Inorganic chlorine is susceptible to water and soil salinization due to its non-degradability and high mobility. To clarify the environmental risks associated with the active inorganic chlorine in municipal solid waste (MSW), the specific characteristics and contributions of inorganic chlorine in different MSW categories were investigated in this study. MSW samples were collected from eight representative waste classification residential areas in Hangzhou, China. It was found that the inorganic chlorine content in different MSW categories varied significantly (0-113 mg/g). Perishable waste, paper, and plastic were found to be the main sources of inorganic chlorine in MSW. A four-category classification system was used to quantify the contribution of inorganic chlorine from each waste category. It was found that the misclassification of inorganic chlorine contributions from perishable waste and other waste accounted for 51.96% and 48.04%, respectively. However, when correctly classified into the four-category system, their contributions were reduced to 67.14% and 30.65%, respectively. Therefore, MSW classification showed a significant reduction in the overall contribution of inorganic chlorine. The misclassification reduces the contribution of inorganic chlorine to 48.04%, while correct classification increases the reduction to 69.35%.

Individuals living near cholera patients have an increased risk of cholera infections. Case-area targeted interventions (CATIs) promoting improved water, sanitation, and hygiene (WASH) present a promising approach to reducing cholera for those residing near cholera cases. However, there is limited evidence on the effectiveness and implementation of this approach in increasing WASH behaviors. We conducted a mixed-methods program evaluation in rural and urban eastern Democratic Republic of the Congo. The quantitative component included household structured observations and spot checks in CATI and control areas to assess WASH conditions and behaviors. The qualitative component included semi-structured interviews with CATI recipients, non-recipients, and implementers to assess CATI implementation. A total of 399 participants were enrolled in the quantitative evaluation conducted within 1 month of CATI delivery. For the qualitative evaluation, 41 semi-structured interviews were conducted, 30 with individuals in CATI areas (recipients and non-recipients) and 11 with CATI implementers. Handwashing with soap was low among both CATI and control area participants (1% vs. 2%, p = 0.89). Significantly more CATI area households (75%) had chlorine tablets present compared to control area households (0%) (p < 0.0001); however, the percentage of households with stored water free chlorine concentrations > 0.2 mg/L was low for both CATI and control area households (11% vs. 6%, p = 0.45). Implementers reported an insufficient supply of soap for distribution to recipients and mistrust in the community of their activities. CATI recipients demonstrated low knowledge of the correct preparation and use of chlorine for water treatment. Recipients also indicated a need for CATI implementers to engage community leaders. As CATIs are part of cholera control plans in many cholera-endemic countries, it is important to evaluate existing programs and develop evidence-based approaches to deliver CATIs that are both tailored to the local context and engage affected communities to increase WASH behaviors to reduce the spread of cholera.

BACKGROUND: Accidents involving chlorinated compounds in the context of cleaning are not uncommon. However, improving the treatment success rate for acute respiratory distress syndrome (ARDS) patients caused by chlorine gas presents significant challenges.
METHODS: A 28-year-old female was admitted to the intensive care unit after accidental inhalation of chlorine gas resulting in ARDS.
METHODS: The patient was diagnosed with ARDS attributed to chlorine gas exposure.
METHODS: The intervention involved utilizing a combination of awake self-prone positioning (ASPP) and high-flow nasal oxygen therapy for treatment.
RESULTS: After continuous ASPP and high-flow nasal oxygen therapy, the patient quickly recovered and was transferred out of the intensive care unit on the 6th day without any adverse events.
CONCLUSIONS: ASPP combined with high-flow nasal oxygen therapy can improve patients\' hypoxemia, prevent the need for intubation, avoid rapid deterioration of the condition, reduce treatment complexity, and lower mortality rate.

Hemodialysis uses municipal water that must be strictly purified and sterilized to be used for that procedure. Large amounts of decontaminants are often used, such as chlorine, and if these compounds are not subsequently removed they can be transferred to the blood of patients causing complications including methemoglobinemia.
In this case series study, dialysis patients in one unit were evaluated. We reviewed clinical characteristics and laboratory findings obtained on the day when the water supply was disinfected with chlorine, with the aim to quantify methemoglobin concentrations. Our objective was to characterize the clinical presentation and management of patients who presented with methemoglobinemia on a specific index day. We also reviewed reported cases in the literature regarding this underreported complication.
Eight patients who presented with chlorine intoxication were evaluated. The methemoglobin concentrations were between 1.3% and 7.9% (reference value 0-1%). We believe this to be caused by water containing 0.78 mg/L of total chlorine. Seven patients presented with cyanosis, 4 with dizziness, 6 with dark brown blood, 4 with dyspnea, and 4 with headache and hemolytic anemia. Subjects were treated with supplemental oxygen, methylene blue, intravenous vitamin C, blood transfusions, and increased doses of erythropoietin. No patient died, and all continued with their usual hemodialysis sessions.
Acute chlorine intoxication transferred by the water used during hemodialysis sessions can present with methemoglobinemia accompanied by cyanosis, oxygen desaturation, and hemolytic anemia. Chlorine levels should be carefully monitored in the water used for hemodialysis treatment.

Recalcitrant contaminants are not usually removed in conventional wastewater treatment plants. Therefore, they are transferred to the water resources that receive treated wastewaters and their presence can cause health and environmental issues. Herbicides are among these compounds. In particular, S-metolachlor (MTLC) is specifically of high concern because its molecule incorporates a chlorine atom that contributes to its toxicity. For its removal, a magnetically recoverable photocatalyst, TiO2/Fe3O4/rGO-5, was synthesised following a hydrothermal method. The performance of TiO2/Fe3O4/rGO-5 has been experimentally assessed and compared to TiO2 and TiO2/rGO-5 catalysts. A characterisation of the materials properties was carried out including adsorption isotherms of MTLC that provided the maximum adsorption capacity of the materials (qm), being 140.85 ± 5.14 mg g-1 for TiO2/Fe3O4/rGO-5. Furthermore, the ternary composite exhibited good recoverability from liquid media after four consecutive cycles thanks to its magnetic character (magnetic saturation of 13.85 emu g-1). Photocatalytic degradation of MTLC started after a dark adsorption step following first order kinetics (0.0197 ± 1.2 × 10-4 min-1 for the degradation of 100 mg L-1 of MTLC with 0.5 g L-1 of TiO2/Fe3O4/rGO-5) similar to the rate of appearance of chloride in solution; after total removal of the solubilized MTLC the chloride concentration in the solution continued increasing with zero-th order kinetics up to the value corresponding to the total MTLC concentration. This second step in the chloride formation was attributed to the degradation of adsorbed MTLC. Specific experiments in the presence of scavengers of reactive oxygen species (ROS) were carried out shedding light on the degradation mechanisms. It was concluded the predominant role of free hydroxyl radicals in the photocatalytic degradation in all the investigated materials, whereas the presence of rGO in the composite photocatalysts improved their electronic conductivity, enhancing the activity of superoxide radicals. The results of this work provide important information for further development of photocatalysis.

UV/peroxymonosulfate (UV/PMS) advanced oxidation process has attracted significant attention for removal of micropollutants in water. However, during practical water treatment applications, the PMS treatment must be performed before the UV treatment to achieve full contact. In this study, sulfamethoxazole (SMX) was selected as the target micropollutant. Four different operational approaches, including UV alone, PMS alone, simultaneous UV/PMS and sequential PMS-UV, were compared for their differences in SMX removal and disinfection by-product (DBP) formation potentials during chlorine-driven disinfection. Among the four approaches, UV/PMS and PMS-UV achieved over 90% removal efficiencies for SMX without substantial differences. For raw water, the trichloronitromethane (TCNM) formation potential after treatment with PMS-UV was lower than that after UV/PMS treatment. The time interval over which the PMS-UV process was conducted had little effect on the final removal efficiency for SMX. However, a brief (5 min) pre-PMS treatment significantly reduced the TCNM formation potential and the genotoxicity from DBPs. The formation risk for TCNM during chlorination increased markedly with increasing PMS dosages, and the appropriate dosage under these experimental conditions was suggested to be 0.5-1.0 mmol/L. Under alkaline conditions, PMS-UV treatment can enhance SMX degradation as well as dramatically reduced the formation potentials for haloketones, haloacetonitriles and halonitromethanes. This study suggests that proper optimization of UV/PMS processes can remove SMX and reduce its DBP formation.

This pilot study aimed to develop a production line for SRF production from RDF by extracting prohibited materials, grinding, and drying, and the energy potential for using SRF in the cement industry as an alternative fuel was evaluated. This paper defined the main characteristics of RDF, which were obtained after the separation of the biological fraction from MSW at an MBT plant. According to its characteristics, RDF can only be used for incineration in the CPP to obtain heat and energy. The produced SRF meets the requirements for fuel from waste and can be used as an alternative fuel for clinker firing. A technological process line for SRF production from RDF has been developed by adding technical units to the existing MBT line. The SRF production line yield was calculated as 4.47 t/h. At the end of the SRF production process, the moisture content of the finished product decreased by 85%, and the volume decreased by 18%. The obtained SRF had a high calorific value, low moisture content, and a permissible value of chlorine and mercury. It was proposed that the produced SRF and sewage sludge (already used during the clinker firing process) be utilized as alternative fuels since they correspond to the oxide composition of the finished clinker in elemental and oxide composition. A calculation to assess the economic and environmental efficiency of the use of SRF in the cement kiln was conducted. The result showed that using 10% SRF as a substitute fuel for coal used in clinker roasting at 1.92 t/h would save 601.7 USD/h coal costs. This use of SRF will emit 3.7 t/h CO2 and achieve net savings of 754.7 USD/h.

The present study tracked the city-wide dynamics of severe acute respiratory syndrome-corona virus 2 ribonucleic acids (SARS-CoV-2 RNA) in the wastewater from nine different wastewater treatment plants (WWTPs) in Jaipur during the second wave of COVID-19 out-break in India. A total of 164 samples were collected weekly between February 19th and June 8th, 2021. SARS-CoV-2 was detected in 47.2% (52/110) influent samples and 37% (20/54) effluent samples. The increasing percentage of positive influent samples correlated with the city\'s increasing active clinical cases during the second wave of COVID-19 in Jaipur. Furthermore, wastewater-based epidemiology (WBE) evidence clearly showed early detection of about 20 days (9/9 samples reported positive on April 20th, 2021) before the maximum cases and maximum deaths reported in the city on May 8th, 2021. The present study further observed the presence of SARS-CoV-2 RNA in treated effluents at the time window of maximum active cases in the city even after tertiary disinfection treatments of ultraviolet (UV) and chlorine (Cl2) disinfection. The average genome concentration in the effluents and removal efficacy of six commonly used treatments, activated sludge process + chlorine disinfection (ASP + Cl2), moving bed biofilm reactor (MBBR) with ultraviolet radiations disinfection (MBBR + UV), MBBR + chlorine (Cl2), sequencing batch reactor (SBR), and SBR + Cl2, were compared with removal efficacy of SBR + Cl2 (81.2%) > MBBR + UV (68.8%) > SBR (57.1%) > ASP (50%) > MBBR + Cl2 (36.4%). The study observed the trends and prevalence of four genes (E, RdRp, N, and ORF1ab gene) based on two different kits and found that prevalence of N > ORF1ab > RdRp > E gene suggested that the effective genome concentration should be calculated based on the presence/absence of multiple genes. Hence, it is imperative to say that using a combination of different detection genes (E, N, RdRp, & ORF1ab genes) increases the sensitivity in WBE.

Pool chemicals are utilized in pools to inactivate pathogens, optimize pH, and increase water clarity. This is conducted to ensure public health and safety by reducing bacteria concentrations and allowing distressed swimmers to be detected underwater. In commercial recreational facilities, muriatic acid and gaseous CO2 are typically used to maintain pH. Chlorine, which can take the form of liquid or solid tablets of sodium hypochlorite or granular calcium hypochlorite, is used to sanitize pool water, and is the most used chemical treatment in the world for swimming pools disinfection. If chlorine is mixed with muriatic acid, chlorine gas is formed, which can lead to severe injuries and fatalities (SIFs) to exposed individuals. This work illustrates an incident that occurred as a result of the simultaneous injection of muriatic acid and liquid sodium hypochlorite into a recreational natatorium chemical feed line. This led to the release of chlorine gas in the indoor environment, which resulted in injuries to five patrons. Furthermore, strategies are proposed to prevent this from occurring and to reduce the likelihood of similar incidents in the future. These include the implementation of fail-safe logic to prevent the controller from malfunctioning and ensuring that controller program settings do not permit simultaneous chemical injection.

A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery.