PEG-lipid-modified agonistic antibody against tumor necrosis factor receptor family elicits superior apoptosis-inducing activity against human carcinoma.

We have recently developed a novel PEG-lipid-modified antibody to enhance the induction of apoptosis by the agonistic antibody. The chemically modified TRA-8 antibody [anti-death receptor 5 (DR5) antibody] with PEG-lipid (DSPE-PEG) demonstrated significant cytotoxic activity in vitro without the need for crosslinking with a secondary antibody, which is typically required. We investigated the correlation between the PEG-lipid structure and the cytotoxic activity of the modified antibodies by varying the PEG length or lipid structure. However, when the DSPE-PEG-modified TRA-8 antibody was incubated with plasma, it lost its cytotoxic activity, likely due to degradation in the DSPE-PEG component. Nevertheless, by designing new PEG-lipids that are intended to be resistant to enzymatic degradation, we were able to prevent this degradation and restore the cytotoxic activity of the modified antibody. These findings provide valuable insights for the design of PEG-lipid-modified antibodies and suggest their potential effectiveness in enhancing cancer therapy.

Factors influencing the continuation of home blood pressure measurement in community-dwelling older adults: the NOSE study.

OBJECTIVE: This study aimed to identify the factors influencing home blood pressure measurement (HBPM) continuation in community-dwelling older adults. METHODS: A longitudinal analysis used the NOSE study intervention group datasets. The participants were encouraged HBPM with self-monitoring devices provided to them twice in the morning and twice in the evening. Every 7-day interval from the HBPM start date was defined as 1 week, and the number of HBPMs per week was counted. The first week in which the number of HBPMs was zero was defined as the week in which HBPM was discontinued. Participants who did not experienced discontinuation until the end of the observation period were considered complete survivors in the survival time analysis. RESULTS: Data from 437 participants were included in the analysis. Of these, 120 (27.5%) discontinued HBPM. In univariate analysis, factors significantly associated with HBPM discontinuation included exercise habits [hazard ratio per one unit 0.47; 95% confidence interval (CI) 0.31-0.69], social participation (hazard ratio 0.65; 95% CI 0.42-0.99), MoCA-J score (hazard ratio 0.94; 95% CI 0.90-0.98), and frailty (hazard ratio 5.20; 95% CI 2.87-9.43). In multivariate analysis, factors significantly associated with HBPM discontinuation included sex (hazard ratio 0.55; 95% CI 0.32-0.95; ref. = female individuals), smoking history (hazard ratio 1.69; 95% CI 1.02-2.80), exercise habits (hazard ratio 0.51; 95% CI 0.30-0.85), MoCA-J score (hazard ratio 0.93; 95% CI 0.88-0.98), and frailty (hazard ratio 3.31; 95% CI 1.50-7.29). CONCLUSION: Among community-dwelling older adults, female sex, smoking history, lack of exercise, cognitive decline, and frailty were identified as factors influencing HBPM discontinuation.

Stealth Omicron: A Novel SARS-CoV-2 Variant That Is Insensitive to RT-qPCR Using the N1 and N2 Primer-Probes.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that is causing a worldwide pandemic since the spring of 2020. In Osaka, the second biggest prefecture in Japan, we identified a novel SARS-CoV-2 variant from a coronavirus disease 2019 (COVID-19) patient that was detected by polymerase chain reaction (PCR) using E primers, but not by real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) using the N1 and N2 primer-probe sets recommended by CDC. We analyzed the S and N gene regions by reverse-transcription and nested PCR using the S and N specific primers, and DNA sequencing, and found that this BA.5 variant contained point mutations in the probe sequences of both the N1 and N2 primer-probe regions. This finding led us to affirm the importance of monitoring the genome sequence of the SARS-CoV-2 variants continuously.

Successful Total Management of Multi-Causative Sleep-Disordered Breathing Complicated with Patient with Adult Congenital Heart Disease.

Sleep-disordered breathing is one of the complications commonly seen in patients with adult congenital heart disease (ACHD) due to multiple causes including complex underlying cardiac defects, cardiomegaly, previous thoracotomies, obesity, scoliosis, and paralysis of the diaphragm. It is often hard to determine its main cause and predict the efficacy of each treatment in its management. We herein report a 30-year-old woman after biventricular repair of pulmonary atresia with intact ventricular septum diagnosed as sleep-related hypoventilation disorder. Simultaneous treatment targeting obesity, paralysis of the diaphragm, and cardiomegaly followed by respiratory muscle reinforcement through non-invasive ventilation resolved her sleep-related hypoventilation disorder. Such management for each factor responsible for the hypoventilation is expected to provide synergetic therapeutic efficacy and increase daily activity in a patient with ACHD.

Review of engagement activities to promote awareness of radiation and its associated risk amongst the Japanese public before and after the Fukushima Daiichi Nuclear Power Plant accident.

Following the Fukushima Daiichi Nuclear Power Plant accident in 2011, many radiation experts directly experienced a vast gap between ideal and real public understanding (PU) of radiation in risk communication. Therefore, this study collated and reviewed information about PU activities for radiation and its risk that six Japanese academic societies-which seem to be socially neutral expert communities-related to radiation and radiation risk conducted before and after the accident. Activities these radiation-related societies provided to the general public were discussed from the following perspectives: (a) difficulties in two-way communication due to resources, motivation and public interest and concerns; (b) balance between academic research and PU activities; (c) academic societies' building trust with the public while ensuring member experts' neutrality and independence; and (d) discussions among academic societies to prepare for public engagement. We hope that this paper encourages experts and academic societies in radiation protection to hold more national and international discussions about their roles in public communication and outreach.

Clinical COVID-19 diagnostic methods: Comparison of reverse transcription loop-mediated isothermal amplification (RT-LAMP) and quantitative RT-PCR (qRT-PCR).

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is a major public health concern. Accurate and rapid diagnosis of COVID-19 is critical for disease control. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) is a nucleic acid amplification assay similar to reverse transcription-polymerase chain reaction (RT-PCR), the former being a simple, low cost, and rapid method. OBJECTIVES: This study aimed to compare the RT-LAMP assay with RT-PCR using the Loopamp™ SARS-CoV-2 Detection Kit. STUDY DESIGN: One hundred and fifty-one nasopharyngeal swab and 88 sputum samples obtained from individuals with suspected or confirmed COVID-19 were examined. RESULTS: RT-LAMP had high specificity (98.5 % (95 % CI: 96.9-100 %)), sensitivity (87.0 % (95 % CI: 82.8-91.3 %)), positive predictive value (97.9 % (95 % CI: 96.1-99.7 %)), negative predictive value (90.2 % (95 % CI: 86.4-94.0 %)), and concordance rate (93.3 % (95 % CI: 90.1-96.5 %)). Nasopharyngeal and sputum samples positive in RT-LAMP contained as few as 10.2 and 23.4 copies per 10 µL, respectively. RT-LAMP showed similar performance to RT-PCR for samples with cycle threshold value below 36. CONCLUSIONS: These results indicate that RT-LAMP is a highly reliable and at least equivalent to RT-PCR in utility, and potentially applicable in settings that are more diverse as a point-of-care tool.

Significance of Pre-treatment Interferon-gamma Release in Patients With Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitors.

BACKGROUND/AIM: We retrospectively investigated the significance of pre-treatment interferon-gamma release (IGR) as a biomarker for predicting the efficacy of immune checkpoint inhibitor treatment (ICI-tx). PATIENTS AND METHODS: This study included non-small-cell lung cancer patients who received ICI-tx between January 1, 2016 and April 30, 2019. IGR was measured using the positive control of an enzyme-linked immunosorbent assay. We defined the pre-treatment cut-off level of IGR as 10 IU/ml. RESULTS: Fifty-four patients were divided into two groups; those with an IGR ≤10 IU/ml (lower group: LG) (n=15) and those with >10 IU/ml (higher group: HG) (n=39). The time to treatment failure (TTF) in the HG was significantly longer than that in the LG. In multivariate analyses, C-reactive protein and IGR levels were significant risk factors for TTF. CONCLUSION: Pre-treatment IGR level of >10 IU/ml is recommended to identify those patients who will respond favourably to ICI-tx.

The ADVIA2120i parameter Revised %MICRO is a surrogate marker of schistocyte formation after hematopoietic stem cell transplantation.

Objectives : Hematopoietic stem cell transplantation (HSCT)-associated thrombotic microangiopathy (TA-TMA) is an important early post-treatment condition. This study evaluated the Revised %MICRO, a parameter obtained from the ADVIA 2120i automated blood cell counter, as a surrogate marker of the schistocyte ratio. We hypothesized that individual differences between the %MICRO value and schistocyte ratio would remain constant. Design and Methods: EDTA-2K-treated peripheral blood samples were collected from 19 patients who underwent allogeneic HSCT from April 2014 to September 2018. First, the baseline difference, X, was calculated using a sample from the first day after HSCT as X = %MICRO (first day) - schistocyte ratio (first day). Next, the Revised %MICRO for each subsequent day was calculated as Revised %MICRO = %MICRO - X. We evaluated correlations of the schistocyte ratio with the calculated %MICRO and Revised %MICRO and the RBC fragment, RBC distribution width, %MICRO and Revised %MICRO data obtained from the ADVIA 2120i. Results : The mean schistocyte percentage and Revised %MICRO were both 0.4% ±â€…0.6. RBC fragments correlated weakly with the %MICRO and schistocyte ratio, respectively (r = 0.162 and r = 0.771, respectively), whereas the Revised %MICRO correlated strongly with the schistocyte ratio (r = 0.893). Conclusion : The Revised %MICRO appears to be a good surrogate of the schistocyte ratio in a clinical setting. J. Med. Invest. 67 : 250-254, August, 2020.

Significance of Quantitative Interferon-gamma Levels in Non-small-cell Lung Cancer Patients' Response to Immune Checkpoint Inhibitors.

BACKGROUND/AIM: We aimed to study the association between the quantitative interferon-gamma (IFN-γ) levels and clinical outcomes in non-small-cell lung cancer (NSCLC) patients receiving immune checkpoint inhibitors (ICIs). PATIENTS AND METHODS: Sample collection for IFN-γ release assay (IGRA) was performed within 14 days before treatment (T1), on day 22±7 (T3), and on day 43±7 (T4). The stored specimens over 10 IU/ml in IGRA were re-examined using the dilution method (with saline as the dilution medium). The patients were classified into Lower and Higher groups by 7.06 IU/ml as a cut-off of IFN-γ levels at T1. RESULTS: Median progression-free survival in the Higher group was significantly longer than that in the Lower group. IFN-γ levels in the non-progression disease group were significantly higher than those in the progression disease group. IFN-γ levels at T1 in patients with immune-related adverse events were significantly lower compared to those at T3. CONCLUSION: IFN-γ could be a biomarker for NSCLC patients receiving ICIs.

Relationship Between Health Behaviors and Obesity in a Sample of Hawai'i's 4 Most Populous Ethnicities.

Proactive health behavior change and maintenance are essential for preventing obesity and other lifestyle diseases. Few studies have examined the relationship between eating behavior and physical condition among multiethnic samples. In this study, ethnic differences were examined to obtain basic data on health education for improvement of obesity in Hawai'i. The intake of fruits and vegetables and exercise habits in each of the transtheoretical model stages of change were evaluated in the 4 most populous ethnic groups in Hawai'i in terms of how the participants' health behaviors were associated with obesity. The participants comprised 2795 white, Native Hawaiian, Filipino, and Japanese adults (age range, 18-55 years). There are 4 main findings of this study. First, there were differences in fruit and vegetable intake and exercise habits in each transtheoretical model stage among the ethnic groups. Second, there were differences in attitudes regarding nutrition and healthy food intake and self-efficacy regarding exercise in each ethnic group. Third, items that have the potential to improve obesity in the theory of planned behavior differed, particularly among men, in the 4 ethnic groups. Finally, a low percentage of participants recognized that the recommended number of servings of fruits and vegetables was 5 or more. Education for men may be particularly important. The findings indicate that modified health education approaches may be needed in accordance with the ethnicity of the population.

The Levels of Interferon-gamma Release as a Biomarker for Non-small-cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors.

BACKGROUND/AIM: The present study aimed to prospectively examine the usefulness of interferon-gamma (IFN-γ) release (IGR) as a biomarker in non-small-cell lung cancer patients receiving immune checkpoint inhibitor treatment (ICI-Tx). PATIENTS AND METHODS: IGR was measured using enzyme-linked immunosorbent assay at four time points: within 14 days before ICI-Tx (T1), and 8±3 (T2), 22±7 (T3), and 43±7 (T4) days after ICI-Tx. RESULTS: Twenty-nine patients were divided into three groups based on IFN-γ levels in the IGR-positive control: Group-1 (n=8) with <10 IU/ml at T1, Group-2 (n=12) with a decrease in IFN-γ levels to <10 IU/ml at T3 and/or T4, and Group-3 (n=9) without changes in IFN-γ levels. Early progression and ICI-induced interstitial pneumonitis were frequently observed in Group-1 and Group-2, respectively. Group-3 exhibited more treatment cycles than the other groups. All three groups showed clear differences in clinical outcomes. CONCLUSION: IFN-γ levels could be a biomarker for ICI-Tx.

Development of an External Radiation Dose Estimation Model for Children Returning to Their Homes in Areas Affected by the Fukushima Nuclear Accident.

On 1 April 2017, around 6 y after the Fukushima Daiichi nuclear power station accident, evacuation orders for large affected areas were lifted, and areas to which people could return were expanded. In the current study, a dose estimation model based on a probabilistic approach has been developed to estimate the external radiation doses children would receive after returning to these areas. The target groups are children from infants to high school students, and the target areas are nine municipalities including evacuation areas as of 5 September 2015. The estimation period is for 4 y starting 1 April 2017. Validation of the model in an area for which individual personal dosimetry measurements were available showed that it is valid for infants, kindergarteners, 3rd and 4th grade elementary school students, 5th and 6th grade elementary school students, and junior high school students. Considering the statement of the International Commission on Radiological Protection, the estimated radiation doses for these five age groups were taken to be the 95th percentiles of the predicted distributions as an index of conservative judgement. As a result of our estimations, the 95th percentile doses to all age groups were less than 20 mSv y in all periods and in all areas. The 95th percentile doses in some areas were less than 1 mSv y, which is the long-term dosimetric target set by the Japanese government. It should be noted that our results are preliminary, being based on several assumptions and limitations regarding environmental contamination conditions and the behavioral patterns of children. To estimate the children's doses precisely, further considerations for these assumptions and limitations will be needed.

Paradoxical response in a patient with non-small cell lung cancer who received nivolumab followed by anti-Mycobacterium tuberculosis agents.

Anti-programmed cell death-1 (PD-1) agents enhance the antitumor immunoresponse. A number of reports have indicated that patients with malignancies who receive anti-PD-1 agents are at risk for tuberculosis (TB) infection. In this report, we present a patient with non-small cell lung cancer who developed pulmonary tuberculosis while receiving the anti-PD-1 agent nivolumab, and who subsequently demonstrated a paradoxical response (PR) 10 days after initiation of anti-MTB treatment. We suggest that anti-PD-1 agents not only induce the development of pulmonary TB, but also development of PR after anti-MTB treatment, through upregulation of the immune response. Furthermore, based on their radiological and immunological similarity, we speculate that the schema of development of PR closely resembles that of pseudoprogression in non-small cell lung cancer patients after anti-PD-1 treatment.

Novel Immunoliposome Technology for Enhancing the Activity of the Agonistic Antibody against the Tumor Necrosis Factor Receptor Superfamily.

We have developed a technology for efficiently enhancing the anticancer apoptosis-inducing activity of agonistic antibodies against the tumor necrosis factor receptor (TNFR) superfamily by the formation of immunoliposomes. To induce apoptosis in cancer cells, agonistic antibodies to the TNFR superfamily normally need cross-linking by internal immune effector cells via the Fc region after binding to receptors on the cell membrane. To develop apoptosis-inducing antibodies that do not require the support of cross-linking by immune cells, we prepared immunoliposomes conjugated with TRA-8, an agonistic antibody against death receptor 5 (DR5), with various densities of antibody on the liposome surface, and evaluated their activities. The TRA-8 immunoliposomes exhibited apoptosis-inducing activity against various DR5-positive human carcinoma cells at a significantly lower concentration without cross-linking than that of the original TRA-8 and its natural ligand (TRAIL). The activity of the immunoliposomes was correlated with the density of antibodies on the surface. As the antibody component, not only the full-length antibody but also the Fab' fragment could be used, and the TRA-8 Fab' immunoliposomes also showed exceedingly high activity compared with the parental antibody, namely, TRA-8. Moreover, cytotoxicity of the TRA-8 full-length or Fab' immunoliposome against normal cells, such as human primary hepatocytes, was lower than that for TRAIL. Enhanced activity was also observed for immunoliposomes conjugated with other apoptosis-inducing antibodies against other receptors of the TNFR superfamily, such as death receptor 4 (DR4) and Fas. Thus, immunoliposomes are promising as a new modality that could exhibit significant activity at a low dose, for cost-effective application of an antibody fragment and with stable efficacy independent of the intratumoral environment of patients as a TNF superfamily agonistic therapy.

Discovery of non-spherical heterogeneous radiocesium-bearing particles not derived from Unit 1 of the Fukushima Dai-ichi Nuclear Power Plant, in residences five years after the accident.

Non-spherical heterogeneous radiocesium-bearing particles were found on masks worn during cleaning work in residences near the Fukushima Dai-ichi Nuclear Power Plant (FDNPP), from which residents had evacuated. Three slightly larger (6.6-12 µm) non-spherical radiocesium-bearing particles were found in a residence in Futaba Town, a straight distance of 2.11 km west-northwest from the FDNPP. These were collected on October 25, 2016, 5 years and 7 months after the Fukushima Dai-ichi nuclear disaster and were presumed to originate from the Plant's Unit 2 based on the measured radioactivity ratio of 134Cs/137Cs. The main elemental composition was similar to particles already reported in other studies. However, this is the first time that such particles had a clearly heterogeneous distribution.

[STUDY OF DIRECT TB-LAMP USING NON-CENTRIFUGAL SPUTUMS ABOUT EFFICIENCY FOR RAPID DIAGNOSIS OF TUBERCULOSIS].

OBJECTIVE: To evaluate the efficiency of the direct tuberculosis-loop-mediated isothermal amplification (TB-LAMP) assay by using non-centrifuged sputum samples. STUDY PERIOD AND METHODS: The study was conducted between June 2013 and February 2014. We collected 111 sputum samples from patients who had been radiographically diagnosed with tuberculosis and had not received any treatments for longer than 5 days. In the direct TB-LAMP assay, a loop-mediated isothermal amplification kit and 60-µL sputum samples were used. A direct smear microscopy test was used as the smear test. Then, the same sputum samples were processed with a CCE pretreatment reagent, and 100 µL of the solution samples were cultured by using the mycobacterial growth indicator tube (MGIT) culture method. RESULTS: Forty-six of the 111 samples were positive in the smear microscopy tests. All the smear-positive samples were positive in both the MGIT and direct TB-LAMP assay (100%). The mean positive detection time with the direct TB-LAMP assay was 13 minutes 55 seconds. Of 56 smear-negative and MGIT positive samples, 44 (78.6%) were judged to be positive using the direct TB-LAMP assay, with a mean positive detection time of 15 minutes 59 seconds. DISCUSSION: The direct TB-LAMP assay using non-centrifuged sputum samples was demonstrated to have a high detection rate and thus may be considered useful for rapid and effective tuberculosis diagnosis.

Comparison of the clinical courses and chemotherapy outcomes in metastatic colorectal cancer patients with and without active Mycobacterium tuberculosis or Mycobacterium kansasii infection: a retrospective study.

BACKGROUND: Although active Mycobacterium tuberculosis (MTB) or Mycobacterium Kansasii (MK) infection could be present in patients with metastatic colorectal cancer (m-CRC), no study is available on the clinical courses and chemotherapy outcomes of these patients. The present study therefore aimed to retrospectively examine whether m-CRC patients with and without active MTB or MK infection could receive cancer chemotherapy similarly. METHODS: This study enrolled 30 m-CRC patients who received first-line chemotherapy between January 31, 2006 and January 31, 2013 at our institution, The clinical courses and tumor response of those with and without active MTB or MK infection were examined and compared. RESULTS: Of 30 m-CRC patients, 6 had active MTB infection, 1 with active MK and the other 23 had neither MTB nor MK. No significant demographic differences were observed between patients with MTB or MK and those without. Chemotherapy response rates of all patients, those with MTB or MK, and those without were 40.0%, 28.6% and 43.5%, respectively. Among patients with MTB or MK, 1 treated with bevacizumab experienced grade-3 hemoptysis while others did not report any severe toxicity. Median survival time of all studied patients, those with MTB or MK, and those without was 26.3, 36.7 and 22.6 months, respectively. No significant difference in overall survival was observed between patients with MTB or MK and those without. Multivariate analysis revealed that performance status and liver metastasis were significant prognostic factors of overall survival (P = 0.004 and 0.030, respectively), whereas other factors, including MTB or MK infection, were not. In our study, all 7 patients with MTB or MK did not experience infection relapse during or after cancer chemotherapy. CONCLUSIONS: Our results indicate that m-CRC patients with MTB or MK should be able to safely and effectively continue cancer chemotherapy to subsequently achieve comparable survival duration to those without the infection if they receive proper MTB or MK treatment.

Plant-integrated measurement of greenhouse gas emissions from a municipal wastewater treatment plant.

Wastewater treatment plants (WWTPs) contribute to anthropogenic greenhouse gas (GHG) emissions. Due to its spatial and temporal variation in emissions, whole plant characterization of GHG emissions from WWTPs face a number of obstacles. In this study, a tracer dispersion method was applied to quantify plant-integrated, real-time emissions of methane and nitrous oxides. Two mobile cavity ring-down spectroscopy sampling devices were used to record downwind gas concentrations emitted from a municipal WWTP situated in Copenhagen, Denmark. This plant is equipped to remove biological nitrogen and employs anaerobic digestion for sludge stabilization. Over the course of nine measurement campaigns, a wide range of emissions were detected: methane from 4.99 kg h(-1) up to 92.3 kg h(-1) and nitrous oxide from below the detection limit (0.37 kg h(-1)) up to 10.5 kg h(-1). High emissions were observed during periods experiencing operational problems, such as during foaming events in anaerobic digesters and during sub-optimal operation of biological nitrogen removal in the secondary treatment of wastewater. Methane emissions detected during measurement campaigns corresponded to 2.07-32.7% of the methane generated in the plant. As high as 4.27% of nitrogen entering the WWTP was emitted as nitrous oxide under the sub-optimal operation of biological treatment processes. The study shows that the unit process configuration, as well as the operation of the WWTP, determines the rate of GHG emission. The applied plant-integrated emission measurement method could be used to ease the burden of quantifying GHG emissions from WWTPs for reporting purposes and could contribute to the development of more accurate depictions of environmental performance of WWTPs.

Influence of data collection schemes on the Life Cycle Assessment of a municipal wastewater treatment plant.

A Life Cycle Assessment (LCA) of a municipal wastewater treatment plant (WWTP) was conducted to illustrate the effect of an emission inventory data collection scheme on the outcomes of an environmental impact assessment. Due to their burden in respect to data collection, LCAs often rely heavily on existing emission and operational data, which are gathered under either compulsory monitoring or reporting requirements under law. In this study, an LCA was conducted using three input data sources: Information compiled under compulsory disclosure requirements (the European Pollutant Release and Transfer Registry), compliance with national discharge limits, and a state-of-the-art emission data collection scheme conducted at the same WWTP. Parameter uncertainty for each collection scheme was assessed through Monte Carlo simulation. The comparison of the results confirmed that LCA results depend heavily on input data coverage. Due to the threshold on reporting value, the E-PRTR did not capture the impact for particulate matter emission, terrestrial acidification, or terrestrial eutrophication. While the current practice can capture more than 90% of non-carcinogenic human toxicity and marine eutrophication, an LCA based on the data collection scheme underestimates impact potential due to limitations of substance coverage. Besides differences between data collection schemes, the results showed that 3-13,500% of the impacts came from background systems, such as from the provisioning of fuel, electricity, and chemicals, which do not need to be disclosed currently under E-PRTR. The incidental release of pollutants was also assessed by employing a scenario-based approach, the results of which demonstrated that these non-routine emissions could increase overall WWTP greenhouse gas emissions by between 113 and 210%. Overall, current data collection schemes have the potential to provide standardized data collection and form the basis for a sound environmental impact assessment, but several improvements are recommended, including the additional collection of energy and chemical usage data, the elimination of a reporting threshold, the expansion of substance coverage, and the inclusion of non-point fugitive gas emissions.

Life cycle assessment of sewage sludge management: a review.

In this article, 35 published studies on life cycle assessment (LCA) of sewage sludge were reviewed for their methodological and technological assumptions. Overall, LCA has been providing a flexible framework to quantify environmental impacts of wastewater and sewage sludge treatment and disposal processes for multiple scales, ranging from process selection to policy evaluation. The results of LCA are, in principle, unique to the goal and scope of each study, reflecting its local conditions and comparison between different LCAs is not intended. Furthermore, the assessments are limited by the methodological development of the life cycle impact assessment (LCIA) and the advancement of research in quantifying environmental emissions associated with wastewater and sewage sludge treatment processes. Thus, large discrepancies were found in the selection of the environmental emissions to be included and how they were estimated in the analysis. In order to reduce these choice uncertainties, consolidation of the modelling approach in the following area are recommended: quantification of fugitive gas emissions and modelling of disposal practices. Besides harmonization of the key technical assumptions, clear documentation of the modelling approach and the uncertainties associating with each assumption is encouraged so as to improve the integrity and robustness of assessment.