Life cycle assessment of biowaste and green waste composting systems: A review of applications and implementation challenges.

Composting is one of the most widely applied methods for recycling organic waste. This process has been proposed as one option that facilitates the reincorporation of materials into the production cycle. However, composting also generates environmental impacts. Life Cycle Assessment (LCA) is the most common approach to evaluate the environmental impacts of a process at different system stages. Nevertheless, applying LCA in composting facilities is challenging due to the extensive information required, the lack of standardization on the initial assumptions, the definition of system boundaries, and the high diversity of existing composting technologies. This paper systematically reviews LCA studies in biowaste and/or green waste composting. The study highlights the challenges that should be met in order to improving the application of LCA to evaluate the environmental impacts of this type or waste treatment strategy. The review protocol used identified 456 papers published between 2010 and 2022. After the screening, 56 papers were selected, read, and thoroughly analyzed. The results show that: i) about 68% of the studies aimed to compare composting with other solid waste management options; ii) there was a wide diversity among the impact categories considered, which predominantly included climate change and ozone depletion; iii) there was no consensus on the functional unit or the system boundaries; iv) the main gaseous emissions studied were ammonia, methane, and nitrogen oxide, which were generally determined by emission factors; v) the avoided environmental impacts associated with the end-product quality and its application as an organic amendment or soil improver were ignored. This work demonstrates the complexity of conducting credible and valid composting LCA studies and proposes seven recommendations for improving the application of this assessment methodology to analyze this waste management alternative.

A systematic review on the composting of green waste: Feedstock quality and optimization strategies.

Green waste (GW) is an important fraction of municipal solid waste (MSW). The composting of lignocellulosic GW is challenging due to its low decomposition rate. Recently, an increasing number of studies that include strategies to optimize GW composting appeared in the literature. This literature review focuses on the physicochemical quality of GW and on the effect of strategies used to improve the process and product quality. A systematic search was carried out, using keywords, and 447 papers published between 2002 and 2018 were identified. After a screening process, 41 papers addressing feedstock quality and 32 papers on optimization strategies were selected to be reviewed and analyzed in detail. The GW composition is highly variable due to the diversity of the source materials, the type of vegetation, and climatic conditions. This variability limits a strict categorization of the GW physicochemical characteristics. However, this research established that the predominant features of GW are a C/N ratio higher than 25, a deficit in important nutrients, namely nitrogen (0.5-1.5% db), phosphorous (0.1-0.2% db) and potassium (0.4-0.8% db) and a high content of recalcitrant organic compounds (e.g. lignin). The promising strategies to improve composting of GW were: i) GW particle size reduction (e.g. shredding and separation of GW fractions); ii) addition of energy amendments (e.g. non-refined sugar, phosphate rock, food waste, volatile ashes), bulking materials (e.g. biocarbon, wood chips), or microbial inoculum (e.g. fungal consortia); and iii) variations in operating parameters (aeration, temperature, and two-phase composting). These alternatives have successfully led to the reduction of process length and have managed to transform recalcitrant substances to a high-quality end-product.

A systematic approach to evaluate parameter consistency in the inlet stream of source separated biowaste composting facilities: A case study in Colombia.

Biowaste is commonly the largest fraction of municipal solid waste (MSW) in developing countries. Although composting is an effective method to treat source separated biowaste (SSB), there are certain limitations in terms of operation, partly due to insufficient control to the variability of SSB quality, which affects process kinetics and product quality. This study assesses the variability of the SSB physicochemical quality in a composting facility located in a small town of Colombia, in which SSB collection was performed twice a week. Likewise, the influence of the SSB physicochemical variability on the variability of compost parameters was assessed. Parametric and non-parametric tests (i.e. Student's t-test and the Mann-Whitney test) showed no significant differences in the quality parameters of SSB among collection days, and therefore, it was unnecessary to establish specific operation and maintenance regulations for each collection day. Significant variability was found in eight of the twelve quality parameters analyzed in the inlet stream, with corresponding coefficients of variation (CV) higher than 23%. The CVs for the eight parameters analyzed in the final compost (i.e. pH, moisture, total organic carbon, total nitrogen, C/N ratio, total phosphorus, total potassium and ash) ranged from 9.6% to 49.4%, with significant variations in five of those parameters (CV>20%). The above indicate that variability in the inlet stream can affect the variability of the end-product. Results suggest the need to consider variability of the inlet stream in the performance of composting facilities to achieve a compost of consistent quality.

Stability and maturity of biowaste composts derived by small municipalities: Correlation among physical, chemical and biological indices.

Stability and maturity are important criteria to guarantee the quality of a compost that is applied to agriculture or used as amendment in degraded soils. Although different techniques exist to evaluate stability and maturity, the application of laboratory tests in municipalities in developing countries can be limited due to cost and application complexities. In the composting facilities of such places, some classical low cost on-site tests to monitor the composting process are usually implemented; however, such tests do not necessarily clearly identify conditions of stability and maturity. In this article, we have applied and compared results of stability and maturity tests that can be easily employed on site (i.e. temperature, pH, moisture, electrical conductivity [EC], odor and color), and of tests that require more complex laboratory techniques (volatile solids, C/N ratio, self-heating, respirometric index, germination index [GI]). The evaluation of the above was performed in the field scale using 2 piles of biowaste applied compost. The monitoring period was from day 70 to day 190 of the process. Results showed that the low-cost tests traditionally employed to monitor the composting process on-site, such as temperature, color and moisture, do not provide consistent determinations with the more complex laboratory tests used to assess stability (e.g. respiration index, self-heating, volatile solids). In the case of maturity tests (GI, pH, EC), both the on-site tests (pH, EC) and the laboratory test (GI) provided consistent results. Although, stability was indicated for most of the samples, the maturity tests indicated that products were consistently immature. Thus, a stable product is not necessarily mature. Conclusively, the decision on the quality of the compost in the installations located in developing countries requires the simultaneous use of a combination of tests that are performed both in the laboratory and on-site.

Abordaje transesternal transpericárdico para cierre de fístula del muñón bronquial post neumonectomía / Trans-sternal, trans-pericardial approach for closure of post-pneumonectomy bronchial stump de hiscence

La fistula del muñón bronquial es una seria complicación de la neumonectomía, por su complejidad tanto en los cambios anatomofisiológicos que el paciente experimenta, como en la diversidad de recursos para su resolución. El objetivo de este estudio es la presentación de este primer caso en la historia quirúrgica del país de abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial post neumonectomía en el Hospital San Vicente en Guatemala. Método: Se presenta el caso de una paciente de sexo femenino a quien se le realizó neumonectomía derecha por tuberculosis pulmonar y que presentó dehiscencia del muñón bronquial por lo que se procedió a realizar abordaje transesternal transpericárdico para el cierre del muñón bronquial a nivel de la Carina. Resultados: Se da seguimiento a la paciente por 8 años tras los cuales el problema se considera resuelto. Conclusión: la utilización del abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial postneumonectomía permite alcanzar el bronquio en un ambiente no contaminado debiendo considerarse como un procedimiento adecuado para resolver este tipo de complicación.

Background: Bronchial stump fstula is a serious complicaton of pneumonectomy. The aim of this case report is to document the frst surgical patenttreated with trans-sternal, trans-pericardial approach for bronchial stump fstula closing afer pneumonectomy at San Vicente Hospital in Guatemala.Methods: A female patent who underwent right pneumonectomy for pulmonary tuberculosis with postoperatve bronchial stump dehiscence.Trans-sternal trans-pericardial approach was performed for closing the bronchial stump fstula at the carina.Results: Afer 8 years of follow up, the problem in the patent had completely resolved.Conclusion: Trans-pericardial trans-sternal approach for bronchial stump fstula closing allows bronchium access in a non-contaminated space andshould be considered to resolve this kind of complicaton.

Hookworm in rural Spain, 1910-1960: shifting paradigms around the Civil War.

BACKGROUND: In Spain, hookworm was first recognised as a miners' disease, becoming the goal of one of the most successful interventions in public health from 1912 to 1931. Hookworm also played a part in the growing interest in rural health problems that peaked during the Republican period (1931-6). The aim of this study was to compare the rationale and content of public health interventions against rural hookworm in Spain before the Civil War (1936-9) with those of interventions after the war. METHODS: Review of published and unpublished documents on hookworm produced by individual physicians and public health officials in the first half of the 20th century. RESULTS: Rural hookworm foci detected in pre-war years were explained in terms of the geographical and human environment and largely attributed to poor working and living conditions, prompting specific health campaigns. New rural foci were detected after the war, but this time the health administration did not intervene. Understanding of the disease changed, its impact on reproduction was highlighted and medical explanations pointed to the negative moral conditions of peasants rather than social issues. CONCLUSION: Civil War brought rupture and continuity to the public health domain. Although the Francoist health administration preserved similar organisation patterns, its practice was governed by different priorities. Moral and even religious positions provided a rationale for what had been previously explained in social and environmental terms. This approach, together with the perception of hookworm as evidence of backwardness, led to official neglect of the condition, which was still prevalent in some rural areas.

Proteína C reactiva como factor pronóstico de mortalidad en los aneurismas de aorta abdominal rotos / C-reactive protein as a prognostic factor for mortality in ruptures abdominal aortic aneurysms

Objetivo. Determinar si el valor plasmático preoperatorio de diversos marcadores biológicos de inflamación –proteína C reactiva (PCR), leucocitos y fibrinógeno– se asocia a la mortalidad de los pacientes con rotura de aneurisma de aorta abdominal (AAA). Pacientes y métodos. Estudio prospectivo de 37 pacientes intervenidos quirúrgicamente de AAA roto. Se extrajo una muestra de sangre periférica a cada uno de ellos para el estudio preoperatorio de los biomarcadores de inflamación. Además, se recogieron datos correspondientes a variables clínicas pre, intra y postoperatorias. Para el análisis de los valores plasmáticos de PCR se utilizó un test convencional (Tina-Quant). Resultados. De los marcadores biológicos de inflamación estudiados, sólo la PCR fue un factor pronóstico de mortalidad perioperatoria, y la mediana fue significativamente superior en los fallecidos en comparación con los supervivientes (p=0,021). Se categorizó la PCR en dos grupos con la utilización como punto de corte el valor obtenido en la curva ROC (3,2 mg/dL) para la máxima sensibilidad y especificidad de esta variable con relación a la mortalidad. Los pacientes cuya PCR al ingreso fue >=3,2 mg/dL tuvieron una mortalidad significativamente mayor que aquellos cuya cifra era < 3,2 mg/dL (71 frente a 10%) (p=0,002). En el análisis multivariante, las variables pronósticas de mortalidad fueron: valor preoperatorio de PCR, duración del pinzamiento aórtico e inestabilidad hemodinámica durante la intervención. Conclusiones. La elevación de la PCR preoperatoria es un factor pronóstico de mortalidad en los AAA rotos, por lo que puede ser, junto a otros factores previamente identificados, útil para la estratificación del riesgo quirúrgico de estos pacientes

Aim. To determine whether the preoperative plasma values of several biological markers of inflammation –C-reactive protein (CRP), leukocytes and fibrinogen– are linked with the mortality of patients with a ruptured abdominal aortic aneurysm (AAA). Patients and methods. We performed a prospective study of 37 patients who had undergone surgery to treat a ruptured AAA. A peripheral blood sample was taken from each of the patients for use in the preoperative study of biomarkers of inflammation. Additionally, data concerning pre, intra and postoperative clinical variables were also collected. A conventional (Tina-Quant) test was used to analyse the CRP values in plasma. Results. Of the biological markers of inflammation studied, only CRP was a prognostic factor for perioperative mortality, and the mean was significantly higher in those who died than in survivors (p=0.021). CRP was categorised in two groups using a cut-off point taken as the value obtained from the ROC curve (3.2 mg/dL) for the maximum sensitivity and specificity of this variable in relation to mortality. Mortality among patients with a CRP on admission >=3.2 mg/dL was significantly higher than among those with a figure < 3.2 mg/dL (71 versus 10%) (p=0.002). In the multivariate analysis, the prognostic variables for mortality were: preoperative CRP value, duration of aortic clamping and haemodynamic instability during the intervention. Conclusions. Elevation of preoperative CRP levels is a prognostic factor for mortality in ruptured AAA, which means that, together with other previously identified factors, it may be useful for the stratification of surgical risk in these patients

The birth of the anti-malaria campaign in Spain during the first 30 years of the 20th century: scientific and social aspects.

The relations between the scientific and the social domains in the particular case of malaria had developed at three levels. The first one operates around the transformation of malaria into an escapable disease and the combined efforts of parasitology and entomology are mixed with the growing development of the concept of social medicine. The second one deals with the rhythm and the content of the measures taken to fight the disease in each concerned country; in that case, very peculiar site-time coordinates ask precise questions. At the same level can be placed the differences in the campaigns led against malaria in colonies and in the mainland, differences that it would be misleading to approach on the sole side of social determinism. Finally the third level corresponds to the complexity of the relationships between the international and the local domains, as present from the birth of "Office International d'Hygiène de la Société des Nations" and the involvement of the Rockefeller Foundation where two strategic positions can be detected opposing people minoring problems and those seeking for eradication, who indeed were opponents at the level of the scientific direction, but also originate within the socio-professional boundary of the members of each group, respectively.

Chronic kidney disease in renal transplant recipients.

UNLABELLED: The aim of the present study was to investigate the utility in renal transplant patients of the guidelines for the diagnosis and classification of chronic kidney disease (CKD) based on the estimated glomerular filtration rate (GFR) elaborated by the Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney Foundation. PATIENTS AND METHODS: Four hundred forty-seven cadaveric kidney transplants performed between 1980 and 1994 with graft function at 12 months were included in the study. The GFR was calculated according to the MDRD equation. RESULTS: The mean GFR at 12 months was 54.5 +/- 20.3 mL/min/1.73 m(2): 23 patients (5.1%) had a GFR > or =90 mL/min/1.73 m(2); 136 patients (30.6%), 60-89; 246 (54.7%), 30-59; 35 patients (7.8%), 15-29; and 7 patients (1.6%), GFR <15. Similar distribution of CKD stages was observed at 5 and 10 years. Unadjusted graft survival at 10 years was better among patients with a higher GFR at 12 months: 87% in patients with GFR >90 mL/min/1.73 m(2); 83% of GFR 60-89 mL/min/1.73 m(2); 63%, GFR 30-59 mL/min/1.73 m(2); and 23%, GFR <30 mL/min/1.73 m(2) (P < .001). The association between GFR and graft survival persisted when adjusted by the age and gender of the recipients and donors, time on dialysis, body mass index, immunosuppression, delayed graft function, rejection, and HLA mismatches. The prevalence of complications, such as anemia, hypertension, dyslipidemias, and number of drugs increased as GFR declined. CONCLUSIONS: More than 60% of recipients presented chronic kidney disease. GFR was a predictive factor for graft survival at 10 years. The classification of renal transplant patients by CKD stages may help to identify patients with increased risk of graft loss and also to design strategies to improve outcomes.

History of health, a valuable tool in public health.

The aim of this article is to highlight the importance of the history of public health for public health research and practice itself. After summarily reviewing the current great vitality of the history of collective health oriented initiatives, we explain three particular features of the historical vantage point in public health, namely the importance of the context, the relevance of a diachronic attitude and the critical perspective. In order to illustrate those three topics, we bring up examples taken from three centuries of fight against malaria, the so called "re-emerging diseases" and the 1918 influenza epidemic. The historical approach enriches our critical perception of the social effects of initiatives undertaken in the name of public health, shows the shortcomings of public health interventions based on single factors and asks for a wider time scope in the assessment of current problems. The use of a historical perspective to examine the plurality of determinants in any particular health condition will help to solve the longlasting debate on the primacy of individual versus population factors, which has been particularly intense in recent times.

Social history of medicine in Spain: points of departure and directions for research.

The development and extension of activities in the domain of die social history of medicine in Spain since the 1960s is reviewed. Attention is paid, first, to the institutional setting and theoretical background of this broad line of research, taking the perspective of the professionalization of the subject of the 'history of medicine' as an under-graduate discipline in the syllabus of the Faculties of Medicine. Secondly, four main directions for research are outlined, namely disease and society, health policies, health professions and gender and medicine, including critical attention to the principal works, active authors, and working and narrative styles.

[Professionalization of physicians and health campaigns in twentieth-century Spain]. / Profesionalización médica y campañas sanitarias en la España del siglo XX.

In this study we analyze the confluence of two processes that characterized the medical profession in Spain during the first third of the twentieth century. Health campaigns provided a formula for strengthening the interests of the professional collective by defining the demand for specific medical services, and consolidating the institutionalization of new areas of medicine, thus justifying their existence on a scientific basis. In addition, these health campaigns, to a great extent, based their propositions on the reputation of the specialist. We analyze two historical cases: the fight against infant mortality and the fight against cancer; the contributions of these two campaigns to the opening of a market for new specialist services, the role of technology, and processes of negotiation with other branches of medicine to guarantee a monopoly in providing treatment are examined.

The making of Spanish public health administration during the first third of the twentieth century.

An overview of the forming of the modern Health Administration in Spain is intended, trying to relate proposals with day to day realities. Starting with the dissection of elements that suggested the sanitary backwardness of Spain to contemporary observers, this paper traces the actual program to modernization in public health services through the analysis of the political action led by an élite of doctors and public health administrators, who happened to be at the same time relevant political figures of the dynastic parties, the legal framework of reform (the General Decree of Health, 1904) and the institutional changes in the provisions for public health surveillance; these are labelled "from the Health Boards to the Institutes of Hygiene", symbolizing the moving away from a traditional, pluri-composed and political instance, the Health Board, where experts performed just as advisers, to a new, scientific based and professionally managed institution which, under the Second Republic, extended its benefits to the rural population. The lack of practical effects of these public health reforms led us to conclude that they were suggested more to extend professional areas of competence as well as part of conciliatory policies regarding the "social question".

[The crusade for health: sanitary campaigns of the first third of the 20th century in the construction of the culture of health]. / La cruzada por la salud. Las campañas sanitarias del primer tercio del siglo XX en la construcción de la cultura de la salud.

From the clarification of the origin and historical development of two of the most impressive health campaigns of the first third of the twentieth century, those against tuberculosis and to prevent infant mortality, an evaluation is sought from a long range view. Their contribution to the modern configuration of health as well as to the genesis of several regular traits of today's community and family medicine are pointed out.

[Space for the sick, space for physicians: hospital planning in Spain from the 18th to the 20 centuries]. / Lugar de enfermos, lugar de médicos. La consideración del hospital en la medicina española, siglos XVIII-XX.

The process of hospitals' evolution into the core of the spanish health system is studied both through a historiographical review and through primary sources. The resulting image is far from a straight one, and we assert that criticisms from the late Enlightenment, which do not preclude a previous age of bloom, prevailed during the first half of the nineteenth century, while the second half saw a contradictory reassessment of hospitals as professional health institutions.

[Morbidity and mortality from the cholera epidemic of 1833-1835 in Andalusia]. / Morbimortalidad del colera epidemico de 1833-35 en Andalucia.

PIP: The author examines the demographic impact of the Asiatic cholera epidemic from 1833 to 1835 in Andalusia, Spain, using archival medical reports. Data on mortality by region, sex, and age are included, and some worldwide comparisons among cities that experienced the 1830s epidemic are made.^ieng