Occurrence and risk assessment of pharmaceuticals in surface waters of the Middle East and North Africa: A review.

Pharmaceutical compounds in surface water are perceived as contaminants of emerging concern due to their impacts on the aquatic environment and human health. The risk associated with these compounds has not been quantified in the Middle East and North Africa (MENA). This review identified that 210 pharmaceutical compounds have been analyzed in MENA water compartments between 2008 and 2022. In fact, 151 of these substances were detected in at least one of 13 MENA countries where occurrence studies had been conducted. Antibiotics claimed the highest number of pharmaceuticals detected with concentrations ranging between 0.03 and 66,400 ng/L (for Thiamphenicol and Spiramycin respectively). To investigate whether any of these compounds exert an ecological, human health, or antibiotic resistance risk, a screening-level risk assessment was performed in surface water matrices using maximum, median, and minimum concentrations. 39 and 8 detected pharmaceuticals in MENA surface waters posed a possible risk on aquatic ecosystems and human health respectively. Extremely high risk quotients (>1000) for six pharmaceuticals (17ß estradiol, spiramycin, diclofenac, metoprolol, ethinylestradiol, and carbamazepine) were enumerated based on maximal concentrations implying an alarming risk on aquatic toxicity. Moreover, hormones posed the highest possible risk on human health whether ingested through drinking water or fish (e.g., 17ß-estradiol had a health risk quotient of 2880 for children). Spiramycin showed a high risk of antibiotic resistance with a risk quotient of 133. This review serves as a basis for future prioritization studies and regulatory guidelines in the MENA region to minimize the risks of the identified compounds.

Assessing the environmental risk and pollution status of soil and water resources in the vicinity of municipal solid waste dumpsites.

Municipal solid waste management remains a major challenge for many developing countries where unsanitary and environmentally damaging practices, such as open dumping and burning of wastes, are consistently utilized as means of waste disposal. This study aimed to assess the impact of local dumpsites in a region in Southern Lebanon and to assess/determine the level of pollution they cause on local ecosystems and the concomitant risks to public health. Accordingly, soil and water samples were collected from the seven dumpsites that were investigated over the course of two seasons. Several biological, chemical, and physical parameters were examined, with the results being utilized to calculate a number of environmental indices. Results indicated that several soil parameters including TN (700-2400 mg/kg), pH (8.3-8.7), COD (39-1995 mg/kg), and sulfate levels (17.8-301.6 mg/kg) were altered by the dumpsites. Heavy metal concentrations varied between dumpsites; however, the most commonly prevalent metals across all dumps were Fe (992-41,500 mg/kg), Cr (17.4-139.5 mg/kg), Zn (24.1-177.4 mg/kg), Cu (9.42-148.2 mg/kg), and Mn (25.2-776.5 mg/kg), though recorded concentrations exceeded permissible limits only in certain instances. Evidently, soil samples collected at dumpsites had higher concentrations compared to the samples collected away from dumpsites reaching 27 times more in certain locations. The altered parameters have a direct effect on soil fertility and, if biomagnified, could disrupt crop yields and impact human health. Physiochemical properties and heavy metal concentrations in water samples were not significantly altered and were found to be within permissible limits. However, it is crucial to develop a monitoring and remediation plan to decrease the percolation of leachate to water resources.

Influence of a University Tobacco-Free Policy on the Attitudes, Perceptions of Compliance, and Policy Benefit Among the University Students: A Pre-Post Investigation.

Objective: To evaluate the effectiveness of a university tobacco-free policy by examining differences in students' attitudes, perceptions of compliance and policy benefits, after one year of the policy's implementation. Methods: Cross-sectional studies were undertaken to collect data pre- and 1 year post-policy implementation. The two samples were selected using stratified random sampling. Results: The prevalence of smoking decreased from 26% pre-policy implementation to 21% 1 year after (p = 0.035). The proportion of smokers who thought the policy had contributed to a reduction in smoking frequency increased from 10% to 70% (p < 0.001). Smokers' support for the policy rose from 42 to 58% (p = 0.007). Conclusion: Against the background of a strongly pro-tobacco environment in Lebanon, it is possible to create a positive change in the mindset of smokers at the levels of the education and smoking cessation and more efforts should be expended to bring it about.

The feasibility of solar-powered small-scale brackish water desalination units in a coastal aquifer prone to saltwater intrusion: A comparison between electrodialysis reversal and reverse osmosis.

In the face of increasing water shortages worldwide, water desalination has the potential to expand the available freshwater supply options in many water stressed regions. This paper assesses the feasibility of adopting photovoltaic powered small-scale brackish water desalination units in a coastal aquifer facing saltwater intrusion and chronic water shortages. Moreover, a detailed cost comparison, which incorporates the associated environmental costs, is conducted between the Electrodialysis Reversal (EDR) technique and Reverse Osmosis (RO). The results showed that PV-powered small-scale desalination units were more economically viable as compared to grid-powered units, when the electricity tariffs reflected non-subsidized electricity prices and environmental costs were internalized. EDR-PV proved to be more economically feasible and with a lower environmental footprint as compared to RO-PV, up until the salinity of the aquifer was below 5000 ppm (EDR: 0.57-1.18 $/m3; RO = 1.19-1.59 $/m3). Beyond that salinity, the RO-PV was found to be the more economically viable option, with costs reaching as high as 2.65 $/m3 at a salinity of 25,000 ppm. Overall, the environmental costs between the two technologies varied significantly, largely due to differences in the generated brine volume, with EDR having better efficiencies at lower salinity levels. Finally, the study highlighted the risk of accelerating saltwater intrusion as a result of the increased market penetration of solar-powered desalination units along vulnerable coastal aquifers.

Occurrence and hazard assessment of natural radioactivity in drinking water in South Lebanon.

This study is intended to assess the natural radioactivity in the drinking water in the southern region of Lebanon and to determine its suitability for human consumption. In this context, activity concentrations for gross alpha, gross beta, 238U, 234U, and radon from selected drinking water sources, wells, and springs and the corresponding tap water, in the area under investigation, were determined during both the wet and the dry seasons. The maximum recorded activities of gross alpha, gross beta, and radon measured using liquid scintillation counter were found to be 374.6 ± 11.5 mBq L-1 for gross alpha, 418 ± 12 mBq L-1 for gross beta, and 42,900 ± 370 mBq L-1 for radon. Whereas, alpha spectroscopy analysis for uranium content showed maximum activities of 53.7 ± 2.1 mBq L-1 for 238U and 55.9 ± 2.3 mBq L-1 for 234U. Significant seasonal activity variation between wet and dry season was noticed only in gross alpha concentrations. In addition, significant variation between sources and tap water was recorded only in radon concentrations. Whereas, no significant variation was noted in radioactivity concentrations in waters from springs and those from wells. In contrast to all sampled locations, the annual effective dose of only one sampled well (Aitaroun) exceeded the WHO individual dose criterion (IDC) level of 100 µSv year-1 and recorded an annual effective dose of 170 µSv year-1, 103 µSv year-1, and 127 µSv year-1 for infants, children, and adults, respectively.

Evaluating a tobacco-free university policy: A repeated cross-sectional survey of faculty and staff in Lebanon.

INTRODUCTION: A growing body of research has evaluated the effect of university tobacco-free policies on faculty and staff, however, none of these studies has been carried out in the Eastern Mediterranean Region. This study evaluates changes in faculty and staff attitudes, perceptions and smoking behavior, at 1 year post adoption of a tobacco-free policy in a medium-sized university in Lebanon and the region. METHODS: Two cross-sectional surveys were conducted in 2017 and 2018: baseline and at 1 year post policy implementation. A random sample of 625 and 624 participants took part in the 2017 and 2018 studies, respectively. RESULTS: Faculty and staff had a positive attitude towards the policy at the two time points. The belief that there should be exceptions to the policy significantly decreased from 79% to 59% (p=0.002) among all smokers, particularly those with lower educational attainment (81% to 57%, p=0.007). Perception of compliance among peer smokers increased from 73% to 87% (p=0.009). The proportion of smokers did not significantly change at 1 year post policy implementation, however, 44% of smokers with lower educational attainment, compared to only 7% of those with higher educational attainment (p<0.001), reported a decrease in their smoking behavior outside campus. CONCLUSIONS: The policy had a positive effect on the attitude, behavior and perception of policy benefits among smokers with lower educational attainment, who constitute the majority of smokers. Findings from this study inform and support future efforts to develop university and workplace tobacco-free policies.

Transdisciplinary interventions for environmental sustainability.

This paper presents a case study of a transdisciplinary research based on an ex-post assessment of the environmental and socio-behavioral contexts of solid waste management in Lebanese peri-urban communities. Lessons learned are compiled into the Transdisciplinary Interventions for Environmental Sustainability conceptual framework. The approach starts with building a team of researchers and non-academic partners, continues with co-creating solution-oriented knowledge, and ends by integrating and applying the produced knowledge. The co-created knowledge includes the environmental and socio-behavioral ex-post assessment's results. The former reveals low air pollution levels, evidence of waste-related water contamination, and higher self-reported frequencies of ill-health symptoms and diseases closer to the landfill. The latter indicates that the community's perception about waste production differs from the real accounting of generated waste. Nine lessons are identified: (1) inherent common interest between the researchers and the community, (2) flexible interdisciplinary research team, (3) representative citizen committee, (4) contextually-informed outreach coordinator, (5) iterative research process accounting for the shifting socio-political context, (6) common expectations of the research process, (7) boundary objects leading to spin-off activities in the same setting, (8) effective communication strategy, and (9) ex-post assessment of subsequent societal and scientific impacts. The non-phased framework links all nine pointers in a logical order to ease scalability. The study answers a global need for a unified, clear, broadly adopted framework for transdisciplinarity and a deeper understanding of factors ensuring full-circle knowledge co-creation in waste-related contexts in the global South. The study offers managerial and research implications and suggests avenues for further research.

Citizen science in Lebanon-a case study for groundwater quality monitoring.

Over the past decade, several citizen science projects have been launched, with a smaller subset addressing citizen scientists' involvement in water quality monitoring. Most of these projects were conducted in developed countries and focused on qualitative assessment and measurements of a limited number of water quality parameters. Moreover, data generated by citizen scientists were mainly for monitoring purposes and rarely resulted in remedial measures. In this work, a collaborative citizen science approach involving local citizens and university researchers was applied to assess the groundwater quality in a Lebanese village. Using a mobile laboratory, winter and summer sampling campaigns were conducted and 12 physical, chemical and biological water quality parameters were tested. Results indicated that the data generated by the citizen scientists were comparable with those generated by university researchers for the majority of physical and chemical water quality parameters. However, the bacteriological test results showed a marked difference and may be attributed to the complexity of the testing procedure and quality of testing material. The collaborative and participatory approach resulted in building local capacity and knowledge and in the formation of a locally elected water committee which will be responsible for continuous monitoring of the groundwater resources.

Factors influencing the reuse of reclaimed water as a management option to augment water supplies.

The reuse of treated wastewater, whether direct or indirect, can raise public concerns as a result of the overall risk perception. As such, community acceptance plays a significant role in the implementation of alternative water systems. Public attitudes towards water reuse are highly influenced by perceived health risk, religious prohibition, political issues, and the degree of human contact with recycled water. In most of the Mediterranean countries, wastewater is reused to different extents either within planned or unplanned schemes. Unfortunately, there are few in-depth studies of the socio-cultural aspects of reuse projects in developing countries, and Lebanon is no exception. Accordingly, this research will comprehensively tackle the issue of public knowledge, perceptions, and acceptance from different perspectives in an effort to provide national baseline information on wastewater reuse that is needed for future regulatory and developmental projects. As such, a survey was developed, tested, and administered. Results showed an inverse relation between the degree of human contact with the treated wastewater and public acceptance. People were found to be more inclined towards reuse for purposes with minimal human contact such as landscaping and agriculture with opposition when it came to use for personal use. Moreover, the results showed a general lack of trust in governing institutions and authorities, which could explain perceived health risks and perceptions of risk resulting from system failure. Overall, the willingness to use treated wastewater was found to vary as a function of the "disgust factor," religious beliefs, and perceptions of a high risk towards contracting waterborne diseases. The disgust towards reuse of treated wastewater was found to be a strong predictor affecting willingness to reuse whereby those who believed it is disgusting to reuse treated wastewater were found to be on average, three times less likely to reuse treated wastewater as compared to those who did not declare disgust. Similarly, a significant association was found between religious beliefs and respondents' willingness to use treated wastewater. Interviewees who thought treated wastewater reuse is not religiously accepted were, on average, twice less likely to use treated wastewater as compared to those who did not believe that reuse contradicts with their religious beliefs. Additionally, people's perceptions on associating the spread of water-borne diseases with reuse were found to be significant. Those who perceived that reusing treated wastewater would lead to diseases and affect the human health, were on average, twice less likely to accept reuse. Developing a comprehensive strategy that integrates increasing awareness and knowledge, setting policies related to water reuse, building public trust and communication channels, increasing public participation/engagement in decision making, and developing a sustainable management framework is thus crucial before any investments are made in reclaimed water-reuse projects.

The fate of selected pharmaceuticals in solar stills: Transfer, thermal degradation or photolysis?

The increase in demand for, and disposal of, pharmaceuticals, positively correlated with the growing human population, has led to the emergence of contaminants with high environmental and health impacts. Several developing countries that endure problems related to water sufficiency and/or quality resort to the use solar stills as an affordable water treatment method. This research is aimed at investigating the fate of five chemically distinct pharmaceuticals that might pervade solar stills; ibuprofen (IBU), diclofenac (DCF), carbamazepine (CBZ), ampicillin (AMP) and naproxen (NPX). The experiments were conducted under three conditions. The first condition studied the combined effect of temperature and light in simulated field-test-scale solar stills. The effect of temperature as a sole variable was investigated in the second while the third condition studied the effect of light only via concentrated solar power (CSP). Results show that distillates from solar stills did not contain the parent compounds for four out of the five pharmaceuticals. IBU was the only pharmaceutical that showed a transfer via vapor into the distillate with the highest recorded transfer percentage of 2.1% at 50°C when subjected to temperature alone and 0.6% under the combined effect of temperature and light. In the case of NPX and DCF, the parent compounds did not undergo transfer into the distillate phase; however their degradation by-products did. In addition, the results also showed that in the case of NPX, IBU and CBZ both high temperatures and sunlight combined were required to attain noticeable degradation. CSP accelerated the degradation of DCF, NPX and IBU with a three-minutes-degradation percentage of 44%, 13% and 2% respectively.

Environmental risk analysis and prioritization of pharmaceuticals in a developing world context.

The impact of residual pharmaceuticals on the aquatic environment has gained widespread attention over the past years. Various studies have established the occurrence of pharmaceutical compounds in different water bodies throughout the world. In view of the absence of occurrence data in a number of developing world countries, and given the limited availability of analytical resources in these countries, it is prudent to devise methodologies to prioritize pharmaceuticals for environmental monitoring purposes that are site specific. In this work, several prioritization approaches are used to rank the 88 most commonly consumed pharmaceuticals in Lebanon. A simultaneous multi-criteria decision analysis method utilizing the exposure, persistence, bioaccumulation, and toxicity (EPBT) approach is applied to a smaller subset of the original list (69 pharmaceuticals). Several base cases are investigated and sensitivity analysis is applied to one of these base case runs. The similarities and differences in the overall ranking of individual, and classes of, pharmaceuticals for the base cases and the sensitivity runs are elucidated. An environmental risk assessment (ERA), where predicted environmental concentrations (PEC) and risk quotients (RQ) are determined at different dilution factors, is performed as an alternative method of prioritization for a total of 84 pharmaceuticals. The ERA results indicate that metformin and amoxicillin have the highest PECs while 17ß-estradiol, naftidrofuryl and dimenhydrinate have the highest RQs. The two approaches, EPBT prioritization and ERA, are compared and a priority list consisting of 26 pharmaceuticals of various classes is developed. Nervous system and alimentary tract and metabolism pharmaceuticals (9/26 and 5/26 respectively) constitute more than half of the numbers on the priority list with the balance consisting of anti-infective (4/26), musculo-skeletal (3/26), genito-urinary (2/26), respiratory (2/26) and cardiovascular (1/26) pharmaceuticals. This list will serve as a basis for the selection of candidate compounds to focus on for future monitoring campaigns.

Assessment of Household Disposal of Pharmaceuticals in Lebanon: Management Options to Protect Water Quality and Public Health.

Pharmaceuticals comprise an extensive group of compounds whose release into the environment has potential adverse impacts on human health and aquatic ecosystems. In many developing countries the extent of the problem and the occurrence of pharmaceuticals in water bodies are generally unknown. While thousands of tons of pharmaceutical substances are used annually, little information is known about their final fate after their intended use. This paper focuses on better understanding the management of human-use pharmaceutical wastes generated at the residential level within the Administrative Beirut Area. A survey encompassing 300 households was conducted. Results revealed that the majority of respondents were found to dispose of their unwanted medications, mainly through the domestic solid waste stream. Willingness to participate in a future collection program was found to be a function of age, medical expenditure, and the respondents' views towards awareness and the importance of establishing a collection system for pharmaceutical wastes. Respondents who stated a willingness to participate in a collection program and/or those who believed in the need for awareness programs on the dangers of improper medical waste disposal tended to favor more collection programs managed by the government as compared to a program run by pharmacies or to the act of re-gifting medication to people in need. Ultimately, collaboration and coordination between concerned stakeholders are essential for developing a successful national collection plan.

Coagulation of highly turbid suspensions using magnesium hydroxide: effects of slow mixing conditions.

Laboratory experiments were carried out to study the effects of slow mixing conditions on magnesium hydroxide floc size and strength and to determine the turbidity and total suspended solid (TSS) removal efficiencies during coagulation of highly turbid suspensions. A highly turbid kaolin clay suspension (1,213 ± 36 nephelometric turbidity units (NTU)) was alkalized to pH 10.5 using a 5 M NaOH solution; liquid bittern (LB) equivalent to 536 mg/L of Mg(2+) was added as a coagulant, and the suspension was then subjected to previously optimized fast mixing conditions of 100 rpm and 60 s. Slow mixing speed (20, 30, 40, and 50 rpm) and time (10, 20, and 30 min) were then varied, while the temperature was maintained at 20.7 ± 1 °C. The standard practice for coagulation-flocculation jar test ASTM D2035-13 (2013) was followed in all experiments. Relative floc size was monitored using an optical measuring device, photometric dispersion analyzer (PDA 2000). Larger and more shear resistant flocs were obtained at 20 rpm for both 20- and 30-min slow mixing times; however, given the shorter duration for the former, the 20-min slow mixing time was considered to be more energy efficient. For slow mixing camp number (Gt) values in the range of 8,400-90,000, it was found that the mixing speed affected floc size and strength more than the time. Higher-turbidity removal efficiencies were achieved at 20 and 30 rpm, while TSS removal efficiency was higher for the 50-rpm slow mixing speed. Extended slow mixing time of 30 min yielded better turbidity and TSS removal efficiencies at the slower speeds.

Precipitation softening: a pretreatment process for seawater desalination.

Reduction of membrane fouling in reverse osmosis systems and elimination of scaling of heat transfer surfaces in thermal plants are a major challenge in the desalination of seawater. Precipitation softening has the potential of eliminating the major fouling and scaling species in seawater desalination plants, thus allowing thermal plants to operate at higher top brine temperatures and membrane plants to operate at a reduced risk of fouling, leading to lower desalinated water costs. This work evaluated the use of precipitation softening as a pretreatment step for seawater desalination. The effectiveness of the process in removing several scale-inducing materials such as calcium, magnesium, silica, and boron was investigated under variable conditions of temperature and pH. The treatment process was also applied to seawater spiked with other known fouling species such as iron and bacteria to determine the efficiency of removal. The results of this work show that precipitation softening at a pH of 11 leads to complete elimination of calcium, silica, and bacteria; to very high removal efficiencies of magnesium and iron (99.6 and 99.2 %, respectively); and to a reasonably good removal efficiency of boron (61 %).