Waste Management in Nepal: Characterization and Challenges to Promote a Circular Economy

open access articleIn Nepal, the informal sector is responsible for treating 15% of household waste. It is the only alternative to landfilling and open disposal; however, the current waste management system does not acknowledge informal recyclers aggravating various challenges and vulnerabilities that the sector already faces. This study identifies and validates for the first time the challenges of the informal waste sector while providing a granular understanding of the actors that shape waste management in the region. The study uses primary data collected over a period of 6 months in Kathmandu and Lalitpur, the first and third most populated areas in Nepal. The methods considered were semi-structured interviews, questionnaires, and a co-creation workshop with formal and informal actors. A novel characterization of waste management actors was conducted to identify two profiles namely cyclists and scavengers and question the formality of the collection centres. Findings suggest that the price volatility of recycled materials and the lack of treatment and absence of regulatory capacity are among the main challenges in promoting a circular economy from the informal sector. The recommendations to overcome these challenges are a series of policy reforms, such as an extended responsibility producer scheme and the review of the tax on recycled material transport. The main policy implication from the finding reveals that circular economy is already being promoted by the informal sector — a responsibility that should fall under the remit of the regional and national governments. The study concludes that integration is not only necessary to improve the conditions of informal workers but essential to developing a circular economy in Nepal

Antiplatelet therapy in patients undergoing oral surgery : a systematic review and meta-analysis

The number of patients under antiplatelet therapy (APT) continues to raise as current recommendations foster this practice. Although some recommendations to manage this treatment during oral surgery procedures exist, these have methodological shortcomings that preclude them from being conclusive. A systematic review and meta-analysis of the best current evidence was carried out; The Cochrane Library, EMBASE and MEDLINE databases were searched for Randomized Controlled Trials (RCT) concerning patients undergoing oral surgery with APT, other relevant sources were searched manually. 5 RCTs met the Inclusion criteria. No clear tendency was observed (RR= 0.97 CI 95%: 0,41?2,34; p=0,09; I2= 51%), moreover, they weren?t clinically significant. According to these findings and as bleeding is a manageable complication it seems unreasonable to undermine the APT, putting the patient in danger of a thrombotic event and its high inherent morbidity, which isn?t comparable in severity and manageability to the former.

Effect of antibiotic prophylaxis for preventing infectious complications following impacted mandibular third molar surgery. A randomized controlled trial

The objective of this study was to determine the effect of antibiotic prophylaxis in preventing postoperative infections after extraction of impacted mandibular third molars. A Parallel-group, randomized, blind, placebo-controlled trial was performed. 154 patients were randomly allocated to 2 groups; experimental (n=77) receiving 2g amoxicillin 1 hour prior to surgery and control (n=77) receiving placebo. Primary outcome was postoperative infections and secondary outcome was the need for rescue analgesia. 4.5% of patients developed postoperative infections, five patients of the control group (4 alveolar osteitis, 1 surgical site infection) and two of the experimental group (1 alveolar osteitis, 1 surgical site infection). Difference between groups was not statistically significant, RR=0.4 (95%CI 0.08-1.99, ?=0.41) NNTB=26. Rescue analgesia intake was significantly higher in the control group (41 vs 18 patients of experimental group) RR=0.49 (95%CI 0.32-0.75, ?<0.05) NNTB=3. The use of 2g amoxicillin 1 hour before surgery was not effective in significantly reducing the risk of postoperative infections from impacted mandibular third molars extraction, when compared to placebo. Nevertheless, antibiotic prophylaxis was associated with a reduced need for rescue analgesia

Propuesta de mejora al sistema de gestión de la calidad en la atención y satisfacción a usuarios en Quintec S. A

Tesis (Ingeniero Industrial)Lo interesante de realizar esta propuesta de mejora al sistema de gestión de calidad en la atención y satisfacción a usuarios Esto deja al descubierto las necesidades de mejora que necesita Quintec S.A. en relación a los niveles de atención y satisfacción de usuarios. Las herramientas que se utilizaran en este proyecto ya han sido utilizadas en proyectos anteriores con gran éxito por lo que sirven de pauta para la implementación de esta memoria. Lo particular de esta propuesta y oportunidad de mejora al actual sistema de gestión a la calidad es que al no tener estandarizado los protocoles y scripts de atención a usuarios se puede categorizar y discriminar oportunamente la información, y mejorar falencias en el servicio actual. Con el fin de que sirva de pauta a futuros usuarios de los servicios que ofrece Quintec S.A. a sus usuarios. Finalmente se busca disminuir considerablemente para Quintec gastos de multas que se deben asumir mensualmente por conceptos de insatisfacciones al cliente

Alzheimer: El Chile olvidado

Memoria para optar al título de PeriodistaChile se encuentra en una etapa de cambios socioculturales, económicos y demográficos, y es justamente en este último punto donde se entrelazan dos situaciones de gran relevancia para el presente y para el futuro del país. Por un lado, la esperanza de vida ha aumentado considerablemente en las últimas décadas, llegando así a los 79 años en promedio. Y, por otra parte, pero en base a la misma idea, el país tiene 2.6 millones de personas en la etapa adulto mayor, lo que equivale al 15% de la población chilena. Si bien existen varias problemáticas a abordar en torno a la tercera edad, existe un tema en específico que requiere de gran atención y urgencia: la enfermedad de Alzheimer. Este diagnóstico, ligado al olvido, a la pérdida de memoria de la persona, se ha convertido en la quinta causa de muerte en Chile y se estima que será la tercera en Estados Unidos. Sin embargo, a pesar de esto, nuestro país todavía no cuenta con las herramientas suficientes para diagnosticar, tratar, cuidar y hacerse cargo de los más de 90 mil enfermos de Alzheimer que hay en Chile. Ni de ellos, ni de sus familias. A través de esta investigación hemos querido dilucidar cuáles son las verdaderas opciones que tiene una persona con Alzheimer en Chile, incluyendo su acceso a costosos medicamentos para retrasar el progreso de la enfermedad, como la posibilidad de un diagnóstico temprano o la opción de ayuda monetaria y psicológica por parte del Estado. En síntesis, 10 distinguir las políticas públicas vigentes –y relacionadas con esta demencia– que existen hoy en Chile

Secondary versus primary closure techniques for the prevention of postoperative complications following removal of impacted mandibular third molars: A systematic review and meta-analysis of randomized controlled trials

Purpose: To determine the impact of secondary versus primary closure techniques on the frequency and severity of pain, facial swelling, trismus, infectious complications, and postoperative bleeding after impacted mandibular third molar extraction. Materials and Methods: Randomized controlled trials were identified through MEDLINE, EMBASE, and CENTRAL, ongoing trial registers, meeting abstracts, doctoral and masters theses, and manual searching of the reference lists of eligible studies. Study selection, data extraction, risk of bias, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) rating of confidence in effect estimates were undertaken independently in duplicate. Results: Of 1,721 identified citations, 14 studies proved eligible. Pain and facial swelling at postoperative days 3 and 7 and infectious complications at day 7 did not differ between techniques. Patients receiving secondary closure had less trismus (in millimeters) at postoperative days 3 (mean difference, 3.72; 95% confidence interval, 1.42 to 6.03, P .002) and 7 (mean difference, 2.35; 95% confidence interval, 0.37 to 4.33; P .02). Four randomized controlled trials reported bleeding: in 2, there was no bleeding in either group; the numbers of bleeding events with primary and secondary closures were 22 and 16 and 5 and 15, respectively, in the other 2. Because of the risk of bias and inconsistency in results, the evidence warranted, at best, low confidence in the estimates of effect across all outcomes. Conclusions: Although differences between primary and secondary closure techniques after impacted mandibular third molar extraction are likely to be small, available evidence provides only low confidence in the effect estimates. The results do not support a preference for either approach

Lizard predation by spiders: A review from the Neotropical and Andean regions

Vertebrate predation by invertebrates has been classically underexplored and thus underestimated, despite the fact that many arthropods consume vertebrates. To shed some light on the relevance that spider predation may have upon lizards in the Neotropical and Andean regions, we compiled the available information in the literature on this trophic interaction. We found 50 reports of spiders consuming lizards in these regions, and the 88% of these were from the Neotropical region. Spiders belong to eight families, but Ctenidae and Theraphosidae were the most frequently reported predators. Lizards belong to 12 families, and the most commonly consumed species corresponded to the families Dactyloidae (all Anolis lizards), Gymnophthalmidae, and Sphaerodactylidae. Data suggest trophic spider–lizard associations between Ctenidae and Dactyloidae, followed by Theraphosidae and Liolaemidae. The body sizes of the spiders and lizards showed a positive relationship, and spiders were smaller than their prey. We conclude that various spider taxa can be considered lizard predators and they may be ecologically important in the Neotropical and Andean regions. However, spiders of prime predation relevance seem to be those of the Ctenidae and Theraphosidae families

Professionally-applied chemically-induced whitening of teeth in adults

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of tooth whitening products developed to be professionally-applied with chemical, bleaching action (in-office). To evaluate the effects of complementary application of accelerators during bleaching therapy (heat, light or laser)