Sustainability assessment of biofuel and value-added product from organic fraction of municipal solid waste

The current study aims to examine the techno-economic and environmental assessment of biorefinery development within a circular bioeconomy context by using an organic fraction of municipal solid waste (OFMSW) by extraction of lipids, carbohydrates, and proteins with 98, 51 and 62 % by mass of conversion efficiency and yield recovery, and value-added fractions production as well. Fatty acid methyl ester (biodiesel) and glycerol (biofuel) were produced by applying transesterification process, and the remaining biomass was converted into biocrude oil by thermal liquefication. The biorefinery using 613 kg of OFMSW produced biodiesel, glycerol, and bioethanol with 126 litter, 14.3 kg, and 172 litter respectively, as well as value-added fractions, such as biocrude oil with 78 kg. The environmental impact was assessed using the life cycle assessment (LCA) framework, ReCiPe2016 Mid-point (H) approach, through 18 different environmental categories. The key findings elucidate that Terrestrial ecotoxicity, Climate change, Fossil depletion and Human toxicity were the main impact categories which are potentially contributed 9.81E+02 kg 1,4-DB eq., 1.43E+03 kg CO2 eq., 2.04E+02 kg oil eq., and 8.08E+01 kg 1,4-DB eq. The normalization (person per equivalent) analysis revealed that only categories of resource reduction (fossil and metal depletion) are the key contributors to environmental degradation. The biorefinery system's total revenue was estimated at USD 6.817,509 million annually. The calculated revenue was USD 0.026 million daily in a shift of 8 h. The Net present worth (NPW) was calculated at USD 499.97 million by assuming a discount factor of 10 % and inflation rate of 5 % for 15 years. The project is considered feasible by demonstrating 7.15 payback year. This research showcased the efficient portrayal of the biorefinery system and succinctly conveyed the significant circular bioeconomy for a greener future. Thus, it could be helpful to the stakeholder's context towards techno-economic and environmental evaluation.

Empirical analysis of cost-effective and equitable solid waste management systems: Environmental and economic perspectives

The solid waste management (SWM) system is in a transitional phase in developing economies, and local municipalities and waste management companies are stepping toward integrating a waste treatment approach in the scheme of waste handling. However, there is an urgent need to explore cost-effective techniques, models, and potential revenue streams to sustain the state-run waste sector self-sufficiently. The proposed SWM model aims to support the local waste sector in Islamabad, the capital city of Pakistan, with 100% service area coverage to attain environmental and economic sustainability by defining dedicated waste collection streams to ensure quality material recovery under a cost-effective approach and modality. The innovative approach is applied to allocate the tonnage to various streams as per the city's current land use plan. The estimated/cost of the cleanliness services will be USD13.1 million per annum with an estimated per ton cost of USD 23. The establishment of the proposed material recovery facility (MRF) will process about 500 t/d of waste to produce 45 t/d compost and recover 130 t/d of recyclables. The environmentally friendly model saves 2.4 million tons of CO2‒eq/month from composting and recycling. The average economic potential from MRF and debris-crushing plants, including environmental benefit value, is calculated as USD 3.97 million annually. Recovery of services fee (70%) for various collection streams based on city land use and socio-economic conditions will generate revenue of USD 7.33 million annually. The total revenue will be USD 11.31 million (86% of total annual expenditures) to track the sector's self-sufficiency. To successfully reach the Sustainable Development Goals (SDGs) and Nationally Determined Contributions (NDCs), engaging the private sector from environmentally advanced economies to collaborate in the waste sector to enhance local technical capabilities is recommended.

Green loops and clean skies: Optimizing municipal solid waste management using data science for a circular economy

The interplay between Municipal Solid Waste (MSW) Management and data science unveils a panorama of opportunities and challenges, set against the backdrop of rising global waste and evolving technological landscapes. This article threads through the multifaceted aspects of incorporating data science into MSW management, unearthing key findings, novel knowledge, and instigating a call to action for stakeholders (e.g. policymakers, local authorities, waste management professionals, technology developers, and the general public) across the spectrum. Predominant challenges like the enigmatic nature of "black-box" models and tangible knowledge gaps in the sector are scrutinized, ushering in a narrative that emphasizes transparent, stakeholder-inclusive, and policy-adaptive approaches. Notably, a conscious shift towards "white-box" and "grey-box" data science models has been spotlighted as a pivotal response to transparency issues. Furthermore, the discourse highlights the necessity of crafting data science solutions that are specifically moulded to the nuanced challenges of MSW management, and it underscores the importance of recalibrating existing policies to be reflexive to technological advancements. A resolute call echoes for stakeholders to not just adapt but immerse themselves in a continuous learning trajectory, championing transparency, and fostering collaborations that hinge on innovative, data-driven methodologies. Thus, as the realms of data science and MSW management entwine, the article sheds light on the potential transformation awaiting waste management paradigms, contingent on the nurtured amalgamation of technological advances, policy alignment, and collaborative synergy.

Unveiling Scapular Pseudo-winging: A Case Report on Ventral Osteochondroma of the Scapula in a 21-year-old

Introduction

Scapular pseudo-winging caused by ventral osteochondromas is a rare condition that has been reported in only a handful of cases. This case report describes a 21-year-old male patient with scapular pseudo-winging due to ventral osteochondromas of the scapula. This report adds to the limited literature on this topic and highlights the importance of considering ventral osteochondromas as a possible cause of scapular pseudo-winging.

Case Report

A 21-year-old male presented with a swelling on his left upper back that had gradually increased in size over the past 10 years. Physical examination revealed a bony hard swelling arising from the medial border of the scapula, with associated scapular pseudo-winging. Diagnostic imaging confirmed the presence of two ventral osteochondromas located on the body of the scapula. Surgical excision was performed to address the patient's cosmetic concerns.

Conclusion

This case report highlights the importance of considering ventral osteochondromas as a possible cause of scapular pseudo-winging. It contributes to the existing literature by documenting a rare presentation and providing insights into the clinical course, diagnostic imaging, and surgical management of this condition. By raising awareness among tumor surgeons and orthopedic surgeons, this report may aid in early recognition and appropriate management of scapular pseudo-winging cases caused by ventral osteochondromas. Furthermore, this report expands our understanding of the etiology and treatment options for scapular pseudo-winging, potentially benefiting patients across various clinical specialties.

Categories

Oncology, orthopedics.

Isolated Tillaux Fracture in a Skeletally-Mature Patient: A Rare Presentation

Isolated Tillaux fractures are uncommon injuries that occur due to external rotational forces acting on the ankle joint. They are more commonly seen in adolescents due to the presence of open epiphyses. In adults, isolated Tillaux fractures present as plafond fractures well described with the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Classification as well as Types 1, 2, and 3 according to the degree of articular comminution present. They occur rarely and can be easily missed or misdiagnosed as other ankle injuries. A thorough clinical examination, combined with imaging studies such as X-rays and CT scans, can aid in accurate diagnosis and treatment planning. Management typically involves open reduction and internal fixation, followed by a short period of immobilization and early mobilization with non-weight bearing. We present a case report of a 27-year-old female who presented with an isolated Tillaux fracture of the ankle following a road traffic accident. This type of fracture is typically seen in teenagers and young adults due to the incomplete closure of the growth plate, which makes it more susceptible to injury. The patient underwent open reduction and internal fixation with a contoured three-hole 3.5 mm titanium T-plate, followed by immobilization in a plaster splint for one week. Early mobilization was encouraged with strict non-weight bearing for 8-10 weeks. Follow-up at 12 weeks revealed complete union at the fracture site, with the patient being asymptomatic except for minimal pain and mild restriction in dorsiflexion.

A review on properties, challenges and commercial aspects of eco-friendly biolubricants productions

Lubricants operate as antifriction media, preserving machine reliability, facilitating smooth operation, and reducing the likelihood of frequent breakdowns. The petroleum-based reserves are decreasing globally, leading to price increases and raising concerns about environmental degradation. The researchers are concentrating their efforts on developing and commercializing an environmentally friendly lubricant produced from renewable resources. Biolubricants derived from nonedible vegetable oils are environmentally favorable because of their non-toxicity, biodegradability, and close to net zero greenhouse gas emissions. The demand for bio lubricants in industry and other sectors is increasing due to their non-toxic, renewable, and environmentally friendly nature. Good lubrication, anti-corrosion, and high flammability are characteristic properties of vegetable oils due to their unique structure. This study presents several key properties of nonedible oils that are used to produce lubricants via the transesterification process. Bibliometric analysis is also performed, which provides us with a better understanding of previous studies related to the production of bio lubricants from the transesterification process. Only 371 published documents in the Scopus database were found to relate to the production of bio lubricants using the transesterification process. The published work was mostly dominated by research articles (286; 77.088%). Significant development can be seen in recent years, with the highest occurrence in 2021, reaching 68 publications accounting for 18.38% of the total documents. In the second step, (i) the authors with the most number of publications; (ii) journals with the most productions; (iii) most productive countries; and (iv) the authors' most frequently used keywords were evaluated. These results will provide a pathway for researchers interested in this field. Lastly, recommendation is made on research gaps to device possible strategies for its commercialization.

A Case to Overcome the Stigma of Testicular Cancer

Testicular cancer is seen commonly in young males and has a high cure rate if diagnosed and treated early. It clinically presents with painless testicular swelling. We discuss the case of a young previously healthy male with an aggressive testicular cancer which started with a testicular swelling but the primary site underwent necrosis secondary to its own vascular demand thus giving the false impression of resolution, but not before metastasizing to the rest of the body. With this case, we aim to highlight the importance of increasing awareness of testicular cancer and its presenting symptoms in young males and the need to overcome the stigma around the evaluation of testicular swellings.

Rationale, study design and methodology of the LANDMARC trial: a 3-year, pan-India, prospective, longitudinal study to assess management and real-world outcomes of diabetes mellitus

AIM

India contributes towards a large part of the worldwide epidemic of diabetes and its associated complications. However, there are limited longitudinal studies available in India to understand the occurrence of diabetes complications over time. This pan-India longitudinal study was initiated to assess the real-world outcomes of diabetes across the country.

METHODS

The LANDMARC study is the first prospective, multicentre, longitudinal, observational study investigating a large cohort of people with type 2 diabetes mellitus across India over a period of 3 years. The primary objective of this ongoing study is to determine the proportion of people developing macrovascular diabetes complications over the duration of the study (36 months ± 45 days) distributed over seven visits; the secondary objective is to evaluate microvascular diabetes complications, glycaemic control and time-to-treatment adaptation or intensification. Overall, 6300 participants (aged 25-60 years) diagnosed with type 2 diabetes for at least 2 years will be included from 450 centres across India. Data will be recorded for baseline demographics, comorbidities, glycaemic measurements, use of anti-hyperglycaemic medications and any cardiovascular or other diabetes-related events occurring during the observational study period.

CONCLUSIONS

The LANDMARC study is expected to reveal the trends in complications associated with diabetes, treatment strategies used by physicians, and correlation among treatment, control and complications of diabetes within the Indian context. The findings of this study will help to identify the disease burden, emergence of early-onset complications and dose titration patterns, and eventually develop person-centred care and facilitate public health agencies to invest appropriate resources in the management of diabetes. (Trial Registration No: CTRI/2017/05/008452).

Waste biorefineries: Enabling circular economies in developing countries

This paper aims to examine the potential of waste biorefineries in developing countries as a solution to current waste disposal problems and as facilities to produce fuels, power, heat, and value-added products. The waste in developing countries represents a significant source of biomass, recycled materials, chemicals, energy, and revenue if wisely managed and used as a potential feedstock in various biorefinery technologies such as fermentation, anaerobic digestion (AD), pyrolysis, incineration, and gasification. However, the selection or integration of biorefinery technologies in any developing country should be based on its waste characterization. Waste biorefineries if developed in developing countries could provide energy generation, land savings, new businesses and consequent job creation, savings of landfills costs, GHG emissions reduction, and savings of natural resources of land, soil, and groundwater. The challenges in route to successful implementation of biorefinery concept in the developing countries are also presented using life cycle assessment (LCA) studies.

An efficient catalytic degradation of trichloroethene in a percarbonate system catalyzed by ultra-fine heterogeneous zeolite supported zero valent iron-nickel bimetallic composite

Zeolite supported nano iron-nickel bimetallic composite (Z-nZVI-Ni) was prepared using a liquid-phase reduction process. The corresponding surface morphologies and physico-chemical properties of the Z-nZVI-Ni composite were determined using scanning electron microscopy (SEM), transmission electron microscopy (TEM), Energy dispersive X-ray spectra (EDS), Brunauer Emmett Teller (BET) adsorption, wide angle X-ray diffractometry (WA-XRD), and Fourier transform infrared spectroscopy (FTIR). The results indicated high dispersion of iron and nickel nano particles on the zeolite sheet with an enhanced surface area. Complete destruction of trichloroethene (TCE) and efficient removal of total organic carbon (TOC) were observed by using Z-nZVI-Ni as a heterogeneous catalyst for a Fenton-like oxidation process employing sodium percarbonate (SPC) as an oxidant. The electron spin resonance (ESR) of Z-nZVI-Ni verified the generation and intensity of hydroxyl radicals (OH•). The quantification of OH• elucidated by using p-chlorobenzoic acid, a probe indicator, confirmed the higher intensity of OH•. The transformation products were identified using GC-MS. The slow iron and nickel leaching offered higher stability and better catalytic activity of Z-nZVI-Ni, demonstrating its prospective long term applications in groundwater for TCE degradation.

Degradation of chlorinated organic solvents in aqueous percarbonate system using zeolite supported nano zero valent iron (Z-nZVI) composite

Chlorinated organic solvents (COSs) are extensively detected in contaminated soil and groundwater that pose long-term threats to human life and environment. In order to degrade COSs effectively, a novel catalytic composite of natural zeolite-supported nano zero valent iron (Z-nZVI) was synthesized in this study. The performance of Z-nZVI-catalyzed sodium percarbonate (SPC) in a heterogeneous Fenton-like system was investigated for the degradation of COSs such as 1,1,1-trichloroethane (1,1,1-TCA) and trichloroethylene (TCE). The surface characteristics and morphology of the Z-nZVI composite were tested using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Total pore volume, specific surface area, and pore size of the natural zeolite and the Z-nZVI composite were measured using Brunauer-Emmett-Teller (BET) method. SEM and TEM analysis showed significant elimination of aggregation and well dispersion of iron nano particles on the framework of natural zeolite. The BET N2 measurement analysis indicated that the surface area of the Z-nZVI composite was 72.3 m(2)/g, much larger than that of the natural zeolite (0.61 m(2)/g). For the contaminant analysis, the samples were extracted with n-hexane and analyzed through gas chromatograph. The degradation of 1,1,1-TCA and TCE in the Z-nZVI-catalyzed percarbonate system were 48 and 39 % respectively, while strong augmentation was observed up to 83 and 99 %, respectively, by adding the reducing agent (RA), hydroxyl amine (NH2OH•HCl). Probe tests validated the presence of OH(●) and O2 (●-) which were responsible for 1,1,1-TCA and TCE degradation, whereas both free radicals were strengthened with the addition of RA. In conclusion, the Z-nZVI/SPC oxidation with reducing agent shows potential technique for degradation of groundwater contaminated by 1,1,1-TCA and TCE.

The influence of key clinical practices on the knowledge of first year doctors about the patients under their care

AIMS

In 2009 in the United Kingdom the 48-h working week was introduced for junior doctors. To comply with this traditional working practices have changed. This study aims to assess how much first year (FY1) doctors know about the acute surgical patients they manage and how this is influenced by changes in key working practices.

METHODS

Surgical FY1s working in NHS hospitals answered 16 clinical questions about a standard acute surgical patient under their care 48 h after admission. Scores were analysed according to how long the FY1 had been looking after the patient, whether they had clerked the patient in, attended the post take ward round (PTWR), used a handover sheet to answer the questions and had sole or shared responsibility for the patient.

RESULTS

Two hundred and seventy-four FY1s (92% response rate) from 36 hospitals were surveyed. The overall median score was 11/16 (inter-quartile range 8-13). Only 8.4% (23/274) FY1s had clerked in the patient and 58.4% (160/274) had attended the PTWR. Clerking patients and attending the PTWR resulted in significantly higher test scores compared to FY1s who did not perform these activities (p = < 0.001 and 0.001 respectively). The scores of the 67.2% who used a handover sheet were significantly lower than those who did not (p = 0.001). Having sole or shared responsibility and duration of care made no significant difference (p = 0.143 and p = 0.458 respectively)

CONCLUSIONS

The results demonstrate that junior doctors' knowledge of their patients is significantly enhanced when they have the opportunity to perform the admission clerking and attend the PTWR. Because of working hours' restrictions this is now rare. Although use of handover sheets appears to ensure that certain key facts immediately related to the current admission are passed on, it is associated with significantly poorer wider knowledge of the patient.

Energy conversion performance of black liquor gasification to hydrogen production using direct causticization with CO(2) capture

This paper estimates potential hydrogen production via dry black liquor gasification system with direct causticization integrated with a reference pulp mill. The advantage of using direct causticization is elimination of energy intensive lime kiln. Pressure swing adsorption is integrated in the carbon capture process for hydrogen upgrading. The energy conversion performance of the integrated system is compared with other bio-fuel alternatives and evaluated based on system performance indicators. The results indicated a significant hydrogen production potential (about 141MW) with an energy ratio of about 0.74 from the reference black liquor capacity (about 243.5MW) and extra biomass import (about 50MW) to compensate total energy deficit. About 867,000tonnes of CO(2) abatement per year is estimated i.e. combining CO(2) capture and CO(2) offset from hydrogen replacing motor gasoline. The hydrogen production offers a substantial motor fuel replacement especially in regions with large pulp and paper industry e.g. about 63% of domestic gasoline replacement in Sweden.

Black liquor gasification integrated in pulp and paper mills: A critical review

Black liquor gasification (BLG) has potential to replace a Tomlinson recovery boiler as an alternative technology to increase safety, flexibility and energy efficiency of pulp and paper mills. This paper presents an extensive literature review of the research and development of various BLG technologies over recent years based on low and high temperature gasification that include SCA-Billerud process, Manufacturing and Technology Conversion International (MTCI) process, direct alkali regeneration system (DARS), BLG with direct causticization, Chemrec BLG system, and catalytic hydrothermal BLG. A few technologies were tested on pilot scale but most of them were abandoned due to technical inferiority and very fewer are now at commercial stage. The drivers for the commercialization of BLG enabling bio-refinery operations at modern pulp mills, co-producing pulp and value added energy products, are discussed. In addition, the potential areas of research and development in BLG required to solve the critical issues and to fill research knowledge gaps are addressed and highlighted.

Bio-refinery system of DME or CH4 production from black liquor gasification in pulp mills

There is great interest in developing black liquor gasification technology over recent years for efficient recovery of bio-based residues in chemical pulp mills. Two potential technologies of producing dimethyl ether (DME) and methane (CH(4)) as alternative fuels from black liquor gasification integrated with the pulp mill have been studied and compared in this paper. System performance is evaluated based on: (i) comparison with the reference pulp mill, (ii) fuel to product efficiency (FTPE) and (iii) biofuel production potential (BPP). The comparison with the reference mill shows that black liquor to biofuel route will add a highly significant new revenue stream to the pulp industry. The results indicate a large potential of DME and CH(4) production globally in terms of black liquor availability. BPP and FTPE of CH(4) production is higher than DME due to more optimized integration with the pulping process and elimination of evaporation unit in the pulp mill.

Prenatal diagnosis of a neonate with fetus in fetu

Fetus in fetu is a rare condition not usually considered in the differential of a neonatal abdominal mass. This article illustrates the importance of prenatal ultrasound in the treatment of this condition as it facilitated the assembly of a multispecialty healthcare team that intervened within days of birth.

Radiation exposure of trainee anaesthetists

This prospective study was conducted to determine the level of radiation exposure of trainee anaesthetists working in urology, orthopaedics and radiology environments. Anaesthetists wore lithium fluoride thermoluminescent dosimeter (TLD) badges over a 6-month period. The position of badges was standardised at the collar site (TLD1) and at waist level (TLD2). Area specific dosimeters were used and exchanged between anaesthetists. Of a total of 723 procedures, anaesthetists were exposed to radiation in 33% of procedures in orthopaedics, 30% in urology and 39% in radiology. The mean (SD) exposure time to radiation per case was significantly greater in orthopaedics than in urology (9.2 (4) min vs. 4.2 (2) min). The radiation exposure per case was highest in radiology (19.2 (22) min). The net combined exposure over a 6-month period was 0.2177 mSv in urology, 0.4265 mSv in orthopaedics and 3.8457 mSv in radiology. The combined exposure was less than the 20 mSv recommended as the maximum exposure per year. Our data does not support the need for routine dosimetric monitoring of anaesthetists working in the above settings.

Gastric ulcer presenting as gastroesophageal reflux and apnea in a term neonate

Apnea in the neonatal period frequently is associated with prematurity. Full-term infants who develop apnea usually have associated clinical conditions such as infection, shock, metabolic disorders, neonatal abstinence syndrome, intracranial pathology, and gastroesophageal reflux. Gastric ulcer also is a rare phenomenon in the neonatal period. We describe a full-term infant presenting with apnea. Upon investigation, a 6-channel pneumocardiogram revealed central apnea and multiple episodes of low esophageal pH (< 4), which is suggestive of gastroesophageal reflux. This was confirmed by an upper gastrointestinal series. A small antral ulcer crater also was demonstrated. When assessing the etiology of apnea in a full-term infant, gastroesophageal reflux and gastric ulcer should be considered.

Immunohistochemical estrogen receptor determination in human breast carcinoma: correlation with histologic differentiation and age of the patients

An immunohistochemical assay for the measurement of estrogen receptor (ER) has been evaluated on 290 consecutive human breast biopsy and mastectomy specimens in the year 1992 at The Aga Khan University Hospital laboratories. Immunohistochemical localization of estrogen receptor on frozen/paraffin section was scored in a semi-quantitative fashion incorporating both the intensity and the distribution of specific staining. Histologic grading of the tumour was performed according to Bloom's method. In this study, 21% of the tumours were estrogen receptor negative, 15% were weak positive, 25% intermediate positive and 39% strong positive. Fifty percent of the well differentiated tumours showed strong ER positivity against 27% of the poorly differentiated tumours. Seventy eight percent of all negative estrogen receptors were in patients younger than 50 years of age (pre-menopausal group), while 52% of strong estrogen receptor positivity was observed in patients older than 50 years (post- menopausal). This study demonstrates the value of immunohistochemical method to determine the ER status in patients with advanced breast cancer.

Postnatal timing of spontaneous umbilical cord separation

A population of 293 consecutive healthy term newborns were enrolled in this study to determine the time of their umbilical cord separation while using our current nursery protocol with isopropyl alcohol as a method of cord care. Cord separation occurred from days 3 to 42, with a mean of 10.9 days. This was considerably shorter than previously reported studies in the United States, but still longer than reported data from the Netherlands and developing countries. In this study there were no significant differences noted when comparing the mode of delivery, sex, or race of infant, with respect to time interval for their cord separation.

Neurodevelopment of monitored versus nonmonitored very low birth weight infants: the importance of family influences

Very low birth weight (VLBW) infants are at increased risk for neurodevelopmental delays. Follow-up programs have been instituted as one form of secondary prevention, to identify delays early and refer affected children to intervention. To examine the relationship between follow-up care and later development, 82 neonates who weighed 1500 g or less at birth were followed to 36 months of age. Effectiveness of care was assessed by neurodevelopmental status of 45 patients who participated and 37 patients who failed to participate in annual post-neonatal intensive care unit (NICU) monitoring service. At the outset, the groups had similar medical and socioeconomic status characteristics. However, by the third year of life, the monitored patients had a 14-point General Cognitive Index (GCI) advantage over the nonmonitored group. Examination of family process variables, family organization styles, and mother-child behaviors revealed significant differences between the groups, and suggested that monitored patients were raised in more normal, supportive home environments. Correlation and stepwise regression analyses indicated that mother-child behaviors and quality of the home environment were most predictive of 3-year intellectual development, with neonatal and biological measures adding to the predictive classification of neurosensory delays. It is suggested that an infant's medical record, mother-child behaviors, and overall quality of home environment be measured prior to hospital discharge, followed by home-based intervention where indicated.