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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Significance: Contrast‐enhanced (CE) and Fluid attenuation inversion recovery (FLAIR) MRI are current standard of care tools for delineating radiation treatment targets in high‐grade glioma (HGG) patients. However, in the setting of retreatment, tumor regrowth and non‐tumor therapy‐related inflammation, known as post‐treatment radiation effect (PTRE), have identical MRI appearances. As a result, FLAIR MRI can be an unreliable tool for treatment planning. Surgical biopsy can definitively distinguish recurrent tumors from PTRE but has many disadvantages, namely operative risk and cost. Dynamic Susceptibility‐weighted Contrast‐ Enhanced (DSC) MRI Perfusion can non‐invasively detect distinct characteristics of tumor and PTRE through measurements of relative cerebral blood volume (rCBV). PTRE exhibits decreased microvascular density, whereas tumor recurrence displays angiogenesis and microvascular proliferation. Thus, DSC‐MRI affords the opportunity to better define tumor burden within and possibly outside of these nonspecific regions. Objective: To assess the extent with which rCBV maps correlate with re‐radiation treatment plans in patients with recurrent tumor in order to identify potential differences in treatment planning. Design: This study enrolled 8 previously treated HGG patients presenting for re‐irradiation of suspected recurrent tumor at a single hospital on an IRB‐approved trial. All patients underwent DSC‐MRI and routine MRI imaging prior to re‐irradiation treatment planning, and underwent treatment as per routine clinical protocol. Following therapy, rCBV and radiation dose maps were overlaid on conventional MR to delineate differences in identified tumor burden. Results: Of the 8 patients, four rCBV images showed evidence of tumor outside of the RT planning volumes, while the other 4 showed fully treated tumor but with large volumes of uninvolved brain receiving radiation. Conclusion: DSC‐MRI better identified unique regions of potential tumor burden in recurrent HGG patients compared to conventional MRI and could be used to improve radiation treatment planning in re‐radiated patients.

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Abstract Centro Universitaire UNIVATES is located in the town Lajeado that is situated in the most southerly state, Rio Grande Do Sul, in Brazil. The university has 5000 students, teachers and others staff. UNIVATES is not satisfied with their present wastewater situation and wants to improve it by eliminate the smell caused by the wastewater. They would also like to remove the oil that the storm water brings into the wetland. The high amount of particles in the storm water gives rise to a lot of sediments that eventually will fill up the wetland, and something has to be done about this, if the wetland should continue to be in use. Another aspect to consider is the wish of some people at UNIVATES, for the wetland to be a beautiful and recreational place. All these factors had to be considered, which led to the main question: How can the use of the wetland for wastewater treatment be combined with the request for the wetland to be a beautiful place with the wildlife preserved? During the course Wetland Technology that we took before our departure to Brazil, we got introduced to the situation at UNIVATES by Professor André Jasper and Odorico Konrad who visited the course several times. They pointed out that the main issue is the smell from the wastewater and later during the field study at UNIVATES, more information were obtained through discussions, meetings and conversations with the people involved. Several visual inspections were carried out by walking around the wetland. We could determine where and how the inlets and outlets to the wetland were and when it was clear which inlets that brought wastewater and which that brought storm water, the water flow of the wastewater was estimated. Water samples from the wetland were collected at five different sites and analyses of pH, BOD, COD, N-Tot, phosphorus and metals were done by the accredited laboratory at UNIVATES. To test some of our theories, we did a smaller practical experiment that got the name Superficial Filtration Bed. The results from the water samples showed the highest BOD, COD, N-Tot and Phosphorus levels in the samples from site 2 and 4 and this reveals that it is wastewater. This was also confirmed by the smell that we felt at these sites during the visual inspections. The results also showed that there is no wastewater coming from site 1, 3 and 5. Our final proposal is to create a multifunctional wetland with the purpose to take care of both storm water and wastewater and at the same time work as a research and recreational area. The wetland, which would be divided into two parts, will constitute of all the fundamental functions; storm water buffering, sedimentation basin and biological oil separation and treatment. There will also be research sites and hybrid system for wastewater treatment. The hybrid system will consist of two steps where the first is aerobic and the second both aerobic and anaerobic. The first step is a Superficial Filtration Bed (SFB) and the second a FWS wetland. The conclusion of this thesis is that more detailed research is needed to be able to dimension the specific functions correctly. With some further investigations the proposal presented is possible to carry through and our feeling when we left UNIVATES was that the people responsible really liked our ideas. They made it clear that they want to make a change and improve the situation and with the help they have gotten from us, they are a few steps closer to solving the problem.

A microwave enhanced advanced oxidation process using hydrogen peroxide (MW/H₂O₂-AOP) was used for the release of nutrients and the destruction of solids from secondary municipal sewage sludge. The significant factors affecting the MW/H₂O₂-AOP that would yield maximum soluble substrates were studied. Using a computer statistical software package for experimental design and data analysis, four factors including microwave heating temperature, heating time, hydrogen peroxide dosage, and sludge solids content, were selected and examined. The initial sludge TS content and hydrogen peroxide dosage were the most significant factors for the solubilization of COD and nutrients release under the experimental conditions selected in this study. Overall, the maximum solubilization of nutrients was obtained at 2.5 % of total solids content, 2% of hydrogen peroxide by weight, 5 min. of microwave heating and 120 ºC. The effects of combination of microwave treatment and oxidative reagents on solids destruction and nutrients release were also investigated. Microwave enhanced advanced oxidation processes (MW-AOP), such as MW/O₃, MW/H₂O₂ and MW/H₂O₂/O₃, were conducted at 100 °C. In terms of nutrients release and solids reduction, the MW/H₂O₂/O₃-AOP yielded the best result. Subsequently, three factors including microwave heating temperature, hydrogen peroxide dosage, and ozone dosage, were investigated. The best result, in terms of the release of phosphate and ammonia, and solids reduction, was obtained with additions of 2 % hydrogen peroxide by weight and ozone dosage of 5.09 mg/ml, and operating at 120ºC. About 95%, 32% and 78% of TP, TKN and COD were released into the solution, respectively. The microwave enhanced advanced oxidation processes, with and without an addition of ferrous sulfate (MW/H₂O₂-AOP and MW/H₂O₂/Fe+²-AOP), were also studied for reducing solids, and solubilizing nutrients from the secondary sewage sludge. For the MW/H₂O₂/Fe+²-AOP, the best results of solubilization, in terms of orthophosphate, ammonia and soluble chemical oxygen demand, were obtained at treatment temperatures of 40 ºC, the yields decreased as the temperature was increased. The highest yields of solubilization were obtained at 60 ºC for orthophosphate, and at 80 ºC for both ammonia and soluble chemical oxygen demand.

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