Dual slag filters for enhanced phosphorus removal from domestic waste water: performance and mechanisms

Abstract

The phosphorus (P) removal of five combinations of dual filters consisting of blast furnace slag (BFS), argon oxygen decarburisation slag (AOD) and electric arc furnace slag (EAF) was evaluated in column experiments with domestic waste water. The columns were fed with waste water for 24 days. The column with only EAF had the best P removal performance (above 93% throughout the experiment). The speciation of the bound P was evaluated by P K-edge X-ray absorption near-edge structure (XANES) spectroscopy. In all five columns, the main P species of the slag packed in the outlet chamber was amorphous calcium phosphate (ACP). In samples from the inlet chambers, the contributions from crystalline Ca phosphates, P adsorbed on gibbsite and P adsorbed on ferrihydrite were usually much greater, suggesting a shift of P removal mechanism as the waste water travelled from the inlet to the outlet. The results provide strong evidence that P was predominantly removed by the slags through the formation of ACP. However, as the pH decreased with time due to the progressively lower dissolution of alkaline silicate minerals from the slag, the ACP was rendered unstable and hence redissolved, changing the P speciation. It is suggested that this process strongly affected the lifespan of the slag filters. Of the slags examined, EAF slag had the best P removal characteristics and BFS the worst, which probably reflected different dissolution rates of alkaline silicates in the slags.

Comparing the effects of 3 different pressure ulcer prevention support surfaces on the structure and function of heel and sacral skin: An exploratory cross-over trial

Special support surfaces are key in pressure ulcer prevention. The aim of this study was to measure the effects of 3 different types of mattresses (reactive gel, active alternating air, basic foam) on skin properties of the sacral and heel skin after 2 hours loading. Fifteen healthy females (median age 66 years) were included. Transepidermal water loss, skin surface temperature, erythema, stratum corneum hydration, epidermal hydration, skin extensibility, elastic function, and recovery as well as skin roughness parameters were measured under controlled room conditions before loading, immediately after loading, and 20 minutes post-loading in the supine position on the different mattresses. The highest increases in transepidermal water loss, skin temperature, and erythema were observed for the foam mattress after loading, indicating higher deformation and occlusion. Cutaneous stiffness decreased in all 3 groups, indicating structural changes during loading. There was a substantial decrease of mean roughness at the heel skin in the foam group, leading to a flattening of the skin surface. Study results indicate that the type of support surface influences skin structure and function during loading. The gel and air mattress appeared to be more protective compared with the foam mattress, but the differences between the gel and air were minor.

Predicting delayed healing: The diagnostic accuracy of a venous leg ulcer risk assessment tool

The aim of this study was to validate a newly developed tool that can predict the risk of failure to heal of a venous leg ulcer in 24 weeks. The risk assessment tool was validated, and performance of the tool was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Retrospective and prospective validation was conducted through multi-site, longitudinal studies. In the retrospective study (n = 318), 30% of ulcers did not heal within 24 weeks, with the tool demonstrating an AUC of 0.80 (95% CI, 0.68-0.93, P < .001) for the total score. In the prospective study across 10 clinical sites (n = 225), 31% (n = 68) of ulcers did not heal within 24 weeks. Participants were classified with the RAT at enrolment as being at low risk (27%), moderate risk (53%) or high risk (20%) of delayed healing; the proportion of wounds unhealed at 24 weeks was 6%, 29% and 59%, respectively. Validation results of the total score indicated good discrimination and goodness of fit with an AUC of 0.78 (95% CI, 0.71-0.85, P < .001). Validation of this risk assessment tool offers assurance that realistic outcomes can be predicted for patients, and scores can guide early decisions on interventions to address specific risk factors for failing to heal, thus promoting timely healing.

Pseudomonas infection following total contact cast application

Efficacy and safety of fosmidomycin-piperaquine as non-artemisinin-based combination therapy for uncomplicated falciparum malaria - A single-arm, age-de-escalation proof of concept study in Gabon

Abstract

Background

Fosmidomycin-piperaquine is being developed as non-artemisinin-based combination therapy to meet the challenge of emerging artemisinin resistance.

Methods

The study was a phase 2 single arm open label proof of concept study of the efficacy, tolerability and safety of fosmidomycin-piperaquine for the treatment of uncomplicated Plasmodium falciparum mono-infection in Gabon. Adults and children of both sexes with initial parasite counts between 1,000 and 150,000/µL were eligible for oral treatment with fosmidomycin (twice daily doses of 30mg/kg), and piperaquine (once daily dose of 16mg/kg) for three days and followed-up for 63 days. The primary efficacy endpoint was the per protocol PCR-corrected Day 28 adequate clinical and parasitological response (ACPR).

Results

100 patients were enrolled. The PCR-corrected Day 28 ACPR rate was 83/83 or 100% (95% CI: 96-100). Fourteen patients had asexual parasitaemia between Day 28 and Day 63; all were typed by PCR as new infections. Fosmidomycin-piperaquine therapy led to rapid parasite clearance (median: 36h; IQR: 6-60) and fever clearance time (median: 12h; IQR: 6-48). The electrocardiogram assessments showed two subjects with QT corrected from the formula of Bazett (QTcB) >500msec following study drug administration. The majority of adverse events affected the gastrointestinal and respiratory tracts and were transient and mild to moderate in severity.

Conclusions

This is the first report of the use of the combination fosmidomycin-piperaquine, a non-artemisinin-based combination therapy in clinical development. The combination appeared to have high efficacy, to be safe and well tolerated despite observed transient changes in electrocardiogram with prolongation of the QT interval.

A Simple Symptom Score for Acute HIV Infection in a San Diego Community Based Screening Program

Abstract

Background

Treatment of acute HIV infection (AHI) decreases transmission and preserves immune function, but AHI diagnosis remains resource-intensive. Risk-based scores predictive for AHI have been described for high-risk groups, however symptom-based scores could be more generalizable across populations.

Methods

Adults who tested either positive for AHI (antibody-negative, HIV nucleic acid test [NAT]-positive) or HIV NAT-negative with the community-based Early Test HIV screening program in San Diego were retrospectively randomized 2:1 into a derivation and validation set. In the former, symptoms significant for AHI in a multivariate logistic regression model were assigned a score value (the odds ratio rounded to the nearest integer). The score was assessed in the validation set using receiver operating characteristics and areas under the curve (AUC). An optimal cut-off score was found using Youden's index.

Results

Of 998 participants (including 737 men who have sex with men (MSM), 149 non-MSM men, 109 ciswomen and 3 trans women), 113 had AHI (including 109 MSM). Compared to HIV-negative cases, AHI cases reported more symptoms (median 4 vs 0, p<0.01). Fever, myalgia and weight loss were significantly associated with AHI in the multivariate model and corresponded to 11, 8 and 4 score points, respectively. The summed score yielded AUC of 0.85 (95%CI 0.77-0.93). A score of ≥11 was 72% sensitive, 96% specific with diagnostic odds ratio of 70.27 (95%CI 28.14-175.93).

Conclusions

A 3-symptom score accurately predicted AHI in a community based screening program and may inform allocation of resources in settings that do not routinely screen for AHI.

Atypical Skeletal Muscle Profiles in HIV+ Asymptomatic Middle-Aged Adults

Abstract

Background

Human immunodeficiency virus (HIV)-infected individuals are at increased risk of age-associated functional impairment, even with effective antiretroviral therapy (ART). A concurrent characterization of skeletal muscle, physical function, and immune phenotype in aviremic middle-aged HIV+ adults represents a knowledge gap in prognostic biomarker discovery.

Methods

We undertook a prospective observational study of 170 middle-aged, HIV-infected ambulatory men and women with CD4+ T-cell counts of at least 350 per microliter and undetectable plasma viremia while on effective antiretroviral therapy, and uninfected control participants. We measured biomarkers for inflammation and immune activation, fatigue, the Veterans Aging Cohort Study (VACS) mortality index, and physical function. A subset also received a skeletal muscle biopsy and computerized tomography scan.

Results

Compared to the uninfected, HIV+ participants displayed increased immune activation (P<0·001), inflammation (P=0·001) and fatigue (P=0·010), and in a regression model adjusting for age and sex displayed deficits in stair climb power (P<0.001), gait speed (P=0.036) and predicted metabolic equivalents (P=0.019). Skeletal muscle displayed reduced nuclear PGC-1alphapositive myonuclei (P=0·006) and increased internalized myonuclei (P<0·001) that correlated with immune activation (P=0·003) and leukocyte infiltration (P<0·001). Internalized myonuclei improved a model for HIV discrimination, increasing the C-statistic from 0·84 to 0·90.

Conclusions

Asymptomatic HIV-infected middle-aged adults display atypical skeletal muscle profiles, subclinical deficits in physical function and persistent inflammation and immune activation. Identifying biomarker profiles for muscle dysregulation and risk for future functional decline in the HIV-infected population will be key to developing and monitoring preventative interventions.

Trial Registration

This protocol is registered with ClinicalTrials.gov (NCT03011957).

CDC Yellow Book 2018: Health Information for International Travel

CDC Yellow Book 2018: Health Information for International Travel Edited by BrunetteGary WKozarskyPhyllis. Oxford University Press, 2017. 704 pp. £49.95 (paperback). ISBN: 9780190628611.

Glucose-6-phosphate dehydrogenase inhibition attenuates acute lung injury through reduction in NADPH oxidase derived reactive oxygen species

Abstract

Acute lung injury (ALI) is a heterogeneous disease with the hallmarks of alveolar capillary membrane injury, increased pulmonary edema and pulmonary inflammation. The commonest direct etiological factor for ALI is usually parenchymal lung infection or hemorrhage. Reactive oxygen species (ROS) generated by NADPH oxidase (NOX2) are thought to play an important role in the pathophysiology of ALI. Glucose-6-phosphate dehydrogenase (G6PD) plays an important role both in production of ROS as well as their removal through supply of NADPH. However, how G6PD modulation affects NOX2-mediated ROS in the airway epithelial cells (AECs) during acute lung injury has not been explored earlier. Therefore, we investigated the effect of G6PD inhibitor, 6-aminonicotinamide on G6PD activity, NOX2 expression, ROS production and enzymatic antioxidants in AECs in a mouse model of ALI induced by lipopolysaccharide (LPS). ALI led to increased G6PD activity in the AECs with concomitant elevation of NOX2, ROS, SOD1, and nitrotyrosine. G6PD inhibitor led to reduction of LPS-induced airway inflammation, bronchoalveolar lavage fluid protein concentration as well as NOX2-derived ROS and subsequent oxidative stress. On the other hand, ALI led to decreased glutathione reductase activity in AECs which was normalized by G6PD inhibitor. These data show that activation of G6PD is associated with enhancement of oxidative inflammation in during ALI. Therefore, inhibition of G6PD might be a beneficial strategy during ALI to limit oxidative damage and ameliorate airway inflammation. This article is protected by copyright. All rights reserved.

Carbon Monoxide Off-Gassing From Bags of Wood Pellets

Abstract

Wood pellets are increasingly used for space heating in the United States and globally. Prior work has shown that stored bulk wood pellets produce sufficient carbon monoxide (CO) to represent a health concern and exceed regulatory standards for occupational exposures. However, most of the pellets used for residential heating are sold in 40-pound (18.1 kg) plastic bags. This study measured CO emission factors from fresh, bagged-wood pellets as a function of temperature and relative humidity. CO concentrations increased with increasing temperature and moisture in the container. CO measurements in a pellet mill warehouse with stored pallets of bagged pellets had 8-h average CO concentrations up to 100 ppm exceeding occupational standards for worker exposure. Thus, manufacturers, distributors, and home owners should be aware of the potential for CO in storage areas and design facilities with appropriate ventilation and CO sensors.

Differentiation of severe fever with thrombocytopenia syndrome from scrub typhus

Abstract

We developed a severe fever with thrombocytopenia syndrome (SFTS) differentiation score in the cohort including 21 patients with SFTS and 91 patients with scrub typhus. This scoring using criteria (score > 1) of altered mental status, leukopenia, prolonged aPTT, and normal CRP provided 100% sensitivity and 97% specificity for SFTS.

Effect of concomitant positive HBsAg on the risk of liver metastasis: a retrospective clinical study of 4033 consecutive cases of newly diagnosed colorectal cancer

Abstract

Aims

To evaluate the effect of chronic hepatitis B infection on the risk of synchronous colorectal liver metastasis (synCRLM).

Methods

A total of 4033 consecutive, newly diagnosed colorectal cancer (CRC) patients with hepatitis B test were enrolled. The prevalence of synCRLM was compared between hepatitis B surface antigen (HBsAg) positive and negative patients; significant predictors for synCRLM were analyzed by logistic regression analysis; a fibrosis index based on the four factors (FIB-4), an aspartate aminotransferase-to-platelet ratio index (APRI) and hepatitis B e antigen (HBeAg) status were compared between patients with or without synCRLM.

Results

The prevalence of synCRLM was significantly higher in the HBsAg⁺ patients than that in the HBsAg^- patients (15.57% vs. 8.60%, P<0.001, χ² test). A logistic regression analysis indicated that HBsAg⁺ showed the highest hazard ratio (HR, 2.317; 95% CI: 1.406-3.820) for synCRLM. Both FIB-4 and APRI were significantly higher in those with HBsAg⁺ but no synCRLM compared to those with HBsAg⁺ and synCRLM [FIB-4: 1.23 (0.92-1.88) vs. 1.09 (0.74~1.51), P=0.045; APRI: 0.23 (0.227~0.387) vs. 0.18 (0.171~0.309), P=0.023; median (P₂₅~P₇₅), Mann-Whitney test]; HBeAg positivity was detected in 26.32% of those with positive HBsAg and synCRLM compared to 18.45% of those with positive HBsAg but no synCRLM, the difference was not statistically significant.

Conclusions

Concomitant chronic HBV infection significantly increases the risk of CRLM, and for HBsAg ⁺ CRC patients, elevated FIB-4/APRI may be anti-metastatic. Further study is needed to determine whether active HBV replication is pro-metastatic.

Coagulation behavior of kaolin-anionic surfactant simulative wastewater by polyaluminum chloride-polymer dual coagulants

Abstract

In this study, polyaluminum chloride (PAC) and cationic polymers were used to treat kaolin suspension in the presence of sodium dodecyl benzene sulfonate (SDBS). Effects of PAC dosage, pH, and rotation rate on the coagulation efficiency and floc properties were studied. And the interaction of chemicals and kaolin-SDBS was discussed. Results showed that dual coagulants could decrease the influence of SDBS on the turbidity removal compared with PAC. PAC + polyacrylamide dual coagulant showed superior performance, and the maximal removal ratios of turbidity and dissolved organic carbon were 98.5 and 42.2%, respectively. Optimal coagulation performance was achieved at pH 5–7, where charge neutralization of Al hydrolysates and bridging of polyacrylamide were the primary mechanisms. And flocs with compact structure and small size were formed. Flocs coagulated by PAC were prone to be broken at the pH of raw water after introducing high rotation rate. After dosing polyacrylamide, floc size was enhanced under alkaline condition. Meanwhile, flocs showed stronger recoverability and an open structure because the regeneration mechanism was mainly the bridging effect of polyacrylamide.

Analysis of the transmission characteristics of China’s carbon market transaction price volatility from the perspective of a complex network

Abstract

Research on the price fluctuation transmission of the carbon trading pilot market is of great significance for the establishment of China's unified carbon market and its development in the future. In this paper, the carbon market transaction prices of Beijing, Shanghai, Tianjin, Shenzhen, and Guangdong were selected from December 29, 2013 to March 26, 2016, as sample data. Based on the view of the complex network theory, we construct a price fluctuation transmission network model of five pilot carbon markets in China, with the purposes of analyzing the topological features of this network, including point intensity, weighted clustering coefficient, betweenness centrality, and community structure, and elucidating the characteristics and transmission mechanism of price fluctuation in China's five pilot cities. The results of point intensity and weighted clustering coefficient show that the carbon prices in the five markets remained unchanged and transmitted smoothly in general, and price fragmentation is serious; however, at some point, the price fluctuates with mass phenomena. The result of betweenness centrality reflects that a small number of price fluctuations can control the whole market carbon price transmission and price fluctuation evolves in an alternate manner. The study provides direction for the scientific management of the carbon price. Policy makers should take a positive role in promoting market activity, preventing the risks that may arise from mass trade and scientifically forecasting the volatility of trading prices, which will provide experience for the establishment of a unified carbon market in China.

Combining Follicular Unit Extraction and Scalp Micropigmentation for the Cosmetic Treatment of Alopecias

Two relatively new modalities, follicular unit extraction (FUE) and scalp micropigmentation have changed the treatment of hair loss, to reduce the number of procedures and the total costs of the hair restoration process. These 2 modalities augment each other when treating patients with thinning hair and balding. The explosion of FUE procedures (which reflected 52.6% of the hair transplant procedures performed in 2016, up from 48.5%) and the appearance of more and more new physicians offering hair restoration technologies employing FUE have caused a 20% annual growth in this industry over the past few years. This article reviews the use of FUE and scalp micropigmentation when used in combination.

Enhanced photocatalytic activity using GO/TiO 2 catalyst for the removal of DCA solutions

Abstract

This work aimed to optimize high-performance photocatalysts based on graphene oxide/titanium dioxide (GO/TiO₂) nanocomposites for the effective degradation of aqueous pollutants. The catalytic activity was tested against the degradation of dichloroacetic acid (DCA), a by-product of disinfection processes that is present in many industrial wastewaters and effluents. GO/TiO₂ photocatalysts were prepared using three different methods, hydrothermal, solvothermal, and mechanical, and varying the GO/TiO₂ ratio in the range of 1 to 10%. Several techniques were applied to characterize the catalysts, and better coupling of GO and TiO₂ was observed in the thermally synthesized composites. Although the results obtained for DCA degradation showed a coupled influence of the composite preparation method and its composition, promising results were obtained with the photocatalysts compared to the limited activity of conventional TiO₂. In the best case, corresponding to the composite synthesized via hydrothermal method with 5% of GO/TiO₂ weight ratio, an enhancement of 2.5 times of the photocatalytic degradation yield of DCA was obtained compared to bare TiO₂, thus opening more efficient ways to promote the application of photocatalytic remediation technologies.

Growth, extracellular alkaline phosphatase activity, and kinetic characteristic responses of the bloom-forming toxic cyanobacterium, Microcystis aeruginosa , to atmospheric particulate matter (PM 2.5 , PM 2.5–10 , and PM >10 )

Abstract

Atmospheric particulate matter (APM), commonly seen and widely excited in environment, appears great enough to influence the biochemical processes in aquatic microorganisms and phytoplankton. Understanding the response of cyanobacteria to various factors is fundamental for eutrophication control. To clarify the response of cyanobacteria to APM, the effects of PM_2.5, PM_2.5–10, and PM_>10 on Microcystis aeruginosa were researched. Variabilities in cell density, chlorophyll a, soluble protein, malondialdehyde, extracellular activity, and kinetic parameters of alkaline phosphatase were evaluated by lab-cultured experiments. Results showed that the PM_2.5 had a slight stimulation impact on the growth and enhanced both of the 48- and 72-h extracellular alkaline phosphatase activity (APA), the affinity of alkaline phosphatase for substrate, and the 72-h maximum enzymatic reaction velocity (V_max). Moreover, the stimulations in extracellular APA and V_max enhanced with the increasing exposure concentrations. We also found there were no obvious distinctions on the effects of growth and alkaline phosphatase in M. aeruginosa between PM_2.5–10 and PM_>10 exposure groups. Obviously, inhibitory effects on growth existed in 4.0 and 8.0 mg/L PM_2.5–10 and 8.0 mg/L PM_>10 at 120 h. Furthermore, PM_2.5–10 and PM_>10 exerted inhibitory effects on the extracellular APA during the 72-h exposure. Simultaneously, the V_max was notably inhibited and the affinity of alkaline phosphatase for substrate was more inseparable compared with control in PM_2.5–10 and PM_>10 treatments. Nevertheless, the inhibitors in extracellular APA and kinetic parameters were unrelated to PM_2.5–10 and PM_>10 exposure concentrations. Two-way ANOVA results revealed that there were significant interactions between exposure concentration and diameter of APM on the 120-h cell density, soluble protein content, APA, and 72 h APA of M. aeruginosa. These results in our study would be meaningful to further researches on relationships between APM deposition and cyanobacterial bloom.

Risk assessment of heavy metals in Vembanad Lake sediments (south-west coast of India), based on acid-volatile sulfide (AVS)-simultaneously extracted metal (SEM) approach

Abstract

Contamination of estuarine system due to heavy metals is a severe issue in tropical countries, especially in India. For the evaluation of the risk due to heavy metals, the current study assessed spatial and temporal variation of acid-volatile sulfide (AVS), simultaneously extracted metal (SEM), and total metal concentration as toxicity indicator of aquatic sediments in Vembanad Lake System (VLS), India. Surface sediment samples collected from 12 locations from the northern portion of VLS for 4 years during different seasons. The results suggest, in post-monsoon season, 91% of the sampling locations possessed high bioavailability of metals and results in toxicity to aquatic biota. The average seasonal distribution of SEM during the period of observations was in the order post-monsoon > pre-monsoon > monsoon (1.76 ± 2.00 > 1.35 ± 0.60 > 0.80 ± 0.54 μmol/g). The concentration of individual metals on ∑SEM are in the order SEM Zn > SEM Cu> SEM Cd ≈ SEM Pb > SEM Hg. Considering annual ΣSEM/AVS ratio, 83% of the sites cross the critical value of 'One,' reveals that active sulfide phase of the sediment for fixing the metals is saturated. The molar ratio (differences between SEM and AVS) and its normalized organic carbon ratio reveals that in the post-monsoon season, about 42% of the sites are in the category of adverse effects are possible. The study suggests the toxicity and mobility of the metals largely depend on the available AVS, and the current situation may pose harm to benthic organisms.

Paraben degradation using catalytic ozonation over volcanic rocks

Abstract

Parabens are widely used as antimicrobial and preservatives in pharmaceutical and personal care products and are continuously reaching the water streams. Conventional wastewater treatments are proven inefficient on the removal of this kind of contaminants from wastewater. Therefore, catalytic ozonation appears as a suitable option, due to the oxidant power of ozone and its high capacity of hydroxyl radical generation in the presence of a suitable catalyst. The main drawback of catalytic ozonation is related with the choice of stable and active catalysts at low cost. On this way, two volcanic rocks were tested to enhance the removal of a mixture of parabens by ozonation, improving their degradation. Indeed, catalytic ozonation with volcanic rock allowed total paraben degradation using a transferred ozone dose (TOD) of 55 mg/L which corresponds to a reduction of about threefold the amount of TOD comparatively with single ozonation (170 mg/L of TOD). Due to the presence of semiconductors on volcanic rock composition, the effect of UVA irradiation on paraben degradation was analyzed. The neutral and basic conditions enhanced catalytic ozonation comparatively to acid conditions. Higher pH values allowed a total methylparaben degradation with 35 mg O₃/L, whereas for low pH values, 55 mg O₃/L was required. The use of a radical scavenger proven that hydroxyl radicals are the main responsible for paraben degradation with catalytic ozonation. This was confirmed through the analysis of the by-products, where 4-hydroxybenzoic acid, 3,4-dihydroxybenzoic acid (3,4-diHBA), 2,4-dihydroxybenzoic acid, and hydroquinone were quantified.

A Novel Adjustable Concept for Permeable Gas/Vapor Protective Clothing: Balancing Protection and Thermal Strain

Abstract

Armed forces typically have personal protective clothing (PPC) in place to offer protection against chemical, biological, radiological and nuclear (CBRN) agents. The regular soldier is equipped with permeable CBRN-PPC. However, depending on the operational task, these PPCs pose too much thermal strain to the wearer, which results in a higher risk of uncompensable heat stress. This study investigates the possibilities of adjustable CBRN-PPC, consisting of different layers that can be worn separately or in combination with each other. This novel concept aims to achieve optimization between protection and thermal strain during operations. Two CBRN-PPC (protective) layers were obtained from two separate manufacturers: (i) a next-to-skin (NTS) and (ii) a low-burden battle dress uniform (protective BDU). In addition to these layers, a standard (non-CBRN protective) BDU (sBDU) was also made available. The effect of combining clothing layers on the levels of protection were investigated with a Man-In-Simulant Test. Finally, a mechanistic numerical model was employed to give insight into the thermal burden of the evaluated CBRN-PPC concepts. Combining layers results in substantially higher protection that is more than the sum of the individual layers. Reducing the airflow on the protective layer closest to the skin seems to play an important role in this, since combining the NTS with the sBDU also resulted in substantially higher protection. As expected, the thermal strain posed by the different clothing layer combinations decreases as the level of protection decreases. This study has shown that the concept of adjustable protection and thermal strain through multiple layers of CBRN-PPC works. Adjustable CBRN-PPC allows for optimization of the CBRN-PPC in relation to the threat level, thermal environment, and tasks at hand in an operational setting.