Conhecimentos e práticas da enfermagem sobre os resíduos de saúde nas unidades pediátricas: revisão integrativa / Nursing knowledge and practices in relation to medical waste in pediatric units: integrative review / Conocimientos y prácticas de enfermería con relación a los residuos sanitarios en unidades pediátricas: revisión integradora

Objetivo: identificar publicações que abordam a educação em saúde relacionada à prevenção da Síndrome da Morte Súbita em Lactentes. Método: revisão integrativa realizada no PubMed, Portal Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Cochrane Reviews, Scientific Electronic Library Online e a Biblioteca Virtual em Saúde. Incluíram-se aquelas nas línguas inglesa, espanhola e portuguesa, sem recorte temporal, disponíveis gratuitamente, independentemente do delineamento. Excluíram-se duplicidades, literatura cinzenta, editoriais e cuja população eram prematuros. Resultados: identificou-se duas categorias de análise: temas para educação em saúde e barreiras e facilitadores de aderência às recomendações de prevenção. O profissional de saúde deve estimular as boas práticas de saúde, identificando barreiras e facilitadores para a adesão às recomendações. Conclusão: o profissional deve trazer a ideia de que todo bebê tem risco potencial para a síndrome da morte súbita e utilizar as estratégias disponíveis para tirá-lo da situação de vulnerabilidade.

Objectives: : identifying the current scientific production in relation to Nursing knowledge and practices on medical waste in pediatric units. Method: integrative review in the Scielo, Cinahl, Web of Science, Pubmed, Scopus and Embase databases, between the years 2016 to 2021, totalizing 13 articles. Results: the findings pointed to three main categories: knowledge and practices in relation to Medical Waste, permanent education like a tool for the disposal of Medical Waste; and sustainability in the context of Medical Waste and its relationship with social responsibility. Conclusion: it is necessary to provide the opportunity for periodic training, as well as the use of self-explanatory instruments that can help all health professionals, especially the Nursing professionals, at the time of practice. It was checked the presence of gaps was verified with studies showing Medical Waste and Pediatric Nursing.

Objetivos:identificar la producción científica actual en relación a los conocimientos y prácticas de enfermería sobre los Residuos Sanitarios en las unidades de pediatría. Método: revisión integrativa en las bases de datos Scielo, Cinahl, Web of Science, Pubmed, Scopus y Embase, con un marco temporal de 2016 a 2021, totalizando 13 artículos. Resultados:los hallazgos apuntaron a tres categorías principales: conocimientos y prácticas en relación a los Residuos Sanitarios, educación permanente con una herramienta para la disposición de los Residuos Sanitarios y sostenibilidad en el contexto de los Residuos Sanitarios y su relación con la responsabilidad social. Conclusión: es necesario brindar oportunidades de capacitación periódica, así como el uso de instrumentos autoexplicativos que puedan ayudar todos los profesionales de la salud, especialmente a los profesionales de Enfermería, en el momento de la práctica. Se verifico la presencia de lagunas en los estudios que destacan los Residuos Sanitarios y la Enfermería Pediátrica.

Waste treatment innovation for infusion bottles using soil solution.

The amount of medical waste, especially infusion bottles, is a problem for environmental pollution. Improper management of infusion bottle waste can have an impact on disease transmission. The medical waste treatment used high technology and high costs will be a financial burden, so simple and effective treatment innovations is needed. This study uses an experimental method of removing bacteria from infusion bottles using a mixture of water and Andoso soil as a solution for washing infusion bottle waste. The soil solution concentration used in washing was 45% with a contact time of 2 minutes. The experiment was carried out with two repetitions. The treatment effect on decreasing the number of bacteria using a multiple linear regression mathematical model. The results showed that the disinfection process of bacterial-contaminated infusion bottles using water required rinsing up to six times, whereas using 45% andosol soil solution only rinsed once. The effectiveness of the disinfection of infusion bottles contaminated with bacteria using soil solution reduces the number of bacteria by 98%.

Green products from herbal medicine wastes by subcritical water treatment.

Herbal medicine wastes (HMWs) are byproducts of medicine factories, which are mainly landfilled for their environmental problems. Only bearing in mind the contamination and concerns caused by the COVID-19 pandemic and environmental emissions, the worth of herbal medicine wastes management and conversion to green products can be understood. In this work, subcritical water treatment was carried out batch-wise in a stainless tube reactor in the pressure range of 0.792-30.0 MPa, varying the temperature (127-327 °C) and time (1-60 min) of extraction. This resulted in new and green material sources, including organic acids, amino acids, and sugars. Amazingly, at very low extraction times (below 5 min) and high temperatures (above 277 °C), about 99% of HMWs were efficaciously converted to clean products by subcritical hydrothermal treatment. The results of hydrothermal extraction after 5 min indicated that at low temperatures (127-227 °C), the total organic carbon in the aqueous phase increased as the residual solid phase decreased, reaching a peak around 220 °C. Acetone soluble extracts or fat phase appeared above 227 °C and reached a maximum yield of 21% at 357 °C. Aspartic acid, threonine, and glycine were the primary amino acids; glycolic acid, formic acid, lactic acid, and acetic acid were obtained as the main organic acids, glucose, fructose, and cellobiose were substantial sugars produced from the aqueous phase after 5 min of hydrothermal subcritical hydrolysis extraction.

Gamma and UV radiations induced treatment of anti-cancer methotrexate drug in aqueous medium: Effect of process variables on radiation efficiency evaluated using bioassays.

This studystudy focuses on the effect of radiation treatment and hydrogen peroxide (H2O2) on the toxicity of anticancer methotrexate. For cytotoxicity, different bioassays such as Allium cepa, hemolytic, brine shrimp were employed. The Ames test was used for mutagenicity analysis. The solutions having concentrations 5, 10 and 15 ppm were irradiated with UV radiation exposure time 15, 30, 45, 60, 75 and 90 min and gamma radiation absorbed doses 0.3, 0.6, 0.9, 1.2, 2, 3 and 4 kGy in combination with with H2O2. There was a clear difference observed for aqueous solution before and after treatment with reference to cytotoxicity and mutagenicity. In Allium cepa test, a 47.07, 44.36 and 38.23% increase in root length (RL), root count (RC) and mitotic index (MI) was observed, respectively, for UV/H2O2 treatment and in the case of gamma/H2O2 treatment, the RL, RC and MI were increased up to 49.39, 52.63 and 52.38%, respectively. Brine shrimp test has shown 85.95 and 91.30% decrease in toxicity using UV/H2O2 and gamma/H2O2 respectively, while hemolytic test has shown 19.21 and 26.32% hemolysis using UV/H2O2 and gamma/H2O2, respectively. The mutagenicity reduced up to 82.3, 86.46 and 89.59% (TA98) and 85.42, 87.5 and 90.63% (TA100) for UV/H2O2 while 89.59, 90.63 and 93.75% (TA98) and 84.38, 89.59 and 92.71% (TA100) for gamma/H2O2. The UV and gamma radiation along with H2O2 based AOPs are promising approaches to detoxify the wastewater which can be extended to real hospital liquid effluent effectively.

Optimization of intravenous immune globulin use at a comprehensive cancer center.

PURPOSE: Intravenous immune globulin (IVIG) is a high-cost medication used in a diverse range of settings. At many institutions, IVIG is dosed using total body weight (TBW). Recent evidence suggests that alternative dosing weights reduce waste without compromising clinical outcomes. The objective of this study was to quantify the waste reduction potential generated through the use of alternative IVIG dosing weights. METHODS: We performed a retrospective analysis of all IVIG doses administered from January 2011 through January 2016 to adults (≥18 years). TBW and height at the time of administration were used to calculate prescribed dose (g/kg), ideal body weight (IBW), and adjusted body weight (AdjBW). Three dosing methods were analyzed, as follows: use of AdjBW if TBW is >120% IBW (method 1), AdjBW for all doses (method 2), and IBW for all doses (method 3). Outcomes included potential IVIG use averted, direct drug cost savings, and reductions in outpatient infusion times for each method. RESULTS: A total of 9,918 doses were administered to 2,564 patients over 5 years, representing an average usage of 75,994 g/year. If dosing methods 1, 2, and 3 had been used, the annual use of IVIG would have decreased by 21.9% (16,658 g/year, p < 0.001), 24.2% (18,371 g/year, p < 0.001), and 35.9% (27,252 g/year, p < 0.001), respectively. This translates into average annual cost differences of $2.37 million, $2.62 million, and $3.89 million and average annual outpatient infusion time savings of 841 hours, 920 hours, and 1,366 hours, respectively. CONCLUSION: IVIG dosing optimization through use of alternative dosing weights represents a significant source of waste reduction and cost reduction.

Torrefaction of herbal medicine wastes: Characterization of the physicochemical properties and combustion behaviors.

To explore the feasibility of using herbal medicine waste (HMW) as solid fuel, HMW was torrefied under different temperatures and atmospheres. The physicochemical properties and combustion behaviors of the torrefied HMW were investigated. Temperature was found to be the most influential factor affecting the torrefaction. Torrefaction improved the hydrophobicity of HMW and decreased the equilibrated moisture uptake from 24.48(0.083) % to 15.22(0.054) %. The HMW samples torrefied under different conditions are easy to ignite. The comprehensive combustibility index (S) of the torrefied HMW increased by 3-5 folds compared to that of the raw sample. In general, the HMW torrefied under lower temperatures and under CO2 and O2 have better flammability. The present results revealed that the torrefied HMW exhibited good combustion characteristics and can thus be used for solid fuel production, such as fuels for co-combustion or raw materials for pelletization.

A Matched Cohort Study of Postpartum Placentophagy in Women With a History of Mood Disorders: No Evidence for Impact on Mood, Energy, Vitamin B12 Levels, or Lactation.

OBJECTIVE: Although empirical studies investigating its effects are scarce, postpartum placentophagy is increasing in popularity because of purported benefits on mood, energy, lactation, and overall nutrition. Therefore, this study sought to test the hypotheses that women who consumed their placenta (placentophagy exposed [PE]) would have (1) fewer depressive symptoms, (2) more energy, (3) higher vitamin B12 levels, and (4) less pharmaceutical lactation support during the postpartum than women who did not consume their placenta (non-placentophagy exposed [NE]). METHODS: Using data from a large, longitudinal study of gene × environment effects involving perinatal women with a history of mood disorders, the study investigators identified a PE cohort and matched them 4:1 (by psychiatric diagnosis, psychotropic medication use, supplementation, income, and age) with an NE cohort from the same dataset. The study investigated differences between the PE and NE cohorts with respect to scores on the Edinburgh Postnatal Depression Scale and Sleep-Wake Activity Inventory, vitamin B12 levels, and the use of pharmaceutical lactation support (Canadian Taskforce Classification II-2). RESULTS: The sample of 138 women (28 in the PE cohort, matched to 110 in the NE cohort) provided 80% power at α = 0.0125 to detect an effect of moderate magnitude (which can be used to approximate an effect of clinically significant magnitude).There were no differences in Edinburgh Postnatal Depression Scaleor Sleep-Wake Activity Inventory scales (P = 0.28 and P = 0.39, respectively), vitamin B12 levels (P = 0.68), or domperidone use (P = 1) between the PE and NE cohorts. CONCLUSION: These data provide no support for the idea that postpartum placentophagy improves mood, energy, lactation, or plasma vitamin B12 levels in women with a history of mood disorders.

Assessment of research waste part 1: an exemplar from examining study design, surrogate and clinical endpoints in studies of calcium intake and vitamin D supplementation.

BACKGROUND: Research waste is estimated to be very common, but assessments of its prevalence and scope are rare. As an example, we assessed research waste in clinical research on calcium intake (assessing study design and endpoint type) and vitamin D supplementation (assessing endpoint type). METHODS: We examined 404 randomised controlled trials (RCTs) and observational studies of calcium intake (diet or supplements) and bone mineral density (BMD) or fracture, and 547 RCTs of vitamin D supplements, and assessed the proportion of studies that used surrogate or clinical endpoints. For studies with BMD or fracture as an endpoint, we estimated when the 'tipping' point occurred indicating the need for RCTs with fracture as an endpoint (based on cumulative meta-analyses of BMD RCTs, and chronological review of observational studies), and whether each study published at least 5y after the tipping point was novel, added new clinical knowledge or was research waste. RESULTS: Observational studies of calcium intake and BMD or fracture outnumbered RCTs by 3.3-4.5 times. For both calcium intake and vitamin D supplements, studies using surrogate endpoints outnumbered studies using clinical endpoints by 1.6-3 times. Of 41 RCT publications of calcium intake and BMD or fracture published at least 5y after the tipping point in 1994, we considered that 19 (46%) lacked novelty, another 13 (32%) added no new clinical knowledge, and 30 (73%) were research waste. Of 204 observational study publications of calcium intake and BMD or fracture, 197 (96%) lacked novelty, another 5 (2%) added no new clinical knowledge, and 202 (99%) were research waste. Of 39 RCTs of vitamin D supplementation and BMD or fracture published at least 5y after the tipping point in 1999, 14 (36%) lacked novelty, another 13 (33%) added no new clinical knowledge, and 27 (69%) were research waste. CONCLUSIONS: A high proportion of studies of calcium intake since 2000 (95%) and trials of vitamin D supplements since 2005 (69%) on BMD or fracture represent research waste.

Assessment of research waste part 2: wrong study populations- an exemplar of baseline vitamin D status of participants in trials of vitamin D supplementation.

BACKGROUND: Research waste can occur when trials are conducted in the wrong populations. Vitamin D deficient populations are most likely to benefit from vitamin D supplementation. We investigated waste attributable to randomised controlled trials (RCTs) of supplementation in populations that were not vitamin D deficient. METHODS: In December 2015, we searched Pubmed, recent systematic reviews, and three trial registries for RCTs of vitamin D with clinical endpoints in adults, and 25-hydroxvitamin D (25OHD) survey data relevant to large (N ≥ 1000) RCTs. We investigated the proportion of RCTs that studied vitamin D deficient populations, temporal trends in baseline 25OHD, and whether investigators in large RCTs considered relevant 25OHD survey data or systematic reviews in their trial justifications. RESULTS: Of 137 RCTs of vitamin D with clinical endpoints, 118 (86%) reported baseline mean/median 25OHD, which was < 25, 25-49, 50-74, and ≥ 75 nmol/L in 12 (10%), 62 (53%), 36 (31%), and 8 (7%) RCTs, respectively. In 70% of RCTs, baseline 25OHD was > 40 nmol/L. Baseline 25OHD increased over time. Before 2006, 38%, 62%, 0% and 0% of RCTs had baseline 25OHD < 25, 25-49, 50-74, and ≥ 75 nmol/L respectively; in 2011-15, the respective proportions were 9%, 49%, 37%, and 6%. Of 12 RCTs with baseline 25OHD < 25 nmol/L, 8 had neutral findings. Of 25 large RCTs (18 completed, 7 ongoing), 1 was undertaken in a vitamin D deficient population, 3 in vitamin D insufficient populations, and 17 had, or probably will have, baseline 25OHD > 40 nmol/L. 44% (8/18) of large completed RCTs cited relevant prior population 25OHD data, and only 3/10 (30%) relevant prior systematic reviews. CONCLUSIONS: Up to 70% of RCTs of vitamin D with clinical endpoints, 71% of large completed RCTs, and 100% of ongoing large RCTs could be considered research waste because they studied cohorts that were not vitamin D deficient.

Reducing polycyclic aromatic hydrocarbon and its mechanism by porous alumina bed material during medical waste incineration.

In this paper, porous alumina was used as an alternative bed material to reduce polycyclic aromatic hydrocarbon (PAH) and monocyclic aromatic hydrocarbons (MAH) emission during medical waste incineration in a fluidized bed combustor (FBC). In order to understand the reduction mechanisms of MAH and PAH, porous alumina, nonporous alumina, and silica sand (180-250 µm and 250-320 µm) were used as the bed materials. In comparison to the silica sand (180-250 µm) bed material, the reduction efficiencies of ∑MAH, ∑PAH and ∑PAH toxic equivalent (TEQ) by porous alumina bed material were in sequence as 91.57%, 58.90% and 73.23% during medical waste incineration under 800 °C. There were three mechanisms for the reduction of PAH under porous alumina bed materials. Firstly, the evolution rate of hydrocarbon was reduced by porous alumina due to its low heat transfer coefficient. Secondly, porous alumina bed materials could absorb more gaseous hydrocarbon and prolong the residence time of hydrocarbon in the diluted zone of FBC due to its higher BET. Lastly, the oxidization of the gaseous hydrocarbon was accelerated by porous alumina due to its catalytic effect. Thus, less light hydrocarbon, MAH and PAH were formed during medical waste incineration. The experimental results also indicated that the heat transmission, catalytic effect, and adsorption effect of porous alumina bed materials respectively accounted for 22.8%, 29.2% and 20.9% of the ∑PAH reduction.

Human placentophagy: a review.

Placentophagy or placentophagia, the postpartum ingestion of the placenta, is widespread among mammals; however, no contemporary human culture incorporates eating placenta postpartum as part of its traditions. At present, there is an increasing interest in placentophagy among postpartum women, especially in the United States. The placenta can be eaten raw, cooked, roasted, dehydrated, or encapsulated or through smoothies and tinctures. The most frequently used preparation appears to be placenta encapsulation after steaming and dehydration. Numerous companies offer to prepare the placenta for consumption, although the evidence for positive effects of human placentophagy is anecdotal and limited to self-reported surveys. Without any scientific evidence, individuals promoting placentophagy, especially in the form of placenta encapsulation, claim that it is associated with certain physical and psychosocial benefits. We found that there is no scientific evidence of any clinical benefit of placentophagy among humans, and no placental nutrients and hormones are retained in sufficient amounts after placenta encapsulation to be potentially helpful to the mother postpartum. In contrast to the belief of clinical benefits associated with human placentophagy, the Centers for Disease Control and Prevention recently issued a warning due to a case in which a newborn infant developed recurrent neonatal group B Streptococcus sepsis after the mother ingested contaminated placenta capsules containing Streptococcus agalactiae. The Centers for Disease Control and Prevention recommended that the intake of placenta capsules should be avoided owing to inadequate eradication of infectious pathogens during the encapsulation process. Therefore, in response to a woman who expresses an interest in placentophagy, physicians should inform her about the reported risks and the absence of clinical benefits associated with the ingestion. In addition, clinicians should inquire regarding a history of placenta ingestion in cases of postpartum maternal or neonatal infections such as group B Streptococcus sepsis. In conclusion, there is no professional responsibility on clinicians to offer placentophagy to pregnant women. Moreover, because placentophagy is potentially harmful with no documented benefit, counseling women should be directive: physicians should discourage this practice. Health care organizations should develop clear clinical guidelines to implement a scientific and professional approach to human placentophagy.

Dietary ascorbic acid reduced micronucleus and nuclear abnormalities in Clarias gariepinus (Burchell 1822) exposed to hospital effluent.

Hospital effluents contain myriad of mutagens and genotoxins capable of increasing DNA damage in aquatic biota. African mudfish, Clarias gariepinus, are exposed to genotoxins when cultured in swamps and derelict water bodies often contaminated by effluents. Moreover, its DNA is susceptible to xenobiotic-induced lesions since it lacks L-gulonolactone oxidase and hence cannot synthesize L-ascorbic acid. This study investigated 96-h acute toxicity and protective effects of dietary ascorbic acid (AA) against micronucleus (MN) and abnormal nuclear (NAs) formation in C. gariepinus exposed to sub-lethal concentrations of hospital effluent. Six concentrations (0.5-3.0%) of the effluent were selected to determine the 96-h acute toxicity of the effluent in C. gariepinus, after range finding test. Fish were exposed to sub-lethal concentrations (0.08-1.30%) of the 96 h LC50. Two other groups were exposed to the 96 h LC50 (1.30%) of the effluent +50 and +100 mg/kg of dietary ascorbic for 7 days, and MN and NAs assessed in peripheral erythrocytes. The 96 h LC50 (1.30%) was 1.18 times more toxic than the 24 h LC50 (1.54%), indicating that the toxicity of the effluent increased with exposure duration. MN, nuclear bud, enucleated, fragmented nucleus (apoptosis), and necrotic erythrocytes significantly increase in effluent treated fish. Dietary AA reduced MN from 6.35-fold (1.30% treated group) to 3.72-fold (1.30% + 50 mg AA) and 3.54-fold (1.30% + 100 mg AA). Also, AA reduced total NAs from 2.26-fold (1.30%) to 1.40-fold (1.30% + 50 mg AA) and 1.06-fold (1.30% + 100 mg AA) compared to the control. Heavy metals and physicochemical parameters analyzed in the tested effluent possibly induced the mortality and cytogenotoxicity in C. gariepinus, and this was ameliorated by dietary AA.

Chemical and toxicological characterisation of anticancer drugs in hospital and municipal wastewaters from Slovenia and Spain.

Anticancer drugs are continuously released into hospital and urban wastewaters, where they, most commonly, undergo conventional treatment in wastewater treatment plants (WWTPs). Wastewaters contain complex mixtures of substances including parent compounds, their metabolites and transformation products (TPs). In this study, samples of hospital effluents and WWTP influents and effluents from Slovenia and Spain were analyzed for twenty-two selected anticancer drugs, their metabolites and transformation products. Acute and chronic toxicity tests were performed on the crustacean Ceriodaphnia dubia, genotoxicity was determined with Tradescantia and Allium cepa micronucleus (MN) assays and in vitro comet assay in zebrafish (Danio rerio) liver cell line (ZFL cells). Sixty of the two hundred-twenty determinations revealed detectable levels of anticancer drug residues. Among the targeted compounds, platinum based were most frequently detected (90%). Furthermore, erlotinib was detected in 80%, cyclophosphamide and tamoxifen in 70% and methotrexate in 60% of the samples. Seven of ten samples were toxic to C. dubia after acute exposure, whereas after chronic exposure all samples reduced reproduction of C. dubia at high sample dilutions. Allium cepa proved insensitive to the potential genotoxicity of the tested samples, while in Tradescantia increased MN frequencies were induced by a hospital effluent and WWTP influents. In ZFL comet assay all but one sample induced a significant increase of DNA strand breaks. Correlations of chemotherapeutics or their TPs were detected for all bioassays except for Allium cepa genotoxicity test, however for each test the highest correlations were found for different substances indicating differential sensitivities of the test organisms.

Thermal treatment of medical waste in a rotary kiln.

This paper presents the results of a study of an experimental system with thermal treatment (incineration) of medical waste conducted at a large complex of hospital facilities. The studies were conducted for a period of one month. The processing system was analysed in terms of the energy, environmental and economic aspects. A rotary combustion chamber was designed and built with the strictly assumed length to inner diameter ratio of 4:1. In terms of energy, the temperature distribution was tested in the rotary kiln, secondary combustion (afterburner) chamber and heat recovery system. Calorific value of medical waste was 25.0 MJ/kg and the thermal efficiency of the entire system equalled 66.8%. Next, measurements of the pollutant emissions into the atmosphere were performed. Due to the nature of the disposed waste, particular attention was paid to the one-minute average values of carbon oxide and volatile organic compounds as well as hydrochloride, hydrogen fluoride, sulphur dioxide and total dust. Maximum content of non-oxidized organic compounds in slag and bottom ash were also verified during the analyses. The best rotary speed for the combustion chamber was selected to obtain proper afterburning of the bottom slag. Total organic carbon content was 2.9%. The test results were used to determine the basic economic indicators of the test system for evaluating the profitability of its construction. Simple payback time (SPB) for capital expenditures on the implementation of the project was 4 years.

Natural UV-protective organic matter in thermal water.

Medical significance of the organic fractions of natural waters is still poorly understood. Nevertheless, there are putative biologically active organic compounds found in natural medical waters and related clay or mud samples. Organic fractions of five thermal (spa) water samples of different geochemical origin were tested for photo-biological effects. To study possible effects on the UV sensitivity of Salmonella typhimurium TA strains, the organic isolates were applied in the "plate incorporation" Ames test combined with UV-irradiation. Four samples showed measurable survival of TA100 his+ revertants following exposure to a normally lethal UV dose. Metabolic activation with a mammalian microsomal fraction (S9) elevated the effect detected (up to 61% survival). This is the first study to demonstrate the UV-protective property of organic matter in natural thermal water samples used in balneotherapy.

Understanding the perceptions, roles and interactions of stakeholder networks managing health-care waste: A case study of the Gaza Strip.

The sustainable management of waste requires a holistic approach involving a range of stakeholders. What can often be difficult is to understand the manner in which different types of stakeholder networks are composed and work, and how best to enhance their effectiveness. Using social network analysis and stakeholder analysis of healthcare waste management stakeholders in the case study region of the Gaza Strip, this study aimed to understand and examine the manner in which the networks functioned. The Ministry of Health was found to be the most important stakeholder, followed by municipalities and solid waste management councils. Some international agencies were also mentioned, with specific roles, while other local institutions had a limited influence. Finally while health-care facilities had a strong interest in waste management, they were generally poorly informed and had limited links to each other. The manner in which the networks operated was complicated and influenced by differences in perception, sharing of information, access to finance and levels of awareness. The lack of a clear legal framework generated various mistakes about roles and responsibilities in the system, and evidently regulation was not an effective driver for improvement. Finally stakeholders had different priorities according to the waste management issues they were involved with, however segregation at the source was identified as a key requirement by most. Areas for improving the effectiveness of the networks are suggested. The analysis utilized an innovative methodology, which involved a large number of stakeholders. Such an approach served to raise interest and awareness at different levels (public authorities, health providers, supporting actors, others), stimulate the discussion about the adoption of specific policies, and identify the effective way forward.

Influence of the organic loading rate on the performance and the granular sludge characteristics of an EGSB reactor used for treating traditional Chinese medicine wastewater.

The effects of the organic loading rate (OLR) on the performance and the granular sludge characteristics of an expanded granular sludge bed (EGSB) reactor used for treating real traditional Chinese medicine (TCM) wastewater were investigated. Over 90% of the COD removal by the EGSB reactor was observed at the OLRs of 4 to 13 kg COD/(m(3) day). However, increasing the OLR to 20 kg COD/(m(3) day) by reducing the hydraulic retention time (HRT 6 h) reduced the COD removal efficiency to 78%. The volatile fatty acid (VFA) concentration was 512.22 mg/L, resulting in an accumulation of VFAs, and propionic acid was the main acidification product, accounting for 66.51% of the total VFAs. When the OLR increased from 10 to 20 kg COD/(m(3) day), the average size of the granule sludge decreased from 469 to 258 µm. There was an obvious reduction in the concentration of Ca(2+) and Mg(2+) in the granular sludge. The visible humic acid-like peak was identified in the three-dimensional excitation-emission matrix (EEM) fluorescence spectra of the soluble microbial products (SMPs). The fatty acid bond, amide II bond, amide III bond, and C-H bond bending were also observed in the Fourier transform infrared (FTIR) spectra of the SMPs. Methanobacterium formicicum, Methanococcus, and Bacteria populations exhibited significant shifts, and these changes were accompanied by an increase in VFA production. The results indicated that a short HRT and high OLR in the EGSB reactor caused the accumulation of polysaccharides, protein, and VFAs, thereby inhibiting the activity of methanogenic bacteria and causing granular sludge corruption.

Effects of untreated hospital effluents on the accumulation of toxic metals in sediments of receiving system under tropical conditions: case of South India and Democratic Republic of Congo.

Physicochemical and ecotoxicological analyses have been performed to assess the quality of sediments receiving untreated hospital effluents from Indian and Democratic Republic of Congo (DRC) hospitals. The sediments were collected monthly and characterized for grain size, organic matter, total organic carbon, total carbon, nitrogen, phosphorus, toxic metals and ecotoxicity. The results highlight the high concentration of toxic metals from the Indian hospital effluent receiving systems, especially for Cr, Cu, As, Zn and Hg. On the other hand, the metal concentrations in the sediment receiving system from DRC are low (e.g. maximum Hg and Zn concentration were 0.46 and 48.84 mg kg(-1) respectively). Ostracods exposed to sediment samples H2 (September month sample) and H3 (June and September month samples) were found dead after 6d of exposure whereas the higher mortality rate for Congo sediments was 23% but was accompanied with 33 ± 7% of growth inhibition. The results of this study show the variation of sediment composition on toxic metal levels as well as toxicity related to both, the type of hospitals and the sampling period. Additionally, hospital effluent disposal practices at the study sites can lead to the pollution of water resources and may generate risks for aquatic organisms and human health.

Occurrence of class 1 and 2 integrons in resistant Enterobacteriaceae collected from a urban wastewater treatment plant: first report from central Italy.

The purpose of this study was to investigate the presence and distribution of integron-carrying isolates among Enterobacteriaceae resistant to ß-lactam antibiotics collected from a wastewater effluent of the city of L'Aquila (Italy). A total of 471 Enterobacteriaceae were collected during a period of 2 years (2005-2006). The presence and distribution of class 1 and 2 integrons was investigated by colony blot hybridization using specific probes labelled with dUTP-fluoresceine kit. The variable region of class 1 and 2 integrons was analyzed by polymerase chain reaction and DNA sequencing in 24 isolates with different random amplified polymorphic DNA profile. The characterization of class 1 and 2 integrons gene cassettes of 24 nonrelated strains showed the presence of four different arrays: dfr17-aadA5; aadA10; dfr1-sat1; dfr1-sat1-aadA1. This is the first report from Italy in which the authors confirm the presence of Enterobacteriaceae carrying class 1 and 2 integrons in a wastewater treatment plant that collects the urban and hospital discharges.

Naproxen degradation test to monitor Trametes versicolor activity in solid-state bioremediation processes.

The white-rot fungus Trametes versicolor has been studied as a potential agent for the removal of environmental pollutants. For long-time solid-phase bioremediation systems a test is required to monitor the metabolic status of T. versicolor and its degradation capability at different stages. A biodegradation test based on the percentage of degradation of a spiked model pharmaceutical (anti-inflammatory naproxen) in 24 h (ND24) is proposed to monitor the removal of pharmaceuticals and personal care products in sewage sludge. ND24 is intended to act as a test complementary to ergosterol quantification as specific fungal biomarker, and laccase activity as extracellular oxidative capacity of T. versicolor. For samples collected over 45 d, ND24 values did not necessarily correlate with ergosterol or laccase amounts but in most cases, they were over 30% degradation, indicating that T. versicolor may be suitable for bioremediation of sewage sludge in the studied period.