Removal of particulate matter and dissolved organic matter from sedimentation sludge water during pre-sedimentation process: Performances and mechanisms.

Sedimentation sludge water (SSW), a prominent constituent of wastewater from drinking water treatment plants, has received limited attention in terms of its treatment and utilization likely due to the perceived difficulties associated with managing SSW sludge. This study comprehensively evaluated the water quality of SSW by comparing it to a well-documented wastewater (filter backwash water (FBW)). Furthermore, it investigated the pollutant variations in the SSW during pre-sedimentation process, probed the underlying reaction mechanism, and explored the feasibility of employing a pilot-scale coagulation-sedimentation process for SSW treatment. The levels of most water quality parameters were generally comparable between SSW and FBW. During the pre-sedimentation of SSW, significant removal of turbidity, bacterial counts, and dissolved organic matter (DOM) was observed. The characterization of DOM components, molecular weight distributions, and optical properties revealed that the macromolecular proteinaceous biopolymers and humic acids were preferentially removed. The characterization of particulates indicated that high surface energy, zeta potential, and bridging/adsorption/sedimentation/coagulation capacities in aluminum residuals of SSW, underscoring its potential as a coagulant and promoting the generation and sedimentation of inorganic-organic complexes. The coagulation-sedimentation process could effectively remove pollutants from low-turbidity SSW ([turbidity]0 < 15 NTU). These findings provide valuable insights into the water quality dynamics of SSW during the pre-sedimentation process, facilitating the development of SSW quality management and enhancing its reuse rate.

Mastering granular activated carbon filtration to remove organic micropollutants, antibiotic resistance and metals for municipal wastewater reuse.

GAC filtration of municipal wastewater was optimized and intensified, making its implementation and operation directly after secondary clarification possible and relevant. GAC was first selected based on laboratory tests. Performances on organic micropollutants were linked to the repartition of BET surface between micropores and meso/macropores. At pilot scale, in order to limit the impact of head loss, downflow declogging sequences (DCS) were implemented and upflow filtration tested. 6 to 12 DCS per day led to a 4.7-5.5-fold increase of particles retention capacity between backwashes (cycle duration of 20-120 h), and upflow operations improved head loss evolution profile with only a slight GAC (<15 %) expansion. DCS allows backwash frequency reduction, enabling significant water savings. Both adaptations maintained high organic micropollutants removals compared to a review of 16 GAC studies at pilot or full-scale, results being in the upper range. A specific dose of 2.0-2.5 g GAC/gC was necessary to obtain an average removal of pharmaceuticals and benzotriazole of 80 % at 20 min contact time, which is comparable to PAC and low granulometry GAC. Higher doses are needed for PFAS but >80 % removals are achievable. Particles, TKN, particulate phosphorus and organic matter are well removed by GAC filtration in both configurations. Biological activity is observed through nitrogen transformation in the GAC bed. Heavy metals are greatly removed in GAC filtration, in particular Cd, Cu, Ni and Pb, probably through biosorption onto the biofilm, developed within the GAC bed. For wastewater reuse applications, GAC filtration has an added value through physicochemical quality improvement and fecal contamination indicators removal of 1 log, facilitating the implementation and optimizing the design of a post-disinfection. Antibiotic resistant bacteria and antibiotic resistance genes are also partially retained in GAC filtration. Finally, biological wastewater treatments combined to GAC filtration is a good solution to effectively treat organic micropollutants together with heavy metals and preparing post-disinfection for reuse.

Barriers encountered with clinical data warehouses: Recommendations from a focus group.

BACKGROUND AND OBJECTIVE: The increasing implementation and use of electronic health records over the last few decades has made a significant volume of clinical data being available. Over the past 20 years, hospitals have also adopted and implemented data warehouse technology to facilitate the reuse of administrative and clinical data for research. However, the implementation of clinical data warehouses encounters a set of barriers: ethical, legislative, technical, human and organizational. This paper proposes an overview of difficulties and barriers encountered during a clinical data warehouse (CDW) development and implementation project. METHODS: We conducted a focus group at the 2023 Medical Informatics Europe Conference and invited professionals involved in the implementation of CDW. These experts described their CDW and the difficulties and barriers they encountered at each phase: (i) launching of the data warehouse project, (ii) implementing the data warehouse and (iii) using a data warehouse in routine operations. They were also asked to propose solutions they were able to implement to address the barriers previously reported. RESULTS: After synthesis and consensus, a total of 26 barriers were identified, 10 pertained to tasks, 5 to tools and technologies, 4 to persons, 4 to organization, and 3 to the external environment. To address these challenges, a set of 15 practical recommendations was offered, covering essential aspects such as governance, stakeholder engagement, interdisciplinary collaboration, and external expertise utilization. CONCLUSIONS: These recommendations serve as a valuable resource for healthcare institutions seeking to establish and optimize CDWs, offering a roadmap for leveraging clinical data for research, quality enhancement, and improved patient care.

Potential for nutrients reuse, carbon sequestration, and CO2 emissions reduction in the practice of domestic and industrial wastewater recycling into agricultural soils: A review.

This review assesses the feasibility of reusing treated wastewater for irrigation in agricultural soils as a strategy for nutrients recycling and mitigation of CO2 emissions. Through a literature review, it was examined wastewater sources enriched with carbon and nutrients, including municipal wastewater and associated sludge, vinasse, swine wastewater, as well as wastewater from the food industry and paper and pulp production. The review also explores the dynamics of organic matter within the soil, discussing the aspects related to its potential conversion to CO2 or long-term storage. It was found that industrial wastewaters, owing to their higher organic matter and recalcitrance, exhibit greater potential for carbon storage. However, the presence of pollutants in wastewater necessitates careful consideration, particularly concerning their impact on soil quality. Toxic metals, microplastics, and organic compounds emerged as significant contaminants that could accumulate in the soil, posing risks to ecosystem health. To mitigate the environmental impacts, it was evaluated various wastewater treatment technologies and their associated carbon emissions. While advanced treatments may effectively reduce the contaminant load and mitigate soil impacts, their adoption is often associated with an increase in CO2 emissions. Membrane bioreactors, microfiltration, ultrafiltration, and up-flow anaerobic sludge blanket reactors were identified as promising technologies with lower carbon footprints. Looking ahead, future research should aim to enhance the understanding of carbon dynamics in soil and validate the environmental impacts of treated wastewater disposal. Despite remaining uncertainties, the literature indicates a positive outlook for wastewater recycling in soil, offering a viable strategy for carbon storage and mitigation of greenhouse gas emissions.

Effect of anaerobic digestion on pathogens and antimicrobial resistance in the sewage sludge.

Antimicrobial resistance (AMR) is recognized as a global threat. AMR bacteria accumulate in sewage sludge however, knowledge on the persistence of human pathogens and AMR in the sludge line of the wastewater treatment is limited. Sludge can be used, with or without additional treatment, as fertilizer in agricultural fields. The aim of this study is to obtain knowledge about presence of human pathogens and AMR in the sewage sludge, before and after the anaerobic digestion (AD) applying innovative combinations of methods. Fifty sludge samples were collected. Cultivation methods combined with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and Antibiotic Susceptibility Test (AST) were used obtaining knowledge about the microbial community, pathogens, and antibiotic resistant bacteria while the droplet digital Polymerase Chain Reaction (ddPCR) was performed to detect most common AMR genes. In total, 231 different bacterial species were identified in the samples. The most abundant species were spore-forming facultative anaerobic bacteria belonging to Bacillus and Clostridium genera. The AD causes a shift in the microbial composition of the sludge (p = 0.04). Seven pathogenic bacterial species constituting 188 colonies were isolated and tested for susceptibility to Clindamycin, Meropenem, Norfloxacin, Penicillin G, and Tigecycline. Of the Clostridium perfringens and Bacillus cereus isolates 67 and 50 %, respectively, were resistant to Clindamycin. Two B. cereus and two C. perfringens isolates were also resistant to other antibiotics showing multidrug resistance. ARGs (blaOXA, blaTEM, ermB, qnrB, tet(A)-(W), sulI-II) were present at 7-8 Log gene copies/kg of sludge. AD is the main driver of a reduction of some ARGs (1 Log) but resistant bacteria were still present. The results showed the usefulness of the integration of the proposed analytical methods and suggest a decrease in the risk of presence of cultivable pathogens including resistant isolates after AD but a persistent risk of ARGs' horizontal transmission.

What is the Difference between Conventional Drinking Water, Potable Reuse Water, and Nonpotable Reuse Water? A Microbiome Perspective.

As water reuse applications expand, there is a need for more comprehensive means to assess water quality. Microbiome analysis could provide the ability to supplement fecal indicators and pathogen profiling toward defining a "healthy" drinking water microbiota while also providing insight into the impact of treatment and distribution. Here, we utilized 16S rRNA gene amplicon sequencing to identify signature features in the composition of microbiota across a wide spectrum of water types (potable conventional, potable reuse, and nonpotable reuse). A clear distinction was found in the composition of microbiota as a function of intended water use (e.g., potable vs nonpotable) across a very broad range of U.S. water systems at both the point of compliance (Betadisper p > 0.01; ANOSIM p < 0.01, r-stat = 0.71) and point of use (Betadisper p > 0.01; ANOSIM p < 0.01, r-stat = 0.41). Core and discriminatory analysis further served in identifying distinct differences between potable and nonpotable water microbiomes. Taxa were identified at both the phylum (Desulfobacterota, Patescibacteria, and Myxococcota) and genus (Aeromonas and NS11.12_marine_group) levels that effectively discriminated between potable and nonpotable waters, with the most discriminatory taxa being core/abundant in nonpotable waters (with few exceptions, such as Ralstonia being abundant in potable conventional waters). The approach and findings open the door to the possibility of microbial community signature profiling as a water quality monitoring approach for assessing efficacy of treatments and suitability of water for intended use/reuse application.

Efficient removal of antibiotic resistance genes and of enteric bacteria from reclaimed wastewater by enhanced Soil Aquifer Treatments.

Soil Aquifer Treatment (SAT) is a robust technology to increase groundwater recharge and to improve reclaimed water quality. SAT reduces dissolved organic carbon, contaminants of emerging concern, nutrients, and colloidal matter, including pathogen indicators, but little is known about its ability to reduce loads of antibiotic resistance genes (ARGs) from reclaimed waters. Here we test six pilot SAT systems to eliminate various biological hazards from the secondary effluents of a wastewater treatment plant (WWTP), equipped with reactive barriers (RBs) including different sorptive materials. Using flow cytometry, qPCR and 16S rRNA gene amplicon sequencing methods, we determined that all six SAT systems reduced total loads of bacteria by 80 to 95 % and of clinically relevant ARGs by 85 to 99.9 %. These efficiencies are similar to those reported for UV/oxidation or membrane-based tertiary treatments, which require much more energy and resources. The presence and composition of reactive barriers, the season of sampling (June 2020, October 2020, and September 2021), or the flow regime (continuous versus pulsating) did not affect ARG removal efficiency, although they did alter the microbial community composition. This suggests that an adequate design of the SAT reactive barriers may significantly increase their performance. Under a mechanistic point of view, we observed an ecological succession of bacterial groups, linked to the changing physical-chemical conditions along the SAT, and likely correlated to the removal of ARGs. We concluded that SAT is as cost-efficient technology able to dramatically reduce ARG loads and other biological hazards from WWTP secondary effluents.

Impact of the circular economy on ecological footprint: evidence from Germany.

The circular economy practices contribute to sustainable development by maximising efficiency, utilising renewable resources, extending product lifespans, and implementing waste reduction strategies. This study investigates the individual impacts of four sources of the circular economy on the ecological footprint in Germany, a country that is among the pioneers in establishing a comprehensive roadmap for the circular economy. The four sources examined are renewable energy consumption (REC), recycling, reuse, and repair of materials. Using time series data from 1990 to 2021, the study employed the dynamic autoregressive distributed lag (ARDL) simulation technique and also applied kernel-based linear regression (KRLS) to test the robustness of the results. The findings revealed that reuse practices significantly reduce the ecological footprint in both the short and long run. REC and repair also substantially decrease the ecological footprint, as shown by the simulation analysis. Conversely, while recycling is generally considered crucial for minimising environmental impact, in this study, it was found to contribute to environmental degradation. This paradox may be attributed to the nascent state of the recycling industry and data limitations. The results from KRLS confirm the findings of the dynamic ARDL. It is recommended that policymakers develop measures that are appropriate, efficient, and targeted to enhance the role of each source of the circular economy in reducing the ecological footprint in Germany. The major limitation of the study is its reliance on the indirect measures of circular economy attributed to the non-availability of data on direct measures.

Waste from the food industry: Innovations in biorefineries for sustainable use of resources and generation of value.

Biorefineries have attracted significant attention from the scientific community and various industrial sectors due to their use of unconventional biomass sources to produce biofuels and other value-added compounds. Various agro-industrial residues can be applied in biorefinery systems, making them economically and environmentally attractive. However, the cost, efficiency, and profitability of the process are directly affected by the choice of biomass, pre-treatments, and desired products. In biorefineries, the simultaneous production of different products during processing is a valuable approach. Chemical, physical, biological, or combined treatments can generate numerous compounds of high commercial interest, such as phenolic compounds. These treatments, in addition to modifying the biomass structure, are essential for the process's viability. Over the years, complex treatments with high costs and environmental impacts have been simplified and improved, becoming more specific in generating high-value resources as secondary outputs to the main process (generally related to the release of sugars from lignocelluloses to produce second-generation ethanol). Innovative methods involving microorganisms and enzymes are the most promising in terms of efficiency and lower environmental impact. Biorefineries enable the use of varied raw materials, such as different agro-industrial residues, allowing for more efficient resource utilization and reducing dependence on non-renewable sources. In addition to producing low-carbon biofuels, biorefineries generate a variety of high-value by-products, such as packaging materials, pharmaceuticals, and nutritional ingredients. This not only increases the profitability of biorefineries but also contributes to a circular economy.

Variations in Dispensing Psychotropic Drugs to Adolescents Depending on School Periods: A French Nationwide Retrospective Study.

Seasonality patterns are reported for various psychiatric disorders. Concerning adolescents, there is an increased frequency of general emergency department visits for mental health disorders observed between March and May, as well as in October and November. We conducted a retrospective cohort study using the French health insurance medico-administrative database. We extracted psychotropic drug deliveries occurring between 2015 and 2019 for patients aged between 12 and 18 years old. Each drug delivery was classified as occurring during a school period (Sc), the summer holidays (SumH) or other shorter holidays periods (ShH). We compared the number of distinct patients, as well as the proportion of new consumers, according to week status. Anxiolytics and hypnotics were more frequently dispensed during the school periods and short breaks than during the summer holidays. Conversely, antidepressants were more commonly dispensed during the short breaks rather than school periods and summer holidays. The stressful effects induced by schooling appear to be addressed in the first line by anxiolytics and hypnotics, while antidepressants are more frequently introduced during school holidays.

The Ouest Data Hub: An Interregional Health Data Sharing Ecosystem for Research.

The Ouest Data Hub (ODH) a project lead by GCS HUGO which is a cooperation group of University Hospitals in the French Grand Ouest region represents a groundbreaking initiative in this territory, advancing health data sharing and reuse to support research driven by real-world health data. Central to its structure are the Clinical Data Warehouses (CDWs) and Clinical Data Centers (CDCs), essential for analytics and as the linchpin of the ODH's status as an interregional Learning Health System. Aimed at fostering innovation and research, the ODH's collaborative and multi-institutional model effectively utilizes both local and shared resources. Yet, the path is not without challenges, especially in data quality and interoperability, where ongoing harmonization and standard adherence are critical. In 2023, this facilitated access to extensive health data from over 9.3 million patient records, demonstrating the ODH's capacity for both monocentric and multicentric research across various clinical fields, in close collaboration with physicians. The integration of healthcare professionals is crucial, ensuring data's clinical relevance and guiding accurate interpretations. Future expansions of the ODH to new hospitals and data types promise to enhance its model further, already inspiring similar frameworks across France. This scalable model for health data ecosystems showcases the ODH's potential as a foundation for national and supranational data sharing efforts.

Reuse of Adverse Effect Reports from the French National Agency of Medicines: A Visual Analytic Tool to Improve Patient Safety.

Adverse drug reaction are defined as "harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product". In France, adverse effects due to medicines are reported to the French National Agency of Medicines (ANSM) by the healthcare professionals or consumers. The objective of this study was to implement a tool that facilitates the utilization of ANSM reports by synthesizing information to effectively inform prescribers and users. We focused on 3 psychotropic classes: antidepressants, antipsychotics and anxiolytics. We extracted relevant data from the ANSM website through a webscraping process, based on the names of molecules in these 3 classes: antidepressants, antipsychotics, and anxiolytics. We implemented a web interface with R Shiny that provides three panels: (i) a presentation of the active ingredient with the fewest reports for a selected adverse effect category, (ii) the adverse reactions for a selected active ingredient ranked in descending order, and (iii) a comparison of two active ingredients where, for each adverse effect, the active ingredient with the fewest reported adverse drug events (ADEs) is displayed. Our application allows for synthesizing information to effectively inform prescribers and users. In the ANSM existing interface, molecules can only be viewed one by one, and the ratio needs to be calculated manually, making it difficult to compare molecules. It is important to note that this is not a prescription assistance device but rather for informational purposes. In the future, the application may be expanded to include other categories of molecules. Finally, the indicators provided by our tool could be compared to those from other pharmacovigilance databases.

Development and Implementation of Standardized, Structured Clinical Reporting for Oncology.

Reuse of clinical data within the healthcare process and for secondary purposes is particularly valuable. This study emphasizes the crucial role of Standardized, Structured Reports (SSRs) in supporting continuity of care while also advancing reusability of data, decision support functionalities, and accommodating future developments. Integrating SSRs with existing information systems poses a serious challenge. The integration of SSRs with information standards enhances their utility in diverse applications. The significance of SSRs is further highlighted by their seamless integration into healthcare processes, and development and implementation is supported by various available applications. This research contributes to the evolution of medical informatics by emphasizing the importance of collaborative efforts in standardized, structured reporting, all aimed at enhancing patient care.

Public Availability of Data Management and Analysis Scripts of Studies Conducted on Open-Access Intensive Care Databases.

Intensive care units (ICUs) provide care for critical patients at high risk of morbidity and mortality, and require continuous monitoring of clinical, biological and, imaging parameters. Collaborative ventures have enabled the emergence of large open access databases for the secondary use of Electronic Health Records (EHRs). The objective of this work was to evaluate the availability of scripts and datasets in publications based on ICU open-access databases. We included 910 original articles based on four ICU open-access databases (Amsterdam University Medical Centers Database, eICU Collaborative Research Database, High time resolution ICU dataset, and Medical Information Mart for Intensive Care). The majority of the studies did not provide their data management scripts (n=839, 92.9%), neither the analysis script (n=843, 93.4%) in the article. Attempts to contact the 845 corresponding authors in question resulted in 89.11% (n=753) of our e-mail requests going unanswered over a two-month period. We received 51 automated messages (55.43%) indicating that emails have not been delivered, while 6 messages (6.52%) redirected to alternative email addresses. Only 20 corresponding authors (18.18%) answered, finally providing the requested materials. Despite scientific journals recommendations to share materials, our study unveils the absence of crucial components for the replication of studies by other research teams.

Sustainability in Secondary Use of Health Data - A Scoping Review.

This scoping review investigates sustainability in the reuse of health data on a technological, intra-organizational, inter-organizational, and regulatory level. Thereby, it focuses on the evolutionary, relational, and durational perspective of sustainability. The study highlights various challenges in achieving data sustainability, from regulatory norms such as FAIR principles towards data governance processes and responsibilities in organizations that facilitate data sharing. By highlighting the need for economic sustainability of health data sharing platforms and adapted principles for data sharing, this study aims to analyze current practices that aim for sustainability in the secondary use of health data.

[An Analysis of the Industrial Water Use Evolution in China].

To deepen the recognition of changes in industrial water use with socio-economic development, a "double-layer nested" structural decomposition analysis has been proposed to decompose the influence of the drivers of industrial water use change by sectors in China from 2002 to 2020. The results showed that the scale expansion factors represented by consumption, investment, and export were the main factors for the growth of industrial water use in different sectors, among which the expansion effect of per capita consumption grew faster. Additionally, there were obvious differences in the major drivers of industrial scale expansion between different sectors, which directly drove the industrial structure change. The production process water use effect and water reuse effect were the main factors to curb the growth of industrial water use. The accumulation of both had completely offset the positive effect of industrial scale expansion during the period, reducing industrial water consumption by 11.2 billion m3. However, the production process water use changes in metal extraction, smelting, and processing and energy processing sectors such as electric power had a smaller negative effect, leading to the potential for improving industrial water efficiency solely through a relatively small improvement in water resource reuse. Therefore, it is necessary to strengthen industrial water conservation management based on the differences in the impact of various sectors to promote the transformation and upgradation of industrial production and consumption structures, and to avoid another increase in industrial water use in China.

Pretreatment for potable reuse: Enhancing the biological removal of 1,4-dioxane from landfill leachate through cometabolism with tetrahydrofuran.

1,4-Dioxane is a probable human carcinogen and a persistent aquatic contaminant. Cometabolic biodegradation of 1,4-dioxane is a promising low-cost and effective treatment technology; however, further demonstration is needed for treating landfill leachate. This technology was tested in two full-scale moving bed biofilm reactors (MBBRs) treating raw landfill leachate with tetrahydrofuran selected as the cometabolite. The raw leachate contained on average 82 µg/L of 1,4-dioxane and before testing the MBBRs removed an average of 38% and 42% of 1,4-dioxane, respectively. First, tetrahydrofuran was added to MBBR 1, and 1,4-dioxane removal was improved to an average of 73%, with the control MBBR removing an average of 37% of 1,4-dioxane. During this period, an optimal dose of 2 mg/L of tetrahydrofuran was identified. Tetrahydrofuran was then fed to both MBBRs, where the 1,4-dioxane removal was on average 73% and 80%. Cometabolic treatment at the landfill significantly reduced the concentration of 1,4-dioxane received from the landfill at a downstream wastewater treatment and indirect potable reuse facility, reducing the load of 1,4-dioxane from 44% to 24% after the study. PRACTITIONER POINTS: Cometabolic degradation of leachate 1,4-dioxane with THF in MBBRs is a feasible treatment technology and a low-cost technique when retrofitting existing biological treatment facilities. The MBBRs can be operated at a range of temperatures, require no operational changes beyond THF addition, and operate best at a mass ratio of THF to 1,4-dioxane of 24. Source control of 1,4-dioxane significantly reduces the concentration of 1,4-dioxane in downstream wastewater treatment plants and potable reuse facilities.

A comparison of four decontamination procedures in Reusing healing abutments: An in vitro study.

Objectives: This study aimed to compare the effect of four decontamination methods on the level of residual contaminants in the re-usage of dental healing abutments. Materials and methods: In this experimental study, 50 used healing abutments were divided into five groups of ten as follows: 1. Control group: healing abutments were submerged in the ultrasonic device then autoclaved at 121 °C for 15 min; 2. Hypochlorite group: Same procedure as the control group, but the healing abutments were additionally immersed in 3 % hypochlorite for 20 min; 3. Chlorhexidine group: Same procedure as the control group, but the healing abutments were additionally treated with 12 % chlorhexidine; 4. Air polishing group: Same procedure as the control group, but the healing abutments were subjected to air polishing; 5. Hydrogen peroxide group: Same procedure as the control group, but the healing abutments were additionally exposed to 3 % hydrogen peroxide. Then, all healing abutments were stained with a protein-specific stain, Phloxine B. Five photographs were taken of each healing abutment, with four capturing the body (shank)and one capturing the top. All images were analysed, to measure the stained (contaminated) areas of each sample. The obtained data were analysed using statistical software (significance set at p < 0.05). Results: The one-way ANOVA test indicated that the average percentage of contamination residues on the occlusal surface did not show a significant difference among the five groups: control: 5.5 ± 2.8, sodium hypochlorite: 4.9 ± 2.5, Chlorhexidine: 5.3 ± 2.5, air polisher: 3.1 ± 1.8 and Hydrogen peroxide: 4.8 ± 3.1. (p = 0.26). The average percentage of residual contamination on the body surfaces (shank part) was significantly lower in the air polisher (1.7 ± 1.1) and sodium hypochlorite (2.4 ± 1.1) groups compared to the other three groups (Control: 6.1 ± 2.3, Hydrogen peroxide: 4.6 ± 0.7, Chlorhexidine: 5.4 ± 2.4) (p < 0.05). Conclusion: The results of this study showed that the use of sodium hypochlorite and air polishing, alongside autoclaving and ultrasonic cleaning, effectively reduced residual contamination on the body surfaces of healing abutments.

Transforming Primary Care Data Into the Observational Medical Outcomes Partnership Common Data Model: Development and Usability Study.

Background: Patient-monitoring software generates a large amount of data that can be reused for clinical audits and scientific research. The Observational Health Data Sciences and Informatics (OHDSI) consortium developed the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to standardize electronic health record data and promote large-scale observational and longitudinal research. Objective: This study aimed to transform primary care data into the OMOP CDM format. Methods: We extracted primary care data from electronic health records at a multidisciplinary health center in Wattrelos, France. We performed structural mapping between the design of our local primary care database and the OMOP CDM tables and fields. Local French vocabularies concepts were mapped to OHDSI standard vocabularies. To validate the implementation of primary care data into the OMOP CDM format, we applied a set of queries. A practical application was achieved through the development of a dashboard. Results: Data from 18,395 patients were implemented into the OMOP CDM, corresponding to 592,226 consultations over a period of 20 years. A total of 18 OMOP CDM tables were implemented. A total of 17 local vocabularies were identified as being related to primary care and corresponded to patient characteristics (sex, location, year of birth, and race), units of measurement, biometric measures, laboratory test results, medical histories, and drug prescriptions. During semantic mapping, 10,221 primary care concepts were mapped to standard OHDSI concepts. Five queries were used to validate the OMOP CDM by comparing the results obtained after the completion of the transformations with the results obtained in the source software. Lastly, a prototype dashboard was developed to visualize the activity of the health center, the laboratory test results, and the drug prescription data. Conclusions: Primary care data from a French health care facility have been implemented into the OMOP CDM format. Data concerning demographics, units, measurements, and primary care consultation steps were already available in OHDSI vocabularies. Laboratory test results and drug prescription data were mapped to available vocabularies and structured in the final model. A dashboard application provided health care professionals with feedback on their practice.

Optimizing ozone treatment for pathogen removal and disinfection by-product control for potable reuse at pilot-scale.

Reclaimed water poses environmental and human health risks due to residual organic micropollutants and pathogens. Ozonation of reclaimed water to control pathogens and trace organics is an important step in advanced water treatment systems for potable reuse of reclaimed water. Ensuring efficient pathogen reduction while controlling disinfection byproducts remains a significant challenge to implementing ozonation in reclaimed water reuse applications. This study aimed to investigate ozonation conditions using a plug flow reactor (PFR) to achieve effective pathogen removal/inactivation while minimizing bromate and N-Nitrosodimethylamine (NDMA) formation. The pilot scale study was conducted using three doses of ozone (0.7, 1.0 and 1.4 ozone/total organic carbon (O3/TOC) ratio) to determine the disinfection performance using actual reclaimed water. The disinfection efficiency was assessed by measuring total coliforms, Escherichia coli (E. coli), Pepper Mild Mottle Virus (PMMoV), Tomato Brown Rugose Fruit Virus (ToBRFV) and Norovirus (HNoV). The ozone CT values ranged from 1.60 to 13.62 mg min L-1, resulting in significant reductions in pathogens and indicators. Specifically, ozone treatment led to concentration reductions of 2.46-2.89, 2.03-2.18, 0.46-1.63, 2.23-2.64 and > 4 log for total coliforms, E. coli, PMMoV, ToBRFV, and HNoV, respectively. After ozonation, concentrations of bromate and NDMA increased, reaching levels between 2.8 and 12.0 µg L-1, and 28-40.0 ng L-1, respectively, for average feed water bromide levels of 86.7 ± 1.8 µg L-1 and TOC levels of 7.2 ± 0.1 mg L-1. The increases in DBP formation were pronounced with higher ozone dosages, possibly requiring removal/control in subsequent treatment steps in some potable reuse applications.