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DisTec 2004. Berlin, 26-28 April 2004.
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[Chemical-physical risks originating from dead animals or animal products for the health of humans and animals and for the environment].
On-farm burial of dead stock principally may lead to an exclusively local contamination of groundwater by nitrogen species and dissolved organic matter. This definitively is a local risk, the size of which, however, depends on the amounts of dead animals buried and the hydrogeological conditions of the site. Emission mitigation by rendering companies has resulted in emissions, which do not present a hazard to humans, animals and the environment. The valuable recycling products contain ubiquitous pollutants in minor concentration not resulting in a effective relevant risk. The role which recycling in rendering plays, as regards redispersion of pollutants and active ingredients, also is very low for the chemicals which have been assessed so far. The role of veterinary medicinal drugs, however, especially of antibiotics for the risk in the environment needs attention.
Environmental management of construction and demolition waste in Kuwait.
There is an increasing pressure on the construction industry to reduce costs and improve the quality of our environment. The fact is that both of these goals can be achieved at the same time. Although construction and demolition (C&D) constitutes a major source of waste in terms of volume and weight, its management and recycling efforts have not yet seen the light in Kuwait. This study focuses on recycling efforts leading to the minimization of the total C&D waste that is currently landfilled in Kuwait. This paper presents the current status of C&D waste disposal system in Kuwait and identifies the potential problems to the environment, people and economy. Then, it investigates alternative solutions to manage and control this major type of waste in an economically efficient and environmentally safe manner. Next, the paper describes the feasibility of establishing a C&D waste recycling facility in Kuwait. It concludes by highlighting the major benefits and bottleneck problems with such a recycling facility.
An international perspective on hazardous waste practices.
In developing countries, public health attention is focused on urgent health problems such as infectious diseases, malnutrition, and infant mortality. As a country develops and gains economic resources, more attention is directed to health concerns related to hazardous chemical wastes. Even if a country has little industry of its own that generates hazardous wastes, the importation of hazardous wastes for recycling or disposal can present health hazards. It is difficult to compare the quantities of hazardous wastes produced in different countries because of differences in how hazardous wastes are defined. In most countries, landfilling is the most common means of hazardous waste disposal, although substantial quantities of hazardous wastes are incinerated in some countries. Hazardous wastes that escape into the environment most often impact the public through air and water contamination. An effective strategy for managing hazardous wastes should encourage waste minimization, recycling, and reuse over disposal. Developing countries are especially in need of low-cost technologies for managing hazardous wastes.
Diagnosis and management of cerebral salt wasting (CSW) in children: the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP).
OBJECTIVE: The aim of this study is to report our experience with diagnosis and management of cerebral salt wasting (CSW) in children and to evaluate the role of atrial natriuretic peptide/brain natriuretic peptide (ANP/BNP) in pediatric patients. MATERIALS AND METHODS: We present nine children suffering from prevalent cerebral disease--seven of whom underwent anesthesia and surgical procedures--with features of CSW, seen within a 22-month period. The symptoms, patient characteristics (including hormone status), monitoring, treatment protocol, and outcome are described. RESULTS: Natriuresis (urine Na+ concentrations 131 to >250 mmol/l) and polyuria (5.5+/-1.5 ml/kg/h) with increased Na+ turnover (maximum Na+ loss: median 1.50 mmol Na+/kg/h, range 0.47 to >3.50) vanished within 2 weeks in 6/9 patients (increase in serum Na+ from 127+/-2 mmol/l to 136+/-1). K+ excretion was also high (maximum K+ loss: median 0.18 mmol K+/kg/h, range 0.09-0.53). ANP/BNP as suspected causes of salt wasting were elevated only in 1/6 and 2/7 patients, respectively. Plasma renin activities and aldosterone levels were either suppressed or in the low normal range. CONCLUSION: Natriuresis and polyuria are the main diagnostic criteria for CSW. The fluid balance in CSW is negative, in contrast to a positive fluid balance in SIADH. The length of the disease is self-limited and generally ceases within 2 weeks, while Na+, K+, and fluid turnover should be monitored carefully. Only a minority of our children showed elevated ANP/BNP levels. A dose/effect relationship for natriuretic peptide levels and increased Na+ turnover could not be established.
Reducing the risks related to the handling and disposal of health-care waste.
Guidelines on the management of hospital waste aim not only to minimise the risks posed to staff at all levels but also to contain potential environmental hazards, such as infection and sharps injuries. It is therefore important for all personnel to be vigilant and to ensure that they dispose of clinical waste safety and appropriately.
Multi-level screening of a proposed hazardous waste treatment and disposal facility site--a case study.
A comprehensive environmental assessment (EA) is a pre-requisite before the site for developing a hazardous waste treatment and disposal facility (HWTDF) is selected. However, the resource limitations, especially for developing countries, often dictate that the detailed EA be restricted to those sites, which are constraint free and have low hazard potentials. Thus, a preliminary screening exercise for assessing the suitability of site for developing the HWTDF needs to be carried out to avoid huge costs involved in detailed EA. While screening a HWTDF site, various factors such as present land use, ecologically sensitive areas, geology and hydrogeology of the area, the quality and quantity of wastes, engineered safeguards, and the operational procedures that need to be adopted. are required to be addressed. In this paper, a multi-level screening criteria employing Remote Sensing, Constraint Mapping, Groundwater Pollution Potential Index (DRASTIC Index), and the Site Ranking was used to assess the suitability of a proposed site for the development of HWTDF. The study helped to identify various constraints at the proposed site and their significance on the development of the HWTDF.
An optimal model and its application for the management of municipal solid waste from regional small cities in China.
Based on the basic characteristics of municipal solid waste (MSW) from regional small cities in China, some optimal management principles have been put forward: regional optimization, long-term optimization, and integrated treatment/disposal optimization. According to these principles, an optimal MSW management model for regional small cities is developed and provides a useful method to manage MSW from regional small cities. A case study application of the optimal model is described and shows that the optimal management scenarios in the controlling region can be gained, adequately validating and accounting for the advantages of the optimal model.
Waste away.
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[The role of the operator of nuclear power plants in disposal of nuclear waste].
Public opinion polls show that the French have largely understood the importance of our nuclear programme in maintaining French independence with regard to power supply and its security and that they have confidence in the technicians for the proper construction and operation of these power plants, but that they retain many questions concerning the disposal of nuclear waste. They have the impression that solutions remain to be found, and especially that the Electricité de France (EDF) devised the nuclear power programme without concern for the disposal of waste. This lack of information is fortunately far from reality. EDF, under the supervision of the security authorities, manages the waste produced in the nuclear power plants. Final stocking of waste is handled by a body that is independent of the waste producer, the "Agence nationale pour la gestion des déchets radioadctifs" (Andra) (National Agency for the Management of Radioactive Waste).
Biohazardous waste: risk assessment, policy, and management.
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High level waste tank closure project: ALARA applications at the Idaho National Engineering and Environmental Laboratory.
Bechtel BWXT Idaho, Maintenance and Operating Contractor for the Department of Energy at the Idaho National Engineering and Environmental Laboratory, has emptied, cleaned, and sampled six of the eleven 1.135 x 10(6) L high level waste underground storage tanks at the Idaho Nuclear Technology and Engineering Center, well ahead of the State of Idaho Consent Order cleaning schedule. Cleaning of a seventh tank is expected to be complete by the end of calendar year 2004. The tanks, with associated vaults, valve boxes, and distribution systems, are being closed to meet Resource Conservation and Recovery Act regulations and Department of Energy orders. The use of remotely operated equipment placed in the tanks through existing tank riser access points, sampling methods and application of as-low-as-reasonably-achievable (ALARA) principles have proven effective in keeping personnel dose low during equipment removal, tank, vault, and valve box cleaning, and sampling activities, currently at 0.03 Sv.
A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered?
OBJECTIVES: To assess the amount of nutrients delivered, prescribed, and required for critically ill patients and to identify the reasons for discrepancies between prescriptions and requirements and between prescriptions and actual delivery of nutrition. DESIGN: Prospective cohort study. SETTING: Twelve-bed medical intensive care unit in a university-affiliated general hospital. PATIENTS: Fifty-one consecutive patients, receiving nutritional support either enterally or intravenously for > or = 2 days. We followed patients for the first 14 days of nutritional delivery. MEASUREMENTS AND MAIN RESULTS: The amount of calories prescribed and the amount actually delivered were recorded daily and compared with the theoretical energy requirements. A combined regimen of enteral and parenteral nutrition was administered on 58% of the 484 nutrition days analyzed, and 63.5% of total caloric intake was delivered enterally. Seventy-eight percent of the mean caloric amount required was prescribed, and 71% was effectively delivered. The amount of calories actually delivered compared with the amount prescribed was significantly lower in enteral than in parenteral administration (86.8% vs. 112.4%, p < .001). Discrepancies between prescription and delivery of enterally administered nutrients were attributable to interruptions caused by digestive intolerance (27.7%, mean daily wasted volume 641 mL), airway management (30.8%, wasted volume 745 mL), and diagnostic procedures (26.6%, wasted volume 567 mL). Factors significantly associated with a low prescription rate of nutritional support were the administration of vasoactive drugs, central venous catheterization, and the need for extrarenal replacement. CONCLUSIONS: An inadequate delivery of enteral nutrition and a low rate of nutrition prescription resulted in low caloric intake in our intensive care unit patients. A large volume of enterally administered nutrients was wasted because of inadequate timing in stopping and restarting enteral feeding. The inverse correlation between the prescription rate of nutrition and the intensity of care required suggests that physicians need to pay more attention to providing appropriate nutritional support for the most severely ill patients.
[Hospital management: quality and economy as management challenges for the physicians].
As a consequence of the Gesundheitsstrukturgesetz (GSG-Health Structure Act) hospitals are called upon to organize the processes of medical, nursing care and administrative services more economically, without there being any reduction in either the social quality or the quality of the process or result of the task of caring for patients. Fulfilling the task of caring for patients professionally entails providing medical efficiency and economy (section 109 SGB V). The hospital management is called upon to harmonize supposedly conflicting objectives such as "increasing the quality whilst reducing the costs" through intelligent organization and leadership concepts. The maxims up to now were: "quality costs money", "innovations need time and money", "a shorter stay can only be guaranteed with additional capacity" etc. The new management paradigm demands: "higher quality and patient-effective innovations (e.g. minimally invasive procedures, out-patient operations) can be realized in a shorter time with a tendency towards falling costs" and "a shorter stay is achieved with less capacity through better organization". To guarantee these standards the doctor in particular is required to be a high performer because the responsibility for medical quality cannot be separated from the responsibility for economical work processes to achieve this quality. Every senior doctor when making his decision about the type and intensity of diagnosis and treatment automatically also makes a decision about executing these processes of medical services in a way which is tailored to suit the needs and economical requests. This management challenge for the doctor presents itself in several areas: --as a manager of the care cascade --as a manager of the services in the regional health network --as a manager of standardization in the field of logistics (e.g. steering of medical products like heart catheters from the point of manufacturing to the point of use) --as a manager who knows how to mobilize the problem-solving knowledge of his employees through delegation-orientated leadership; the concept of the management of wastefulness as an organization and management approach is particularly suitable for hospitals.
Household food waste to wastewater or to solid waste? That is the question.
Decision makers need sound analyses of economic and environmental impacts of options for managing household food waste. Food waste impacts public health (it rots, smells, and attracts rodents) and costs (it drives collection frequency). A life cycle inventory is used to quantify total materials, energy, costs and environmental flows for three municipal solid waste systems (collection followed by compost, waste-to-energy or landfill) and two wastewater systems (kitchen food waste disposer followed by rural on-site or municipal wastewater treatment) for food waste management. Inventory parameters are expressed per 100 kg of food waste (wet weight) to place data on a normalised basis for comparison. System boundaries include acquisition, use and decommissioning. Parameters include inputs (land, materials, water) and output emissions to air, water and land. Parameters are ranked simply from high to low. Ranking highest overall was the rural wastewater system, which has a high amount of food waste and carrier water relative to the total throughput over its design life. Waste-to-energy was second; burning food waste yields little exportable energy and is costly. Next, municipal wastewater tied with landfill. Municipal wastewater is low for land, material, energy and cost, but is highest for food waste by-product (sludge). Landfill ranks low for air emissions and cost. Compost ranks lowest; it has the lowest material and water inputs and generates the least wastewater and waterborne waste.
Risk-informed radioactive waste classification and reclassification.
Radioactive waste classification systems have been developed to allow wastes having similar hazards to be grouped for purposes of storage, treatment, packaging, transportation, and/or disposal. As recommended in the National Council on Radiation Protection and Measurements' Report No. 139, Risk-Based Classification of Radioactive and Hazardous Chemical Wastes, a preferred classification system would be based primarily on the health risks to the public that arise from waste disposal and secondarily on other attributes such as the near-term practicalities of managing a waste, i.e., the waste classification system would be risk informed. The current U.S. radioactive waste classification system is not risk informed because key definitions--especially that of high-level waste--are based on the source of the waste instead of its inherent characteristics related to risk. A second important reason for concluding the existing U.S. radioactive waste classification system is not risk informed is there are no general principles or provisions for exempting materials from being classified as radioactive waste which would then allow management without regard to its radioactivity. This paper elaborates the current system for classifying and reclassifying radioactive wastes in the United States, analyzes the extent to which the system is risk informed and the ramifications of its not being so, and provides observations on potential future direction of efforts to address shortcomings in the U.S. radioactive waste classification system as of 2004.
The trash can blues. Environmental health issues related to waste disposal: its history, management and implications for nursing.
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