•Contemporary review of trends/insights to established/emerging e-waste issues.•Four typical future WEEE management scenarios are identified & discussed.•Emerging concerns: stockpiling; reuse ...standards; obsolescence; IoT, space e-debris.•Key areas of concern & measures to improve WEEE management identified & recommended.•Generation & management data standardisation required alongside political solutions.
Waste electrical and electronic equipment (WEEE) comprises a globally important waste stream due to the scarcity and value of the materials that it contains; annual generation of WEEE is increasing by 3–5% per annum. The effective management of WEEE will contribute critically to progress towards (1) realisation of the United Nations’ Sustainable Development Goals, (2) a circular economy, and (3) resource efficiency. This comprehensive review paper provides a critical and contemporary examination of the current global situation of WEEE management and discusses opportunities for enhancement. Trends in WEEE generation, WEEE-related policies and legislation are exemplified in detail. Four typical future WEEE management scenarios are identified, classified and outlined. The European Community is at the forefront of WEEE management, largely due to the WEEE Directive (Directive 2012/19/EU) which sets high collection and recycling targets for Member States. WEEE generation rates are increasing in Africa though collection and recycling rates are low. WEEE-related legislation coverage is increasing in Asia (notably China and India) and in Latin America. This review highlights emerging concerns, including: stockpiling of WEEE devices; reuse standards; device obsolescence; the Internet of Things, the potential for collecting space e-debris, and emerging trends in electrical and electronic consumer goods. Key areas of concern in regard to WEEE management are identified: the partial provision of formal systems for WEEE collection and treatment at global scale; further escalation of global WEEE generation (increased ownership, and acceleration of obsolescence and redundancy); and absence of regulation and its enforcement. Measures to improve WEEE management at global scale are recommended: incorporation of circular economy principles in EEE design and production, and WEEE management, including urban mining; extension of WEEE legislation and regulation, and improved enforcement thereof; harmonisation of key terms and definitions to permit consistency and meaning in WEEE management; and improvements to regulation and recognition of the informal WEEE management sector.
Lutetium-177 177LuLu-PSMA-617 is a radiolabelled small molecule that delivers β radiation to cells expressing prostate-specific membrane antigen (PSMA), with activity and safety in patients with ...metastatic castration-resistant prostate cancer. We aimed to compare 177LuLu-PSMA-617 with cabazitaxel in patients with metastatic castration-resistant prostate cancer.
We did this multicentre, unblinded, randomised phase 2 trial at 11 centres in Australia. We recruited men with metastatic castration-resistant prostate cancer for whom cabazitaxel was considered the next appropriate standard treatment. Participants were required to have adequate renal, haematological, and liver function, and an Eastern Cooperative Oncology Group performance status of 0–2. Previous treatment with androgen receptor-directed therapy was allowed. Men underwent gallium-68 68GaGa-PSMA-11 and 2-flourine-1818Ffluoro-2-deoxy-D-glucose (FDG) PET-CT scans. PET eligibility criteria for the trial were PSMA-positive disease, and no sites of metastatic disease with discordant FDG-positive and PSMA-negative findings. Men were randomly assigned (1:1) to 177LuLu-PSMA-617 (6·0–8·5 GBq intravenously every 6 weeks for up to six cycles) or cabazitaxel (20 mg/m2 intravenously every 3 weeks for up to ten cycles). The primary endpoint was prostate-specific antigen (PSA) response defined by a reduction of at least 50% from baseline. This trial is registered with ClinicalTrials.gov, NCT03392428.
Between Feb 6, 2018, and Sept 3, 2019, we screened 291 men, of whom 200 were eligible on PET imaging. Study treatment was received by 98 (99%) of 99 men randomly assigned to 177LuLu-PSMA-617 versus 85 (84%) of 101 randomly assigned to cabazitaxel. PSA responses were more frequent among men in the 177LuLu-PSMA-617 group than in the cabazitaxel group (65 vs 37 PSA responses; 66% vs 37% by intention to treat; difference 29% (95% CI 16–42; p<0·0001; and 66% vs 44% by treatment received; difference 23% 9–37; p=0·0016). Grade 3–4 adverse events occurred in 32 (33%) of 98 men in the 177LuLu-PSMA-617 group versus 45 (53%) of 85 men in the cabazitaxel group. No deaths were attributed to 177LuLu-PSMA-617.
177LuLu-PSMA-617 compared with cabazitaxel in men with metastatic castration-resistant prostate cancer led to a higher PSA response and fewer grade 3 or 4 adverse events. 177LuLu-PSMA-617 is a new effective class of therapy and a potential alternative to cabazitaxel.
Prostate Cancer Foundation of Australia, Endocyte (a Novartis company), Australian Nuclear Science and Technology Organization, Movember, The Distinguished Gentleman's Ride, It's a Bloke Thing, and CAN4CANCER.
Growing pace of urban living is expected to simultaneously aggravate both the waste and the energy crises. This study presents feasibility assessment of a community scale hybrid renewable energy ...system (HRES) utilising biomass to serve the local energy needs while reducing the household solid waste volume. A modelling framework is presented and evaluated for a biomass HRES, comprising of a Wind turbine-PV Array-Biogas generator-Battery system, applied to two European cities - Gateshead (UK) and Sofia (Bulgaria) - accounting for their distinct domestic biowaste profiles, renewable resources and energy practices. Biogas generator is found to make the most substantial share of electricity generation (up to 60–65% of total), hence offering a stable community-scale basal electricity generation potential, alongside reduction in disposal costs of local solid waste. Net present cost for the biomass-integrated HRESs is found within 5% of each other, despite significant differences in the availability of solar and wind resources at the two sites. Based on a survey questionnaire targeting construction companies and energy solution developers, project costs and planning regulatory red tapes were identified as the two common implementation challenges in both the countries, with lack of awareness of HRES as a further limitation in Bulgaria, impeding wider uptake of this initiative.
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•Integrating biomass overcomes local municipal solid waste (MSW) disposal issue.•Moderate community loads can be met economically using a biomass generator.•One tonne MSW can potentially produce up to 1000 kWh of electricity.•Project net present cost strongly depends on the size of the biomass generator.•Project costs and legislative red tapes deter localised waste-to-energy initiatives.
In double-blind, placebo-controlled trials, budesonide-formoterol used on an as-needed basis resulted in a lower risk of severe exacerbation of asthma than as-needed use of a short-acting β
-agonist ...(SABA); the risk was similar to that of budesonide maintenance therapy plus as-needed SABA. The availability of data from clinical trials designed to better reflect clinical practice would be beneficial.
We conducted a 52-week, randomized, open-label, parallel-group, controlled trial involving adults with mild asthma. Patients were randomly assigned to one of three treatment groups: albuterol (100 μg, two inhalations from a pressurized metered-dose inhaler as needed for asthma symptoms) (albuterol group); budesonide (200 μg, one inhalation through a Turbuhaler twice daily) plus as-needed albuterol (budesonide maintenance group); or budesonide-formoterol (200 μg of budesonide and 6 μg of formoterol, one inhalation through a Turbuhaler as needed) (budesonide-formoterol group). Electronic monitoring of inhalers was used to measure medication use. The primary outcome was the annualized rate of asthma exacerbations.
The analysis included 668 of 675 patients who underwent randomization. The annualized exacerbation rate in the budesonide-formoterol group was lower than that in the albuterol group (absolute rate, 0.195 vs. 0.400; relative rate, 0.49; 95% confidence interval CI, 0.33 to 0.72; P<0.001) and did not differ significantly from the rate in the budesonide maintenance group (absolute rate, 0.195 in the budesonide-formoterol group vs. 0.175 in the budesonide maintenance group; relative rate, 1.12; 95% CI, 0.70 to 1.79; P = 0.65). The number of severe exacerbations was lower in the budesonide-formoterol group than in both the albuterol group (9 vs. 23; relative risk, 0.40; 95% CI, 0.18 to 0.86) and the budesonide maintenance group (9 vs. 21; relative risk, 0.44; 95% CI, 0.20 to 0.96). The mean (±SD) dose of inhaled budesonide was 107±109 μg per day in the budesonide-formoterol group and 222±113 μg per day in the budesonide maintenance group. The incidence and type of adverse events reported were consistent with those in previous trials and with reports in clinical use.
In an open-label trial involving adults with mild asthma, budesonide-formoterol used as needed was superior to albuterol used as needed for the prevention of asthma exacerbations. (Funded by AstraZeneca and the Health Research Council of New Zealand; Novel START Australian New Zealand Clinical Trials Registry number, ACTRN12615000999538.).
Accurate assessment of carbon stocks remains a global challenge. High levels of uncertainty in Land Use, Land Use Change and Forestry reporting has hindered decision-makers and investors worldwide to ...support sustainable soil and vegetation management. Potential mitigation-driven activities and effects are likely to be locally/regionally unique. A spatially-targeted approach is thus required to optimise strategic carbon management. This study provides a new regional carbon assessment (tier 3) approach using biophysical-process modelling of high-resolution Land Cover (LC) data within a UK National Park (NFNP) to provide higher accuracy. Future Land Cover Change (LCC) scenarios were simulated. Vegetation-driven carbon dynamics were modelled by coupling two widely-used models, LPJ-GUESS and RothC-26.3. Transition and persistence analysis was conducted using Terrset's Land Change Modeller to predict likely future LCC for 2040 using Multi-Layer Perceptron Markov-Chain Analysis. Current total carbon in the NFNP is 7.32–8.73 Mt C, with current trajectories of LCC leading to minor losses of up to 0.39 Mt C. Alternative LCC scenarios indicated possible gains or losses of 1.27 Mt C, or 136.7 t C ha−1. The importance of vegetation-driven carbon storage was greater than the national average, with a VegC pool 12–14% of the soil organic C pool, placing greater significance on local/regional LC and management policy. The potential storage capacity of each LC class was ranked (highest to lowest): Coniferous > Broadleaved/Mixed > Coastal > Semi-natural Grassland > Heath > Improved Grassland > Arable (Cropland). Opportunities were prioritised to inform landscape-scale management to reduce future carbon losses and/or to enhance gains through LCC. Balancing the carbon budget relies upon maintaining existing LC. The more detailed LC classification facilitated accounting of management through stock change factors and disaggregation of classes, achieving greater detail and accuracy. Forthcoming policy decisions must optimise carbon storage at a local/regional landscape-scale.
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•New regional C assessment approach using high-resolution Land Cover data studied•Future Land Cover Change scenarios simulated & potential storage capacity ranked•Vegetation-driven C storage > national average; VegC 12–14% of soil organic C pool•More detailed Land Cover classification achieved greater detail and accuracy.•Targeted policies required to optimise strategic C management to local contexts
Background Patients with moderate exacerbations of COPD and the eosinophilic phenotype have better outcomes with prednisolone. Whether this outcome is similar in patients hospitalized with a severe ...exacerbation of COPD is unclear. We investigated the rate of recovery of eosinophilic and noneosinophilic exacerbations in patients participating in a multicenter randomized controlled trial assessing health outcomes in hospitalized exacerbations. Methods Patients were recruited at presentation to the hospital with an exacerbation of COPD. They were stratified into groups according to eosinophilic exacerbations if the peripheral blood eosinophil count on admission was ≥ 200 cells/μL and/or ≥ 2% of the total leukocyte count. Admission details, serum C-reactive protein levels, length of stay, and subsequent rehospitalization data were compared between groups. Results A total of 243 patients with COPD (117 men) with a mean age of 71 years (range, 45-93 years) were recruited. The inpatient mortality rate was 3% (median time to death, 12 days; range, 9-16 days). The median absolute eosinophil count was 100 cells/μL (range, 10-1,500 cells/μL), and 25% met our criteria for an eosinophilic exacerbation; in this population, the mean length of stay (in days) was shorter than in patients with noneosinophilic exacerbations (5.0 range, 1-19 vs 6.5 range, 1-33; P = .015) following treatment with oral corticosteroids and independent of treatment prior to admission. Readmission rates at 12 months were similar between groups. Conclusions The study patients presenting to the hospital with a severe eosinophilic exacerbation of COPD had a shorter length of stay. The exacerbations were usually not associated with elevated C-reactive protein levels, suggesting that better treatment stratification of exacerbations can be used. Trial Registry http://www.isrctn.com/ISRCTN05557928.
The automotive industry is one of the most significant and increasing sources of pollution worldwide. Previous studies examining its impacts focus on the post-1950 era as data available before this ...period is scarce. This study carefully reconstructs six datasets from the early 20th century to 2019 for the UK: annual number of motor cars, road lengths, road fatalities, NOx and CO emissions, and fuel consumption. Interpolation was prudently used to fill gaps in the data sets. Results highlight changing health, social and environmental effects throughout the growth of the automotive sector. Ratios of fatalities to cars indicate social ingraining of the car and rapid response to legislation. Significant emissions resulted from the early industry. Successful remediation of emissions occurred in the late 20th century. All variables studied were interrelated, but expansion of road networks particularly contributed to a range of both positive and (unintended) negative consequences. World War 2 appears to have been a landmark for the automotive industry, producing capacity for mass production, personal mobility and research and therefore a struggle between impacts and social policies. We have demonstrated that technological developments and regulatory interventions relating to the motor industry, alongside events that have catalysed societal change, have been crucial in terms of subsequently providing benefits to society whilst also acting to mitigate (but not prevent) the adverse and frequently devastating impacts of motor vehicles on human health and the environment. A periodic, regular, overarching, independent review (~ every 5 years) of the collective positive and negative impacts of the motor vehicle industry and appropriate interventions are essential to maintain and improve social benefits and public and environmental health, as well as supporting delivery of the United Nations' Sustainable Development Goals by 2030 and beyond.
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•Original datasets relating to the UK automotive sector reconstructed 1900–2020•Significant emissions resulted from early industry; successful remediation late C20•Ratios of fatalities to cars show social ingraining & rapid response to legislation•World War 2 a landmark for auto industry, creating capacity for mass production•Future developments require renewable energy & overcoming resource scarcity, etc
•GHG EFs for source-segregated materials recycling were derived using partial LCA.•The purpose was to support waste management decision making at multiple scales.•Source-segregated materials ...recycling was generally found to result in GHG savings.•Results were found to be highly sensitive to the assumed market substitution ratio.•Findings reveal a dearth of high quality material recycling LCI data available.
A key challenge for the waste management sector is to maximise resource efficiency whilst simultaneously reducing its greenhouse gas (GHG) emissions. For stakeholders to better understand the GHG impacts of their waste management activities and identify emissions reduction opportunities, they need to be able to quantify the GHG impacts of material recycling. Whilst previous studies have been undertaken to develop GHG emission factors (EF) for materials recycling, they are generally insufficient to support decision-making due to a lack of transparency or comprehensiveness in the range of materials considered. In this study, we present for the first time a comprehensive, scientifically robust, fully transparent, and clearly documented series of GHG EFs for the recycling of a wide range of source-segregated materials. EFs were derived from a series of partial life cycle assessments (LCA) performed as far as possible in accordance with the ISO 14040 standard. With the exceptions of soil, plasterboard, and paint, the recycling of source-segregated materials resulted in net GHG savings. The majority of calculated GHG EFs were within the range of data presented in the literature. The quality of secondary data used was assessed, with the results highlighting the dearth of high quality life cycle inventory (LCI) data on material reprocessing and primary production currently available. Overall, the results highlight the important contribution that effective source-segregated materials recycling can have in reducing the GHG impacts of waste management.
Material flow analysis (MFA) and life cycle assessment (LCA) have both widely been applied to support solid waste management (SWM) decision making. However, they are often applied independently ...rather than conjointly. This paper presents an approach that combines the MFA and LCA methodologies to evaluate large and complex SWM systems from an environmental perspective. The approach was applied to evaluate the environmental performance, focusing on greenhouse gas (GHG) emissions, of a local authority SWM system and to compare it with alternative systems to assess the potential effectiveness of different waste policy measures. The MFA results suggest that national recycling targets are unlikely to be met even if the assessed policies are implemented optimally. It is likely that for the targets to be met, investigated policies would need to be combined with additional policies that target reductions in waste arisings. The LCA results found landfilling of residual waste to be the dominant source of GHG burdens for the existing system, whilst material reprocessing was found to result in GHG benefits. Overall, each of the alternative systems investigated were found to result in lower GHG impacts compared to the existing system, with the diversion of food waste from the residual waste stream found to be potentially the most effective strategy to reduce GHG emissions. The results of this study demonstrate that the complementary methodologies of MFA and LCA can be used in combination to provide policy and decision makers with valuable information about the environmental performance of SWM systems.
•A combined MFA–LCA approach was applied to evaluate a large and complex SWM system.•The potential effectiveness of waste policies were assessed with scenario modelling.•The purpose was to provide information on SWM system performance to decision makers.•The MFA revealed that recycling targets will be missed even with enacted policies.•The LCA revealed food waste diversion from landfill to be the optimum strategy.
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