Lifecycle of surgical devices: Global, environmental, and regulatory considerations

BACKGROUND

Technological advancements, improved surgical access, and heightened demand for surgery have fueled unprecedented device and supply turnover impelling wealthy hospitals to upgrade continually and sell, donate, recycle, or dispose of used, expired, antiquated, or surplus goods. This paper reviews the issues related to device and supply lifecycles and discusses the opportunities and challenges they present for sustainable surgical growth in low- and middle-income (LMICs) countries.

OBSERVATIONS

This review found, in LMICs countries, regulatory disparities persist that limit effective harmonization secondary to highly variable national policies and a lack of prioritized enforcement. Heterogeneity in the regulatory landscape, specifically in the classification, nomenclature, and identification of medical devices, encumbers effective regulation and distribution. Once devices are sold, donated, or reused in LMICs countries, complexities arise in regulatory compliance, maintenance, and appropriate use of these technologies. At the end of the lifecycle, waste management poses significant obstacles with limited resources hindering the implementation of best practices.

CONCLUSION

There are major disparities in access to quality surgical equipment and supplies around the world. Improved communication between relevant stakeholders and harmonization of manufacture and disposal regulations will be needed to ensure adequate and appropriate responses to these challenges.

TRIAL REGISTRATION NUMBER

Not applicable.

Sustainable waste management solutions for the foodservice industry: A Delphi study

Foodservice businesses influence the sustainability of their natural environment by producing significant amounts of waste. Yet, research has, thus far, been dominated by studies that limit their scope to food waste alone. Few studies have taken a broader look at sustainable waste initiatives, including innovative waste processing techniques, with a view to constructing management indicators for foodservices. This study combines management innovation practices related to resource management, waste prevention, processing and disposal techniques, and stakeholder involvement to offer sustainable standards. It primarily adopts the Delphi technique to propose specific solutions pertaining to waste management. Experts from government, industry, and academia reveal that potential waste management initiatives comprise three facets - service, process (operational), and organisational practices and innovations, 15 sub-facets and 41 indicators. This study thus establishes a catalogue of solutions for food, packaging and other 'non-food' waste that foodservice establishments can implement. In addition to its practical implications, an important contribution is its focus on management systems to establish waste management standards for hospitality, food and beverage (F&B) services, restaurants, and non-commercial catering.

The role of Environmental Health in preventing antimicrobial resistance in low- and middle-income countries

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research.

Perceived risk and associated factors of healthcare waste in selected hospitals of Kathmandu, Nepal

BACKGROUND

Healthcare waste management is the subject of a neglected issue in many developing countries. Health care facilities are facing a major challenge in handling healthcare wastes and reducing their potential risks to human health and the environment. Insufficient understanding of the risk associated with healthcare waste by health workforce can contribute to poor waste management practices. The main aim of this study is to assess risk perception towards healthcare waste among hospital attendants and to identify associated factors.

METHODOLOGY

We carried out a cross-sectional hospital-based study among 120 attendants of a private and public hospital in Kathmandu, Nepal. We used two-stage random sampling for the selection of hospital and participants. We conducted a face-to-face interview with the participants using semi-structured questionnaires. Based on the mean score, we classified risk perception as good and poor. Bivariate and multivariate analysis was carried out to determine associates of risk perception towards healthcare waste.

RESULTS

Approximately 51.0% of hospital attendants had poor risk perception of healthcare waste. Nearly half of the participants (49.2%) had inadequate knowledge and 43.0% had a negative attitude. Factors such as healthcare waste management training (p = 0.028), housekeeping department (p = 0.036) and attitude (p = 0.001) were associated with risk perception of healthcare waste.

CONCLUSION

Hospital attendants had a poor understanding of risk perception of healthcare waste. Periodic training on healthcare waste management and edification on the risk associated with healthcare waste is essential to boost awareness among all healthcare workers. Communication on behavioral improvements for appropriate waste management must be prioritized to change the perception of health workers.

Adherence to safety practices and risks associated with health care waste management at an academic hospital, Pretoria, South Africa

Background

Adequate knowledge on hazards of healthcare waste and proper handling methods can result in its safe disposal and protection of workers and communities. The study assessed perceptions of healthcare workers on the adherence and risks associated with the practices of healthcare waste management.

Methods

A total of 126 questionnaires were administered in selected wards at an academic hospital to establish training and knowledge on legislations regarding healthcare waste and health hazards associated with such waste.

Results

Sixty nine percent (69.0%) of participants had received training on healthcare waste handling. The highest number of cleaning staff (85.7%) received training from work while 34.8% of the doctors also received training from work. Only 44.1% of the nurses had knowledge about policies on healthcare waste. The majority of the participants (82.0%) had knowledge on the risks associated with handling of healthcare waste. However, only 20.0% of the participants re-capped needles after use and of these 43.5% were doctors. Most of the nurses (64.0%) had been exposed to needle pricks.

Conclusion

Even though 82.0% of the participants believed there were enough management practices enforced with regards to the healthcare waste, it was recommended that there should be more education on the handling of healthcare waste.

Influencing factors behind inappropriate solid waste management of small clinics in a resource-constrained country

Appropriate clinical waste management is a critical concern in today's era. Resource-constrained countries agonize greatly over this issue in order to mitigate inappropriate clinical waste management practices. The goal of this study is to assess factors behind inappropriate waste management of small clinics in resource-constrained countries. We tested the hypothesis that negligence of government, knowledge and awareness, and financial burden are three key factors behind inappropriate solid waste management of small clinics. A two-phase survey including a pilot study and a main study was conducted for exploratory factor analysis and confirmatory factor analysis, respectively, in the fourth largest city of Pakistan, i.e., Hyderabad. One sample t test was used to validate the hypothesis, the correlation between the three key factors, and the location of the clinics were established. These factors were found to have a contribution to inappropriate waste management of small clinics. The hypothesis was then validated, and all three factors were found to have no significant variation in responses with the contrast of three types of clinic locations, namely, low-, medium-, and high-income areas. Responses were almost identical and bear equal significance from all locations, the financial burden factor is at the highest, the second factor is the negligence of government, and the third factor is that of knowledge and awareness. This study highlights the factors that are usually neglected and can help to improve solid waste management of small clinics in resource-constrained countries.

A Scientometric Review of Resource Recycling Industry

With rapid economic development and urbanization, a large number of primary resources are consumed and accumulate in society as recyclable resource, which causes great pressure on the environment. The development of the resource recycling industry (RRI) can reduce environmental impacts and achieve sustainable development and green growth. Scholars are paying more attention to the resource recycling industry (RRI), and the related literature continues to increase. There are over 7041 publications covering RRI in the Web of Science database from 1996 to 2018. This paper analyzes the time distribution characteristics of the literature and the status of the scientific research cooperation network using the visualization analysis software CiteSpace. The number of documents increased from 94 in 1996 to a peak of 963 in 2018. There is no relatively stable core author group. The number of papers published by “Chinese Acad Sci” ranks first among all research institutions. Document co-citation analysis and burst detection are adopted to assess the status and emerging trends in the RRI research domain. A publication by M.C. Monte on waste management is the most cited paper. Additionally, “green and sustainable and technology” and “science and technology—other topics” are the latest emerging subject categories in RRI research. Furthermore, “e-waste”, “reverse logistics” and “lean manufacturing” are emerging research trends for RRI, and “carbon emissions”, “policy”, “demolition waste”, “supply chain management” and “compressive strength” have become hot topics. These findings may provide inspiration for scholars to search for new research directions and ideas.

Efficiency of Health Care Risk Waste Management in Rural Healthcare Facilities of South Africa: An Assessment of Selected Facilities in Vhembe District, Limpopo Province

Waste generated form healthcare facilities is a potential source of health risks to the public, if it is not properly handled from the point of generation to disposal. This study was conducted to assess the efficiency of healthcare risk waste (HCRW) management in Vhembe District of Limpopo Province, South Africa. Fifteen healthcare facilities were selected in Vhembe District for this study. Data were obtained through in-depth interviews, semi-structured questionnaires, observation and pictures. Qualitative data were thematically analyzed, while the quantitative data were analyzed using the Statistical Package for the Social Sciences, version 25. In all the healthcare facilities; mismanagement of HCRW was noted at different points along the management chain. Poor segregation, overfilling of waste bins, inappropriate transportation and storage of waste in substandard storage rooms were observed in the facilities. All the waste from the district are transported to a private-owned treatment facility outside the district, where they are mainly incinerated. Enforcement of healthcare risk waste guidelines, provision of standardized equipment for temporary storage, empowerment of each healthcare facility to treat at least some of the waste, and employment of non-burn techniques for treatment of waste are recommended for more efficient management of healthcare risk waste in Vhembe District.

Agent-Based Modelling for Simulation-Based Design of Sustainable Faecal Sludge Management Systems

Re-using faecal sludge (FS) to generate value has the potential to contribute towards solving the issue of long term sanitation solutions in growing urban areas across sub-Saharan Africa; however, hitherto, no design tools have been available that are capable of simulating a system involving economic factors, complex social issues and environmental circumstances. We hypothesized that Agent-Based Modelling (ABM), when deployed with appropriate rigour, can provide such a tool. Extensive field work was carried out in a Malawian city, investigating the adoption of Skyloo above-ground composting toilets by households, and the operation of the municipal FS site. 65 semi-structured interviews and 148 household interviews, together with observations, were carried out to characterize these processes, with the data acquired being used to construct two separate ABMs. The Skyloo ABM was run for various scenarios of start-up capital for business and payback of loans against the toilet cost to households. The municipal FS Site ABM was run for different patterns of dumping fee and enforcement structure. The field work demonstrated that there is potential for further expansion of FS reuse, with a market for agricultural application. The Skyloo ABM identified the significance of start-up capital for a business installing the toilet technology; the municipal FS Site ABM showed that existing fees, fines and regulatory structure were insufficient to reduce illegal dumping of FS to any useful degree, but that a monthly permit system would provide enhanced revenue to the city council compared with per-visit charging of disposal companies at the municipal FS site. Whilst each ABM ideally requires some additional data before full application, we have, for the first time, shown that ABM provides a basis for the simulation-based design of FS management systems, including complex social, economic and environmental factors.

Environmental assessment in health care organizations

The aim of this research is to design a multi-criteria model for environmental assessment of health care organizations. This is a model which guarantees the objectivity of the results obtained, is easy to apply, and incorporates a series of criteria, and their corresponding descriptors, relevant to the internal environmental auditing processes of the hospital. Furthermore, judgments were given by three experts from the areas of health, the environment, and multi-criteria decision techniques. From the values assigned, geometric means were calculated, giving weightings for the criteria of the model. This innovative model is intended for application within a continuous improvement process. A practical case from a Spanish hospital is included at the end. Information contained in the sustainability report provided the data needed to apply the model. The example contains all the criteria previously defined in the model. The results obtained show that the best-satisfied criteria are those related to energy consumption, generation of hazardous waste, legal matters, environmental sensitivity of staff, patients and others, and the environmental management of suppliers. On the other hand, those areas returning poor results are control of atmospheric emissions, increase in consumption of renewable energies, and the logistics of waste produced. It is recommended that steps be taken to correct these deficiencies, thus leading to an acceptable increase in the sustainability of the hospital.

Litter impacts on beach/dune systems along the Atlantico Department, the Caribbean Coastline of Colombia

Eight beach/dune systems located along the Atlantico Department, Caribbean coast of Colombia were surveyed to determine litter influences over its scenic quality. Application of the Coastal Scenic Evaluation System (CSES) categorized these systems into two of the five available classes. Five of the investigated beach/dune systems belong to Class IV, while three systems correspond to V. Classes I, II and III were not found. Along these beach/dune systems, a total amount of 1908 litter items were collected with average abundances of 4.2 items/m². Currently, 82% of surveyed sites are under an unacceptable condition of cleanness. User's habits as well as bad litter management practices are directly responsible for the decline of scenic quality of the Atlantico Department beach/dune systems. Litter management must be centered on strategies to eliminate or minimize litter sources. Specific remedial actions need to be defined and developed.

Terminal restriction fragment length polymorphism is an "old school" reliable technique for swift microbial community screening in anaerobic digestion

The microbial community in anaerobic digestion has been analysed through microbial fingerprinting techniques, such as terminal restriction fragment length polymorphism (TRFLP), for decades. In the last decade, high-throughput 16S rRNA gene amplicon sequencing has replaced these techniques, but the time-consuming and complex nature of high-throughput techniques is a potential bottleneck for full-scale anaerobic digestion application, when monitoring community dynamics. Here, the bacterial and archaeal TRFLP profiles were compared with 16S rRNA gene amplicon profiles (Illumina platform) of 25 full-scale anaerobic digestion plants. The α-diversity analysis revealed a higher richness based on Illumina data, compared with the TRFLP data. This coincided with a clear difference in community organisation, Pareto distribution, and co-occurrence network statistics, i.e., betweenness centrality and normalised degree. The β-diversity analysis showed a similar clustering profile for the Illumina, bacterial TRFLP and archaeal TRFLP data, based on different distance measures and independent of phylogenetic identification, with pH and temperature as the two key operational parameters determining microbial community composition. The combined knowledge of temporal dynamics and projected clustering in the β-diversity profile, based on the TRFLP data, distinctly showed that TRFLP is a reliable technique for swift microbial community dynamics screening in full-scale anaerobic digestion plants.

Environmental quality and well-being level in Turkey

The environment is an indispensable dimension of human life and affects important concepts such as health, quality of life, life satisfaction, and well-being. The purpose of this study is to determine the effect of environmental elements such as air quality, forest area, waste services, and noise pollution on the well-being in Turkey. The data of the research were obtained from the well-being index for the Provinces Study prepared by the Turkey Statistical Institute in 2015. A hierarchical multiple regression model was performed to predict the relationship between the environmental variables and well-being by using the Statistical Package for Social Science. Income and education level of provinces were controlled variables of model. At the end of analyses, it was found out that only forest area was positively related with well-being (β = 0.191, t = 2.369, p = 0.020), and there were no association between the air pollution, the noise problems, waste services, and dependent variable. The survey results are expected to provide important evidence-based information about an association between environment and well-being to policymakers and academicians on environmental health and public health.

Solid Waste Management Solutions for a Rapidly Urbanizing Area in Thailand: Recommendations Based on Stakeholder Input

Municipal solid waste is a significant problem, particularly in developing countries that lack sufficient infrastructure and useable land mass to process it in an appropriate manner. Some developing nations are experiencing a combination of issues that prevent proper management of solid waste. This paper reviews the management of municipal solid waste in northeast Thailand, using the Tha Khon Yang Sub-district Municipality (TKYSM) in Maha Sarakham Province as a case study. The combination of rapid population and economic growth and its associated affluence has led to an increase in the use of consumer items and a concomitant increase in the production of municipal solid waste. In the TKYSM there is pressure on local government to establish a suitable waste management program to resolve the escalating waste crisis. The aim of this study is to provide viable solutions to waste management challenges in the TKYSM, and potentially to offer guidance to other similar localities also facing the same challenges. It is well established that successful changes to waste management require an understanding of local context and consideration of specific issues within a region. Therefore, extensive community consultation and engagement with local experts was undertaken to develop an understanding of the particular waste management challenges of the TKYSM. Research methods included observations, one-on-one interviews and focus groups with a range of different stakeholders. The outcomes of this research highlight a number of opportunities to improve local infrastructure and operational capacity around solid waste management. Waste management in rural and urban areas needs to be approached differently. Solutions include: development of appropriate policy and implementation plans (based around the recommendations of this paper); reduction of the volume of waste going to landfill by establishing a waste separation system; initiation of a collection service that supports waste separation at source; educating the citizens of the municipality; and the local government staff, and for the local government to seek external support from the local temples and expertise from the nearby university.

A new approach to stabilize waste biomass for valorization using an oxidative process at 90 °C

This study aimed to establish a new methodology for upgrading biomass quality using low-temperature (below 100 °C) oxidation to achieve simultaneous drying and decomposition. Sterilized manure (63% wet basis) was heated at 90 °C for 49 days under an oxidative environment. The obtained solid and moisture reduction curves indicated that drying and decomposition proceeded simultaneously. The biomass was decomposed by oxidation with the release of water, carbon dioxide, and volatile fatty acids such as acetic acid. The oxidation process stopped when the biomass was dehydrated, indicating that the water originally present in the biomass governed the process. Elemental and calorific analyses revealed no remarkable increase in carbon content or increased heating value, and a slight decrease in oxygen content. Although the severity of the process was insufficient to produce an optimum solid fuel due to the low temperature used, the process would enable the stabilization of waste biomass with low energy consumption such as using waste heat.

Contextual factors and motivations affecting rural community sanitation in low- and middle-income countries: A systematic review

BACKGROUND

Unsafe management of human faecal waste represents a major risk for public health, particularly in low- and middle-income countries. Efforts to improve sanitation conditions are considerably sensitive to contextual specifics of natural and social environments. This review operationalises, analyses, and synthesises evidence of how contextual factors and motivations affect different sanitation outcomes with a specific focus on community approaches to rural sanitation.

METHODS AND FINDINGS

We operationalised contextual factors and motivations as determinants that influence sanitation conditions independently of the examined intervention. We conducted a systematic search of both peer-reviewed and grey literature with no restriction on the methods After screening the titles and abstracts of 19,198 records obtained through initial searches, we scrutinised the full content of 621 studies for relevance. While 102 of these studies qualified to be assessed for risk of bias and information content, ultimately, just 40 studies met our eligibility criteria. Of these 40 studies from 16 countries, 26 analysed specific interventions and 14 were non-interventional. None of the experimental studies reported the effects of contextual factors or motivations as operationalised in this study and only observational evidence was thus used in our review. We found that sanitation interventions are typically seen as the principal vehicles of change, the main instruments to fix 'deviant' behaviour or ensure access to infrastructure. The programmatic focus of this study on sanitation determinants that act independently of specific interventions questions this narrow understanding of sanitation dynamics. We identified 613 unique observations of quantitatively or qualitatively established relationships between certain contextual factors or motivations and 12 different types of sanitation outcomes. The sanitation determinants were classified into 77 typologically similar groups clustered into 12 broader types and descriptively characterised. We developed a graphical synthesis of evidence in the form of a network model referred to as the sanitation nexus. The sanitation nexus depicts how different groups of determinants interlink different sanitation outcomes. It provides an empirically derived conceptual model of sanitation with an aggregate structure indicating similarities and dissimilarities between sanitation outcomes with respect to how their sets of underlying determinants overlap.

CONCLUSION

This study challenged the understanding of context as merely something that should be controlled for. Factors that affect targeted outcomes independently of the analysed interventions should be scrutinised and reported. This particularly applies to interventions involving complex human-environment interactions where generalisability is necessarily indirect. We presented a novel approach to comprehending the contextual factors and motivations which influence sanitation outcomes. Our approach can be analogously applied when mapping and organising underlying drivers in other areas of public and environmental health. The sanitation nexus derived in this study is designed to inform practitioners and researchers about sanitation determinants and the outcomes they influence.

An interpretive structural modeling (ISM) and decision-making trail and evaluation laboratory (DEMATEL) method approach for the analysis of barriers of waste recycling in India

Increasing amount of wastes is posing great difficulties for all countries across the world. The problem of waste management is more severe in developing countries such as India where the rates of economic growth and urbanization are increasing at a fast pace. The governments in these countries are often constrained by limited technical and financial capabilities, which prevent them from effectively addressing these problems. There is a limited participation from the private players too in terms of setting up of waste recycling units. The present study aims at identifying various barriers that challenge the establishment of these units, specific to India. Further, it attempts to identify the most influential barriers by utilizing multicriterion decision-making tools of interpretive structural modeling (ISM) and decision-making trail and evaluation laboratory (DEMATEL). The findings of the study suggest that the lack of funds, input material, and subsidy are the most influential barriers that are needed to be addressed for the development of waste recycling infrastructure in India.

IMPLICATIONS

This work has been carried out to address the problem of proper waste management in India. To deal with this problem, the method of waste recycling has been felt appropriate by the government of various countries, including India. Therefore, the barriers that play vital role in waste recycling for private players have been identified and their importance has been established with the help of ISM and DEMATEL methods. Doing so will assist the government to take appropriate steps for the betterment of waste recycling infrastructure in India and enhance waste management.

Fate of bisphenol A, perfluorooctanoic acid and perfluorooctanesulfonate in two different types of sewage treatment works in Hong Kong

This study aimed at investigating the removal efficiencies of perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS) and bisphenol A (BPA) of two major sewage treatment works in Hong Kong: Stonecutters Island STW (SCISTW) which adopts chemically enhanced primary treatment (CEPT) process and Sha Tin STW (STSTW) which employs biological treatment. Liquid portion (LP) and particulate matter (PM) of liquid sewage samples and sludge samples were collected and followed by liquid chromatograph system. It was found that BPA (44.6 ± 35.1%) generally achieved higher TRE than the two other chemicals (PFOS (-18.8 ± 34.8%) and PFOA (-104 ± 86.8%)) in STSTW (p < 0.05). Most of the PFOA, PFOS and BPA was discharged through final effluent (PFOA: 95.6 ± 1.00% and 94.5 ± 3.13%; PFOS: 77.7 ± 1.48% and 72.6 ± 6.07%; BPA: 99.2 ± 0.950% and 92.8 ± 7.25%, respectively) rather than stored in the sludge/cake (PFOA: 4.45 ± 1.00% and 5.47 ± 3.13%, PFOS: 22.3 ± 1.48% and 27.4 ± 6.07%, BPA: 0.844 ± 0.950% and 7.20 ± 7.25%, respectively). After the sewage purification process, the two STW released considerable amounts of PFOA, PFOS and BPA in the final effluent (PFOA: 0.638 ± 0.227 kg/year; PFOS: 0.409 ± 0.126 kg/year; BPA: 10.4 ± 3.83 kg/year in STSTW; PFOA: 3.08 ± 1.415 kg/year; PFOS: 2.13 ± 0.452 kg/year; BPA: 714 ± 768 kg/year in SCISTW) and in the sludge (PFOA: 0.0360 ± 0.0250 kg/year; PFOS: 0.149 ± 0.00100 kg/year; BPA: 1.09 ± 1.47 kg/year in STSTW; PFOA: 0.139 ± 0.0670 kg/year; PFOS: 0.606 ± 0.0780 kg/year; BPA: 3.05 ± 3.95 kg/year in SCISTW). This study may help to provide crucial information for further development of municipal sewage system in treating synthetic emerging chemicals.

Environmental impact assessment of municipal solid waste management options using life cycle assessment: a case study

The goal of this study is to use life cycle assessment (LCA) tool to assess possible environmental impacts of different municipal solid waste management (MSWM) scenarios on various impact categories for the study area Dhanbad City, India. The scenarios included in the present study are collection and transportation (denoted as S1); baseline scenario consisting of recycling, open burning, open dumping, and finally unsanitary landfilling without energy recovery (denoted by S2); composting and landfilling (denoted by S3); and recycling and composting followed by landfilling of inert waste without energy recovery (denoted by S4). One ton of municipal solid waste (MSW) was selected as the functional unit. The primary data were collected through sampling, surveys, and literatures. Background data were obtained from Eco-invent data of SimaPro 8.1 libraries. The scenarios were compared using the CML 2 baseline 2000 method, and the results indicated that the scenario S1 had the highest impact on marine aquatic ecotoxicity (1.86E + 04 kg 1,4-DB eq.) and abiotic depletion (2.09E + 02 kg Sb eq.). S2 had the highest impact on global warming potential (9.42E + 03 kg CO₂ eq.), acidification (1.15E + 01 kg SO₂ eq.), eutrophication (2.63E + 00 kg PO₄^3- eq.), photochemical oxidation (2.12E + 00 kg C₂H₄ eq.), and human toxicity (2.25E + 01 kg 1,4-DB eq.). However, S3 had the highest impact on abiotic depletion (fossil fuels) (2.71E + 02 MJ), fresh water aquatic ecotoxicity (6.54E + 00 kg 1,4-DB eq.), terrestrial ecotoxicity (3.36E - 02 kg 1,4-DB eq.), and ozone layer depletion (2.73E - 06 kg CFC-11 eq.). But S4 did not have the highest impact on any of the environmental impact categories due to recycling of packaging waste and landfilling of inert waste. Landfilling without energy recovery of mixed solid waste was found as the worst disposal alternative. The scenario S4 was found as the most environmentally suitable technology for the study area and recommended that S4 should be considered for strategic planning of MSWM for the study area.

The City Blueprint Approach: Urban Water Management and Governance in Cities in the U.S

In this paper, we assess the challenges of water, waste and climate change in six cities across the U.S.: New York City, Boston, Milwaukee, Phoenix, Portland and Los Angeles. We apply the City Blueprint^® Approach which consists of three indicator assessments: (1) the Trends and Pressures Framework (TPF), (2) the City Blueprint Framework (CBF) and (3) the water Governance Capacity Framework (GCF). The TPF summarizes the main social, environmental and financial pressures that may impede water management. The CBF provides an integrated overview of the management performances within the urban watercycle. Finally, the GCF provides a framework to identify key barriers and opportunities to develop governance capacity. The GCF has only been applied in NYC. Results show that all cities face pressures from heat risk. The management performances regarding resource efficiency and resource recovery from wastewater and solid waste show considerable room for improvement. Moreover, stormwater separation, infrastructure maintenance and green space require improvement in order to achieve a resilient urban watercycle. Finally, in New York City, the GCF results show that learning through smart monitoring, evaluation and cross-stakeholder learning is a limiting condition that needs to be addressed. We conclude that the City Blueprint Approach has large potential to assist cities in their strategic planning and exchange of knowledge, experiences and lessons. Because the methodology is well-structured, easy to understand, and concise, it may bridge the gap between science, policy and practice. It could therefore enable other cities to address their challenges of water, waste and climate change.

An evaluation of the social dimensions in public participation in rural domestic waste source-separated collection in Guilin, China

A comprehensive evaluation of public participation in rural domestic waste (RDW) source-separated collection in China was carried out within a social-dimension framework, specifically in terms of public perception, awareness, attitude, and willingness to pay for RDW management. The evaluation was based on a case study conducted in Guilin, Guangxi Zhuang Autonomous Region, China, which is a representative of most inland areas of the country with a GDP around the national average. It was found that unlike urban residents, rural residents maintained a high rate of recycling, but in a spontaneous manner; they paid more attention to issues closely related to their daily lives, but less attention to those at the general level; their awareness of RDW source-separated collection was low and different age groups showed significantly different preferences regarding the sources of knowledge acquirement. Among potential information sources, village committees played a very important role in knowledge dissemination; for the respondents' pro-environmental attitudes, the influencing factor of "lack of legislation/policy" was considered to be significant; mandatory charges for waste collection and disposal had a high rate of acceptance among rural residents; and high monthly incomes had a positive correlation with both public pro-environmental attitudes and public willingness to pay for extra charges levied by RDW management. These observations imply that, for decision-makers in the short term, implementing mandatory RDW source-separated collection programs with enforced guidelines and economic compensation is more effective, while in the long run, promoting pro-environmental education to rural residents is more important.

Assessment of the municipal solid waste management system in Accra, Ghana: A 'Wasteaware' benchmark indicator approach

This article assesses the performance of the city of Accra, Ghana, in municipal solid waste management as defined by the integrated sustainable waste management framework. The article reports on a participatory process to socialise the Wasteaware benchmark indicators and apply them to an upgraded set of data and information. The process has engaged 24 key stakeholders for 9 months, to diagram the flow of materials and benchmark three physical components and three governance aspects of the city's municipal solid waste management system. The results indicate that Accra is well below some other lower middle-income cities regarding sustainable modernisation of solid waste services. Collection coverage and capture of 75% and 53%, respectively, are a disappointing result, despite (or perhaps because of) 20 years of formal private sector involvement in service delivery. A total of 62% of municipal solid waste continues to be disposed of in controlled landfills and the reported recycling rate of 5% indicates both a lack of good measurement and a lack of interest in diverting waste from disposal. Drains, illegal dumps and beaches are choked with discarded bottles and plastic packaging. The quality of collection, disposal and recycling score between low and medium on the Wasteaware indicators, and the scores for user inclusivity, financial sustainability and local institutional coherence are low. The analysis suggests that waste and recycling would improve through greater provider inclusivity, especially the recognition and integration of the informal sector, and interventions that respond to user needs for more inclusive decision-making.

Anatomy of a decision II: Potential effects of changes to Tier I chemical approaches in Canadian Disposal at Sea program sediment assessment protocols

The effects of possible changes to the Canadian 2-tiered assessment framework for dredged material based on outcomes of the 2006 Contaminated Dredged Material Management Decisions Workshop (CDMMD) are evaluated. Expanding on the "data mining" approach described in a previous paper, which focused solely on chemical lines of evidence, the efficacy of Tier 1 approaches (increases to the number of chemical analytes, use of mean hazard quotients, and the use of a screening bioassay) in predicting toxicity are evaluated. Results suggest value in additional work to evaluate the following areas: 1) further expanding minimum chemical requirements, 2) using more advanced approaches for chemical interpretation, and 3) using a screening-level bioassay (e.g., Canadian solid-phase photoluminescent bacteria test) to determine whether it would complement Tier 1 chemistry as well as or better than the solvent-based Microtox™ test method evaluated in the present study. Integr Environ Assess Manag 2017;13:1072-1085. © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Anatomy of a decision III: Evaluation of national disposal at sea program action level efficacy considering 2 chemical action levels

The potential performance (i.e., ability to separate nontoxic from toxic sediments) of a range of international Disposal at Sea (DaS) chemical Action Levels (ALs) was compared using a sediment chemical and toxicological database. The use of chemistry alone (without the use of further lines of evidence) did not perform well at reducing costs and protecting the environment. Although some approaches for interpreting AL1 results are very effective at filtering out the majority of acutely toxic sediments, without subsequent toxicological assessment, a large proportion of nontoxic sediments would be unnecessarily subjected to treatment and containment, and a number of sublethally toxic sediments would be missed. Even the best tiered systems that collect and evaluate information sequentially resulted in the failure to catch at least some sublethally or acutely toxic sediments. None of the AL2s examined were particularly effective in distinguishing between non-, sublethally, or acutely toxic sediments. Thus, this review did not support the use of chemical AL2s to predict the degree to which sediments will be toxic. Integr Environ Assess Manag 2017;13:1086-1099.© 2017 The Authors. Integrated Environmental Assessment and Management Published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Environmental performance of household waste management in Europe - An example of 7 countries

An attributional life cycle assessment (LCA) of the management of 1ton of household waste was conducted in accordance with ISO 14044:2006 and the ILCD Handbook for seven European countries, namely Germany, Denmark, France, UK, Italy, Poland and Greece, representing different household waste compositions, waste management practices, technologies, and energy systems. National data were collected from a range of sources regarding household waste composition, household sorting efficiency, collection, waste treatments, recycling, electricity and heat composition, and technological efficiencies. The objective was to quantify the environmental performance in the different countries, in order to analyze the sources of the main environmental impacts and national differences which affect the results. In most of the seven countries, household waste management provides environmental benefits when considering the benefits of recycling of materials and recovering and utilization of energy. Environmental benefits come from paper recycling and, to a lesser extent, the recycling of metals and glass. Waste-to-energy plants can lead to an environmental load (as in France) or a saving (Germany and Denmark), depending mainly on the composition of the energy being substituted. Sensitivity analysis and a data quality assessment identified a range of critical parameters, suggesting from where better data should be obtained. The study concluded that household waste management is environmentally the best in European countries with a minimum reliance on landfilling, also induced by the implementation of the Waste Hierarchy, though environmental performance does not correlate clearly with the rate of material recycling. From an environmental point of view, this calls for a change in the waste management paradigm, with less focus on where the waste is routed and more of a focus on the quality and utilization of recovered materials and energy.

A 'Knowledge Ecologies' Analysis of Co-designing Water and Sanitation Services in Alaska

Willingness to collaborate across disciplinary boundaries is necessary but not sufficient for project success. This is a case study of a transdisciplinary project whose success was constrained by contextual factors that ultimately favoured technical and scientific forms of knowledge over the cultural intelligence that might ensure technical solutions were socially feasible. In response to Alaskan Water and Sewer Challenge (AWSC), an international team with expertise in engineering, consultative design and public health formed in 2013 to collaborate on a two-year project to design remote area water and sanitation systems in consultation with two native Alaskan communities. Team members were later interviewed about their experiences. Project processes are discussed using a 'Knowledge Ecology' framework, which applies principles of ecosystems analysis to knowledge ecologies, identifying the knowledge equivalents of 'biotic' and 'abiotic' factors and looking at their various interactions. In a positivist 'knowledge integration' perspective, different knowledges are like Lego blocks that combine with other 'data sets' to create a unified structure. The knowledge ecology framework highlights how interactions between different knowledges and knowledge practitioners ('biotic factors') are shaped by contextual ('abiotic') factors: the conditions of knowledge production, the research policy and funding climate, the distribution of research resources, and differential access to enabling infrastructures (networks, facilities). This case study highlights the importance of efforts to negotiate between different knowledge frameworks, including by strategic use of language and precepts that help translate social research into technical design outcomes that are grounded in social reality.

Disposing of Excess Vaccines After the Withdrawal of Oral Polio Vaccine

Until recently, waste management for national immunization programs was limited to sharps waste, empty vaccine vials, or vaccines that had expired or were no longer usable. However, because wild-type 2 poliovirus has been eradicated, the World Health Organization's (WHO's) Strategic Advisory Group of Experts on Immunization deemed that all countries must simultaneously cease use of the type 2 oral polio vaccine and recommended that all countries and territories using oral polio vaccine (OPV) "switch" from trivalent OPV (tOPV; types 1, 2, and 3 polioviruses) to bivalent OPV (bOPV; types 1 and 3 polioviruses) during a 2-week period in April 2016. Use of tOPV after the switch would risk outbreaks of paralysis related to type 2-circulating vaccine-derived poliovirus (cVDPV2). To minimize risk of vaccine-derived polio countries using OPV were asked to dispose of all usable, unexpired tOPV after the switch to bOPV. In this paper, we review the rationale for tOPV disposal and describe the global guidelines provided to countries for the safe and appropriate disposal of tOPV. These guidelines gave countries flexibility in implementing this important task within the confines of their national regulations, capacities, and resources. Steps for appropriate disposal of tOPV included removal of all tOPV vials from the cold chain, placement in appropriate bags or containers, and disposal using a recommended approach (ie, autoclaving, boiling, chemical inactivation, incineration, or encapsulation) followed by burial or transportation to a designated waste facility. This experience with disposal of tOPV highlights the adaptability of national immunization programs to new procedures, and identifies gaps in waste management policies and strategies with regard to disposal of unused vaccines. The experience also provides a framework for future policies and for developing programmatic guidance for the ultimate disposal of all OPV after the eradication of polio.

Incorporating ToxCast and Tox21 datasets to rank biological activity of chemicals at Superfund sites in North Carolina

BACKGROUND

The Superfund program of the Environmental Protection Agency (EPA) was established in 1980 to address public health concerns posed by toxic substances released into the environment in the United States. Forty-two of the 1328 hazardous waste sites that remain on the Superfund National Priority List are located in the state of North Carolina.

METHODS

We set out to develop a database that contained information on both the prevalence and biological activity of chemicals present at Superfund sites in North Carolina. A chemical characterization tool, the Toxicological Priority Index (ToxPi), was used to rank the biological activity of these chemicals based on their predicted bioavailability, documented associations with biological pathways, and activity in in vitro assays of the ToxCast and Tox21 programs.

RESULTS

The ten most prevalent chemicals found at North Carolina Superfund sites were chromium, trichloroethene, lead, tetrachloroethene, arsenic, benzene, manganese, 1,2-dichloroethane, nickel, and barium. For all chemicals found at North Carolina Superfund sites, ToxPi analysis was used to rank their biological activity. Through this data integration, residual pesticides and organic solvents were identified to be some of the most highly-ranking predicted bioactive chemicals. This study provides a novel methodology for creating state or regional databases of biological activity of contaminants at Superfund sites.

CONCLUSIONS

These data represent a novel integrated profile of the most prevalent chemicals at North Carolina Superfund sites. This information, and the associated methodology, is useful to toxicologists, risk assessors, and the communities living in close proximity to these sites.

A comprehensive approach for diagnosing opportunities for improving the performance of a WWTP

High quality services of wastewater treatment require a continuous assessment and improvement of the technical, environmental and economic performance. This paper demonstrates a comprehensive approach for benchmarking wastewater treatment plants (WWTPs), using performance indicators (PIs) and indices (PXs), in a 'plan-do-check-act' cycle routine driven by objectives. The performance objectives herein illustrated were to diagnose the effectiveness and energy performance of an oxidation ditch WWTP. The PI and PX results demonstrated an effective and reliable oxidation ditch (good-excellent performance), and a non-reliable UV disinfection (unsatisfactory-excellent performance) related with influent transmittance and total suspended solids. The energy performance increased with the treated wastewater volume and was unsatisfactory below 50% of plant capacity utilization. The oxidation ditch aeration performed unsatisfactorily and represented 38% of the plant energy consumption. The results allowed diagnosing opportunities for improving the energy and economic performance considering the influent flows, temperature and concentrations, and for levering the WWTP performance to acceptable-good effectiveness, reliability and energy efficiency. Regarding the plant reliability for fecal coliforms, improvement of UV lamp maintenance and optimization of the UV dose applied and microscreen recommissioning were suggested.

Hurdles in the investigation of influent fractionation for measurement campaigns under diluted wastewater conditions

Evaluating the performance of a wastewater treatment plant (WWTP) requires a good characterization of the biodegradable substrate entering the plant. As is generally acknowledged, the wastewater characteristics under rain or storm weather conditions vary significantly from dry weather conditions but this is rarely accounted for in modelling exercises. In order to address this defect, a measurement campaign was set up and samples were analysed using respirometric assays. In this paper, some hurdles regarding measurement campaigns under dilute wastewater conditions and a better exploration of the impact of using respirometric assays are described and discussed. The dependence of the heterotrophic yield on different substrates severely hampers the evaluation of the respirograms under dilute wastewater conditions. In addition, the low load conditions limit the application of the assays due to insufficient sensitivity of the experiment and uncontrolled oxygen inputs. The results clearly demonstrate the need for further research in order to allow for a proper evaluation of WWTP performance under rain and storm weather conditions.

The Central Importance of Laboratories for Reducing Waste in Biomedical Research

The global biomedical research enterprise is driving substantial advances in medicine and healthcare. Yet it appears that the enterprise is rather wasteful, falling short of its true innovative potential. Suggested reasons are manifold and involve various stakeholders, such that there is no single remedy. In the present paper, I will argue that laboratories are the basic working units of the biomedical research enterprise and an important site of action for corrective intervention. Keeping laboratories relatively small will enable better training and mentoring of individual scientists, which in turn will yield better performance of the scientific workforce. The key premise of this argument is that people are at the heart of the successes and failures of biomedical research, yet the human dimension of science has been unduly neglected in practice. Renewed focus on the importance of laboratories and their constituent scientists is one promising approach to reducing waste and increasing efficiency within the biomedical research enterprise.

Specifying the Concept of Future Generations for Addressing Issues Related to High-Level Radioactive Waste

The nuclear community frequently refers to the concept of "future generations" when discussing the management of high-level radioactive waste. However, this notion is generally not defined. In this context, we have to assume a wide definition of the concept of future generations, conceived as people who will live after the contemporary people are dead. This definition embraces thus each generation following ours, without any restriction in time. The aim of this paper is to show that, in the debate about nuclear waste, this broad notion should be further specified and to clarify the related implications for nuclear waste management policies. Therefore, we provide an ethical analysis of different management strategies for high-level waste in the light of two principles, protection of future generations-based on safety and security-and respect for their choice. This analysis shows that high-level waste management options have different ethical impacts across future generations, depending on whether the memory of the waste and its location is lost, or not. We suggest taking this distinction into account by introducing the notions of "close future generations" and "remote future generations", which has important implications on nuclear waste management policies insofar as it stresses that a retrievable disposal has fewer benefits than usually assumed.

[Promoting the sustainable management of hospital waste in Kinshasa]

The management of hospital waste is a high-risk practice in the hospitals of Kinshasa, the largest city of the Democratic Republic of the Congo, from the point of view of public health and the environment. A multi-criteria study carried out in 4 hospitals assessed the situation and put forward solutions.

Assessing the environmental performance of construction materials testing using EMS: An Australian study

This paper reports the audit findings of the waste management practices at 30 construction materials testing (CMT) laboratories (constituting 4.6% of total accredited CMT laboratories at the time of the audit) that operate in four Australian jurisdictions and assesses the organisation's Environmental Management System (EMS) for indicators of progress towards sustainable development (SD). In Australia, waste indicators are 'priority indicators' of environmental performance yet the quality and availability of waste data is poor. National construction and demolition waste (CDW) data estimates are not fully disaggregated and the contribution of CMT waste (classified as CDW) to the national total CDW landfill burden is difficult to quantify. The environmental and human impacts of anthropogenic release of hazardous substances contained in CMT waste into the ecosphere can be measured by construing waste indicators from the EMS. An analytical framework for evaluating the EMS is developed to elucidate CMT waste indicators and assess these indicators against the principle of proportionality. Assessing against this principle allows for: objective evaluations of whether the environmental measures prescribed in the EMS are 'proportionate' to the 'desired' (subjective) level of protection chosen by decision-makers; and benchmarking CMT waste indicators against aspirational CDW targets set by each Australian jurisdiction included in the audit. Construed together, the EMS derived waste indicators and benchmark data provide a composite indicator of environmental performance and progress towards SD. The key audit findings indicate: CMT laboratories have a 'poor' environmental performance (and overall progress towards SD) when EMS waste data are converted into indicator scores and assessed against the principle of proportionality; CMT waste recycling targets are lower when benchmarked against jurisdictional CDW waste recovery targets; and no significant difference in the average quantity of waste diversion away from landfill was observed for laboratories with ISO14001 EMS certification compared to non-ISO14001 certified laboratories.

Quantification of effective exoelectrogens by most probable number (MPN) in a microbial fuel cell

The objective of this work was to quantify the number of exoelectrogens in wastewater capable of producing current in a microbial fuel cell by adapting the classical most probable number (MPN) methodology using current production as end point. Inoculating a series of microbial fuel cells with various dilutions of domestic wastewater and with acetate as test substrate yielded an apparent number of exoelectrogens of 17perml. Using current as a proxy for activity the apparent exoelectrogen growth rate was 0.03h(-1). With starch or wastewater as more complex test substrates similar apparent growth rates were obtained, but the apparent MPN based numbers of exoelectrogens in wastewater were significantly lower, probably because in contrast to acetate, complex substrates require complex food chains to deliver the electrons to the electrodes. Consequently, the apparent MPN is a function of the combined probabilities of members of the food chain being present.

Waste flow analysis and life cycle assessment of integrated waste management systems as planning tools: Application to optimise the system of the City of Bologna

The results of this case study are used to argue that waste management planning should follow a detailed process, adequately confronting the complexity of the waste management problems and the specificity of each urban area and of regional/national situations. To support the development or completion of integrated waste management systems, this article proposes a planning method based on: (1) the detailed analysis of waste flows and (2) the application of a life cycle assessment to compare alternative scenarios and optimise solutions. The evolution of the City of Bologna waste management system is used to show how this approach can be applied to assess which elements improve environmental performance. The assessment of the contribution of each waste management phase in the Bologna integrated waste management system has proven that the changes applied from 2013 to 2017 result in a significant improvement of the environmental performance mainly as a consequence of the optimised integration between materials and energy recovery: Global Warming Potential at 100 years (GWP100) diminishes from 21,949 to -11,169 t CO2-eq y(-1) and abiotic resources depletion from -403 to -520 t antimony-eq. y(-1) This study analyses at great detail the collection phase. Outcomes provide specific operational recommendations to policy makers, showing the: (a) relevance of the choice of the materials forming the bags for 'door to door' collection (for non-recycled low-density polyethylene bags 22 kg CO2-eq (tonne of waste)(-1)); (b) relatively low environmental impacts associated with underground tanks (3.9 kg CO2-eq (tonne of waste)(-1)); (c) relatively low impact of big street containers with respect to plastic bags (2.6 kg CO2-eq. (tonne of waste)(-1)).

Environmental Behavior's Dirty Secret: The Prevalence of Waste Management in Discussions of Environmental Concern and Action

Humankind and the planet face many thorny environmentally related challenges that require a range of responses, including changing behaviors related to transportation, eating habits, purchasing, and myriad other aspects of life. Using data from a 1201-person survey and 14 Community Listening Sessions (CLSs), we explore people's perceptions of and actions taken to protect the environment. Our data indicate a striking prevalence of waste management-related actions. Survey respondents described actions and concerns related to trash, recycling, and composting as the most common environmental behaviors; similarly, participants in CLSs discussed waste-related topics, for which we did not prompt, as frequently as those topics for which we specifically prompted. Explanations for this prevalence emerging from the data include (1) the nature of waste-related behaviors (concrete, supported by infrastructure, simple, compatible with lifestyle); (2) norms and social dynamics (family interactions, feelings of belonging/participation, government policy); and (3) internal psychological processes (internalized norms and environmental concern). We also found that many waste-related discussions were relatively superficial, focusing on immediate waste-related issues (e.g., litter or recycling) rather than larger issues such as consumption. Our results may provide insight into future efforts to encourage pro-environmental behavior. Given that most pro-environmental behavior involves tasks more complex and lifestyle-changing than those related to simple aspects of waste management, we suggest focusing on the latter two intertwined categories that our data suggest are important: encouraging social dynamics and related development of norms concerning environmental behavior (category 2), and fostering internalized norms and environmental concern (category 3).

Nurses lead on waste reduction

Waste in the NHS accounts for about 20% of health expenditure. This article examines the literature on reducing waste, analyses some approaches to waste reduction, and identifies the role of nurses and other health professionals in developing a sustainable NHS.

A new large-volume metal reference standard for radioactive waste management

A new large-volume metal reference standard has been developed. The intended use is for calibration of free-release radioactivity measurement systems and is made up of cast iron tubes placed inside a box of the size of a Euro-pallet (80 × 120 cm). The tubes contain certified activity concentrations of (60)Co (0.290 ± 0.006 Bq g(-1)) and (110m)Ag (3.05 ± 0.09 Bq g(-1)) (reference date: 30 September 2013). They were produced using centrifugal casting from a smelt into which (60)Co was first added and then one piece of neutron irradiated silver wire was progressively diluted. The iron castings were machined to the desirable dimensions. The final material consists of 12 iron tubes of 20 cm outer diameter, 17.6 cm inner diameter, 40 cm length/height and 245.9 kg total mass. This paper describes the reference standard and the process of determining the reference activity values.

Expanding worldwide urban solid waste recycling: The Brazilian social technology in waste pickers inclusion

'If an integrated urban waste management system includes the informal recycling sector (IRS), there is a good chance that more solid waste is recycled' is common sense. However, informal integration brings additional social, environmental, and economic benefits, such as reduction of operational costs and environmental impacts of landfilling. Brazil is a global best practice example in terms of waste picker inclusion, and has received international recognition for its recycling levels. In addition to analysing the results of inclusive recycling approaches, this article evaluates a selection of the best Brazilian inclusive recycling practices and summaries and presents the resulting knowledge. The objective is to identify processes that enable the replication of the inclusion of the informal recycling sector model as part of municipal solid waste management. Qualitative and quantitative data have been collected in 25 Brazilian cities that have contracted waste pickers co-operatives for door-to-door selective collection of recyclables. Field data was collected in action research projects that worked with waste pickers co-operatives between 2006 and 2013. The Brazilian informal recycling sector integration model improves municipal solid waste recycling indicators: it shows an increase in the net tonness recycled, from 140 to 208 t month(-1), at a much lower cost per tonne than conventional selective collection systems. Inclusive systems show costs of US$35 per tonne of recyclables collected, well below the national average of US$195.26. This inclusive model improves the quality of collected material and the efficiency of municipal selective collection. It also diminishes the negative impacts of informal recycling, by reducing child labour, and by improving the conditions of work, occupational health and safety, and uncontrolled pollution. Although treating the Brazilian experience as a blueprint for transfer of experience in every case is unrealistic, the results suggest that this approach to informal sector integration can be considered among the global best practices for informal sector integration. The article closes with recommendations for deploying technology in other urban areas throughout the world.

Nonmedical Uses of Antibiotics: Time to Restrict Their Use?

The global crisis of antibiotic resistance has reached a point where, if action is not taken, human medicine will enter a postantibiotic world and simple injuries could once again be life threatening. New antibiotics are needed urgently, but better use of existing agents is just as important. More appropriate use of antibiotics in medicine is vital, but the extensive use of antibiotics outside medical settings is often overlooked. Antibiotics are commonly used in animal husbandry, bee-keeping, fish farming and other forms of aquaculture, ethanol production, horticulture, antifouling paints, food preservation, and domestically. This provides multiple opportunities for the selection and spread of antibiotic-resistant bacteria. Given the current crisis, it is vital that the nonmedical use of antibiotics is critically examined and that any nonessential use halted.

Review of extended producer responsibility: A case study approach

Principles of extended producer responsibility have been the core of most of the recent policies and legislation dealing with the end-of-life management of recyclable goods. This article makes an exploratory review of 27 cases of extended producer responsibility from developed and developing economies with and without informal recycling, to ascertain the most important aspect of extended producer responsibility. A comparative analysis of the cases with respect to role of stakeholders in the upstream and downstream stages of the extended producer responsibility has been carried out. Further, the study uses exploratory factor analysis to determine the important aspects of the extended producer responsibility in practice using 13 variables identified from the review. Findings of the comparative analysis reveal that financial responsibility of the producers and separate collecting and recycling agencies contributed significantly to the success of the extended producer responsibility-based environmental policies. Regulatory provisions, take-back responsibility and financial flow come out to be the three most important aspects of the extended producer responsibility. Presence of informal sector had a negative impact on the regulatory provisions. The outcomes of this study could serve as a guideline for designing of effective extended producer responsibility-based policies.

Rural domestic waste management in Zhejiang Province, China: Characteristics, current practices, and an improved strategy

Lack of access to adequate sanitation facilities has serious health implications for rural dwellers and can degrade the ecosystems. This study offers a systemantic and quantitative overview of historical data on rural domestic waste (RDW) production and past and current management practices in a prototype region in China, where rural areas are undergoing rapid urbanization and are confronted with great environmental challenges associated with poor RDW management practices. The results indicate that RDW is characterized with a large fraction of kitchen waste (42.9%) and high water content (53.4%). The RDW generation (RDWG) per capita between 2012 and 2020 is estimated to increase from 0.68 to 1.01 kg/d-cap. The Hill 1 model is able to adequately simulate/project the population growth in a rural area from 1993 to 2020. The annual RDWG in the region is estimated to double from 6,033,000 tons/year in 2008 to 12,030,000 tons/year by 2020. By comparing three RDW management scenarios based on the life-cycle inventory approach and cost-benefit analysis, it is strongly recommended that the present Scenario 2 (sanitary landfill treatment) be upgraded to Scenario 3 (source separation followed by composting and landfill of RDW) to significantly reduce the ecological footprint and to improve the cost-effectiveness and long-term sustainability.

IMPLICATIONS

Rural domestic waste (RDW) is affecting 720 million people in China and more than 3221 million people worldwide. Consequently, handling and disposal of RDW have serious health implications to rural dwellers and the ecosystems. This study offers a systemantic and quantitative overview and analysis of historical data on RDW production and management practices in a prototype region in China, which is confronted with great environmental challenges associated with RDW. Then we predict future production of RDW and propose a sustainable RDW management strategy, which holds the promise of greatly mitigating the mounting environmental pressure associated with RDW and provides science-based guidance for decision makers and practitioners for assuring rapid yet "green" economic development.

[Wastes in nursing practice: findings from a phenomenological study]

BACKGROUND

the International economic crisis has challenged the sustainability of health care systems imposing reforms aimed to reduce costs and increase production efficiency. At the international level, waste reduction is considered to be the basis to ensure the heath care systems sustainability. To reduce waste and increase production efficiency is required to document the types, the extent and the level were they occur. The purpose of this paper is to document the experience of waste in nurses clinical practice.

METHODS

a descriptive phenomenological study was conducted. Clinical nursing operating in different care settings of the National Heath Care Service were recruited adopting a maximum variation purposeful sampling. Data saturation was considered as the finish line for the participants recruitment.

RESULTS

thirty nurses participated in the study. They were mainly female (n = 28, 93.3%) and with an average age of 41.4 ± 7.3 years. For nurses waste means inadequate allocation of resources. Wastes are caused by individual and organizational choices determining improper, inefficient or ineffective use of material, human or virtual heath care resources and time as well as the incorrect application of clinical pathways, the inadequate use of electricity, food, and the improper disposal of the hospital waste. Wastes generates negative emotional impact on nurses such as frustration, anger and sense of impotence. Avoidable wastes were identified. They were mainly related to the expiration date, the use and the type of drugs and materials. Also unavoidable wastes were identified and they were related to established practices to ensure patients safety and changes in treatment choices due to the clinical instability of the patients.

CONCLUSION

within the limits of the qualitative approach, in this study have been identified different types of waste present in clinical practice as perceived by nurses. National Health Service policies could focus on this evidences to improve production efficiency. To involve health care professionals in the choices and their awareness to the conscious and responsible use of public resources available, would avoid linear cuts and enhancing such operators.

Municipal solid waste composition: sampling methodology, statistical analyses, and case study evaluation

Sound waste management and optimisation of resource recovery require reliable data on solid waste generation and composition. In the absence of standardised and commonly accepted waste characterisation methodologies, various approaches have been reported in literature. This limits both comparability and applicability of the results. In this study, a waste sampling and sorting methodology for efficient and statistically robust characterisation of solid waste was introduced. The methodology was applied to residual waste collected from 1442 households distributed among 10 individual sub-areas in three Danish municipalities (both single and multi-family house areas). In total 17 tonnes of waste were sorted into 10-50 waste fractions, organised according to a three-level (tiered approach) facilitating comparison of the waste data between individual sub-areas with different fractionation (waste from one municipality was sorted at "Level III", e.g. detailed, while the two others were sorted only at "Level I"). The results showed that residual household waste mainly contained food waste (42 ± 5%, mass per wet basis) and miscellaneous combustibles (18 ± 3%, mass per wet basis). The residual household waste generation rate in the study areas was 3-4 kg per person per week. Statistical analyses revealed that the waste composition was independent of variations in the waste generation rate. Both, waste composition and waste generation rates were statistically similar for each of the three municipalities. While the waste generation rates were similar for each of the two housing types (single-family and multi-family house areas), the individual percentage composition of food waste, paper, and glass was significantly different between the housing types. This indicates that housing type is a critical stratification parameter. Separating food leftovers from food packaging during manual sorting of the sampled waste did not have significant influence on the proportions of food waste and packaging materials, indicating that this step may not be required.