Multistage Constructed Wetland in the Treatment of Greywater under Tropical Conditions: Performance, Operation, and Maintenance

Greywater (GW) can be separated in different fractions where the kitchen component might be included. Constructed wetland (CW) systems are commonly used for the onsite treatment of GW, and the fraction treated might impact the performance, operation, and maintenance. These aspects are still poorly explored in the literature and are of importance for a proper design and system sustainability. In this study, a multi-stage household-scale CW system composed of a horizontal flow (HF), followed by a vertical flow (VF) unit, was monitored over 1330 days, focusing on different GW fractions and hydraulic and organic loading rates. The biochemical oxygen demand (BOD) was ~50% lower without the kitchen sink component (GWL) in the system inlet, while no drop was observed in the chemical oxygen demand (COD). Treatment with the GWL component caused a sudden drop in the hydraulic loading rate applied at the HF-CW (~114 to 35 mm per day) and the VF-CW (~230 to 70 mm per day). Even when the HF-CW received ~90 gCOD m−2 per day (GW), the multistage system reached a COD removal of 90%. The lower BOD load when treating GWL avoids clogging and decreases the frequency of maintenance. These variables can be used for the optimal design and operation of a CW, contributing with empirical data to CW guidelines in Brazil, and could additionally be expanded for application in other countries with similar climates.

Treat and Release for Patients Requiring Emergency Medical Services

“Treat and release” and “treat and refer” protocols or practices refer to the onsite treatment of patients by responding emergency medical services personnel that does not involve transporting patients to health care facilities for additional assessment and treatment. The goal of these protocols is to allow patients to be released from care or to be referred directly to non-emergency services by emergency medical services personnel when appropriate, diverting patients from emergency departments. One health technology assessment that included a relevant randomized controlled trial and economic evaluation and 2 non-randomized studies were identified for inclusion. These studies examined treat and release or treat and refer protocols for treating hypoglycemia and exertional heat stroke, and for attending to older people following a fall. Overall, the clinical evidence summarized in this report suggests that treat and release protocols are as good as, or better than, usual care (i.e., onsite treatment of immediate medical care followed by transportation to health care facilities). Across most reported outcomes, there were no significant differences between patients who received care using treat and release or treat and refer protocols, and those who received usual care; however, there were some instances where the use of these protocols was associated with improvements in some clinical outcomes, such as patient satisfaction, risk for future falls or fractures, and some measures of repeat access to health care services. Findings related to the cost-effectiveness of treat and refer protocols were inconclusive because of the limited generalizability of the findings from the included economic evaluation. The economic evaluation estimated that implementing a treat and refer protocol for older patients who experienced a fall did not result in significant changes to health care resource utilization and did not generate improved health-related quality of life compared to usual care. No evidence-based guidelines regarding the use of treat and release protocols for patients requiring emergency medical services were identified.

Pollutant Removal from Sewage in Tropical Climate by Constructed Wetland System: An Asset for Irrigation

In the global outlook, letting of untreated sewage in existing river bodies deteriorates the water quality. The seepage likely depreciates the quality of ground water too. The quality of groundwater with special reference to India has tremendously gone down in the past twenty years leading to sour taste. On the other hand, agriculture sector is deprived of water in many places of India. A solution can be arrived concurrently by treating sewage and consuming the effluent in agricultural sector. First order kinetics was applied in constructed wetland system at different flow rates and optimised. At optimised HLR, effluent met the standards of discharge that can be utilized for agricultural/ irrigational purpose. The emanating major pollutants can be effectively treated using constructed wetland system under tropical climate. A few clippings at the onsite treatment illustrated the diversity of species thus adjoining sustainable biodiversity and treatment. Thus in tropical countries like India, constructed wetland system might pave solution not only for the treatment of sewage but in deploying the effluent in agricultural sector. A clean ecosystem can be achieved with sustainability.