A study of pilot sludge treatment reed beds for sludge dewatering and treatment under a hot and arid climate.

In the effort to identify sustainable sludge management options, pilot-scale sludge treatment reed beds (STRBs) were tested and assessed in the Sultanate of Oman in the first integrated experimental study of this nature-based solution in the Middle East region. A total of 18 pilot STRB units were established and monitored for almost 2 years; half were planted with native Phragmites australis reed species, and half served as unplanted control units. Employing a randomized complete block design, the study examined varying sludge loading rates (SLR) of 75, 100, and 125 kg/m2/year. Results underscored the effectiveness of STRBs in reducing the sludge volume, with observed reductions reaching 98.0% of the applied sludge volume, particularly prominent in the SLR75 units. During the final resting phase, the STRBs showed slightly higher concentrations of total Kjeldahl nitrogen (TKN) and total phosphorus (TP) compared to the unplanted beds, while maintaining concentrations lower than those of the applied activated sludge. Furthermore, heavy metal concentrations were consistently diminished in the STRBs compared to the unplanted beds, aligning with the established national and international standards for sludge reuse in agricultural contexts. The results of this study provide the first valuable insight into the potential of STRBs as an effective, sustainable, and climatically suitable approach for sludge dewatering. Specifically, an SLR of 100 kg/m2/year is proposed as an optimum loading rate for the hot and arid Middle East climate. This study advances our understanding of STRBs as a pivotal component in the realm of arid-region sludge treatment, shedding light on their capacity to facilitate enhanced dewatering, mineralization, and nutrient removal, thereby contributing to the broader discourse on sustainable waste management practices.

Trends and Outcomes of Transcatheter Aortic Valve Implantation in Patients With Peripheral Arterial Disease: Insights From the National Readmissions Database.

Due to shared risk factors, many patients with severe aortic stenosis (AS) also have concomitant peripheral arterial disease (PAD). The readmission rates and long term clinical outcomes of these patients following transcatheter aortic valve implantation (TAVI) in a large sample has not been well defined. The National Readmissions Database (NRD) (2015-2019) was used to identify patients undergoing TAVI. TAVI in patients with PAD was compared with those without PAD using a propensity score matched (PSM) analysis to obtain adjusted odds ratios (aOR) with 95% confidence intervals (CI) of net adverse clinical events (NACE), and its components. A total of 189,216 patients were identified, of which 14,925 patients (7386 with PAD, 7539 without PAD) were selected for adjusted analysis. Using PSM, patients with PAD undergoing TAVI had significantly higher in-hospital adjusted odds of NACE (aOR 1.60, 95% CI 1.36-1.88), and mortality (aOR 4.10, 95% CI 2.88-5.83). However, rates of other in-hospital peri procedural complications (stroke, major bleeding, paravalvular leak, cardiogenic shock) were not significantly different. There was no significant difference in the incidence of NACE, mortality, or other complications between the 2 groups at 30- and 180 days follow-up. Patients with PAD undergoing TAVI have an increased risk of mortality and NACE during the periprocedural period. However, following discharge, there was no statistically significant difference in 30 days and 6 month outcomes of TAVI in this population compared to those without significant PAD.

Communities, universal health coverage and primary health care.

Universal health coverage (UHC) depends on a strong primary health-care system. To be successful, primary health care must be expanded at community and household levels as much of the world's population still lacks access to health facilities for basic services. Abundant evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care. Policies and actions to improve primary health care must regard community members as more than passive recipients of health care. Instead, they should be leaders with a substantive role in planning, decision-making, implementation and evaluation. Advancing the science of primary health care requires improved conceptual and analytical frameworks and research questions. Metrics used for evaluating primary health care and UHC largely focus on clinical health outcomes and the inputs and activities for achieving them. Little attention is paid to indicators of equitable coverage or measures of overall well-being, ownership, control or priority-setting, or to the extent to which communities have agency. In the future, communities must become more involved in evaluating the success of efforts to expand primary health care. Much of primary health care has taken place, and will continue to take place, outside health facilities. Involving community members in decisions about health priorities and in community-based service delivery is key to improving systems that promote access to care. Neither UHC nor the Health for All movement will be achieved without the substantial contribution of communities.

La couverture maladie universelle (CMU) repose sur un solide système de soins de santé primaires. Pour rendre les soins de santé primaires efficaces, il faut les étendre aux communautés et aux ménages car la majorité de la population mondiale n'a toujours pas accès aux structures médicales offrant des services de base. Nombreux sont les éléments qui prouvent que les interventions communautaires contribuent à améliorer l'utilisation des soins de santé et les résultats cliniques lorsqu'elles font partie intégrante des services proposés au sein des établissements. L'implication des communautés constitue la clé de voûte d'un système de soins de santé primaires local, équitable et intégré. Les politiques et actions visant à le renforcer doivent tenir compte des membres des communautés, et ne pas se limiter à les considérer comme des bénéficiaires passifs de soins de santé. Au contraire, leurs dirigeants devraient jouer un rôle prépondérant dans la planification, la prise de décisions, la mise en œuvre et l'évaluation. Faire progresser la science des soins de santé primaires requiert une optimisation des cadres analytiques et conceptuels, ainsi que des questions de recherche. Les paramètres employés pour évaluer les soins de santé primaires et la CMU se concentrent souvent sur les résultats cliniques, sur les activités et moyens utilisés pour les atteindre. Peu d'attention est accordée aux indicateurs d'une couverture équitable, ou aux mesures de bien-être général, de possession, de contrôle ou de définition des priorités, ou encore à l'étendue du pouvoir d'action des communautés. À l'avenir, les communautés doivent s'engager davantage dans l'évaluation de la réussite des efforts déployés pour développer les soins de santé primaires. La plupart de ces soins ont toujours été et continueront à être prodigués en dehors des structures médicales. Impliquer les membres des communautés dans les décisions destinées à définir les priorités sanitaires et la fourniture de services communautaires est essentiel pour améliorer des systèmes qui permettront de promouvoir l'accès aux soins. Ni la CMU, ni le mouvement «Santé pour tous¼ ne parviendront à leurs fins sans la contribution majeure des communautés.

La cobertura sanitaria universal (CSU) depende de un sistema de atención primaria de salud sólido. Sin embargo, la atención primaria de salud se debe ampliar a nivel de la comunidad y de los hogares para que logre resultados efectivos, ya que gran parte de la población mundial sigue sin tener acceso a los centros de salud para recibir los servicios básicos. Existen muchas pruebas que demuestran que las intervenciones basadas en la comunidad son efectivas para mejorar el uso y los resultados de la atención de la salud cuando se integran con los servicios que se prestan en los centros de salud. La participación de la comunidad es el elemento fundamental de la atención primaria de salud local, equitativa e integrada. Las políticas y las medidas para mejorar la atención primaria de salud deben tener en cuenta que los miembros de la comunidad son más que receptores pasivos de la atención de salud. Por el contrario, deben ser líderes con una función importante en la planificación, la toma de decisiones, la implementación y la evaluación. El progreso de la ciencia en la atención primaria de salud requiere mejorar los marcos conceptuales y analíticos y los temas de investigación. Los parámetros que se usan para evaluar la atención primaria de salud y la CSU se centran en gran medida en los resultados clínicos de la salud y en los recursos y las actividades que permiten alcanzarlos. Se presta poca atención a los indicadores de cobertura equitativa o a las medidas de bienestar general, propiedad, control o establecimiento de prioridades, o a la medida en que las comunidades participan activamente. Por consiguiente, las comunidades deben participar más en la evaluación del éxito de los esfuerzos por ampliar la atención primaria de salud en el futuro. Gran parte de la atención primaria de salud siempre ha tenido y seguirá teniendo lugar fuera de los centros de salud. La participación de los miembros de la comunidad en las decisiones sobre las prioridades sanitarias y en la prestación de servicios comunitarios es fundamental para mejorar los sistemas que promueven el acceso a la atención, ya que ni la CSU ni el movimiento Salud para Todos se lograrán si las comunidades no contribuyen de manera sustancial.

Ecological and human health risk assessment.

The literature review presented in this paper covers the risk assessment process that is important to human health as well as the health of ecology in the form of receptors. One of the important objectives of present review is to provide summary of the scientific studies published in the year 2018. The review starts with literature published on the assessment of health risks, which are valuable to human and ecology. Most of the literature in the entire article focuses on techniques used for the analysis of scientific data and methods. In addition, review also highlights data interpretation, uncertainty, policy, and regulatory guidance associated with the management of human and ecological risks. Particularly, the review on the risk assessment related to human health and ecology is divided into two main sections. These sections provide broad state of knowledge on the risk assessment process used to health of human and ecological systems focused on investigation of polluted sites, techniques of remediation, and tools required for natural resource management.

Pesticides and Herbicides.

This paper highlights scientific literature that was published in the year 2017 related to the presence of pesticides and herbicides in the environment. The review on pesticides and herbicides is divided into four sections with focus on toxicology, ecology, risk assessment, modeling, and treatment strategies.

Effects of Pollution on Freshwater Organisms.

The scientific literature review in this paper includes research papers published in 2017 on issues related to pollutants from human activity and its effects on organisms of freshwater reported from the different parts of the world. The fist part of the literature review highlights on two broad sections that are focused on research conducted at the field level as well as surveys based on field experiments. A number of sections categorized in order to reflect the different class of pollutants follows the first part of literature review. Sections in this part of review includes non-point source pollution, stormwater, wastewater, nutrients, sediment cap materials and suspended clays, botanical extracts, surfactants, metals, persistent organic pollutants, pharmaceuticals, endocrine disruptors, pesticides, petroleum hydrocarbons and polycyclic aromatic hydrocarbons, nanomaterials and ionic liquids. The final part of the literature review highlights the published research on recent innovations of recent in addressing problem of pollution in the freshwater and its management.

Ecological and Human Health Risk Assessment.

The review of literature in this paper includes the assessment of risk process and addresses issues of both human as well as ecological receptors. The main objective of this review is to highlight an overview of the scientific research literature published in year 2017. The review is focused on assessment of risk on human and ecology published in the literature such as analysis, methodology, interpretation, management, uncertainty, policy and regulatory guidance. The review on ecological and human health risk assessment is divided into two main sections namely ecological and human health. The focus of the review is on the risk assessment process as it is applied to human health, ecoological systems, site investigation, aspects of remediation as well as natural resources.

Bioenergy from Biofuel Residues and Wastes.

This review includes works published in the general scientific literature during 2016 on the production of bioenergy and biofuel from waste residues generated during bioethanol and biodiesel production with a brief overview of current and emerging feedstocks. A section of this review summarizes literature on culturing algae for biofuels including bioreactors and open pond cultivation systems with the utilization of inorganic and organic sources of nutrients. New methods applicable to the mass culture of algae are highlighted. Algal cell harvesting and oil extraction techniques are discussed along with policies and economics.

Textiles.

A review of the literature published in 2016 on topics relating to the treatment alternatives for wastewater from the textile industries is presented. This review is divided into the following sections: a brief introduction on the implementation of the Best Available Techniques into textile industry, a review of the more promising treatment technologies distinguished into physico-chemical, biological and combined processes.

Radioactive Wastes.

Papers reviewed herein present a general overview of radioactive waste related activities around the world in 2016. The current reveiw include studies related to safety assessments, decommission and decontamination of nuclear facilities, fusion facilities, transportation. Further, the review highlights on management solutions for the final disposal of low and high level radioactive wastes (LLW and HLW), interim storage and final disposal options for spent fuel (SF), and tritiated wastes, with a focus on environmental impacts due to the mobility of radionuclides in ecosystem, water and soil alongwith other progress made in the management of radioactive wastes.

Extended use of grey water for irrigating home gardens in an arid environment.

The use of treated grey water (GW) for home gardens, peri-urban agriculture and landscaping is becoming popular in many water stressed countries such as Oman. This study aims to investigate the treatment efficacy, health and chemical concerns, cost-benefits and maintenance protocol of a GW treatment system as well as the effect of irrigation with GW on crop yield. Therefore, a decentralized homemade GW treatment system was installed in a newly constructed house in Muscat, Oman and studied over a 2-year period. The treated GW was found to be suitable for irrigation as per Omani standards. GW when mixed with kitchen effluent substituted the use of nutrient supplements for plants and did not show any harmful chemical or biological contamination. The capital cost of the system was around US $980, and the annual operating cost was US $78 with annual income and savings from the system being around US $572 indicating a payback period of nearly 2 years. It was found that the system required simple but regular maintenance particularly cleaning of the top layer of the filter. It can be concluded from this study that such a GW system should be technically, economically and environmentally feasible in Oman. Also, wider acceptance by the general public to the idea of GW reuse will help in mitigating the water shortage problem of the country to some extent.

Wastewater and sludge management and research in Oman: An overview.

It is well recognized that management of wastewater and sludge is a critical environmental issue in many countries. Wastewater treatment and sludge production take place under different technical, economic, and social contexts, thus requiring different approaches and involving different solutions. In most cases, a regular and environmentally safe wastewater treatment and associated sludge management requires the development of realistic and enforceable regulations, as well as treatment systems appropriate to local circumstances. The main objective of this paper is to provide useful information about the current wastewater and sludge treatment, management, regulations, and research in Oman. Based on the review and discussion, the wastewater treatment and sludge management in Oman has been evolving over the years. Further, the land application of sewage sludge should encourage revision of existing standards, regulations, and policies for the management and beneficial use of sewage sludge in Oman. IMPLICATIONS: Wastewater treatment and sludge management in Oman have been evolving over the years. Sludge utilization has been a challenge due to its association with human waste. Therefore, composting of sewage sludge is the best option in agriculture activities. Sludge and wastewater utilization can add up positively in the economic aspects of the country in terms of creating jobs and improving annual income rate. The number of research projects done on wastewater reuse and other ongoing ones related to the land application of sewage sludge should encourage revision of existing standards, regulations, and policies for the management and beneficial use of sewage sludge in Oman.

Determinants of age-specific undernutrition in children aged less than 2 years-the Bangladesh context.

Globally, undernutrition affects nearly half of all children aged less than 5 years. It is more prominent in low- and middle-income countries. This study aimed to identify the age-specific risk factors for different categories of undernutrition among Bangladeshi children aged less than 2 years. Data of 10,291 children aged less than 2 years were collected between October 2011 to November 2013 through the Food Security Nutritional Surveillance Project in Bangladesh. Simple logistic regression established bivariate relationships between the categories of undernutrition and the relevant risk factors. Multiple logistic regression constructed the age-specific regression models depicting the independent association and effect size of the risk factors contributing to the various categories of undernutrition among study population. Stunting was prevalent among 30.9% of the study children, whereas 9.7% were wasted and 24.9% were underweight. Being a male child, increase in age, maternal body mass index and education, and household food insecurity were the strongest predictors for all categories of undernutrition in terms of effect size. Our study shows that the different categories of childhood undernutrition have different age-specific risk factors. Maternal body mass index and household food insecurity were the common age-specific risk factors for all categories of undernutrition. We expect our findings to enhance the existing evidence base for the risk factors of undernutrition among children aged less than 2 years.

The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution.

BACKGROUND: Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007. METHODS: The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward. RESULTS: HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers. CONCLUSIONS: Bangladesh is suffering from a severe HRH crisis--in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution--which requires immediate attention from policy makers.