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This paper deals with the case of one of the most important industrial application of membrane technology in the world: the upgrading of the main industrial wastewater treatment plant (WWTP) of the petrochemical site of Porto Marghera, Northern Italy, completed on December 2005 and tested on September 2006. It describes the principal interventions of the plant upgrading and it discusses the removal obtained during the test periods for conventional pollutants as well as for micropollutants. The plant upgrading consisted of a series of improvements of the existing industrial WWTP, in order to increase the removal efficiency of the total suspended solids and the associate removal of ten micropollutant compounds, the so called forbidden substances. The most important intervention was the conversion of the existing activated sludge section into a membrane biological reactor, in order to guarantee adherence to the severe limits imposed by the special law issued to protect the Venice Lagoon, with particular reference to the mentioned 10 forbidden compounds. The experimental results and the numerous test-runs conducted confirmed the respect of the legal limits for the pollutants in the final effluent as well of the required removal rates for the different parameters. Therefore, the upgraded treatment plant was declared agreeing with the approved design. [ABSTRACT FROM AUTHOR]

Summary: The paper presents a study carried out in the environmentally sensitive area of the Po Valley in northern Italy, with the aim of evaluating, from technical and economic perspectives, a project to reuse part of the final effluent from the Ferrara wastewater treatment plant for irrigation and to develop the site for recreational purposes. Although this area features plentiful supplies of surface water, the Ministry of the Environment has declared it to be at risk of environmental crises due to eutrophication and the drought recurring over the last decade. Thus the availability of fresh water, particularly for agricultural purposes, is threatened, and prompt water saving and protection measures are required. Hence, the possibility of reusing reclaimed wastewater from this plant was investigated, with the aim of exploiting the space around the WWTP, situated within a large urban park, to install natural polishing treatment systems and create green spaces for recreational use. Based on experimental investigation on a pilot plant (featuring both natural and conventional treatments), the study outlines the rationale behind the treatment train selected for the project, details the initial and ongoing costs involved, evaluates the benefits deriving from the project, and assesses public acceptance of the project by the contingent valuation method. A cost–benefit analysis completes the study, and various economic indicators (net present value, benefit–cost ratio, pay-back period, and internal rate of return) revealed that the proposed project was financially feasible. [Copyright &y& Elsevier]

Background and Aim: Appropriate end of life (EOL) management in Internal Medicine wards is challanging. The aim of this study was to analyze the burden of an educational program on EOL management in a Internal Medicine ward. Materials and methods: We retrospectively analysed characteristics and management of patients consecutively died in an italian Internal Medicine ward along one year. We compared demographic, co-morbidity, pharmacological treatment in the last 48-hours of life and procedures during hospital stay in patients died six months before and after an educational program on palliative cares and EOL management addressed to a team of physicians and nurses., Results: Study population was composed by 354 patients (190 females), with mean age ± DS 83.5 ± 10.6 years, one half admitted after the educational program. Eighty-four percent of deaths was exepected in the last 48 hours before exitus. Demographic characteristics and causes of hospitalization were not different before and after educational program. After the educational program the sharing of palliative care program with patient, relatives and/or caregivers (97.7% vs 85.8%, p=0.0001) and written order to withdrawal vital parameters relevation (39.5% vs 22%, p=0.0005) significantly increased, while difference in pharmacological classes prescribed in the last 48 hours of life was not find. Blood (54.8% vs 67.2%, p=0.0219) and arterial gas analysis (28.8% vs 39.5%, p=0.0435) samples in the last 48 hours of life were significantly reduced. Radiological and/or endoscopic examinations, red cells or platelets transfusion were reduced and palliative therapy was increased, despite difference between the two periods was not statistically significant., Conclusion: Educational program in Internal Medicine wards aimed to improve skills could contribute to make EOL management more appropriate and patient-oriented and it should be strongly encour-aged.

Background: Guidelines recommend triple therapy (TT) with ACE inhibitors or ARBs, beta-blockers and mineralcorticoid receptor antagonists in symptomatic heart failure patients with ejection fraction <35 % (HFrEF). Nevertheless, many patients remain untreated. This study was aimed to evaluate the use of TT in HFrEF patients discharged from internal medicine wards of Tuscany, Italy., Methods and Results: We analyzed the database of a multicenter observational study which included 770 patients consecutively hospitalized for HF in 32out of 36 Internal Medicine Units of Tuscany, Italy. The value of ejection fraction was available in 490 of the 725 patients discharged alive. Of the 117 patients with HFrEF, only 46 (39.3%) were on TT at discharge while 71 (60.7%) were not. In the latter group we observed a significantly greater percentage of patients with cognitive deficit (25.3% vs 10.8%, p=0.05). In the same group there was a slightly greater percentage of patients with hypertension (61.9% vs 58.6%), diabetes (43.6% vs 36.9%), GFR<60 ml/min (74.6% vs 67.3%), anemia (52.1% vs 45.6%) and atrial fibrillation (40.8% vs 34.7%), but the differences were not statistically significant., Conslusions: These results indicate that TT is underutilized in internal medicine wards of Tuscany. Untreated patients had a greater rate of cognitive deficit and were probably sicker, more complex and fragile.

Although new oral anticoagulants (NOAs) have been marketed in many countries, concern exists about the management of bleedings related to these drugs due to the lack of specific antidotes. The aim of our study was to report on real life management of NOAs-related life-threatening or major bleedings. We report data from consecutive cases of NOAs related major bleedings admitted to 4 hospitals since NOAs became marketed in Italy. We treated 8 patients, 4 males, with mean age 84 ± 7 years, 7 of whom were on dabigatran and one on rivaroxaban. The indication for NOA was atrial fibrillation. All bleedings were spontaneous and involving the gastro-intestinal tract. At the time of bleeding all patients had a drop in hemoglobin levels over 20 g/L. Creatinine clearance was ≤30 mL/min in 4 patients. All patients received general supportive measures, 4 of 8 patients were transfused with packed red cells and one patient received platelet transfusion. Three patients were treated with tranexamic acid and one patient on dabigatran received 4-factor prothrombin complex concentrate (PCC) with bleeding cessation, although coagulation parameters were not corrected. The median time for normalization of coagulation parameters was 3 days (range 1-6 days). All patients were discharged alive and NOAs were discontinued. In NOAs related major gastro-intestinal bleeding general supportive measures seem to be effective for the majority of patients. Despite promoting bleeding cessation, 4-factor PCC does not reverse abnormal coagulation parameters.

The exact prevalence of mobile right heart thromboemboli (RHTh) in patients with pulmonary embolism (PE) is unknown, depending upon PE severity and the use of early echocardiography. Similarly, the mortality rate is variable, though RHTh detection appears to substantially increase the risk of death in patients with PE. The aim of this study was to assess the prevalence of RHTh in different risk categories in a wide series of patients with PE, and to analyse the effect of RHTh on in-hospital mortality. Among 1,716 patients enrolled in the Italian Pulmonary Embolism Registry, 1,275 (13.3% at high risk, 59.3% at intermediate risk and 27.4% at low risk) had echocardiography within 48 hours from hospital admission and entered the study. Overall, RHTh were detected in 57 patients (4.5%, at admission echocardiography in 88%): in 27/169 (16%) high-risk, in 29/756 (3.8%) intermediate-risk and 1/350 (0.3%) low-risk patients, respectively. At multivariate analysis, only advanced age (odds ratio [OR] 1.61, 95% confidence [CI] 1.27-2.03, p<0.0001), high-risk category (OR vs low-risk category 37.82, 95% CI 11.26-127.06, p<0.0001) and recurrent PE (OR 45.92, 95%CI 15.19-139.96, p<0.0001) showed a statistically significant effect on mortality. The presence of RHTh significantly increased the risk of dying (OR 3.89, 95%CI 1.98-7.67, p=0.0001) at univariate analysis, but this result was not mantained in the multivariate model (OR 1.64, 95%CI 0.75-3.60, p=0.216). In conclusion, though patients with RHTh had a more severe presentation of PE, this study did not detect an association between RHTh and prognosis.

Chemical and petrochemical wastewaters contain a host of contaminants that require different treatment strategies. Regulation of macropollutants and micropollutants in the final discharge from industrial wastewater treatment plants (WWTPs) have become increasingly stringent in recent decades, requiring many WWTPs to be upgraded. This article presents an analysis of a WWTP treating petrochemicals in Porto Marghera, Italy, that recently was upgraded following legislative changes. Because of strict legal limits for macropollutants and micropollutants and a lack of space necessary for a full-scale WWTP overhaul, the existing activated sludge tank was converted into a membrane biological reactor. The paper presents experimental data collected during a five-month investigation showing the removal rates achieved by the upgraded plant for macropollutants (particularly nitrogen compounds) and micropollutants (heavy metals and organic and inorganic toxic compounds).

Hospitals are the main source of pharmaceutical compounds (PhCs) released into the environment. Generally, their discharges are co-treated with domestic wastewaters, resulting in a decrement of the recalcitrant compound concentrations in the final effluent due to water dilution. However, as many PhCs resist normal treatments, pollutant load does not change. This paper compares the chemical characteristics of hospital and domestic wastewaters on the basis of an experimental investigation for macro-pollutants and literature data for PhCs. A membrane biological reactor pilot plant fed by a hospital effluent is tested in order to evaluate the feasibility of treating these kinds of wastewaters with membrane systems. The paper then presents the possible scenarios in the management of the effluent of a large hospital situated in a small town. In particular, it reports on a case study of designing a (new) treatment plant for the effluent of the 900 bed hospital in Ferrara, Northern Italy, located on the outskirts of the town. Finally, costs for the intervention are given.