PFAS removal from landfill leachate by ozone foam fractionation: System optimization and adsorption quantification.

Landfills are the primary endpoint for the disposal of PFAS-laden waste, which subsequently releases PFAS to the surrounding environments through landfill leachate. Ozone foam fractionation emerges as a promising technology for PFAS removal to address the issue. This study aims to (i) assess the effectiveness of the ozone foam fractionation system to remove PFAS from landfill leachate, and (ii) quantify equilibrium PFAS adsorption onto the gas-water interface of ozone bubbles, followed by a comparison with air foam fractionation. The results show that ozone foam fractionation is effective for PFAS removal from landfill leachate, with more than 90 % long-chain PFAS removed. The identified operating conditions provide valuable insights for industrial applications, guiding the optimization of ozone flow rates (1 L/min), dosing (43 mg/L) and minimizing foamate production (4 % wettability). The equilibrium modelling reveals that the surface excess of air bubbles exceeds that of ozone bubbles by 20-40 % at a corresponding PFAS concentration. However, the overall removal of PFAS from landfill leachate by ozone foam fractionation remains substantial. Notably, ozone foam fractionation generates foamate volumes 2 - 4 times less, resulting in significant cost savings for the final disposal of waste products and reduced site storage requirements

Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review

The members of the Vietnam ICU Translational Applications Laboratory (VITAL) group are as follows: Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam: An Phuoc Luu, Chanh Quang Ho, Duc Hong Du, Duc Minh Tran, Dung Thi Phuong Nguyen, Giang Thi Nguyen, Hai Bich Ho, Hien Van Ho, Hung Manh Trinh, Huy Quang Nguyen, Khanh Nguyen Quoc Phan, Khoa Dinh Van Le, Kien Trung Dang, Lam Khanh Phung, Lieu Thi Pham, Ngoc Thanh Nguyen, Nhat Tran Huy Phung, Phuong Thanh Le, Quyen Than Ha Nguyen, Thanh Thi Le Nguyen, Thy Bui Xuan Doan, Trieu Trung Huynh, Trinh Huu Khanh Dong, Van Minh Tu Hoang, Van Thi Thanh Ninh, Vuong Lam Nguyen, Yen Minh Lam, Sayem Ahmed, Joseph Donovan, Ronald Geskus, Evelyne Kestelyn, Angela Mcbride, Guy Thwaites, Louise Thwaites, Hugo Turner, Jennifer Ilo Van Nuil, and Sophie Yacoub. Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam: Tam Thi Cao, Thuy Bich Duong, Duong Thi Hai Ha, Nghia Dang Trung Ha, Chau Buu Le, Thu Ngoc Minh Le, Thao Thi Mai Le, Tai Thi Hue Luong, Phu Hoan Nguyen, Viet Quoc Nguyen, Nguyen Thanh Nguyen, Phong Thanh Nguyen, Anh Thi Kim Nguyen, Hao Van Nguyen, Duoc Van Thanh Nguyen, Chau Van Vinh Nguyen, Oanh Kieu Nguyet Pham, Van Thi Hong Phan, Qui Tu Phan, Tho Vinh Phan, and Thao Thi Phuong Truong. University of Oxford, Oxford, United Kingdom: David Clifton, Mike English, Shadi Ghiasi, Heloise Greeff, Jannis Hagenah, Ping Lu, Jacob McKnight, Chris Paton, and Tingting Zhu. Imperial College London, London, United Kingdom: Pantellis Georgiou, Bernard Hernandez Perez, Kerri Hill-Cawthorne, Alison Holmes, Stefan Karolcik, Damien Ming, Nicolas Moser, and Jesus Rodriguez Manzano. King's College London, London, United Kingdom: Alberto Gomez, Hamideh Kerdegari, Marc Modat, and Reza Razavi. ETH Zurich, Zurich, Switzerland: Abhilash Guru Dutt, Walter Karlen, Michaela Verling, and Elias Wicki. The University of Melbourne, Melbourne, Australia: Linda Denehy and Thomas Rollinson.Background: There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence–based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government’s requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability. Objective: This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals. Methods: We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Thư Viện Pháp Luật, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step. Results: In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians’ performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system’s capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks. Conclusions: Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting.This study was supported by the Wellcome Trust United Kingdom WT217650/Z/19/Z

Clinical Outcomes of Patients With Drug-Resistant Tuberculous Meningitis Treated With an Intensified Antituberculosis Regimen

Background. Drug-resistant tuberculous meningitis (TBM) is difficult to diagnose and treat. Mortality is high and optimal treatment is unknown. We compared clinical outcomes of drug-resistant and -susceptible TBM treated with either standard or intensified antituberculosis treatment. Methods. We analyzed the influence of Mycobacterium tuberculosis drug resistance on the outcomes of patients with TBM enrolled into a randomized controlled trial comparing a standard, 9-month antituberculosis regimen (containing rifampicin 10 mg/kg/day) with an intensified regimen with higher-dose rifampicin (15 mg/kg/day) and levofloxacin (20 mg/kg/day) for the first 8 weeks. The primary endpoint of the trial was 9-month survival. In this subgroup analysis, resistance categories were predefined as multidrug resistant (MDR), isoniazid resistant, rifampicin susceptible (INH-R), and susceptible to rifampicin and isoniazid (INH-S + RIF-S). Outcome by resistance categories and response to intensified treatment were compared and estimated by Cox regression. Results. Of 817 randomized patients, 322 had a known drug resistance profile. INH-R was found in 86 (26.7%) patients, MDR in 15 (4.7%) patients, rifampicin monoresistance in 1 patient (0.3%), and INH-S + RIF-S in 220 (68.3%) patients. Multivariable regression showed that MDR (hazard ratio [HR], 5.91 [95% confidence interval {CI}, 3.00–11.6]), P Conclusions. Early intensified treatment improved survival in patients with INH-R TBM. Targeted regimens for drug-resistant TBM should be further explored

Clinical Outcomes of Patients With Drug-Resistant Tuberculous Meningitis Treated With an Intensified Antituberculosis Regimen

Background. Drug-resistant tuberculous meningitis (TBM) is difficult to diagnose and treat. Mortality is high and optimal treatment is unknown. We compared clinical outcomes of drug-resistant and -susceptible TBM treated with either standard or intensified antituberculosis treatment. Methods. We analyzed the influence of Mycobacterium tuberculosis drug resistance on the outcomes of patients with TBM enrolled into a randomized controlled trial comparing a standard, 9-month antituberculosis regimen (containing rifampicin 10 mg/kg/day) with an intensified regimen with higher-dose rifampicin (15 mg/kg/day) and levofloxacin (20 mg/kg/day) for the first 8 weeks. The primary endpoint of the trial was 9-month survival. In this subgroup analysis, resistance categories were predefined as multidrug resistant (MDR), isoniazid resistant, rifampicin susceptible (INH-R), and susceptible to rifampicin and isoniazid (INH-S + RIF-S). Outcome by resistance categories and response to intensified treatment were compared and estimated by Cox regression. Results. Of 817 randomized patients, 322 had a known drug resistance profile. INH-R was found in 86 (26.7%) patients, MDR in 15 (4.7%) patients, rifampicin monoresistance in 1 patient (0.3%), and INH-S + RIF-S in 220 (68.3%) patients. Multivariable regression showed that MDR (hazard ratio [HR], 5.91 [95% confidence interval {CI}, 3.00–11.6]), P < .001), was an independent predictor of death. INH-R had a significant association with the combined outcome of new neurological events or death (HR, 1.58 [95% CI, 1.11–2.23]). Adjusted Cox regression, corrected for treatment adjustments, showed that intensified treatment was significantly associated with improved survival (HR, 0.34 [95% CI, .15–.76], P = .01) in INH-R TBM. Conclusions. Early intensified treatment improved survival in patients with INH-R TBM. Targeted regimens for drug-resistant TBM should be further explored