Search

Objectives: We previously analysed the preparedness to deliver a disease-modifying Alzheimer's treatment in the United Kingdom and predicted substantial wait times. This study updates the prediction for the National Health Service (NHS) in England, using an improved model and newer data. Methods: We reviewed published data on capacity for diagnosis of cognitive impairment combined with expert input and constructed a model for wait times to access from 2023 to 2043. The model tracks patients from initial evaluation in primary care, cognitive testing by a dementia specialist, confirmatory biomarker testing with positron emission tomography (PET) scans or examination of cerebrospinal fluid and infusion delivery. Capacity for specialist visits and PET scans are assumed to be capacity constrained, and cerebrospinal fluid testing and infusion delivery to be scalable. Results: Capacity constraints were projected to result in substantial wait times: patients referred to specialists based on a brief cognitive test, which is the current standard of care, would expect an overall initial wait times of 56 months in 2023, increasing to 129 months in 2029 and then falling slowly to around 100 months. Use of a blood test for the confirmation of Alzheimer's pathology as an additional triage step, would reduce wait times to around 17 to 25 months. Discussion: The NHS England lacks capacity to provide timely access to a disease-modifying treatment, which is estimated to result in significant wait times and potentially avoidable disease progression. Better diagnostic tools at initial evaluation may reduce delays. [ABSTRACT FROM AUTHOR]

Since the enforcement of the EU Landfill Directive, EU waste directives were successively enforced in EU member states to facilitate the establishment of sustainable MSW management. Various changes have been made in England to reduce the global impact of its MSW management, but the effectiveness of these changes on mitigating the global warming potential (GWP) from MSW management has never been investigated in detail. This study assessed the historical GWP of MSW management in Nottingham throughout the period from April 2001 to March 2017 through life cycle assessment (LCA). The LCA results indicate continuous reductions in greenhouse gas (GHG) emissions from MSW management during the study period due to improvements in waste collection, treatment and material recycling, as well as waste prevention. These improvements resulted in a net reduction of GHG emission from 1076.0 kg CO 2 –eq./t of MSW (or 498.2 kg CO 2 –eq./Ca) in 2001/02 to 211.3 kg CO 2 –eq./t of MSW (or 76.3 kg CO 2 –eq./Ca) in 2016/17. A further reduction to −142.3 kg CO 2 –eq./t of MSW (or −40.2 kg CO 2 –eq./Ca) could be achieved by separating food waste from incinerated waste, treating organic waste via anaerobic digestion and by pretreating incinerated waste in a material recovery facility. • GHG emissions from MSW management generally show a reduction trend. • Waste prevention significantly contributed to mitigation of GWP. • GHG emissions arising from the transport of material for recycling have increased. • Separately collecting and treating food waste further reduces GHG emissions. • Improving energy recovery efficiency in the city's EfW plant is recommended. [ABSTRACT FROM AUTHOR]

Sustainable municipal solid waste (MSW) management is regarded as one of the key elements for achieving urban sustainability via mitigating global climate change, recycling resources and recovering energy. Landfill is considered as the least preferable disposal method and the EU Landfill Directive (ELD) announced in 1999 requires member countries to reduce the volume of landfilled biodegradable materials. The enforcement of ELD initiated the evolution of MSW management system UK. This study depicted and assessed the transition and performance of MSW management after the millennium in Nottingham via materials flow analysis (MFA), as well as appropriately selected indicators based on the concept of waste management hierarchy and targets set in waste management regulations. We observed improvements in waste reduction, material recycling, energy recovery, and landfill prevention. During the period 2001/02 to 2016/17, annual waste generation reduced from 463 kg/Ca to 361 kg/Ca, the recycling and composting share increased from 4.6% to 44.4%, and the landfill share reduced from 54.7% to 7.3%. These signs of progress are believed to be driven by the ELD and the associated policies and waste management targets established at the national and local levels. An alternative scenario with food waste and textile separation at source and utilizing anaerobic digestion to treat separately collected organic waste is proposed at the end of this paper to fulfil the high targets set by local government and we further suggest that the recycling share may be improved by educating and supporting the public on waste separation at the sources., (Copyright © 2019 Elsevier Ltd. All rights reserved.)