Several Small or Single Large? Quantifying the Catchment-Wide Performance of On-Site Wastewater Treatment Plants with Inaccurate Sensors.

On-site wastewater treatment plants (OSTs) often lack monitoring, resulting in unreliable treatment performance. They thus appear to be a stopgap solution despite their potential contribution to circular water management. Low-maintenance but inaccurate soft sensors are emerging that address this concern. However, how their inaccuracy impacts the catchment-wide treatment performance of a system of many OSTs has not been quantified. We develop a stochastic model to estimate catchment-wide OST performances with a Monte Carlo simulation. In our study, soft sensors with a 70% accuracy improved the treatment performance from 66% of the time functional to 98%. Soft sensors optimized for specificity, indicating the true negative rate, improve the system performance, while sensors optimized for sensitivity, indicating the true positive rate, quantify the treatment performance more accurately. This new insight leads us to suggest programming two soft sensors in practical settings with the same hardware sensor data as input: one soft sensor geared to high specificity for maintenance scheduling and one geared to high sensitivity for performance quantification. Our findings suggest that a maintenance strategy combining inaccurate sensors with appropriate alarm management can vastly improve the mean catchment-wide treatment performance of a system of OSTs.

Urban Sanitation: New Terminology for Globally Relevant Solutions?

Progress toward Sustainable Development Goals for global access to safe sanitation is lagging significantly. In this Feature, we propose that misleading terminology leads to errors of categorization and hinders progress toward sanitation service provision in urban areas. Binary classifications such as "offsite/onsite" and "sewered/nonsewered" do not capture the need for "transport to treatment" or the complexity of urban sanitation and should be discarded. "Fecal sludge management" is used only in the development context of low- or middle-income countries, implying separate solutions for "poor" or "southern" contexts, which is unhelpful. Terminology alone does not solve problems, but rather than using outdated or "special" terminology, we argue that a robust terminology that is globally relevant across low-, middle-, and upper-income contexts is required to overcome increasingly unhelpful assumptions and stereotypes. The use of accurate, technically robust vocabulary and definitions can improve decisions about management and selection of treatment, promote a circular economy, provide a basis for evidence-based science and technology research, and lead to critical shifts and transformations to set policy goals around truly safely managed sanitation. In this Feature, the three current modes of sanitation are defined, examples of misconceptions based on existing terminology are presented, and a new terminology for collection and conveyance is proposed: (I) fully road transported, (II) source-separated mixed transport, (III) mixed transport, and (IV) fully pipe transported.

Challenges to Accurate Estimation of Methane Emission from Septic Tanks with Long Emptying Intervals.

Septic tanks in low- and middle-income countries are often not emptied for a long time, potentially resulting in poor pollutant removal efficiency and increased greenhouse gas emissions, including methane (CH4). We examined the impact of long emptying intervals (4.0-23 years) on the biochemical oxygen demand (BOD) removal efficiency of 15 blackwater septic tanks and the CH4 emission rates of 23 blackwater septic tanks in Hanoi. The average BOD removal efficiency was 37% (-2-65%), and the average CH4 emission rate was 10.9 (2.2-26.8) g/(cap·d). The emptying intervals were strongly negatively correlated with BOD removal efficiency (R = -0.676, p = 0.006) and positively correlated with CH4 emission rates (R = 0.614, p = 0.001). CH4 emission rates were positively correlated with sludge depth (R = 0.596, p = 0.002), but against expectation, negatively correlated with BOD removal efficiency (R = -0.219, p = 0.451). These results suggest that shortening the emptying interval improves the BOD removal efficiency and reduces the CH4 emission rate. Moreover, the CH4 emission estimation of the Intergovernmental Panel on Climate Change, which is a positive conversion of BOD removal, might be inaccurate for septic tanks with long emptying intervals. Our findings suggest that emptying intervals, sludge depth, and per-capita emission factors reflecting long emptying intervals are potential parameters for accurately estimating CH4 emissions from septic tanks.

Phase III study of bilayer sustained-release tramadol tablets in patients with cancer pain: a double-blind parallel-group, non-inferiority study with immediate-release tramadol capsules as an active comparator.

PURPOSE: We investigated whether twice-daily administration of a bilayer tablet formulation of tramadol (35% immediate-release [IR] and 65% sustained-release) is as effective as four-times-daily IR tramadol capsules for managing cancer pain. METHODS: This randomized, double-blind, double-dummy, active-comparator, non-inferiority study enrolled opioid-naïve patients using non-steroidal anti-inflammatory drugs or acetaminophen (paracetamol) to manage cancer pain and self-reported pain (mean value over 3 days ≥ 25 mm on a 100-mm visual analog scale [VAS]). Patients were randomized to either bilayer tablets or IR capsules for 14 days. The starting dose was 100 mg/day and could be escalated to 300 mg/day. The primary endpoint was the change in VAS (averaged over 3 days) for pain at rest from baseline to end of treatment/discontinuation. RESULTS: Overall, 251 patients were randomized. The baseline mean VAS at rest was 47.67 mm (range: 25.6-82.7 mm). In the full analysis set, the adjusted mean change in VAS was - 22.07 and - 19.08 mm in the bilayer tablet (n = 124) and IR capsule (n = 120) groups, respectively. The adjusted mean difference was - 2.99 mm (95% confidence interval [CI] - 7.96 to 1.99 mm). The upper 95% CI was less than the predefined non-inferiority margin of 7.5 mm. Other efficacy outcomes were similar in both groups. Adverse events were reported for 97/126 (77.0%) and 101/125 (80.8%) patients in the bilayer tablet and IR capsule groups, respectively. CONCLUSION: Twice-daily administration of bilayer tramadol tablets was as effective as four-times-daily administration of IR capsules regarding the improvement in pain VAS, with comparable safety outcomes. CLINICAL TRIAL REGISTRATION: JapicCTI-184143/jRCT2080224082 (October 5, 2018).

Effect of handwashing on the reduction of Escherichia coli on children's hands in an urban slum Indonesia.

Poor hand hygiene practice has been linked to an increase in the number of infections among children in urban slums. Hands are considered an intersection for bacterial transmission, but it is unclear whether the handwashing technique affects bacteria elimination. This study investigated the effect of handwashing on the concentration of Escherichia coli (E. coli) and factors related to its reduction among children in an urban slum in Bandung, Indonesia. We observed handwashing and conducted repeated hand swabs before and after handwashing among 137 participants. The mean E. coli concentration on the hands decreased after handwashing, with a higher reduction in E. coli count among students who used soap and had soap contact for more than 10 s during handwashing. Cleaning in-between fingers, using soap, soap contact for more than 10 s, and drying hands with a single-use towel were effective factors for reducing E. coli concentration after handwashing (p < 0.05). More than half of the swab samples (59%) tested positive for E. coli after handwashing, indicating that the children's handwashing technique was not effective in completely removing E. coli from the hands. Moreover, sustained and consistent handwashing practice as a daily behavior in children would maximize the effect.

A simplified material flow analysis employing local expert judgment and its impact on uncertainty.

Material flow analysis (MFA) is an effective tool for waste management, but low- and middle-income countries lack essential data for MFA. This study proposed a simplified MFA (sMFA) utilizing local expert judgment (LEJ) and examining the impact of simplification on its uncertainty. A stochastic sMFA model was developed for nitrogen and phosphorus in urban Mandalay, Myanmar. This model was compared with the intensive MFA (iMFA) model employing intensive surveys for primary data collection. For the total loadings to the environment, the medians of the sMFA were higher by 3% and 11%, respectively, for nitrogen and phosphorus than those of the iMFA. The widths of the 80% confidence intervals of these loadings in the sMFA, normalized by those in the iMFA, were - 0.05 and - 0.11, respectively. The three largest flows to the environment were the same for the two models: on-site sanitation effluent/leakage, greywater, and industrial wastewater. Large median gaps between the models were observed for industrial wastewater, fecal sludge, and human excreta, associated with informal waste management, whereby LEJ did not work well. Overall, the sMFA demonstrated a good estimation of nitrogen and phosphorus flows with limited increase of uncertainty, still requiring focused attention on informal waste streams. Supplementary Information: The online version contains supplementary material available at 10.1007/s10163-023-01660-5.

Human source identification by using a human-associated Escherichia coli genetic marker in the Mae Klong River, Thailand.

Contamination caused by microbial fecal pollution in water bodies is a serious problem in many countries, especially in low- and middle-income countries. Therefore, fecal source tracking is an important method used to understand the source of fecal contamination and to decrease the hazard of waterborne diseases that occurs in the environment. In this study, a human-associated genetic marker for Escherichia coli (H8) was used to investigate the source of fecal contamination in the Mae Klong River, Thailand. Real-time PCR was performed with this marker for 500 E. coli isolates collected from 10 sampling sites along the river, including MK10 (upstream) to MK1 (downstream). The results showed that the proportions of H8-positive isolates were 46, 14, 10, 18, 14, 38, 12, 26, 32, and 14% at MK10-MK1, respectively. All positive proportions were significantly different between the locations (p < 0.001). The higher occurrence of E. coli with H8 marker detection indicated that domestic wastewater was largely discharged without proper treatment, which is attributable to the high population and the absence of proper sewage treatment in those areas.

Detection of Escherichia coli, rotavirus, and Cryptosporidium spp. from drinking water, kitchenware, and flies in a periurban community of Lusaka, Zambia.

Fecal contamination with a poor water, sanitation and hygiene environment in urban informal settlements poses diarrhea risks. Little information is available on the contamination of environmental media with enteric pathogens in such settlements. We investigated the contamination of Escherichia coli, rotavirus, and Cryptosporidium spp. in water, on kitchenware, and on flies in urban informal settlements of Chawama and Kanyama, Lusaka, Zambia. These environmental media were examined by XM-G agar cultivation for E. coli and specific real-time RT-PCR assays to detect rotavirus and Cryptosporidium spp. E. coli; rotavirus, and Cryptosporidium spp. were detected in samples of household stored drinking water (6 of 10 samples, 3 of 10 samples, and 2 of 10 samples, respectively), cups (10 of 20 samples, 2 of 13 samples, 1 of 13 samples, respectively), and flies (35 of 55 samples, 5 of 17 samples, 1 of 17 samples, respectively). The ranges of rotavirus concentrations in household stored drinking water, on cups, and flies were 2.9 × 102-2.2 × 105 copies/L, 1.2 × 102-4.3 × 102 copies/cup, and 5.0 × 101-2.0 × 102 copies/fly, respectively. These results indicate the contribution of drinking water and kitchenware to enteric pathogen exposure and potential role of flies in microbial transmission.

Greenhouse Gas Emissions from Blackwater Septic Systems.

Septic systems are potentially a significant source of greenhouse gases (GHGs). The present study investigated GHGs from the blackwater septic systems that are widely used especially in low- and middle-income countries. Ten blackwater septic tanks in Hanoi, Vietnam, were investigated using the floating chamber method. The average methane and carbon dioxide emission rates measured at the first compartment (65% of total capacity) of the septic tanks were 11.92 and 20.24 g/cap/day, respectively, whereas nitrous oxide emission was negligible. Methane emission rate was significantly correlated with septage oxidation-reduction potential (ORP) (R = -0.67, p = 0.034), chemical oxygen demand mass (R = 0.78, p = 0.007), and biochemical oxygen demand mass (R = 0.78, p = 0.008), whereas it was not significantly correlated with water temperature (R = 0.26, p = 0.47) and dissolved oxygen (R = -0.59, p = 0.075) within the limited range: 30.6-31.7 °C and 0.03-0.34 mg-O2/L. The methane emission rates from septic tanks accumulating septage for >5 years were significantly higher than those at 0-5 years (p = 0.016). These results suggest that lower ORP and higher biodegradable carbon mass, in association with longer septage storage periods are key conditions for methane emissions. To the best of our knowledge, this is the first study to characterize GHG emissions from septic systems.

Seasonal and gender impacts on fecal exposure trends in an urban slum.

Seasonal and gender impacts have not been well considered in fecal exposure assessment, especially in low- and middle-income countries. This study examined the seasonal and gender impacts on fecal exposure trends in children through daily living activities in an urban slum in Bangladesh. We determined Escherichia coli concentrations in seven types of environmental samples (n = 232) and the activity data of children via diary recording, questionnaires, and interview surveys. Daily and monthly exposures were stochastically estimated for drinking, eating, pond bathing, well bathing, and hand-to-mouth contact. Of the five pathways, pond bathing and drinking contributed a large part of the daily and monthly exposure. Significant seasonal differences were observed in daily exposures for bathing, which were higher in the rainy season (2.59 × 102 CFU/day for boys and 6.19 × 10-1 CFU/day for girls) than in the dry season (1.69 × 102; 4.30 × 10-2), because of longer pond bathing time and more contaminated bathing water in the rainy season. In contrast, eating had significantly higher exposure in the dry season (3.71 × 10; 3.22 × 10) than the rainy season (1.50 × 10; 1.24 × 10) due to the higher dish contamination. Significantly higher daily exposure was observed in the bathing for boys than girls, as boys spent longer time for bathing at a heavily contaminated pond.

Informal Emptying Business in Mandalay: Its Reasons and Financial Impacts.

Globally, 2.8 billion people use on-site sanitation facilities, which need regular emptying of accumulated fecal sludge. Illegal dumping from informal emptying businesses, one of the major challenges in environmental management, is widely observed. Considering Mandalay, Myanmar, this study aimed to determine why informal emptying businesses are selected and estimate the lost revenue for a formal emptying service provider (FP) due to the informal businesses. We interviewed 400 households on their recognition and experiences regarding emptying services and willingness-to-pay for improved service. Revenue loss was estimated by comparing the present and theoretical maximum revenues. Results showed that 91.0% of households recognized FP only. Among 134 emptying-experienced households, 32.8%, 59.7%, and 4.5% chose FP with legal contact, FP with illegal contact, and informal service providers, respectively. The service fees from FP with illegal contact did not become revenue for FP; this was a major informal emptying business in the city. Differently from previous studies, the major illegal dumping was done by FP in this area. A great financial loss was estimated that FP lost 76.5% of the theoretical maximum revenue due to informal business. Logistic regression analysis indicated people's intention to shorten the waiting time through illegal contact, even by paying a higher fee. As emptying services are typically required immediately after fecal sludge is over-accumulated, shorter waiting times and faster contact methods were the reasons why the informal business was selected. Less bureaucratic and more customer friendly system could reduce revenue loss, charge more, and increase profits.

Evaluation of a human-associated genetic marker for Escherichia coli (H8) for fecal source tracking in Thailand.

High levels of microbial fecal pollution are a major concern in many countries. A human-associated genetic marker for Escherichia coli (H8) has recently been developed for fecal source tracking. The assessment of the H8 marker performance is crucial before it can be applied as a suitable method for fecal source tracking in each country. The performance (specificity and sensitivity) of the H8 marker was evaluated by using non-target host groups (cattle, buffalo, chicken, duck, and pig feces) and target host groups (influent and effluent from a wastewater treatment plant and septages). SYBR based real-time PCR (polymerase chain reaction) was done on 400 E. coli isolates from non-target and target host groups after E. coli isolation. It was found that the specificity from animal feces samples collected in Thailand was 96%. Moreover, influent, effluent, and septage samples showed the values of the sensitivity at 18, 12, and 36%, respectively. All of the non-target host groups were found to be significantly different with positive proportions from the target host group (septage samples) (p ≤ 0.01). Based on the results, this marker is recommended for use as a human-associated E. coli marker for identifying sources of fecal pollution in Thailand.

Comprehensive assessment of handwashing and faecal contamination among elementary school children in an urban slum of Indonesia.

OBJECTIVE: Globally, the challenge of handwashing with soap (HWWS) still exists despite the importance of HWWS being shown previously. This study aimed to evaluate faecal contamination on the hands of children and to find factors related to faecal contamination from handwashing techniques, HWWS, knowledge and awareness of water, sanitation, and hygiene (WASH), and a comprehensive WASH index. METHODS: The study was conducted at two elementary schools with 169 children in a densely populated area of Bandung, Indonesia. The survey involved handwashing observation using a checklist, hand bacteria sampling and questionnaires. RESULTS: Most children (98.7%) had faecal contamination. Girls had significantly fewer Escherichia coli than boys (P < 0.05). Ability in handwashing techniques, HWWS, and knowledge and awareness of WASH were poor in the lower grades. Escherichia coli counts were negatively correlated with handwashing technique (r = -0.171, P < 0.05), HWWS (r = -0.225, P < 0.01) and the WASH index (r = -0.205, P < 0.05). CONCLUSIONS: Proper handwashing technique and HWWS at appropriate times can reduce faecal contamination. Moreover, it is important that both grade-based and gender-based handwashing education be considered in elementary school education.

OBJECTIF: A l'échelle mondiale, le défi du lavage des mains au savon (HWWS) existe toujours, en dépit de l'importance révélée de ce procédé. Cette étude visait à évaluer la contamination fécale sur les mains des enfants et à trouver des facteurs liés à la contamination fécale résultant des procédés de lavage des mains, du lavage des mains au savon, de la connaissance et de la sensibilisation à l'eau, aux sanitaires et à l'hygiène (WASH), ainsi qu'un indice WASH détaillé. MÉTHODES: L'étude a été menée dans deux écoles élémentaires avec 169 enfants dans une zone densément peuplée de Bandung, en Indonésie. L'enquête comprenait l'observation du lavage des mains à l'aide d'une liste de contrôle, un échantillonnage bactérien sur les mains et des questionnaires. RÉSULTATS: La plupart des enfants (98,7%) avaient une contamination fécale. Escherichia coli était nettement moins présent chez les filles que chez les garçons (p <0,05). L'aptitude dans les techniques de lavage des mains, le lavage des mains au savon, ainsi que la connaissance et la sensibilisation au WASH étaient faibles dans les classes inférieures. Les comptages d'E. Coli corrélaient négativement avec la technique de lavage des mains (r = -0,171 ; p <0,05), le lavage des mains au savon (r = 0,225 ; p <0,01) et l'indice WASH (r= - 0,205 ; p <0,05). CONCLUSIONS: Une technique de lavage des mains appropriée et un lavage des mains au savon à des moments opportuns peuvent réduire la contamination fécale. De plus, il est important de prendre en compte l'éducation au lavage des mains basée sur le niveau et le sexe dans l'enseignement primaire.

Comparison of the protective effects of direct ischemic preconditioning and remote ischemic preconditioning in a rabbit model of transient spinal cord ischemia.

INTRODUCTION: This study aimed to determine the relative potency of direct ischemic preconditioning (DIPC) and remote ischemic preconditioning (RIPC) for protection against ischemic spinal cord injury in rabbits and to explore the mechanisms involved. METHODS: In experiment 1, we compared the neurological and histopathological outcomes of DIPC, kidney RIPC, and limb RIPC. The DIPC and kidney RIPC groups received two cycles of 5-min occlusion/15-min reperfusion of the abdominal aorta and left renal artery, respectively. The limb RIPC group received two cycles of 10-min occlusion/10-min reperfusion of the femoral arteries bilaterally. Thirty minutes after the conditioning ischemia, spinal cord ischemia was produced by occluding the abdominal aorta for 15 min. In experiments 2 and 3, we investigated whether pretreatment using a free-radical scavenger, dimethylthiourea (DMTU), an adenosine A1 receptor antagonist, 8-cyclopentyl-1,3-dipropylxanthine (DPCPX), or a mitochondrial ATP-sensitive potassium channel antagonist, 5-hydroxydecanoate (5HD), could attenuate the protective effects of DIPC. In experiment 4, comprehensive analysis of phosphorylated proteins in the spinal cord was performed using a Proteome Profiler Array followed by immunoblotting to elucidate the signal pathway activated by DIPC. RESULTS: In experiment 1, DIPC improved the neurological and histopathological outcomes, whereas kidney and limb RIPC had no protective effects. In experiments 2 and 3, strong protective effects of DIPC were reconfirmed but were not attenuated by DMTU, DPCPX, or 5HD. In experiment 4, DIPC induced phosphorylation of Akt2. CONCLUSIONS: DIPC, but not kidney or limb RIPC, protected against ischemic spinal cord injury in rabbits. Akt2 might contribute to this protective effect.

Characterization of Pathogenic Escherichia coli in River Water by Simultaneous Detection and Sequencing of 14 Virulence Genes.

The occurrence of pathogenic Escherichia coli in environmental waters increases the risk of waterborne disease. In this study, 14 virulence genes in 669 E. coli isolates (549 isolates from the Yamato River in Japan, and 30 isolates from each of the following hosts: humans, cows, pigs, and chickens) were simultaneously quantified by multiplex PCR and dual index sequencing to determine the prevalence of potentially pathogenic E. coli. Among the 549 environmental isolates, 64 (12%) were classified as extraintestinal pathogenic E. coli (ExPEC) while eight (1.5%) were classified as intestinal pathogenic E. coli (InPEC). Only ExPEC-associated genes were detected in human isolates and pig isolates, and 11 (37%) and five (17%) isolates were classified as ExPEC, respectively. A high proportion (63%) of cow isolates possessed Shiga-toxin genes (stx1 or stx2) and they were classified as Shiga toxin-producing E. coli (STEC) or enterohemorrhagic E. coli (EHEC). Among the chicken isolates, 14 (47%) possessed iutA, which is an ExPEC-associated gene. This method can determine the sequences as well as the presence/absence of virulence genes. By comparing the sequences of virulence genes, we determined that sequences of iutA were different among sources and may be useful for discriminating isolates, although further studies including larger numbers of isolates are needed. Results indicate that humans are a likely source of ExPEC strains in the river.

Machine-learning-aided application of high-gravity technology to enhance ammonia recovery of fresh waste leachate.

Stripping is widely applied for the removal of ammonia from fresh waste leachate. However, the development of air stripping technology is restricted by the requirements for large-scale equipment and long operation periods. This paper describes a high-gravity technology that improves ammonia stripping from actual fresh waste leachate and a machine learning approach that predicts the stripping performance under different operational parameters. The high-gravity field is implemented in a co-current-flow rotating packed bed in multi-stage cycle series mode. The eXtreme Gradient Boosting algorithm is applied to the experimental data to predict the liquid volumetric mass transfer coefficient (KLa) and removal efficiency (η) for various rotation speeds, numbers of stripping stages, gas flow rates, and liquid flow rates. Ammonia stripping under a high-gravity field achieves η = 82.73% and KLa = 5.551 × 10-4 s-1 at a pH value of 10 and ambient temperature. The results suggest that the eXtreme Gradient Boosting model provides good accuracy and predictive performance, with R2 values of 0.9923 and 0.9783 for KLa and η, respectively. The machine learning models developed in this study are combined with experimental results to provide more comprehensive information on rotating packed bed operations and more accurate predictions of KLa and η. The information mining behind the model is an important reference for the rational design of high-gravity-field-coupled ammonia stripping projects.

Worldwide surveys of perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) in water environment in recent years.

Recently, perfluorinated compounds (PFCs) have been noted as causes of some of the important environmental problems in recent years due to their occurrences and properties. The most commonly used PFCs are perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), which have been used in many kinds of products. They have been found in surface water and tap water in both developed and developing countries around the world including in North America, Europe and Asia. In most countries, rivers are the source of tap water, which is one of the important pathways in which PFCs reach humans. It is essential to evaluate PFOS and PFOA contamination in the river basin. The purpose of this field study was to determine the presence of PFOS and PFOA in rivers around the world. The surveys were conducted in 15 countries during 2004 to 2010. In total, 539 samples were collected from the rivers in 41 cities. A solid phase extraction (SPE) coupled with HPLC-ESI-MS/MS were used for the analysis of these chemicals. PFOS and PFOA were detected in all 41 cities not only in industrialized areas but also in non-industrialized areas, representing that these compounds undergo long-range transportation in the environment. The average concentration of PFOS in each city ranged from not detected to 70.1 ng/L. The average concentration of PFOA in each city was in the range 0.2-1,630.2 ng/L. The industrialized areas show higher contamination in both PFOS and PFOA concentrations than non-industrialized areas. Industrial activities are some of the major sources of PFCs contamination in rivers.

Exfiltration and infiltration effect on sewage flow and quality: a case study of Hue, Vietnam.

Sewage generated in Southeast Asia is typically characterized by small per-capita flow and low concentration. This study investigated the impacts of exfiltration (leaking-out) and infiltration (leaking-in) on sewage flow and quality in Hue, Vietnam. Sewage flow and quality were continuously monitored at the sewer outlet of a residential drainage area for 68 and 82 days during dry and rainy seasons, respectively. Infiltration was estimated based on the least sewage flow before morning. Lithium tracer tests were conducted to estimate the exfiltration ratio. The results indicated that sewage of the target sewer was weaker than the typical weak-strength sewage even on no-rain days of the dry season. Monitoring of electrical conductivity indicated that rainfall persistently decreased the sewage concentration for a maximum duration of 228 h. The estimated infiltration accounted for 11% and 62% of the total sewage inflow to the sewer during dry and rainy seasons, respectively. The tracer test indicated that exfiltration ratios during the dry and rainy seasons were 65.6% and 24.0%, respectively. As a result of developing the water balance, only 23% of the water supplied to the area reached the sewer outlet in the dry season, while 123% flowed in the rainy season. These results demonstrate that exfiltration decreased the sewage flow in the dry season, while infiltration significantly increased the sewage flow and decreased the sewage concentration in the rainy season. To the best of our knowledge, this is the first study to quantify the impacts of infiltration and exfiltration on sewage in Southeast Asia.

Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain.

Low back pain (LBP) is the most common cause of chronic pain. Numerous clinical scales are available for evaluating pain, but their objective criteria in the management of LBP patients remain unclear. This study aimed to determine an objective cutoff value for a change in the Pain Intensity Numerical Rating Scale (ΔPI-NRS) three months after LBP treatment. Its utility was compared with changes in six commonly used clinical scales in LBP patients: Pain Disability Assessment Scale (PDAS), Pain Self-Efficacy Questionnaire (PSEC), Pain Catastrophizing Scale (PCS), Athens Insomnia Scale (AIS), EuroQoL 5 Dimension (EQ5D), and Locomo 25. We included 161 LBP patients treated in two representative pain management centers. Patients were partitioned into two groups based on patient's global impression of change (PGIC) three months after treatment: satisfied (PGIC = 1, 2) and unsatisfied (3-7). Multivariate logistic regression analysis was performed to explore relevant scales in distinguishing the two groups. We found ΔPI-NRS to be most closely associated with PGIC status regardless of pre-treatment pain intensity, followed by ΔEQ5D, ΔPDAS, ΔPSEC, and ΔPCS. The ΔPI-NRS cutoff value for distinguishing the PGIC status was determined by ROC analysis to be 1.3-1.8 depending on pre-treatment PI-NRS, which was rounded up to ΔPI-NRS = 2 for general use. Spearman's correlation coefficient revealed close relationships between ΔPI-NRS and the six other clinical scales. Therefore, we determined cutoff values of these scales in distinguishing the status of ΔPI-NRS≥2 vs. ΔPI-NRS<2 to be as follows: ΔPDAS, 6.71; ΔPSEC, 6.48; ΔPCS, 6.48; ΔAIS, 1.91; ΔEQ5D, 0.08; and ΔLocomo 25, 9.31. These can be used as definitive indicator of therapeutic outcome in the management of chronic LBP patients.

Effects of nutrient supply and nutrient ratio on diversity-productivity relationships of phytoplankton in the Cau Hai lagoon, Vietnam.

Diversity and productivity of primary producers are known to be influenced simultaneously by resource availability and resource ratio, but the relative importance of these two factors differed among studies and so far only entire phytoplankton communities were investigated which might ignore specific nutrient requirements and stoichiometric plasticity of different functional groups. We measured nutrient availability (DIN, total N [TN], total P [TP]), nutrient imbalance (TN:TP, DIN:TP, N:Pseston), species richness, and abundance of the whole phytoplankton community, as well as those specific for cyanobacteria, diatoms, and dinoflagellates in Cau Hai lagoon in Vietnam. We determined the correlation among these variables, using structural equation modeling. The models applied to the whole phytoplankton community indicated that the nutrient availability (particularly TP and DIN) drove variation in phytoplankton abundance and richness, and that abundance also depended on species richness. The models applied to different functional groups differed considerably from the entire community and among each other, and only a part of the models was significant. The relationship between nutrient availability (mainly TP) and abundance was driven by cyanobacteria, and the relationship between nutrient imbalance (only with N:Pseston) and species richness was driven by diatoms. Remarkably, the positive relationship between species richness and abundance, as consistently observed for the whole phytoplankton community, was only observed for one of the three functional groups (diatoms), indicating that resource complementarity occurs particularly among species of different functional groups. Our results emphasized that nutrient availability (TP and to a lesser extent DIN) as well as nutrient imbalance (albeit only with N:Pseston as proxy) were driving factors for the phytoplankton community in the Cau Hai lagoon and hence alterations in both of these factors leading to a shift in phytoplankton species composition and productivity.