Electronic waste control and management in Ghana: A critical assessment of the law, perceptions and practices

The aim of the study was to assess the impact of Ghana’s hazardous and e-waste control and management Act 917 of 2016 on current e-waste management practices and the level of awareness among key stakeholders (general public, repairers, wholesalers/retailers, recyclers and importers of electronic items) in the Greater Accra Region of Ghana. Both quantitative and qualitative data were collected and examined in this study. Results showed a low level (12%) of awareness among stakeholders on the e-waste legislation. Almost 13% of respondents had been educated on e-waste management. Community engagement and the mass media were the main sources of information on e-waste. Significant associations between background information of respondents and awareness level on ‘Ghana’s Act 917’ were observed. Relative to general e-waste issues, only education and stakeholder showed significant associations with e-waste legislation and management. The main e-waste disposal methods adopted by respondents were disposal at dumpsites (22.7%), repair and reuse (21.1%) and reselling (20.1%). Almost 10% of respondents made changes to their e-waste disposal practices over the past 5 years. These changes were mainly due to the economic benefits derived from reselling e-waste (37.6%) and the perceived adverse impacts of e-waste on the environment (23.9%). Overall, there is the need to intensify awareness on ‘Ghana’s Act 917’, especially issues regarding sustainable e-waste management practices

Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients

BACKGROUN

Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients

Bococizumab is a humanized monoclonal antibody that inhibits proprotein convertase subtilisin- kexin type 9 (PCSK9) and reduces levels of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the efficacy of bococizumab in patients at high cardiovascular risk. METHODS In two parallel, multinational trials with different entry criteria for LDL cholesterol levels, we randomly assigned the 27,438 patients in the combined trials to receive bococizumab (at a dose of 150 mg) subcutaneously every 2 weeks or placebo. The primary end point was nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina requiring urgent revascularization, or cardiovascular death; 93% of the patients were receiving statin therapy at baseline. The trials were stopped early after the sponsor elected to discontinue the development of bococizumab owing in part to the development of high rates of antidrug antibodies, as seen in data from other studies in the program. The median follow-up was 10 months. RESULTS At 14 weeks, patients in the combined trials had a mean change from baseline in LDL cholesterol levels of -56.0% in the bococizumab group and +2.9% in the placebo group, for a between-group difference of -59.0 percentage points (P<0.001) and a median reduction from baseline of 64.2% (P<0.001). In the lower-risk, shorter-duration trial (in which the patients had a baseline LDL cholesterol level of ≥70 mg per deciliter [1.8 mmol per liter] and the median follow-up was 7 months), major cardiovascular events occurred in 173 patients each in the bococizumab group and the placebo group (hazard ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P = 0.94). In the higher-risk, longer-duration trial (in which the patients had a baseline LDL cholesterol level of ≥100 mg per deciliter [2.6 mmol per liter] and the median follow-up was 12 months), major cardiovascular events occurred in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to 0.97; P = 0.02). The hazard ratio for the primary end point in the combined trials was 0.88 (95% CI, 0.76 to 1.02; P = 0.08). Injection-site reactions were more common in the bococizumab group than in the placebo group (10.4% vs. 1.3%, P<0.001). CONCLUSIONS In two randomized trials comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no benefit with respect to major adverse cardiovascular events in the trial involving lower-risk patients but did have a significant benefit in the trial involving higher-risk patients