Chapter
Chapter 2: Environmental Contamination From Health-Care Facilities
PPCPs in Health Care Facilities Effluents
Hospital Effluent—Other Treatment Options
PPCPs Emission and Ecological Risks
Chapter 3: Fate and Behavior of Environmental Contaminants Arising From Health-Care Provision
Environmental Fate Processes
Physicochemical Properties of Healthcare Contaminants
Fate Processes Impacting Wastewater Treatment
Fate in the Aquatic Ecosystem
Fate in the Terrestrial Ecosystem
Wastewater and Biosolids Application on Land
Disposal of Poorly Treated Healthcare Waste
Chapter 4: Ecotoxicological Perspectives on Health Care and the Environment
Health care and the Environment: Pharmaceuticals are Indicators of Urbanization
Historical Bioaccumulation and Ecotoxicology Tools: Inadequate for Pharmaceuticals?
Ecotoxicology During Retrospective Studies of Water Quality
Bioaccumulation During Prospective Studies of Chemicals
Ecotoxicity during Prospective Studies of Chemicals
Emerging Ecotoxicology Approaches for Studying Health-care Impacts
Biological Read-Across, Fish Plasma Modeling and Behavioral Ecotoxicology
Ecotoxicology and Bioaccumulation Approaches to Study Medicines in the Environment
Ecotoxicology Outlook for Medicines: Opportunities to Advance Sustainability Science?
Chapter 5: Terrestrial Ecotoxicity
Introduction of Health-Care Products into Terrestrial Environments
Regulatory and Technical Aspects of Health-Care Products in the Terrestrial Environment
Soil Invertebrate (Earthworm) Toxicity
Outlook and Future Research Needs
Chapter 6: Environmental Contaminants of Health-Care Origin: Exposure and Potential Effects in Wildlife
Sources of Health-care Contaminants and Exposure Pathways for Wildlife
Current Knowledge of Exposure, Hazard and Risks of Contaminants of Health-care Origin
Approaches for Characterizing Exposure, Hazard and Risk Posed by Contaminants From Health care to Wildlife
Hazard Assessment: Empirical Data and the Use of Read-Across From Preclinical and Clinical Drug Trials
Exposure and Risk of APIs to Wildlife in Developing Countries
Novel Ideas and Thinking Outside of the Box
Do Wildlife Act as Vectors for the Transfer of Antimicrobial Resistance?
Chapter 7: Pharmaceuticals in the Environment and Human Health
Routes of Human Exposure to Pharmaceuticals in the Environment
Toxicological Risks of Pharmaceutical Residues in the Environment
Potential Indirect Effects of Pharmaceutical Residues on Human Health and Well-being
Chapter 8: Antibiotics and Antibiotic Resistance: Closing the Loop Between Hospitals and the Environment
What is Antibiotic Resistance?
How to Combat Antibiotic Resistance
Antibiotic Resistance Genes as Environmental “Contaminants”
Opportunities to Mitigate the Spread of Antibiotic Resistance via the Water Cycle
“Hot-Spot” Treatment at Hospitals
Wastewater Treatment Plants and Recycled Water
Chapter 9: Antimicrobial Use and Ecotoxicological Risks from Pandemics and Epidemics
Case Study: Influenza Pandemic 2009
Secondary Bacterial Infections
Environmental Relevance of Medical Response
Preparing for the Next Pandemic
The Special Cases of Mosquito Transmission
The Known and Unknown Unknowns
Pandemics of Chronic Diseases
Chapter 10: Management of Waste from the Health-Care Sector
The Need for Healthcare Waste Management
Defining “Healthcare” Waste
UK Definition of Healthcare Waste
Healthcare Waste Management in Economically Less Developed Countries
The Basics of Healthcare Waste Management
Options for Healthcare Waste Treatment and Disposal
Low Temperature Sterilization Processes
The Legislative Framework of the Healthcare Waste Sector in the United Kingdom
How European Legislation Works in the United Kingdom and Implications for Brexit
The UK Regulatory Authorities
Applying the Waste Hierarchy in the Healthcare Sector
The Circular Economy Approach
The “Duty of Care” Principle
Classifying a Waste Using the European Waste Catalogue
Color Coding of Waste Containers
Research and Laboratory Wastes
Environmental Permitting and Waste Management Licensing
Conclusions—Legislation Shaping and Creating a Healthier Healthcare Waste Sector
Chapter 11: Stewardship Approaches to Reducing Health-Care Contaminants
Environmental Stewardship
The Medicinal Product Chain
The Legislative Context of Healthcare Contaminants
Stewardship at Regulatory Level
Stewardship Approaches along the Medicinal Product Chain
Product Design and Production
Stewardship at National, Regional, and Institutional Levels of Governance: The Example of Plastics Additives
Pharmaceuticals: Prescribing and Consumption
Notions of Health and Illness
Alternatives to Medicines
Overprescription and Dosage
Learning from Antimicrobial Experience
Source Segregation of Urine
Chapter 12: Management of Environmental Contaminants From Health Care: Sustainable Pharmacy
Sustainable Chemistry and Pharmacy
The End of the Pipe's End
Chapter 13: Policy, Regulations, and Risk Assessment
Pharmaceutical Manufacturing
Regulatory ERA and EA Approaches
Environmental Legislation
Relationship Between Medicines and Environmental Legislation
Unused and Life Expired Medicines
Health Care and Environmental Contamination
( Environmental Contaminants )
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