Adoption of water reuse technologies: An assessment under different regulatory and operational scenarios.

Water reuse technologies may alleviate the water scarcity problems that affect many world regions, but their adoption is still limited. In particular, key actors in the adoption of water reuse technologies are water utilities, that provide both urban water and wastewater treatment services. Water utilities are embedded in the urban water system, which includes several stakeholders (urban water users, citizens at large, the environment) that may drive or pose barriers to water reuse adoption. Therefore, to ensure a smooth introduction of water reuse technologies, it is fundamental to understand how water reuse interacts with the existing urban water system and impacts its stakeholders. This paper contributes to the ongoing debate on water reuse by conceptualizing the interaction between water reuse technologies and the urban water system and its stakeholders, and addressing the adoption decision of water utilities by assessing its economic and environmental consequences. Based on a review of literature, policy and other secondary documents, and on primary data coming from interviews with experts from a water utility operating in Southern Italy, the study models the utility's response to a shift from urban to reuse water. It then simulates how reuse water introduction impacts on the utility and other stakeholders of the water system, under various regulatory and operational scenarios defined through a thorough analysis of policy documents and literature. Results show that the adoption of water reuse reduces the utility's margin by cannibalizing urban water demand, but appropriate policy measures may enhance the economic sustainability of reuse. System-level performances, such as impact on freshwater savings, costs for users, effects on the public budget, are also assessed, showing how different regulatory options moderate the intensity of impacts for the different stakeholders of the water system. Furthermore, the adoption of reuse water by the most distant users is found to enhance the economic sustainability of reuse and positively impact the utility's margin.

What factors affect the selection of industrial wastewater treatment configuration?

Industrial wastewater treatment is gaining significance in literature due to stricter environmental policies and increased environmental awareness. The selection of the wastewater configuration encompasses both the treatment as well as several decisions around wastewater collection and disposal pertaining industrial decision-making sphere. However, so far in the wastewater literature, research has mostly discussed either technical features of wastewater technologies, or wastewater policy issues at broader level, without focusing on the industrial decision-making issues and driving factors leading to the selection of a specific configuration. Starting from a literature review, the present study provides an innovative framework of the possible options for wastewater system configuration, as well as major adoption factors by industrial decision-makers. The factors have been classified according to 7 categories, namely: influent-related, technological, economic/financial, internal socio-cultural, external socio-cultural, regulation, site characteristics. The framework, validated with acknowledgeable experts, policy makers and firms, has been preliminarily applied to Italian and Australian food firms. Our investigation reveals that the framework was able to include all relevant problems faced by industries in the selection of a treatment system configuration; besides, the relative importance of factors has been assessed: legal requirements emerge as the most critical factors, followed by volume and discharge fee, the latter particularly interesting for policy makers purposes, since it may guide the decision-making process. Further, the wastewater volume seems to play a key role in our exploratory investigation, with smaller firms preferring a complete off-site treatment to reduce the complexity, whilst larger firms preferring instead more partial or complete on-site treatment configurations for compliance costs reduction. In conclusion, we have provided policy and managerial implications stemming from the study as well as sketched interesting future research avenues.

Epidural analgesia does not influence anastomotic leakage incidence after open colorectal surgery for cancer: A retrospective study on 1,474 patients.

BACKGROUND: Anastomotic leakage is a major cause of morbidity after colorectal surgery. Epidural analgesia is the most effective method for postoperative pain relief after major abdominal surgery. Anyhow, its effect on anastomotic leakage rate is still controversial. This study aimed to compare epidural versus intravenous analgesia as risk factor for anastomotic leakage requiring reoperation in patients undergoing open colorectal surgery for cancer. METHODS: A retrospective study on 1,474 patients was performed. The Cox proportional hazards model was used to study the relation between primary and secondary factors of risk and anastomotic leakage occurrence within 30 days after elective operation. RESULTS: Overall 30-day anastomotic leakage requiring reoperation was 4.9% (95%CI: 3.8-6.0%). No difference in anastomotic leakage occurrence was observed between the epidural analgesia group and the intravenous analgesia group (Hazard ratio: 0.94; 95%CI: 0.53-1.67%; P = 0.8338). Females had a rate of anastomotic leakage 43% lower than males (P = 0.0301). The diverting stoma resulted to be protective for anastomotic leakage occurrence (P = 0.0052). AL significantly increased postoperative median length of stay but not in-hospital mortality. CONCLUSIONS: Epidural analgesia does not influence the AL risk after open colorectal surgery for cancer.