Selective degradation of endogenous organic metabolites in acidified fresh human urine using sulphate radical-based advanced oxidation.

The human urine metabolome is complex, containing a wide range of organic metabolites that affect treatment of urine collected in resource-oriented sanitation systems. In this study, an advanced oxidation process involving heat-activated peroxydisulphate was used to selectively oxidise organic metabolites in urine over urea and chloride. Initial experiments evaluated optimal conditions (peroxydisulphate dose, temperature, time, pH) for activation of peroxydisulphate in unconcentrated, non-hydrolysed synthetic urine and real urine acidified to pH 3.0. Subsequent experiments determined the fate of 268 endogenous organic metabolites (OMs) and removal of COD from unconcentrated and concentrated real urine (80-90% mass reduced by evaporation). The results revealed >90% activation of 60 mM peroxydisulphate in real unconcentrated urine heated to 90 °C for 1 h, resulting in 43% ΣOMs degradation, 22% COD removal and 56% total organic carbon removal, while >94% of total nitrogen and >97% of urea in real unconcentrated urine were recovered. The mechanism of urea degradation was identified to be chemical hydrolysis to ammonia, with the rate constant for this reaction determined to be 1.9 × 10-6 s-1 at pH 3.0 and 90 °C. Treating concentrated real urine resulted in similar removal of COD, ΣOMs degradation and total nitrogen loss as observed for unconcentrated urine, but with significantly higher chloride oxidation and chemical hydrolysis of urea. Targeted metabolomic analysis revealed that peroxydisulphate treatment degraded 157 organic metabolites in urine, of which 67 metabolites were degraded by >80%. The rate constant for the reaction of sulphate radicals with oxidisable endogenous organic metabolites in urine was estimated to exceed 108 M-1 s-1. These metabolites were preferentially oxidised over chloride and urea in acidified, non-hydrolysed urine treated with peroxydisulphate. Overall, the findings support the development of emerging urine recycling technologies, including alkaline/acid dehydration and reverse osmosis, where the presence of endogenous organic urine metabolites significantly influences treatment parameters such as energy demand and product purity.

Marital Status, Race, Insurance Type, and Socioeconomic Status-Assessment of Social Predictors for Outcomes After Total Knee Arthroplasty.

BACKGROUND: The purpose of this study was to investigate the effect of various social determinants of health on outcomes and dispositions after total knee arthroplasty (TKA). METHODS: A retrospective review was conducted on 14,462 consecutive TKA procedures between 2013 and 2021 at a multicenter hospital system. Data abstraction was done by inquiry to the Michigan Arthroplasty Registry Collaborative Quality Initiative. Data points requested included basic demographics, marital status, race, insurance status, socioeconomic status measured by the Area of Deprivation Index, perioperative course, and incidence of emergency department (ED) visits and readmissions within 3 months of surgery. Subsequent multivariate analyses were conducted. RESULTS: Unmarried patients required markedly greater lengths of hospital stay and had an increased rate of discharge to skilled nursing facilities and a higher likelihood of any purpose ED visit within 90 days of surgery compared with married patients, who had a significantly greater rate of same-day discharge ( P < 0.001). Race did not markedly correlate with outcomes. Medicare patients showed a greater rate of same-day discharge, nonhome discharge, and 90-day ED visits compared with privately insured patients ( P < 0.001). Medicaid patients were more likely than privately insured patients to have a 90-day ED visit ( P < 0.001). Socioeconomic status had a minimal clinical effect on all studied outcomes. CONCLUSION: Social factors are important considerations in understanding outcomes after TKA. Additional investigations are indicated in identifying at-risk patients and subsequent optimization of these patients.