Wastewater reuse in irrigation: A microbiological perspective on implications in soil fertility and human and environmental health

The reuse of treated wastewater, in particular for irrigation, is an increasingly common practice, encouraged by governments and official entities worldwide. Irrigation with wastewater may have implications at two different levels: alter the physicochemical and microbiological properties of the soil and/or introduce and contribute to the accumulation of chemical and biological contaminants in soil. The first may affect soil productivity and fertility; the second may pose serious risks to the human and environmental health. The sustainable wastewater reuse in agriculture should prevent both types of effects, requiring a holistic and integrated risk assessment. In this article we critically review possible effects of irrigation with treated wastewater, with special emphasis on soil microbiota. The maintenance of a rich and diversified autochthonous soil microbiota and the use of treated wastewater with minimal levels of potential soil contaminants are proposed as sine qua non conditions to achieve a sustainable wastewater reuse for irrigation.     

Fuzzy synthetic evaluation of treated wastewater reuse for agriculture

Reuse of treated wastewater (TWW) for agriculture is in practice in many countries. TWW reuse requires wastewater collection, treatment and recycling, which is associated with cost as well as risk to human and ecological systems. In contrast, it can increase agricultural production and reduce environmental risks by reducing wastewater discharge into the natural environment. In Saudi Arabia, where available water resources are extremely limited, TWW reuse can save significant amount of non-renewable groundwater used in agricultural development, which is a strategic goal for the country. In this paper, a multicriteria decision-making approach was developed where cost, risk, benefits and social acceptance of TWW reuse were considered to be the main criteria. A multistage hierarchy risk management model was constructed for this evaluation. Fuzzy synthetic evaluation technique was incorporated where fuzzy triangular membership functions were developed to capture uncertainties of the basic criteria. The analytic hierarchy process was used to determine the relative importance of various criteria at different hierarchy levels. This study indicated that TWW reuse could have positive impact on agriculture, risk reduction and groundwater conservation.     

Occurrence,fate and ecological risk of chlorinated paraffins in Asia: A review

Chlorinated paraffins (CPs), complex mixtures of polychlorinated alkanes, are widely used in various industries and are thus ubiquitous in the receiving environment. The present study comprehensively reviewed the occurrence, fate and ecological risk of CPs in various environmental matrices in Asia. Releases from the production and consumption of CPs or CP-containing materials, wastewater discharge and irrigation, sewage sludge application, long-range atmospheric transport and aerial deposition have been found to be most likely sources and transport mechanisms for the dispersion of CPs in various environmental matrices, such as air, water, sediment, soil and biota. CPs can be bioaccumulated in biota and biomagnified through food webs, likely causing toxic ecological effects in organisms and posing health risks to humans. Inhalation, dust ingestion and dietary intake are strongly suggested as the major routes of human exposure. Research gaps are discussed to highlight the perspectives of future research to improve future efforts regarding the analysis of CPs, the environmental occurrence and elimination of CPs, the total environmental pressure, and the risks to organisms and populations.     

The significance of different health institutions and their respective contributions of active pharmaceutical ingredients to wastewater

Active pharmaceutical ingredients (APIs) have been frequently found in the environment. It is, however, still not quite clear who is mainly responsible for API emissions. Hospitals have been considered to be the main contributing point sources for wastewater (WW) discharge of APIs. However, recent studies have shown that the contribution of hospitals to the input of APIs into the aquatic environment is quite low. Due to demographic change and the increase of psychiatric diseases, health institutions (HIs) such as psychiatric hospitals and nursing homes are likely to be important sources as well, but no data is available in this respect. This study aims to assess the impact of HIs and to provide a methodology to measure their respective contributions. Drawing on pharmaceutical consumption data for the years 2010, 2011, and 2012, this study identified API usage patterns for a psychiatric hospital (146 beds), a nursing home (286 inhabitants), and a general hospital (741 beds), the latter of which comprises three separate locations. All the HIs are located in two sub-regions of a county district with about 400,000 citizens in southwestern Germany. A selection of neurological drugs was quantified in the sewer of these facilities to evaluate the correlation between consumption and emission. The API contribution of HIs was assessed by comparing the specific consumption in the facilities with the consumption in households, expressed as the emission potential (I_EP). The study shows that the usage patterns of APIs in the psychiatric hospital and the nursing home were different from the general hospital. Neurological drugs such as anticonvulsants, psycholeptics, and psychoanaleptics were mainly consumed in the psychiatric hospital and the nursing home (74% and 65%, respectively). Predicted and average measured concentrations in the effluent of the investigated HIs differed mostly by less than one order of magnitude. Therefore, the consumption-based approach is a useful method to assess usage patterns of APIs in HIs and to predict their respective contributions to WW. The national contribution of HIs on total WW discharge of APIs compared to households was very low. Only the results for the sedative clomethiazole in general hospitals as well as the antidepressant moclobemide and the antipsychotic quetiapine for the nursing homes were found to deserve some attention. The regional comparison showed that in sub-regions with a comparably higher density of HIs, the allocated facilities could be seen as point sources emitting particular APIs. However, in general, the bulk of the consumed pharmaceuticals to WW discharge has to be attributed to households.     

Occurrence and fate of pharmaceutical products and by-products,from resource to drinking water

Among all emerging substances in water, pharmaceutical products (PPs) and residues are a lot of concern. These last two years, the number of studies has increased drastically, however much less for water resources and drinking water than for wastewater. This literature review based on recent works, deals with water resources (surface or groundwater), focusing on characteristics, occurrence and fate of numerous PPs studied, and drinking water including water quality. Through this review, it appears that the pharmaceutical risk must be considered even in drinking water where concentrations are very low. Moreover, there is a lack of research for by-products (metabolites and transformation products) characterization, occurrence and fate in all water types and especially in drinking water.     

Residues and source identification of persistent organic pollutants in farmland soils irrigated by effluents from biological treatment plants

Sewage and industrial effluents from biological treatment plant have been widely used for agricultural irrigation in north part of China. However, effluents after biological treatment still contain heavy metals and persistent organic contaminants. The persistent organic contaminants accumulated in soil may transfer through the food chains and cause adverse health effects on human or biological effects on soil fauna and flora after long-term application. In present study, field surveys were carried out in the farmlands irrigated by effluents from biological treatment plants that receive sewage wastewater and industrial discharges. Residues of polycyclic aromatic hydrocarbons (PAHs) and organochlorine pesticides (OCPs) in the soils irrigated using both ground water and effluents were compared. The origins of PAHs in the soils were discussed. The results showed that wastewater irrigation could cause accumulation of PAHs in soils close to the pollution discharge. Significantly higher concentrations of PAHs were observed in the sampling sites close to the entrance of main channel in contrast to those along branches and the reference sites. There was no significant relationship between the accumulation of persistent organic pollutants and organic matter content in soil (TOC). Soil contamination of these persistent organic pollutants as affected by effluent irrigation was characterized by the dominant accumulation of high-molecular-weight PAHs (HMW-PAHs). In the case study, concentration of benzo[a]pyrane (BaP, 45.6 ng/g), indeno[1,2,3-cd]pyrene (IcP, 86.3 ng/g), benzo[g,h,i]perlene (BgP, 66.9 ng/g) could exceed the limits of the soil quality standard for biodegraded soils. In identification of the sources, the IcP/BgP values of PAHs in soils were more close to that in air particulates from coal/coke source (1.09+/-0.03 ng/g) [Dickhut RM, Canuel EA, Gustafson KE, Liu K, Arzayus KM, Walkers E, et al. Automotive sources of carcinogenic polycyclic aromatic hydrocarbons associated with particulate matter in the chesapeake bay region. Environ Sci Technol 2000;34:4635-40]. Therefore, both of the PAHs residues in effluents and emission from a nearby coal/coke plant were responsible. Also in this case study, low levels of the OCPs were observed and were not of significant concern in this wastewater irrigation area. Among the different OCPs analyzed, DDTs (mean 8.41 ng/g) and HCHs (mean 2.91 ng/g) were the major components. From the ratios of DDT/DDTs and beta-HCH/HCHs, it indicated that OCPs residues should be from historical usage.     

The influence of uncertainty and location-specific conditions on the environmental prioritisation of human pharmaceuticals in Europe

The selection of priority APIs (Active Pharmaceutical Ingredients) can benefit from a spatially explicit approach, since an API might exceed the threshold of environmental concern in one location, while staying below that same threshold in another. However, such a spatially explicit approach is relatively data intensive and subject to parameter uncertainty due to limited data. This raises the question to what extent a spatially explicit approach for the environmental prioritisation of APIs remains worthwhile when accounting for uncertainty in parameter settings. We show here that the inclusion of spatially explicit information enables a more efficient environmental prioritisation of APIs in Europe, compared with a non-spatial EU-wide approach, also under uncertain conditions. In a case study with nine antibiotics, uncertainty distributions of the PAF (Potentially Affected Fraction) of aquatic species were calculated in 100 1 100 km² environmental grid cells throughout Europe, and used for the selection of priority APIs. Two APIs have median PAF values that exceed a threshold PAF of 1% in at least one environmental grid cell in Europe, i.e., oxytetracycline and erythromycin. At a tenfold lower threshold PAF (i.e., 0.1%), two additional APIs would be selected, i.e., cefuroxime and ciprofloxacin. However, in 94% of the environmental grid cells in Europe, no APIs exceed either of the thresholds. This illustrates the advantage of following a location-specific approach in the prioritisation of APIs. This added value remains when accounting for uncertainty in parameter settings, i.e., if the 95th percentile of the PAF instead of its median value is compared with the threshold. In 96% of the environmental grid cells, the location-specific approach still enables a reduction of the selection of priority APIs of at least 50%, compared with a EU-wide prioritisation.     

Diclofenac and its transformation products: Environmental occurrence and toxicity - A review

Diclofenac (DCF) is a prevalent anti-inflammatory drug used throughout the world. Intensive researches carried out in the past few decades have confirmed the global ubiquity of DCF in various environmental compartments. Its frequent occurrence in freshwater environments and its potential toxicity towards several organisms such as fish and mussels makes DCF an emerging environmental contaminant. At typical detected environmental concentrations, the drug does not exhibit toxic effects towards living organisms, albeit chronic exposure may lead to severe effects. For DCF, about 30–70% removal has been obtained through the conventional treatment system in wastewater treatment plant being the major primary sink. Thus, the untreated DCF will pass to surface water. DCF can interact with other inorganic contaminants in the environment particularly in wastewater treatment plant, such as metals, organic contaminants and even with DCF metabolites. This process may lead to the creation of another possible emerging contaminant. In the present context, environmental fate of DCF in different compartments such as soil and water has been addressed with an overview of current treatment methods. In addition, the toxicity concerns regarding DCF in aquatic as well as terrestrial environment along with an introduction to the metabolites of DCF through consumption as well as abiotic degradation routes are also discussed. Further studies are required to better assess the fate and toxicological effects of DCF and its metabolites and must consider the possible interaction of DCF with other contaminants to develop an effective treatment method for DCF and its traces.     

Comparing environmental issues in Cuba before and after the Special Period: balancing sustainable development and survival

Following the Earth Summit in 1992, Cuba designed and implemented a variety of programs, administrative structures, and public awareness activities to promote sound environmental management and sustainable development. This came shortly after the fall of the Soviet Union and the strengthening of the US blockade in 1990, which resulted in a 35% drop in Cuban GDP. This period, referred to as the Special Period, witnessed a decrease in many environmentally damaging activities both by choice and by necessity, but also resulted in many decisions to resuscitate the Cuban economy. The purpose of this work was to compare and rank the environmental risks Cuba faced before and during the Special Period (1990-2000) using two Comparative environmental risk assessments (CERAs). To do so, an ecosystem integrity risk assessment matrix was constructed with 42 risk end points. The matrix assessed the risk posed by 17 problem areas including air pollution, water contamination, solid waste sites, pesticides and ecosystem degradation. The risks were calculated using five criteria: area affected, vulnerability of affected population, severity of impact, irreversibility of effect and uncertainty. To construct this matrix, both literature reviews and expert interviews in Cuba were conducted in 2000. The results showed a general decrease in risk scores during the Special Period. Before the Special Period, high risks were posed by: terrestrial degradation and industrial wastewater and sludge, followed by freshwater degradation, surface water stressors, and pesticides. After the Special Period, industrial wastewater and sludge and pesticides were no longer high-risk areas, but municipal wastewater and marine coastal degradation ranked higher than previously. Also, the risk endpoints most stressed after 1990 were affected by activities controlled by the government, such as mining and tourism, and lack of infrastructure. Therefore, the claims that public environmental education is the main pathway to sustainable development in Cuba seem uninformed and other management practices should be evaluated.     

Impacts of sewage irrigation on heavy metal distribution and contamination in Beijing, China

A potential hazard to Beijing was revealed due to the accumulation trend of heavy metals in agricultural soils with sewage irrigation, which results in metal contamination and human exposure risk. Samples including soils and plants were collected to assess the impacts of sewage irrigation on the irrigated farming area of Beijing. Concentrations of the five elements Cd, Cr, Cu, Zn, and Pb were determined in samples to calculate the accumulation factor and to establish a basis for environmental protection and the suitability of sewage irrigation for particular land use in the urban-rural interaction area of Beijing. Using reference values provided by the Beijing Background Research Cooperative Group in the 1970s, the pollution load index (PLI), enrichment factor (EF), and contamination factor (CF) of these metals were calculated. The pollution load indices (sewage irrigation land 3.49) of soils indicated that metal contamination occurred in these sites. The metal enrichment (EF of Cd 1.8, Cr 1.7, Cu 2.3, Zn 2.0, Pb 1.9) and the metal contamination (CF of Cd 2.6, Cr 1.5, Cu 2.0, Zn 1.7, Pb 1.6) showed that the accumulation trend of the five toxic metals increased during the sewage irrigation as compared with the lower reference values than other region in China and world average, and that pollution with Cd, Cu, Zn, and Pb was exacerbated in soils. The distributions of these metals were homogeneous in the irrigation area, but small-scale heterogeneous spatial distribution was observed. Irrigation sources were found to affect heavy metal distributions in soils. It was suggested that heavy metal transfer from soils to plants was a key pathway to human health exposure to metal contamination. However, with the expansion of urban areas in Beijing, soil inhalation and ingestion may become important pathways of human exposure to metal contamination.     

Beyond the medicine cabinet: an analysis of where and why medications accumulate

Active pharmaceutical ingredients (APIs) from medications can enter the environment as trace contaminants, at individual concentrations generally below a part per billion (microg/L). APIs enter the environment primarily via the discharge of raw and treated sewage. Residues of unmetabolized APIs from parenteral and enteral drugs are excreted in feces and urine, and topically applied medications are washed from skin during bathing. These trace residues may pose risks for aquatic life and cause concern with regard to subsequent human exposure. APIs also enter the environment from the disposal of unwanted medications directly to sewers and trash. The relative significance of this route compared with excretion and bathing is poorly understood and has been subject to much speculation. Two major aspects of uncertainty exist: the percentage of any particular API in the environment originating from disposal is unknown, and disposal undoubtedly occurs from a variety of dispersed sources. Sources of disposal, along with the types and quantities of APIs resulting from each source, are important to understand so that effective pollution prevention approaches can be designed and implemented. Accumulation of leftover, unwanted drugs poses three major concerns: (i) APIs disposed to sewage or trash compose a diverse source of potential chemical stressors in the environment. (ii) Accumulated drugs represent increased potential for drug diversion, with its attendant risks of unintentional poisonings and abuse. (iii) Leftover drugs represent wasted healthcare resources and lost opportunities for medical treatment. This paper has four major purposes: (1) Define the processes, actions, and behaviors that control and drive the consumption, accumulation, and need for disposal of pharmaceuticals. (2) Provide an overview of the diverse locations where drugs are used and accumulate. (3) Present a summary of the first cataloging of APIs disposed by a defined subpopulation. (4) Identify opportunities for pollution prevention and source reduction.     

南京地区农田土壤和蔬菜重金属污染状况研究

采集了南京市5县4郊5个环境单元（矿冶区、交通干线、工厂周边、污灌地、农产品基地）共100个样点的农田土壤及部分蔬菜样品,测定了重金属（Pb、Cu、Zn、Cd）的质量分数。结果表明,土壤Pb、Cu、Zn、Cd 质量分数的变化范围分别为26.1~4 138.8、16.5 ~3 375.1、46.0~3 587.6、0.09~17.61 mg/kg。不同功能区土壤重金属含量存在明显差异,以矿区周边农田污染最为严重,其次为污灌地和公路沿线农田, 部分农产品基地存在轻度Cd污染,工厂周边农田土壤污染相对较小。19个样点的青菜地上部重金属Pb、Cu、Zn、Cd质量分数的变化范围分别为0.11~7.11、5.04~76.42、36.8~364.3、0.04~2.96 mg/kg,同样以矿区周边污染农田的青菜样本重金属含量最高。青菜重金属含量与土壤重金属生物有效性含量和总量之间呈极显著相关。不合理的矿业开采和冶炼是导致南京地区农田土壤和蔬菜重金属污染的重要原因。     

Human exposure to PCDD/Fs in the UK: the development of a modelling approach to give historical and future perspectives

In order to assess the long-term impact of persistent organic contaminants such as polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) it is important to be able to quantify historical exposure. An understanding of past exposure is not only important to place our current body burdens in perspective, but is useful in assessing our potential future exposure. Unfortunately, very few direct measurements of our main source of exposure (i.e., food) over the past decades are available. This study attempts to reconstruct the historical exposure of the UK population to PCDD/Fs using a combination of emission estimates, information on environmental temporal trends derived from sediment cores and archived materials, and environmental/human fate modelling. Predicted adipose and blood lipid concentrations for a typical cross section of the population are derived over time (1920-2000), which is compared with measured data. The approach has been tested with two PCDDs and two PCDFs and showed encouraging agreement with measured data. Certain parts of the modelling methodology have been highlighted where there is still poor understanding of the processes governing fate and behaviour. These areas are discussed and recommendations for future improvements are made. The paper thus represents an initial modelling approach which defines both the historical (1920-present) and future (present-2020) fate of PCDD/Fs in the UK population.     

Effect of pH on the sorption of uranium in soils

This work was undertaken to study the influence of soil type and chemical composition on uranium sorption ratios (SR in 1 kg-1) in order to reduce the uncertainty associated with this parameter in risk assessment models. Thirteen soil samples were collected from three different locations in France under different geological conditions. Clay content varied from 7.0 to 50.0%, pH ranged from 5.5 to 8.8 and organic matter content from 1.0 to 4.6%. Soils were incubated at room temperature in polyethylene packets for 28 days in the presence of 1 mg U kg-1 soil. Sorption ratio values varied from 0.9 to 3198 for all soils with no significant effect of soil texture or of organic matter. However, soil pH was highly linearly correlated with (log SR) as a probable consequence of the existence of different uranium complexes as a function of soil pH. The sorption behaviour differences between UO2(2+) and UO2(2+)-carbonate complexes are so great that any other effect of soil properties on U sorption is hidden. Thus, soil pH should be the focus variable for reduction of the uncertainty associated with the soil Kd value used in environmental risk assessments, even for reducing the uncertainty in site-specific Kd values.     

Viruses in wastewater aerosols

Agricultural land application of wastewater is becoming a widely used means of dealing with water scarcity and diminishing sources of unpolluted water. One of the most common forms of land application—sprinkler irrigation—poses an environmental problems in that it created wastewater aerosols. Air sampling experiments done at distances of up to 100 meters from wastewater irrigation sprinklers have detected several airborne enteroviruses: echovirus 1, 25, 29; poliovirus II, and coxsackie B1. The levels of airborne viruses found in wastewater aerosols may be potentially hazardous at any level. Since the impact of these findings on public health is not clear, epidemiological investigations by standard techniques should be conducted. It is estimated that the number of viruses isolated in environmental samples may be smaller by one or two orders of magnitude (90%–99%) than their actual number due to the limitations of virus recovery procedures. The unvailability of a reliable indicator microorganism which fulfills all the requirements for a biological indicator also makes it difficult to determine the virus level in the aerosols. Thus the scientific knowledge available today is insufficient to determine with certainty that no public health risk is created by wastewater aerosols. A comprehensive prospective study will, in all likelihood, provide answers to most questions and make it possible to assess more reliably the extent of the health risk due to wastewater aerosols.     

Wastewater re-use for peri-urban agriculture: a viable option for adaptive water management?

Urbanization is known to spur land modification in the form of conversion of common land to human settlements. This factor, combined with climate variability, can alter the duration, frequency and intensity of storm drain overflows in urban areas and lead to public health risks. In peri-urban regions where these risks are especially high it has been argued that, when domestic wastewater is managed, better prospects for freshwater water savings through swaps between urban water supply and irrigated agriculture may be possible. As a consequence of re-use of domestic wastewater, expenditure on inorganic inputs by farmers may decline and source sustainability of water supply could be enhanced. Given the fact that, at present, approximately 20 million ha of land worldwide is being cultivated by re-using domestic wastewater, this paper draws on evidence from India to explore: (1) the economic costs–benefits of wastewater reuse in the context of hypothesized links to climate variability; (2) the role of local farming practices, market conditions and crop variety in influencing wastewater reuse in agriculture; and (3) the role of inter-governmental financing in influencing the selection of technical adaptation options for collection, treatment and disposal of wastewater.     

Sustainable graywater reuse for residential landscape irrigation – a critical review

The demand for potable water is rising rapidly due to an ever-increasing population, economic activities, and dwindling water supplies. To provide adequate water supplies in the future, understanding the issues and challenges in the reuse of water and developing appropriate strategies for reuse will be critical. One way to augment water supplies for residential use is to reuse graywater – the wastewater from kitchens, bathrooms, and laundries. In this article, we critically review the evolution of water reuse, the definition of graywater, graywater reuse practices, volumes and flow in different situations, and graywater characteristics. We then examine the issues associated with different graywater treatment methods and how using graywater for irrigation around homes affects soil quality and plant growth. The study concludes that graywater treatment costs, human health risks, and its effect on soil quality are some of the challenges that need to be addressed in the future for widespread and sustainable reuse of graywater for irrigation around homes.     

滇池流域水资源综合平衡管理研究

随着滇池治理的进展,在今后一个时期内,恢复滇池饮用水环境功能,成为滇池治理的首要目标和任务。围绕滇池流域水资源供求平衡,采用水资源全要素配置框架下的三次平衡分析理论,从整体上分析了滇池流域水资源供求平衡关系及存在的主要问题,提出了以需求为导向,建立滇池流域水资源综合平衡管理目标和措施。分析表明：在滇池治理的基础上,通过建立滇池流域水资源综合平衡管理体系,落实管理措施,从总量平衡的理论上能够充分发挥引水工程的作用,恢复滇池饮用水环境功能,实现水量、水质供求的综合平衡。建议进一步开展量化分析和模拟实验研究,为在滇池流域实施综合平衡管理提供可靠依据和建议     

Concentrations, transport, fate, and releases of polybrominated diphenyl ethers in sewage treatment plants in the Pearl River Delta, South China

Wastewater has proved to be a significant source of polybrominated diphenyl ethers (PBDEs) in the environment. Seventeen congeners from tri- to deca-BDEs were determined to characterize the occurrence, fate, and transport of PBDEs in two sewage treatment plants in the Pearl River Delta, South China. The PBDE concentrations varied substantially from 13.3 to 2496.4 ng L(-1) in the raw wastewater, depending on the wastewater types and contents of the suspended particulate matter (SPM). The concentrations declined to 0.9 to 4.4 ng L(-1) in the treated effluent and were closely associated with SPM contents. BDE-209 was the predominant congener in the wastewater and sewage sludge. Most of PBDEs might have ended up in the sewage sludge, with <4.7% being discharged with the treated effluent. The results revealed that PBDEs were not significantly degraded by biological treatment and chlorination in the STPs. An annual release of PBDEs was estimated at 2280 kg/year through wastewater from the Pearl River Delta.     

Modelling microbial health risk of wastewater reuse: A systems perspective

There is a widespread need for the use of quantitative microbial risk assessment (QMRA) to determine reclaimed water quality for specific uses, however neither faecal indicator levels nor pathogen concentrations alone are adequate for assessing exposure health risk. The aim of this study was to build a conceptual model representing factors contributing to the microbiological health risks of reusing water treated in maturation ponds. This paper describes the development of an unparameterised model that provides a visual representation of theoretical constructs and variables of interest. Information was collected from the peer-reviewed literature and through consultation with experts from regulatory authorities and academic disciplines. In this paper we explore how, considering microbial risk as a modular system, following the QMRA framework enables incorporation of the many factors influencing human exposure and dose response, to better characterise likely human health impacts. By using and expanding upon the QMRA framework we deliver new insights into this important field of environmental exposures. We present a conceptual model of health risk of microbial exposure which can be used for maturation ponds and, more importantly, as a generic tool to assess health risk in diverse wastewater reuse scenarios.