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Lung cancer, or lung carcinoma, is the uncontrolled division of epithelial cells which line the

respiratory tract.

There are two main categories of lung cancer, small cell and non-small cell, which depend

on the type of epithelial cell that's dividing.

Both types can be fatal, especially if the cancerous cells aggressively spread and establish

secondary sites of cancer in other tissues.

The major cause of lung cancer is smoking tobacco products, and it has contributed to

the deaths of millions of people including famous individuals like Walt Disney and Claude

Monet.

Air enters the respiratory tract through either the nose or mouth and flows down the trachea,

which divides into the right and left bronchi.

Each bronchi enters its respective lung at the hilum, or root of the lung.

The bronchi then divides into lobar bronchi, which divide into segmental bronchi, then

into subsegmental bronchi, which further branch to form conducting bronchioles and then respiratory

bronchioles which end with small, sacs called alveoli that are surrounded by capillaries,

which is where gas exchange occurs.

Lining these airways are several types of epithelial cells which serve multiple functions.

These include ciliated cells that have hair-like project called cilia that work to sweep foreign

particles and pathogens back to the throat to be swallowed.

Another type, called goblet cells--which are called that because they look like goblets--secrete

mucin to moisten the airways and trap foreign pathogens.

There are also basal cells that are thought to be able to differentiate into other cells

in the epithelium, club cells that act to protect the bronchiolar epithelium, and neuroendocrine

cells, that secrete hormones into the blood in response to neuronal signals.

Cells can become mutated because of environmental or genetic factors.

A mutated cell becomes cancerous when it starts to divide uncontrollably.

As cancer cells start piling up on each other they become a small tumor mass, and they need

to induce blood vessel growth, called angiogenesis, to supply themselves with energy.

Malignant tumors are ones that are able to break through the basement membrane.

Some of these malignant tumors go a step further and detach from their basement membrane at

the primary tumor site, enter nearby blood vessels, and establish secondary sites of

tumor growth throughout the body - a process called metastasis.

A well known risk factor for small cell lung cancer and some types of non-small cell lung

cancer is smoking tobacco, and it's dose-dependent which means that smoking more cigarettes over

a longer period of time increases the risk.

Another risk factor is exposure to radon, a colorless, odorless gas which is a natural

breakdown product of uranium found in the soil.

Other environmental factors include asbestos, air pollution, and ionizing radiation, like

from medical imaging with chest X rays and CT scans.

There are also some gene mutations that are known to be associated with an increased risk

of lung cancer development.

Once it develops, lung cancer tends to metastasize quickly, rapidly establishing sites of secondary

tumors in other tissues.

Tissues particularly at risk as a secondary site are the mediastinum and hilar lymph nodes

because of their proximity to the lungs, but other sites include the lung pleura - the

lining of the lungs, heart, breasts, liver, adrenal glands, brain, and bones.

Lung cancer can be categorized as either small cell or non-small cell carcinomas.

Small cell carcinomas account for a small portion of lung cancers and originate from

small, immature neuroendocrine cells.

That means that non-small cell carcinomas account for most lung cancers, and these can

be further subdivided into four categories: adenocarcinomas which frequently form glandular

structures or have the ability to generate mucin; squamous cell carcinomas; which have

squamous, or square shaped, cells that produce keratin; carcinoid tumors from mature neuroendocrine

cells; and large cell carcinomas which lack both glandular and squamous differentiation.

Small cell carcinoma is strongly associated with smoking and usually develops centrally

in the lung, near a main bronchus.

In general, they grow the fastest and more rapidly metastasize to other organs than other

types of non-small cell lung cancers.

Because of this, by the time it's diagnosed, it's common to find large tumors in multiple

locations both within and outside the lung.

Typically when small cell carcinoma is within one lung, it's considered limited, if it

spreads beyond one lung it's considered extensive.

Small cell carcinomas can also sometimes secrete hormones and that can lead to what is called

a paraneoplastic syndrome.

One example is when the tumor releases adrenocorticotropic hormone causing an increase in production

and release of cortisol from the adrenal glands.

This causes what's known as Cushing's syndrome which causes a number of symptoms

including an elevated blood glucose and high blood pressure.

Another example is when the tumor releases antidiuretic hormone which causes water retention

leading to high blood pressure, edema and concentrated urine.

A slightly different type of paraneoplastic syndrome, is when small cell carcinoma prompts

the body to produce autoantibodies which bind and destroy neurons causing myasthenic syndrome,

which is a type II hypersensitivity reaction.

Non-small cell carcinomas are more of a mixed bag in terms of where they usually arise.

Just like small cell carcinoma, squamous cell carcinoma tends to be centrally located and

has a strong association with smoking.

In contrast, adenocarcinoma tends to develop peripherally, in a bronchiole or alveolar

wall, and doesn't have a link to smoking.

Large cell carcinomas and bronchial carcinoid tumors can be found throughout the lungs - centrally

and peripherally.

Of these two, large cell carcinoma is linked to smoking.

Both adenocarcinoma and squamous cell carcinoma can form Pancoast tumors, which are masses

in the upper region of the lung that compress the blood vessels and nerves located there.

In particular, pancoast tumors can compress and damage the thoracic inlet, brachial plexus,

and cervical sympathetic nerves leading to their dysfunction and Horner syndrome.

Clinical symptoms of Horner syndrome include a constricted pupil, a drooping upper eyelid,

and loss of ability to sweat on the same side of the body as the dysfunctional sympathetic

nerve.

A classic paraneoplastic syndrome associated with squamous cell carcinoma is the release

of parathyroid hormone which depletes calcium from the bones causing them to become brittle

and increasing calcium levels in the blood.

And, finally, a paraneoplastic syndrome specific to carcinoid tumors is carcinoid syndrome

which causes the secretion of hormones, particularly serotonin, which leads to increased peristalsis

and diarrhea, and bronchoconstriction causing asthma.

Since non-small cell carcinomas tend to be slower growing and slower to spread than small

cell, staging is more elaborate.

It's called "TNM" staging and represents three diagnostic categories: T, for tumor

size and extent of local extension; N, for spread into nearby lymph nodes in the chest,

particularly the mediastinum and hilar lymph nodes; and M, for metastasis to a secondary

site.

Within each of these categories are sub-stages, T0-T4, N0-N3, and M0-M1, where an increasing

number means increasing severity.

Finally, the combinations of these sub-stages determine thes stage group, assigned 0 to

IV.

So for example, if the diameter of the tumor is less than or equal to 3 cm and not in a

main bronchus, has invaded the hilar lymph node on the same side of the chest, but has

not spread outside the chest to other tissues, it's categorized as T1, N1, M0 and can be

considered stage group II.

But if the tumor metastasizes to a secondary site, it's considered M1 and staging group

IV regardless of it's T or N value.

Symptoms of lung cancer vary based on the size and location of the tumor, whether or

not is has spread to other organs, and whether or not it generates hormones - all of which

is often predicted by the type of cancer.

In response to the cancer cells, the body mounts an immune response which results in

the release of chemokines like TNF-alpha, IL1-beta, and IL-6 which can cause weight

loss, fevers, and night sweats.

If the primary tumor physically obstructs the airway and presses on surrounding tissue

structures it can cause a cough, shortness of breath, and leads to a pneumonia in the

lung tissue behind the obstruction.

Compression of nearby nerves can cause pain, and compression of specific nerves like the

recurrent laryngeal nerve and phrenic nerves can cause changes in voice or difficulty breathing,

respectively.

Compression of nearby vessels like the superior vena cava can cause a backup of blood in the

face leading to facial swelling and shortness of breath.

Finally, if a cancer cells invade into a blood vessel then mucus can get blood tinged or

blood clots can get coughed up.

Initially lung cancer is usually identified as a coin-shaped spot, called a coin lesion

on chest X-ray, or a non calcified nodule on chest CT.

Infections can also cause similar shaped spots, so a tissue biopsy from a bronchoscopy or

a CT-guided fine-needle aspiration is typically done to make a histopathologic diagnosis.

Though treatment will vary by category and stage of the lung cancer, often a commonality

is the use of surgery if appropriate, chemotherapy or immunotherapy, and radiation therapy when

possible.

In general, the goal of surgery is to remove as much of a tumor, ideally all of it, and

to have a small border of healthy tissue around it so that all of the cancerous cells are

gone.

Depending on the size and location of the tumor, a small wedge of tissue may be taken,

or up to an entire lung, in which case the airway is sutured shut to prevent air from

leaking into the body cavity.

In addition, it's typical to remove nearby lymph nodes which have metastasis and manage

clinical symptoms.

Since pain is a significant chronic symptom of lung cancer, it's often managed through

both nonpharmacologic approaches like yoga and guided imagery as well as pain medications.

So, a quick recap: Lung cancer is the uncontrolled growth of respiratory epithelial cells.

The minority are small cell cancers and the majority are non-small cell, which are further

categorized into adenocarcinoma, squamous cell carcinoma, bronchial carcinoid, and large

cell carcinoma.

Some common issues for all lung cancers is that they can cause airway obstruction, compression

of nearby nerves and the superior vena cava, cause paraneoplastic syndromes, and induce

an immune response which causes symptoms like weight loss, fevers, and night sweats.

Overall, lung cancers have a high rate of metastasis to other organs, and are treated

with a combination of surgery, chemotherapy, immunotherapy, and radiation depending on

the situation.

For more infomation >> Lung cancer - causes, symptoms, diagnosis, treatment, pathology - Duration: 12:16.

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How To Removal Blackheads & Whiteheads On The Face Easy Acne Treatment On Face #266 - Duration: 10:00.

For more infomation >> How To Removal Blackheads & Whiteheads On The Face Easy Acne Treatment On Face #266 - Duration: 10:00.

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4.10 Semi Centralized Treatment, Aerobic Technologies - Duration: 11:38.

Now we will look at the aerobic technologies, which can be used as stand-alone systems

or to polish the effluent of anaerobic units.

Aerobic systems are biological systems which rely on the action of bacteria

needing oxygen to live, like us.

Thus, in all of them oxygen provision is a key aspect.

Without sufficient oxygen, the environment becomes anaerobic,

which leads to processes such as described in the last module.

Some aerobic technologies try to imitate nature, such as the "waste stabilization ponds", or

the "constructed wetlands".

Some of these are more engineered, such as the "trickling filter" or the "activated

sludge".

Let's start with the waste deposition ponds, or lagoons.

It is a system that consists in a succession of ponds

with different functions.

First one anaerobic pond, then one or two facultative ponds,

and finally, one or two maturation ponds.

Let's look in more detail at the differences between these three types of ponds.

The anaerobic pond is the deepest, with a depth of two to five meters,

and also the smallest.

It is highly loaded because it receives the rawest water.

The anaerobic pond has a hydraulic retention time from one to three days,

and its main function is sedimentation and anaerobic stabilization of sludge, thus,

settling.

The facultative pond or facultative ponds if they are several, are shallower.

Usually, less than 1.5 meters, but large.

The idea here is to maximize the oxygen supply either through algae, wind, or artificial

aeration.

The hydraulic retention time there is longer: from ten to twenty days.

Here, the main function is the aerobic degradation of suspended and dissolved matter,

thus, degradation.

Finally, the maturation ponds are even shallower, usually less than one meter, but large.

The hydraulic retention time is about ten days.

Here the main function is the final sedimentation of suspended solids,

the bacterial mass, and pathogens, thus polishing.

Waste stabilization ponds can treat high strength wastewater

to a high quality effluent.

They are generally reliable and good functioning and inexpensive, compared to either centralized

options.

However, they require a lot of space and may generate bad odors,

especially the anaerobic pond, if poorly designed.

It requires expert design and supervision, especially to avoid short-circuiting,

in which case, the effluent goes from the inlet to the outlet without

mixing properly, that is, not staying through the intended

retention time.

Besides, if they work at best in warm climates, waste stabilization ponds are not always appropriate

for colder climates.

This picture shows large waste stabilization ponds

for the city of Cuenca, in Ecuador.

A way to increase the performance of waste stabilization ponds

is to provide artificial aeration, which is done in Cuenca in the first pond,

upstream of this picture.

It is also a good way to upgrade the ponds when then reach design capacity,

especially extension, is not always easy.

In aerated ponds, mechanical aerators provide oxygen

and keep the aerobic organisms suspended to achieve a high rate of organic degradation.

Increased mixing and aeration means that the ponds can be deeper

and tolerate much higher organic loads than the maturation pond.

The depth may be from two to five meters and a retention time from three to twenty

days.

In some cases, it can even replace the anaerobic pond,

thus avoiding the bad odors that anaerobic ponds may generate.

The downside of it is that aeration implies a high energy consumption,

and thus costs, and requires a constant source of electricity.

Interruption of electricity service may cause the pond to turn anaerobic,

thus changing completely the inner biological processes.

We will now have a look at another family of treatment technologies: the "constructed

wetlands".

"Constructed wetlands" aim to replicate the naturally occurring processes

of a natural wetland, marsh or swamp.

We distinguish three types: the "free water surface constructed wetland",

the "horizontal subsurface flow constructed wetland",

and the "vertical flow constructed wetland".

Let's start with the "free water surface constructed wetland".

In that case, the water slowly flows through the wetland,

particles settle, and pathogens are eliminated through the combined action of sun, settling,

adsorption, and predation from higher organisms.

The organisms and plants utilize the nutrients.

This style of constructed wetland is commonly used as a polishing step

after secondary or tertiary treatment processes.

It is only appropriate for low strength wastewater.

This is a really important fact.

The depth of the water is ten to 45 cm above ground level.

Wastewater needs to be well distributed at the inlet.

Good operation and maintenance is needed for it not to turn into a mosquito breeding

area, and to avoid short-circuiting.

Let's look now at the "horizontal subsurface flow constructed wetland".

Its performance regarding reduction of BOD, suspended solids, and pathogens

is higher than in the freewater surface constructed wetlands,

and it does not have the mosquito problem as the water flows only under the surface,

as its name indicates.

As in the previous technology, the good distribution of the influent at the

inlet is very important.

The gravel bed is between 50 cm and one meter deep.

The water level is maintained at 5 to 15 cm below the surface.

As wastewater flows horizontally through the basin,

the filter material filters out particles.

It acts both as a filter and as a fixed surface upon which bacteria can attach, forming large

biofilms.

The plant roots play an important role in maintaining permeability in the filter.

It is very important to have a good primary treatment

before the wetland.

Otherwise, the risk of clogging will be very high.

Expert follow-up is necessary to monitor the plants,

especially the startup periods.

As a final remark, we have to mention that the wetlands need a lot of space,

generally a surface of about five to ten square meters per person equivalent.

This picture illustrates the last type of constructed wetland,

the "vertical flow constructed wetland", which is, of course, difficult to differentiate

from outside.

This is the most sophisticated and performance type of wetland

By injecting the wastewater from above the whole surface,

the distribution is greatly improved.

The water flows down and is collected by a drainage system.

The important difference between vertical and horizontal wetlands

is not simply the direction of the flow path, but rather, the aerobic conditions.

The wastewater is applied intermittently, four to ten times a day.

Thus, the filter goes through stages of being saturated and unsaturated,

and accordingly, different phases of aerobic and anaerobic conditions.

With this regime, there is less plugging risk than in horizontal subsurface flow wetland.

Other than that, the treatment processes are the same as in

the horizontal flow wetland.

Because of the mechanical dosing system, this technology is most appropriate where

trained maintenance staff, constant power supply, and spare parts are

available.

Constructed wetlands can reach a good performance with processes close to nature.

However, one has to be aware of the risk of clogging

and the management of the plants, especially the startup and maintenance,

and beware high ammonia levels which may prevent the plants from growing

properly.

In all cases, a good primary treatment is crucial.

Before finishing this module, we will look at two higher end technologies

which we may call Conventional: the "trickling filter", and the "activated

sludge".

These systems are really performant in developed countries,

but imply high capital costs, operation and maintenance by skilled personnel,

and a constant source of energy.

The "trickling filter" is a fixed bed biological reactor

that operates mostly under aerobic conditions.

After primary treatment, wastewater is continuously trickled

or sprayed through the filter, for example, through a rotating sprinkler.

Organics are degraded by the biofilm covering the filter material.

The filter is usually from one to 2.5 meter high,

but some filters may reach a height up to 12 meters.

Adequate airflow is important to ensure sufficient treatment performance

and prevent odors.

The air can circulate vertically through the filter.

The advantage of a trickling filter over the technologies presented before

is the small land requirement; however, flies and odors are often problematic.

The "activated sludge system" is the best known and most widespread in Western

countries under different forms, such as sequencing

batch reactor, oxidation ditches, moving beds, or membrane

bioreactors.

It makes use of highly concentrated micro-organisms to degrade organics and remove nutrients,

leading to a high quality effluent.

To maintain aerobic conditions and to keep the activated sludge suspended,

a continuous and well-timed supply of oxygen is required.

Aeration and mixing can be provided by pumping air or oxygen into the tank

or by surface aerators.

Agglomerations of sludge particles called flux

form in the aerated tank and are removed in a settler

called in that case "secondary clarifier".

We are now at the end of this module on aerobic treatment technologies.

We saw very different technologies that can all perform well,

but have different requirements.

To sum up, we can say that the main decision factors are:

the availability of space, financial resources, skills, and electricity.

For more infomation >> 4.10 Semi Centralized Treatment, Aerobic Technologies - Duration: 11:38.

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3.5 Water Treatment [Maryna Peter (EAWAG)] - Duration: 14:15.

Here is your source water.

How do we make it to look so?

And even if looks so, is it really safe?

During this lecture, we will find out about different water treatment steps, processes

and technologies, understand basic principles behind most commonly used technologies.

We will also discuss advantages, disadvantages and limitations of each treatment process.

All water treatment methods can be divided in five major groups which can function as

a single step treatment or should be applied as part of a large multi-stage treatment.

The five groups of methods are structured around the type of contaminants removed by

the method.

Those groups are clarification which is removal of particulate matter, inactivation of microorganisms

also called disinfection, desalination, and reduction of concentrations of geogenic and

anthropogenic contaminants to meet water quality guidelines.

A meaningful combination of technologies is in most cases necessary to achieve the WHO

water quality standards for safe drinking water.

The choice of technologies or its combinations we make depends on the many factors including

available water resources, their quality and seasonality, legal requirements, scale, space,

financial resources, local availability of products, consumables and skills as well as

available energy sources.

The purpose of clarification is to remove as much as possible particulate material.

The conventional treatment systems usually apply coagulation/flocculation combined with

sedimentation or filtration.

Rapid sand filtration without coagulation is used as well on large centralized drinking

water treatment plants or community supplies.

In community supplies, roughing filtration has been used successfully as efficient and

low maintenance pre-treatment.

Coagulation is usually a pre-treatment step.

Its goal is to change the fine dispersed particles into larger agglomerates that can be removed

by sedimentation or filtration or both.

In coagulation process, a metal salt such as aluminium or iron salts are added to water

containing dispersed often negatively charged particles.

Aluminium or iron ions destabilize the particles by neutralizing their charge.

Water is being mixed rapidly and pH might need a correction.

The destabilized particles form flocks which grow larger during slow mixing and finally

settle down or can be easier filtered out.

Another method of reducing particulate matter content is a rapid sand filtration.

Water passes through the filter media which is coarse or medium sized sand, which is loaded

over the more coarse gravel layer.

During filtration, solids get trapped, settle or adsorb onto the sand material.

After trapped material accumulated in the filter layers, the filter requires backwashing

– reverse flow of water to remove accumulated material.

The filters are operated at linear velocity of 1-40 m/h, which is considerably higher

than in slow sand filters which we discuss later.

The filter can be constructed with locally available resources and does not require consumables,

but proper design, adequate operational parameters and maintenance are crucial for good performance.

For a rather turbid waters, roughing filters can be used prior to rapid or slow sand filtration

or disinfection.

Differently sized coarse material is used in roughing filters.

The size decreases in the direction of flow.

Gravel from riverbed, broken stones, rocks or bricks, plastics, burnt charcoal or coconut

fibre can be used as filtration media.

There are different configurations of roughing filters: up-flow, down-flow or horizontal

flow.

In an up-flow filter you see here, water moves from down to top and the retained solids accumulate

predominantly in the bottom of the filter.

They can be flushed out by reversing the flow or simply draining the filter.

They are quite simple to maintain, do not require any chemicals and have low operational

costs.

Filter design, maintenance practices and raw water quality fluctuations can influence the

performance to a large extent.

Disinfection of drinking water ensures that bacteria viruses and protozoa have been inactivated

or removed from water so they do not longer pose health risk.

Disinfection is always done after clarification and not before, as particles reduce the efficiency

of many disinfectants.

Disinfection by chlorination is most commonly used method.

Chlorine or sodium hypochlorite can also be produced on-site by hypochlorite generators

by electrolysis of salt.

Ozone and UV light inactivate microorganisms while slow sand filtration and membranes filtration

are based on filtration purely or combined with biological processes.

When chlorine is dissolved in water, it forms equilibrium between the chlorine Cl2, hypochlorous

acid HOCl and hydrochloric acid HCl by this reaction forming:

When chlorine is added to water, it reacts first with reduced compounds and is being

destructed.

At a higher dose, it reacts also with organic matter and nitrogen species to form chloro-organic

and chloramine compounds, which at higher dose of chlorine are partly destructed.

Breakpoint is the point at which complete oxidation of all chloramine species occurred.

Figure summarizes the processes occurring during breakpoint chlorination.

In short, at first chlorine residual increases proportionally to the amount of chlorine added

until the mole ratio of ammonia to chlorine is about 1.

Beyond that, addition of chlorine reduces total chlorine residual due to oxidation of

some chloramine species.

Breakpoint (point C) is the point at which complete oxidation of all chloramine species

occurred.

The location of this point depends on the presence of organic matter, nitrogen and reduced

inorganic ions.

After the breakpoint is reached, free chlorine residual proportionally increases with the

chlorine dose.

After the breakpoint is reached, free chlorine residual proportionally increases with the

chlorine dose.

The part of chlorine which participates in disinfection and is called chlorine demand.

The part which remains in water after chlorine demand is satisfied is called total chlorine.

The free chlorine is chlorine which is present in water in form of hypochlorous acid HOCl

or hypochlorite ion OCl-.

Free chlorine inactivates microorganisms or kills them during a defined period of time,

called contact time.

Chlorine residual is the chlorine which remains in water after the disinfection process has

been predominantly completed and acts as a safeguard against additional microbial contamination

that could be introduced in the distribution network or at the point of use.

Recommended residual chlorine concentration is about 0.5 mg/L of free chlorine which should

be applied to water during at least 30 min.

Chlorine dose is being expressed in concentration multiplied by contact time, called Ct value.

Ct99 means the concentration and time required to kill 99 % of target microorganisms.

IN case of bacteria, the Ct values are low, indicating the inactivation of bacteria occurs

relatively fast and at low concentration.

The time and concentration are considerably higher to inactivate viruses, and very high

for protozoa, indicating that chlorination is not very efficient for protozoa inactivation.

Cryptosporidium oocysts are resistant to chlorine which often does not provide sufficient level

of inactivation to protect from a disease.

Presence of particulate matter in water leading to high turbidity of water compromise chlorination

and water has to be clarified before it can be disinfected with chlorine.

There are different forms of chlorine available, and it can even be produced on site by electrolysis

of salt and water.

The choice of the most appropriate form of chlorine will depend on such factors as scale

and water volume which needs to be treated, skills available, safety management practices

and power supply reliability.

Ozone is highly effective oxidant, not only disinfecting water but also reducing color,

micro pollutants content and other organic contamination.

It is however expensive and does not provide residual protection.

Due to high costs and relative complexity it is usually not used in the developmental

or emergency context.

In contrary, UV disinfection is cheap and relatively simple.

It inactivates microorganisms by damaging their DANN and RNA.

In contrary to chlorination it is also efficient against protozoa.

No supply of chemicals is also an advantage of the method.

However, it does not provide residual protection, requires reliable power supply and frequent

cleaning of the UV lamps which are the source of UV light.

As well as in case of chlorination, it is sensitive to turbidity and water should be

clarified before UV treatment.

Slow sand filters are operated at slower filtration rates of 0.1-0.3 m/h compare to rapid sand

filters which are commonly operated at 1-40 m/h.

Slow filtration rates allow development of a biological activity within the filter.

Thus the slow sand filtration is a combination of different biological and physical processes

including Mechanical trapping, Adsorption or attachment, Predation and Natural death

leading to reduction of solids but also micro and macro organisms .Slow sand filters are

usually down-flow filters and are operated by gravity.

Each filter requires ripening period of few days to few weeks, until removal rates stabilize.

Mainly the top layer of the slow sand filter contains a diverse microbiological community

and particles which is also called schmutzdecke, where inactivation of microorganisms occurs.

The technology is simple, low cost and has a long lifespan, but requires large area and

is sensitive to mal-operation or during the periods of excessive turbidity or algal matter

in inflow.

During membrane filtration was is driven by pressure difference between the feed water

and filtrate through a filter with pores of a defined size range.

usually polymeric membranes and sometime ceramic membranes are used.

Microfiltration has pores in the size of bacteria or high and removes them and particulate matter

by siue exclusion.

Ultrafiltration membranes are more tight and remove also viruses which is the size of 20-80

nm.

Nanofiltration requires considerable higher pressure as the pores are small and is capable

of retaining macromolecules and larger ions.

Small ions such as salt ions can be removed by reverse osmosis, requiring even higher

pressure.

For disinfection purposes, ultrafiltration membranes are most common as an effective

barrier against pathogenic microorganisms and particles.

Different configurations of membranes are available.

In drinking water supply hollow fiber membranes are commonly used.

Spiral wound elements – so flat membrane is rolled together with a spacer- are more

often used in desalination processes.

Flat sheet membrane modules are more often used in wastewater treatment in membrane bioreactors.

Membranes need to be frequently backflushed to remove a layer of particles or microorganisms

accumulating on the surface of the membrane.

This layer is also called fouling layer.

The drinking water filtration systems offer constant and reliable operation, which however

requires high degree of automation, reliable power supply and relatively high costs.

There are also gravity driven systems on the market and in development, more suitable for

remote applications.

Desalination is used to remove salt from sea or brackish water.

If a semipermeable membrane is installed between pure and saline water containers, pure water

be drawn by saline water creating osmotic pressure.

In order to overcome this osmotic pressure, external pressure which is higher than osmotic

pressure, needs to be applied.

Seawater has an osmotic pressure of about 25 bar.

Thus RO systems are operated at 30-70 bar to achieve movement of pure water from saline

water through the membrane.

Thus, high pressure pumps and good power supply are required, as well as pretreatment to protect

membranes from fouling.

Chemical contaminants are either naturally occurring chemicals in rocks and soils such

as F and As or synthetic chemicals introduced into environment through industrial waste

and wastewater, agricultural practices or untreated municipal wastewater.

Adsorption on granular activated carbon, sometimes ozonation as well as nanofiltration or RO

are common methods to reduce concentrations to the acceptable level.

It is quite complex and costly processes and it is advisable to look for other water sources

if this is possible if concentrations of synthetic chemicals are too high.

Fluoride and arsenic are most commonly occurring geogenic chemicals which pose a health risk.

There are few methods based on adsorption, coagulation, ion exchange and membranes to

reduce concentrations of these chemicals.

All of them have advantages and disadvantages and no best option exist yet.

There is a large variety of different treatment technologies and part of these we have not

considered here.

Some processes are still in development or few promising systems still exist as pilots.

Nevertheless in this course we considered major conventional drinking water treatment

steps which include clarification and disinfection.

Disinfection is not efficient if water is turbid, and thus clarification needs to be

done before.

Geogenic and anthropogenic contamination of water require special additional treatment

steps, which adds complexity to the system Desalination of sea water is complex, has

high energy demand and often only appropriate in cases were ultimately no other water source

is available.

So, we clarified and disinfected this water.

Let's drink it!

For more infomation >> 3.5 Water Treatment [Maryna Peter (EAWAG)] - Duration: 14:15.

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Marta's Dad receives acupucture treatment! "I'll be fine.." [One Night Sleepover Trip/ 2018.03.20] - Duration: 9:17.

(Mar-car is heading somewhere again)

(But!)

(Only Marta's family is in the car!)

(Julia seems rather happy)

(And they arrive somewhere)

(Careful, careful)

(Could this be...)

(Confused)

(Energy, meridian and oriental medicinal herbs)

(Everything is new to Marta's family)

(For the health of Marta's family)

Are you guys Sangmin's friends?

Yes.

(Half worried and half excited)

(What lies ahead in their future?)

(Welcome to the world of acupuncture)

I'll pass with the acupuncture treatment.

I'll pass with the acupuncture treatment.

Maybe just a small one here.

No, it'll be on your back.

No! I'll decide where I'm getting it done.

I'll just get one on my finger.

It all depends on where you have a problem.

Julia can get the treatment then.

No, no.

No, no?

Why would I need it when I'm not sick?

Come in.

(They carefully enter into the doctor's office)

(So nervous)

Hello.

Hello.

(After saying hello, she studies the doctor's face)

(The horror of the white doctor's gown)

BIGBANG!

BIGBANG!

"If You!"

- Yes! / - I saw you!

(BIGBANG magic that made Julia smile at once!)

(United as one with BIGBANG!)

I was told by Sangmin

that very important guests were visiting.

He asked me to treat all of you very carefully.

(Thank you, Sangmin!)

So who will be first?

Shall we start with you?

(Why me first?)

Oh, mommy...

(Don't worry, mom!)

(Tongue examination to check her status of health)

Okay, ready!

(Following the instructions obediently)

Open your mouth.

Open it wider.

And stick out your tongue as much as you can.

And stick out your tongue as much as you can.

(Trying it on her own)

Close your eyes.

(Even though it's not her turn)

Close your eyes.

(Like this?)

Just a moment.

(It's Marta's turn now)

(Shy, shy)

Close your eyes.

Open your mouth and... Okay.

(Her very first picture of her tongue)

Good, good, good.

(Let's see how pretty my daughter's tongue is)

I'll explain it to you with the pictures.

(Worried, worried)

I'm scared.

I'm scared.

(Truly worried)

(How is the health of Marta?)

Marta.

Perfect.

No acupuncture for me!

(But...)

But Marta's mom has many problems.

(Oh, no)

Let me show you.

Look. I have many problems.

(Don't worry, it won't be too serious)

This is mother's tongue.

It's not good.

(A clear difference can be seen in the pictures)

(Feeling complicated)

First of all, the crevice here is too deep.

She might have a problem with her spine.

And if you look at the color,

there is too thick of a white coat on her tongue.

- Okay. / - In cases like this...

There is often a problem with blood circulation.

In this case, especially,

there may be a high level of cholesterol in the body.

So, from now, I will be treating you.

Shall we start with the father?

Me?

(Congratulations, mister!)

- Good? / - I don't really need a treatment...

Put a needle on his tongue.

(I'm afraid of needles, too)

My leg hair is kind of ugly.

I thought I could avoid it...

Lie down and relax.

Oh, I'm sorry.

I'll be fine. I'll be fine.

- Relax, Marcello. / - Can I start?

(Here we go)

(First, one on the head)

- Okay, okay. / - Alright? Okay?

My head's empty, so it doesn't even hurt.

(There comes his gag spirit)

What are you saying in front of the doctor?

He must be scared to be spitting out any words.

(This time, one on the arm)

(Ouch)

(Hahaha)

(Feeling good for some reason)

I could feel a current running through me.

(Next, his legs)

(Hmm, this is strange)

My tinnitus stopped.

Really? No way!

The ringing stopped?

Yeah, it's somehow gone.

(Marta's dad has been suffering from tinnitus)

He's been suffering from tinnitus for a few years.

(The doctor is like Asclepius to Marta's father)

I think I should walk around with this needle.

I think I should walk around with this needle.

(Oh, gosh)

(Funny!)

This is very effective.

So you'll walk around with the needle on your head?

(Oh, my goodness)

(While Marta's mother is getting her treatment)

(The doctor examines Julia)

Could you ask her if she ever had trouble with

her lung or her respiratory system?

Your liver and respiratory system are weak.

My liver is not well?

No, it's a question.

No!

No, no, no!

It was just a question.

Julia, I misunderstood his words.

He simply asked if you've had trouble with

your liver or your respiratory system before.

Julia is sensitive about being sick.

No, no. Okay, okay.

It's okay.

It's okay.

(Julia can't stop her tears easily)

(Her tears tell the story of her painful past)

Having being born in just 7 months,

Julia suffered from several problems.

(She visited the hospital often since she was young)

(She would get frightened by seeing doctors)

Close your eyes.

(Following the doctors' instructions became a habit)

(Because of her handicap)

(Julia had always needed the help of others)

(She began to feel sorry for her family)

(And it became her reason not to be sick)

I can't be sick any further.

Give her some tissues.

Don't worry.

It was just a question. Calm down.

I'm really not sick, right?

Don't worry. Trust me.

I shouldn't be sick.

(Knowing Julia's heart)

(Her family members' hearts ache even more)

(7 hours to meeting BIGBANG)

For more infomation >> Marta's Dad receives acupucture treatment! "I'll be fine.." [One Night Sleepover Trip/ 2018.03.20] - Duration: 9:17.

-------------------------------------------

Healthwatch: New Treatment For Prostate Cancer - Duration: 3:10.

For more infomation >> Healthwatch: New Treatment For Prostate Cancer - Duration: 3:10.

-------------------------------------------

Get Rid of Warts with This Garlic-Lemon Treatment - Australia 365 - Duration: 7:56.

Get Rid of Warts with This Garlic-Lemon Treatment

Preventing the growth of warts it is important.

This home remedy will help to strengthen your immune system and lower the chance of future growth.

caused by the human papilloma virus (HPV).

This virus causes a sudden acceleration of cell growth.

As time goes on, it produces painless and benign growths that spread quickly.

And while their appearance doesnt mean anything serious is wrong, it is a sign of a weakened immune system that didnt manage to stop the spread of the virus.

In addition, many want to get rid of them for aesthetic reasons.

Luckily, there is now a wide range of commercial and home remedies with active ingredients that allow reduction or even complete removal of warts.

Among these remedies we find this simple garlic and lemon treatment.

When used for a time, this treatment speeds up healing without leaving marks or scars.

Try it!.

Garlic-lemon treatment to fight warts.

The age-old combination of garlic and lemon is one of the most widely used natural antibiotics and antifungals for skin infections.

Both ingredients have powerful active agents.

Once applied, these agents destroy and inhibit the growth of several types of fungi, viruses, and bacteria.

As if that wasnt enough, they are very economical, widely available, and, unlike their commercial counterparts, dont contain compounds that cause undesirable side effects.

The benefits of garlic.

Considered the most powerful antibiotic in nature, garlic has been proven to be very effective at eliminating infections that lead to warts.

Its active agent, allicin, gives it its antiviral and anti-inflammatory properties.

They are ideal for reducing the growths that tend to form on the fingers, neck and other visible parts of the body.

Both eating it and directly applying it help heal this unsightly issue.

This is because its nutrients strengthen the immune system and stimulate the immune response against the attack of microorganisms.

Best of all, it promotes cell regeneration, which reduces the appearance of scars after the complete removal of warts.

The benefits of lemon.

Lemon juice is rich in acidic compounds that help regulate skin pH levels.

Therefore, it encourages the elimination of blemishes like warts.

This is because of it antifungal, antibacterial, and antiviral properties.

They all support the elimination of many germs that affect health both internally and externally.

Thats why lemon juice is ideal for relieving some skin problems that irritate and cause pain.

In addition, it has an interesting lightening effect.

After a time, it significantly reduces the appearance of spots, scars, and other kinds of blemishes.

How to make a garlic-lemon wart treatment.

Overall, garlic and lemon are two ingredients most people always have on hand, usually for their culinary uses.

Thus, this remedy is really easy to make and doesnt require a big investment.

Its important to understand that its effects dont happen with just one application.

Thus, you must use it every day to get good results.

We recommend: 10 Natural Remedies to Remove Warts.

Ingredients.

1 clove of garlic The juice of 1/2 lemon Tape (as necessary).

What do I do?.

First, crush the garlic clove until a thick paste is formed.

Then, mix it with the juice from half of a lemon.

After, wait a few minutes while the ingredients gel, then apply it directly to the wart.

Make sure to cover the affected area and seal with tape to let it work overnight.

The next day, rinse the skin well with a generous amount of water and dry well.

Repeat every night until the wart has been removed.

Keep in mind:.

Never try to forcibly remove the wart.

This can cause injury and infection.

To prevent the spread of warts, avoid reusing items that have had direct contact with them.

 If you must use them, be sure to disinfect them first.

To go along with this treatment, consume foods and supplements that support the immune system.

For more infomation >> Get Rid of Warts with This Garlic-Lemon Treatment - Australia 365 - Duration: 7:56.

-------------------------------------------

Get Rid of Warts with This Garlic-Lemon Treatment - Australia 360 - Duration: 7:47.

Get Rid of Warts with This Garlic-Lemon Treatment

Preventing the growth of warts it is important.

This home remedy will help to strengthen your immune system and lower the chance of future growth.

caused by the human papilloma virus (HPV).

This virus causes a sudden acceleration of cell growth.

As time goes on, it produces painless and benign growths that spread quickly.

And while their appearance doesnt mean anything serious is wrong, it is a sign of a weakened immune system that didnt manage to stop the spread of the virus.

In addition, many want to get rid of them for aesthetic reasons.

Luckily, there is now a wide range of commercial and home remedies with active ingredients that allow reduction or even complete removal of warts.

Among these remedies we find this simple garlic and lemon treatment.

When used for a time, this treatment speeds up healing without leaving marks or scars.

Try it!.

Garlic-lemon treatment to fight warts.

The age-old combination of garlic and lemon is one of the most widely used natural antibiotics and antifungals for skin infections.

Both ingredients have powerful active agents.

Once applied, these agents destroy and inhibit the growth of several types of fungi, viruses, and bacteria.

As if that wasnt enough, they are very economical, widely available, and, unlike their commercial counterparts, dont contain compounds that cause undesirable side effects.

The benefits of garlic.

Considered the most powerful antibiotic in nature, garlic has been proven to be very effective at eliminating infections that lead to warts.

Its active agent, allicin, gives it its antiviral and anti-inflammatory properties.

They are ideal for reducing the growths that tend to form on the fingers, neck and other visible parts of the body.

Both eating it and directly applying it help heal this unsightly issue.

This is because its nutrients strengthen the immune system and stimulate the immune response against the attack of microorganisms.

Best of all, it promotes cell regeneration, which reduces the appearance of scars after the complete removal of warts.

The benefits of lemon.

Lemon juice is rich in acidic compounds that help regulate skin pH levels.

Therefore, it encourages the elimination of blemishes like warts.

This is because of it antifungal, antibacterial, and antiviral properties.

They all support the elimination of many germs that affect health both internally and externally.

Thats why lemon juice is ideal for relieving some skin problems that irritate and cause pain.

In addition, it has an interesting lightening effect.

After a time, it significantly reduces the appearance of spots, scars, and other kinds of blemishes.

How to make a garlic-lemon wart treatment.

Overall, garlic and lemon are two ingredients most people always have on hand, usually for their culinary uses.

Thus, this remedy is really easy to make and doesnt require a big investment.

Its important to understand that its effects dont happen with just one application.

Thus, you must use it every day to get good results.

We recommend: 10 Natural Remedies to Remove Warts.

Ingredients.

1 clove of garlic The juice of 1/2 lemon Tape (as necessary).

What do I do?.

First, crush the garlic clove until a thick paste is formed.

Then, mix it with the juice from half of a lemon.

After, wait a few minutes while the ingredients gel, then apply it directly to the wart.

Make sure to cover the affected area and seal with tape to let it work overnight.

The next day, rinse the skin well with a generous amount of water and dry well.

Repeat every night until the wart has been removed.

Keep in mind:.

Never try to forcibly remove the wart.

This can cause injury and infection.

To prevent the spread of warts, avoid reusing items that have had direct contact with them.

 If you must use them, be sure to disinfect them first.

To go along with this treatment, consume foods and supplements that support the immune system.

For more infomation >> Get Rid of Warts with This Garlic-Lemon Treatment - Australia 360 - Duration: 7:47.

-------------------------------------------

Baystate Medical's Dr. Heba Wassif on Breast Cancer Treatment and Heart Disease | Connecting Point - Duration: 8:25.

>>> IN MEDICAL NEWS TONIGHT, WE TAKE A LOOK AT THE CONNECTION

BETWEEN CERTAIN BREAST CANCER TREATMENTS CAUSING AN INCREASED

RISK OF HEART DISEASE FOR SOME PATIENTS.

THE AMERICAN HEART ASSOCIATION RECENTLY RELEASED A STATEMENT ON

THE CONNECTION, AND CAROLEE MCGRATH SAT DOWN WITH

NON-INVASIVE CARDIOLOGIST DR.

HEBBA WASIF FROM BAY STATE MEDICAL CENTER TO LEARN MORE.

>> THE EMERGING PARADIGM, FOR THREE REASONS, THERE ARE COMMON

RISK FACTORS BETWEEN BREAST CANCER AND CARDIOVASCULAR

DISEASE, LIKE A SEDENTARY LIFESTYLE, CERTAIN DIETS,

EXCESSIVE MEATS, FOR EXAMPLE, SMOKING THAT HAS SOME

ASSOCIATION ALSO WITH BREAST CANCER.

SO THE DISEASE, BOTH DISEASES CAN EXIST IN THE SAME PERSON, SO

A PERSON CAN BE SUFFERING FROM BABIES AS WELL AS CARDIOVASCULAR

DISEASE.

THE SECOND REASON IS THERE ARE MANY TREATMENT OPTIONS NOW FOR

BREAST CANCER THAT HAVE SOME CARDIOVASCULAR TOXICITY THAT I

BELIEVE WE'LL BE DISCUSSING LATER ON.

SO IT'S IMPORTANT TO KNOW WHAT AN INDIVIDUAL'S UNDERLYING

CARDIOVASCULAR RISK IS.

THE THIRD OBVIOUSLY THAT IF YOU HAVE UNDERLYING CARDIOVASCULAR

DISEASE, THAT MAY DETERMINE OR DIRECT SOME OF YOUR TREATMENT

OPTIONS FOR BREAST CANCER.

>> SO WHAT TYPES OF TREATMENTS ARE WE TALKING ABOUT THIS WOULD

BE THE MOST ADEGREESIVE AND CAUSE PROBLEMS WITH THE HEART?

>> ONE OF THE MOST AGGRESSIVE TREATMENTS IS A GROUP OF DRUGS,

THERE ARE SEVERAL OF THEM IN THE GROUP, SOME CAUSE MORE

CARDIOTOXICITY THAN OTHERS.

>> EXPLAIN THAT.

>> FOR THE LAY PERSON, CARDIOTOXICITY, BECAUSE AS THESE

DRUGS ARE TOXIC AND KILL THE BREAST CANCER CELLS, THEY ALSO

KILL THE MYO CARDIAL CELLS, THE CELLS OF THE HEARTS.

THEY HAVE THE SAME IMPACT, SO THEY INTERACT WITH THE D.N.A.

IN A SIMILAR FASHION THAT THEY

WOULD DO WITH THE TUMOR CELLS.

BUT HERE NOW WE'RE TALKING ABOUT A LIVING HEART CELL.

AND THEREFORE IT CAN POTENTIALLY CAUSE WEAKNESS OF THE HEART

MUSCLE.

THESE DRUGS WERE USED FROM THE EARLY 70'S.

IT WASN'T UNTIL ALMOST 10 YEARS LATER THAT WE DISCOVERED SUCH

THESE TOXICITIES, SO TO SAY. AND WE'VE ALSO DISCOVERED THAT

IT'S SOMEWHAT DOSE DEPENDENT.

AND I WILL QUALIFY THAT STATEMENT, THAT THE I'MER THE

DOSE THE MORE RISK FOR THE HEART MUSCLE.

HOWEVER, THERE'S SOME INDIVIDUALS THAT ARE MORE

SUSCEPTIBLE EVEN AT VERY LOW DOSES, THEY CAN POTENTIALLY HAVE

PROBLEMS WITH THE HEART MUSCLE.

>> WHAT KINDS OF CONDITIONS ARE THOSE INDIVIDUALS IN?

THEY ALREADY HAVE UNDERLYING FACTORS FOR HEART DISEASE?

>> EXACTLY, SO IF THEY HAVE UNDERLYING CARDIOVASCULAR

DISEASE OR IF THEIR HEART MUSCLE IS BORDER LINE WEAK, SO WE

DEFINE A STRONG HEART MUSCLE IN THE WORLD OF MEDICINE IS A HEART

MUSCLE THAT PUMPS ABOUT 60% OF THE BLOOD.

IF YOUR HEART MUSCLE IS BORDER LINE, 50 TO 55%, THEN WE'RE

STARTING AT A WEAKER HEART MUSCLE, THAT CAN POTENTIALLY BE

AT RISK.

AND SOME OF IT IS ALL -- IT'S A WORLD OF UNCERTAINTIES.

BUT WE CAN ONLY TRY TO FIND WHAT ARE THE POSSIBLE ASSOCIATIONS

THAT WOULD INCREASE THE RISK, IDENTIFY THEM, AND THEN MODIFY

WHAT WE DO TO MINIMIZE THAT RISK.

SO IF AN INDIVIDUAL IS OVER 60 YEARS OLD, THEY HAVE TWO OR MORE

CARDIOVASCULAR RISK FACTORS, THEY HAVE A WEAK HEART MUSCLE,

AS I MENTIONED, LIKE A BORDER LINE HEART MUSCLE, THEN WE HAVE

TO MAYBE USE LESS AGGRESSIVE THERAPIES.

OR DO CONTINUOUS MONITORING AT THE BEGINNING OF THE TREATMENT,

AS THE TREATMENT PROGRESSES, AND EVEN AFTER THE TREATMENT IS

TERMINATED BECAUSE SOME OF THESE EFFECTS COULD BE VERY LATE AFTER

THE TREATMENT HAS ENDED.

>> WHEN WOMEN HEAR BREAST CANCER, YOU KNOW, IT'S AN

AUTOMATIC, AS IT SHOULD BE, YOU KNOW, YOU'RE FRIGHTENED, YOU'RE

SO WORRIED ABOUT YOUR FUTURE, YOUR CHILDREN, YOUR HUSBAND.

AND WHAT THE MEDICAL OUTCOME WILL BE.

SO I'M SURE PEOPLE ARE SAYING, YOU KNOW, GIVE METHE STRONGEST

TREATMENT POSSIBLE BECAUSE I WANT TO GET RID OF THIS.

BECAUSE YOU HAVE TO TREAT IT AGGRESSIVELY.

>> ABSOLUTELY.

AND THAT'S NOT HAVING SAID THAT BECAUSE OF THE CONCERN OF

CARDIOVASCULAR RISK OR CARDIOTOKS ISITY, THAT DOESN'T

MEAN THAT WE SHOULD HOLD TREATMENT FOR BREAST CANCER.

YOU HAVE TO TREAT THE CANCER IF IT'S AGGRESSIVE, YOU'RE MORE

LIKELY TO DIE FROM BREAST CANCER THAN DIEING FROM CARDIOVASCULAR

DISEASE.

SOME OF THESE POSSIBILITIES MAY BE LONG TERM.

AND BECAUSE WE HAVE LONG-TERM SURVIVORS, WE ARE SEEING MORE

WOMEN THAT ARE SURVIVING BREAST CANCER, WHICH IS AN AMAZING

ENDEAVOR THAT HAS BEEN ACHIEVED OVER THE LAST 25 YEARS MARKS THE

MORTALITY FROM BREAST CANCER HAS BEEN REDUCED SIGNIFICANTLY.

WE'RE SEEING WOMEN THAT ARE NOW DYING AS OLDER WOMEN FROM

CARDIOVASCULAR DISEASE, WHO HAD BREAST CANCER.

NOT FROM THE RECURRENCE OF THE BREAST CANCER, BUT RATHER FROM

CARDIOVASCULAR DISEASE.

SO IT'S IMPORTANT TO IDENTIFY WHO IS AT RISK FIRST, AND IT IS

AN EVOLVING FIELD WHERE THERE'S A LOT OF WORK THAT'S CURRENTLY

BEEN DONE.

AND IT'S ALSO BEEN IDENTIFIED AS A UNIQUE SUB SPECIALTY OF

CARDIOLOGY WHICH IS ALMOST NEW IN EXISTENCE OVER THE LAST FEW

YEARS.

>> GIVE US THE NUMBERS AS FAR AS THE MORTALLY RATES FOR HEART

DISEASE VERSUS BREAST CANCER.

>> TO PUT THINGS INTO PERSPECTIVE, THERE ARE MORE

WOMEN LIVING WITH CARDIOVASCULAR DISEASE IN THE U.S. THAN THERE

ARE WOMEN WITH BREAST CANCER.

ALMOST 48 MILLION WOMEN WITH CARDIOVASCULAR DISEASE, AND ONE

OUT OF THREE WOMEN WILL DIE FROM CARDIOVASCULAR DISEASE.

AND THAT'S INCLUDING STROKE AS WELL.

ONE OUT OF 31 WOMEN WILL DIE FROM BREAST CANCER.

SO WOMEN ARE MORE LIKELY TO DIE FROM HEART DISEASE THAN BREAST

CANCER.

BUT THIS IS AGAIN WHERE WE'RE IDENTIFYING AWE BREAST CANCERS

IN ALL ITS STAGES AND ALL ITS FORMS AS WELL AS CARDIOVASCULAR

DISEASE.

IT DOESN'T SPEAK FOR THE PARTICULAR INDIVIDUAL.

>> HOW DO YOU WORK WITH THE ONCOLOGIST, WHEN YOU HAVE A

PATIENT WHO HAS HEART DISEASE WHO IS ALSO BEING TREATED FOR

BREAST CANCER, TELL ME HOW THAT RELATIONSHIP HAS TO WORK TO BEST

BENEFIT THE PATIENT.

>> AS I SAID, THIS IS AN EMERGING PARADIGM, AND IT'S AN

EVOLVING COLLABORATION NOW BETWEEN CARDIOLOGISTS AND

ONCOLOGISTS.

THE ONCOLOGIST IS THE PRIMARY TREATING PHYSICIAN, THEY

IDENTIFY WHAT IS THE MOST APPROPRIATE THERAPY FOR THE

PATIENT.

BUT THEY WORK HAND IN HAND WITH THE CARDIOLOGIST TO FIRST

MONITOR THE PATIENTS FROM A CARDIOVASCULAR STANDPOINT, FOR

EXAMPLE, IF THE HEART MUSCLE IS RELATIVELY WEAK TO START WITH,

THEN MAYBE INITIATING CERTAIN THERAPIES MAY BE ADVICABLE.

IF HEART WEAKNESS OCCURS DURING THE THERAPY, AJUSTMENT OF THE

TREATMENT OPTIONS IS WARRANTED.

AND THIS CONTINUOUS MONITORING BY CARDIAC ECHO CARD YOG REAF,

WHICH IS THE ULTRASOUND FOR THE MART MUSCLE, I VERY --

IS VERY IMPORTANT.

IT'S A COLLABORATION OF THE BEGINNING, MIDDLE OF THERAPY AND

EVEN AFTER THE THERAPY IS TERMINATED.

>> I KNOW YOU'RE A MEDICAL DOCTOR, BUT I HAVE TO IMAGINE

THAW SEE THE EMOTIONAL SIDE OF YOUR PATIENTS.

>> SLEUMENT.

>> HERE YOU HAVE BREAST CANCER AND NOW YOU'RE AT HIGH RISK FOR

A HEART, SOME SORT OF HEART FAILURE OR HIGH RISK OF HEART

DISEASE.

THAT'S LIKE TWO MAJOR THINGS THAT PEOPLE WOULD HAVE TO DEAL

WITH.

HOW DO YOU HELP PATIENTS UNDERSTAND THE PROCESS?

>> IT'S OBVIOUSLY, YOU CAN'T TAKE AT THE MOTION OUT OF EITHER

CONDITION.

THERE'S A LOT OF EMOTIONS ASSOCIATED WITH THEM AND PEOPLE

ARE PEOPLE, WE'RE HUMAN BEINGS.

AT THE END OF THE DAY THIS IS LIFE THREATENING ON BOTH ENDS.

IT'S ALL ABOUT ASSESSING RISK, WHAT IS THE MOST RISK NOW, AND

IF THE BREAST CANCER IS THE MOST RISK, WHICH IT USUALLY IS

IMMEDIATELY, THEN YOU MANAGE THE BREAST CANCER, AND YOU MONITOR.

AND YOU MAY, AS I SAID, MAYBE USE LESS AGGRESSIVE THERAPIES.

AND THERE ARE LESS AGGRESSIVE THERAPIES, BUT IT HAS TO BE WITH

THE AGREEMENT OF THE ONCOLOGIST THAT THAT IS AN APPROPRIATE

THERAPY FOR THAT PARTICULAR PATIENT.

For more infomation >> Baystate Medical's Dr. Heba Wassif on Breast Cancer Treatment and Heart Disease | Connecting Point - Duration: 8:25.

-------------------------------------------

4.8 Semi Centralized Treatment, Treatment Stages - Duration: 5:33.

Unfortunately, around the world, huge amounts of waste water and sludge end up untreated

into rivers, lakes, and into the sea.

What does it take to treat them?

I will now introduce you to the centralized and semi-centralized treatment technologies.

The treatment process can be divided into several stages.

The pre-treatment, the primary treatment, the secondary treatment, the tertiary treatment,

or post-treatment.

Within these categories, some technologies are based on biological

processes: aerobic, anaerobic or both.

And some others on physical, chemical ones.

In this module, we'll have a look at the different treatment stages

and then focus on pre- and post-treatment, which can be implemented in any system.

we will review the anaerobic technologies, The learning goals

of this series of modules on treatment are: get to know the different treatment technologies,

understand the different treatment stages and processes,

and understand the different functions of the treatment technologies.

Let's start.

First, let's review the different treatment stages.

The two main treatment stages are called primary and secondary.

"Primary treatment" consists in the liquid/solid separation.

For example, through sedimentation.

As for the "Secondary treatment", it consists of the removal

of organic matter and suspended solids.

The "pre-treatment" is the preliminary removal of waste water or sludge constituents, such

as oil, grease and various solids, like sand and trash.

Pre-treatment is a must.

On the other hand, the "tertiary treatment" and "post-treatment"

consist of removing elements like remaining pathogens,

nutrients such as nitrogen and phosphorous, or micropollutants from the effluent.

Tertiary treatment embraces a large spectrum of technologies,

and most of them are not implemented in low- and middle-income countries.

Too expensive and too complex.

Let's have a look at a few pre-treatment technologies.

Pre-treatment is a preliminary removal of waste water

or sludge constituents, either before conveyance, or before treatment systems.

It is meant to prevent the accumulation of solids

in further stages and avoid blockages.

It can also help produce abrasion of mechanical parts and extend the life

of sanitation infrastructure.

Pre-treatment technologies use physical removal mechanisms such as screening,

flotation, settling, and filtration.

"Screening" is used, for example, in the screens to prevent trash

and coarse solids to end up in the sewerage system

or the treatment plant.

"Flotation" is used, for example, in grease traps and grids interceptors

to remove the fats, oil and grease.

Finally, "settling" is used, for example, in the sand trap,

or grit chambers, to remove the heavier solids.

As you can see in this figure, grease traps and grit chambers

can be combined in one technology.

On the other end of the treatment process, there are different possibilities to polish

the effluent: the so called post- treatment technologies.

Depending on the design and use of the effluent, or on national standards for discharging water

bodies, a post-treatment step may be required

to remove pathogens, residual suspended solids, or its soil constituents.

This can be mainly achieved through tertiary filtration

and disinfection techniques.

Filtration process can be classified in two categories: first, the depth,

or "packed-bed filtration", as shown in this figure,

where the effluent passes through a filter medium,

such as sand or activated carbon.

On the other hand, "surface filtration" removes undesired elements through sieving;

for example, through membranes.

As for "disinfection", its target is the elimination of pathogenic micro-organisms.

Chlorine is the most widespread technique.

Chlorine is mixed with effluent at the outset of the treatment plant,

as shown in this figure, with a chlorine diffuser and a chlorine mixer.

You can also do disinfection through UV radiation or ozonation,

the two being more energy intensive.

However, you have to be cautious with disinfection.

For example, chlorine together with organic matter

can form toxic byproducts, harmful for the environment.

It should thus only be applied if strictly necessary.

You don't want to create more problems than you actually solve.

To sum up, we saw that treatment is a succession of different steps,

the main ones being the primary and secondary treatment.

Pre-treatment is a must, as a kind of preventive measure,

either at the household level, at the street level,

or at the inlet of a treatment plant.

Post-treatment is not always necessary, and a pragmatic approach is recommended.

The effluent quality should match the intended end use

practice, or the quality of the receiving water body.

For more infomation >> 4.8 Semi Centralized Treatment, Treatment Stages - Duration: 5:33.

-------------------------------------------

4.6 Collection and Storage Treatment, Anaerobic Technologies - Duration: 7:44.

In this lecture, we are going to look at technologies for on-site blackwater and

greywater management, including the septic tank and the biogas reactor.

These technologies are based on anaerobic processes, and I will just

explain what that means.

The word 'anaerobic' describes biological processes that occur in the

absence of oxygen.

These processes naturally take place in swamps, marshes, ponds and other

standing water bodies.

They can easily be recognized by the formation of gas bubbles, as shown

in these beautiful photographs.

The gas is formed, for example, at the bottom of a pond, where the anaerobic

bacteria decompose carbon-rich organic substances into methane and carbon dioxide

(also called 'biogas').

The gas bubbles then rise to the surface.

In cold areas, where the lake surfaces freeze in wintertime, it can sometimes be

observed that the bubbles get trapped below the ice surface,

as shown on the two pictures on the right side.

In wastewater engineering, we often talk about 'anaerobic digestion.'

The term 'anaerobic digestion' refers to the degradation and stabilization of

organic matter by microorganisms without oxygen, leading to production of biogas.

Both anaerobic and aerobic processes are used for wastewater treatment.

The aerobic ones need aeration systems to provide enough oxygen and are technically

a bit more complex.

They are, therefore, not so commonly used at the collection and storage level.

We will introduce those technologies later in the collectors about centralized and

semi-centralized treatment.

So much for an introduction to the general processes.

Now we want to look at a few technologies.

The septic tank is among the most widespread onsite sanitation technologies.

There are two important things you have to know about the septic tank.

First - it is a water-tight tank, typically made of reinforced concrete,

polyethylene or fiberglass and, second - it has an outlet, through which

the clarified effluent leaves the tank.

In practice, people are not always aware of those two aspects.

They may even call an open-bottom pit a septic tank, which is actually wrong.

Blackwater and greywater enter the tank through an inlet T.

Settleable solids fall down to the bottom, where they accumulate as sludge.

With time, the sludge undergoes some stabilization by anaerobic digestion.

It has to be removed every 3-5 years.

Floatable substances move up to the surface, forming a scum layer.

The effluent from the clearwater zone, in the middle, flows out through an outlet T

and is then typically infiltrated, for example, in a leach field.

One or two separation walls in the tank can improve the solid / liquid

separation process.

The good thing about septic tanks is that they are passive and do not require

electrical energy to function.

This makes this technology quite robust.

Construction is relatively costly but the technology has a long service life

and requires little maintenance.

The costs for mechanical emptying, however, may be considerable.

Little space is required because this technology is typically built underground.

On the negative side - it has to be mentioned that the removal of

pathogenic organisms, suspended matter, organic substances and nutrients is

relatively low, therefore, the effluent, as well as the sludge,

require further treatment and / or appropriate discharge.

To ensure optimum performance of the septic tank, it has to be regularly pumped

as shown in the photo.

An anaerobic baffled reactor, or ABR, is like an improved version of a large

septic tank.

Its functioning is very similar, but it is equipped with baffles,

which form several anaerobic chambers to remove and digest organics and improve

the treatment performance.

The treatment can be further improved by providing 1 to 3

fixed-bed filter units, which helps to trap non-settleable suspended particles

and provide an increased surface for microbial growth.

This technology is called "anaerobic filter."

An ABR, or an anaerobic filter, can be installed at the small scale for on-site

collection and treatment, but also at semi-centralized or centralized

treatment level.

More detailed explanations of these two technologies will be provided in module 3.2.

In the septic tank, ABR (or anaerobic filter), the gases produced in the anaerobic processes

are just released into the atmosphere because their quantities are relatively

low.

The biogas reactor, or anaerobic digestor, however, is designed

to generate as much biogas as possible and to capture and collect it,

so that it can be used as a renewable energy source for cooking or other purposes.

The blackwater from a toilet can be directly connected to the digestor.

In order to produce significant amounts of biogas, additional inputs like cow dung or

organic solid waste, are normally mixed in at the inlet.

The substrate flows into the reactor, where it has a retention time of,

typically, 15-to-25 days.

The biogas collects in the dome at the top of the reactor, and is transported

to the point of use, through a gas pipe.

When new substrate is added to the reactor or when the gas pressure rises, the digestate

flows into the expansion chamber from where it can be removed.

In the photos, you can see some examples of different biogas reactor designs.

Picture on the upper left shows a thick stone reactor under construction.

This is another thick stone digestor, similar to

the one previously shown on the drawing.

As you can see, the space requirement is quite low, because it can be built underground.

On the right side, you can see a floating dome reactor, where the

gas storage can move up and down, depending on the gas volume inside;

and this one here is a biogas stove.

This technology has the clear benefit that no energy is required for operation, but energy

is actually produced.

A high reduction of organic matter and particles can be achieved.

The digestate is almost odorless and still contains all the nutrients, so it

can be used as an excellent fertilizer, however, the agricultural application

has to be done correctly and carefully because the digestate may still contain

some pathogens.

This technology has many benefits but its success depends on correct implementation

by experts, proper operation and regular maintenance.

We have seen that there are several anaerobic technologies that are robust

and easy to operate for on-site treatment of blackwater and greywater.

I want you to remember two things from this module:

First - septic tanks can be a good solution but it is important that the

effluent is properly disposed of and that the sludge is regularly removed.

The second thing that I want you to remember is that the biogas reactor

can be an attractive technology, but the economic benefits do not mean that it is

always automatically successful.

Whether or not the initial investment costs can be recovered will depend on the

correct design and implementation and their motivated operator.