BACKGROUND: Delays in surgery start times can lead to poor patient outcomes and considerable increases in healthcare expenditures. This is especially true in developing countries that often face systemic inefficiencies, such as a shortage of operating rooms and trained surgical personnel. With substantial effects on patient outcomes, healthcare efficiency, and resource allocation, identifying delays in first-case elective surgery is a crucial area of research.
METHODS: A multicenter observational study was conducted at three comprehensive and specialized hospitals in the Amhara region of Ethiopia from May 1 to October 30, 2023. The primary aim of the study was to determine the occurrence of late first-case start times, defined as a patient being in the operating room at or after the hospital\'s incision time of 2:30 a.m. The secondary aim was to discover potential root causes of delayed first-case start times. All patients scheduled for elective surgery as the first case on the operating list throughout the study period were included in the study. Every emergency, day case, after-hours case, and canceled case was excluded.
RESULTS: A total of 530 surgical patients were included during the study window from May 1 to October 1, 2023. Of these, 41.5% were general surgeries, 20.4% were gynecology and obstetrics surgeries, and 13.2% were orthopedic surgery procedures. Before the procedure started, nine (1.7%) of the participants had prolonged discussion with a member of the surgical team. Patients who arrived in the operating room waiting area at or after 2:30 a.m. were 2.5 times more likely to experience a first-case start time delay than those who arrived before or at 2:00 a.m. (AOR = 2.50; 95% CI: 1.13-5.14). Furthermore, participants with abnormal investigation results were 2.4 times more likely to have a late first-case start time (AOR = 2.41; 95% CI: 1.06, 5.50). Moreover, the odds of a late first-case start time were increased by 10.53 times with the surgeon being in the operating room at or after 2:30 a.m. (AOR = 10.53; 95% CI: 5.51, 20.11).
CONCLUSIONS: The research highlights a significant occurrence of delayed start times for the first elective surgical procedures. Therefore, directing attention to aspects such as ensuring patients and surgical teams arrive promptly (by or before 2:00 a.m.) and timely evaluation and communication of investigative findings before the scheduled surgery day could facilitate efforts to maximize operating room efficiency and enhance patient health outcomes.

Landfill site selection is an essential aspect of sustainable solid waste management as it ensures that the waste generated by a community or region is disposed of in an environmentally friendly and safe manner. The approach for selecting landfill sites seeks to choose locations that provide the least risk to the environment and public health while still satisfying the demands of the local community. This research aims to use a multi-criteria assessment to determine a landfill location in Al-Balqa Governorate in Jordan to ensure that the chosen site meets the needs of all stakeholders while minimizing the negative impact on the environment and the community. This research developed a hierarchy structure to make landfill site selection decisions, which involves identifying parameters such as distance to surface water, land cover, distance from urban and rural areas, distance to roads, slope, and soil permeability. A rating system was used to evaluate each criterion, and weights were assigned to reflect their relative importance. An overlay weighting technique was then used to assess site suitability based on expert opinions from related fields. In this studied area, about 204,283 m2 is required to address 25 years of municipal solid waste volume, whereas this technique identified around 79,210,000 m2 of potential landfill sites. Overall, the research highlights the importance of using a multi-criteria assessment approach for landfill site selection to ensure that the chosen site meets the needs of all stakeholders while minimizing negative impacts on the environment and public health. The study provides insights that can be useful for decision-makers involved in sustainable solid waste management in Jordan and other similar regions. -How to Find the suitable landfills to achieve sustainable development.-What aspects and criteria were comsidered in choosing the landfill site.

Today, Ukraine is far from European standards, and the country\'s waste management system remains confronted with environmental and technogenic problems, with 7 % of the territory occupied by landfills. Most settlements in Ukraine do not have solid waste management programs or sanitation schemes. Landfills, and especially municipal solid waste dumps, are significant contributors to air, water, and soil pollution. The objective of this research is to develop a comprehensive understanding of the environmental impact of landfills, to translate them from a descriptive and abstract plane to a mathematical plane, and to identify the sanitary protection zones currently utilized for landfills. The subject of this study is the municipal waste landfill of the Zhytomyr territorial community (Ukraine), a typical Ukrainian landfill operated with minimal environmental protection measures. The authors used an original approach to assess the environmental hazard of a municipal waste landfill, taking into consideration the values of absolute indicators of water pollution for specific physicochemical characteristics; maximum permissible concentrations of the studied indicators; distance from the landfill boundary; the amount of excess of the absolute indicator of pollution compared to the MPC; and the intensity of odor in the landfill. The calculated pollution indicators served as the basis for an integrated assessment of the environmental hazards posed by the municipal waste landfill. The study revealed that the Ot indicator (evaluation of the environmental hazards of municipal waste landfills) depends exponentially on the landfill boundary. Based on the value of Ot, environmental zoning was carried out: according to the calculations and taking into account the monitoring of the environmental condition in the landfill\'s impact zone, the authors recommended the parameters of environmental zoning on the basis of the Ot value. The purpose of this study is to clarify the sanitary protection zones that are currently used for landfills and solid household waste disposals. The research materials can also be used to create databases on landfills, enabling the development of a plan to manage them as sources of heightened environmental risk.

OBJECTIVE: the objective of the study is to assess the effect of the delivery channel on adherence, persistence and potential wastage of new antidiabetic drugs.
METHODS: longitudinal descriptive observational study. New users were defined as subjects who received a first prescription of drugs belonging to the antidiabetic category in the period between 01.01.2021 and 31.03.2021 (index date) and who did not receive prescriptions for drugs belonging to the same category in the previous 6 months, as of 01.07.2020. Each subject was followed for a follow-up period of 9 months.
METHODS: the study examined adherence and persistence to treatment with antidiabetic drugs in Italy for patients aged>=45 years (information flow of pharmaceutical services performed in direct distribution and on behalf established by Ministerial Decree Health 31 July, 2007).
METHODS: adherence to treatment measured by the Medication Possession Rate (MPR) indicator, defined as the ratio of the number of days of therapy dispensed (calculated from DDDs) to the number of days covered by drug therapy; persistence to treatment defined as \"time elapsed between the initiation and discontinuation of a prescribed drug therapy\" estimated by as \"time elapsed between the initiation and discontinuation of a drug therapy\" estimated by Cox semi-parametric model; difference in terms of waste understood as the number of packs not fully used by non-persistent subjects.
RESULTS: the analysis showed that there were no significant differences between the dispensing channels in adherence, persistence, and medication wastage (defined as the distribution of packages to non-persistent patients). Specifically, it turns out that the percentage of highly adherent subjects at 9 months is 62.2 for those on treatment in the direct distribution channel and 64.6 for those on treatment with account distribution; with regard to persistence at 9 months, however, a difference of less than one percentage point was observed between the two channels. Although this study focused on a specific therapeutic class, the results can be generalised to other high-prevalence chronic diseases. However, some limitations of the study were pointed out, such as the difficulty of replicating the results due to the variability of data depending on the drug category and the time period considered.
CONCLUSIONS: the choice of distribution channel for antidiabetic drugs should not be based on adherence or persistence to treatment, but on other determinants such as cost of service and logistical complications.

Productivity improvement is a significant issue for the textile and garment industry to survive global competition. Therefore, the nation\'s efforts towards this improvement are one of the key weapons to attain cost, time, and quality advantages for rivalry. Ethiopian garment industries are not competitive due to low productivity, which is caused by multidimensional productivity factors related to humans, methods, control, processes, and products. Hence, a single tool or simple model cannot boost significant change for productivity improvement and cannot solve both internal and external productivity factors of the garment industry at this time. However, combined techniques or tools of lean and work-study are preferable. Lean manufacturing is a procedure to identify and eliminate non-value-adding activities in a consistent, continuous improvement. Lean techniques provide a good overview of the processes, whereas work-study methods focus on the critical areas of the operation. This research deals with productivity improvement in the assembly operation of the garment industry with a case study using integrated techniques and tools, such as line balancing, work standardization, time and method study, total working method, and process improvement related to kaizen and 5S. These tools help to eliminate non-value-adding activities were reduce lead time, and defects. The study illustrates, using a case study, the most critical factors that hinder the productivity of Ethiopian garment industries and how to solve these factors through integrated techniques or tools. The research is practical and realistic, and the necessary data was collected using primary and secondary data from the Minister of the Ethiopian garment industry and the case garment. The observed results indicated that non-value-adding activities were minimized from 43% to 5%, bottlenecks from 3 to 0, and the transportation distance of the workers was reduced by 650 m per shift. The daily production output of the case garment and main exports of Flat sheet and Quilt cover products increased from 43.3% to 57.7%-75.8% and 100% pcs per shift, respectively. The standard time for each operator can be set using time study, which can save 315 min for the case garment operation, achieving its production targets of 800 pcs per shift. Therefore, using a single tool or model has not significantly improved this garment industry, but it should be used as a combined tool of lean and work-study for attractive productivity improvement.

Landfills are commonly seen as the most cost-efficient and practical approach to waste management in various regions around the world. Nonetheless, the infiltration of hazardous materials from poorly managed dumping sites remains a significant environmental issue in most developing countries such as India. Leachate serves as a prominent point source of contamination in many environmental media like soil, groundwater, and surface water around the world. So the prime issues humans are experiencing are associated with water quality. Thus, the investigation was undertaken to assess the impact of leachate from the Achan landfill on surface water quality in the Temperate Himalayas. Monitoring was done during in all four seasons, viz., spring, summer, autumn, and winter. Among the sites, the leachate outflow site was found to have the highest mean value of pH (7.95), EC (2.16 dS/m), total nitrogen (2.64 mg/l), P (4.75 mg/l), K (1.41 mg/l), Ca (107.45 mg/l), Mg (54.93 mg/l), Zn (0.8 mg/l), Fe (1.78 mg/l), Cu (0.66 mg/l), Mn (0.81 mg/l), BOD (21.47 mg/l), COD (66.24 mg/l), temperature (14.22 °C), turbidity (14.29 NTU), while lowest mean values of all parameters were recorded at control site. Among the seasons, summer season was found to have maximum value of pH (7.9), EC (2.36 dS/m), total nitrogen (2.54 mg/l), P (4.0 mg/l), K (0.89 mg/l), Ca (85.94 mg/l), Mg (43.91 mg/l), Fe (1.4 mg/l), Cu (0.52 mg/l), Mn (0.64 mg/l), BOD (22.82 mg/l), COD (65.87 mg/l), temperature (18.99 °C), and turbidity (8.49 NTU). The maximum mean value of Zn (0.66 mg/l) was recorded during winter season, while other parameters were found to be minimum during winter season. From this study, we concluded that a decreasing trend was observed during all the seasons in the concentration of all physico-chemical parameters with an increase in distance from the landfill. So it is recommended that the leachate should be treated at the source before disposing into the water body and the landfill should be lined properly to prevent the entry of leachate into water sources.

Developing strategies to control environmental challenges and various aspects of health consequences of waste management is one of the major programs in metropolitan management. The main purpose of this study is to examine the level of preparedness, having a contingency plan and the emergency response ability to waste management in disaster situations. A descriptive study was designed in two phases: in the first phase of the study, composition, quantity and characteristics of municipal solid waste in the disaster were estimated, and by using DotMapper software, temporary waste sites for disaster situations (map waste) were determined. In the second phase of the study, the preliminary hazard analysis (PHA) to identify the initial events and risk analysis in the municipal waste management system was considered. Results show that more than 50% of the generated waste in the disaster is allocated to construction waste resulting from the destruction and more than 30% to recyclable items (metals, glass, plastic), and a very small part of about 1% of biodegradable waste was determined. Twenty points were designated as temporary sites for municipal waste in a disaster situation. Results of risk analysis in the disaster were described that for three events containing lack of temporary waste storage sites, lack of identification and determination of hazardous waste production centres and lack of waste management training programme in emergency situations were in the red range. Developing the necessary strategies to control environmental challenges and various aspects of health outcomes in waste management is one of the basic programmes in metropolitan management.

The use of waste as an energy source in cement clinker production is a promising way to transition toward a circular economy and limit carbon dioxide (CO2) in the atmosphere. The cement industry is responsible for around 5% of global CO2 emissions. In this paper, the analysis of environmental and economic profits associated with the substitution of coal by two refuse-derived fuels (RDF) and sewage sludge (SS) in a cement kiln was presented. Differences in the fuel-related CO2 emissions were calculated for two-, three-, and four-component fuel blends based on the fuel consumption data, heating values, and the correspondent emission factors. The biogenic fraction content of 19% and 43% were measured in RDFs. The material balance of fuels with the assumed technological parameters of the cement clinker production installation (capacity of 6000 Mg per day and unit heat of 3.6 GJ) shows that the RDF heat substitution at the level of 90% allows for a saving of approximately 28.6 Mg per hour of coal, and to manage even approx. 40 Mg per hour of RDF. The increase in the share of SS in the total heat consumption to 6% contributed to reducing the actual emissions by 17 kg of CO2 per 1 Mg of clinker. Multilateral benefits due to the use of RDF in the cement plant were evident.

Excessive waste is continually accumulating owing to increased consumption, and an excellent example is the consumption of electrical and electronic equipment (EEE), which are eventually transformed into waste from electrical and electronic equipment (WEEE). WEEE is an interesting material stream because it includes various valuable materials that have great potential for recycling and reutilization. To maximize recycling and utilization potential, all fractions in WEEE must be reviewed from a sustainable perspective. Several WEEE contain plastic, which comprises approximately one-third of the total WEEE composition; thus, this plastic content is a good target for recycling purposes. However, the recycling of WEEE plastics might include some challenges, such as the treatment of harmful substances in the material, which can prevent effective and high-quality material recycling. This study investigates the polymer composition and critical elements of the material stream of WEEE polymer. These polymers were identified using portable near-infrared (NIR) spectroscopy and energy-dispersive X-ray spectroscopy (EDS) at an elemental level. The results showed that among various other polymers, acrylonitrile butadiene styrene (ABS) was the main polymer identified in WEEE. The proportion of unidentified polymers was alarmingly large; specifically, when the presence of bromine was positively correlated with the presence of an unidentified WEEE polymer. This study also corroborated that bromine is actually not present in bromine-free plastics, demonstrating that industrial classification works with WEEE polymers.

In Europe there are nearly 500 incinerators. There are over 2000 of them in the world. It is estimated that the combustion of 1 ton (Mg) of waste produces about 250-300 kg of slag. Due to the large amounts of this waste, the construction industry\'s demand for raw materials and the reduction of CO2 emissions, research was undertaken to use slags as a cement component. The problem was complex because slags generated in the thermal treatment of municipal waste have different chemical compositions and physical properties and contain variable amounts of impurities. The choice of chemical analyses of slag was dictated by the potential influence on the properties of cement mortars. The total moisture of raw slag (4-10%), the bulk density (600-1267 kg/m3) and the specific surface after grinding (over 3000 cm2/g) were determined. The pH (11.9) and the content of sulphates (3.5% by weight), chlorides (0.3% by weight) and selected heavy metals (Cd, Cu, Fe, Mn, Zn, Pb) were measured in the aqueous extract. The obtained results of the washing test were compared with the values resulting from the currently binding legal regulations. In the next step, cement mortars with 30% addition of tested slags were designed and made. The article presents the results of compressive strength tests, which were compared with the results of samples without the addition of slag. The addition of slag to the cement mortar decreased S_MSWI 1 by 64% and S_MSWI 2 by 31%. The high loss of strength and the swelling of the S_MSWI 1 test led to the activation of the NaOH slag. In the endurance test, an increase from 16 to 32 MPa was recorded. Preliminary studies show that the addition of slag in the cement mortar allows obtaining the strength at the level of 30-32 MPa.