Medical waste: the dark side of healthcare.

Hospitals and other health facilities generate an ever-increasing amount of waste, approximately 15% of which may be infectious, toxic, or radioactive. The World Health Organization has been addressing the issue since the 1980s. After initially focusing on high-income countries, it then focused on low-income countries, with unsafe disposal methods in landfills and inadequate incinerators as major concerns. Gradually, the understanding of the issue has undergone several shifts, including from a focus on the component of medical waste considered "hazardous" to all forms of waste, and from accepting medical waste as a necessary downside of high-quality healthcare to seeing the avoidance of healthcare waste as a component of high quality healthcare.

Medical waste: the dark side of healthcare / Resíduo hospitalar: o lado sombrio da assistência médica

Abstract Hospitals and other health facilities generate an ever-increasing amount of waste, approximately 15% of which may be infectious, toxic, or radioactive. The World Health Organization has been addressing the issue since the 1980s. After initially focusing on high-income countries, it then focused on low-income countries, with unsafe disposal methods in landfills and inadequate incinerators as major concerns. Gradually, the understanding of the issue has undergone several shifts, including from a focus on the component of medical waste considered "hazardous" to all forms of waste, and from accepting medical waste as a necessary downside of high-quality healthcare to seeing the avoidance of healthcare waste as a component of high quality healthcare.

Resumo Hospitais e outros centros de tratamento de saúde geram um volume de resíduos cada vez maior, dos quais cerca de 15% podem ser infecciosos, tóxicos ou radioativos. A Organização Mundial da Saúde começou a enfrentar o problema na década de 1980. Inicialmente, concentrou-se nos países ricos, depois mudou o foco para os países pobres, onde métodos de eliminação inseguros, como aterros sanitários e incineradores inadequados, preocupavam. Aos poucos, a compreensão do problema passou por mudanças, inclusive do enfoque no conteúdo do resíduo hospitalar considerado "perigoso", passando para todas as formas de resíduos, e da aceitação do resíduo médico como um inconveniente inerente aos cuidados de saúde de alta qualidade, até o conceito de que evitar a produção de resíduos hospitalares faz parte dos cuidados de saúde de alta qualidade.

Investigating the complex story of one ditch-A multidisciplinary study of ditch infill provides insight into the spatial organisation within the oppidum of Bibracte (Burgundy, France).

Seemingly empty spaces in various archaeological settings have left many unanswered questions. This paper focuses on the appearance, maintenance and possible function of a large empty area situated at the summit plateau of the Iron Age oppidum Bibracte in France. Multidisciplinary research of the infill of the ditch that delimited this area in the 1st century BC has provided evidence on the primary function and the formation processes of the structure itself, and for the reconstruction of the appearance, maintenance and function of the area it enclosed. The results allow us to gain insight into a variety of topics, including the role of trees, hygiene measures and waste management strategies at this urbanised hilltop centre. This paper demonstrates that multi-proxy analyses provide detailed insight into the function of archaeological features in a local environmental context and the potential of such approaches in archaeology.

Two Paradigmatic Waves of Public Discourse on Nuclear Waste in the United States, 1945-2009: Understanding a Magnitudinal and Longitudinal Phenomenon in Anthropological Terms.

This project set out to illuminate the discursive existence of nuclear waste in American culture. Given the significant temporal dimension of the phenomenon as well as the challenging size of the United States setting, the project adapted key methodological elements of the sociocultural anthropology tradition and produced proxies for ethnographic fieldnotes and key informant interviews through sampling the digital archives of the New York Times over a 64-year period that starts with the first recorded occurrence of the notion of nuclear waste and ends with the conclusion of the presidency of George W. Bush. Two paradigmatic waves of American public discourse on nuclear waste come to light when subjecting this empirical data to quantitative inventorying and interpretive analysis: between 1945 and 1969 nuclear waste was generally framed in light of the beneficial utilizations of nuclear reactions and with optimistic expectations for a scientific/technological solution; by contrast, between 1969 and 2009 nuclear waste was conceptualized as inherited harm that could not be undone and contestation that required political/legal management. Besides this key finding and the empirical timing of the two paradigms, the study's value lies also with its detailed empirical documentation of nuclear waste in its sociocultural existence.

Instrumentation, control and automation in wastewater--from London 1973 to Narbonne 2013.

Key developments of instrumentation, control and automation (ICA) applications in wastewater systems during the past 40 years are highlighted in this paper. From the first ICA conference in 1973 through to today there has been a tremendous increase in the understanding of the processes, instrumentation, computer systems and control theory. However, many developments have not been addressed here, such as sewer control, drinking water treatment and water distribution control. It is hoped that this review can stimulate new attempts to more effectively apply control and automation in water systems in the coming years.

Public­private partnerships in solid waste management: sustainable development strategies for Brazil.

An often overlooked issue in the discussion of sustainable development is that of municipal solid waste management. Yet solid waste management is pervasive in all sustainable development objectives: its management, or lack thereof, can have major implications for the health of the environment, economy and society. This article argues the need for a governance dimension in the sustainability model, taking into account implementation strategies, monitoring and institutional controls. This focus heavily relies on integrated public­private partnerships and deliberative democracy approaches in order to achieve sustainability within the solid waste management sector. In this article, national and local policies in Brazil are analysed, primarily focusing on the inclusion of informal waste collection into municipal solid waste management schemes. The city of Curitiba, in the state of Paraná, which is world-renowned for its innovative sustainable development policies, is used to frame and illustrate the case.

Historical development and evolution of EPRI's post-closure dose assessment of potential releases to the biosphere from the proposed HLW repository at Yucca Mountain.

This paper describes the development and evolution of the Electric Power Research Institute's (EPRI) post-closure dose assessment for potential releases of radionuclides from the proposed High Level Waste repository at Yucca Mountain. The starting point for this work was the 1995 publication of Technical Bases for Yucca Mountain Standards by the Commission on Geosciences, Environment and Resources of the National Research Council. This report proposed the development and application of an individual risk-based standard for releases from the repository to replace the existing one, which was based on radionuclide release limits. This in turn implied the development and application of methods to assess radiation doses to humans. Accordingly, EPRI produced a methodology for such dose assessment as part of its Total System Performance Assessment program for the proposed Yucca Mountain repository site. The methodology initially addressed releases via groundwater and then releases associated with extrusive igneous events. The methodology was updated and applied over the following years to take account of regulatory developments, changes in estimates of the source term to the biosphere, peer review through international model comparison exercises, new site generic data, and new data concerning conditions at the point of compliance in Amargosa Valley. The main outputs were Biosphere Dose Conversion Factors, which relate radionuclide levels in environmental media to the annual individual doses to a member of a hypothetical critical group and to the regulator-defined Reasonably Maximally Exposed Individual. Most recently, consideration has been given to uncertainty in the dose estimates based on a probabilistic analysis. The paper provides a perspective on the evolution of the dose assessments in response to the developments listed above.

Beyond water, beyond boundaries: spaces of water management in the Krishna river basin, South India.

As demand and competition for water resources increase, the river basin has become the primary unit for water management and planning. While appealing in principle, practical implementation of river basin management and allocation has often been problematic. This paper examines the case of the Krishna basin in South India. It highlights that conflicts over basin water are embedded in a broad reality of planning and development where multiple scales of decisionmaking and non-water issues are at play. While this defines the river basin as a disputed "space of dependence", the river basin has yet to acquire a social reality. It is not yet a "space of engagement" in and for which multiple actors take actions. This explains the endurance of an interstate dispute over the sharing of the Krishna waters and sets limits to what can be achieved through further basin water allocation and adjudication mechanisms ­ tribunals ­ that are too narrowly defined. There is a need to extend the domain of negotiation from that of a single river basin to multiple scales and to non-water sectors. Institutional arrangements for basin management need to internalise the political spaces of the Indian polity: the states and the panchayats. This re-scaling process is more likely to shape the river basin as a space of engagement in which partial agreements can be iteratively renegotiated, and constitute a promising alternative to the current interstate stalemate.

Radioactive waste management in the Chernobyl exclusion zone: 25 years since the Chernobyl nuclear power plant accident.

Radioactive waste management is an important component of the Chernobyl Nuclear Power Plant accident mitigation and remediation activities in the so-called Chernobyl Exclusion Zone. This article describes the localization and characteristics of the radioactive waste present in the Chernobyl Exclusion Zone and summarizes the pathways and strategy for handling the radioactive waste-related problems in Ukraine and the Chernobyl Exclusion Zone and, in particular, the pathways and strategies stipulated by the National Radioactive Waste Management Program.

Enhancing livelihoods and the urban environment: the local political framework for integrated organic waste management in Diadema, Brazil.

Drawing on a participatory study of integrated organic waste management, this article explores the local political barriers and preconditions for its implementation in Diadema, Brazil. Solid waste management in Brazil is embedded in and mediated by a political framework that is characterised by uneven power geometries. This article explores how the local political context affects the potential for integrated organic waste management in Diadema, paying particular attention to relations between stakeholders. The discussion addresses the contested nature of deliberative decision-making spaces and the need for pro-active socio-environmental policies. The findings underline the importance of a praxis of everyday public participation that goes beyond rhetoric.

Resource management as a key factor for sustainable urban planning.

Due to fast urbanization and increasing living standards, the environmental sustainability of our global society becomes more and more questionable. In this historical review we investigate the role of resources management (RM) and urban planning (UP) and propose ways for integration in sustainable development (SD). RM follows the principle of circular causation, and we reflect on to what extent RM has been an element for urban planning. Since the existence of the first settlements, a close relationship between RM, urbanization and technological development has been present. RM followed the demand for urban resources like water, energy, and food. In history, RM has been fostered by innovation and technology developments and has driven population growth and urbanization. Recent massive resource demand, especially in relation to energy and material flows, has altered natural ecosystems and has resulted in environmental degradation. UP has developed separately in response to different questions. UP followed the demand for improved living conditions, often associated to safety, good manufacturing and trading conditions and appropriate sanitation and waste management. In history UP has been a developing research area, especially since the industrial era and the related strong urbanization at the end of the 18th century. UP responded to new emerging problems in urban areas and became increasingly complex. Nowadays, UP has to address many objectives that are often conflicting, including, the urban sustainability. Our current urban un-sustainability is rooted in massive resource consumption and waste production beyond natural limits, and the absence of flows from waste to resources. Therefore, sustainable urban development requires integration of RM into UP. We propose new ways to this integration.

GHGs emissions from waste disposal in Lombardia (Italy): inventory 1975-2008 and projections 2009-2020.

A survey has been conducted across all MSW landfills with gas extraction system in the Lombardia Region (Italy) in order to collect data for an emission inventory assessment of greenhouse gas (GHG) emissions in the timeframe 1975-2008. The survey results identified a large number of landfills opened over the last 35 years and characterized by different kinds and amounts of waste disposed. Using the IPCC methodology, GHG emissions in the year 2008 were quantified to be 1.81 Mt CO(2)-eq, which corresponds to 1.9% of overall GHG emissions in Lombardia. A dependency between collection efficiency and age of the collecting network has been established and used for the projection of GHG emission in the period 2009-2020, and for two scenarios: a business as usual (BAU) and an alternative one that implies policies to reduce biodegradable carbon content in the residual waste. The latter allows for a 45% reduction of the GHG emissions in 2020 compared to the year 2008, whereas in the BAU scenario the expected reduction is 32%. The sensitivity analysis shows that a variation of parameters that represent the carbon content of the waste category and degradation rate constant, within the range reported in the literature, could affect GHG emission level by about ±18%, whereas the uncertainty due to landfill gas (LFG) composition is less relevant.

Wastewater management through the ages: a history of mankind.

Although much has been written about the history of water supply systems, there is a lack of corresponding information on wastewater management. This is surprising since the lack of sanitation affects human development to the same or even greater extent as the lack of clean water. While there may be an added stigma to discussing waste treatment, sanitation is widely perceived as meriting a significant claim on financial and political resources as well on the evolution of mankind. A literature review is presented on the evolution of wastewater management through the ages and its concurrent impact on human health and environment. Hopefully this information will improve the awareness of the past with a view to impacting future policies and technical developments. The review highlights the connection of environmental contamination with the ability to measure it, as well as the ways pollution control has been changed by advances in scientific knowledge. Attention is also drawn to the effects of political and societal events on wastewater management. A sanitation timeline has been constructed pointing out significant developments in the treatment of wastewater and improvements in analytical environmental chemistry. This review has been written in the belief that historical research showing the collective experience and "philosophy of sanitation" can provide inspiration to face future challenges.

Terra Preta sanitation: re-discovered from an ancient Amazonian civilisation - integrating sanitation, bio-waste management and agriculture.

The recent discovery of the bio-waste and excreta treatment of a former civilisation in the Amazon reveals the possibility of a highly efficient and simple sanitation system. With the end product that was black soil they converted 10% of former infertile soil of the region: Terra Preta do Indio (black soil of the Indians). These soils are still very fertile 500 years after this civilisation had disappeared. Deriving from these concepts, Terra Preta Sanitation (TPS) has been re-developed and adopted. TPS includes urine diversion, addition of a charcoal mixture and is based on lactic-acid-fermentation with subsequent vermicomposting. No water, ventilation or external energy is required. Natural formation processes are employed to transform excreta into lasting fertile soil that can be utilised in urban agriculture. The authors studied the lacto-fermentation of faecal matter with a minimum of 4 weeks followed by vermicomposting. The results showed that lactic-acid fermentation with addition of a charcoal mixture is a suitable option for dry toilets as the container can be closed after usage. Hardly any odour occured even after periods of several weeks. Lactic-acid fermentation alone without addition of bulking agents such as paper and sliced-cut wood to raise the C/N ratio is creating a substrate that is not accepted by worms.