Strong Sustainability of Medical Technologies: A Medical Taboo? The Case of Disposable Endoscopes

This paper aims to question the sustainability of biomedical engineering practices. The strong sustainability framework is applied to the evaluation and development of medical technologies through the definition of clinical sustainability. A roadmap for developing and evaluating medical technologies in this respect is derived from this framework, as a first step toward a multidisciplinary evaluation tool. On this basis, the current trend towards disposable endoscopes is analyzed and discussed. This highlights the subtle balance between economic, clinical, social, and environmental factors, the lack of evidence at these multiple levels, and the need for multidisciplinarity. This paper concludes with the need to assess all aspects of sustainability and identify and quantify the trade-offs, instead of focusing on one or two key indicators, to have more relevant information in order to make better and more effective decisions. Towards sustainable healthcare, we outline two paths of action: (1) providing evidence that is lacking on the environmental impact of existing or currently developed medical technologies and (2) clarifying the premises and visions underlying our practices.Clinical Relevance- This work provides insights regarding the strong sustainability of medical technologies. This clinical framework may help clinicians and developers in decision-making to reduce indirect negative ecological, social, and health impacts.

Coupling optimization with territorial LCA to support agricultural land-use planning

The life cycle assessment framework was adapted to the territorial level (the "territorial LCA") to assess the environmental impacts and services of land-use planning scenarios. Given the various geographical conditions of the territory, the potential alternatives of land-use scenarios could be enormous. To prevent the iterative process of proposing and comparing alternative scenarios, this work aims to move one step further to automatically generate optimal planning scenarios by linking the novel territorial LCA with multi-objective optimization (MOO). A fuzzy optimization approach is adopted to deal with the trade-offs among objectives and to generate optimized scenarios, minimizing the environmental damages and maximizing the satisfaction level of the desired land-use functions subjected to constraints such as area availability and demand. Geographical Information System (GIS) is employed to manipulate geographic datasets for spatial assessment. An illustrative case study tests the novel integrated method (the territorial LCA, MOO, and GIS) on its ability to propose optimal land-use planning for bioenergy production in a region in Belgium. The study results reveal the competition of land uses for different energy products, the trade-offs among impact categories, and potential impacts on other territories if implementing optimal land planning for the territory under study. The optimization outcomes can help decision-making on the optimal locations for different crop types (i.e., miscanthus, willow, and maize in the case study) and utilizations (i.e., electricity, heat, biogas, and bioethanol in this study) complying with the objectives and constraints. This integrated tool holds the potential to assist policymakers when deciding on how to use the territory facing the global context of increasing demands for multiple uses of bio-based products, such as for food, feed, fuel, fiber, and chemicals. Limitations of the current method and its potential for real-world applications are discussed, such as expanding the scope to include life cycle sustainability assessment and taking farmers' behavior and crop rotation into account.

Regional waste footprint and waste treatments analysis

This paper provides a detailed analysis of the waste footprint and waste treatments at subnational level, for Brussels, Flanders, and Wallonia. The paper details the waste footprint components into direct waste from households (disposed in bins), indirect waste generated upstream in the supply chains and induced by household consumption and waste materials from the degradation of in-use stocks. For each component, we analysed the contribution of waste types, products consumed and location where the waste was generated, as well as the associated treatments. The results show that Flanders had the highest total waste footprint in absolute terms; Brussels the highest direct waste in capita terms and Wallonia the highest indirect waste and stock depletion in capita terms. In each region, almost 78 ± 2% of the regional waste footprints were attributed to the consumption of food products, manufactured products and restaurants and accommodation services. For each region, around 45 ± 4% of the indirect waste was generated within its boundaries, 16 ± 9% in other regions and 39 ± 5% out of Belgium. Incineration was the predominant waste treatment type of the regional waste footprint, followed by recycling. Landfill was the second widely applied treatment for indirect waste. Results constitute key information relevant to enhance the waste data monitoring practices at regional level with effects at national level. We unveiled the waste footprint and associated treatments inherent to the interregional and international linkages. Results are also useful resources to substantiate waste management and circular economy policies, enacting on waste prevention and reduction, ecodesign and product lifetime extension.

Assessing the environmental performance for more local and more circular biowaste management options at city-region level

Biomass, biobased materials and food waste are considered priority areas for Europe's transition towards a circular economy (CE). Waste management is a central activity for this transition and offers multiple CE implementation options which should be evaluated from environmental perspective. The purpose of this work was to analyze the environmental consequences when redirecting biowaste flows from conventional to more circular management systems and to identify the CE option with the best environmental performance. We were particularly interested in studying the combined management of green and food waste, analyzing the challenges when introducing separate collection and different treatment processes, and evaluating the substitution potential for by-products. To determine environmental impacts, we performed a life cycle assessment (LCA) based on local data. Following the purpose analyzing a change in the system, we applied a consequential LCA and compared impacts from processes that are replaced with impacts from alternative management options such as co-composting, anaerobic digestion (AD) and decentralized composting. The LCA results show clear advantages for impacts on ecosystems and resource use for the local AD system with separate combined collection. The decentralized system shows reductions in resource use, whereas the industrial co-composting system has higher or similar impacts than the baseline scenario. We conclude that local systems with combined food and green waste management can show benefits if process emissions are properly managed and if by-products are used in applications with high substitution potentials. However, a change towards a CE does not necessarily result in environmental benefits. Our research highlights the complexity of biowaste systems and proposes a novel combination of local data, databases and models to handle this issue. With this research we are further contributing to the understanding of the combined management of food and green waste, which is a relevant, but so far under-researched, management option for cities.

Urban waste flows and their potential for a circular economy model at city-region level

To enable cities to become more circular, i.e. close material cycles, decision-makers need detailed data about the production and treatment of waste. At city level, conventional statistics on waste are often incomplete or lack detail. Waste input-output accounting offers an alternative, using waste supply and use tables to create detailed inventories of economy-wide flows of waste. In this study we develop such tables for the city-region of Brussels (Belgium) and use them to analyse the urban waste metabolism in terms of waste flows, waste production intensity and waste treatment performance. The waste flow analysis revealed: the amount of collected waste; the proportion contributed by individual sectors; the material composition of waste flows and the location of treatment. Currently, around 50% of the 1.5 million tons of waste collected in Brussels is treated in local facilities. However, less than 1% of the collected waste is used in a way that closes material cycles within city limits. The waste performance analysis reveals that the construction sector had the highest waste production intensity and the household sector the highest incineration intensity. In terms of waste prevention and local valorisation potential, we identified flows and sectors for future targeting, one of the most promising being food waste. We conclude that the urban context can restrict the local valorisation of waste flows, thus we see the role of cities such as Brussels in a circular economy as mainly contributing to the closing of material cycles at national or even global level.

EFO-LCI: A New Life Cycle Inventory Database of Forestry Operations in Europe

Life cycle assessment (LCA) has become a common methodology to analyze environmental impacts of forestry systems. Although LCA has been widely applied to forestry since the 90s, the LCAs are still often based on generic Life Cycle Inventory (LCI). With the purpose of improving LCA practices in the forestry sector, we developed a European Life Cycle Inventory of Forestry Operations (EFO-LCI) and analyzed the available information to check if within the European forestry sector national differences really exist. We classified the European forests on the basis of "Forest Units" (combinations of tree species and silvicultural practices). For each Forest Unit, we constructed the LCI of their forest management practices on the basis of a questionnaire filled out by national silvicultural experts. We analyzed the data reported to evaluate how they vary over Europe and how they affect LCA results and made freely available the inventory data collected for future use. The study shows important variability in rotation length, type of regeneration, amount and assortments of wood products harvested, and machinery used due to the differences in management practices. The existing variability on these activities sensibly affect LCA results of forestry practices and raw wood production. Although it is practically unfeasible to collect site-specific data for all the LCAs involving forest-based products, the use of less generic LCI data of forestry practice is desirable to improve the reliability of the studies. With the release of EFO-LCI we made a step toward the construction of regionalized LCI for the European forestry sector.

Life cycle assessment of a palm oil system with simultaneous production of biodiesel and cooking oil in Cameroon

The use of palm oil as a biofuel has been heavily debated for its land-use conflict with nature and its competition with food production, being the number one cooking oil worldwide. In that context, we present a life cycle assessment of a palm oil production process yielding both biodiesel and cooking oil, incorporating the land-use impact and evaluating the effect of treating the palm oil mill effluent (POME) prior to disposal. The results show that the nonrenewable energy requirement, global warming potential (GWP; exclusive land-use change), and acidification potential are lower than those of the fossil alternative. However, the system triggers an increase in eutrophication potential (EP) compared to the fossil fuel reference. This system shows less energy requirement, global warming and acidification reduction, and less eutrophication increase compared to the reference than the same system converting all palm oil into biodiesel (no cooking oil production). The land occupation of palm oil triggers ecosystem quality (EQ) loss of 30-45% compared to the potential natural vegetation. Furthermore, such land-use change triggers a carbon debt neutralizing the GWP reduction for 45-53 years. The POME treatment scenarios reveal a trade-off between GWP and EP.