Hydraulic characterization and removal of metals and nutrients in an aerated horizontal subsurface flow "racetrack" wetland treating primary-treated oil industry effluent.

Constructed wetlands (CW) are an attractive technology due to their operational simplicity and low life-cycle cost. It has been applied for refinery effluent treatment but mostly single-stage designs (e.g., vertical or horizontal flow) have been tested. However, to achieve a good treatment efficiency for industrial effluents, different treatment conditions (both aerobic and anaerobic) are needed. This means that hybrid CW systems are typically required with a respectively increased area demand. In addition, a strong aerobic environment that facilitates the formation of iron, manganese, zinc and aluminum precipitates cannot be established with passive wetland systems, while the role of these oxyhydroxide compounds in the further co-precipitation and removal of heavy metals such as copper, nickel, lead, and chromium that can simplify the overall treatment of industrial wastewaters is poorly understood in CW. Therefore, this study tests for the first time an innovative CW design that combines an artificially aerated section with a non-aerated section in a single unit applied for oil refinery wastewater treatment. Four pilot units were tested with different design (i.e., planted/unplanted, aerated/non-aerated) and operational (two different hydraulic loading rates) characteristics to estimate the role of plants and artificial aeration and to identify the optimum design configuration. The pilot units received a primary refinery effluent, i.e., after passing through a dissolved air flotation unit. The first-order removal of heavy metals under aerobic conditions is evaluated, along with the removal of phenols and nutrients. High removal rates for Fe (96-98%), Mn (38-81%), Al (49-73%), and Zn (99-100%) generally as oxyhydroxide precipitates were found, while removal of Cu (61-80%), Ni (70-85%), Pb (96-99%) and Cr (60-92%) under aerobic conditions was also observed, likely through co-precipitation. Complete phenols and ammonia nitrogen removal was also found. The first-order rate coefficient (k) calculated from the collected data demonstrates that the tested CW represents an advanced wetland design reaching higher removal rates at a smaller area demand than the common CW systems.

Outcomes That Matter Most to Young Adults Diagnosed with Cancer: A Qualitative Study.

Purpose: The purpose of this study is to provide insight for improvement in care for young adults diagnosed with cancer (YADC), by identifying underemphasized outcomes that strongly matter to YADC and the gaps in care that may limit achieving these outcomes for this unique and vulnerable population. Methods: Twenty-seven YADC, ages 25-39, participated in unstructured discussions focusing on topics relating to diagnosis, daily experiences living with cancer outside of the clinical setting, goals, concerns, and clinical care experience. Most participants engaged in group discussions using Experience Group methodology. Discussions were designed to collect information on three dimensions of health: capability, comfort, and calm (CCC). Data were coded using thematic analysis with NVivo software. Results: Several themes were identified within the CCC framework: capability in terms of confronting mortality at a young age, losing youthful identity and control over major life course decisions, especially fertility, and debilitating side effects, comfort in terms of the lack of understanding from peers and family and the fear of cancer recurrence, and calm was discussed as the difficulty of making complex medical decisions, financial toxicity, and loss of clinical support in survivorship. Conclusion: This research highlighted four care additions that are important for YADC: (1) concise and understandable education about their condition and treatment; (2) same-age support groups; (3) fertility support; and (4) better care transitions for life after cancer. These findings emphasize the importance of creating a collaborative, multidisciplinary care team and a holistic approach with care innovations that support clinicians to meet the unique needs of YADC.

Removal of phosphorus, fluoride and metals from a gypsum mining leachate using steel slag filters.

The objective of this work was to evaluate the capacity of steel slag filters to treat a gypsum mining leachate containing 11-107 mg P/L ortho-phosphates, 9-37 mg/L fluoride, 0.24-0.83 mg/L manganese, 0.20-3.3 zinc and 1.7-8.2 mg/L aluminum. Column tests fed with reconstituted leachates were conducted for 145-222 days and sampled twice a week. Two types of electric arc furnace (EAF) slags and three filter sequences were tested. The voids hydraulic retention time (HRT(v)) of columns ranged between 4.3 and 19.2 h. Precipitates of contaminants present in columns were sampled and analyzed with X-ray diffraction at the end of tests. The best removal efficiencies over a period of 179 days were obtained with sequential filters that were composed of Fort Smith EAF slag operated at a total HRT(v) of 34 h which removed 99.9% of phosphorus, 85.3% of fluoride, 98.0% of manganese and 99.3% of zinc. Mean concentration at this system's effluent was 0.04 mg P/L ortho-phosphates, 4 mg/L fluoride, 0.02 mg/L manganese, 0.02 zinc and 0.5 mg/L aluminum. Thus, slag filters are promising passive and economical systems for the remediation of mining effluents. Phosphorus was removed by the formation of apatite (hydroxyapatite, Ca(5)(PO(4))(3)OH or fluoroapatite, Ca(5)(PO(4))(3)F) as confirmed by visual and X-ray diffraction analyses. The growth rate of apatite was favored by a high phosphorus concentration. Calcite crystals were present in columns and appeared to be competing for calcium and volume needed for apatite formation. The calcite crystal growth rate was higher than that of apatite crystals. Fluoride was removed by precipitation of fluoroapatite and its removal was favored by a high ratio of phosphorus to fluoride in the wastewater.

Model of phosphorus precipitation and crystal formation in electric arc furnace steel slag filters.

The objective of this study was to develop a phosphorus retention mechanisms model based on precipitation and crystallization in electric arc furnace slag filters. Three slag columns were fed during 30 to 630 days with a reconstituted mining effluent at different void hydraulic retention times. Precipitates formed in columns were characterized by X-ray diffraction and transmission electronic microscopy. The proposed model is expressed in the following steps: (1) the rate limiting dissolution of slag is represented by the dissolution of CaO, (2) a high pH in the slag filter results in phosphorus precipitation and crystal growth, (3) crystal retention takes place by filtration, settling and growth densification, (4) the decrease in available reaction volume is caused by crystal and other particulate matter accumulation (and decrease in available reaction time), and (5) the pH decreases in the filter over time if the reaction time is too low (which results in a reduced removal efficiency). Crystal organization in a slag filter determines its phosphorus retention capacity. Supersaturation and water velocity affect crystal organization. A compact crystal organization enhances the phosphorus retention capacity of the filter. A new approach to define filter performance is proposed: saturation retention capacity is expressed in units of mg P/mL voids.

Creating a high-value delivery system for health care.

Health care reform that focuses on improving value enhances both the well-being of patients and the professional satisfaction of physicians. Value in health care is the improvement in health outcomes achieved for patients relative to the money spent. Dramatic and ongoing improvement in the value of health care delivered will require fundamental restructuring of the system. Current efforts to improve safety and reduce waste are truly important but not sufficient. The following three structural changes will drive simultaneous improvement in outcomes and efficiency: (1) reorganizing care delivery into clinically integrated teams defined by patient needs over the full cycle of care; (2) measuring and reporting patient outcomes by clinical teams, across the cycle of care and for identified clusters of medical circumstances; and (3) enabling reimbursement tied to value rather than to quantity of services. Many of these changes require physician leadership. We discuss steps on the journey to value-based care delivery.