On-site Facilities Research Articles

A study of the feasibility, ability and acceptability of self-testing of HbA1c before consultation (FLASH) in primary care setting

Background: HbA1c test is the most-ordered laboratory test in public primary care clinics, accounting for 17% of laboratory services. In recent years, there has been growing adoption of self-service technology in taking clinical measurements. However, there are currently no on-site self-testing HbA1c facilities. This study assessed patients’ acceptability and ability to perform self-testing of HbA1c levels and the feasibility of implementation in primary care setting. Methods: A total of 30 eligible diabetic patients were recruited in Tampines Polyclinic. Participants were shown a demonstration video before self-testing with a Point-of-Care HbA1c analyzer and completed a questionnaire after self-testing. The usability of the system was assessed using System Usability Scale (SUS). Acceptance and ability were assessed using either a five or six point-Likert Scale for the 7-step procedure. Fisher’s exact test was used to test for association with SUS score. Results: The study population comprises mainly males (60.0%), Chinese (50.0%), had highest qualification of secondary education and beyond (80.0%), with a mean age of 61.4 ± 8.3 years. The mean SUS score was 66.5 ± 13.3 and the average time taken to complete the HbA1c self-testing was 11.8 ± 4.5 min. No significant association was observed between demographics and SUS score. Although 40.0% of participants experienced some difficulty in inserting the cartridge into the analyzer, all were able to understand and follow the video and were willing to perform self-testing in the future. Conclusion: There is high level of acceptance and ability among diabetic patients to adopt HbA1c self-testing. It is feasible for use in primary care.

Cytogenetics Technologists and Workforce- Private and Academic Collaboration to Sustain Expertise as Formal Training Programs get curtailed

Abstract Introduction/Objective Cancer Cytogenetics (CG) and Fluorescence in-situ Hybridization (FISH) testing are essential parts of molecular genetics (MG) in clinical diagnosis for patients suffering from hematopoietic disorders. Even though MG assays are clinically offered, and technical expertise is available, the need for expertise in CG and FISH cannot be understated. Due to budget constraints, deviated focus on innovation by academic programs and lack of awareness in the undergraduate programs, only a handful of centers offer formal training programs. Therefore, the need for qualified CG and FISH technologists to support the industry pipeline is continuously needed. Methods/Case Report With the increased workload and the need to combat workforce shortages, we continue to support academic centers as an on-site training facility. In addition, we have initiated academic collaborations with accredited training programs, both national and international, by training of our own technicians with a pilot program. These individuals hold bachelor’s degrees in biological sciences and are qualified to perform high-complexity testing under Clinical Laboratory Improvement Amendments (CLIA) and College of American Pathologists (CAP) regulations. Results (if a Case Study enter NA) Since 2009, we have had 32 qualified CG/FISH technologists with a CG (ASCP) board certification, most of whom graduated through academic programs. We took the initiative to train four staff members who acquired job experience while working in our CLIA/CAP accredited lab. After the ASCP year requirement was fulfilled, they became eligible to take the ASCP registry exam in CG. All four have passed and are certified cytogenetic technologists. Conclusion Challenged by a reduction in training programs and increasing demand in the industry, we have been successful in training and certifying our technologists with academic and private collaborations. More collaborative efforts are needed to fulfill such an important need in the field of CG.

Characterization and Methanogenic Potential Evaluation of Faecal Sludge: Case of the Kossodo Biogas Plant in Ouagadougou

The use of faecal sludge (FS) in anaerobic digestion (AD) requires a perfect knowledge of their composition. Considered as a very heterogeneous material, the high variability of FS can disturb biodigesters’ functionality and impact biogas production. Unique in West Africa, Kossodo’s biogas plant in Ouagadougou receives sludge from septic tanks and pit latrines. To evaluate the quality of sludge discharged in this treatment plant and its ability for AD, a characterization of 130 FS trucks from several onsite sanitation facilities was carried out. Physico-chemicals, including heavy metals and microbiological parameters, were analyzed using standard protocols. A biochemical methane potential test was employed to evaluate biogas yield. Results showed that raw sludge averaged 1.12% total solids (TS), 54.74% volatile solids (VS), 9253 mg/L chemical oxygen demand (COD), and 1645 mg/L biochemical oxygen demand (BOD). Settled faecal sludge exhibited higher levels of total coliforms, E. coli, helminth eggs, and heavy metals. Heavy metal levels met AD standards defined by VDI 4630, with decreasing toxicity order: Zn > Mn > Cu > Cr > Ni > Pb > As ≥ Hg. The carbon-to-nitrogen (C/N) ratio was 6.7 ± 4.3, indicating unsuitability for AD. Sludge settling increased C/N ratio by 46%, which was still below optimal AD conditions (20–30). Methane yield of raw and settled FS averaged 61 ± 0.2 and 156 ± 3.2 NL CH4/kg VS removed, respectively. Co-substrate addition could enhance the methanogenic yield of these sludges. This study provides a valuable database on the characteristics of FS, supporting sustainable recovery options.

Site and capacity selection for on-site production facilities in a nationwide hydrogen supply chain deployment plan

The Republic of Korea intends to establish a nationwide hydrogen supply chain (HSC) infrastructure to promote the adoption of hydrogen fuel cell vehicles. As the hydrogen demand for mobility may be higher than the estimated production capacity of existing facilities, additional on-site hydrogen refueling stations (HRSs) are required. To address infrastructure deployment problems, a two-stage (demand and supply stages) optimization approach is proposed based on mixed-integer linear programming models. The maximal covering location and p-median models at the demand stage determine the location and chargers of the HRSs and the demand allocation to the stations. At the supply stage, the supply model determines the installation of additional on-site production facilities for the deployed HRSs and the supply allocation to the stations by minimizing the installation and transportation costs. We estimated high-resolution demand data using public sources and utilized investigated supply data from reputable institutions representing the hydrogen economy in the Republic of Korea. The proposed approach provides realistic HSC infrastructure deployment plans, satisfying over 90% of the hydrogen demand in the years 2025 and 2030. Additionally, a sensitivity analysis indicated the effects of various parameters on the deployment plan, including the demand coverage and the need for additional on-site HRSs to address potential hydrogen supply shortages.

Model parameter sensitivity and identifiability for urban river water quality: impact of domestic wastewater discharges from on-site treatment facilities

Abstract River water quality degradation is a risk to human health. Hence, many water quality models have been developed to predict the future states of water bodies and understand how the current water treatment systems will respond to future pollution loads and climatic drivers. A Japanese river was evaluated with the River Water Quality Model No.1 (RWQM1), and parameter sensitivity and identifiability analyses were executed on the model output using parameter sensitivity ranking, collinearity index, and Fisher Information Matrix-derived criterion. Among RWQM1 kinetic parameters, those related to hydrolysis, growth of aerobicheterotrophs, and first-stage nitrifiers were the most influential. Reactive soluble organic substances included in untreated gray waters, in addition to a prevalence ratio of the most advanced on-site treatment facility, strongly contributed to the model output variability. A remediation analysis revealed that a renewal to the most advanced on-site treatment facility by 20% increment was almost equivalent to the 70% decrease in the effluent concentration from an on-site treatment facility producing the highest pollutant load in terms of a BOD concentration decrease in the stream. This study provided baseline data assisting in policy implementation regarding the management of effluents from on-site treatment facilities.

Factors affecting the performance of on-site aerated fluidized-biofilm carrier reactors treating individual household wastewater

The application of decentralized small wastewater treatment facility is increasing for individual households that do not have access to centralized sewage systems. However, how to achieve optimal facility operation and management is a topic of challenge in order to realize higher facility performance due to the large variations in both quality and quantity of the wastewater. In this study, 15 on-site facilities treating individual household wastewater based on aerated reactor of fluidized-biofilm carriers (FBCR) were targeted and the impacts of such indexes as waste sludge cleaning time and the content and activity of biofilm on the performance of the facilities were evaluated. Wastewater samples were collected from 15 FBCRs treating individual household wastewater, each with varying waste sludge cleaning time. These samples were subjected to measurements of suspended substances (SS), biological oxygen demand (BOD), chemical oxygen demand (COD), total organic carbon (TOC), total nitrogen (TN), and total phosphorus (TP). The measurement results, along with those from principal components analysis (PCA) and agglomerative hierarchical clustering (AHC), led to the classification of the facilities into three groups (G1, G2, and G3) based on their different treatment performances. For group G1, although the waste sludge cleaning time differed in 22–586 days, the effluent from its five facilities showed higher water quality, with effluent concentrations reaching 5.30 ± 2.46 mg/L (SS), 5.26 ± 1.80 mg/L (BOD), 36.20 ± 8.70 mg/L (COD), 10.63 ± 2.72 mg/L (TOC), 1.35 ± 0.22 mg/L (TP) and 26.46 ± 3.47 mg/L (TN). Remaining COD, TOC, N and P primarily existed in dissolved forms. Biofilm analysis indicated that maintaining suitable biofilm content and activity was important for stable biodegradation and effective adsorption of suspended matter, surpassing factors like sludge cleaning time in regulating water quality. The result for microbial activity and the content of extracellular polymeric substance (EPS) suggested that the sludge during its storage inside the facility contributed to further degradation of remaining dissolved substances and to overall sludge reduction. The findings are important for optimizing the operation and maintenance of FBCR facility and further improving the treatment performance.

Greenhouse Gas Emissions of an Urban Water System in Korea: A case study of Paju city

Objectives : This study assessed the greenhouse gas emissions (GHG) in the urban water system from a life cycle perspective in the city of Paju. It serves as a case study to provide a quantitative basis for the net-zero water management.Methods : The scope of the study included the centralized local water supply and inter-basin water import system (water abstraction facilities, water treatment plants, pump stations, and water pipelines), wastewater system (wastewater pipelines, pump stations, and wastewater treatment plants, public industrial wastewater treatment plants, on-site wastewater treatment facilities), and circular water use (rainwater harvesting, greywater reuse, and wastewater recycling). This study considered scope 1 emissions, specifically CH<sub>4</sub> and N<sub>2</sub>O emissions generated from wastewater treatment plants, scope 2 emissions from the electricity use during the operation of water infrastructure, and scope 3 emissions associated with the production of water and wastewater pipelines and chemicals. Scope 1 emissions were quantified using both the national guidelines and the 2019 IPCC guideline, and the estimates based on the two methods were compared. Scope 2 and scope 3 emissions were evaluated using life cycle assessment. To quantify GHG emissions for the year 2018, data were collected or estimated from various sources, including public statistics, field interviews, and the literature.Results and Discussion : In 2018, the total GHG emissions from Paju’s water system were 197.4 thousand tons of CO<sub>2</sub> eq. Among these emissions, the scope 2 emissions accounted for the largest share, comprising 66.3% of the total. Notably, circular water use, which included wastewater recycling for high-quality industrial uses, accounted for 41.0% of the scope 2 emissions. Scope 1 emissions accounted for 25.5% and scope 3 emissions accounted for 8.2% of the total emissions. However, in the case of scope 1 emissions, the estimates varied significantly by 2.9 to 6.5 times, depending on the calculation methods and emission factors provided by two different guidelines.Conclusion : To achieve carbon neutrality in the water sector of the city of Paju, two approaches are required: enhancing energy efficiency to reduce scope 2 emissions and implementing measures to reduce scope 1 emissions. However, to obtain accurate and reliable estimates of the GHG emissions, it is crucial to develop applicable scope 1 emission factors based on field data. Furthermore, to gain a comprehensive understanding of GHG emissions in the water sector, further studies are necessary to analyze embodied GHG emissions in water infrastructure and GHG emissions associated with the end use of water.

Towards clinical applicability and computational efficiency in automatic cranial implant design: An overview of the AutoImplant 2021 cranial implant design challenge.

Cranial implants are commonly used for surgical repair of craniectomy-induced skull defects. These implants are usually generated offline and may require days to weeks to be available. An automated implant design process combined with onsite manufacturing facilities can guarantee immediate implant availability and avoid secondary intervention. To address this need, the AutoImplant II challenge was organized in conjunction with MICCAI 2021, catering for the unmet clinical and computational requirements of automatic cranial implant design. The first edition of AutoImplant (AutoImplant I, 2020) demonstrated the general capabilities and effectiveness of data-driven approaches, including deep learning, for a skull shape completion task on synthetic defects. The second AutoImplant challenge (i.e., AutoImplant II, 2021) built upon the first by adding real clinical craniectomy cases as well as additional synthetic imaging data. The AutoImplant II challenge consisted of three tracks. Tracks 1 and 3 used skull images with synthetic defects to evaluate the ability of submitted approaches to generate implants that recreate the original skull shape. Track 3 consisted of the data from the first challenge (i.e., 100 cases for training, and 110 for evaluation), and Track 1 provided 570 training and 100 validation cases aimed at evaluating skull shape completion algorithms at diverse defect patterns. Track 2 also made progress over the first challenge by providing 11 clinically defective skulls and evaluating the submitted implant designs on these clinical cases. The submitted designs were evaluated quantitatively against imaging data from post-craniectomy as well as by an experienced neurosurgeon. Submissions to these challenge tasks made substantial progress in addressing issues such as generalizability, computational efficiency, data augmentation, and implant refinement. This paper serves as a comprehensive summary and comparison of the submissions to the AutoImplant II challenge. Codes and models are available at https://github.com/Jianningli/Autoimplant_II.

Analysis of sanitation system and coliform number in groundwater in Wonosari District, Gunungkidul Regency, Indonesia

Sanitation visualizes the environment’s health status, comprising housing, sewage disposal, and clean water provision. In general, sewerage can have on-site and offsite sanitation facilities. The research was conducted to characterize the sanitation system for sewage disposal, determine the water quality from biological parameters, and enumerate coliform bacteria in groundwater for every sanitation system observed in Wonosari District, Gunungkidul Regency, Indonesia. These sets of information can help detect groundwater contamination by coliform that reflects the sanitary characteristics of the sewage disposal to be further considered in sanitation management and treatment policies. The research used purposive sampling, field surveys, interviews with a questionnaire, laboratory analyses, and a descriptive-comparative design. The results showed that the sanitation system for sewage disposal at the study site consisted of individual septic tanks and wastewater treatment plants (WWTPs). In terms of quality, the coliform counts exceeded the existing standards, with the highest presence found in groundwater downstream of improperly maintained WWTPs and substandard septic tanks close to other sources of pollutants.

Two Listeria monocytogenes outbreaks in a cancer centre: onsite food premises and their potential health risk to patients

BackgroundThis report describes two L. monocytogenes outbreak investigations that occurred in March and September of 2018 and that linked illness to a food premises located in an Ontario cancer centre. The cancer centre serves patients from across the province.MethodsIn Ontario, local public health agencies follow up with all reported laboratory-confirmed cases of listeriosis to identify possible sources of disease acquisition and to carry out investigations, including at suspected food premises. The Canadian Food Inspection Agency (CFIA) is notified of any Listeria-positive food product collected in relation to a case. The CFIA traces Listeria-positive product through the food distribution system to identify the contamination source and ensure the implicated manufacturing facility implements corrective measures.ResultsOutbreaks one and two each involved three outbreak-confirmed listeriosis cases. All six cases were considered genetically related by whole genome sequencing (WGS). In both outbreaks, outbreak-confirmed cases reported consuming meals at a food premises located in a cancer centre (food premises A) before illness onset. Various open deli meat samples and, in outbreak two, environmental swabs (primarily from the meat slicer) collected from food premises A were genetically related to the outbreak-confirmed cases. Food premises A closed as a result of the investigations.ConclusionsWhen procuring on-site food premises, healthcare facilities and institutions serving individuals with immuno-compromising conditions should consider the potential health risk of foods available to their patient population.

Pharmaceutical residues in the ecosystem: Antibiotic resistance, health impacts, and removal techniques

Hospital wastewater has emerged as a major category of environmental pollutants over the past two decades, but its prevalence in freshwater is less well documented than other types of contaminants. Due to compound complexity and improper operations, conventional treatment is unable to remove pharmaceuticals from hospital wastewater. Advanced treatment technologies may eliminate pharmaceuticals, but there are still concerns about cost and energy use. There should be a legal and regulatory framework in place to control the flow of hospital wastewater. Here, we review the latest scientific knowledge regarding effective pharmaceutical cleanup strategies and treatment procedures to achieve that goal. Successful treatment techniques are also highlighted, such as pre-treatment or on-site facilities that control hospital wastewater where it is used in hospitals. Due to the prioritization, the regulatory agencies will be able to assess and monitor the concentration of pharmaceutical residues in groundwater, surface water, and drinking water. Based on the data obtained, the conventional WWTPs remove 10–60% of pharmaceutical residues. However, most PhACs are eliminated during the secondary or advanced therapy stages, and an overall elimination rate higher than 90% can be achieved. This review also highlights and compares the suitability of currently used treatment technologies and identifies the merits and demerits of each technology to upgrade the system to tackle future challenges. For this reason, pharmaceutical compound rankings in regulatory agencies should be the subject of prospective studies.

Sustainable Management of Bio Medical Waste in Chennai: A case study

The aim of the current research article is to study various treatment techniques involved in the management of bio medical waste and select the most appropriate treatment method in terms of cost savings, energy recovery and waste volume reduction in a sustainable manner. Most of the HCF (Health Care Facilities) lacks the provision for on-site waste treatment facility. One of the major reasons might be the fear of high pollutant emission levels from multiple machines or equipment used in the treatment process. At times, it could be due to lack of sufficient space within the clinical premises. To overcome this situation, a minor amendment has to be introduced in the bio medical waste management rules 2016, which includes providing a suitable area necessary for medical waste treatment within the premises, during the construction stage itself. Further, the identification of appropriate treatment techniques based on the type of waste generated is also important. Even a primary HCF too should be equipped with the requisite treatment facilities, considering the emission levels to be within the standards. This sort of installing an on-site waste treatment facility will reduce the amount spent upon external agencies for disposal and treatment of the medical waste. Then, the leftover residue is securely landfilled in the dedicated site or even be liable to mix with the municipal solid garbage. The current study concludes that the implementation of one of the treatment techniques in a specific hospital helps in energy recovery, huge reduction in the volume of waste generation and avoids illegal dumping of the waste, thereby creating less impact on the surrounding environment.

Fleet Operator Perspectives on Heavy-duty Vehicle Alternative Fueling Infrastructure

Despite the aggressive policy goals aiming to transition heavy-duty vehicles (HDVs) toward zero-emission technologies, the penetration rates of zero-emission or even alternative fuel technologies (including zero-emission and other fuels cleaner than petroleum) are still very low. Given that the majority of HDVs are used as fleet vehicles, a better understanding of fleet operator behavior and perspectives on clean fuel technologies is crucial to develop effective demand-side strategies to achieve such policy goals. Of many adoption barriers, a well-known major obstacle is the lack of fueling/charging infrastructure. However, there is limited understanding on how HDV fleet operators have navigated the issues involving the insufficient infrastructure. This study explores how HDV fleets have used alternative fueling infrastructure, how dis/satisfied fleet operators are with the infrastructure, and for what reasons they have decided to construct their own on-site fueling facilities, or to use off-site stations. Based on a case study of compressed natural gas, the most prevalent alternative fuel option so far in the HDV sector, 17 in-depth qualitative interviews were conducted with HDV fleet operators in California. Content and thematic analyses of the data yielded detailed qualitative inferences on use behavior, satisfaction, and fleet decisions between on-site versus off-site fueling. The study findings are the first step toward enhancing our understanding of HDV fleet behavior regarding alternative fueling infrastructure, which can contribute to filling the knowledge gap in this field and to developing further research questions to elicit policy recommendations that can support the adoption of clean fuel technologies in HDV fleets.

Reclamation Potential of Onsite Wastewater Post-Treatment with Microalgae: Chemical Elements Perspective

Algae-based wastewater treatment is a promising technology with various applications for excess biomass such as biofertilizer production or valuable elements extraction. The benefits of the technology have been discussed for larger wastewater treatment plants (WWTPs), but the use of microalgae in decentralized wastewater treatment has been barely reported. The current study screens the possible resource recovery potential of onsite technology, which adds algae-based post-treatment to the conventional biological treatment of domestic wastewater. The effluent from the onsite sequencing batch reactor (SBR) of a household was further processed in laboratory conditions using an SBR technology with two local monocultures of algae—Klebsormidium nitens (Kützing) Lokhorst and Tetradesmus obliquus (Turpin) M. J. Wynne. The decant and the generated algal biomass were analyzed in terms of their element content. The post-treated effluent has a slightly better quality for irrigation purposes than the effluent of the onsite treatment facility—up to 1.6 times increased concentration for macro-elements and up to 1.9 times for micro elements. However, the generated algal biomass shows promising potential for re-use as a fertilizing agent since it contains valuable macro- and micro-elements and the heavy (hazardous) metal content is considerably lower than the limiting values in the current European and national legislations. The K. nitens strain may attract interest since it accumulates valuable metals such as chromium (36 mg/kgDS), nickel (83 mg/kgDS), and silver (0.7 mg/kgDS) that can be derived from the biomass and turn the technology to a circular one.

Evaluation of bioenergy production and material flow in treating Japanese concentrated Johkasou sludge using high-solid anaerobic membrane bioreactor based on one-year operation

The treatment of waste sludge generated from on-site wastewater treatment facilities (Johkasou) applied extensively in Japan is a key concern. In this study, a high-solid anaerobic membrane bioreactor (AnMBR) was continuously operated throughout a year to investigate the bioenergy production, material flow and seasonal impacts of concentrated Johkasou sludge (CJoS). The CJoS has higher carbon-to-nitrogen ratio and lipid fraction, but less proteins than waste activated sludge (WAS). The biogas yield of CJoS by AnMBR ranged from 0.47 to 0.52 L/g-VSfed, which was higher than the anaerobic digestion of WAS and lower than mixed sewage sludge from centralized wastewater treatment facilities. The greatest biogas production rate was observed during summer (0.63 L/L/d), owing to the high total organic and solid content. However, winter CJoS had the highest biogas yield and carbon conversion rate owing to the conservation of soluble organic matter in low temperature and high digestibility. The material flow results revealed that 46.5–52.4% total COD and 50.2–58.0% carbon was converted to biogas. The energy recovery rates ranged from 8.69 to 9.96 kJ/g-VSfed and the system energy self-sufficiency rates ranged from 1.92 to 3.02. The optimal dewaterability of digested sludge was achieved when polyamidine flocculant dosage was 30 mg/g-MLSS and the corresponding sludge specific resistance to filtration was 2.26 × 1012 m/kg. The results demonstrated that AnMBR yielded high energy conversion efficiency without co-digestion and pretreatment processing.

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.

580 Burn Camp in the Midst of the COVID-19 Pandemic

Abstract Introduction Previous literature has shown that pediatric burn camps provide numerous benefits to childhood burn survivors. Unfortunately, the COVID-19 pandemic resulted in the inability to host camp for fear of viral transmission to burn survivors and camp personnel alike. A comprehensive burn center, with assistance from the firefighter community, hosted its first burn camp since the onset of the COVID pandemic in August of 2022. A camp staff of 54 volunteers modified the previous camp processes to ensure camp was safe, fun and accessible to 20 pediatric burn survivors. Methods This is an academic short report that reviews the process changes necessary to host a safe pediatric burn camp in the midst of the COVID pandemic. All attendees and staff were required to show a negative PCR test result 48 hours prior to arrival at camp. COVID vaccination was encouraged in all participants, however, staff and patients were not required to be vaccinated. Daily symptom tracking was implemented immediately upon arrival to camp. All participants were assigned a thermometer, and daily temperatures and symptom monitoring was performed by the camp director. Masks were mandated when indoors or within close proximity or group activities. There was a quarantine plan in place in the case a camper or staff member became symptomatic, or tested positive for COVID. Lastly, the number of people per cabin decreased from 12 to 8. Results In the early planning phase of camp, it was discovered that some of the participants and staff were unable to obtain a PCR test prior to camp. Therefore, onsite testing was implemented to allow testing as the participants and camp staff arrived to camp. The onsite testing facility was available for the entirety of camp in the case anyone became symptomatic. Implementation of additional camp processes resulted in a successful and safe camp. There were no reported cases of COVID during or after camp. Conclusions As the Public Health Emergency from COVID-19 continues, group activities, such as summer burn camps, with medically vulnerable populations must be altered to protect all stakeholders. We described the steps taken by one burn-center-run camp that enabled children and firefighter volunteers to participate in the full burn camp experience. Plans for the 2023 burn camp are already in process, and the processes implemented in 2022 will be implemented in all upcoming camps to ensure the children and staff are safe from the transmission of COVID. Applicability of Research to Practice N/A

The Impact of Introducing Midwives and also Mentoring on the Quality of Sexual, Reproductive, Maternal, Newborn, and Adolescent Health Services in Low- and Middle-Income Countries: An Integrative Review Protocol.

Midwives have the potential to significantly contribute to health-delivery systems by providing sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) care. However, scant research finds barriers to understanding what midwives need to realize their full potential. There are gaps in the definition of a midwife and an understanding of effective means to support the implementation of midwifery care. Mentorship has been found to support systems and healthcare providers to improve care availability and quality. We describe the methodology of an integrative review that aims to generate evidence of the impact of introducing midwives and also on-site facility mentoring to better understand facilitators and barriers to implementation of the quality and availability of SRMNAH services in low- and middle-income countries (LMICs). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used to carry out the integrative review. Four electronic bibliographic databases, PubMed MEDLINE, EMBASE, Scopus, and CINAHL, will be used to identify eligible studies. All types of qualitative or quantitative studies will be considered. Eligible studies will be screened according to Population, Intervention, Comparison, and Outcome (PICO) inclusion criteria, and data will be extracted against a predetermined format. The aspects of health system strengthening in providing improved SRMNCH care will be examined in this review to generate evidence on how midwives and mentorship can improve routine care and health outcomes using the World Health Organization's Six Building Blocks approach. The quality of the articles will be thematically analyzed in four areas: coherence and integrity, appropriateness for answering the question, relevance and focus, and overall assessment using the Gough weight-of-evidence framework. The literature review will consider assessing both upstream health systems regulators and downstream effectors for implementing midwifery interventions. Within this building block framework, this research will report on the outcomes and experiences of introducing midwives and the effectiveness of mentoring midwives and other staff in midwives' roles in improving care quality and health outcomes.

Source separation of human excreta: Effect on resource recovery via pyrolysis

More people globally are now using on-site sanitation technologies than sewered connections. The management of faecal sludge generated by on-site facilities is still challenging and requires an understanding of all sanitation service chain components and their interactions; from source conditions to treatment and resource recovery. This study aimed to improve the current lack of knowledge regarding these interactions, by establishing a quantifiable relationship between human excreta source separation and resource recovery via pyrolysis. The effects of source separation of faeces and urine on biochar quality were investigated for different pyrolysis temperatures (450 °C, 550 °C, 650 °C) and this information was used to assess energy and nutrient recovery. Results quantify the benefits of urine diversion for nitrogen recovery (70% of total N losses during thermal treatment avoided) and show an increase in the liming potential of the produced faecal-based biochars. The quality of produced solid fuels is also improved when source-separated faeces (SSF) are used as a feedstock for pyrolysis, including a 50% increase in char calorific value. On the other hand, biochars from mixed urine and faeces (MUF) are more rich in phosphorus and potassium, and surface morphology investigation indicates higher porosity compared to SSF biochars. The high salinity of MUF biochars should be considered before agricultural applications. For both biochar types (SSF, MUF), the presence of phosphate compounds of high fertiliser value was confirmed by X-ray diffraction analysis, and temperatures around 500 °C are recommended to optimise nutrient and carbon behaviour when pyrolysing human excreta. These findings can be used for the design of circular faecal sludge management systems, linking resource recovery objectives to source conditions, and vice-versa. Ultimately, achieving consistent resource recovery from human excreta can act as an incentive for universal access to safe and sustainable sanitation.

ICT-based solution for efficient fecal sludge management: An experience from Bangladesh

In Bangladesh, people primarily depend on on-site sanitation facilities (OSSF) with an immense challenge in achieving safe sanitation due to unplanned infrastructure development, improper management of fecal sludge, and inadequate monitoring. The commitment of attaining Sustainable Development Goals (SDG) 6.2 (ensuring safe sanitation for all) by 2030 requires immediate attention in the management of fecal sludge for low-middle income countries. This paper presented the findings, challenges, and possible ways forward from a study conducted to provide data for Information and Communication Technology (ICT)-based fecal sludge management (FSM) at a municipality in the northwest of Bangladesh. A total of 18,808 households and 407 institutions in Saidpur municipality, a non-sewered town in Nilphamari district, were studied to understand the type of containment structures and on-ground desludging practices. The study showed around 10% of containments were connected to the drains illegally, 95% of the people in Saidpur practiced unsafe disposal, and 7% still practiced open defecation. To identify these malpractices, the study also implemented an ICT-based sustainable solution through a web application that enabled the local administrator to have a global look at the sanitation scenario of the municipality. The dashboard was developed to create a total sanitation monitoring system, identify defaulters, allow target-based safe managed sanitation service strategies, and ensure sustainability in FSM. The study highlighted the accessibility of vacuum truck services projecting through a spatial map and identified methods to empty the septic tanks where Vacutag services are unavailable by engaging local pit emptiers. The innovative approach of fecal sludge management will help not only to improve the existing sanitation practices but also raise community awareness to ensure sustainable sanitation system. Altogether, the web system will work as a medium to manage the faecal sludge for the existing co-compost plant where the faeces is converted into organic soil conditioner, creating prospects for a green business mechanism.