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Brown TW, Murphy JL, Akers P, Patrick M, Hill V, Mattioli M, Tsige Y, Adow A, Abdirashid M, Mohamed MN, Githiri D, Handzel T. An environmental evaluation of urine-diverting dry toilets in Hiloweyn Camp, Dollo Ado, Ethiopia. Sci Total Environ 2024; 926:171838. [PMID: 38518820 DOI: 10.1016/j.scitotenv.2024.171838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
Safe and hygienic management of human waste is essential in humanitarian settings. Urine-diverting dry toilets (UDDTs) can enable this management in some humanitarian emergency settings. A seeded, longitudinal environmental study was conducted in Hiloweyn refugee camp, Dollo Ado, Ethiopia, to measure Escherichia coli and Ascaris suum ova inactivation within closed UDDT vaults and to document environmental conditions (temperature, moisture content, and pH) that could influence inactivation. Hiloweyn camp represented an optimal location for a desiccation-based sanitation technology such as the UDDT. E. coli and Ascaris ova inactivation was observed in UDDTs under warm, dry, alkaline conditions at 6, 9, and 12 months of storage; UDDTs with samples containing <1000 E. coli/g total solids increased from 30 % to 95 % over 12 months, and a >2.8-log10 reduction in Ascaris ova viability was observed after 6 months. Additional laboratory-based studies were conducted to provide insights into the field study findings and study the impact of hydrated lime on E. coli and Ascaris ova inactivation. Results suggest that adding hydrated lime to elevate pH > 12 may increase inactivation and decrease storage time. Overall, UDDTs could contribute to the safe and hygienic management of human waste in comparable warm and dry humanitarian settings.
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Affiliation(s)
- Travis W Brown
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA; Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jennifer L Murphy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Akers
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Molly Patrick
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Vincent Hill
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mia Mattioli
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yegerem Tsige
- United Nations High Commissioner for Refugees, Switzerland
| | | | | | | | - David Githiri
- United Nations High Commissioner for Refugees, Switzerland
| | - Thomas Handzel
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Moreno Cruz CF, Monroy Hermosillo O, Thalasso F, Tzintzun Camacho O, Ramírez Vives F. Toilet effluent separation and brown water treatment: Survey and initial feasibility testing in Mexico. Sci Total Environ 2024; 922:171281. [PMID: 38417526 DOI: 10.1016/j.scitotenv.2024.171281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/10/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
Separation of domestic effluents at the source and the utilization of low-flush toilets offer alternative approaches for developing efficient wastewater treatment systems while promoting energy generation through anaerobic digestion. This study focused on assessing toilet usage in Mexico and exploring the potential of anaerobic co-digestion of brown water (feces) and toilet paper as influential factors in wastewater treatment systems. A survey was conducted on a representative sample of Mexicans to gather information on toilet usage frequency, toilet paper use and disposal practices, as well as the type and quantity of commercial disinfectants and pharmaceutical compounds they use or consume. The survey revealed that per capita toilet paper consumption is 2.9 kg annually, that 58 % of respondents do not dispose used paper in the toilet, and that about 47 % use two to three cleaning and disinfection products. Notably, 97 % of the sampled Mexican population expressed a willingness to transition to more eco-friendly toilet options. Subsequently, in a second step, the anaerobic co-digestion of brown water with toilet paper was evaluated, demonstrating a relatively high production of volatile fatty acids but low methane production. This suggests an efficient hydrolysis/acidogenesis process coupled with restrained methanogenesis, probably due to pH decrease caused by acidogenesis. This study underscores that toilet paper and brown water are potential suitable substrates for anaerobic co-digestion. Furthermore, it sheds light on the behaviors of Mexican society regarding bathroom use and cleaning, contributing to the establishment of foundations for wastewater treatment systems with effluent separation at the source.
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Affiliation(s)
- Carlos Francisco Moreno Cruz
- Universidad Autónoma Metropolitana Iztapalapa, Av. San Rafael Atlixco No. 186, Col. Vicentina, Iztapalapa, Ciudad de México C.P. 09340, Mexico; Universidad Autónoma de Baja California, Instituto de Ciencias Agrícolas, Carretera a Delta s/n, C.P. 21705, Ejido Nuevo León, Mexicali, Baja California, Mexico.
| | - Oscar Monroy Hermosillo
- Universidad Autónoma Metropolitana Iztapalapa, Av. San Rafael Atlixco No. 186, Col. Vicentina, Iztapalapa, Ciudad de México C.P. 09340, Mexico
| | - Frederic Thalasso
- Departamento de Biotecnología y Bioingeniería, Centro de Investigación y de Estudios Avanzados (Cinvestav), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, Gustavo A. Madero, C.P. 07360 Ciudad de México, Mexico
| | - Olivia Tzintzun Camacho
- Universidad Autónoma de Baja California, Instituto de Ciencias Agrícolas, Carretera a Delta s/n, C.P. 21705, Ejido Nuevo León, Mexicali, Baja California, Mexico
| | - Florina Ramírez Vives
- Universidad Autónoma Metropolitana Iztapalapa, Av. San Rafael Atlixco No. 186, Col. Vicentina, Iztapalapa, Ciudad de México C.P. 09340, Mexico
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Zhang Z, Liu J, Sato Y, Daigger G, Chen G. Achieving Carbon Mitigation with Economic Benefits through High-Resolution Analysis of Renewable Resource Integration in Global Coastal Cities. Environ Sci Technol 2024; 58:6158-6169. [PMID: 38546376 DOI: 10.1021/acs.est.3c06982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Coastal regions, home to more than half of the global population and contributing over 50% to the global economy, possess vast renewable resources, such as seawater and solar energy. The effective utilization of these resources, through the seawater-cooled district cooling system (SWDCS), seawater toilet flushing (SWTF), and rooftop solar photovoltaic system (RTPV), has the potential to significantly reduce carbon emissions. However, implementing these technologies in different geographic contexts to achieve the desired carbon and economic outcomes at the city level lacks a clear roadmap. To address this challenge, we comprehensively analyzed 12 coastal megacities worldwide by integrating geospatial building data. Our study evaluated the potential energy savings, carbon mitigation, and levelized carbon abatement costs (LCACs) from a life cycle perspective. The results revealed that using seawater and solar energy within urban boundaries can reduce electricity consumption from 1 to 24% across these cities. The spatial distribution of the LCAC for seawater-based systems exhibited more variation compared to the RTPV. By applying specific LCAC thresholds ranging from 0 to 225 USD/tCO2e, all cities could achieve both carbon reductions and economic benefits. These thresholds resulted in up to 80 million tonnes of carbon emission reductions and 5 billion USD of economic benefits, respectively. Our study provides valuable insights into integrating renewable resource systems, enabling coastal cities to achieve carbon and economic advantages at the city scale simultaneously.
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Affiliation(s)
- Zi Zhang
- Department of Civil and Environmental Engineering, Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch) and Water Technology Center, The Hong Kong University of Science and Technology, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Jie Liu
- Department of Civil and Environmental Engineering, Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch) and Water Technology Center, The Hong Kong University of Science and Technology, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Yugo Sato
- Department of Civil and Environmental Engineering, Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch) and Water Technology Center, The Hong Kong University of Science and Technology, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Glen Daigger
- Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Guanghao Chen
- Department of Civil and Environmental Engineering, Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch) and Water Technology Center, The Hong Kong University of Science and Technology, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Hong Kong, China
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Vieira E, Allen G, Al-Majid S. BPI24-010: Temporary Toilet Lids Minimize Contamination of Bathroom Surfaces With Hazardous Drugs. J Natl Compr Canc Netw 2024; 22:BPI24-010. [PMID: 38580243 DOI: 10.6004/jnccn.2023.7279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- Eliane Vieira
- 1MemorialCare Orange Coast Medical Center, Fountain Valley, CA
| | - Grace Allen
- 1MemorialCare Orange Coast Medical Center, Fountain Valley, CA
| | - Sadeeka Al-Majid
- 2Fullerton School of Nursing, California State University, Fullerton, CA
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Dahler AM, Andersen PT, Olesen F. Arrangements of wash toilets and ageing bodies - an exploratory study. Disabil Rehabil Assist Technol 2024; 19:721-729. [PMID: 36074607 DOI: 10.1080/17483107.2022.2120640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study is to study how a specific assistive technology, namely wash toilet systems, are used and which values they enact for their users. MATERIALS AND METHODS The study is primarily based on ten semi-structured interviews conducted with older adults who were offered a wash toilet as an element in the welfare service of a large Danish municipality. RESULTS The study shows how, in various ways, specific aspects of wash toilet systems are associated with specific aspects of human physiology. Essential challenges to older adults that implicate the use of wash toilet systems either relate to 'arms that cannot reach behind', or the leakage of urine and eventually faeces. Furthermore the study shows that values enacted by wash toilet systems differ in the various arrangements, e.g., enabling social relations, being a part of something, being self-reliant or independent, preserving intimacy limits, or just 'be pleased with'. CONCLUSIONS The wash toilet systems are woven into several different arrangements of the ageing body, wheelchairs, walkers, care personnel, spouses, diapers, etc. being situated in differently spaced bathrooms in different homes and different municipalities. We propose that the abandonment of focus on abstract policy values in favour of an emphasis on the actual arrangements of technology and the human body in old age will, in fact, be beneficial to our understanding of how welfare technology can contribute to enhanced citizenship.Implications for rehabilitationAn implication of this study for rehabilitation is not to take for granted how a wash toilet system will interact in arrangements with older adults, but attend to the potentially various/many ways the system can create value for the user in the actual arrangement it is part of.Another implication of the study is that it is always an empirical question whether self-reliance - which is often an aim of implementing assistive technologies - is an effect of a specific arrangement of a wash toilet system and the human body in old age.
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Affiliation(s)
- Anne Marie Dahler
- Centre for Applied Welfare Research, UCL University College, Odense, Denmark
| | | | - Finn Olesen
- School of Communication and Culture, Information Studies, Aarhus University, Aarhus, Denmark
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Tanaka Y, Kamikura T, Owada H, Inaba H. Identification of causal diseases associated with the occurrence of out-of-hospital cardiac arrest in toilets. Eur J Emerg Med 2024; 31:152-154. [PMID: 38416587 DOI: 10.1097/mej.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Yoshio Tanaka
- Department of Emergency and Disaster Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
- Department of Surgery, Shin Kyoto-Minami Hospital, Kyoto, Japan
| | - Takahisa Kamikura
- Department of Emergency Medical Science, Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Hitoshi Owada
- Department of Emergency Medical Science, Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Hideo Inaba
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Bechmann L, Bauer K, Zerban P, Esser T, Tersteegen A, Fuchs SA, Kaasch AJ, Wolleschak D, Schalk E, Fischer T, Mougiakakos D, Geginat G. Prevention of legionella infections from toilet flushing cisterns. J Hosp Infect 2024; 146:37-43. [PMID: 38224856 DOI: 10.1016/j.jhin.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Immunocompromised patients are at an increased risk of severe legionella infections. We present the results of an outbreak investigation initiated following a fatal case of hospital-acquired legionellosis linked to contaminated water from a toilet-flushing cistern. Additionally, we provide experimental data on the growth of Legionella spp. in flushing cisterns and propose a straightforward protocol for prevention. METHODS We monitored the growth of Legionella spp. in the building's hot- and cold-water systems using quantitative bacterial culture on selective agar. Molecular typing of Legionella pneumophila isolates from the infected patient and the water system was conducted through core-genome multi-locus sequence typing (cgMLST). RESULTS Legionella contamination in the hospital building's cold-water system was significantly higher than in the hot-water system and significantly higher in toilet flushing cistern's water compared with cold water from bathroom sinks and showers. Isolates from the patient and from the flushing cistern of the patient's bathroom were identical by cgMLST. In an experimental setting, daily toilet flushing for a period of 21 days resulted in a 67% reduction in the growth of Legionella spp. in the water of toilet flushing cisterns. Moreover, a one-time disinfection of cisterns with peracetic acid, followed by daily flushing, decreased legionella growth to less than 1% over a period of at least seven weeks in these setting. CONCLUSIONS One-time disinfection of highly contaminated cisterns with peracetic acid and daily toilet flushing as short-term measure can significantly reduce legionella contamination in flushing cisterns. These measures may aid in preventing legionella infection among immunocompromised patients.
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Affiliation(s)
- L Bechmann
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
| | - K Bauer
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - P Zerban
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - T Esser
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - A Tersteegen
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - S A Fuchs
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - A J Kaasch
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - D Wolleschak
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - E Schalk
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - T Fischer
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - D Mougiakakos
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - G Geginat
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Eisenberg S, Walton A, Connor TH. The Occupational and Environmental Hazards of Uncovered Toilets. Am J Nurs 2024; 124:55-60. [PMID: 38511713 DOI: 10.1097/01.naj.0001010592.45177.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
ABSTRACT Substantial evidence demonstrates that plumes from uncovered toilets potentially expose nurses and other health care workers to aerosols containing infectious agents and hazardous drugs, including antineoplastic drugs. Most hospitals in the United States utilize flushometer-type toilets, which operate under high pressure and do not have a permanently attached closure or lid, which is known to reduce the aerosols generated by flushing. This article aims to raise awareness among nurses of the potential exposure risks associated with toilet plume aerosols, so they can educate other health care workers and take part in initiatives to address these risks.
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Affiliation(s)
- Seth Eisenberg
- Seth Eisenberg is an oncology nursing consultant and the former professional practice coordinator of infusion services at the Fred Hutchinson Cancer Center, Seattle. AnnMarie Walton is an associate professor at the Duke University School of Nursing, Durham, NC. Thomas Harry Connor is a retired hazardous drug researcher for the National Institute for Occupational Safety and Health and a former associate professor at the University of Texas Health Science Center at Houston. Contact author: Thomas Harry Connor, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Ladyzhets B. What toilets can reveal about COVID, cancer and other health threats. Nature 2024; 628:492-494. [PMID: 38632479 DOI: 10.1038/d41586-024-01092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
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Perelshtein I, Shoshani S, Jacobi G, Natan M, Dudchenko N, Perkas N, Tkachev M, Bengalli R, Fiandra L, Mantecca P, Ivanova K, Tzanov T, Banin E, Gedanken A. Protecting the Antibacterial Coating of Urinal Catheters for Improving Safety. ACS Appl Bio Mater 2024; 7:990-998. [PMID: 38226433 DOI: 10.1021/acsabm.3c00988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Catheter-associated urinary tract infections (CAUTI) are among the most common bacterial infections associated with prolonged hospitalization and increased healthcare expenditures. Despite recent advances in the prevention and treatment of these infections, there are still many challenges remaining, among them the creation of a durable catheter coating, which prevents bacterial biofilm formation. The current work reports on a method of protecting medical tubing endowed with antibiofilm properties. Silicone catheters coated sonochemically with ZnO nanoparticles (NPs) demonstrated excellent antibiofilm effects. Toward approval by the European Medicines Agency, it was realized that the ZnO coating would not withstand the regulatory requirements of avoiding dissolution for 14 days in artificial urine examination. Namely, after exposure to urine for 14 days, the coating amount was reduced by 90%. Additional coatings with either carbon or silica maintained antibiofilm activity against Staphylococcus aureus while resisting dissolution in artificial urine for 14 days (C- or SiO2-protected catheters exhibited only 29% reduction). HR-SEM images of the protected catheters indicate the presence of the ZnO coating as well as the protective layer. Antibiofilm activity of all catheters was evaluated both before and after exposure to artificial urine. It was shown that before artificial urine exposure, all coated catheters showed high antibiofilm properties compared to the uncoated control. Exposure of ZnO-coated catheters, without the protective layer, to artificial urine had a significant effect exhibited by the decrease in antibiofilm activity by almost 2 orders of magnitude, compared to unexposed catheters. Toxicity studies performed using a reconstructed human epidermis demonstrated the safety of the improved coating. Exposure of the epidermis to ZnO catheter extracts in artificial urine affects tissue viability compared with control samples, which was not observed in the case of ZnO NPs coating with SiO2 or C. We suggest that silica and carbon coatings confer some protection against zinc ions release, improving ZnO coating safety.
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Affiliation(s)
- Ilana Perelshtein
- Department of Chemistry, Bar-Ilan University, Ramat-Gan 5290002, Israel
- Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Sivan Shoshani
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Gila Jacobi
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Michal Natan
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Nataliia Dudchenko
- Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Nina Perkas
- Department of Chemistry, Bar-Ilan University, Ramat-Gan 5290002, Israel
- Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Maria Tkachev
- Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Rossella Bengalli
- Department of Earth and Environmental Sciences, Research Center POLARIS, University of Milano Bicocca, Milan 20126, Italy
| | - Luisa Fiandra
- Department of Earth and Environmental Sciences, Research Center POLARIS, University of Milano Bicocca, Milan 20126, Italy
| | - Paride Mantecca
- Department of Earth and Environmental Sciences, Research Center POLARIS, University of Milano Bicocca, Milan 20126, Italy
| | - Kristina Ivanova
- Grup de Biotecnologia Molecular i Industrial, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Rambla Sant Nebridi 22, 08222 Terrasa, Spain
| | - Tzanko Tzanov
- Grup de Biotecnologia Molecular i Industrial, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Rambla Sant Nebridi 22, 08222 Terrasa, Spain
| | - Ehud Banin
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Aharon Gedanken
- Department of Chemistry, Bar-Ilan University, Ramat-Gan 5290002, Israel
- Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 5290002, Israel
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Niu Y, Wang F, Luo D, Shu Z, Huang J, Zhang Y, Liu C, Qian H. Vertical transmission of infectious aerosols through building toilet drainage system: An experimental study. Environ Pollut 2024; 343:123284. [PMID: 38163630 DOI: 10.1016/j.envpol.2023.123284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/23/2023] [Accepted: 12/30/2023] [Indexed: 01/03/2024]
Abstract
The building's toilet drainage system has been identified as a potential route for the transmission of SARS-CoV-2 during outbreaks. This study employed agar-fluorescein sodium semi-solid as trace particles to investigate the possibility of vertical transmission of the SARS-CoV-2 in drainage system. In both scenarios, where floor drains were all properly sealed or dried out, simulated faeces containing fluorescein sodium were flushed into the toilet bowl. Air sampling was conducted in each restroom, and differential pressure measurements at the floor drain locations were taken. The experimental results showed that when all floor drains were properly sealed, the differential pressure at each floor drain was 0. The fluorescein sodium-traced aerosol did not transmit through the drainage system to various floors, which significantly reduced the risk of infection for users through this route. However, when all floor drains dried out, toilet users above the neutral pressure layer (NPL) were at a high risk of virus infection. Due to the increasing maximum negative pressure at the floor drain above the NPL with ascending floor levels, users on each floor above the NPL faced an elevated infection risk in restrooms. Specifically, users on the top floor were exposed to infectious aerosols roughly 1.6 times that of the first floor above the NPL. Conversely, owing to the increasing maximum positive pressure at the floor drain below the NPL with descending floor levels, users below the NPL experienced a comparatively lower infection risk. This finding has important implications for understanding the vertical transmission dynamics of SARS-CoV-2 in residential or public building and can inform the development of effective control measures.
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Affiliation(s)
- Yuanyuan Niu
- School of Energy and Environment, Southeast University, Nanjing, 210096, China
| | - Fang Wang
- School of Energy and Power Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China
| | - Danting Luo
- School of Energy and Environment, Southeast University, Nanjing, 210096, China
| | - Zhiyong Shu
- School of Energy and Environment, Southeast University, Nanjing, 210096, China
| | - Jiayu Huang
- School of Energy and Environment, Southeast University, Nanjing, 210096, China
| | - Yongpeng Zhang
- School of Energy and Power Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China
| | - Cong Liu
- School of Energy and Environment, Southeast University, Nanjing, 210096, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, 210096, China.
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Valzano F, Coda ARD, Marangi M, La Bella G, Liso A, Arena F. Activity of a foam in preventing rebound of vancomycin-resistant Enterococcus faecium-containing droplets generated from the toilet bowl. Arch Microbiol 2024; 206:57. [PMID: 38189992 PMCID: PMC10774183 DOI: 10.1007/s00203-023-03775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024]
Abstract
In hospital environments, droplets generated by urination within shared toilets may represent a route of dissemination for bacteria such as vancomycin-resistant Enterococcus faecium (VREfm), which contributes significantly to the burden of hospital-acquired infections. We investigated the potential activity of a foam in preventing the generation of droplets containing Enterococcus spp. during urination. A uniform layer of foam was deposited in the inner walls and at the bottom of an experimental toilet contaminated with suspensions of Enterococcus strains (including a VREfm strain). Human urination was simulated, and colonies of Enterococcus were recovered through a toilet lid where agar plates had been placed. Results showed that the foam was able to suppress production of droplets containing Enterococcus spp. generated by a liquid hitting inner toilet walls. Conversely, Enterococcus colonies were recovered in absence of foam. Moreover, the foam did not show antibacterial activity. We propose a new non-antimicrobial approach aimed at limiting transmission of multidrug-resistant bacteria, particularly in healthcare settings.
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Affiliation(s)
- Felice Valzano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Anna Rita Daniela Coda
- Department of Medical and Surgical Sciences, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Marianna Marangi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Gianfranco La Bella
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
- Istituto Zooprofilattico Sperimentale Della Puglia E Della Basilicata, Via Manfredonia 20, 71121, Foggia, Italy
| | - Arcangelo Liso
- Department of Medical and Surgical Sciences, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Fabio Arena
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy.
- IRCCS Don Carlo Gnocchi Foundation, Via Di Scandicci 269, 50143, Florence, Italy.
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月井 直, 藤井 涼, 新谷 夏, 藤生 大. [The effect of marking and brightness adjustment on nocturnal toilet visits and repeated questions in person with dementia]. Nihon Ronen Igakkai Zasshi 2024; 61:84-86. [PMID: 38583975 DOI: 10.3143/geriatrics.61.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
| | | | | | - 大我 藤生
- 認知症介護研究・研修東京センター
- 医療法人大誠会介護老人保健施設大誠苑認知症専門棟
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Başıbüyük GÖ, Güler ZÖ, Kılıç B, Yaylagül NK, Ay F, Bekdaş O, Özgür Ö, Gültekin T. Designing ergonomic toilets and bathrooms for older adults: A study on anthropometric dimensions and recommendations. Geriatr Nurs 2024; 55:263-269. [PMID: 38091712 DOI: 10.1016/j.gerinurse.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 02/06/2024]
Abstract
AIMS This study aimed to evaluate the ergonomic design of toilets and bathroom equipment for older adults using anthropometric measurements. DESIGN This was a descriptive cross-sectional study. METHODS Data were collected from 2,721 people aged ≥ 65 years in Turkey. Fourteen anthropometric measurements were evaluated. Body dimension characteristics were described using minimum, maximum, and arithmetic means and standard deviations and the 5th, 25th, 50th, 75th, and 95th percentiles. RESULTS The measurements showed that companies generally do not design bathroom toilet equipment that is suitable for older adults. CONCLUSION This study provides advice to designers and manufacturers on how to adapt their products to the bathroom according to users' body characteristics in order to increase person-environment fit for older people.
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Affiliation(s)
| | - Zümre Özdemir Güler
- Department of Economics, Söke Faculty of Management, Aydın Adnan Menderes University, Aydın, Türkiye
| | - Barış Kılıç
- Department of Gerontology, Faculty of Health Sciences, Akdeniz University, Antalya, Türkiye.
| | | | - Faruk Ay
- Department of Anthropology, Faculty of Literature, Sivas Cumhuriyet University, Sivas, Türkiye
| | - Ozan Bekdaş
- Department of Anthropology, Faculty of Literature, Sivas Cumhuriyet University, Sivas, Türkiye
| | - Özlem Özgür
- Department of Gerontology, Faculty of Health Sciences, Akdeniz University, Antalya, Türkiye
| | - Timur Gültekin
- Department of Anthropology, Faculty of Language, History and Geography, Ankara University, Ankara, Türkiye
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Beer M, Schuler J, Kraus E, Zhou S, Stanzel S, Lorenz S, Rygula A, Schmidt SA, Niederste-Hollenberg J. Discharge of iodine-containing contrast media into the environment - problem analysis and implementation of measures to reduce discharge by means of separation toilets - experience from a pilot project. ROFO-FORTSCHR RONTG 2023; 195:1122-1127. [PMID: 37793416 DOI: 10.1055/a-2168-8346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE Environmental aspects and sustainability are becoming increasingly important. In addition to energy consumption, the consumption and environmental discharge of contrast agents pose a particular challenge. Because of their desired stability, X-ray contrast agents (XCAs) are deposited in surface water at a rate of up to 400 tons per year. MATERIALS AND METHODS In a pilot project, a set of measures (installation of specific separation toilets, the establishment of feedback systems, interviews, questionnaires, and observation) was implemented to sensitize patients and staff to the problem of XCAs during outpatient CT examinations and a retention and recovery system for XCAs was evaluated. RESULTS In the initial baseline phase, a separation toilet with an additional collection system and a feedback/button system was installed. The built-in feedback system indicated that the separation toilets were used by approx. 16 % of patients without measures. In two subsequent intervention phases, accompanying measures significantly (p < 0.01) increased the use of these separation toilets to 21 % and 25 %, respectively. The measures to reduce the discharge of XCAs were positively assessed by both staff and patients. CONCLUSION Measures to reduce the discharge of XCAs into the environment have a high acceptance among staff and patients. The subsequent installation of separation toilets is one possibility to achieve on-site retention of XCAs. However, this measure is likely to be of high value only if patients stay on site for a correspondingly long time, as is the case in cardiology, for example. KEY POINTS · The input of X-ray contrast agents into the environment is relevant in light of the quantity. · Measures to reduce the discharge of X-ray contrast agents into the environment have been investigated in pilot projects. · The (subsequent) installation of separation toilets is possible and allows retention of X-ray contrast agents. · This measure is considered useful by patients and staff. · The financing of these measures needs to be clarified. CITATION FORMAT · Beer M, Schuler J, Kraus E et al. Discharge of iodine-containing contrast media into the environment - problem analysis and implementation of measures to reduce discharge by means of separation toilets - experience from a pilot project. Fortschr Röntgenstr 2023; 195: 1122 - 1127.
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Affiliation(s)
- Meinrad Beer
- Department for Diagnostic and Interventional Radiology, Ulm University Hospital, Ulm, Germany
| | - Johannes Schuler
- ISI, Fraunhofer Institute for Systems and Innovation Research ISI, Karlsruhe, Germany
| | - Elena Kraus
- Department for Diagnostic and Interventional Radiology, Ulm University Hospital, Ulm, Germany
| | - Shaoxia Zhou
- Central Facility Clinical Chemistry, Ulm University Hospital, Ulm, Germany
| | - Stefan Stanzel
- Construction and Facility management, Ulm University Hospital, Ulm, Germany
| | - Stefanie Lorenz
- Department for Diagnostic and Interventional Radiology, Ulm University Hospital, Ulm, Germany
| | - Alexander Rygula
- Department for Diagnostic and Interventional Radiology, Ulm University Hospital, Ulm, Germany
| | - Stefan Andreas Schmidt
- Department for Diagnostic and Interventional Radiology, Ulm University Hospital, Ulm, Germany
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Shkalim Zemer V, Cohen HA, Richenberg Y, Gerstein M, Atias I, Gur S, Laks Y, Levinsky Y, Dvir O, Brown I, Cohen M, Ben Meir D. Personal hygiene, environmental conditions, and toilet use of children in primary schools: A cohort study. J Pediatr Urol 2023; 19:721-727. [PMID: 37357079 DOI: 10.1016/j.jpurol.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/07/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Many primary school children withhold urine and stool whilst at school for various reasons. Limited toilet access and the failure to provide safe, sanitary toilets are putting children at risk for toilet avoidance behavior. OBJECTIVE We aimed to examine personal hygiene, environmental conditions, the perception of these on children, and their toilet use in primary schools. STUDY DESIGN Children aged 6-12 and their parents were asked to complete a self-report questionnaire regarding toilet behavior and the perception of school toilet standards. RESULTS The main findings are listed below using the data from the questionnaire. DISCUSSION We found that 9% and 63% of the children avoided urination and defecating at school, respectively. Similar results were reported previously. The participants' perceptions regarding the environmental conditions of school toilets and conditions revealed that 34% of the children felt that the toilets were dirty or very dirty. Around one-third of them reported a lack of toilet paper sometimes or most of the time. These unsatisfying hygienic conditions of school toilets can be easily solved. Unfortunately, 46% of the children in our study experienced bullying in school toilets. These worrisome data are seldom reported in other studies. The urination habits of the girls, who mostly preferred to partially squat or stand may lead to dysfunctional voiding and incomplete bladder emptying. Our study was limited by the relatively small population, the subjectiveness of the self-reporting questionnaire, and the voiding and defecation habits of the investigated children during school hours. These hours do not necessarily reflect the children's habits after school hours and during the weekends. Despite these limitations, the discussed issues regarding personal hygiene and the environmental conditions in the sampled primary schools are extremely important. CONCLUSION Nearly half of the school children had negative perceptions of school toilets. This should raise awareness and concern for school staff to consider and investigate potential facilities improvement in light of the impact observed here. Implementation of appropriate education and a better environment of toilet facilities and security is important for the children's well-being.
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Affiliation(s)
- Vered Shkalim Zemer
- Clalit Health Services, Dan-Petach-Tikva District, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel.
| | - Herman Avner Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; Pediatric Ambulatory Community Clinic, Petach Tikva, Israel.
| | | | - Maya Gerstein
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; Pediatric Ambulatory Community Clinic, Petach Tikva, Israel.
| | - Ifat Atias
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; Neve Gan Clinic, Petach Tikva 4926040, Israel.
| | - Shmuel Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; Pediatric Ambulatory Community Clinic, Kfar Saba 4422941, Israel.
| | - Yoseph Laks
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; Pediatric Ambulatory Community Clinic, Ramat Aviv, Tel Aviv 6905234, Israel.
| | - Yoel Levinsky
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; Schneider Children's Medical Center of Israel, Petach Tikva 49420235, Israel.
| | - Or Dvir
- Pediatric Urology Unit, Schneider Children's Medical Center of Israel, Petach Tikva 49420235, Israel.
| | - Iris Brown
- Pediatric Urology Unit, Schneider Children's Medical Center of Israel, Petach Tikva 49420235, Israel.
| | - Moriya Cohen
- Microbiology Unit, Ariel University, Ariel 98603, Israel.
| | - David Ben Meir
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; Pediatric Urology Unit, Schneider Children's Medical Center of Israel, Petach Tikva 49420235, Israel.
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Esmaeilzadeh P. Older Adults' Perceptions About Using Intelligent Toilet Seats Beyond Traditional Care: Web-Based Interview Survey. JMIR Mhealth Uhealth 2023; 11:e46430. [PMID: 38039065 PMCID: PMC10724815 DOI: 10.2196/46430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND In contemporary society, age tech (age technology) represents a significant advancement in health care aimed at enhancing patient engagement, ensuring sustained independence, and promoting quality of life for older people. One innovative form of age tech is the intelligent toilet seat, which is designed to collect, analyze, and provide insights based on toileting logs and excreta data. Understanding how older people perceive and interact with such technology can offer invaluable insights to researchers, technology developers, and vendors. OBJECTIVE This study examined older adults' perspectives regarding the use of intelligent toilet seats. Through a qualitative methodology, this research aims to unearth the nuances of older people's opinions, shedding light on their preferences, concerns, and potential barriers to adoption. METHODS Data were collected using a web-based interview survey distributed on Amazon Mechanical Turk. The analyzed data set comprised 174 US-based individuals aged ≥65 years who voluntarily participated in this study. The qualitative data were carefully analyzed using NVivo (Lumivero) based on detailed content analysis, ensuring that emerging themes were coded and classified based on the conceptual similarities in the respondents' narratives. RESULTS The analysis revealed 5 dominant themes encompassing the opinions of aging adults. The perceived benefits and advantages of using the intelligent toilet seat were grouped into 3 primary themes: health-related benefits including the potential for early disease detection, continuous health monitoring, and seamless connection to health care insights. Technology-related advantages include the noninvasive nature of smart toilet seats and leveraging unique and innovative data collection and analysis technology. Use-related benefits include ease of use, potential for multiple users, and cost reduction owing to the reduced need for frequent clinical visits. Conversely, the concerns and perceived risks were classified into 2 significant themes: psychological concerns, which included concerns about embarrassment and aging-related stereotypes, and the potential emotional impact of constant health monitoring. Technical performance risks include concerns centered on privacy and security, device reliability, data accuracy, potential malfunctions, and the implications of false positives or negatives. CONCLUSIONS The decision of older adults to incorporate intelligent toilet seats into their daily lives depends on myriad factors. Although the potential health and technological benefits are evident, valid concerns that need to be addressed remain. To foster widespread adoption, it is imperative to enhance the advantages while simultaneously addressing and mitigating the identified risks. This balanced approach will pave the way for a more holistic integration of smart health care devices into the routines of the older population, ensuring that they reap the full benefits of age tech advancements.
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Affiliation(s)
- Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
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18
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Gu Y, Zhou W, Zheng T, Huang F. Health effects and externalities of the popularization of sanitary toilets: evidence from Rural China. BMC Public Health 2023; 23:2225. [PMID: 37951864 PMCID: PMC10640730 DOI: 10.1186/s12889-023-17192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND This study aimed to assess the impact of the increased prevalence of sanitary toilets in rural areas on the health of rural residents, and whether the popularity thereof has a positive externality. This study investigates whether the broader use of sanitary toilets has had a positive effect on the health of people who do not have access to them. METHODS Data from the China Family Panel Studies from 2012 to 2014 and a two-way fixed effect model were used to investigate the relationship between the prevalence of village sanitary toilets and the health of rural residents of all ages. RESULTS The results showed that: (1) the increase in the prevalence of sanitary toilets in villages is conducive to improving the health level of rural residents; (2) the widespread adoption of sanitary toilets in rural areas has improved the health of not only residents with access to these toilets but also residents without access; (3) the health of children is more sensitive to improvements in sanitary conditions of toilets; and (4) there are significant regional differences in the impact of the popularity of sanitary toilets on the health of rural residents. CONCLUSIONS This study found that the popularity of sanitary toilets has externalities, improving not only the health of residents who use them but also the health of other residents. This study enriches the literature in the field of health effects of sanitation improvement, while providing a reference for developing countries to further enhance the living environment in rural areas. In the future, the popularization of sanitary toilets should be vigorously promoted to reduce the incidence of diseases.
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Affiliation(s)
- Yingwen Gu
- College of Humanities, Hubei University of Chinese Medicine, Wuhan, China
- Hubei Shizhen Laboratory, Wuhan, China
| | - Wanli Zhou
- School of Finance and Public Administration, Hubei University of Economics, Wuhan, China.
- Collaborative Innovation Center for Medical Insurance Reform, Hubei University of Economics, Wuhan, China.
| | - Tan Zheng
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Fang Huang
- Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China.
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Namba T, Furusawa K, Tanimoto Y, Tokuhiro A, Ogawa T, Mikami Y, Tajima F. Comparative analysis of effects of various toilet seat cushions on buttock pressure during toileting in persons with spinal cord injury. J Spinal Cord Med 2023; 46:875-880. [PMID: 34292131 PMCID: PMC10653774 DOI: 10.1080/10790268.2021.1953314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To measure buttock pressure during toilet seating in persons with spinal cord injury (SCI). DESIGN A case series study. SETTING Kibikogen Rehabilitation Center for Employment Injuries. METHODS The study included 41 persons with SCI. Buttock pressure was measured during toilet seating, with or without a toilet seat cushion (foam cushion, gel cushion, air cushion) on the toilet seat. RESULTS The subjects were classified into three groups according to the site of the maximum pressure [greater trochanter (GT) region, ischial tuberosities (IT), and sacral region (SR)] recorded on the pressure map of the non-cushioned toilet seat, into the GT, IT and SR groups, respectively. All three types of cushions altered the buttock pressure distribution during no-cushion toilet seating. In the GT group, all three cushions significantly reduced the peak pressure in the GT area, compared to the control (no-cushion). The foam cushion significantly increased the peak pressure in the IT area (Pisch) in the GT group, relative to the control. However, the foam cushion significantly increased while the gel cushion significantly reduced Pisch, relative to the control. In SR group, the air cushion significantly reduced the peak pressure in the SR, relative to the control. CONCLUSION We recommend the use of the gel cushion for the IT group and the air cushion in GT and SR group to reduce buttock pressure during toilet seating in persons with SCI.
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Affiliation(s)
- Takanori Namba
- Department of Rehabilitation Medicine, Okayama City Hospital, Okayama, Japan
| | - Kazunari Furusawa
- Department of Rehabilitation Medicine, Kibikogen Rehabilitation Center for Employment Injuries, Kibichuo-cho, Japan
| | - Yoshio Tanimoto
- Department of Rehabilitation Medicine, Kibikogen Rehabilitation Center for Employment Injuries, Kibichuo-cho, Japan
| | - Akihiro Tokuhiro
- Department of Rehabilitation Medicine, Kibikogen Rehabilitation Center for Employment Injuries, Kibichuo-cho, Japan
| | - Takahiro Ogawa
- Department of Rehabilitation Medicine, Chuzan Hospital, Okinawa, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
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Babbar K, Das U, Ashraf S, Shpenev A, Bicchieri C. Unlocking the Role of Social Norms: How They Shape Women's Public Toilet Usage in India. Am J Trop Med Hyg 2023; 109:1177-1186. [PMID: 37917999 PMCID: PMC10622457 DOI: 10.4269/ajtmh.23-0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/07/2023] [Indexed: 11/04/2023] Open
Abstract
Poor access to toilets has significant impacts on hygiene, health, safety, and well-being. Women in resource-poor areas may not use public toilets because of concerns about personal safety and the disapproval of others. This study examines social beliefs about women's use of public toilets in India, using data from 5,052 households in rural, semi-urban, and urban slum areas of Bihar and Tamil Nadu in 2018. We asked respondents about their beliefs regarding the prevalence of young women aged 16 to 30 years using public toilets alone and whether this behavior was approved of in their community. We also asked about their personal beliefs on this issue. We used hypothetical vignettes to assess perceptions of a young woman's behavior in different settings regarding public toilet usage by women. Our results show that people who believe many women in their community use public toilets alone and approve of it are more likely to have positive beliefs about this behavior. The experimental vignettes suggest a potential causal link between the prevalence and approval of public toilet usage among young women and their likelihood of using it. These findings are consistent across Bihar and Tamil Nadu and the three administrative regions, indicating that interventions aimed at changing social expectations about women's use of public toilets should focus on highlighting community members' usage and approval. Efforts to encourage woman's access to public toilets and services should target shifting beliefs about public toilet usage among women without disapproval from others.
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Affiliation(s)
- Karan Babbar
- Jindal Global Business School, O.P. Jindal Global University, Sonipat, India
| | - Upasak Das
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, Pennsylvania
- Global Development Institute, University of Manchester, Manchester, United Kingdom
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alex Shpenev
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cristina Bicchieri
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, Pennsylvania
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Kumar D, Sood SK, Rawat KS. Empowering elderly care with intelligent IoT-Driven smart toilets for home-based infectious health monitoring. Artif Intell Med 2023; 144:102666. [PMID: 37783534 DOI: 10.1016/j.artmed.2023.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
The COVID-19 pandemic highlights the need for effective and non-intrusive methods to monitor the well-being of elderly individuals in their homes, especially for early detection of potential viral infections. Conspicuously, the present paper develops a Multi-scaled Long Short Term Memory (Ms-LSTM) model for the routine health monitoring of elderly patients to detect COVID-19. The proposed method offers home-based health diagnostics through urine analysis by leveraging the IoT-Fog-Cloud paradigm. Mainly, the proposed model constitutes a four-layered architecture: data acquisition, fog layer, cloud layer, and interface layer. Each layer serves distinct functionalities and provides specific services, thereby collectively enhancing the overall effectiveness of the model. The statistical results of the study demonstrate the superior performance of the proposed Ms-LSTM model in comparison to state-of-the-art methods, including Artificial Neural Networks (ANN), K-Nearest Neighbors (K-NN), Support Vector Machine (SVM), Random Forest, and LSTM. Further, the proposed model attains a mean temporal efficiency of 39.23 seconds. It exhibits high reliability (92.97%), stability (70.06%), and predictive accuracy (93.25%).
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Affiliation(s)
- Dheeraj Kumar
- Central University of Himachal Pradesh, Dharmashala, Himachal Pradesh, India.
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Pinto HA, Campos JR, Gomes LCM, Costa VS, Marcello Junior HB, Tenório Mati VL. A worm in the toilet bowl! What does it tell us about the challenges in the identification of supposed human parasites in practical parasitology? Ann Parasitol 2023; 69:31-36. [PMID: 37768302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Non-parasitic vermiform organisms can circumstantially be associated with humans and their identification can be challenging for medical professionals. The present report describes the finding of a worm in the toilet bowl by a patient from Brazil, who thought he had expelled it in his feces. The gross analyses in a clinical laboratory reveal the worm was different from other macroscopic organisms routinely identified, and the laboratory staff requested assistance in an academic laboratory specialized in helminthology. After preliminary analysis in a stereomicroscope, the supposed human worm was identified as an oligochaete annelid (earthworm). The patient was contacted to investigate a possible case of pseudoparasitism. However, we were informed that the organism had been collected in a toilet bowl from a rural environment where the untreated water comes from a cistern indicating our finding was circumstantial. The methodology revisited herein allowed a quick microscopic analysis of easy-to-view morphological structures, which are useful to separate oligochaete annelids from helminths and can prevent misdiagnosis in similar situations. We discuss the overly restricted view on human parasites by health professionals in collecting clinical history and laboratory analysis, providing some epistemological insights on the necessary interdisciplinarity between parasitology and other basic knowledge with health practice.
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Affiliation(s)
- Hudson A Pinto
- Departamento de Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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23
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Tanne JH. Smart toilets, bored students, why crowds gather, and tasty rocks-it's the 2023 Ig Nobel Awards. BMJ 2023; 382:2116. [PMID: 37714533 DOI: 10.1136/bmj.p2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
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Yoshiyama A, Tsujimura A, Hiramatsu I, Morino J, Anno Y, Kurosawa M, Kure A, Uesaka Y, Nozaki T, Shirai M, Kiuchi H, Horie S. Circadian Rhythm of Voided Volume, Maximum Flow Rate, and Voiding Time Evaluated by Toilet Uroflowmetry in Hospitalized Women With Nocturia. Urology 2023; 179:50-57. [PMID: 37353090 DOI: 10.1016/j.urology.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To clarify the circadian rhythm of urination in hospitalized women with nocturia measured by toilet uroflowmetry and its age-related change. METHODS We evaluated 2602 urinations of 58 female patients (age, 68.4 ± 15.2 years) who were hospitalized in our institution for urological disease. We assessed voided volume (VV) as averages of every hour by generalized linear mixed models with an identity link function to adjust for personal bias and age. Maximum flow rate and voiding time were analyzed by the same method after adjustment for age, personal bias, and VV. We also compared these circadian rhythms between women <70 and ≥70 years. RESULTS VVs in the nighttime were significantly higher than that from 06:00-07:00 (205.6 ± 11.7 ml). Maximum flow rates in the afternoon were significantly higher than that from 06:00-07:00 (18.8 ± 0.93 ml/sec). Voiding time showed no statistically significant difference between the values at any time of day and that from 06:00-07:00. We also showed that the circadian rhythm of VV becomes less clear in the elderly women (P interaction = .0057). However, no significant difference was found in the maximum flow rate and voiding time regarding the pattern of the circadian rhythm between women <70 and ≥70 years old. CONCLUSION The present study clearly showed a circadian rhythm of VV and maximum flow rate in hospitalized women with nocturia. In addition, the pattern of the circadian rhythm of VV was attenuated in women ≥70 years old.
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Affiliation(s)
- Azusa Yoshiyama
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Ippei Hiramatsu
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Junki Morino
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuta Anno
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Makoto Kurosawa
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akimasa Kure
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuka Uesaka
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Taiji Nozaki
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Masato Shirai
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hiroshi Kiuchi
- Osaka University Graduate School of Medicine Department of Urology, Suita, Osaka, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Nancy S, Sofia S. Low-cost alternative toilet construction materials and methods for the promotion of durable toilets in rural areas. Indian J Public Health 2023; 67:487-488. [PMID: 37929400 DOI: 10.4103/ijph.ijph_50_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Affiliation(s)
- S Nancy
- Assistant Professor, Department of Community Medicine, Vinayaka Mission's Medical College and Hospital, Vinayaka Mission's Research Foundation - Deemed to be University, Puducherry, India
| | - S Sofia
- Postgraduate, Department of Oral and Maxillofacial Pathology and Oral Microbiology, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
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26
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Wu H, Wang G, Li L, Gao Z, Wang M, Wang J, Zhang Z, Wang A, Tian X, Li J. Partial nitritation and nitrogen removal of vacuum toilet wastewater from high-speed trains in a sequential batch reactor. Chemosphere 2023; 329:138657. [PMID: 37040837 DOI: 10.1016/j.chemosphere.2023.138657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/14/2023] [Accepted: 04/08/2023] [Indexed: 05/03/2023]
Abstract
Owing to the high contents of organics and nitrogen in vacuum toilet wastewater (VTW) generated from high-speed trains, onsite pretreatment is usually required before VTW can be discharged into municipal sewers. In this study, a partial nitritation process was stably established in a sequential batch reactor to efficiently utilize the organics in synthetic and real VTWs for nitrogen removal and to produce an effluent suitable for anaerobic ammonia oxidation. In spite of the high fluctuations of COD and nitrogen in VTW, the organics used for nitrogen removal stabilized at 1.97 ± 0.18 mg COD mg N-1 removed, and the effluent NO2--N/NH4+-N ratios were maintained at 1.26 ± 0.13. The removal efficiencies of nitrogen and COD were 31.8 ± 3.5% and 65.2 ± 5.3% under the volumetric loading rates of 1.14 ± 0.15 kg N m-3 d-1 and 1.03 ± 0.26 kg COD m-3 d-1 for real VTW, respectively. Microbial community analysis revealed that Nitrosomonas (0.95%-1.71%) was the dominant autotrophic ammonium-oxidizing bacterial genus, but nitrite-oxidizing bacteria, Nitrolancea, was severely inhibited, with a relative abundance less than 0.05%. The relative abundance of denitrifying bacteria increased by 7.34% when the influent was switched to real VTW. Functional profile predictions of the biomass showed that the decrease in the COD/N ratio and the switch of reactor influent from synthetic to real VTW increased the relative abundance of enzymes and modules involved in carbon and nitrogen metabolisms.
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Affiliation(s)
- Haoyuan Wu
- Beijing Key Laboratory of Aqueous Typical Pollutants Control and Water Quality Safeguard, School of Environment, Beijing Jiaotong University, Beijing, 100044, China
| | - Guotian Wang
- Beijing Key Laboratory of Aqueous Typical Pollutants Control and Water Quality Safeguard, School of Environment, Beijing Jiaotong University, Beijing, 100044, China
| | - Lei Li
- Institute of Watershed and Ecology, Beijing Water Science and Technology Institute, Beijing, 100048, China
| | - Zhenchao Gao
- Beijing Key Laboratory of Aqueous Typical Pollutants Control and Water Quality Safeguard, School of Environment, Beijing Jiaotong University, Beijing, 100044, China
| | - Mengyu Wang
- Beijing Key Laboratory of Aqueous Typical Pollutants Control and Water Quality Safeguard, School of Environment, Beijing Jiaotong University, Beijing, 100044, China
| | - Jin Wang
- Beijing Key Laboratory of Aqueous Typical Pollutants Control and Water Quality Safeguard, School of Environment, Beijing Jiaotong University, Beijing, 100044, China
| | - Zhongguo Zhang
- Institute of Resources and Environment, Beijing Academy of Science and Technology, Beijing, 100089, China
| | - Aimin Wang
- Beijing Key Laboratory of Aqueous Typical Pollutants Control and Water Quality Safeguard, School of Environment, Beijing Jiaotong University, Beijing, 100044, China
| | - Xiujun Tian
- Beijing Key Laboratory of Aqueous Typical Pollutants Control and Water Quality Safeguard, School of Environment, Beijing Jiaotong University, Beijing, 100044, China
| | - Jiuyi Li
- Beijing Key Laboratory of Aqueous Typical Pollutants Control and Water Quality Safeguard, School of Environment, Beijing Jiaotong University, Beijing, 100044, China.
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27
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Zhang Z, Sato Y, Dai J, Chui HK, Daigger G, Van Loosdrecht MCM, Chen G. Flushing Toilets and Cooling Spaces with Seawater Improve Water-Energy Securities and Achieve Carbon Mitigations in Coastal Cities. Environ Sci Technol 2023; 57:5068-5078. [PMID: 36892576 DOI: 10.1021/acs.est.2c07352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Exploring alternative water sources and improving the efficiency of energy uses are crucial approaches to strengthening the water-energy securities and achieving carbon mitigations in sub(tropical) coastal cities. Seawater use for toilet flushing and district cooling systems is reportedly practical for achieving multiaspect benefits in Hong Kong. However, the currently followed practices are yet to be systematically evaluated for scale expansions and system adaptation in other coastal cities. The significance of using seawater to enhance local water-energy securities and carbon mitigations in urban areas remains unknown. Herein, we developed a high-resolution scheme to quantify the effects of the large-scale urban use of seawater on a city's reliance on non-local and non-natural water and energy supplies and its carbon mitigation goals. We applied the developed scheme in Hong Kong, Jeddah, and Miami to assess diverse climates and urban characteristics. The annual water and energy saving potentials were found to be 16-28% and 3-11% of the annual freshwater and electricity consumption, respectively. Life cycle carbon mitigations were accomplished in the compact cities of Hong Kong and Miami (2.3 and 4.6% of the cities' mitigation goals, respectively) but not in a sprawled city like Jeddah. Moreover, our results suggest that district-level decisions could result in optimal outcomes supporting seawater use in urban areas.
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Affiliation(s)
- Zi Zhang
- Department of Civil and Environmental Engineering, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
| | - Yugo Sato
- Department of Civil and Environmental Engineering, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
| | - Ji Dai
- Department of Civil and Environmental Engineering, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
| | - Ho Kwong Chui
- Department of Civil and Environmental Engineering, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
| | - Glen Daigger
- Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Mark C M Van Loosdrecht
- Department of Biotechnology, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Guanghao Chen
- Department of Civil and Environmental Engineering, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution (Hong Kong Branch), The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
- Water Technology Center, The Hong Kong University of Science and Technology, Kowloon 999077, Hong Kong, China
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28
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Eisenberg S, Cai C. Comparing Two Methods of Reducing Hospital Toilet Aerosols. Clin J Oncol Nurs 2023; 27:191-197. [PMID: 37677838 DOI: 10.1188/23.cjon.191-197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND When flushed, uncovered hospital toilets have been shown to generate aerosols potentially containing bacteria, viruses, and hazardous drugs, which can be inhaled by healthcare workers and contaminate surfaces. Guidelines recommend placing a plastic-backed absorbent pad (PBP) over the toilet, although no studies have evaluated the effectiveness of this intervention. OBJECTIVES The purpose of this study was to evaluate the effectiveness of using a PBP versus the Splashblocker®, a solid, reusable engineering barrier control, to reduce post-flush aerosol particles. METHODS Aerosol measurements were taken with an optical particle counter in a bathroom testing chamber equipped with a commercial hospital toilet and flushometer valve. Three tests were performed at a height of 16 inches above the floor and 40 inches above the floor. FINDINGS Both the PBP and the Splashblocker significantly reduced the number of post-flush particles by more than 99% at 16 inches above the floor and 40 inches above the floor. The results indicate that both interventions are equally beneficial in reducing aerosols after flushing a hospital toilet.
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29
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Luo D, Huang J, Zheng X, Liu F, Li Y, Wang Y, Qian H. Spread of flushing-generated fecal aerosols in a squat toilet cubicle: Implication for infection risk. Sci Total Environ 2023; 859:160212. [PMID: 36395842 DOI: 10.1016/j.scitotenv.2022.160212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/27/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
Toilet flushing generates and spread fecal aerosols, potentially leading to infection transmission risk. Squat toilets are widely used in public restrooms in some Asian countries including China and India, and remain to be studied. Aerosol dispersion while flushing squat toilet in cubicle was visualized, while the aerosol concentrations were measured on different surfaces by monitoring fluorescence intensity through seeding simulated fluorescence feces. Flushing-generated fecal aerosols could spread to the breathing zone, deposit on floor, and partitions in squat toilet cubicles, and spread even beyond to the restroom lobby. A total of 0.24 % and 0.17 % of seeded fecal waste deposits on the floor and partition (lower than 0.20 m) for each flush. Aerosol concentration decays rapidly, with 86.8 ± 2.2 % reduction in the second minute after a previous flush compared to that in the first minute. Public toilet users are recommended to wait for 2 min after the early flush before entering the cubicle.
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Affiliation(s)
- Danting Luo
- School of Energy and Environment, Southeast University, Nanjing, China; Engineering Research Center for Building Energy Environments & Equipments, Ministry of Education, China; Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China
| | - Jiayu Huang
- School of Energy and Environment, Southeast University, Nanjing, China; Engineering Research Center for Building Energy Environments & Equipments, Ministry of Education, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, China; Engineering Research Center for Building Energy Environments & Equipments, Ministry of Education, China
| | - Fan Liu
- School of Energy and Environment, Southeast University, Nanjing, China; University of Shanghai for Science and Technology, Shanghai, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Ying Wang
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China; Department of infection management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China; Engineering Research Center for Building Energy Environments & Equipments, Ministry of Education, China; Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China.
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30
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Kachoria P, Sasidaran S, Welling CM, Rosario P, Zhou J, Chakrabarty K, Gründl H, Kristoferitsch L, Grego S. Sensor-based evaluation of a Urine Trap toilet in a shared bathroom. Sci Total Environ 2023; 857:159178. [PMID: 36202366 PMCID: PMC9742848 DOI: 10.1016/j.scitotenv.2022.159178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/03/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Urine diversion in a No-Mix Toilet is a promising approach for sustainable fertilizers and reduction of the nutrient load for wastewater treatment; however, user adoption remains a challenge. This study evaluates the Urine Trap, a passive No-Mix toilet design based on the teapot effect, wherein the urine stream inlet is invisible to the user and therefore it does not impact the user experience for increased adoption. This study evaluated the nutrient separation performance of a Urine Trap flush toilet in a bathroom shared by women in two sites in India. Over three different testing periods, 841 uses of this squat plate were recorded in 50 days. Analytical measurements found 36 % separation efficiency for total nitrogen (TN). While effective, the Urine Trap under test by users did not yield a 70-80 % TN separation efficiency observed under engineering characterization. High temporal resolution data from sensors on waste collection tanks, the opening of the bathroom door, and cleansing water flow were used to gain insights into hygiene practices. The data showed a frequent habit of wetting the squat plate during physiological excretion, a hygienic practice that eases cleaning but degrades the teapot separation effect of the Urine Trap design. By using sensors, we demonstrate a method to non-invasively gain quantitative insights into hygiene practices to inform sanitation technologies deployment strategies for improved outcomes.
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Affiliation(s)
| | | | - Claire M Welling
- Center for Water, Sanitation, Hygiene and Infectious Disease (WASH-AID), Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | | | - Jin Zhou
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | | | - Harald Gründl
- EOOS Design GmbH, Zelinkagasse 2/6, 1010 Vienna, Austria
| | | | - Sonia Grego
- Center for Water, Sanitation, Hygiene and Infectious Disease (WASH-AID), Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA.
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31
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Smoyer AB, Pittman A, Borzillo P. Humans peeing: Justice-involved women's access to toilets in public spaces. PLoS One 2023; 18:e0282917. [PMID: 36897925 PMCID: PMC10004595 DOI: 10.1371/journal.pone.0282917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Justice-involved women face myriad challenges as they negotiate the terms of community supervision and manage the long-term implications and stigma of living with a criminal record. Major tasks that women juggle include securing safe, affordable housing, finding and retaining employment, accessing physical and mental health care (including substance use treatment), and handling relationships with family, friends, children, and intimate partners. In addition to these responsibilities, women must meet their basic physiological needs to eat, sleep, and use the toilet. Women's ability to safely meet their personal care needs may impact their capacity to manage their criminal-legal challenges. This study uses qualitative methods to understand justice-involved women's lived experiences related to urination. Specifically, the study reports on a thematic analysis of 8 focus groups conducted with justice-involved women (n = 58) and the results of a toilet audit conducted in the downtown areas of the small city in the United States where the focus group participants were living. Findings suggest that women had limited access to restrooms and reported urinating outside. Lack of restroom access impacted their engagement with social services support and employment and their ability to travel through public spaces. Women perceived their public toilet options as unsafe, increasing their sense of vulnerability and reinforcing the idea that they did not have full access to citizenship in the community because of their criminal-legal involvement. The exclusion and denial of women's humanity that is perpetuated by a lack of public toilet access impacts women's psychosocial outcomes. City governments, social service agencies, and employers are encouraged to consider how lack of toilet access may impact their public safety and criminal-legal objectives and expand opportunities for people to access safe restroom facilities.
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Affiliation(s)
- Amy B. Smoyer
- Department of Social Work, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Adam Pittman
- Department of Sociology, College of Arts and Sciences, Southern Connecticut State University, New Haven, Connecticut, United States of America
| | - Peter Borzillo
- Department of Curriculum and Learning, College of Education, Southern Connecticut State University, New Haven, Connecticut, United States of America
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32
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Peate I. World Toilet Day: making the invisible visible. Br J Nurs 2022; 31:1017. [PMID: 36370393 DOI: 10.12968/bjon.2022.31.20.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Ian Peate
- Editor in Chief, British Journal of Nursing
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33
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Li J, Liu X, Li L, Zhu C, Luo L, Qi Y, Tian L, Chen Z, Qi J, Geng B. Performance exploration and microbial dynamics of urine diverting composting toilets in rural China. J Environ Manage 2022; 321:115964. [PMID: 36007385 DOI: 10.1016/j.jenvman.2022.115964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
The ongoing "toilet revolution" in China provides new opportunities to improve the rural living environment and sanitation, and the introduction of new sanitation facilities such as urine diverting composting toilets (UDCTs) is conducive to the effective treatment and resource utilization of feces. This study revealed the degradation performance and microbial community dynamics of UDCTs and clarified the influence mechanism of fecal volume in aerobic composting treatment. The results showed that UDCTs could effectively decompose human feces, with an organic matter degradation rate of 25%⁓30%. The temperature, water content, NH4+-N and nutrient accumulation were higher in the high fecal volume treatment than in the low fecal volume treatment. Bacterial community composition and structure in UDCTs varied with composting stage and fecal volume. The diversity and richness of bacterial community in compost were changed with different fecal volumes, but the dominant groups were similar. Redundancy analysis (RDA) showed that nitrogen and organic carbon were the main drivers of bacterial community changes during composting. Highly nutritious and non-phytotoxic compost products were suitable for agronomic uses. Based on these results, UDCTs can be an effective way to solve the problem of fecal pollution in rural areas, and fecal dosage is a potential influencing factor in the operation and maintenance of composting systems.
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Affiliation(s)
- Jiabin Li
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, 100081, PR China
| | - Xue Liu
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, 100081, PR China
| | - Luyao Li
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, 100081, PR China
| | - Changxiong Zhu
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, 100081, PR China
| | - Liangguo Luo
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, 100081, PR China
| | - Yuanyi Qi
- Zhangye Lanbiao Biotechnology Co., Ltd, Zhangye, Gansu, 734000, PR China
| | - Lan Tian
- Zhangye Lanbiao Biotechnology Co., Ltd, Zhangye, Gansu, 734000, PR China
| | - Zhuobo Chen
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, 100081, PR China
| | - Jin Qi
- Zhangye Lanbiao Biotechnology Co., Ltd, Zhangye, Gansu, 734000, PR China
| | - Bing Geng
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, 100081, PR China.
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34
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Sugawara M. Accessibility Improvement of Public Schools Through User Involvement in JAPAN. Stud Health Technol Inform 2022; 297:589-596. [PMID: 36073442 DOI: 10.3233/shti220891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
According to the amendment (2020) of the Act on the Promotion of Smooth Transportation, etc. of Elderly Persons, Disabled Persons, etc. in Japan, public primary and junior high schools, which are newly built/renovated/extended, should be designed to be physically accessible for students with special needs. In addition, existing schools should also make efforts to improve accessibility. On this background, this paper focuses on the methods to effectively promote accessibility in schools that is achieved through user involvement for inclusive education. The survey subjects were all 164 public schools in Saitama city. A questionnaire to all schools was conducted to find out 1) the features of physical obstacles impeding inclusive education and 2) examples of user involvement in the planning stage of accessibility. In the results, accessible toilets have been installed progressively. However, inaccessible routes and spaces remained because there were no lifts in most existing schools. Regarding user involvement, a good practice was discovered in one case of restroom renovation which reflected parents' requests. In reality, because of the limitation of the budget of the municipality, it was obviously difficult to provide sufficient accessibility in all 164 schools in the short period. To achieve fully accessible schools for everyone, it is crucial to create short/mid/long-term facility management strategies and to share knowledge/skills regarding accessibility improvement among administrative officers, architects, and users, so that they can find efficient and effective ways to promote accessibility.
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Affiliation(s)
- Maiko Sugawara
- Department of Human Environment Design, Toyo University, Japan
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35
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Steensma DP, Kyle RA. Austria's Unusual Pandemic-Themed Postage Stamps: Toilet Paper, Facemask, Bandage. Mayo Clin Proc 2022; 97:1758-1759. [PMID: 36058590 PMCID: PMC9433919 DOI: 10.1016/j.mayocp.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- David P Steensma
- Novartis Institutes for BioMedical Research, Cambridge, MA. https://twitter.com/DavidSteensma
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36
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Francis J, Sachan P, Waters Z, Trapp G, Pearce N, Burns S, Lin A, Cross D. Gender-Neutral Toilets: A Qualitative Exploration of Inclusive School Environments for Sexuality and Gender Diverse Youth in Western Australia. Int J Environ Res Public Health 2022; 19:10089. [PMID: 36011720 PMCID: PMC9407760 DOI: 10.3390/ijerph191610089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
School toilets have been identified by sexuality and gender diverse (SGD) students as the least safe spaces in educational institutions. They are sites of verbal, physical and sexual victimisation. Providing gender-neutral toilets in primary and secondary schools may reduce the bullying and victimisation of SGD students, particularly those who are transgender or gender-diverse. This study explored factors influencing the inclusion of gender-neutral toilets in primary and secondary schools in Western Australia. Thirty-four interviews were conducted from May to December 2020 with policy makers or practitioners (n = 22) and school staff (n = 12) in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis of the cross-sectional qualitative data was undertaken. School staff, policy makers, and practitioners identified school toilets as sites of bullying and victimisation of SGD youth and expressed support for gender-neutral toilets as an anti-bullying strategy. Perceived barriers to introducing gender-neutral toilets in schools included financial and spatial costs, building code compliance constraints, resistance from parents and students, privacy and confidentiality concerns, and cultural appropriateness. Including gender-neutral toilets in schools may reduce school-based bullying and victimisation, and improve the mental and physical health of SGD youth.
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Affiliation(s)
- Jacinta Francis
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- Centre for Child Health Research, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Pratishtha Sachan
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Zoe Waters
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- School of Psychological Science, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Gina Trapp
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Natasha Pearce
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Sharyn Burns
- School of Population Health, Curtin University, Kent St., Bentley, WA 6102, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- Centre for Child Health Research, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Donna Cross
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
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Duijster D, Monse B, Marquez M, Pakes U, Stauf N, Benzian H. Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention. Int J Environ Res Public Health 2022; 19:10059. [PMID: 36011699 PMCID: PMC9407854 DOI: 10.3390/ijerph191610059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
This study evaluated the impact of packaged interventions for operation and maintenance (O&M) on the usability and cleanliness of toilets in public schools in the Philippines. In this cluster-randomized controlled trial, the divisions of Roxas City and Passi City were randomly assigned to the intervention or control group. Schools in Roxas City (n = 14) implemented the packaged O&M interventions; schools in Passi City (n = 16) formed the control group. Outcome variables were toilet usability-defined as accessible, functional and private-and toilet cleanliness, measured using the Sanitation Assessment Tool (SAT) and the Cleaner Toilets, Brighter Future (CTBF) instruments at baseline and at four months follow-up through direct observation of school toilets. SAT results showed that intervention schools had a 32.0% (4.6%; 59.3%) higher percentage of usable toilets than control schools at follow-up after full adjustment (p = 0.024). CTBF results found a similar result, although this was not statistically significant (p = 0.119). The percentage of toilets that were fully clean was 27.1% (3.7%; 50.6%) higher in intervention schools than in control schools after adjustment (p = 0.025). SAT results also showed an improvement in cleanliness of toilets in intervention schools compared to those in controls, but this did not remain significant after adjustment. The findings indicate that the additional implementation of O&M interventions can further stimulate progress towards reaching Water, Sanitation and Hygiene service levels aligned with the Sustainable Development Goals.
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Affiliation(s)
- Denise Duijster
- Department of Oral Public Health, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - Bella Monse
- Regional Fit for School Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), 10th Floor, Bank of Makati Building, Ayala Avenue Extension near Corner Metropolitan Avenue, Makati City 1209, Philippines
| | - Marvin Marquez
- Population Institute, College of Social Science and Philosophy, University of the Philippines Diliman, Diliman, Quezon City 1101, Philippines
| | - Ubo Pakes
- Center for Environmental Informatics, University of the Philippines Cebu, Gorordo Avenue, Cebu City 6000, Philippines
| | - Nicole Stauf
- The Health Bureau Ltd., Whiteleaf Business Center, 11 Little Balmer, Buckingham MK18 1TF, UK
| | - Habib Benzian
- WHO Collaborating Center Quality Improvement & Evidence-Based Dentistry, Department of Epidemiology & Health Promotion, College of Dentistry, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, USA
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Abstract
Airborne particles play a significant role in the transmission of SARS-CoV-2, the virus that causes COVID-19. A previous study reported that institutional flush-O-meter (FOM) toilets can generate 3-12 times as many droplets as other toilets by splashing (large droplets) and bubble bursting (fine droplets). In this study, an aerosol suppression lid was evaluated to measure the reduction of particles by size using three metrics; number, surface area, and mass concentrations. To quantify toilet flush aerosol over time, detailed particle size distributions (from 0.016-19.81 µm across 152 size bins) were measured from a FOM toilet in a controlled-environment test chamber, without ventilation, with and without use of the suppression lid. Prior to each flushing trial, the toilet bowl water was seeded with 480 mL fluorescein at 10 mg/mL. A high-speed camera was used to record the large droplet movements after flushing. An ultraviolet-visible spectrophotometer was used to analyze the wipe samples to evaluate the contamination on the lid. The particle number, surface area, and mass concentrations without a lid were elevated compared to a lid in the first 90 sec. Overall, the lid reduced 48% of total number concentration, 76% of total surface area concentration, and 66% of total mass concentration, respectively. Depending on the particle size, the number concentration reduction percentage ranged from 48-100% for particles larger than 0.1 µm. Large droplets created by splashing were captured by the high-speed camera. Similar studies can be used for future particle aerodynamic studies. The fluorescein droplets deposited on the lid back sections, which were closer to the FOM accounted for 82% of the total fluorescein. Based on two-way ANOVA analysis, there were significant differences among both the experimental flushes (p = 0.0185) and the sections on the lid (p = 0.0146). Future work should explore the aerosolization produced by flushing and the performance of the lid in real restroom environments, where feces and urine exist in the bowl water and the indoor ventilation system is in operation.
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Affiliation(s)
- Changjie Cai
- Department of Occupational and Environmental Health, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Peter Kim
- Department of Occupational and Environmental Health, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Thomas H Connor
- Applied Research and Technology, National Institute for Occupational Safety and Health (Retired), Washington, District of Columbia
| | - Yingtao Liu
- Department of Aerospace and Mechanical Engineering, Gallogly College of Engineering, The University of Oklahoma, Norman, Oklahoma
| | - Evan L Floyd
- Department of Occupational and Environmental Health, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma
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Robredo JPG, Eala MAB, Marquez NDE, Camiling-Alfonso R. The costs of inadequate toilet coverage in the Philippines. Lancet Gastroenterol Hepatol 2022; 7:387. [PMID: 35397239 DOI: 10.1016/s2468-1253(22)00046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | | | - Norman Dennis E Marquez
- Health Sciences Program, School of Science and Engineering, Ateneo de Manila University, Quezon City, Philippines
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Antwi-Agyei P, Monney I, Amaning Adjei K, Kweyu R, Simiyu S. Shared but Clean Household Toilets: What Makes This Possible? Evidence from Ghana and Kenya. Int J Environ Res Public Health 2022; 19:4271. [PMID: 35409952 PMCID: PMC8998870 DOI: 10.3390/ijerph19074271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Shared sanitation facilities are not considered as basic sanitation owing to cleanliness and accessibility concerns. However, there is mounting evidence that some shared household toilets have a comparable level of service as private toilets. This study examined the factors that contribute to the quality of shared household toilets in low-income urban communities in Ghana and Kenya. The study design comprised household surveys and field inspections. Overall, 843 respondents were interviewed, and 838 household shared sanitation facilities were inspected. Cleanliness scores were computed from the facility inspections, while a total quality score was calculated based on 13 indicators comprising hygiene, privacy, and accessibility. Regression analyses were conducted to determine predictors of cleanliness and the overall quality of the shared sanitation facilities. More than four out of five (84%) shared toilets in Ghana (N = 404) were clean, while in Kenya (N = 434), nearly a third (32%) were clean. Flush/pour-flush toilets were six times (p < 0.01 aOR = 5.64) more likely to be clean. A functional outside door lock on a toilet facility and the presence of live-in landlords led to a threefold increase (p < 0.01 aOR = 2.71) and a twofold increase (p < 0.01 aOR = 1.92), respectively in the odds of shared sanitation cleanliness. Sanitation facilities shared by at most five households (95% CI: 6−7) were generally clean. High-quality shared toilets had live-in landlords, functional door locks, and were water-dependent. Further studies on innovative approaches to maintaining the quality of these high-quality shared toilets are needed to make them eligible for classification as basic sanitation considering the increasing reliance on the facilities.
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Affiliation(s)
- Prince Antwi-Agyei
- Regional Centre of Energy and Environmental Sustainability (RCEES), Civil and Environmental Engineering Department, School of Engineering, University of Energy and Natural Resources (UENR), P.O. Box 214, Sunyani BS0061, Ghana
| | - Isaac Monney
- Department of Environmental Health and Sanitation Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, P.O. Box M40, Mampong 3JG3+PFQ, Ghana;
| | - Kwaku Amaning Adjei
- Department of Civil Engineering, Regional Water and Environmental Sanitation Centre (RWESCK), Kwame Nkrumah University of Science and Technology (KNUST), PMB, University Post Office, Kumasi AK448, Ghana;
| | - Raphael Kweyu
- Department of Geography, Kenyatta University, P.O. Box 43844, Nairobi 00100, Kenya;
| | - Sheillah Simiyu
- Urbanisation and Well-Being Unit, African Population & Health Research Center, P.O. Box 10787, Nairobi 00100, Kenya;
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Yingst B, Reeves PT, Krishnamurthy J, Pasman EA, Nylund CM. Toilet Injuries Presenting to Emergency Departments, 2000-2019: A Different Game of Thrones. Pediatr Emerg Care 2022; 38:e906-e909. [PMID: 35072990 DOI: 10.1097/pec.0000000000002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Toilet training is a major developmental milestone. Unsupervised periods combined with immature gross and fine motor skills may lead to toddler injuries during toilet training. Our aim was to investigate toilet-related injuries (TIs) in children. METHODS Data from the National Electronic Injury Surveillance System were used to evaluate emergency department encounters of children ages 0 to 6 years with TI from 2000 to 2019. RESULTS There were an estimated 142,606 children (95% confidence interval, 115,599-168,613) who presented to the emergency department for TI. Toilets were involved in 95% of injuries, and other potty chairs (PCs) involved 5% of injuries. Children had higher odds of sustaining head injury while using a toilet versus PC (adjusted odds ratio = 1.91; 95% CI, 1.06-3.45). CONCLUSIONS Toilet-related injuries present a high burden of risk to young children. Our data support that the safest vessel for use in toilet training is a PC/training seat as opposed to the toilet.
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Denpetkul T, Pumkaew M, Sittipunsakda O, Leaungwutiwong P, Mongkolsuk S, Sirikanchana K. Effects of face masks and ventilation on the risk of SARS-CoV-2 respiratory transmission in public toilets: a quantitative microbial risk assessment. J Water Health 2022; 20:300-313. [PMID: 36366988 DOI: 10.2166/wh.2022.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Public toilets may increase the risk of COVID-19 infection via airborne transmission; however, related research is limited. We aimed to estimate SARS-CoV-2 infection risk through respiratory transmission using a quantitative microbial risk assessment framework by retrieving SARS-CoV-2 concentrations from the swab tests of 251 Thai patients. Three virus-generating scenarios were investigated: an infector breathing, breathing with a cough, and breathing with a sneeze. The infection risk (95th percentile) was as high as 10-1 with breathing and increased to 1 with a cough or a sneeze. No significant gender differences for toilet users (receptors) were noted. The highest risk scenario, namely breathing with a sneeze, was further evaluated for risk mitigation measures. Mitigation to a lower risk under 10-3 succeeded only when the infector and the receptor both wore N95 respirators or surgical masks. Ventilation of up to 20 air changes per hour (ACH) did not decrease the risk. However, an extended waiting time of 10 min between an infector and a receptor resulted in approximately 1.0-log10 further risk reduction when both wore masks with the WHO-recommended 12 ACH. The volume of expelled droplets, virus concentrations, and receptor dwell time were identified as the main contributors to transmission risk.
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Affiliation(s)
- Thammanitchpol Denpetkul
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Monchai Pumkaew
- Environmental Engineering and Disaster Management Program, School of Multidisciplinary, Mahidol University, Kanchanaburi Campus, Sai Yok, Kanchanaburi 71150, Thailand
| | - Oranoot Sittipunsakda
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Pornsawan Leaungwutiwong
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand 10400
| | - Skorn Mongkolsuk
- Research Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand E-mail: ; Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Thailand
| | - Kwanrawee Sirikanchana
- Research Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand E-mail: ; Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Thailand
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43
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Moreira FD, Rezende S, Passos F. Public toilets from the perspective of users: a case study in a public place, Brazil. J Water Health 2022; 20:41-53. [PMID: 35100153 DOI: 10.2166/wh.2021.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Public toilets are essential infrastructure to guarantee the right to sanitation in public spaces and, in more general terms, the right to inclusive and sustainable cities. Moreover, since the equipment has a direct user interface, it is important to understand their demands and needs. Given this, the present research aims to understand the perspective of public toilet users on the Pampulha Lake Shore (PLS), a public touristic place in Belo Horizonte, Brazil. For that, observations and semi-structured interviews were carried out with different public toilet users. In addition, comments posted on the Google Local Guides tool of Google Maps were used as a secondary database for understanding users' experience of PLS toilets. The analysis made it possible to identify aspects related to availability, quality (health and hygiene), security, and accessibility. Collected data showed how the conflicting choice of whether or not to use the toilet was directly related to the health and conservation of the urban equipment and interfered with social and leisure prospects. On the whole, the importance of the user's perspective was highlighted in this study with emphasis on elaborating adequate urban planning with regard to health, sanitation, and accessibility issues.
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Affiliation(s)
- Fernanda Deister Moreira
- Department of Sanitary and Environmental Engineering, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, 31270-901 Belo Horizonte, Brazil E-mail:
| | - Sonaly Rezende
- Department of Sanitary and Environmental Engineering, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, 31270-901 Belo Horizonte, Brazil E-mail:
| | - Fabiana Passos
- Department of Sanitary and Environmental Engineering, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, 31270-901 Belo Horizonte, Brazil E-mail:
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44
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Hylton E, Noad L, Templeton MR, Sule MN. The rate of vermi-compost accumulation within 'Tiger Toilets' in India. Environ Technol 2022; 43:376-385. [PMID: 32597333 DOI: 10.1080/09593330.2020.1789750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
Tiger Toilets use a worm-based ecosystem to degrade human waste and have recently been demonstrated as a cost-effective innovation in on-site sanitation. The benefits over traditional pit latrines include slower fill rate, fewer odours, and safer emptying. However, a question remains around how to measure the rate of accumulation of vermi-compost and predict the fill rate into the future. In this study, fifteen Tiger Toilets of varying installation ages in the villages of Jejuri, Bhalgudi and Walhe/Adachiwadi, in Maharashtra province, India were investigated to determine the rate of filling. A laser measure was used to define cross-sections of the depth to vermi-compost layers within the Tiger Toilet digesters. Bench-scale column tests were used to estimate liquid infiltration rates from the digesters into the surrounding soils. Changes over time in the interior digester conditions were photographed and a video camera was installed in selected digesters to confirm and observe the worm activity in situ under red light. Calculated fill rates of the Tiger Toilets were significantly lower compared to estimated fill rates of traditional pit latrines of a similar size and usage rate. The infiltration of the liquid fraction of the waste into the surrounding soil was observed to be a key factor in filling.
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Affiliation(s)
- Erin Hylton
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Liam Noad
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Michael R Templeton
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - May N Sule
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
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45
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Oie S, Kawai S. Microbial contamination of hands with or without the use of bidet toilets (electric toilet seats with water spray) after defecation. J Water Health 2022; 20:271-275. [PMID: 35100172 DOI: 10.2166/wh.2021.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bidet toilets (electric toilet seats with water spray) are increasing in popularity worldwide. However, the extent of reduction of microbial contamination of the hands with the use of bidet toilets after defecation is unclear. Microbe contamination of the hands with and without the use of bidet toilets after defecation was examined in 32 nursing students. Double gloves were worn on the dominant hand and four layers of toilet paper were used to wipe the buttocks after defecation, and microbe contamination of the second glove (outer glove) of the double gloves was examined. The volunteers were free to select the flow volume, wash time of the bidet, and the type of bidet. Without the use of a bidet toilet, the average value ± standard deviation of the number of microbes attached to the gloves was 39,499.3 ± 77,768.3 colony forming units (cfu)/glove; however, it was 4,146.9 ± 11,427.7 cfu/glove when the bidet toilet was used. The number of microbes adhering to gloves was significantly reduced when a bidet toilet was used (p < 0.00001, Wilcoxon signed-rank test).
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Affiliation(s)
- Shigeharu Oie
- Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, 1-1-1, Daigakudori, Sanyo-Onoda 756-0884, Japan E-mail:
| | - Shinya Kawai
- Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, 1-1-1, Daigakudori, Sanyo-Onoda 756-0884, Japan E-mail:
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46
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Guo S, Zhou X, Simha P, Mercado LFP, Lv Y, Li Z. Poor awareness and attitudes to sanitation servicing can impede China's Rural Toilet Revolution: Evidence from Western China. Sci Total Environ 2021; 794:148660. [PMID: 34218147 PMCID: PMC8434418 DOI: 10.1016/j.scitotenv.2021.148660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
The ongoing Toilet Revolution in China offers an opportunity to improve sanitation in rural areas by introducing new approaches, such as urine source separation, that can contribute to achieving SDG6. However, few studies have systematically assessed the social acceptability of managing human excreta collected in new sanitation systems. Therefore, in this study we performed face-to-face interviews with 414 local residents from 13 villages across three provinces in western China, to analyze the current situation and attitudes to possible changes in the rural sanitation service chain. We found that the sanitation chain was predominantly pit latrine-based, with 86.2% of households surveyed collecting their excreta in a simple pit, 82% manually emptying their pits, and 80.2% reusing excreta in agriculture without adequate pre-treatment. A majority (72%) of the households had a generally positive attitude to production of human excreta-derived fertilizer, but only 24% agreed that urine and feces should be collected separately. Multivariate logistic regression indicated that three factors (level of education, number of permanent household residents, perceived social acceptability) significantly influenced respondents' attitudes to reuse of excreta, although only perceived social acceptability had a high strength of association. Overall, our survey revealed that rural households often misuse toilet systems, fail to comply with government-specified sanitation guidelines, have low awareness of alternative solutions, and are over-reliant on the government to fix problems in the service chain. Thus while new sanitation technologies should be developed and implemented, information campaigns that encourage rural households to manage their excreta safely are also important.
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Affiliation(s)
- Shaomin Guo
- Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, PR China
| | - Xiaoqin Zhou
- Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, PR China
| | - Prithvi Simha
- Department of Energy and Technology, Swedish University of Agricultural Sciences, Box 7032, SE-750 07 Uppsala, Sweden.
| | - Luis Fernando Perez Mercado
- Department of Energy and Technology, Swedish University of Agricultural Sciences, Box 7032, SE-750 07 Uppsala, Sweden; Center for Water and Environmental Sanitation (Centro de Aguas y Saneamiento Ambiental, CASA), Universidad Mayor de San Simon, Calle Sucre y Parque Latorre, Cochabamba, Bolivia
| | - Yaping Lv
- Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, PR China
| | - Zifu Li
- Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, PR China.
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47
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Kumar S, Shan CW, Aow JW, Lee HP. Mitigating the toilet flush noise: A psychometric analysis of noise assessment and design of labyrinthine acoustic Meta-absorber for noise mitigation. J Acoust Soc Am 2021; 150:3747. [PMID: 34852587 DOI: 10.1121/10.0007282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
Modern apartments in major cities are usually made of lightweight structures with inadequate acoustic properties, leading to a growing number of noise complaints by residents of inadequate sound insulation in high-rise buildings. When a toilet is flushed, loud and irregular sounds like humming, gurgling, or bubbling, "explosive" fury from vacuum-assisted toilets are generated. Though these toilet flushing sounds are not very harmful, they can still be perceived as nuisances by users nearby. The toilet flushing noise has posed a serious concern among apartment occupants and adjacent residents, causing health problems like sleep disturbance and irritation. In this study, the psychoacoustical investigations have been performed in four stages. In the first stage, the toilet flushing noise was recorded for several toilets with two designs: a close-coupled floor-mount toilet and a back-to-wall mount toilet. The second stage evaluated the physical and psychoacoustical characteristics of those recorded flushing sounds using psychoacoustic analysis software. The noise qualities were determined in the third stage by assessing autocorrelation function/interaural cross correlation function factors from the post-processed recorded sound data. Finally, we designed and successfully demonstrated an innovative acoustic meta-absorber prototype for mitigating the toilet flushing noise. The results have revealed a significant reduction in loudness because of meta-absorbers.
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Affiliation(s)
- Sanjay Kumar
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575 Singapore
| | - Chua Wei Shan
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575 Singapore
| | - Jie Wei Aow
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575 Singapore
| | - Heow Pueh Lee
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575 Singapore
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48
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Dancer SJ, Li Y, Hart A, Tang JW, Jones DL. What is the risk of acquiring SARS-CoV-2 from the use of public toilets? Sci Total Environ 2021; 792:148341. [PMID: 34146809 PMCID: PMC8192832 DOI: 10.1016/j.scitotenv.2021.148341] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 05/18/2023]
Abstract
Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS, Lanarkshire G75 8RG, Scotland, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh EH14 1DJ, Scotland, UK.
| | - Yuguo Li
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China
| | - Alwyn Hart
- Environment Agency, Research Assessment & Evaluation, Streetsbrook Road, Solihull B91 1QT, West Midlands, England, UK
| | - Julian W Tang
- Respiratory Sciences, University of Leicester, Leicester LE1 7RH, England, UK
| | - Davey L Jones
- Environment Centre Wales, Bangor University, Deiniol Road, Bangor, Gwynedd LL57 2UW, Wales, UK; UWA School of Agriculture and Environment, University of Western Australia, Perth, WA 6009, Australia
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Zhou W, Gu Y, Wang X. Access to sanitary toilets and health outcomes: A panel data analysis using two-way fixed effects model. Math Biosci Eng 2021; 18:8815-8830. [PMID: 34814324 DOI: 10.3934/mbe.2021435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Based on the data regarding the renovation of the toilets of 30 provinces (municipalities) in rural China from 2005 to 2017, this study utilized a two-way fixed effect model to empirically test the impact of access to sanitary toilets on health, which include intestinal infectious diseases (consisting of hepatitis A, dysentery, and typhoid) and child mortality (consisting of perinatal mortality, infant mortality, and the mortality rate of children under 5). This study attempted to assess the health outcomes of the "toilet revolution" in rural China. The results showed that: (1) Access to sanitary toilets effectively reduced the incidence of hepatitis A and dysentery. For every 1% increase in the rate of access to sanitary toilets, the incidence of hepatitis A was reduced by 5.6%, and the incidence of dysentery was reduced by 36.5%. (2) Access to sanitary toilets does not significantly reduce child mortality. (3) There are obviously regional differences in the impact of access to sanitary toilets on the health outcomes. The renovation of sanitary toilets has shown the most significant effect on reducing the incidence of intestinal infectious diseases in the central region as well as the effect on reducing child mortality in the western region. It is implied that the health outcomes of China's "toilet revolution" may provide supporting evidence and experience for other developing countries and regions in implementing toilet renovation projects.
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Affiliation(s)
- Wanli Zhou
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, P.R. China
| | - Yingwen Gu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, P.R. China
| | - Xiulin Wang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, P.R. China
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Khare K, Suresh L. Justice and sanitation well-being: an analysis of frameworks in the context of slippage, based on findings from Shravasti, Uttar Pradesh, India. J Water Health 2021; 19:823-835. [PMID: 34665774 DOI: 10.2166/wh.2021.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Access to safe drinking water and adequate sanitation is considered as a basic human right. Swachh Bharat Mission - Gramin (Rural), launched by the Government of India in 2014, is hailed as an attempt towards that direction. On 2nd October 2019, India was declared free from open defecation, with rural households having full toilet coverage. However, despite Government claims, the existing literature indicates the presence of slippage: where households practice open defecation despite having access to toilets. Equating progress in sanitation interventions with mere toilet provision presents a partial assessment of sanitation. To address the gap, the 'Sanitation Well-being' framework, based on Amartya Sen's concept of justice, has been proposed. It identifies slippage as an outcome of various underlying factors across the sanitation life-cycle. The framework provides a lens to analyse existing frameworks and secondary data sets and finds that they do not capture the dynamism inherent in the sector. The efficacy of the framework has been tested in the rural district of Shravasti, Uttar Pradesh, India, through the rapid rural appraisal method. Through our investigation, we found that slippage exists in the field, and that the framework is a feasible instrument to assess sanitation as a comprehensive phenomenon.
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Affiliation(s)
- Kopal Khare
- Department of Humanities and Social Sciences, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Shamirpet-Keesara Road, Jawahar Nagar, Shamirpet, Hyderabad, Telangana 500078, India E-mail:
| | - Lavanya Suresh
- Department of Humanities and Social Sciences, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Shamirpet-Keesara Road, Jawahar Nagar, Shamirpet, Hyderabad, Telangana 500078, India E-mail:
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