conventional iron electrocoagulation (Fe-EC) to enable its use in the rural Californian (U.S.) context. Barriers and limitations of Fe-EC's application in rural California considered in this work include: 1) Frequent labor intensive electrode cleaning is required to overcome rust accumulation, 2) Electrolysis durations are long, reducing throughput for a given system size, and 3) Waste needs compliance with California standards. We report results from an investigation for overcoming these limitations via a field trial on a farm in Allensworth, a small, low-income, rural community in California. Our strategies to overcome each of the above barriers and limitations are respectively, 1) operating the Fe-EC reactor at high current density to result in sustained Fe production, 2) operating at high charge dosage rate with external H2O2, and 3) characterization of the arsenic-laden waste, and are discussed further in the paper. Main findings are: (1) Fe-EC removed arsenic consistently below the federal (and state) standard of 10 µg/L, (2) high current density failed to sustain Fe production whereas low current density did not, (3) electrolysis time decreased from > 1 hour to < 2 min with H2O2 dosing of 5 mg/L at higher charge dosage rates, (4) dilution of As-sludge is required to comply with State's non-hazardous waste status, and (5) discrepancies were observed between lab and field results in using current density to overcome labor-intensive electrode cleanings. Finally, implications of overcoming limitations to scale-up of Fe-EC in relevant California communities are discussed.

Safety and effectiveness of a non-electric infant warmer for hypothermia in Rwanda: A cluster-randomized stepped-wedge trial.

BACKGROUND: Neonatal hypothermia is a common source of morbidity and mortality in low resource settings. We developed the Dream Warmer, a low cost, re-usable non-electric infant warmer to prevent and treat hypothermia. METHODS: We conducted a cluster-randomized stepped-wedge trial. The primary aim was to assess the effect on overall euthermia rates of introducing the warmer compared to standard of care in rural Rwandan hospitals. The secondary aims were to assess effects of warmer introduction on mortality, as well as the safety and feasibility of the warmer. Ten district hospitals participated in the study from November 19th 2019 to July 15th 2020. Patients were eligible to use the warmer if they were 1) hypothermic (temp < 36·5 °C) or 2) or at risk of hypothermia (weight < 2·5 kg or estimated post menstrual age < 35 weeks) when Kangaroo Mother Care was not available. An encounter was defined as the data from an individual infant on a single day. Trial of a Non Electric Infant Warmer for Prevention and Treatment of Hypothermia in Rwanda [NCT03890211]. FINDINGS: Over the study period, 3179 patients were enrolled across the ten neonatal wards, yielding 12,748 encounters; 464 unique infants used the warmer 892 times, 79% eligible due to hypothermia. Because of limited study nurse resources, the warmer was used in only 18% of eligible encounters. Despite this low rate of warmer use, the rate of euthermia rose from 51% (95% CI 50-52%) of encounters pre-intervention to 67% (66-68%) post-intervention; p < 0·0001. Among the encounters in which the warmer was used, only 11% (9-13%) remained hypothermic. While mortality rates pre- and post-intervention did not change, mortality rate among those who used the warmer was significantly lower than among those who did not (0·9% vs 2·8%, p = 0·01). Use of the warmer did not affect hyperthermia rates. There were no safety concerns or instances of incorrect warmer use. INTERPRETATION: Introduction of the warmer increased rates of euthermia with no associated safety concerns.