Product slate examples [21].
\r\n\tThere are different types of multiple pregnancies: fraternal twins, identical twins, triplets, and higher-order multiples. Symptoms of multiple pregnancies are larger uterus than expected for the date in pregnancy, increased morning sickness, increased appetite, and excessive weight gain. In this book, we will examine the clinical aspects of multiple pregnancies and management. Also, we will examine the management of cases of twins including antenatal care, delivery, and postpartum.
",isbn:"978-1-80356-198-1",printIsbn:"978-1-80356-197-4",pdfIsbn:"978-1-80356-199-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"70396c6f5f2928c422c1eaf6d33c6269",bookSignature:"Prof. Hassan S Abduljabbar",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11732.jpg",keywords:"Multiple Pregnancies, Twins, Physiology, Incidence, Epidemiology, Demographics, Predisposing Factors, Prenatal Diagnosis, Zygosity, Complications, Management of Birth, Antenatal Care",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 4th 2022",dateEndSecondStepPublish:"May 4th 2022",dateEndThirdStepPublish:"July 3rd 2022",dateEndFourthStepPublish:"September 21st 2022",dateEndFifthStepPublish:"November 20th 2022",remainingDaysToSecondStep:"16 days",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Professor of Obstetrics and Gynecology at King Abdulaziz University, Saudi Arabia, consultant, clinician, researcher, editor, and referee of many international scientific medical journals. Dr. Abduljabbar is president of the Saudi Society of Obstetrics and Gynecology and the president of the Federation of Arab Gynecology Obstetrics Societies. He has published more than seventy-five scientific articles and edited several books.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"68175",title:"Prof.",name:"Hassan",middleName:"S",surname:"Abduljabbar",slug:"hassan-abduljabbar",fullName:"Hassan Abduljabbar",profilePictureURL:"https://mts.intechopen.com/storage/users/68175/images/system/68175.png",biography:"Hassan S. Abduljabbar, MD, FRCSC, American Board Diplomate, is a professor at the College of Medicine, King Abdulaziz\nUniversity, Saudi Arabia. He is also the president of the Saudi Society of Obstetrics and Gynecology and the Federation of Arab\nGynecology Obstetric Societies (FAGOS). He is a referee for\nmany international scientific journals. 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When healthcare is viewed as a right and a responsibility, the state’s active role in maintaining its people’s health becomes even more pro-active more pro-active. This remedies the often-neglected individual’s responsibility toward his/her health. There has always been an inverse distribution of healthcare services in rural when compared to the urban population, which is often referred to as the inverse care law or Pareto’s Law. Pareto’s law of distribution applied to healthcare (according to the British General practitioner Julian Hart in 1971) hypothesized that those in the greatest need of medical services in healthcare get the lowest quality possible healthcare and at the very end [2].
The term rural population also differs from country to country and is defined by the country’s statistical office. In 2019, the world bank estimated that about 3,397,467,990 individuals were residing in rural areas globally. However, the global increase in rural population has been less than 1% per annum [3]. Even though these population growth rates in rural areas are minuscule there is also a projected increase in population. The existing deficiencies in the healthcare delivery system rural areas will only compound the problems with further urbanization and the healthcare policies favoring healthcare privatization [4]. There is also a growing need to create rural communities which are healthy and at par with healthcare facilities in urban areas [5]. Therefore, prioritizing rural health is imperative and will be a dire necessity for the future.
Rural healthcare delivery systems are often deficient in human resource, infrastructure structure, equipment, and financial support. These are essential to provide quality clinical and community healthcare services to the population they cater to. Some countries define healthcare services provision in areas (or communities) that are at a distance of more than 80 km or more than one hour by road from a designated healthcare facility (providing round the clock anesthesia, surgical and obstetrical facilities) [5]. This phenomenon, however, is relative to urban healthcare delivery systems and not an absolute absence of healthcare facilities. The services providers in rural areas are mainly the state or the government. The rest of the health care providers in rural regions are primarily indigenous systems of medicine with or without formal training in healthcare provision.
Remote healthcare is a term often used interchangeably with rural healthcare. Remote healthcare refers to hard to reach areas geographically. This happens mainly in the rural areas where access via roads are challenging [5, 6]. These areas may benefit from a remote health monitoring system, especially for health conditions and diseases that need long-term healthcare. These regions, however, would be significantly helped by the use of Telemedicine, given information and communication technology widely available. Whenever access to healthcare for an emergency or serious condition is required, these remote areas would need referral-service access to a secondary or a tertiary healthcare facility.
Rural Healthcare access is the ability of rural communities (or individuals residing in such communities) who can be promptly approached for health promotive, preventive, curative, and rehabilitative services. This works on the tenets of availability, utility, acceptability, feasibility, and equitability [7].
Barriers to healthcare access are systematic hindrances that may interfere with access to healthcare systems. In rural health systems, they could be broadly classified as structural (Infrastructure, human resources and time-related inadequacies), financial (leading to catastrophic expenditures, unaffordability of medical aid, or lack of completeness in treatment due to inability of money) or personal or socio-cultural (Physical and/or physiological hindrances, socio-cultural inappropriateness) [8].
Social Acceptability of rural health services may be defined as the individual’s subjective-attitudinal perception of health care service provision and providers [9]. Acceptability may also refer to the pertinent interaction and client satisfaction accompanying service provision in the socio-cultural context of the rural areas [10].
The financial moratorium also changed from a collective and mutual aid basis (through a rural cooperative medical system) to a paid service model. The new system in China rolled back many positive health reforms. These reforms included reduced mortality, improved life expectancy for almost three decades and most importantly widening the already existing urban and rural health disparity [14].
In India, maternal and child health, especially midwifery and childbirth assistance, was mainly through the “Traditional Dai” system. However, lack of formal training in midwifery and safe delivery practices led to significant mortality and morbidity among mothers and infants. Training of these traditional birth attendants in 2006 under the National Rural Health Mission (NRHM) was an essential step toward providing trained birth assistance and improving mothers and newborn health in rural areas.
The paradigm shift in India’s healthcare provision was through the National Rural Health Mission effort in health activism through ASHA (Accredited Social Health Activist). Through local community participation, an ASHA worker proficient in various aspects of preventive, promotive, rehabilitative services largely concentrated in maternal and child health through local community participation. The ASHA worker also collaborates with local rural bodies to improve health, sanitation, and nutrition in India’s rural communities, a bottom-up approach [16].
The healthcare system in India had stressed the need for primary healthcare right from the pre-independence era (The Joseph Bhore Committee report in 1946) [17]. The Health Survey and Development Committee report (or the Bhore Committee Report) laid down the blueprint for a three-tier system to deliver healthcare at centers in India before the first national health policy, in the year 1983. The unique nature of the Indian healthcare sector is the blend of traditional(commonly called the AYUSH system- made up of Ayurveda, Yoga, Unani, Siddha and Homeopathy medicine) and allopathic medicine that is made available through a myriad of public and private healthcare providers. However, these healthcare services are also negatively skewed toward the rural areas where more than 60% of the population resides.
The three-tier healthcare system is divided into the primary or first point of contact of healthcare through the sub-centers that cater to a population of 3000 to 5000 [17]. The sub-centers are then linked to the Primary Health Centers (P.H.Cs.) established in the rural and urban areas for a population of 30,000 in plains and 20,000 in hilly and tribal areas. The first point of referral for the Primary health centers in the Community Health Centers (C.H.C.) is set up for every 1,20,000 population in plain areas. Every 80,000 people in hilly, tribal areas form the second tier of the public health system in India. The third tier of healthcare providing tertiary healthcare is the First Referral Units (F.R.U.)s that are set up at district or sub-district levels with round- the-clock services for healthcare. These public healthcare centers were plagued with human resource and infrastructural deficiencies. They suffered a vital mechanism for referral of patients and follow-up from higher level healthcare centers, with less than 11.5% seeking healthcare at these centers [18]. However, the private healthcare sector and the non-governmental healthcare agencies also contribute to addressing the population’s healthcare needs. Because of financial and other infrastructural strengths, these healthcare facilities are often beyond the reach of many, especially in rural areas [18]. Under the country’s National Health Mission (N.H.M.), through the National Health Policy of 2017, recommended the establishment of “Health and Wellness Centers (H.W.C.)” for delivery of Comprehensive Primary Healthcare (CPHC) by up-gradation of sub-centers and Primary Health Centers as shown in Figure 1. The deficiencies seen in the implementation of rural healthcare seen earlier would now be overcome by improved spending to up to 70% of the budgetary allocation, institutional and governmental mechanisms under the flagship of National Health Mission (N.H.M.) for Primary Health care for Universal Health Coverage (UHC) in India and the Pradhan Mantri Jan Arogya Yojana (PMJAY).
Re-organization of public healthcare facilities for Rural India under the Ayushman Bharath scheme in India [
The National Rural Health Strategy through the RHSET programme, the Rural Incentives Program and the collective efforts of the doctors, nurses, Allied health professionals’ associations worked toward healthcare service delivery in the remote and rural areas of Australia along with a Non-governmental rural health body called the National Rural Health Alliance. Although these efforts were primarily focused on incentivizing doctors and other paramedical staff of rural and remote Australia, it was ineffective in satisfying the rural health concept. This was because of issues of financial, infrastructural resource allocation to this programme, as indicated by the performance indicators measuring the remote and rural Australians’ health.
The Australian rural and remote health program underwent a radical change through a dedicated policy framework improvement keeping in mind the provision of health services in these areas by 2008 and Healthy Horizons. This programme currently supports the implementation of local programs that are culturally sensitive, practical forging partnerships in the community and the health care providers by equipping the physical and social capabilities of rural and remote health care service centers in Australia [5].
The World Health Organization (WHO) defines health as “The state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. Perception of health was considered “working hard, staying busy, exercising, drinking water and eating well”. Being healthy often referred to a more subjective consciousness of self-dependence to carry out their daily living activities in rural areas. A relative inability to carry out Daily activities to maintain a household or to perform farm-related chores was considered ill health. This perception of subjective health and wellbeing is particularly true in rural elderly. Physical, mental, social, and spiritual wellbeing are knitted into a mosaic of the everyday life fabric of rural elderly [21]. There is a distrust, especially in seeking professional help for mental health-related issues. The presence of indigenous systems of healthcare usually handles the burden of preventive and promotive health services. However, they are generally not trained or qualified in managing emergency medical conditions and have an inadequate system for referral for these conditions.
The intuitive feeling of health compounded with a low level of trust in the medical healthcare system, decreased demand for services for the “non-urgent” health issues” by healthcare providers, long waiting periods at hospitals for health-related issues. These factors often translate to neglect and apathy toward health-seeking at in the health care institutes in rural areas [21]. This perception of health and disease in rural residents goes a long way in planning healthcare service provision in rural areas [21].
Disparities exist among urban and rural healthcare delivery systems, but within the healthcare systems, there exist socio-cultural and ethnic differences in the accessibility and utilization of healthcare facilities [22]. The situational analysis will focus on aspects of any healthcare system, i.e., accessibility, utilization, acceptability, feasibility, and equity.
Healthcare services in rural areas are less accessible than the urban areas, which could be attributed to the topographical differences [5, 23]. Studies from the Indian subcontinent show that the bed population ratio, percentage of trained medical practitioners, and healthcare provision infrastructure are substantially lesser in rural areas compared to urban areas [4]. Even with a sharp increase in the need for emergency services for rural residents when compared to the incremental rise among urban residents in need of emergency services [24], more trained emergency physicians were present in urban areas than rural areas [25]. The number of healthcare professionals and availability of medical services in remote areas is sparse [5]. The problems with transport facilities and communication technologies further compound the problem of poor healthcare accessibility [23].
The factors that enabled healthcare service utilization in Africa’s urban areas were motivational benefits, the individuals’ current health status, and services availability. However, in rural areas, geographical adjacency, free or low-cost healthcare availability, health insurance, ethnicity, and and family income, influence the rural residents’ health services utilization [26]. In general, the individuals would preferred to be treated by healthcare personnel of the local areas, though often under-staffed or resource-constrained [23]. The underutilization has also been attributed to the lack of quality-assured healthcare services sensitive to people’s health needs in rural areas [27].
The concept of acceptability has frequently been intermingled with availability and affordability of healthcare service provision and patient satisfaction [10]. The concept of trust in the healthcare provider, endorsement of the provider by leaders in the rural community in addition to early community interaction and home visits were found to improve the acceptability of maternal and child healthcare services in rural Uganda [28]. In rural northeast India, facilities for safe and sound quality healthcare services were linked to healthcare service acceptability [29].
The availability of healthcare-related services was substantially lesser in institutes providing rural healthcare vis a vis with their urban counterparts [30].
Equity in healthcare within rural areas also play an essential role in the rural healthcare delivery system. In the Republic of Suriname, a study conducted showed that equitable resource distribution for primary healthcare services was comparable in rural and urban areas. However, factors like perceived need, female gender, and socioeconomic status contributed to inequity for services related to chronic healthcare-related issues within the Republic of Suriname’s rural areas [31].
Provision and upgrading healthcare-related insurance schemes and policies positively contributed to reducing the inequitable distribution of healthcare services [31]. The Development of tailor-made healthcare services addressing these principles to provide timely, socio-culturally appropriate, economically sustainable and equitable services in rural areas is necessary [5, 32].
The healthcare facilities in rural and remote areas are often deficient in core or essential health services, especially for support and local outpatient basis treatment [33]. The problem of shortages in trained global healthcare force and support, provision of geriatric and mental health services, infrastructure for timely healthcare services have affected rural healthcare services more than urban services [5]. The lack of healthcare insurance and the treatment costs incurred compounded with the insufficient healthcare expenditure of Gross National Product (G.N.P.) on health has worsened this situation [34]. The rural population of elderly, sick, uninsured and suffering from chronic diseases is significantly higher than its urban counterpart, which need to be addressed [33].
Planning rural healthcare services need an optimum mix of primary and secondary healthcare services at the community and individual levels. An ideal system delivering rural healthcare services should focus on “core healthcare services” or basic health-related amenities for maternal, child health, oral health. This must also include primary health care providers and emergency services for stabilizing patients needing urgent medical care with a timely referral system that provides a continuum of care [35]. The health systems should be locally sourced through community-based organizations, depending on the rural community’s health care needs through a formal inquiry vide community- healthcare- needs assessment [35]. The aim of delivering healthcare in rural areas should not be limited only to improve the quantum of services provided but also the quality of healthcare services [35]. The Institutes of Medicine (I.O.M.) quality in healthcare can be approached through an integrated prioritized public health intervention at individual, family, community levels [29]. There should be provision for a support system for the healthcare service delivery personnel and the communities they serve through appropriate education, financial incentives, human resource, and infrastructural capacity. The feasibility and acceptability of Information and Communication Technology (I.C.T.), especially for diagnostic emergencies like Acute abdomen, Myocardial infarction, Stroke etc., should be explored, especially in remote areas [34]. These systems of I.C.T., if feasible and planned correctly, can be used for monitoring of chronic that arise in Non-communicable and communicable diseases [34]. Leveraging the concept of a “healthy village” like the RURBAN initiative in India needs to be looked at while planning services in these areas [27].
A health care team providing these services, which are community-based with sustainable financial sourcing, can ensure healthcare facilities from seemingly simple medical issues to complex health conditions needing sophisticated tertiary care health system interventions, need to be planned too. The rural health care services need to be backed up by community participation with leaders and members of both health and non-health-based organizations in the rural community. The above system would also need to be socio-culturally sensitive and appropriate, catering to the rural community’s health needs. This healthcare provision will depend on the healthcare funding through the nation’s allocation of funds for health for rural and urban areas [28, 29].
As emphasized by the Alma Ata declaration of 1978 in Kazakhstan, any healthcare system’s precept should be based on primary healthcare [36]. Scarce resources are allocated in terms of human resources, infrastructure, and money for rural healthcare delivery, equitable healthcare provision can be made possible only by improving accessibility and acceptability of healthcare services among rural communities [18]. Sustainable healthcare delivery in rural areas can be possible only if the focus is shifted from providing healthcare service to providing a continuum of care in rural areas [6].
The Continuum healthcare delivery should be planned through a three-tier system of primary, secondary, and tertiary healthcare. This can be coordinated through collaboration and socially accountable healthcare institutes in these areas. In a consultation forum with Australia, Brazil, South Africa, Nepal, and India on A consultation forum with Australia, Brazil, South Africa, Nepal, and India on delivery of rural-primary healthcare, showed that geographically accessible, socio-culturally acceptable, family-centered healthcare needs to be developed. Integrating these concepts based on preventive, promotive, and curative, sensitive to the perceived requirements of the rural communities, need to be crafted. Creating a rural healthcare delivery system should begin with community healthcare needs and demands assessment that identifies potential strengths, weaknesses, threats, and opportunities in terms of human resource, infrastructure, and costs in building a sustainable rural healthcare delivery system sensitive to local healthcare needs. Once the healthcare-related needs are identified, prioritizing these needs based on either a nominal group technique or the Hanlon’s basic priority rating system, or an intervention mapping can be employed. Implementing a healthcare system engaging community partners, a community-based organization ensuring the fullest community participation in making healthcare decisions through sustainable healthcare and financial incentivization schemes would be the next challenge to overcome.
When appropriate linkages being forged with referral systems, higher budgetary spending on healthcare by the states, healthcare insurance that improves affordability to build and empower healthcare teams providing rural healthcare [32]. With a shortage of trained rural healthcare professionals on health emergency and maternal and child health, individuals sourced from the local rural communities like the ASHA workers in India [16], Barefoot doctors in China [6, 12] could be looked at as potential bridges to the healthcare-related gap in rural areas. However, adequate and regular training and accreditation of rural healthcare providers who are sensitive to the family-centered practice of evidence-based medicine are paramount [32].
A concept of extended-community-care team sourced from trained staff of urban social and healthcare professionals who provide their skill and expertise prevalent in Scotland’s remote and rural areas [6]. Research models for developing such extended healthcare teams in rural and remote with evidence through health impact assessment can ultimately translate to advocacy for policy-orientation prioritizing rural health.
Dissemination of information in rural healthcare delivery systems in research is also paramount for other rural communities to develop or adapt such models to achieve the best healthcare-related outcomes.
Telemedicine has leveraged the benefits of advanced telecommunication and computer technologies, which can provide diagnostic and therapeutic support to patients residing in remote and rural areas [6, 37, 38]. Modern technology like Clinical Decision Systems (C.D.S.), Picture Archiving and Communication Systems (P.A.C.S) that capture, store, and disseminate health-related information from patients in rural and remote areas to healthcare providers on a real-time basis. These systems can help in making immediate and urgent healthcare decisions in these areas [37]. Information and Communication technologies improve accessibility to primary health care needs, maximizes service delivery, transfer and sharing of appropriate technology for instruction, training, continued education of healthcare service providers is also maximized in rural and remote areas [39, 40].
The characteristics of a programme that supports information and communication technology in remote and rural healthcare systems (which helps in return to improve health especially in developing countries are as follows:
Use of appropriate technology that is locally applicable to rural and remote health infrastructure
Leveraging and strengthening existing systems in the rural and remote communities
Demonstrating the benefit of using such health related information and communication technologies through showcasing of approaches in I.C.T delivery
Capacity building to innovate, develop and demonstrate the effectiveness of Information and Communication Technologies
Monitoring and evaluation through Participatory and Rapid Rural Appraisal
Designing better methods of communication strategies for delivery of healthcare in rural and remote areas
Continued research and information sharing regarding the strengths and challenges faced in setting up such technologies in rural and remote areas [40].
The three-pronged benefits that can be reaped by use of Information and Communication Technology (I.C.T.) would be in
The information and communication technology can also aid in lifelong learning, improvement and retraining in healthcare delivery system’s accountability [38]. The establishment of electronic health records using barcoding and other such indexing systems for an individual also helps in maintaining the patients’ continuity of care [37]. The WHO e-health strategy envisages, e- health-solutions exploration by identifying and addressing needs, innovative methods and research. This provides evidence, information, guidance, best practices and management of such solutions in rural and remote areas [40].
The challenges in implementation of Information and Communication technology like telemedicine, e-health include:
The lack of access to internet and mobile connectivity
The ack of credible and culturally sensitive information and communication technologies,
Insufficient political commitment toward establishment of a sustainable system for health information and communication
The need of extensive co-operation from stakeholders at the local, regional and national levels,
Paucity of foreign development investment for establishment of information and communication technologies.
Rural and remote healthcare delivery is essential to achieve a “Healthy Nation” through quality-assured core or basic healthcare centered on preventive, promotive, curative and rehabilitative service delivery. The healthcare- delivery system’s focus on a constraint resource setting, lies in developing tailor-made models for the sustainable provision of healthcare facilities in rural and remote areas. Healthcare research into factors affecting accessibility, utilization, the feasibility of healthcare delivery models in rural areas should be encouraged to provide advanced insights into what works and what does not work in rural areas. The opportunities offered by information and communication technology, (including Telemedicine) bridge the gaps in rural and remote areas.
The authors declare no conflict of interest.
Reduce, reuse, recycle – this is the current strategy to prevent the world from being flooded by plastic waste. There are many initiatives led by governments, regulators, and also companies and entrepreneurs to follow these guidelines: the so-called “Single Use Plastics” Directive (SUP) [1]. The Circular Plastics Alliance, and The Alliance to End Plastic Waste – to name a few. Incineration and energy recovery of plastics seem to no longer be the promoted solution due to increasing carbon dioxide emissions and causing the loss of the potential hidden within polymers. Although landfilling of plastics practically does not emit CO2, it can lead to microplastic release into the environment [2].
Chemical recycling is now more recognised as a potential solution to recycling or ending the life of plastic, as it can potentially treat the waste that cannot be mechanically recycled, keeping “carbon” in the industry loop. But there is no one official understanding of the term “chemical recycling” worldwide. European regulation defines recycling only at a very general level as any operation that takes waste and makes products, materials, and substances, except fuel components [3]. ISO 15270 is even more precise, limiting chemical (feedstock) recycling to cracking, gasification and depolymerisation processes to convert plastic waste into monomer of new raw materials, excluding energy recovery and incineration [4]. On the other hand, American Chemistry Council (ACC) defines chemical (advanced) recycling as any technology that converts post-use plastics into monomers, specialty polymers, feedstocks and fuels [5]. What is more, the process of waste to value-added chemicals is also known as upcycling [6].
Recycling itself, both mechanical or chemical, can produce two types of products. Suppose the properties of the recycled material are not considerably different from those of the virgin material and can be used in the same application. In that case, the recycling process is called “closed-loop recycling”. This approach is difficult for the mechanical recycling of some polymers for specific applications (like food packaging or specialty applications) as, in many cases, the processing of plastic waste causes partial degradation of the polymer structure and a change to its mechanical properties. When recycled material has different properties and is used in different applications to the original one, the recycling process is called “open-loop”.
In the current chapter, both types of chemical recycling technologies of polyolefins (polyethylene and polypropylene) – closed-loop and open-loop, will be described.
Polyethylene (PE) and polypropylene (PP) are polymers called polyolefins. These are the two largest plastic resins based on production worldwide. One of the reasons for this is the variety of applications where these plastics are used: mainly in packaging but also in toys, piping, cable covers, automotive parts, ship ropes or even bulletproof vests. Polyolefins are inert, have low thermal conductivity (are good insulators) and are not subject to attack by most chemicals. As thermoplastic resins, most polyolefins can be mechanically recycled; however, thanks to the chemical and hydrocarbon structure, they are also proper materials for chemical recycling via cracking (pyrolysis) and gasification.
Polyethylene is a product of ethylene polymerisation. Depending on the production process and consequent chemical structure and properties, many types of PE are produced. The major ones are:
low-density polyethylene (LDPE),
high-density polyethylene (HDPE),
linear low-density polyethylene (LLDPE),
crosslinked polyethylene (PEX).
LDPE is a type of polyethylene with the most branched structure and a density lower than that of HDPE. HDPE is a polymer with a linear structure with a low degree of branching. LLDPE is produced by the polymerisation of ethylene with other olefins with longer hydrocarbon chains, like 1-butene, 1-hexene or 1-octene. The result, a linear backbone with short and uniform branches. Finally, PEX is a polymer obtained by crosslinking the process of polyethylene. This crosslinking changes the properties of polyethylene significantly – increased temperature, pressure, or corrosion resistance. Thermoplastic polyethylene becomes thermoset which limits the possibility of mechanical recycling of this material significantly.
Polypropylene is a product of the polymerisation of propylene. It means that every monomer has a methyl side group. Due to the presence of asymmetric carbon atoms in the chain, stereoisomerism is observed for this polymer.
Differences in the structures are presented in Figure 1. These differences influence the polymer’s mechanical properties and the cracking or gasification process conditions, and the composition of products from chemical recycling processes.
Structures of polyethylene and polypropylene.
It should be noted that many different additives are used to change the properties of the polymer during the production of plastic items. For example, pigments and dyes are added to change the colour; glass fibres can be added to alter the mechanical properties of the polymer, and talk is sometimes added to reduce the price of the final goods. Stabilisers (like UV stabilisers), flame retardants, lubricants and plasticisers are other types of additives commonly used in the plastic industry. The quantity of these additives may be vast, from parts of a percent up to 60–70%. What is more, in many cases, polyolefins are used together with other polymers. For example, in multilayer films used for packaging, PE is used together with poly(ethylene terephthalate) (PET). What is more, flexible packaging is often highly printed. The final yield and composition of chemical recycling products will depend on the type and quantity of all of the impurities.
The cracking of polymers is a process where long polymer chains are broken into products with shorter chains. During heating (at around 350–600°C), molecules start to vibrate until the vibrations are intense enough to overcome van der Waals forces. The short-chain molecules then evaporate. When the energy of the van der Waals force is higher than the enthalpy between carbon atoms in the molecule, the bond in the molecule will break instead of evaporating. In polyolefins’ chains, the most unstable bonds will be the first to break, leading to the creation of radicals. The dissociation energy needed to break the bond between carbon atoms lowers with the order of carbon classification: primary > secondary > tertiary, which means that the first place in a polymer molecule where the bond will break is at the branching. This already indicates that polypropylene cracks at lower temperatures than polyethylene because all carbons in the structure (apart from terminal ones) are tertiary. It also means that LDPE cracks easier than HDPE because of higher branching. All types of polyethylene and polypropylene can be cracked, including those that are challenging for mechanical recycling, like PEX.
In general, the following steps of the cracking reaction can be identified:
initiation – free-radical creation,
propagation – products and secondary radicals creation, isomerisation,
termination – recombination, disproportionation, cyclisation, arenes creation, polycondensation.
When the bond between hydrogen and carbon atom is broken, a radical is created (initiation step). In the second step of the process, polymer bond breaks at the
unzipping – the chain break at the
backbiting – intramolecular transfer of a hydrogen atom from one part of the molecule to the other part of the same molecule and then
random scission – intermolecular transfer of hydrogen atom and then
Cracking of polyolefins by random scission reaction, redrawn from [
In the case of polyolefins, cracking occurs mainly by random scission and backbiting reactions.
In the last step of the process, the radical can react with another radical, creating saturated alkane (recombination), one alkane and one alkene (disproportionation), create cyclic structure (cyclisation), dehydrogenate and condensate and take part in other reactions. In the end, a mixture of different types of hydrocarbons with varying chain lengths is created. When condensation and dehydrogenation reaction progress, polycyclic aromatic hydrocarbons (PAH) are created, which still react and finally create a coke, that is reach in carbon.
As mentioned before, the cracking of polyolefin chains produces different hydrocarbons. In general, three types of streams are created during the pyrolysis of polyethylene and polypropylene: gas fraction that consists of hydrocarbons with the lowest molecular weights, a liquid or semisolid fraction (pyrolysis oil) that consists of hydrocarbons that were created in the form of vapours which after cooling were condensed and the process residue (char), that consists of plastic’s additives and coke, which was created during the process. The composition and yields of each of these products depend on the feedstock’s composition and process conditions such as temperature, pressure, residence time, and catalyst used.
For example, during the process in a rotary kiln reactor with quartz sand used as a heat carrier, pyrolysis oil consisting of 43,1% of aliphatic hydrocarbons and 55,5% of aromatic hydrocarbons were obtained from polyethylene. Pyrolysis oil from polypropylene consisted of 44,7% aliphatic and 52,9% aromatic hydrocarbons [9]. On the other hand, during thermal cracking of PE and PP in a microreactor at different temperatures gave products consisting of 59,7% alkanes, 31,90% alkenes, 8,40% cycloalkanes and 66,55% alkanes, 25,7% alkenes and 7,58% cycloalkanes, respectively. No aromatics were identified [10]. These two examples already indicate how different products can be obtained, depending on the process conditions.
In general, it can be observed that raising the temperature and residence time can increase arenes creation and can also raise the alkane to alkene ratio in the product, for example, in [11]. Aromatics content can also be significantly raised by the use of certain catalysts, like zeolites. The type of catalyst also influences the alkane/alkene ratio [12]. It should be noted that catalysts can be rapidly deactivated, limiting their use in continuous processes [13]. An increase in the temperature can increase the yield of long-chain hydrocarbons due to reduced residence time. However, it can also favour increased gas and lower molecular weight product formation by increasing the number of secondary reactions if the residence time is long enough. The majority of cracking processes are conducted at atmospheric pressures. However, some investigations present that higher pressure can increase the gas formation at lower temperatures, but with the increase of the temperature, the effect was diminished. A decrease of double bonds formation with the pressure increase was also observed [14]. What is more, different polymers can have a synergistic effect on co-pyrolysis [15]. Polystyrene (PS) is also a valuable feedstock for pyrolysis. The product of PS cracking is almost fully aromatic, with styrene monomer as a major product [16]. It can also be co-pyrolysed with polyolefins. Poly(methyl methacrylate) (PMMA) is another polymer that can be pyrolysed [17]. Poly(vinyl chloride) (PVC) produces large quantities of corrosive hydrogen chloride and can contaminate all – gas, liquid, and residue. PET gives low yields of oil, and the thermal cracking of polyurethanes provides products reach in organic nitrogen components [18]. Pyrolysis of biomass converts waste into oil with high oxygen content and increase coke formation [19]. That is why most of the research and developed technologies are based on polyolefins, optionally with the addition of polystyrene, while other plastics and biomass are treated as impurities.
Pyrolysis of plastics is a complex process with many variables that produce hydrocarbons from polyolefin feedstock. It makes the process difficult but flexible at the same time. That is why many different solutions are used (other types of reactors), but also different product types for different applications are obtained.
As described in the previous section, cracking of polyethylene and polypropylene can lead to many different products. The composition of the products – hydrocarbon type and chain length – will determine their application.
Pyrolysis oil obtained during thermal or thermocatalytic cracking of polyolefins is a complex mixture of hydrocarbons with different chain lengths (5 to 30 and more carbon atoms). Linear and branched paraffins and olefins, together with aromatics: mono and polyaromatics – with and without aliphatic side chains, are obtained. Such a complex mixture does not have a direct application without additional treatment. However, as a hydrocarbon product, it can be mixed with refinery and petrochemical streams and processed together with crude. The process is simple, consisting of only a cracking reactor, product cooling system, residue discharge system and gaseous product burning unit (for energy production).
However, the capacity of commercial chemical recycling plants is limited due to plastic waste availability and the process itself – polymers have a low thermal conductivity which makes the scale-up of the pyrolysis reactor challenging. The biggest pyrolysis plants have a capacity of about 100 000 tons per year which is very small compared to the standard refinery size of about 4–10 million tons per year. This means that the recycled stream is highly dissolved in the refinery. As a result, the product can be contaminated, so there is no need for expensive detailed sorting and washing of the plastic waste or purification of the pyrolysis oil. Even though this makes the process much cheaper, the solution is not economically feasible.
Cracking is an endothermic process that requires a lot of energy to melt the plastic and break polymer bonds, as plastics are excellent insulators. The residue obtained from cracking is usually a high-calorific by-product and contains a high level of contamination, limiting its use in incinerators, especially if the raw material used for pyrolysis was not properly separated and cleaned. For example, the presence of PVC significantly raises the chlorine content, which is limited in incinerators’ feedstock specifications. Special treatment of this residue increases the overall cost of operations.
Pyrolysis of plastic waste into feedstock for refineries was very popular a couple of years ago. For example, in Poland until 2007, many commercial (Technology Readiness Level, TRL = 9) plants were operated, but their profitability was based on relief in excise tax. When regulation changed, they were all bankrupted. Low prices of crude oil caused the closure of other companies worldwide, or they changed their profile. For example, Agilyx from the US had to shut down its flagship plant in Tigard in 2016, later changing its activity profile to polystyrene recycling [20].
The most popular application for products from the chemical recycling of polyethylene and polypropylene are fuels and fuel components. Hydrocarbon product can be separated into more narrow fractions like gasoline, diesel, light and heavy fuel oil. Hydrocarbons with the highest molecular weights (waxes) can be circulated back to the cracking reactor or cracked in an additional catalytic process. Proper process parameters can also limit the quantity of waxy hydrocarbons, but it usually causes high gas yields. Pyrolysis reactors are followed by distillation units. The ratio between different products depends on technology. An example of two companies’ products slates are presented in Table 1 [21].
Type of product | Cynar | PK Clean |
---|---|---|
Kerosene, % | 10 | — |
Diesel, % | 70 | 66 |
Light fuel oil/Naphtha, % | 20 | 33 |
Wax, % | — | re-circulated |
Product slate examples [21].
From one side, fuels obtained from the pyrolysis of polyolefins are characterised by low concentrations of sulphur (less than 0,1%) and are easily burned as hydrocarbon fractions. On the other hand, high olefin content reduces oxidation stability. Furthermore, reactive alkenes relatively easily undergo polymerisation reaction creating gums with high molecular weights. That is why products from PE and PP cracking should not be stored for a longer time. This tendency to polymerisation can also cause issues in distillation units where resins deposit at surfaces of elevated temperatures, reducing heat transfer coefficient in heaters and heat exchangers, also plugging the distillation columns and reducing mas flow in these units. Foaming during distillation is also observed [22, 23].
Hydrotreatment (catalytic reactions with hydrogen) of the products from pyrolysis could be a solution – olefins can be saturated into paraffins, stabilising the product. But it would raise the total cost of the process as it usually carries out at elevated pressures and requires special, separate units. What is more, products reach in linear paraffins may have high pour point of diesel and light fuel oil fractions. Unsuitable gasoline fraction octane number and cold-temperature behaviour of heavier fractions limit their use in combustion. To keep proper fuel parameters, blends of hydrotreated fractions from chemical recycling of plastics and commercial fuels can be prepared. But to keep proper parameters, a maximum of 1% of gasoline fraction, 10% of diesel fraction and 20% of light fuel fraction from polyolefins’ cracking can be used [24]. If the process is controlled to produce a highly aromatic product, then higher octane gasoline and lower cetane diesel could be obtained.
Fuels and fuel components obtained from plastic waste compete in price with fossil fuels, making the profitability of the process challenging. Also, this type of application in European regulation is seen as energy recovery, so it is not considered chemical recycling. Nevertheless, there are several companies that are focused on the production of fuels. For example, Bightmark Energy is building a 100 000 t/a commercial facility (TRL 9) in Ashley (US), which is planned to be commissioned in 2021. Braven Environmental is planning a 65 000 t/a plant in Virginia. Nexus Fuels commercial-scale plant’s capacity is 50 t/d, similar to one module of Integrated Green Energy Solutions’ plant constructed in Amsterdam. Polish company Handerek Technologies develops technology for fuels production by pyrolysis of plastics and further hydrotreatment at atmospheric pressure, using syngas (mixture of hydrogen and carbon oxide). The process at an early stage of commercialisation, presenting only a small scale pilot plant (TRL 4–5) with plans to build commercial plants with a capacity of 10 000 t/a.
The production of monomers that would be firther used for polymerisation could be the only solution for closed-loop recycling of PE and PP waste. Depolymerisation of polyolefins is not easy as bonds between carbon atoms in the chain are relatively strong. As described before, thermal or thermocatalytic cracking leads to a mixture of hydrocarbons with different chain lengths. Gas fraction is produced, but alkenes content in it is usually low. A research was conducted to maximise the gas fraction and olefin content, but the highest ethylene concentration in the gas stream achieved was 25%. Still, a minimum of 40% of liquid product was obtained [7]. In other research, steam was used in a fluidised bed reactor for pyrolysis of plastic waste to maximise olefin yields. 20–31% ethene and 14–18% propene were obtained. Additionally, 19–23% gasoline was produced. These yields are similar to standard naphtha steam cracker’s product, but the research was run at lab-scale, and no information about scale-up is available [25].
The most extensively investigated process currently is the production of feedstock for commercial steam crackers. Plastic waste is cracked thermally or catalytically into a liquid fraction with proper boiling range and further mixed with fossil feedstock. Some research presented that it would be possible to use liquid from plastic pyrolysis only, receiving results similar to use naphtha [26]. But to avoid coking of the colder section of the steam cracking reactor and contamination of created streams with heteroatoms present in pyrolysis oils, co-cracking with standard feeds is preferred. Purification of the pyrolysis oil by hydrotreatment upfront steam cracking could be a solution that increases the total cost of the process. Considering the capacities of chemical recycling plants and current steam crackers (millions of tons of ethylene), significant dissolution of pyrolysis oil in fossil-based feedstock might be a solution for this issue, as pyrolysis oil can be only a small part of the inlet stream to the steam cracker.
Although making monomers and then polymers from polyolefin waste look like a very promising route for closed-loop recycling of polyethylene and polypropylene, several concerns should be considered. First, the basic question mark is about yields of the process. If it is assumed that pyrolysis oil has similar properties to commercial naphtha, then yields of ethylene and propylene that can be used for further polymerisation is limited, as presented in Table 2 [27]. In the case of higher boiling fractions (like gasoil or diesel fraction) or oils reach in branched or aromatic hydrocarbons, yields of ethylene and propylene are lower, and the yield of liquid products rises [28]. These products can be used as feedstock for chemical processes but are currently used primarily as fuels, which is not considered as recycling according to European regulations.
Product | % wt. |
---|---|
Residual gas (methane, hydrogen) | 16,0 |
Ethylene | 35,0 |
Propylene | 15,0 |
C4 fraction | 8,5 |
Fraction >C4 (C5, pyrolysis gasoline, residual oil) | 25,5 |
Products of steam cracking of naphtha [27].
As the plastic-based liquid has to be blended with naphtha or other steam cracking fossil-based feeds, it is challenging to trace the flow of materials along the supply chain. For that purpose, a mass balance accounting system is required. It is a set of rules for allocating the recycled content to different products in order to be able to claim the recycled content. Products can be accredited by the independent scheme, for example, the International Sustainability and Carbon Certification Plus (ISCC) scheme. NGOs challenge the currently used calculation method as requiring more clarification and a more strict approach as it can be misused, claiming incorrect recycled contents [29]. It is understandable as long as detailed and correct data is not shared. For example, in one of the published Life Cycle Assessments (LCA) for the process, the considered amounts of naphtha from chemical recycling that is needed to produce 1 kg of LDPE were 1,2–2,0 kg with the baseline of 1,5 kg of naphtha per 1 kg of LDPE produced. These numbers are not in line with ethylene yields from fossil naphtha (as presented in Table 2) and require a broader explanation [30].
The final consideration is about the overall environmental impact of the process. For evaluating the influence of the process or product, a systematic analysis of the environmental impacts, called Life Cycle Assessment (LCA), is used. Currently, only two executive summaries of LCA were published, which were also criticised by NGOs [31]. As not enough data is publicly available, it is difficult to evaluate these concerns. What is sure, the process chain is very long and complex, as presented in Figure 3, and requires the use of fossil-based feedstocks and only part of the plastic pyrolysis oil is converted back to a polymer. The yield of the fraction that can be processed in a steam cracker in the plastic pyrolysis process is unknown. In this case, LCA analysis should consider yields and processing of other products from plastic pyrolysis and steam cracking to present the whole impact. Lastly, the feasibility of these processes are a matter of concern, especially if hydrotreatment is used for pyrolysis oil purification.
Scheme of polyethylene and polypropylene from the plastic waste production process.
Currently, big polyolefin producers are involved in projects for the chemical recycling of plastics into monomers, like BASF, SABIC, Borealis or Chevron Philips Chemical, cooperating with companies experienced in pyrolysis, like Plastic Energy, Quantafuel or Nexus Fuels. In Geleen, the Netherlands, a plant for cracking of polyolefins is constructed and a hydrotreating system for purification of pyrolysis oil, which will later be fed to a steam cracker. This project is a joint investment of Plastic Energy and SABIC [32]. The plant is expected to have a capacity of 15–20 000 t/a and to become operational in 2022.
The production of valuable chemicals from waste, called upcycling, is an interesting alternative. The mixture of hydrocarbons obtained from polyolefins’ pyrolysis can be upgraded or separated into different hydrocarbon types. What is more, the flexibility of the cracking process enables the maximisation of target fractions.
The major advantage of plastic-to-chemicals processes is that most of the proposed solutions offer final market products that do not require further processing in petrochemical plants. In this case, a mass balance approach is not required as products are based entirely on plastic waste. As products are not dedicated to be burned for energy production, these technologies can be classified as open-loop recycling also under European regulations. What is more, special, niche applications enable higher margin than compared to naphtha or fuel. On the other hand, these applications are limited when products are produced from waste, require high purity (virgin) polymers or complex pre- or post-treatment and purification, which may significantly influence the feasibility.
Benzene, toluene and xylenes (BTX) are important aromatics used by petrochemical industry to produce valuable chemicals like polystyrene, nylons, methacrylates, polyurethanes, plasticisers and many more. The pyrolysis process of polyethylene and polypropylene can be controlled to maximise aromatic hydrocarbons. A presence of polystyrene in the raw material could increase yields of BTX fraction. Nevertheless, it is possible to obtain 53% and 32% BTX from PP and PE, respectively [33, 34, 35]. These aromatics have to be further separated from the pyrolysis oil.
Encina from the US is an example of a company that provides a technology of catalytic cracking for BTX and propylene production but is currently not at a commercial scale. The planned unit will produce about 90 000 t/a of chemicals [36].
Polyolefin waxes can also be produced by the cracking of polymers. These kinds of waxes are widely used in PVC production, surface modifiers, additives to other waxes etc., and can be produced as a by-product of polyolefins production. Some companies, like Mitsui Chemicals America, Hana Corp., EPChem or Merlob, crack virgin polymers for the purpose of wax production. In this case, an issue of contamination by additives does not exist. If polyolefin wastes are considered, then a proper purification process should be implemented, or the application range would be significantly limited to those where colour and presence of inorganics is not an issue.
GreenMantra Technologies from Canada produces waxes by catalytic pyrolysis of plastic wastes at elevated pressure (4,5–25 bar). Wax products under the name of Ceranovus can be used for bitumen and asphalt modification, polymer processing or adhesives production. As an addition, fuel oil is produced. The current plant (TRL 9) has a capacity of 5 000 t/a [37]. Another company producing waxes (“EnviroWax”) from plastic waste through pyrolysis is Trifol from Ireland. The by-products are fuels: diesel/kerosene and naphtha. The company has a pilot plant (TRL 6–7) with plans for scale-up to 37 000 t/a [38].
Clariter carries out the most complex process for plastic waste conversion into chemicals. Aliphatic solvents (“Solventra”), white oils (“Oilter”) and paraffin waxes (“Clariwax”) of high purity are produced from polyolefin waste via thermal cracking, hydrotreatment, and distillation and are alternatives to similar fossil-based products available in the market (Figure 4). To maximise on profit, target products are deeply purified from heteroatoms and hydrogenated so they can potentially be used in the cosmetic industry. Other applications are: paints, inks, degreasers, wax emulsions, paper and wood impregnation, lubrication, car or furniture polishes, silicone sealants and others. The company owns a pilot plant in Poland (TRL 5) and an Industrial-scale Plant in South Africa (TRL 7) with scale-up plans for 60 000 t/a facilities. Most interestingly, the company claims to achieve a net negative carbon footprint which is unique compared to other LCA’s published [39].
Clariter products.
Gasification is a well-established process for the conversion of many non-renewable sources, like petroleum resids, petcoke or coal. In general, it can process any carbonaceous material into a valuable mixture of hydrogen, carbon monoxide and carbon dioxide – called syngas (synthetic gas). Syngas itself is a source of hydrogen and carbon monoxide used for various chemical processes or as fuel when separated into pure streams, or as a high calorific fuel or feedstock for chemical synthesis into other chemicals, like methanol, ethylene glycol, acetic anhydride and hydrocarbons (via Fischer-Tropsch synthesis) when not separated. Examples of syngas applications are presented in Figure 5. As polyolefins consist of carbon and hydrogen, these can be very good feedstock for gasification.
Overview of potential syngas applications [
Gasification is a complex process with several reactions taking place between carbon-based material, oxygen and steam at high temperatures (700–1500°C). Examples of reactions that take place during gasification are presented in Table 3.
Reaction | ΔH, kJ/mol |
---|---|
Primary reactions | |
+118,9 | |
+160,9 | |
−87,4 | |
−246,3 | |
Secondary reactions | |
−42,3 | |
−205,8 |
Examples of gasification process reactions [28].
The hydrogen to carbon oxide ratio in obtained syngas varies significantly (from 0,7 to 6 for different fossil fuels) depending on the type of the raw material and technology. For different applications, different ratios are required. It is technically possible to obtain every required syngas composition from every feedstock, but it has economic limitations [28].
Polyolefin waste is potentially a very good source of carbon for gasification. What is more, as biomass and other plastic wastes are also reach in carbon, mixed wastes streams can be used. Gasification of waste has the following steps: drying, pyrolysis, cracking and reforming, char gasification. Drying of plastics has an insignificant role but might be important when plastics are processed with biomass, unlike the pyrolysis step, which is key in the gasification of plastics. The poor heat conductivity, sticky nature, high content of volatiles created during pyrolysis of polyolefins, and relative low char and high tar yields make the process different from coal or biomass gasification challenging but also promising. Air and steam gasification processes are proposed with different pros and cons. Finally, co-gasification with fossil-based feedstock or other waste streams is possible, expanding the flexibility of the process. The variability of quality and composition of the feedstock is a significant problem [40].
Gasification seems to be a promising alternative to pyrolysis for chemical recycling of plastic waste, which can produce chemicals or fuels without detailed separation and washing of the feedstocks. It is attractive due to the versatility of potential products. On the other hand, it is related to high capital and operational costs [41]. What is more, currently, only fuels are produced, which might be related to instability of the waste streams, which may cause problems with keeping proper hydrogen to carbon oxide ratio.
Canadian company Enerkem provides the most advanced waste pyrolysis technology. The company currently operates a commercial (TRL 9) plant in Edmonton with a capacity of 38 000 m3/a of methanol and ethanol used as a fuel. Another plant in Canada for fuels and chemicals production with a capacity of 125 000 m3/a is under construction, and two more projects with capacities of 270 000 m3/a of methanol each are developed currently in Europe [42]. Ebara Environmental Plant and Ube Industries from Japan provide gasification of plastic waste through partial oxidation by oxygen and steam. 70 000 tons of plastic waste is processed at Showa Denko’s Kawasaki Plant since 2003. Currently, a feasibility study for the next plant in South Korea is being processed [43].
Chemical recycling of polyethylene and polypropylene gained much attention over the last years due to the rising plastic waste issue. Many projects of demonstration or commercial facilities are currently being developed. Although the definition of chemical recycling is inconsistent worldwide, four main types of products can be identified: intermediates for further chemical processing, fuels and fuel components, monomers and final chemical products. Pyrolysis and gasification are processes that can be used for polyolefins providing mainly open-loop recycling solutions. These technologies require deep feasibility and environmental impact analyses due to their complexity, different values of products, need for co-processing with fossil-based feedstock or high capital cost. Nevertheless, intensive growth of plastic waste volumes is an opportunity for these technologies to be further developed, optimised and commercially used.
The author declares no conflict of interest.
This review is dedicated to Dr. Mieczysław Steininger’s (1950–2021) memory, a well-respected academic, extraordinary scientist and wonderful mentor. On behalf of the Clariter Board, Management, all the staff and especially myself, I would like to thank you for all the research, involvement, impact and inspiration of your extraordinary mind and charming personality.
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