Climate-related risk assessment in water safety plans: the case study of Acque Bresciane (Italy).

Acque Bresciane is a public company that manages the integrated water cycle for more than 580,000 inhabitants in the Province of Brescia, in the north of Italy, providing drinking water, waste water treatment, and sewer systems. Drinking water systems are supplied with different types of groundwater, springs, and surface water sources (from lakes and rivers) whose availability and quality can be affected by climate change events. A multidisciplinary team, in collaboration with the University of Milano Bicocca, developed a specific Water Safety Plan (WSP) risk matrix focusing on the evaluation of climate-related hazardous events and calculation of their likelihood of occurrence, also using thematic maps. Moreover, to reduce the residual risks, in the risk matrix, possible control measures are suggested, such as the activation of an emergency plan, the use of other water sources, storage tanks, and interconnection with other water distribution networks. This work shows a simple and effective tool that can be applied by drinking water utilities to evaluate climate-related catchment risks, using a WSP risk matrix, thematic maps, and possible control measures to reduce risks in terms of water quality and availability and to respond with resilience to changes.

Patients' recollections of helmet-CPAP treatment during COVID-19 pandemic: A qualitative study.

BACKGROUND: During the pandemic outbreak, helmet continuous positive airway pressure (CPAP) was widely used as respiratory support for COVID-19 patients, inside and outside of intensive care units. The available literature suggests specific interventions to improve the comfort of patients treated with helmet-CPAP. Few reports are available on the experiences of patients undergoing this treatment. AIM: This qualitative study aimed to explore the views and recollections of COVID-19 patients undergoing helmet-CPAP. STUDY DESIGN: We conducted semi-structured interviews with thematic analysis. Participants were recruited from the follow-up programme for COVID-19 patients discharged from an Italian general intensive care unit. Participants were interviewed by telephone. Data analysis followed the principles of thematic synthesis approach. FINDINGS: We conducted 29 phone calls in patients eligible for the study. Five participants declared that they did not remember the time spent in hospital on helmet-CPAP. Twenty-four patients were then included. Two themes and six subthemes were generated from their interview data: (1) The helmet-CPAP as a life-saving treatment (subthemes: recognition of the usefulness of treatment and resilience); (2) the negative feelings related to helmet-CPAP application (subthemes: communication problems, entrapment, mental confusion, fear of dying). Each patient's experience was unique, but some discomfort elements such as noise, gas flow turbulence, choking sensation and thirst were found to be very common. CONCLUSIONS: The application of helmet-CPAP treatment generated positive and negative memories and feelings in COVID-19 patients during the pandemic. The patients' experience has provided an overview of the main factors of discomfort. This can be a starting point for taking corrective measures to promote greater helmet tolerance and subsequent treatment success. RELEVANCE TO CLINICAL PRACTICE: This study has provided an insight into the patient's recollections about helmet-CPAP treatment during a worldwide pandemic. The findings suggested strict applications of interventions aimed to reduce some issues that participants reported, to improve their compliance to treatment. Results from this study could help nurses in understanding the needs of patients treated with helmet-CPAP and may foster a care focused on patient-centred outcomes.

Distress in Infants and Young Children: Don't Blame Acid Reflux.

OBJECTIVE: The role of gastroesophageal reflux (GER) causing distress in infants is controversial but acid inhibitors are often empirically prescribed. We evaluated the relation between distress assessed by the Face, Legs, Activity, Cry, Consolability (FLACC) scale and GER in infants. METHODS: We analyzed multiple intraluminal impedance-pH (MII-pH) monitoring tracings of infants with persistent unexplained fussiness or distress. Symptoms occurring during investigation were scored by parents using the FLACC scale and were grouped as "distress" episodes. RESULTS: We recruited 62 children (ages 15 days to 23 months, median age 3.5 months). During MII-pH, 452 episodes of distress were registered: 217 (48%) were temporally associated with GER and 235 (52%) were not, with no difference in the median value of FLACC between the 2 groups. Infants with abnormal acid exposure index had a significantly lower FLACC compared with the group with acid reflux index <7% (P < 0.001). When associated with symptoms, GER occurred significantly more often before than simultaneously or after an episode of distress (P = 0.001). Age, proximal extension, and duration of GER did not correlate with FLACC scores. Episodes of distress associated with nonacid reflux presented a significant higher FLACC compared with the ones with acid content (FLACC 6 vs 5, P = 0.011). In infants, episodes of distress do not significantly correlate with GER. CONCLUSIONS: No difference in infant distress was noted between proximal and distal GER. Non-acid reflux is perceived at least as painful than acid GER. Our results stress that acid inhibitors should not be started in infants presenting distress unless a clear association with acid GER is demonstrated.

Classifying zones of suitability for manual drilling using textural and hydraulic parameters of shallow aquifers: a case study in northwestern Senegal.

A method is proposed that uses analysis of borehole stratigraphic logs for the characterization of shallow aquifers and for the assessment of areas suitable for manual drilling. The model is based on available borehole-log parameters: depth to hard rock, depth to water, thickness of laterite and hydraulic transmissivity of the shallow aquifer. The model is applied to a study area in northwestern Senegal. A dataset of boreholes logs has been processed using a software package (TANGAFRIC) developed during the research. After a manual procedure to assign a standard category describing the lithological characteristics, the next step is the automated extraction of different textural parameters and the estimation of hydraulic conductivity using reference values available in the literature. The hydraulic conductivity values estimated from stratigraphic data have been partially validated, by comparing them with measured values from a series of pumping tests carried out in large-diameter wells. The results show that this method is able to produce a reliable interpretation of the shallow hydrogeological context using information generally available in the region. The research contributes to improving the identification of areas where conditions are suitable for manual drilling. This is achieved by applying the described method, based on a structured and semi-quantitative approach, to classify the zones of suitability for given manual drilling techniques using data available in most African countries. Ultimately, this work will support proposed international programs aimed at promoting low-cost water supply in Africa and enhancing access to safe drinking water for the population.

Une méthode est. proposée utilisant l'analyse des logs stratigraphiques des forages pour la caractérisation des aquifères peu profonds et pour l'évaluation des zones favourable pour le forage manuel. Le modèle repose sur l'analyse des paramètres extraits des logs de forage disponibles: profondeur au socle, profondeur au niveau piézométrique, épaisseur de la latérite et transmissivité hydraulique de l'aquifère peu profond. Le modèle est. appliqué à une zone d'étude dans le nord-ouest du Sénégal. Un ensemble de données de logs de forages a été traité en utilisant l'application informatique TANGAFRIC développée au cours de la recherche. Après une procédure manuelle pour attribuer une catégorie standardisée décrivant les caractéristiques lithologiques, l'étape suivante et une extraction automatique des différents paramètres texturaux et l'estimation de la conductivité hydraulique en utilisant des valeurs de référence disponibles dans la littérature. Les valeurs de conductivité hydraulique estimées à partir des données stratigraphiques ont été partiellement validées, en les comparant aux valeurs mesurées à partir d'une série de pompages d'essais réalisés sur des forages de grand diamètre. Les résultats indiquent que cette méthode permet de produire une interprétation fiable du contexte hydrogéologique peu profond en utilisant des informations généralement disponibles dans la région. La recherche contribue à améliorer l'identification de régions pour lesquelles des conditions sont en faveur de forages manuels. Ceci est. réalisé en appliquant la méthode décrite, basée sur une approche structurée et semi-quantitative, pour classer l'aptitude de zones à des techniques données de forage manuel en utilisant les données disponibles dans la plupart des pays africains. En fin de compte, ce travail appuiera les programmes internationaux proposés visant à promouvoir l'approvisionnement en eau potable à un faible coût en Afrique et à améliorer l'accès à l'eau potable pour la population.

Se propone un método que utiliza el análisis de registros estratigráficos de pozos para la caracterización de acuíferos poco profundos y para la evaluación de áreas aptas para la perforación manual. El modelo se basa en el análisis de parámetros extraídos de registros de pozos disponibles: profundidad de la roca dura, profundidad del agua, espesor de laterita y transmisividad hidráulica del acuífero poco profundo. El modelo se aplica a un área de estudio en el noroeste de Senegal. Un conjunto de datos de registros de perforaciones se ha procesado utilizando un paquete de software (TANGAFRIC) desarrollado durante la investigación. Después de un procedimiento manual para asignar una categoría estándar que describe las características litológicas, el siguiente paso es la extracción automatizada de diferentes parámetros texturales y la estimación de la conductividad hidráulica usando los valores de referencia disponibles en la literatura. Los valores de conductividad hidráulica estimados a partir de datos estratigráficos han sido parcialmente validados, comparándolos con valores medidos de una serie de ensayos de bombeo realizados en pozos de gran diámetro. Los resultados muestran que este método es capaz de producir una interpretación confiable del contexto hidrogeológico superficial usando información generalmente disponible en la región. La investigación contribuye a mejorar la identificación de áreas donde las condiciones son aptas para la perforación manual. Esto se logra aplicando el método descrito, basado en un enfoque estructurado y semicuantitativo, para clasificar la idoneidad para determinadas técnicas de perforación manual utilizando datos disponibles en la mayoría de los países africanos. En última instancia, este trabajo apoyará los programas internacionales propuestos para promover el suministro de agua a bajo costo en África y mejorar el acceso al agua potable para la población.

Um método é proposto usando análise estratigráfica de perfis de poços para a caracterização de aquíferos rasos e avaliação de áreas favoráveis para perfuração manual. O modelo é baseado na análise dos parâmetros extraídos de perfis de poços disponíveis: profundidade da rocha dura, profundidade da água, espessura da laterita, e transmissividade hidráulica do aquífero raso. O modelo é aplicado a uma área de estudo no noroeste do Senegal. Os perfis dos poços foram processados usando o programa de computador (TANGAFRIC) desenvolvido durante a pesquisa. Após um procedimento manual para assinalar uma categoria padrão descrevendo as características litológicas, o próximo passo é a extração automática de diferentes parâmetros texturais e a estimativa da condutividade hidráulica usando os valores de referência disponíveis na literatura. Os valores de condutividade hidráulica estimados de dados de estratigrafia foram parcialmente validados comparando estes com valores medidos através de uma série de testes de bombeamento realizados em poços de grande diâmetro. Os resultados mostram que este método é capaz de produzir uma interpretação confiável do contexto hidrogeológico raso usando informações disponíveis na região. A pesquisa contribui para promover a identificação de áreas onde as condições são favoráveis para perfuração manual. Isso é obtido aplicando o método descrito, baseado no processo estruturado e semiquantitativo para classificar a favorabilidade para uma certa técnica de perfuração manual usando os dados disponíveis na maioria dos países Africanos. Por último, este trabalho suportará programas internacionais propostos com o objetivo de promover o abastecimento de água a baixo custo na África e aumentar o acesso seguro a água potável para a população.

Origin of arsenic in groundwater from the multilayer aquifer in Cremona (northern Italy).

An analysis of 70 wells that tap groundwater from depths of up to 260 m in and around the town of Cremona, N. Italy, shows that 50 of them contain more than 10 µg/L of arsenic. Concentrations of As >10 ppb are accompanied by concentrations of Fe ranging from <0.1 to 6 mg/L and high concentrations of NH4 and Mn (<19 and <1.3 mg/L, respectively). The associations suggest that the mechanism of mobilization of As is the reductive dissolution of Fe oxides driven by the degradation of peat, which is commonly found in the aquifer system. Groundwater in the aquifer has a component of downward flow via leakage through aquitards and flow through lateral discontinuities in them. Along these flow paths, As is released by reductive dissolution of Fe oxides in shallow and intermediate aquifers (0-85 m below surface), reaching up to 183 µg/L, and is attenuated (<95 µg/L) at greater depths (100-150 m). Coprecipitation in iron sulfides could play an important role in As attenuation at these depths. The lower As concentration (<37 µg/L) in the deepest aquifer (160-260 m) is less related to the As concentration of the overlying aquifers because the groundwater here has a component of upward flow.

The "ZEEP-PEEP test" to evaluate the response to positive end-expiratory pressure delivered by helmet: A prospective physiologic study.

Introduction: The improvement in oxygenation after helmet application in hypoxemic patients may be explained by the alveolar recruitment obtained with positive end expiratory pressure (PEEP) or by the administration of a more accurate inspiratory fraction of oxygen (FiO2). We have designed the "ZEEP-PEEP test", capable to distinguish between the FiO2-related or PEEP-related oxygenation improvement. Our primary aim was to describe the use of this test during helmet CPAP to assess the oxygenation improvement attributable to PEEP application. Material and methods: We performed a prospective physiological study including adult critically ill patients. Respiratory and hemodynamic parameters were recorded before helmet application (PRE step), after helmet application without PEEP (ZEEP step) and after the application of the PEEP valve (PEEP step), while maintaining a constant FiO2. We defined as "PEEP responders" patients showing a PaO2/FiO2 ratio improvement ≥10% after PEEP application. Results: 93 patients were enrolled. Compared to the PRE step, PaO2/FiO2 ratio was significantly improved during helmet CPAP both at ZEEP and PEEP step (189 ± 55, 219 ± 74 and 241 ± 82 mmHg, respectively, p < 0.01). Both PEEP responders (41%) and non-responders showed a significant improvement of PaO2/FiO2 ratio after the application of helmet at ZEEP, PEEP responders also showed a significant improvement of oxygenation after PEEP application (208 ± 70 vs 267 ± 85, p < 0.01). Conclusions: Helmet CPAP improved oxygenation. This improvement was not only due to the PEEP effect, but also to the increase of the effective inspired FiO2. Performing the ZEEP-PEEP test may help to identify patients who benefit from PEEP.

One hundred ECMO retrivals before and during the Covid-19 pandemic: an observational study.

OBJECTIVES: Patients with severe acute respiratory distress syndrome may require veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. For patients in peripheral hospitals, retrieval by mobile ECMO teams and transport to high-volume centers is associated with improved outcomes, including the recent COVID-19 pandemic. To enable a safe transport of patients, a specialised ECMO-retrieval program needs to be implemented. However, there is insufficient evidence on how to safely and efficiently perform ECMO retrievals. We report single-centre data from out-of-centre initiations of VV-ECMO before and during the COVID-19 pandemic. DESIGN & SETTING: Single-centre retrospective study. We include all the retrievals performed by our ECMO centre between January 1st, 2014, and April 30th, 2021. RESULTS: One hundred ECMO missions were performed in the study period, for a median retrieval volume of 13 (IQR: 9-16) missions per year. the cause of the acute respiratory distress syndrome was COVID-19 in 10 patients (10 %). 98 (98 %) patients were retrieved and transported to our ECMO centre. To allow safe transport, 91 of them were cannulated on-site and transported on V-V ECMO. The remaining seven patients were centralised without ECMO, but they were all connected to V-V ECMO in the first 24 hours. No complications occurred during patient transport. The median duration of the ECMO mission was 7 hours (IQR: 6-9, range: 2 - 17). Median duration of ECMO support was 14 days (IQR: 9-24), whereas the ICU stay was 24 days (IQR:18-44). Overall, 73 patients were alive at hospital discharge (74 %). Survival rate was similar in non-COVID-19 and COVID-19 group (73 % vs 80 %, p = 0.549). CONCLUSION: In this single-centre experience, before and during COVID-19 era, retrieval and ground transportation of ECMO patients was feasible and was not associated with complications. Key factors of an ECMO retrieval program include a careful selection of the transport ambulance, training of a dedicated ECMO mobile team and preparation of specific checklists and standard operating procedures.

Linking local natural background levels in groundwater to their generating hydrogeochemical processes in Quaternary alluvial aquifers.

Calculating natural background levels (NBLs) in groundwater is vital for supporting a sustainable use of groundwater resources. Although NBLs are often assessed through a unique concentration value per groundwater body, where hydrogeochemical features are highly variable, spatial heterogeneity needs to be accounted for, leading to the calculation of so-called "local" NBLs. Despite much research devoted to the identification of the best performing techniques for local NBLs spatialization, a deep understanding of the link between local NBL values and their generating hydrogeochemical processes is often lacking and so is addressed here for the redox-sensitive species As, NH4, Fe and Mn in the groundwater bodies of Lombardy region, N Italy. Local NBLs were calculated by a tired approach involving the hybridization of preselection and probability plot methods. Since the spatial variability of the target species depends mainly on redox conditions, a redox zonation was performed using multivariate statistical analysis. A conceptual model was developed and improved combing factor and cluster analysis. Results showed that NBLs for arsenic were up to 291 µg/L, reached in groundwaters under methanogenesis, a condition related to the prolonged degradation of peat buried in aquifer sediments. Ammonium NBLs up to 6.62 mg/L were generated by the upwelling of fluids from deep sediments hosting petroleum systems; ammonium NBLs up to 4.48 mg/L were generated as the accumulation of by-products of peat degradation. Iron and manganese NBLs up to, respectively, 6.0 and 1.51 mg/L were generated by the oxidation of younger and less stable Mn and Fe oxides within river valleys, mostly the Po River valley. The evaluation of local NBLs, and their association to generating natural hydrogeochemical processes/conditions, achieves a step forward from the commonly used approach of a single NBL per groundwater body, improving decision-support tools for sustainable groundwater management and protection.

Overlapping redox zones control arsenic pollution in Pleistocene multi-layer aquifers, the Po Plain (Italy).

Understanding the factors that control As concentrations in groundwater is vital for supplying safe groundwater in regions with As-polluted aquifers. Despite much research, mainly addressing Holocene aquifers hosting young (<100 yrs) groundwater, the source, transport, and fate of As in Pleistocene aquifers with fossil (>12,000 yrs) groundwaters are not yet fully understood and so are assessed here through an evaluation of the redox properties of the system in a type locality, the Po Plain (Italy). Analyses of redox-sensitive species and major ions on 22 groundwater samples from the Pleistocene arsenic-affected aquifer in the Po Plain shows that groundwater concentrations of As are controlled by the simultaneous operation of several terminal electron accepters. Organic matter, present as peat, is abundant in the aquifer, allowing groundwater to reach a quasi-steady-state of highly reducing conditions close to thermodynamic equilibrium. In this system, simultaneous reduction of Fe-oxide and sulfate results in low concentrations of As (median 7 µg/L) whereas As reaches higher concentrations (median of 82 µg/L) during simultaneous methanogenesis and Fe-reduction. The position of well-screens is an additional controlling factor on groundwater As: short screens that overlap confining aquitards generate higher As concentrations than long screens placed away from them. A conceptual model for groundwater As, applicable worldwide in other Pleistocene aquifers with reducible Fe-oxides and abundant organic matter is proposed: As may have two concentration peaks, the first after prolonged Fe-oxide reduction and until sulfate reduction takes place, the second during simultaneous Fe-reduction and methanogenesis.

Identification of groundwater pollution sources in a landfill site using artificial sweeteners, multivariate analysis and transport modeling.

In this study, sources of groundwater pollution in a landfill site were identified, using artificial sweeteners as chemical tracers, multivariate statistical analysis and a quantitative analysis of the groundwater flow system through particle tracking and transport modeling. The study area, located in northern Italy, hosts an older unlined landfill and a newer lined municipal solid waste landfill placed downstream of the former. Groundwater, surface water, treated wastewater, and leachate samples were collected in March 2017 for analysis of the artificial sweeteners saccharin, cyclamate, acesulfame and sucralose together with major cations and anions, inorganic nitrogen compounds, total phosphorus, COD and some further parameters. The interpretation of the results suggests that two main leachate leaks/spills are affecting the study area. The first one concerns leachate probably spilling out of the leachate collection system serving the younger lined landfill, the other one involves leachate from the older unlined landfill that also seems to affect an area downstream of the lined landfill. Direct leachate leaks from the lined landfill seem unlikely, although they cannot be definitively excluded. This work underlines the importance of a multi-methods approach, which integrates here chemical tracers, multivariate analysis and transport modeling, for assessing groundwater pollution sources generated from complex landfill sites, where multiple and different sources may exist. In particular, this work highlights how artificial sweeteners can be used for tracing leachate plumes from landfills. The methodology applied in this study can have a broad applicability also in other polluted landfill sites worldwide.

The effects of irrigation on groundwater quality and quantity in a human-modified hydro-system: The Oglio River basin, Po Plain, northern Italy.

For several hundred years, farming in the Po Plain of Italy (46,000 km2, 20 million inhabitants) has been supported by intensive surface irrigation with lake and river water. Despite the longevity of irrigation, its effects on the quality and quantity of groundwater is poorly known and so is investigated here through seasonal measurements of hydraulic heads and water quality in groundwaters, rivers, lake, springs and rainwaters. In the north of the study region, an unconfined coarse-grained alluvial aquifer, infiltration of surface irrigation water, sourced from the Oglio River and low in NO3, contributes much to aquifer recharge (up to 88%, as evidenced by a δ2H-Cl/Br mixing model) and has positive effects on groundwater quality by diluting high concentrations of NO3 (decrease by 17% between June and September). This recharge also helps to maintain numerous local springs that form important local micro-environments. Any increase in water-use efficiency in irrigation will reduce this recharge, imperil the spring environments, and lessen the dilution of NO3 leading to increasing NO3 concentrations in groundwater. These findings can be extended by analogy to the entire Po Plain region and other surface-water-irrigated systems worldwide where inefficient irrigation methods are used and similar hydrogeological features occur.

Determination of trigger levels for groundwater quality in landfills located in historically human-impacted areas.

Landfills are one of the most recurrent sources of groundwater contamination worldwide. In order to limit their impacts on groundwater resources, current environmental regulations impose the adoption of proper measures for the protection of groundwater quality. For instance, in the EU member countries, the calculation of trigger levels for identifying significant adverse environmental effects on groundwater generated by landfills is required by the Landfill Directive 99/31/EC. Although the derivation of trigger levels could be relatively easy when groundwater quality data prior to the construction of a landfill are available, it becomes challenging when these data are missing and landfills are located in areas that are already impacted by historical contamination. This work presents a methodology for calculating trigger levels for groundwater quality in landfills located in areas where historical contaminations have deteriorated groundwater quality prior to their construction. This method is based on multivariate statistical analysis and involves 4 steps: (a) implementation of the conceptual model, (b) landfill monitoring data collection, (c) hydrochemical data clustering and (d) calculation of the trigger levels. The proposed methodology was applied on a case study in northern Italy, where a currently used lined landfill is located downstream of an old unlined landfill and others old unmapped waste deposits. The developed conceptual model stated that groundwater quality deterioration observed downstream of the lined landfill is due to a degrading leachate plume fed by the upgradient unlined landfill. The methodology led to the determination of two trigger levels for COD and NH4-N, the former for a zone representing the background hydrochemistry (28 and 9 mg/L for COD and NH4-N, respectively), the latter for the zone impacted by the degrading leachate plume from the upgradient unlined landfill (89 and 83 mg/L for COD and NH4-N, respectively).

Pollutant sources in an arsenic-affected multilayer aquifer in the Po Plain of Italy: Implications for drinking-water supply.

In aquifers 160 to 260m deep that used for public water-supply in an area ~150km2 around the town of Cremona, in the Po Plain of Northern Italy, concentrations of arsenic (As) are increasing with time in some wells. The increase is due to drawdown of As-polluted groundwater (As ≤144µg/L) from overlying aquifers at depths 65 to 150m deep in response to large-scale abstraction for public supply. The increase in As threatens drinking-water quality locally, and by inference does so across the entire Po Plain, where natural As-pollution of groundwater (As >10µg/L) is a basin-wide problem. Using new and legacy data for Cl/Br, δ18O/δ2H and other hydrochemical parameters with groundwater from 32 wells, 9 surface waters, a sewage outfall and rainwater, we show that the deep aquifer (160-260m below ground level), which is tapped widely for public water-supply, is partly recharged by seepage from overlying aquifers (65-150m below ground level). Groundwater quality in deep aquifers appears free of anthropogenic influences and typically <10µg/L of As. In contrast, shallow groundwater and surface water in some, not all, areas are affected by anthropogenic contamination and natural As-pollution (As >10µg/L). Outfalls from sewage-treatment plants and black water from septic tanks firstly affect surface waters, which then locally infiltrate shallow aquifers under high channel-stages. Wastewater permeating shallow aquifers carries with it NO3 and SO4 which suppress reduction of iron oxyhydroxides in the aquifer sediments and so suppress the natural release of As to groundwater.