Global changes to the chemotherapy service during the covid-19 pandemic.

PURPOSE: In response to the COVID-19 pandemic, changes to chemotherapy services were implemented as a means of managing imposed workload strains within health services and protecting patients from contracting COVID-19. Given the rapidly evolving nature of the pandemic many changes were rapidly adopted and were not substantiated by robust evidence. This study aimed to describe the changes adopted internationally to chemotherapy services, which may be used to guide future changes to treatment delivery. METHODS: A survey was developed to understand the impact of COVID-19 on the delivery of systemic anti-cancer therapies (SACT). It comprised 22 questions and examined the strategies implemented during the pandemic to prioritise and protect patients receiving SACT and the participants' professional opinion of the strategies employed. The survey was available in English, Spanish and French and was distributed via professional bodies. RESULTS: 129 responses were obtained from healthcare professionals working across 17 different countries. 45% of institutions had to implement treatment prioritisation strategies and all hospitals implemented changes in the delivery of treatment, including: reduction in treatments (69%), using less immunosuppressive agents (50%), allowing treatment breaks (14%) and switching to oral therapies (45%). Virtual clinic visits were perceived by participants as the most effective strategy to protect patients. CONCLUSIONS: The pandemic has forced chemotherapy healthcare professionals to adopt new ways of working by reducing health interactions. Many areas of research are needed following this period, including understanding patients' perceptions of risks to treatment, utilisation of oral treatments and the impact of treatment breaks on cancer outcomes.

Ecology and performance of aerobic granular sludge treating high-saline municipal wastewater.

The successful development of aerobic granular sludge (AGS) for secondary wastewater treatment has been linked to a dedicated anaerobic feeding phase, which enables key microbes such as poly-phosphate-accumulating organisms (PAOs) and glycogen-accumulating organisms to gain a competitive advantage over floc-forming organisms. The application of AGS to treat high-saline sewage and its subsequent impacts on microbial ecology, however, are less well understood. In this study, the impacts of high-saline sewage on AGS development, performance and ecology were investigated using molecular microbiology methods. Two feeding strategies were compared at pilot scale: a full (100%) anaerobic feed; and a partial (33%) anaerobic feed. The results were compared to a neighbouring full-scale conventional activated sludge (CAS) system (100% aerobic). We observed that AGS developed under decreased anaerobic contact showed a comparable formation, stability and nitrogen removal performance to the 100% anaerobically fed system. Analysis of the microbial ecology showed that the altered anaerobic contact had minimal effect on the abundances of the functional nitrifying and denitrifying bacteria and Archaea; however, there were notable ecological differences when comparing different sized granules. In contrast to previous work, a large enrichment in PAOs in AGS was not observed in high-saline wastewater, which coincided with poor observed phosphate removal performance. Instead, AGS exhibited a substantial enrichment in sulfide-oxidising bacteria, which was complemented by elemental analysis that identified the presence of elemental sulfur precipitation. The potential role for these organisms in AGS treating high-saline wastewater is discussed.

Analysis of nitrous oxide emissions from aerobic granular sludge treating high saline municipal wastewater.

Conventional activated sludge (CAS)-based wastewater treatment processes have the potential to emit high concentrations of nitrous oxide (N2O) during nitrification and denitrification, which can significantly impact the environmental performance and carbon footprint of wastewater treatment operations. While N2O emissions from CAS have been extensively studied, there is little knowledge of N2O emissions from aerobic granular sludge (AGS) which is now an increasingly popular secondary treatment alternative. The N2O emissions performance of AGS needs to be investigated to ensure that the positive benefits of AGS, such as increased capacity and stable nutrient removal, are not offset by higher emissions. This study quantified N2O emissions from a pilot-scale AGS reactor operated under a range of organic loading rates. A second CAS pilot plant was operated in parallel and under identical loading rates to allow for side-by-side comparison of N2O emissions from floc-based activated sludge. Under low loadings of <0.6 kg COD/m3/d the N2O emission factor from AGS and CAS were similar, at around 1.46 ± 0.1% g N2Oemitted/g ammonium loaded. A step increase in the organic loading rate increased N2O emissions from AGS more so than CAS which appeared to be attributed to the reactor feeding strategy that was required for AGS formation. The use of a separate anaerobic feeding phase which was followed by the aeration phase, resulted in extended periods of low dissolved oxygen (DO) concentrations combined with an initial high biomass ammonium loading rate, which favours N2O production and was exacerbated at higher organic loads. Conversely, the combined feeding plus aeration operation (aerobic feed) employed by the CAS system enabled a more even biomass ammonium loading rate and DO supply. This work has shown that while AGS has many operational benefits, the impacts that aeration profile, loading rate and feeding strategy have on N2O emissions must be considered.

Mitigating nitrous oxide emissions at a full-scale wastewater treatment plant.

Mitigation of nitrous oxide (N2O) emissions is of primary importance to meet the targets of reducing carbon footprints of wastewater treatment plants (WWTPs). Despite of a large amount of N2O mitigation studies conducted in laboratories, full-scale implementation of N2O mitigation is scarce, mainly due to uncertainties of mitigation effectiveness, validation of N2O mathematical model, risks to nutrient removal performance and additional costs. This study aims to address the uncertainties by investigating the quantification, development and implementation of N2O mitigation strategies at a full-scale sequencing batch reactor (SBR). To achieve this, N2O emission dynamics, nutrient removal performance and operation of the SBR were monitored to quantify N2O emissions, and identify the N2O generation mechanisms. N2O mitigation strategies centered on reducing dissolved oxygen (DO) levels were consequently proposed and evaluated using a multi-pathway N2O production mathematical model before implementation. The implemented mitigation strategy resulted in a 35% reduction in N2O emissions (from the emission factor of 0.89 ± 0.05 to 0.58 ± 0.06%), which was equivalent to annual reduction of 2.35 tonne of N2O from the studied WWTP. This could be mainly attributed to reductions in N2O generated via the NH2OH oxidation pathway due to the lowering of DO level. As the first reported mitigation strategy permanently implemented at a full scale WWTP, it showcased that the mitigation of N2O emissions at full-scale is feasible and that widely accepted N2O mitigation strategies developed in laboratory studies are also likely effective in full-scale plants. Furthermore, the close agreement between the validated and predicted N2O emission factors (0.58% vs 0.55%, respectively), showed that the N2O mathematical model is a useful tool to evaluate N2O mitigation strategies at full-scale. Importantly this work demonstrated that N2O mitigation does not necessarily require additional operational cost to meet reduction targets. In contrast, the N2O mitigation applied here reduced energy requirements for aeration by 20%. Equally important, long-term monitoring identified that N2O mitigation did not affect the nutrient removal performance of the plant. Finally, with the knowledge acquired in this study, a standard approach for mitigating N2O emissions from full-scale treatment plants was proposed.

Comparing the performance of aerobic granular sludge versus conventional activated sludge for microbial log removal and effluent quality: Implications for water reuse.

The application of aerobic granular sludge (AGS) technology has increased in popularity, largely due to the smaller physical footprint, enhanced biological nutrient removal performance and ability to perform with a more stable operation when compared to conventional activated sludge (CAS) systems. To date, the ability of AGS to remove microbial pathogens such as; Escherichia coli, Giardia, and Cryptosporidium has not been reported. This study compared the log10 removal performance of commonly used pathogen surrogates (sulfite-reducing clostridia spores, f-RNA bacteriophage, E. coli and total coliforms) by AGS and CAS during the start-up phase, through to maturation. Results showed that AGS performed as well as CAS for the log10 removal performance of all microbial surrogates, except for spores which were removed more effectively by AGS most likely due to greater adherence of spores to the AGS biomass compared to CAS mixed liquor. Results suggest that AGS is capable of meeting or exceeding CAS-equivalent health-based targets for pathogen removal in the context of water recycling as well as not adversely affecting the secondary effluent water quality (suspended solids, turbidity and particle size) in terms of ultraviolet light transmissivity (254 nm). These findings confirmed for the first time that the adoption of AGS operation would not adversely impact downstream tertiary disinfection processes from altered water quality, nor would it require further pathogen treatment interventions in addition to what is already required for CAS systems.

Comparison of an anaerobic feed and split anaerobic-aerobic feed on granular sludge development, performance and ecology.

The retrofitting of existing wastewater sequencing batch reactors (SBRs) to select for rapid-settling aerobic granular sludge (AGS) over floc-based conventional activated sludge (CAS), could be a viable option to decrease reactor cycle time and increase hydraulic capacity. Successful CAS-to-AGS conversion has previously been shown to be highly dependent on having a dedicated anaerobic feed, which presents additional engineering challenges when retrofitting SBRs. In this study we compared the performance of a split anaerobic-aerobic (An-Aer) feed with that of a traditional dedicated anaerobic feed regarding AGS formation and stability, nitrogen removal performance and microbial ecology. Using pilot trials, we showed that AGS could be established and maintained when using a split An-Aer feed at low organic loading rates analogous to that of a parallel full-scale conventional SBR. Additionally, we showed that AGS start-up time and nitrogen removal performance were comparable under a split An-Aer feed and dedicated anaerobic feed. Microbial ecology characterisations based on whole-of-community 16S rRNA profiles and targeted analysis of functional genes specific for nitrifying and denitrifying microorganisms, showed that the two different feed strategies had only subtle impacts on both the overall community composition and functional ecology. A much greater divergence in microbial ecology was seen when comparing AGS with CAS. Data presented here will be of value to those planning to retrofit existing CAS-based SBRs to operate with AGS and demonstrates the viability of using a more cost-effective split An-Aer feed configuration over a dedicated anaerobic feed.