Littérature scientifique sur le sujet « Management sanitaria »

INTRODUZIONE La valutazione del paziente ed il relativo trattamento effettuato dal primo equipaggio sanitario giunto sul luogo dell’evento hanno un’importante impatto sull’evoluzione clinica e sull’outcome del paziente traumatizzato; è necessario infatti applicare un approccio sistematico a queste situazioni guidato da raccomandazioni chiare e semplici che vedono interagire il soccorso tecnico con il soccorso sanitario[1]. È ben noto che il soccorso tecnico è in capo al Corpo Nazionale dei Vigili del Fuoco[2] e al Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS)[3]. È altrettanto evidente che in determinate condizioni cliniche del paziente, sebbene l’evento sia in un’ambiente impervio, il soccorso sanitario non può tardare il suo essenziale intervento[4] [5]. La durata e l’esposizione a fattori ambientali per il paziente stesso convalidano l’importanza delle figure sanitarie di emergenza territoriale anche nei luoghi impervi: il personale sanitario oltre ad avere le necessarie conoscenze per il supporto vitale dovrebbe avere competenze logistiche e sulle operazioni di soccorso[6] [7]. La “Golden Hour”, termine coniato nell’ormai lontano 1961, è un concetto ben noto ai soccorritori del setting pre-ospedaliero; successivamente si è vista la nascita del termine “Platinum Ten Minutes”[8]. In entrambi i casi accorciare il tempo che trascorre dall’evento traumatico alla cura definitiva è di fondamentale importanza per un migliore esito del paziente stesso[9] [10]. Esistono anche pareri contrastanti espressi in letteratura circa l’efficacia della stessa “Golden Hour”[11]; tuttavia se vengono presi in considerazioni quei pazienti traumatizzati con patologie evidentemente tempo dipendenti (es. shock emorragico)[12] [13] [14], l’importanza di un trattamento precoce torna ad essere di grande attualità[15] [16]. Questo case report descrive un soccorso in ambiente impervio dove l’infermiere di emergenza territoriale, quale primo MSA[17] (mezzo di soccorso avanzato) giunto sul posto e quindi prima figura sanitaria, ha raggiunto il paziente sul luogo dell’evento per poterlo valutare e trattare precocemente, in piena collaborazione con il personale del soccorso tecnico giunto sul posto. L’obiettivo è quindi quello di richiamare gli attori del sistema di emergenza territoriale all’importanza della collaborazione fra enti diversi, sanitari e tecnici non sanitari, avente chiaramente come scopo finale un più precoce ed efficace trattamento del paziente sul posto per migliorarne l’outcome.

Uno dei temi di maggiore interesse ed attualità in ambito sanitario è la necessità di conciliare l’attenzione verso le esigenze assistenziali della popolazione con il contenimento dei costi, di per sé in crescita costante e per molti aspetti incontrollabile. Questa sfida è stata sino ad oggi solo in parte raccolta dal nostro Sistema Sanitario, anche a causa di una incompleta ed inadeguata formazione degli operatori su tali tematiche. Nondimeno, le ricerche finalizzate ad un più razionale utilizzo delle risorse disponibili sono sempre più numerose ed - ovviamente - coinvolgono direttamente i clinici. Tra gli aspetti indagati frequentemente vi è quello che concerne l’appropriatezza dei ricoveri ospedalieri. Muovendo da queste considerazioni gli Autori hanno voluto analizzare i margini di azione entro cui è possibile impostare seri programmi di tutela dei bisogni collettivi di salute che soddisfino sia le esigenze di una maggiore qualità delle prestazioni sanitarie - anche attraverso soluzioni organizzative alternative rispetto al ricovero tradizionale - sia i necessari requisiti di eticità, secondo la visione morale personalistica.

L'articolo presenta uno stato dell'arte delle politiche internazionali ed europee e una rassegna delle iniziative implementate dagli operatori privati per la sicurezza sanitaria nelle filiere agroalimentari. L'analisi č incentrata sugli effetti economici della combinazione degli approcci pubblico e privato in comparazione con i potenziali effetti in termini di riduzione del rischio sanitario a cui č esposto il consumatore. Partendo da una rassegna critica della letteratura economica e da un'analisi basata sugli strumenti della Nuova Economia Industriale, gli autori mostrano come, a determinate condizioni, l'obiettivo della sicurezza sanitaria nella filiere agroalimentari possa essere soltanto parzialmente conseguito per effetto di distorsioni economiche derivanti dall'effetto combinato di politiche pubbliche e standard privati.

En este artículo se realiza un pequeño repaso de la acción sanitaria de España en la zona norte de Marruecos durante el Protectorado. Se aborda el origen y la organización del Protectorado, tanto política como administrativamente, para a continuación referirse a la situación sanitaria en Marruecos antes del inicio de la acción protectora. Posteriormente se analiza la organización sanitaria que España creó en esta zona y fundamentalmente en dos secciones: Los servicios de la Dirección General y las luchas y campañas sanitarias. El artículo finaliza recordando cuáles fueron los resultados obtenidos y cuál la situación médica y sanitaria de Marruecos al independizarse este país en 1956.This article presents a brief review of what has been the sanitary action that Spain has carried out in the northern region of Morocco during the Protectorate. It deals with the origin and the Protectorate’s organization, both political and administratively, afterwards to refer to the situation in Morocco before the beginning of the protective action. Subsequently, it analyses the sanitary organisation Spain created within this area and fundamentally within these two sections: Services of general management and sanitary campaigns. In conclusion, the article records the final results and what the medically sanitary situation was when they became independent in 1956.

La cuestión de la gestión sanitaria en España planteainterrogantes sobre cómo abordar las causas que inciden en sussíntomas de falta de sostenibilidad y como resolver sus ineficienciasmás significativas, es decir, cómo encontrar modelos más eficientesde gestión de las prestaciones sanitarias para hacer sostenible el derechoa la prestación sanitaria de los ciudadanos.Se propone una reforma del Sistema Nacional de Salud (SNS)con un modelo alternativo de financiación y provisión de las prestacionessanitarias, basado en los principios de competencia, eficacia,eficiencia y libre elección de los asegurados entre centros concertadospúblicos y privados.The issue of health management in Spain raises questionsabout how to address the causes that affect its symptoms oflack of sustainability and how to solve its most significant inefficiencies,that is, how to find more efficient models of health benefitsmanagement to make sustainable the right to health care for citizens.A reform of the National Health System is proposed with an alternativemodel of financing and provision of health benefits, basedon the principles of competence, effectiveness, efficiency and freechoice of insured persons between public and private contractedcenters.

- The main task of emergency dispatch operators is to obtain required key-information and to decided arrangement in order to react within a minute. The aim of this explorative study was to detect characteristics of communication during emergency telephone calls. To this end, 244 emergency calls, were collected at 118 ReggioSoccorso emergency dispatch centre. Results showed that callers' and operators' characteristics were associated with differential length of the call, ways of communication and ways of getting key-information. Finally, the implications for professional practice, such as human resource management and training, are discussed.Keywords: telephone calls, emergency, emergency dispatch operators.Parole chiave: comunicazione telefonica, emergenza, operatori del soccorso sanitario.

El artículo analiza la organización de la atención sanitaria pública en España, mediante un marco conceptual que permite integrar los aspectos más relevantes de la misma. Asimismo, se profundiza en los aspectos organizativos de los hospitales descritos como Burocracias Profesionales, Meritocracias y Organizaciones Intensivas en Conocimientos, aspectos que condicionan la gestión de los mismos. Finalmente, mediante las aportaciones de la teoría de los Recursos y Capacidades se concluye que la gestión sanitaria implica la gestión del conocimiento que reside en el capital humano altamente especializado, el capital organizativo acumulado y la reputación conseguida con el paso del tiempo, todo ello en un entorno tecnológico de alta complejidad y elevado dinamismo.<br /><br />How public health is organized in Spain is analyzed through using a theoretical framework which includes the most relevant issues regarding this topic. Likewise, this paper deals with organizational aspects from hospitals which determine the way they are managed, such as Professional Bureaucracies, Meritocracies, and Knowledge-Intensive Organizations. Finally, drawing on Resource-Based View contributions, this article concludes that health management, which occurs in a technological, highly complex and dynamic environment, involves the management of knowledge derived from three sources: highly specialized human capital, accumulated organizational capital, and reputation.<br />

El artículo analiza la organización de la atención sanitaria pública en España, mediante un marco conceptual que permite integrar los aspectos más relevantes de la misma. Asimismo, se profundiza en los aspectos organizativos de los hospitales descritos como Burocracias Profesionales, Meritocracias y Organizaciones Intensivas en Conocimientos, aspectos que condicionan la gestión de los mismos. Finalmente, mediante las aportaciones de la teoría de los Recursos y Capacidades se concluye que la gestión sanitaria implica la gestión del conocimiento que reside en el capital humano altamente especializado, el capital organizativo acumulado y la reputación conseguida con el paso del tiempo, todo ello en un entorno tecnológico de alta complejidad y elevado dinamismo.<br /><br />How public health is organized in Spain is analyzed through using a theoretical framework which includes the most relevant issues regarding this topic. Likewise, this paper deals with organizational aspects from hospitals which determine the way they are managed, such as Professional Bureaucracies, Meritocracies, and Knowledge-Intensive Organizations. Finally, drawing on Resource-Based View contributions, this article concludes that health management, which occurs in a technological, highly complex and dynamic environment, involves the management of knowledge derived from three sources: highly specialized human capital, accumulated organizational capital, and reputation.<br />

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Esta dissertação de mestrado consistiu em elaborar e construir uma Estação de Tratamento de Esgoto (ETE) que utilizasse o sistema de Alagados Construídos (wetlands) para tratar o esgoto gerado no Departamento de Educação Física e da Moradia Estudantil, ambos ligados a Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP de Bauru. Para isso foi criado um sistema híbrido de fluxo subsuperficial horizontal seguido por outro de fluxo vertical, com recirculação. O projeto foi desenvolvido no campo da universidade para atender 91 habitantes equivalentes. Nesse trabalho, foram explorados as etapas construtivas da ETE e realizado análises físico-químicos e biológicos dos alagados construídos de fluxo vertical na fase de maturação do sistema. A elaboração deste estudo é uma ferramenta importante para o desenvolvimento do sistema de alagados construídos no Brasil, uma vez que, possibilita o conhecimento das técnicas de construção, manutenção e gastos para implantação de um sistema desse tipo
The realization of this research project is to develop and build a sewage treatment plant using the system of Constructed Wetlands to treat sewage generated in the Department of Physical Education and Student Housing, both linked to Universidade Estadual Paulista Julio de Mesquita Filho - UNESP in Bauru. For it was created a hybrid system of horizontal subsurface flow followed by another vertical flow, with recirculation. The project was developed at the university campus to meet 91 equivalent inhabitants. In this work were explored constructive steps ETE and testing of physico-chemical and biological of vertical flow constructed wetlands in the maturation phase of the system. The preparation of this study is an important tool for the development of constructed wetlands system in Brazil, since it enables the knowledge of construction techniques, maintenance and expenses fopr deploying such a system

European Water Framework Directive (2000/60/EC) regards underground water resource protection and one of its main challenges is to provide a quantitative and qualitative monitoring activities in order to achieve a "good" status of groundwater resources. A good environmental status of the groundwater resource is linked to its chemical conditions and to its quantitative state, which depends on the equilibrium between withdrawals in the medium-long term and natural recharge. The main objective of this research was to use alternative and non-conventional methods of analysis useful for groundwater resources management and sustainable procurement in environments characterized by dry events and water deficit, paying particular attention to the evaluation of the natural groundwater recharge sources. The specific objective of this thesis was defining the episodes of natural recharge in a porous aquifer located in an area of Tuscany considered semi-arid and characterized by dry events. In order to do this, hydrological and hydrogeological assessments based on automated methods, such as the recession curves MRC (Master Recession Curve) were used. These methods represent the relationship between the value of a hydrograph response and its rate of change over time (dR/dt) at a time when there is no infiltration or other entry of water. The MRC calculated for the time series of the response variable (i.e. the groundwater level) also allowed to determine the recharge episodes through the EMR Episodic Master Recession method. The EMR method is based on the level fluctuation algorithm (Water Table Fluctuation-WTF) and is suitable for identifying discrete recharging episodes from the hydrograph, the recharge amounts attributable to each episode and the amount of precipitation that caused this answer. This method considers a recharge flow in a saturated zone, that causes an increase of groundwater level before that dissipation processes that take place in the saturated zone bring it back to its steady state. This phenomenon is the product of the Specific yield (Sy) of the aquifer and the groundwater table level change (H = H/dt) attributable to recharge. The main challenge of the WTF method is to estimate Sy in groundwater zone fluctuation. Thanks to field measurements obtained with geophysical methods, the actual Sy parameter value was obtained. The integration of utilizes procedures and techniques was useful not only for evaluating recharge episodes, but also for assessing the relationship between recharge events and possible climate changes taking place in the study area. Thus, this research was able to link climatic changes with the modifications in the water level of the studied aquifer.

In order to combat drought and desertification, it is essential a holistic approach such as that one represented by the paradigm of the Integrated Water Resources Management (IWRM). IWRM can be considered as a flexible conceptual framework based on the principles of equity, efficiency and sustainability that indicates general guidelines for a more efficient water management. Within this framework, an effective solution consists, in particular in arid and semi-arid regions, in sustainable water management practices which include, in many cases, a combination of both water harvesting and managed aquifer recharge (MAR) techniques. This research was developed within the WADIS-MAR “Water harvesting and Agricultural techniques in Dry lands: an Integrated and Sustainable model in MAghreb Regions” demonstration Project (2011-2016) (www.wadismar.eu), funded by the EC under the Regional Programme “Sustainable Water Integrated Management” (SWIM) (www.swim-sm.eu). Among its objectives, the Project aimed at increasing groundwater availability through an integrated water harvesting and managed aquifer recharge system in two watersheds in Maghreb Region: Wadi Biskra in Algeria and Oum Zessar in Tunisia. Both areas are characterized by water scarcity, overexploitation of groundwater resources and high vulnerability to climate change risk. The overall objective of this research was to develop an interdisciplinary methodology to define guidelines for the design and implementation of integrated and innovative MAR systems that can be applied in arid and semi-arid environments. This methodology was tested in the two study areas in Algeria and Tunisia. As required by its application, with the support of the interdisciplinary research group of WADIS-MAR, the different components of the Water Resources System (WRS) at local level were defined: the water budget, the 3D hydrogeological model and the hydrogeochemical and isotopic characterization. Because of the lack of a sufficient number of quality data for hydrological modeling, a physiography-based indirect method for determining the runoff coefficient was applied at sub-basin scale for three watersheds (Koutine, Megarine-Arniane and Hajar) in the Tunisian study area. The water budget was estimated on a daily time scale basis, over a 10-year period (2003-2012), by using a simplified water balance model, through an agronomic approach, that considers effective infiltration as part of the surplus from water storage in the soil. An average Available Water Content (AWC) of soils and an average runoff coefficient were considered for each sub-basin. 3D hydrogeological models were implemented for both study areas through the realization of several balanced geological cross-sections and data processing in a 3D environment by 3D MOVE software. A detailed hydrogeochemical characterization was carried out, including bulk chemistry and multi-isotopic analyses of water and solid samples. The estimated average annual groundwater recharge of the aquifers resulted consistent with the reference values in literature. 3D hydrogeological model reconstruction showed that the groundwater circulation and the geometry of aquifers is strongly influenced by several tectonic structures and this evidence is confirmed by hydrogeochemical and isotopic results. All these results allowed to design MAR systems which are innovative because they present some technical innovations to improve the efficiency of managed aquifer recharge: the recharge chambers and the Passive Treatment System. Finally, the estimated potential recharge rate (m3 year-1) for the targeted aquifers related to the designed MAR systems were about 1.7 hm3 year-1 and 1.2 hm3 year-1 in Algerian and Tunisian study area, respectively.

E’ stato appurato che il consumo mondiale di farmaceutici ad uso umano e dei prodotti per la cura personale (FPCPs) è in aumento a causa dell'invecchiamento della popolazione e del miglioramento delle condizioni di vita delle persone. Una volta somministrati, i farmaci (FCs) vengono metabolizzati dal corpo umano e i loro residui vengono escreti attraverso l’urina e le feci. Anche i prodotti per la cura personale (PCPs), utilizzati per la pulizia e l’igiene, vengono scaricati nelle acque reflue dopo l'uso. Una volta raggiunto l'impianto di depurazione, questi composti possono subire modifiche a causa di processi fisici, chimici e biologici che ivi avvengono. Possono, dunque, essere completamente o solo parzialmente rimossi dalle acque reflue. Anche se molte indagini hanno messo in evidenza che la presenza dei residui di questi composti in ambienti acquatici è dovuta principalmente agli scarichi dell'impianto di depurazione (Daughton e Ruhoy, 2009), fino ad oggi, non sono stati fissati limiti di legge che ne regolamentino la presenza né esistono linee guida che indichino i trattamenti più idonei per ridurne la concentrazione negli effluenti depurati (Verlicchi et al., 2012d). Inoltre, recenti studi hanno evidenziato che gli effluenti ospedalieri possono comportare considerevoli immissioni di composti farmaceutici nelle acque reflue. La ricerca di una gestione e di un trattamento adeguato per questi reflui è una questione estremamente urgente. Poiché questi composti possono mostrare effetti tossici sull’ambiente, è molto importante indagarne la presenza nelle acque reflue urbane ed ospedaliere oltre che analizzare diverse strategie per ridurne lo scarico nelle acque superficiali. Questo lavoro ha proprio questo scopo. Prima di tutto, è stata effettuata un’analisi delle concentrazioni di residui farmaceutici nell’influente e nell’effluente dell’impianto di depurazione attraverso la raccolta di dati pubblicati in letteratura riguardanti 244 impianti a fanghi attivi di tipo convenzionale. Inoltre, le efficienze di rimozione, ottenute con questo sistema di trattamento, sono state analizzate in relazione alle proprietà chimiche e fisiche dei composti selezionati, vale a dire solubilità, volatilità, capacità di assorbimento, capacità di assorbimento, biodegradabilità, polarità che, variando notevolmente, ne influenzano il comportamento durante i trattamenti. Tra i molti fattori che regolano le complesse interazioni che avvengono durante il trattamento, la lipofilicità influenza l'assorbimento dei FCs nei fanghi di depurazione. Un'analisi approfondita della presenza di PCPs nei fanghi di depurazione trattati e non trattati è stata effettuata partendo dalla raccolta dei dati presenti in 59 pubblicazioni internazionali. I fanghi prodotti durante i processi biologici, che avvengono negli impianti di depurazione, contengono un ampio spettro di PCPs che si separano dalla fase liquida durante i trattamenti. Lo smaltimento dei fanghi di depurazione in agricoltura è disciplinato a livello comunitario e i regolamenti nazionali di ogni paese appartenete alla Comunità Europea ne recepiscono le Direttive. In generale, sono regolamentate le massime concentrazioni ammissibili di elementi potenzialmente tossici per il terreno dopo l'applicazione dei fanghi di depurazione, ma non sono impostati limiti di concentrazione per i PCPs. C'è un dibattito in corso all'interno della comunità scientifica al fine di valutare i potenziali rischi ambientali di questo tipo di pratica, a causa della presenza di sostanze tossiche e persistenti nei fanghi. In questo lavoro di tesi è stata effettuata la valutazione del presenza di FCs in diversi tipi di fango e del rischio ambientale connesso, al fine di individuare i composti che presentano il più alto rischio. Non solo i trattamenti convenzionali, ma anche quelli naturali sono studiati nella tesi. I sistemi di fitodepurazione (SFs) sono sistemi in cui differenti microambienti possono coesistere e contribuire alla rimozione di FPCPs. La presenza di questi composti nell’influente e nell'effluente di diversi tipi di SFs, così come la corrispondente efficienza di rimozione, è stata studiata raccogliendo dati di rimozione e concentrazione da 47 e 36 pubblicazioni riferite rispettivamente a FCs e PCPs. I fattori principali (parametri di progettazione e condizioni operative) che influenzano la rimozione sono stati discussi. Dopo l'analisi dei dati di letteratura, per valutare l'efficienza di rimozione raggiunta da un sistema a fanghi attivi di tipo convenzionale seguito da un SFs e il loro rispettivo contributo, è stata eseguita una campagna sperimentale presso un grande impianto di depurazione del nord Italia, dove un impianto pilota di SFs, direttamente alimentato da un effluente secondario, era in funzione da 10 anni. E’ stato analizzato il carico di FCs corrispondente all’influente e all’effluente dell’impianto a fanghi attivi nonché all’effluente affinato dall’impianto pilota. Questi valori sono stati confrontati al fine di valutarne il contributo depurativo. Considerando gli effluenti ospedalieri, sono stati raccolti dati di letteratura al fine di esaminare e discutere le lezioni apprese dalle precedenti indagini e dagli studi condotti sul trattamento dedicato di acque reflue ospedaliere in diversi paesi di tutto il mondo. E’ stata effettuata un’analisi critica dei dati raccolti da pubblicazioni che riguardano impianti di laboratorio, pilota e di trattamento a scala reale, che fungono da trattamenti primari, secondari e terziari. L'attenzione è rivolta alle efficienze di rimozione osservate per i contaminanti convenzionali e, in particolare, emergenti: principalmente FCs, detergenti e disinfettanti. Conoscere le concentrazioni presenti in effluenti ospedalieri potrebbe essere difficile a causa, non solo degli alti costi di analisi delle indagini, ma anche dalle difficoltà nell’organizzare campagne di campionamento all'interno dei centri di cura. Per questo motivo, è stato valutato un modello per prevedere la concentrazione di FCs in base al loro consumo interno alla struttura. Sono state confrontate le concentrazioni previste con quelle misurate nell’effluente di un ospedale situato nel Nord Italia. Le differenze sono state discusse considerando anche i risultati di un’analisi di sensitività svolta per identificare i parametri del modello che maggiormente ne influenzano i risultati. Infine, l'attenzione è stata posta ai carici di inquinanti sversati dagli sfioratori di pioggia presenti lungo la rete fognaria. In occasione di eventi di pioggia di particolare entità i residui farmaceutici, presenti nelle acque reflue, possono non raggiungere il trattamento e possono essere scaricati direttamente nel corpo acqua attraverso gli sfioratori. Lo studio ha permesso di quantificare il carico di batteri indicatori di inquinamento fecale (E.Coli) e di tre FCs selezionati scaricato dagli sfioratori nella zona di Comacchio, Italia. Questo lavoro dà indicazioni circa la gestione e il trattamento dell’acqua scaricata dagli sfioratori. Questa tesi ha considerato 250 farmaci appartenenti a 28 classi terapeutiche indicate nelle righe seguenti insieme al numero di composti scelti indicato tra parentesi. Analgesici / Anti-infiammatori (27); Anestetici (6); Antiangina (1); Antiaritmici (1); Antibiotici (59); Anticoagulanti (1); Antidiabetici (3); Anti diarrea (1); Antiemetici (1); Antifungini (7); Antiipertensivi (13); Antineoplastici (5); Anti-parkinson (2); Antipiastrinici (3); Antiprotozoici (1); Anti spasmodici (1); Antivirali (4); beta-agonisti (4); Barbiturici (2); beta-bloccanti (13); mezzi di contrasto (8); Ormoni (7); regolatori del metabolismo lipidico (10); psicofarmaci (54); antagonisti del recettore (1); Stimolanti (3); Vaso dilatori (1); Prodotti per uso topico (1). Inoltre, 36 PCPs appartenenti a 11 classi sono indagati. Particolare attenzione è stata posta a due classi di tensioattivi (anionici e non ionici).
It was found that the global consumption of human Pharmaceuticals and Personal Care Products (PPCPs) is growing for the aging of the population and for the improvement of living conditions. Once administered, pharmaceuticals (PhCs) are metabolized and their residues are excreted through urine and feaces into the sewer. Also personal care products (PCPs), used for bathing and cleaning, are discharged in wastewater after being used. Once reached the wastewater treatment plant (WWTP), these compounds can undergo modification due to biological, chemical and physical processes. They may be completely or partially removed from wastewater. Although many investigations have pointed out the occurrence of PCPs in aquatic environments is mainly due to wastewater treatment plant (WWTP) discharges (Daughton and Ruhoy, 2009), up to now, legal limits regarding PCPs have not far been set, and no technical guidelines or suggestions indicating the most suitable treatments for reducing their concentrations in final effluent are yet available (Verlicchi et al., 2012d). Moreover, recent studies evidenced that hospital effluents can be considered hot-spot sources and the search for their appropriate management and treatment is an extremely pressing issue. As PPCPs may show toxic effects in the environment, it is very important to investigate the presence of these compounds in urban and hospital wastewater (WW) and to analyze different strategies in order to reduce their discharge into surface water. This work has precisely this purpose. First of all, an overview of the PhC concentrations in WWTP influent and effluent has been carried out collecting data referred to 244 conventional activated sludge. Moreover, PhC removal efficiencies obtained by this treatment system were investigated in relation with their chemical and physical properties, namely solubility, volatility, adsorbability, absorbability, biodegradability, polarity that vary greatly, with obvious repercussions on their behavior during the treatments. Among the many factors governing the complex interactions in treatment systems, lipophilicity was found to influence the sorption of pollutants onto sludge. An in-depth analysis of the occurrence of PCPs in untreated and treated sewage sludge was carried out collecting data from 59 international papers. Sludge originates during biological processes in WWTPs contains a wide spectrum of PCPs which are separated from the liquid phase during treatments. Land disposal of sewage sludge is regulated at EU level and in each EU country national regulations have also been set in accordance with European Directives. Generally, they set the maximum allowable concentrations of potentially toxic elements in soil after the application of sewage sludge, but they do not set concentration limits for PCPs. There is an ongoing debate within the scientific community in order to evaluate potential (environmental) risks in this kind of practice, due to the occurrence of toxic and persistent substances in sludge. In this work an assessment of the occurrence in different kind of sludge and of environmental risk has been performed in order to identify the compounds that pose the highest risk. Not only conventional treatments but also natural ones are investigated in the thesis. Constructed wetlands (CWs) are systems where different micro-environments may coexist and contribute to the removal of PPCPs. The occurrence of these compounds in influent and effluent of different kinds of CWs, as well as the corresponding removal efficiency, were investigated collecting data from 47 and 36 literature works, referring to PhCs and PCPs respectively. The main factors (design parameters and operational conditions) that affect the removal was discussed. After the analysis of literature data, in order to evaluate the removal efficiency achieved by a conventional activate sludge system followed by a CW and their respective contribution, an experimental campaign was performed at a large municipal WWTP in the Po Valley, northern Italy, where a pilot CW station, directly fed by the WWTP secondary effluent, has been in operation for 10 years. The PhC mass load in the raw WWTP influent and secondary effluent, as well as in the polished effluent, was then analysed and the mass loads discharged in the presence and absence of this polishing treatment were compared. Moving the attention to hospital effluent, literature data were collected in order to review and discuss lessons learned from previous investigations and studies carried out on dedicated treatment of hospital wastewater in different countries worldwide. It offers a critical analysis of data collected from lab, pilot and full scale treatment plants acting as primary, secondary and tertiary steps. Attention is paid to the removal efficiencies observed for contaminants, including conventional parameters but in particular emerging ones: mainly PhCs, detergents and disinfectants. As knowing hospital effluent concentrations could be difficult due to not only to high analysis costs of the investigations, but also by the difficulties in organizing water sampling campaigns inside health facilities, a model for predicting concentration based on PhCs consumption was evaluated. Predicted and measured concentrations in the effluent of a hospital located in North Italy were compared. The differences between the two models were discussed considering also the results of a sensitivity analysis performed in order to identify the parameter of the model that most influence the results. Finally, the attention was posed to combined sewage overflows (CSOs) present along the sewage network. In fact, PhCs cannot get treatment and may be discharged directly into the water body through CSOs during rainfall events of particular entities. The study quantify the contribution of the load of faecal indicator bacteria (FIB) and of three selected PhCs discharged by CSOs in the area of Comacchio, Italy. This work give indications about the management and treatment of the water flow discharged by CSOs. This thesis considered 250 pharmaceuticals belonging to 28 therapeutic classes listed in the following lines together with the number of selected compounds. Analgesics/Anti-inflammatories (27); Anesthetics (6); Antianginal (1); Antiarrhythmics (1); Antibiotics (59); Anticoagulant (1); Antidiabetics (3); Anti diarrhea (1); Antiemetic (1); Antifungals (7); Antihypertensives (13); Antineoplastic (5); Anti-parkinson (2); Antiplatelets (3); Antiprotozoal (1); Anti spasmodic (1); Antiviral (4); Beta-agonists (4); Barbiturates (2); Beta-blokers (13); Contrast media (8); Hormones (7); Lipid regulators (10); Psychiatric drugs (54); Receptor antagonists (1); Stimulants (3); Vasodilator (1); Topical Products (1). Moreover, 36 PCPs belonging to 11 classes are investigated. Particular attention was posed to two classes of surfactants (anionic and non ionic).

Municipal Solid Waste Management and Health Risks: is it time for a Solid Waste Safety Plan? Analysis of case studies from Serbia and Ghana
Municipal Solid Waste Management and Health Risks: is it time for a Solid Waste Safety Plan? Analysis of case studies from Serbia and Ghana

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
O tema dos resÃduos sÃlidos recebeu uma maior atenÃÃo depois de promulgada a PolÃtica Nacional de ResÃduos SÃlidos, sob a Lei Federal 12.305 de 2010 e pelo Decreto 7404 /2010, a qual transitou no Congresso Nacional durante 19 anos, conseguindo mexer nas antigas estruturas e rever os antigos moldes com os quais o poder pÃblico tratava a questÃo. Antes, as polÃticas tinham carÃter remediativo, com baixa qualidade tÃcnica, altos gastos pÃblicos e de pouco alcance social, dando Ãs cidades brasileiras um modelo de gestÃo ineficiente, com repercussÃo negativa na saÃde pÃblica, no crescente nÃmero de pessoas que vivem informalmente e que tiram sua sobrevivÃncia dos lixos brasileiros como à o caso dos catadores de material reciclÃveis em um mercado informal e ainda pouco lucrativo de materiais reciclÃveis.O presente trabalho tem como objetivo principal avaliar a atual gestÃo, com base em um conjunto de indicadores de sustentabilidade e criar um modelo de aÃÃes voltadas para os gestores municipais, a fim de ser utilizada por estes como ferramenta para a elaboraÃÃo de um plano maior de gestÃo municipal dentro dos novos moldes da LegislaÃÃo brasileira. Os resultados obtidos mostraram que o MunicÃpio de Caucaia possui um bom gerenciamento, tendo a coleta de cerca de 100% de seu territÃrio urbano. No entanto, à sendo tambÃm um grande gerador de resÃduos orgÃnicos, cerca de 57% das amostras extraÃdas na anÃlise gravimÃtrica pelo mÃtodo do quarteamento, nÃo recebem, portanto um tratamento final adequado para esse tipo de resÃduo e com uma anÃlise dos indicadores de sustentabilidade tendendo a ser desfavorÃvel pela ausÃncia de polÃticas sociais que englobam os atores sociais envolvidos na cadeia dos resÃduos, devendo o MunicÃpio refazer suas leis e adotar o uso de outras tecnologias a fim de se adequar Ãs novas exigÃncias da Lei.
The issue of solid waste received greater attention after the enactment of the National Solid Waste under Federal Law 12,305 of 2010 and Decree 7404/2010, which moved in Congress for 19 years, getting messing with old structures and review the old molds with which the government was the question. Earlier policies had remedial character, with low technical quality, high public spending and some social reach, giving Brazilian cities a model of inefficient management, with negative repercussions on public health, the growing number of people living informally and take survival of Brazilian waste such as waste pickers of recyclable materials in an informal market and little lucrative recyclables.The present study aims at evaluating the current management, based on a set of sustainability indicators and create a model of actions for municipal managers in order to be used by them as a tool for the development of a larger plan municipal management within the new mold of Brazilian law.The results showed that the City of Caucaia has good management, and the collection of about 100% of its urban territory. However, it is also a major generator of organic waste, about 57% of the samples in the gravimetric analysis by the method of quartering, not given, so a final treatment suitable for this type of waste and an analysis of sustainability indicators trending to be unfavorable for the absence of social policies that encompass the social actors involved in the chain of waste, the municipality must redo their laws and adopt the use of other technologies in order to adapt to the new demands of the Law.

2013 - 2014
The research project explores the theme of management education in healthcare in the regional context Campano referring to its strategic role in a perspective of change and management innovation to ensure performance improvement in health care. In the Campania Region, the PRS track the educational goals of the health system and defines the extremely important management training to achieve the desired organizational change... [edited by author]
XIII n.s.

The problem of food waste management is currently on an increase, regarding all steps from collection to disposal. Discharge of food materials occurs along the entire Food Supply Chain and it produces an impact at an environmental, social, and economical level. The interconnection of biotechnological processes in the co-production of bio-fuels and bio-products represents a key strategy aimed at maximising the utilisation of food waste and raising the potential income of the entire bioprocess chain. Therefore, when considering properly segregated food waste streams, both from decentralized and not-decentralized realities, these become sustainable non-virgin feedstock.
Il problema relativo alla gestione degli scarti alimentari è in costante aumento. Lo spreco alimentari avviene lungo l'intera catena di approvvigionamento e produce effetti negativi a livello ambientale, sociale ed economico. L'interconnessione dei processi biotecnologici nella co-produzione di bio-carburanti e bio-prodotti rappresenta una strategia chiave volta a massimizzare l'utilizzo degli scarti alimentari e ad aumentare il reddito potenziale dell'intera filiera. Pertanto, quando si considerano flussi di rifiuti organici adeguatamente segregati, sia in realtà decentralizzate che non, questi diventano feedstock (non vergini) sostenibili.

La presente tesi di dottorato è stata focalizzata sulla gestione ottimizzata delle vecchie discariche per rifiuti solidi urbani (RSU). In particolare, si è ipotizzato di applicare la tecnica dell’aerazione in-situ all’interno di una vecchia discarica al fine di ridurre il potenziale impatto a lungo termine e massimizzare la rimozione dei composti del carbonio e dell’azoto. Precedenti studi hanno dimostrato l’efficacia dell’aerazione in-situ intermittente per il miglioramento della stabilità biologica di una discarica di rifiuti solidi urbani. Considerandone dunque anche i vantaggi economici, l'aerazione in-situ è stata applicata in modalità intermittente e sono stati così valutati due principali aspetti: 1. La fattibilità del processo di denitrificazione in una vecchia discarica RSU caratterizzata da contenuto molto basso di carbonio organico biodegradabile, sfruttando le condizioni anossiche generate dall'aerazione intermittente. In particolare, è stata analizzata la capacità di un vecchio sistema discarica di ricorrere sia alla via eterotrofa che a quella autotrofa per la rimozione dei nitrati, a seconda del substrato disponibile; 2. I possibili effetti dell’aerazione intermittente sul potenziale rilascio dei metalli pesanti in fase liquida ed il loro comportamento nel percolato e nel rifiuto solido, considerando la possibile influenza della tecnica dell’aerazione in-situ sulle condizioni interne del sistema discarica. Un ulteriore esperimento è stato condotto per valutare un aumento della rimozione della sostanza organica residua in una vecchia discarica RSU, accoppiando l’aerazione in-situ alla tecnologia a celle combustibili microbiche (MFC) al fine di sfruttare i vantaggi di entrambi. Tutti gli aspetti sono stati analizzati durante numerosi test in scala di laboratorio mediante l’impiego di reattori di simulazione di discarica. I risultati dell’attività di ricerca possono essere riassunti come segue: Il processo di denitrificazione non sembra essere inibito all’interno di una vecchia discarica per RSU, in quanto i nitrati possono essere rimossi per via eterotrofa e/o autotrofa a seconda della tipologia di substrato disponibile nel sistema. Sebbene la via eterotrofa possa essere considerata preferenziale, quando la sostanza organica biodegradabile non risulta disponibile o è prossima allo zero, la rimozione dei nitrati può avvenire in modo autotrofo, anche se più lentamente. I risultati relativi ai test effettuati sui metalli pesanti nel percolato e nel rifiuto solido sembrano confermare il ruolo dominante del meccanismo di adsorbimento all’interno del sistema discarica, che ha ridotto il rilascio di metalli pesanti nel percolato dopo l'aerazione e ha mantenuto piuttosto costante il contenuto di metalli nel rifiuto solido. Conseguentemente, i metalli pesanti non sembrano costituire un fattore di rischio a seguito dell’aerazione in-situ in discarica. I risultati preliminari relativi l’integrazione della tecnologia MFC con i reattori di simulazione di discarica hanno evidenziato alcuni aspetti critici del sistema, quali la debolezza del materiale catodico, la grande influenza della modalità di ricircolo del percolato sulle prestazioni dell'intero sistema e la scelta ottimale del flusso di aerazione necessario per mantenere aerato il compartimento catodico. Queste considerazioni evidenziano la necessità di modificare la configurazione MFC all'interno dei reattori di simulazione di discarica. La presente tesi di dottorato è divisa in due parti principali. Nella prima parte sono sintetizzati l’attività di ricerca svolta ed i principali risultati. La seconda parte descrive in dettaglio tutti gli esperimenti e i relativi risultati, riportando gli articoli scritti durante il corso di dottorato.
The Ph.D. research project was focused on the optimized management of old municipal solid waste (MSW) landfills. In particular, it was supposed to apply the in-situ aeration technique within an old landfill in order to reduce the long-term pollution potential and to maximize the removal of nitrogen and carbon compounds. Previous studies proved that intermittent in-situ aeration is an effective tool to improve the biological stability of a MSW landfill. Considering the economic advantages, the in-situ aeration technique was applied in an intermittent way; two main aspects, not still well understood were considered: 1. the occurrence of denitrification process in old MSW landfills characterized by very low biodegradable organic carbon content, taking advantage of the anoxic conditions of the intermittent aeration. In particular, it was analysed the capacity of an old landfill system to exploit both the heterotrophic and autotrophic pathway for nitrogen removal, according to the available substrate; 2. the possible effects of the intermittent aeration on the potential release of heavy metals into the liquid phase and their behaviour both in the leachate and in the solid waste material, considering that the application of in-situ aeration technique may affect the internal conditions of the landfill system. A further lab-scale experiment was carried out to evaluate the increase of the in-situ aeration efficiency to remove the residual organic carbon within an old landfill. The in-situ aeration was coupled with the microbial fuel cells (MFCs) technology in order to exploit the advantages of both of them. All aspects have been evaluated during several lab-scale tests by means of landfill simulating bioreactors. Results of all experiments carried out during the Ph.D. Course can be summarized as follows. Denitrification process does not seem to be limited in a very old MSW landfill as it can occur in a heterotrophic and/or autotrophic way according to the kind of available substrate. Although the heterotrophic pathway can be considered the preferred one, when the biodegradable organic matter is not available or it is close to zero, nitrate can be removed in a autotrophic way, even if more slowly. The results of the experiments on the behaviour of heavy metals in the leachate and in the solid waste matrix seem to confirm the dominant role of adsorption mechanism within the landfill system that reduces the release of heavy metals in the leachate after aeration and keeps quite constant the metals content in the solid waste material. Therefore, heavy metals in landfill leachate do not seem a major concern in case of in-situ aeration. The preliminary results of the integration of MFCs with landfill bioreactors pointed out some critical aspects of the system, such as the weakness of the cathode material, the great influence of the leachate recirculation mode on the performance of the whole system and the optimal choice of the aeration flux required to keep the cathodic compartment aerated. These considerations highlight the need of slightly modify the configuration of the MFC system within the landfill simulation reactors. The present Ph.D. thesis includes the description of the research activities with the related results and it is divided in two main parts. In the first part, named “Thesis development” the Ph.D. research activity and the main results are briefly summarized. The second part, named “List of Papers” describes in details all the experiments and the related results, listing all the papers written during the Ph.D. course.

AbstractMenstruation hygiene management (MHM) is an important factor in gender-sensitive sanitation promotion. MHM is a concept and an approach in international development that gained greater attention in the last decade. This chapter first reviews the development of MHM (also recently referred to as menstrual health and hygiene: MHH) as an international agenda. The second part focuses on the cultural aspects of menstruation. To illuminate the local reality and cultural context of female students in a secondary school, a case study from the Manafwa district in Uganda will be described. The research results show that seemingly simple behaviors associated with menstrual management pass through the filter of cultural norms and girls’ perceptions. Those behaviors include (1) changing menstrual absorbents, (2) using a latrine, (3) discarding used sanitary pads or other sanitary items, (4) washing menstrual items or underwear, and (5) drying them. The chapter will provide some recommendations for MHM interventions.

Con la irrupción de la pandemia, las restricciones de movilidad y los cambios sociales vinculados, muchos museos han optado por redirigir su estrategia, con el objetivo de retener y cautivar audiencias, hacia la oportunidad de consumo que representa el ámbito online. La implementación de contenidos accesibles a través del escaparate de la red y el desarrollo de actividades digitales permite generar difusión, publicidad e, incluso, conciencia de marca a un coste muy contenido, evitando así que la organización caiga, en cierto modo, en el olvido. Pero, si rascamos un poco en la superficie, podemos observar como parte de las tácticas parapetadas en la planificación estratégica digital ignoran las carencias o necesidades reales de los consumidores, transformando el medio en un fin que apenas genera atracción, fideliza con dificultad y pone en fuga a las audiencias bien definidas. Así, la planificación errónea puede transfigurar la oferta en mero entretenimiento de consumo rápido y banalizar a la organización. Dicha depreciación transforma el museo en una especia de take away de saldo cultural, donde la comunicación palidece a favor de una difusión aleatoria, propia de modas efímeras y totalmente ajena al receptor. Esta tendencia, un tanto apocalíptica, es propia de aquellos museos empeñados en evitar las necesidades reales de sus públicos, haciendo oídos sordos ante la opinión de las audiencias. Dichos espacios se dejan cautivar por el gratificante y efímero espejismo de los likes y el número de ciberseguidores, obviando adaptar la oferta a la demanda real de los segmentos del mercado. La respuesta a esta contingencia puede hallarse en la puesta en marcha de los procesos del marketing, tanto en su faceta estratégica como operativa, ampliamente ignorados en el desarrollo global de la estrategia digital de los museos. Esto implica, entre otras muchas cuestiones, atender a las necesidades reales de las audiencias, para más tarde seducirlas y fidelizarlas con corrección. En conclusión, la presente propuesta pretende elevar una crítica hacia el modelo gestión de la estrategia digital seguido desde hace tiempo por infinidad de museos, implementado exponencialmente en la actualidad como solución de emergencia ante la crisis sanitaria sobrevenida. Tanto para llevar a buen puerto la nave del museo como para alcanzar eficazmente a las audiencias en remoto se precisa, sin duda, de estrategia, creatividad y resiliencia, pero no debemos obviar a los procesos del marketing, garantes de capacidad para encauzar a estas instituciones hacia su razón de ser y misión social.

Waste management in the United States presently has the following major three dimensions: Sanitary landfills, recycling, waste to energy predominantly based on the technologies of mass bum technology or refuse derived fuel. These three dimensions have undergone significant evolution during the past three decades. The design of sanitary landfills has evolved to include environmental protection features such as bottom liners, leachate collection systems and landfill gas management systems. Material recycling programs, many based on materials recycling facilities, have become more prevalent. Approximately 100 operating waste to energy facilities (“Facilities”) now exist in the United States. Improvements in the air pollution control systems incorporated in the Facilities have significantly lowered their air emissions. A fourth dimension, waste gasification technology, is evolving as a viable component of a waste management system and the hydrogen energy economy.

Durante la pandemia por COVID-19, gran número de organizaciones dedicadas a la industria cultural emprendieron esfuerzos para conocer que ocurría con sus públicos una vez que esta emergencia sanitaria obligó a cerrar las puertas de prácticamente todos los recintos culturales del mundo. A dos años de aquel momento, puede afirmarse que la pandemia cerró puertas físicas pero abrió ventanas digitales hasta entonces poco exploradas. A través de estas ventanas digitales, museos de todo el mundo se aventuraron a preguntar a sus públicos sobre sus experiencias en este contexto, utilizando herramientas en línea para elaborar encuestas, distribuirlas, analizar los datos y presentar sus resultados. En aquel momento, en el grupo de trabajo Foro de Estudios de Públicos en el cual participamos, nos propusimos recopilar y analizar más de una veintena de estudios sobre públicos con igual diversidad de estrategias de investigación y con hallazgos interesantes, pero con deficiencias más o menos graves en aspectos metodológicos fundamentales como la elaboración del instrumento para recopilar datos. Y es que se tiene la creencia de que las encuestas en línea obedecen a las mismas reglas que aquellas destinadas a la presencialidad, error equiparable a pensar que una sala virtual del museo ha de tener las mismas características que una física. Si bien ambos tipos de encuestas son similares en lo general, el medio digital tiene rasgos específicos que exige saberes de distintos campos, como diseño gráfico y diseño web (diseño de la interfaz persona-mundo digital), gestión de redes sociales (community management), comunicación en entornos digitales, investigación en línea (e-research), además de conocer y manejar herramientas digitales en constante actualización. El presente trabajo reúne saberes clave para emplear encuestas en línea como parte de la metodología de estudios sobre públicos de museos, procedentes de artículos publicados entre 2000 y 2021, además de conocimientos derivados de nuestra propia experiencia en el campo. Pretende ser un metaanálisis en forma de guía práctica para acompañar a quienes se embarquen en esta tarea durante sus diferentes etapas: planeación (canales de distribución según público objetivo), elaboración (formatos de ítems, uso de plataformas para crear encuestas, diseño gráfico adecuado), levantamiento de información (muestreo, canales digitales de distribución), y procesamiento de información (confidencialidad, resultados automáticos). El fin último es obtener información fidedigna sobre los públicos que anhelan visitar los museos en forma física o virtual, a partir de estrategias fundamentadas para aprovechar al máximo las múltiples ventajas del internet.

This paper presents the connection between the main schools of economic thoughts, which explain the role of governmental intervention in the economy and the importance of wages, as countercyclical stabilizers in an economic system. This work aims to look into the economic European situation during the period which precedes the beginning of the current sanitary crisis, in light of empirical analysis. This analysis uses the corresponding data for two years, 2018 and 2019 and includes a series of activity business sectors considered to be relevant (for instance public administration and HoReCa/hospitality, in the light of the impact the sanitary crisis had upon them). The results of this sectoral analysis have as scientific objective the study of the relationship between the evolution of the staff expenditures in the public administration and the evolution of the Gross Domestic Product, emphasizing the level of correlation between these two. Into the assessed context, the research question remains open: if - in the event of a certain reduction of the staff expenditures from the state budget, in order to reach a balanced budget - this could be a real solution (even if only an emergency solution) since there is a high risk of recession; or even more – could be the trigger factor in driving the Romanian economy to a vicious cycle of austerity.

Abstract According to the TrataBrasil Institute (2015), basic sanitation is understood as a set of actions aimed at preserving the environment to prevent diseases and promote health, improving the quality of life of the population. In Brazil, it is a constitutional, composed of public services, infrastructure, and operational facilities of water supply, sanitary sewage, urban cleaning and management of solid waste, drainage, and management of urban rainwater (Brasil, 2020).

The Manhattan Engineer District previously used the 191-acre Niagara Falls Storage Site (NFSS) in Niagara County, New York, to store radioactive residues and wastes from uranium (U) ore processing. At present, management practices will determine whether enhanced evapotranspiration rates produced by hybridized shrub willow cuttings planted in 2016 will affect groundwater hydrology. Two shrub willow varieties were planted in an approximately one-half acre area to examine growth performance along a U impacted sanitary sewer line. Additionally, control plots will compare the effectiveness of shrub willows to unplanted areas. Observations of the planted area after 18 months showed success of shrub willow growth with increasing biomass. Chemical analysis from tree tissue samples of the field study showed no significant uptake of U or thorium (Th) to date. A greenhouse study conducted in parallel to the field study tested the willows under controlled greenhouse conditions and evaluated their ability to grow and accumulate contaminants under controlled conditions. Results from the greenhouse study demonstrated that U accumulation was minimal. Thus, this study demonstrates that the shrub willows are not accumulators of U or Th, an advantageous characteristic that implies stabilized contaminants in the soil and no translocation of U into the aboveground biomass.