Special Issue "Electronic Waste — Impact, Policy and Green Design"

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A special issue of Challenges (ISSN 2078-1547).

Deadline for manuscript submissions: closed (31 December 2015)

Special Issue Editors

Guest Editor
Prof. Dr. William Bullock

Illinois Sustainable Technology Center, Sustainable Electronics Initiative (SEI), Design for Energy and Environment Laboratory (DEE Lab), School of Art and Design, University of Illinois at Urbana-Champaign, 408 E. Peabody Drive, MC 590, Champaign, IL 61820, USA
Website | E-Mail
Phone: 217.390.8291
Interests: sustainability; product development
Co-Guest Editor
Ms. Joy J. Scrogum

Sustainable Electronics Initiative (SEI), Illinois Sustainable Technology Center (ISTC), Prairie Research Institute, University of Illinois Urbana-Champaign, 1 E. Hazelwood Drive, Champaign, IL 61820, USA
Website | E-Mail
Interests: sustainability; pollution prevention; education

Special Issue Information

Dear Colleagues,

Electronics are at the heart of an economic system that has brought many out of poverty and enhanced quality of life. In Western society in particular, our livelihoods, health, safety, and well being are positively impacted by electronics. However, there is growing evidence that our disposal of electronics is causing irreparable damage to the planet and to human health, as well as fueling social conflict and violence.

While global demand for these modern gadgets is increasing, policy to handle the increased volumes of electronic waste has not kept pace. International policy governing safe transfer, disposal, reclamation, and reuse of electronic waste is nonexistent or woefully lacking. Where laws do exist about exporting and importing hazardous waste, they are routinely circumvented and enforcement is spotty at best. While European Union countries lead the way in responsible recycling of electronic and electrical devices under various EU directives, most industrialized nations do not have such policies. In the U.S., for example, most electronic waste is still discarded in landfills or ground up for scrap.

It is imperative that we consider how green design practices can address the growing electronic waste problem. This special issue is meant to do just that and spur discussions on how electronic products can become greener and more sustainable.

Prof. Dr. William Bullock
Ms. Joy J. Scrogum
Guest Editors

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Challenges is an international peer-reviewed Open Access biannual journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. For the first couple of issues the Article Processing Charge (APC) will be waived for well-prepared manuscripts. English correction and/or formatting fees of 250 CHF (Swiss Francs) will be charged in certain cases for those articles accepted for publication that require extensive additional formatting and/or English corrections.

Keywords

  • e-waste
  • electronics
  • sustainable design
  • conflict minerals
  • planned obsolescence
  • design for the environment
  • recycling
  • refurbishing
  • remanufacturing
  • rare earth elements
  • extended producer responsibility
  • product stewardship
  • lifecycle analysis
  • supply chain
  • EPEAT
  • e-stewards
  • R2
  • WEEE
  • RoHS
  • green engineering
  • green chemistry

Published Papers (7 papers)

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Research

Jump to: Review

Open AccessArticle Potential for Reuse of E-Plastics through Processing by Compression Molding
Challenges 2016, 7(1), 13; doi:10.3390/challe7010013
Received: 22 February 2016 / Revised: 7 May 2016 / Accepted: 10 May 2016 / Published: 19 May 2016
PDF Full-text (2617 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
The amounts of e-waste, consisting of metal (e-metals) and plastic (e-plastics) streams from electronic goods, are increasing in the United States and elsewhere. The e-metals waste streams are being recycled to a reasonable degree due to the value of precious metals. E-plastic waste
[...] Read more.
The amounts of e-waste, consisting of metal (e-metals) and plastic (e-plastics) streams from electronic goods, are increasing in the United States and elsewhere. The e-metals waste streams are being recycled to a reasonable degree due to the value of precious metals. E-plastic waste streams currently are not recycled or reused to a significant extent. As a result, most e-plastics are disposed of by landfilling or thermal treatment, or sent overseas for alleged recycling or reuse, any of which could result in unsafe worker exposure and release into the environment. Two of the major barriers to e-plastics’ reuse or recycling are the mixed plastic content and the presence in the e-plastics of flame retardants (FR), of which two classes in particular, the brominated flame retardants (BFR) and organo-phosphorus flame retardants (OPFR), have associated health concerns. The major goal of this project is to investigate the possibility of direct reuse of e-plastics in compression molding. Preliminary data generated have identified a molding procedure that yields remanufactured e-plastics having a tensile strength of 29.3 MPa. This moderate strength level is suspected to be due to inclusions of plastic bits that did not melt and internal voids from out-gassing. Handheld X-ray fluorescence (XRF) was utilized to characterize elemental components in the e-plastics tested for compression molding. Several high “hits” for Br were found that could not be predicted visually. The preliminary XRF data for BFR and OPFR in this work are helpful for environmental and occupational hazard assessments of compression molding activities. Additionally, methods are suggested to characterize the metals, BFR, and OPFR content of the e-plastics using several different additional laboratory analytical techniques to determine the suitability for cost-effective and easy-to-use technologies. Full article
(This article belongs to the Special Issue Electronic Waste — Impact, Policy and Green Design)
Open AccessArticle Bridging the Gap between Eco-Design and the Human Thinking System
Challenges 2016, 7(1), 5; doi:10.3390/challe7010005
Received: 31 December 2015 / Revised: 19 February 2016 / Accepted: 2 March 2016 / Published: 10 March 2016
PDF Full-text (2379 KB) | HTML Full-text | XML Full-text
Abstract
Technological progress has enabled widespread adoption and use of consumer electronics, changing how global society lives and works. This progress has come with immense environmental cost, including extraction of scarce materials, consumption of fossil fuels, and growing e-waste challenges. Eco-design has emerged as
[...] Read more.
Technological progress has enabled widespread adoption and use of consumer electronics, changing how global society lives and works. This progress has come with immense environmental cost, including extraction of scarce materials, consumption of fossil fuels, and growing e-waste challenges. Eco-design has emerged as a promising approach to reduce the environmental footprint of electronics by integrating sustainability-oriented decisions early in the product realization process. However, most approaches focus on the product itself, not on the consumer who ultimately decides how to purchase, use, maintain, and dispose of the device. This article presents a new framework to guide designers in developing products with features that encourage consumers to use them in an environmentally sustainable manner. The Sustainable Behavior Design (SBD) framework links common design concepts (ergonomic, emotional, preventative, and interaction design) with core aspects of the human thinking system to create features to make users aware of their behavior and decisions (reflective thinking) or result in sustainable behaviors even when users are unaware (automatic thinking). The SBD framework is demonstrated using a case study on a smartphone, a high demand product. The reimagined smartphone design integrates solutions addressing both automatic and reflective thinking systems, potentially reducing life cycle impacts by almost 30%. Full article
(This article belongs to the Special Issue Electronic Waste — Impact, Policy and Green Design)
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Open AccessArticle Practical Eco-Design and Eco-Innovation of Consumer Electronics—the Case of Mobile Phones
Challenges 2016, 7(1), 3; doi:10.3390/challe7010003
Received: 3 December 2015 / Revised: 26 January 2016 / Accepted: 2 February 2016 / Published: 15 February 2016
Cited by 2 | PDF Full-text (1530 KB) | HTML Full-text | XML Full-text
Abstract
Annually, it is estimated that about 4 billion units of consumer electronics for mobile communications are produced worldwide. This could lead to various ecological imbalances unless the design and disposal of the products are handled optimally. To illustrate how industry looks at and
[...] Read more.
Annually, it is estimated that about 4 billion units of consumer electronics for mobile communications are produced worldwide. This could lead to various ecological imbalances unless the design and disposal of the products are handled optimally. To illustrate how industry looks at and responds to the increasing social awareness, this article describes how sustainability is successfully implemented in practice at a large Chinese company, developing and producing various kinds of electronic products used for communication. It also describes how a variety of eco-innovations and business models contribute to reducing the environmental impact; for example, through increased recovery and recycling. A new kind of eco-design procedure is presented along with a new methodology which shows how a mobile phone gradually becomes more sustainable from one generation to the next. The issues with and set-up of new eco-labeling schemes for mobile phones, eco-rating, is described in detail. The conclusion is that due to high competition between companies, the industry acts resourcefully and a lot is done to the save the ecological environment. Full article
(This article belongs to the Special Issue Electronic Waste — Impact, Policy and Green Design)
Open AccessArticle Linking Informal and Formal Electronics Recycling via an Interface Organization
Challenges 2013, 4(2), 136-153; doi:10.3390/challe4020136
Received: 26 April 2013 / Revised: 18 June 2013 / Accepted: 11 July 2013 / Published: 23 July 2013
Cited by 5 | PDF Full-text (530 KB) | HTML Full-text | XML Full-text
Abstract
Informal recycling of electronics in the developing world has emerged as a new global environmental concern. The primary approach to address this problem has been command-and-control policies that ban informal recycling and international trade in electronic scrap. These bans are difficult to enforce
[...] Read more.
Informal recycling of electronics in the developing world has emerged as a new global environmental concern. The primary approach to address this problem has been command-and-control policies that ban informal recycling and international trade in electronic scrap. These bans are difficult to enforce and also have negative effects by reducing reuse of electronics, and employment for people in poverty. An alternate approach is to link informal and formal sectors so as to maintain economic activity while mitigating environmental damages. This article explores the idea of an interface organization that purchases components and waste from informal dismantlers and passes them on to formal processors. Environmental, economic and social implications of interface organizations are discussed. The main environmental questions to resolve are what e-scrap components should be targeted by the interface organization, i.e., circuit boards, wires, and/or plastic parts. Economically, when formal recycling is more profitable (e.g., for circuit boards), the interface organization is revenue positive. However, price subsidies are needed for copper wires and residual waste to incentivize informal dismantlers to turn in for formal processing. Socially, the potential for corruption and gaming of the system is critical and needs to be addressed. Full article
(This article belongs to the Special Issue Electronic Waste — Impact, Policy and Green Design)
Open AccessArticle In Vivo Cytogenotoxicity and Oxidative Stress Induced by Electronic Waste Leachate and Contaminated Well Water
Challenges 2013, 4(2), 169-187; doi:10.3390/challe4020169
Received: 30 May 2013 / Revised: 14 July 2013 / Accepted: 16 July 2013 / Published: 23 July 2013
Cited by 7 | PDF Full-text (661 KB) | HTML Full-text | XML Full-text
Abstract
Environmental, plant and animal exposure to hazardous substances from electronic wastes (e-wastes) in Nigeria is increasing. In this study, the potential cytogenotoxicity of e-wastes leachate and contaminated well water samples obtained from Alaba International Electronic Market in Lagos, Nigeria, using induction of chromosome
[...] Read more.
Environmental, plant and animal exposure to hazardous substances from electronic wastes (e-wastes) in Nigeria is increasing. In this study, the potential cytogenotoxicity of e-wastes leachate and contaminated well water samples obtained from Alaba International Electronic Market in Lagos, Nigeria, using induction of chromosome and root growth anomalies in Allium cepa, and micronucleus (MN) in peripheral erythrocytes of Clarias gariepinus, was evaluated. The possible cause of DNA damage via the assessments of liver malondialdehyde (MDA), catalase (CAT), reduced glutathione (GSH) and superoxide dismutase (SOD) as indicators of oxidative stress in mice was also investigated. There was significant (p < 0.05) inhibition of root growth and mitosis in A. cepa. Cytological aberrations such as spindle disturbance, C-mitosis and binucleated cells, and morphological alterations like tumor and twisting roots were also induced. There was concentration-dependent, significant (p < 0.05) induction of micronucleated erythrocytes and nuclear abnormalities such as blebbed nuclei and binucleated erythrocytes in C. gariepinus. A significant increase (p < 0.001) in CAT, GSH and MDA with concomitant decrease in SOD concentrations were observed in the treated mice. Pb, As, Cu, Cr, and Cd analyzed in the tested samples contributed significantly to these observations. This shows that the well water samples and leachate contained substances capable of inducing somatic mutation and oxidative stress in living cells; and this is of health importance in countries with risk of e-wastes exposure. Full article
(This article belongs to the Special Issue Electronic Waste — Impact, Policy and Green Design)
Figures

Open AccessArticle Integrating Emotional Attachment and Sustainability in Electronic Product Design
Challenges 2013, 4(1), 19-33; doi:10.3390/challe4010019
Received: 5 February 2013 / Revised: 24 February 2013 / Accepted: 4 March 2013 / Published: 14 March 2013
Cited by 1 | PDF Full-text (3329 KB) | HTML Full-text | XML Full-text
Abstract
Current models for Information and Communication Technology (ICT) products encourage frequent product replacement with newer versions that offer only minor incremental improvements. This pattern, named planned obsolescence, diminishes user experience and shortens product lifespan. This paper presents the conceptual basis for a two-part
[...] Read more.
Current models for Information and Communication Technology (ICT) products encourage frequent product replacement with newer versions that offer only minor incremental improvements. This pattern, named planned obsolescence, diminishes user experience and shortens product lifespan. This paper presents the conceptual basis for a two-part integrated approach to combating planned obsolescence in ICT devices. First, design for emotional attachment, which creates products that users enjoy, value, and use for longer. Second, technological adaptability, which anticipates product upgrades and repairs as new technologies emerge. A model interdisciplinary design course in industrial design and sustainability, also described herein, trains students to apply this approach to create innovative ICT products with smaller environmental footprints. Full article
(This article belongs to the Special Issue Electronic Waste — Impact, Policy and Green Design)

Review

Jump to: Research

Open AccessReview Carbon Nanotubes in Electronics: Background and Discussion for Waste-Handling Strategies
Challenges 2013, 4(1), 75-85; doi:10.3390/challe4010075
Received: 26 February 2013 / Revised: 12 March 2013 / Accepted: 24 April 2013 / Published: 7 May 2013
Cited by 1 | PDF Full-text (329 KB) | HTML Full-text | XML Full-text
Abstract
Carbon nanotubes (CNTs) are increasingly being used in electronics products. CNTs have unique chemical and nanotoxicological properties, which are potentially dangerous to public health and the environment. This report presents the most recent findings of CNTs’ toxicity and discusses aspects related to incineration,
[...] Read more.
Carbon nanotubes (CNTs) are increasingly being used in electronics products. CNTs have unique chemical and nanotoxicological properties, which are potentially dangerous to public health and the environment. This report presents the most recent findings of CNTs’ toxicity and discusses aspects related to incineration, recycling and potential remediation strategies including chemical and biological remediation possibilities. Our analysis shows that recycling CNTs may be challenging given their physiochemical properties and that available strategies such as power-gasification methods, biological degradation and chemical degradation may need to be combined with pre-handling routines for hazardous materials. The discussion provides the background knowledge for legislative measures concerning specialized waste handling and recycling procedures/facilities for electronics products containing CNTs. Full article
(This article belongs to the Special Issue Electronic Waste — Impact, Policy and Green Design)

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Type of Paper: Article
Title: Linking Informal and Formal Electronics Recycling via an Interface Organization
Authors: Eric Williams 1,*, Magnus Bengtsson 2, Shiko Hayashi 2, Yasuhiko Hotta 2, Ramzy Kahhat 3 and Yoshiaki Totoki 2
Affiliations: 1 Golisano Institute of Sustainability, Rochester Institute of Technology, 111 Lomb Memorial Drive, Rochester, NY 14623, USA; E-Mail: exwgis@rit.edu
2 Institute for Global Environmental Strategies, Hayama, Kanagawa-ken, Japan
3 Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Perú
Abstract: Informal recycling of electronics in the developing world has emerged as a new global environmental concern. The primary policy approach to address the problem has been command and control policies that ban informal recycling and international trade in electronic scrap. Enforcement of such policies is challenging and as yet largely unsuccessful. An alternate approach is to link informal and formal sectors so as to maintain economic activity while mitigating environmental damages. This article explores the idea of an interface organization that purchases components and waste from informal collectors and dismantlers and passes on to formal processors. This article explores the potential for establishing interface organizations through an analysis of environmental, economic and social aspects. The main environmental questions to resolve are what e-waste components should be targets of the interface organization, and at what point in the chain of processes (collection, refurbishment/repair, component reuse, etc.) should the interface organization intervene to channel material? Economically, the interface organization can be market based (e.g. for circuit boards) and/or publicly subsidized (e.g. for residual waste) depending on its objectives and technical and market conditions. There are questions on how to build a coalition of organizations with the appropriate expertise and financial connections. Socially, the potential for corruption and gaming of the system is critical and needs to be successfully addressed. In the final section of the article, the case of informal and formal recycling of printed circuit boards is discussed in some depth.

Type of Paper: Article
Title: Cytogenotoxicity and Oxidative Stress Induced by Electronic Saste Leachate and Contaminated Groundwater In vivo
Authors: Adekunle A. Bakare 1,*, Adeyinka M. Gbadebo 2, Olusegun I. Ogunsuyi 1, Okunola A. Alabi 1,3 and Chibuisi G. Alimba 1
Affiliation: 1 Cell Biology and Genetics Unit, Department of Zoology, University of Ibadan, Ibadan, Nigeria
2 Ecology and Environmental Biology Unit, Department of Zoology, University of Ibadan, Ibadan, Nigeria
3 Department of Biosciences and Biotechnology, Babcock University, Ilisan Remo, Ogun State, Nigeria
Abstract: Environmental, plant and animal exposure to hazardous substances from electronic wastes (e-wastes) in Nigeria is increasing. In this study, the potential cytogenotoxicity of e-wastes leachate and contaminated well waters obtained from Alaba international electronic market in Lagos, Nigeria, using induction of chromosome and root growth anomalies in Allium cepa, and micronucleus (MN) in peripheral erythrocytes of Clarias gariepinus were evaluated. The possible cause of DNA damage via the assessments of liver malondialdehyde (MDA), catalase (CAT), reduced glutathione (GSH) and superoxide dismutase (SOD) as indicators of oxidative stress in mice was also investigated. There was significant (p<0.05) inhibition of root growth and mitosis in A. cepa. Cytological aberrations such as spindle disturbance, C-mitosis and binucleated cells, and morphological alterations like tumor and twisting roots were also induced. There was concentration-dependent, significant (p<0.05) induction of micronucleated erythrocytes and nuclear abnormalities such as blebbed nuclei and binucleated erythrocytes in C. gariepinus. A significant increase (p<0.001) in CAT, GSH and MDA with concomitant decrease in SOD concentrations were observed in the treated mice. Pb, As, Cu, Cr, and Cd analysed in the tested samples contributed significantly to these observations. This shows that the well waters and leachate contained substances capable of inducing somatic mutation and oxidative stress in living cells; and is of health importance in countries with risk of e-wastes exposure.
Keywords: Cytogenotoxicity; micronucleus; reactive oxygen species; Allium cepa; Clarias gariepinus

Type of Paper: Article
Title: Decision Factors for E-Waste in Northern Mexico: To Waste or Trade
Authors: Jesus Estrada-Ayub 1 and Ramzy Kahhat 2,*
Affiliation: 1. Tecnologico de Monterrey, Mexico
2. Department of Engineering, Pontificia Universidad Catolica del Peru; E-Mail: ramzy.kahhat@pucp.pe
Abstract: Electronic waste (E-waste) is a concern because of the increasing volume of materials being disposed of. There are economical, social and environmental implications derived from these materials. For example, the international trade of used computers creates jobs, but the recovery from valuable materials is technically challenging, and currently there are environmental and health problems derived from inappropriate recycling practices. Forecasting the flows of used computers and e-waste materials supports the prevention of environmental impacts. However, the nature of these material flows is complex. There are technological geographical and cultural factors that affect how users purchase, store or dispose of their equipment. The result of these dynamics is a change in the composition and volume of these flows. Collectors are affected by these factors and the presence of markets, labor and transportation costs. In northern Mexico, there is an international flow of new and used computers between Mexico and the United States and an internal flow of materials and products among Mexican cities. In order to understand the behavior of these flows, a field study was carried out in 8 different Mexican cities. Stakeholders were interviewed and through a structured analysis the system and relevant stakeholders were expressed as Data Flow Diagrams in order to understand the critical parts from the system. The results show that Mexican cities have important qualitative differences. For example, location and size define the availability of resources to manage e-waste. Decisions to dispose of a computer depend on international factors, such as the price of new computers, and also on regional factors such as the cost to repair them. Decisions to store a computer depend on external factors, such as markets, and also internal factors such as how users perceive the value of old equipment. In addition, e-waste collection depends on the value of e-waste, but also on costs to collect and extract value from them. The main implication is that a general policy base on how E-waste is managed at a big city might not be the most efficient for a small one. Moreover, combining strengths from different cities might overcome respective weaknesses and create new opportunities; this integration can be stimulated by designing policies that consider diversity.

Type of Paper: Article
Title: Laptop Battery Charge Cycles as an Indicator of Longevity
Author: Willie Cade
Affiliation: PC Rebuilders & Recyclers, Home of the Computers for Schools Program, 3053 N Knox, Chicago, IL 60641, USA; E-Mail: wpcade@illinois.edu
Abstract: Lithium-ion batteries are a “mature” technology in today's laptop computers. There are new technologies anticipated in the next five years that will significantly increase the longevity and reduce the charge cycle time of lithium-ion batteries. Common wisdom suggests that charge cycles are the determining factor for laptop battery longevity. This paper reviews data collected from an ideal laptop/battery usage scenario. Queen of Peace High School in Burbank, Illinois initiated a one-to-one laptop program for all students starting in 2007. Each student in each grade is issued a similar laptop and battery which includes a nine cell lithium ion battery. Students are required to bring their laptops to school each day fully charged. They are not allowed to charge their batteries during the school day therefore reinforcing the fully charged policy. These conditions meet the manufacturers recommended use for batteries. We examine the correlation of use (i.e. charge cycles) to full charge capacity (FCC). Our results find an unexpectedly low correlation between charge cycles and FCC.

Type of Paper: Article
Title: Technology Trends on a Collision Heading
Authors: Wayne Rifer and Pamela Brody-Heine
Affiliation: Green Electronics Council/EPEAT; E-Mail: WRifer@greenelectronicscouncil.org
Abstract: Two major trends in the arena of high technology and the environment are fast approaching a collision. One is the evolution, based on consumer demand and advancing technologies, of product miniaturization. The other is a growing environmental stakeholder demand to break the back of the take/make/waste society—the eternal enemy of sustainability—as manifested in short lifetimes for throw-away electronic gadgets.

Standing between these trends, and acting as a magnet drawing them towards each other, is the increasing sophistication of the material content of high technology. Products today contain rarely-before-used elements—upwards of 60 elements in all, most of the periodic table. Some of these resources may become supply-challenged for a myriad of causes. Their potential scarcity, the difficulties of mining in a highly populated world, and geo-political forces can affect their supply and challenge the sustainability of the high technology industry.
This paper will examine the factors inherent in this potentially intractable conflict of business and environmental values. It will focus on key resources in these products, some of which occur in very small quantities, but which greatly enhance certain functionalities. These resources are the focus of increasing attention, most notably the report by the International Resource Panel of UNEP “Metal Recycling: Opportunities, Limits and Infrastructure”. This report highlights that they are not currently recovered at substantial rates because recycling systems are not designed to do so. The policies that define effective electronics recycling as achieving higher recovery for bulk materials—ferrous, glass and plastic—neglect the challenges that these more highly evolved products pose for a sustainable world and a sustainable technology industry.

A key to averting this collision lies in redesigning the system—from product design to final treatment—to optimize product reuse (getting longer service from the invested materials, energy and ingenuity) and recycling (extending the use of materials into next-generation products).

Several factors are major impediments. These impediments, and opportunities, relate most especially to miniaturized computing devices in the form of tablets, slates, phones, cameras, etc. They especially exist in two areas:

• The lack of product design for end-of-first-life and end-of-life (EoL):
o Inconsistent design for disassembly to repair, upgrade, refurbish and reuse
o The lack of attention given to design for high value material recovery
• Inefficient EoL systems—collection, processing and treatment—for optimal recovery of valuable resources:
o Conflicted motivations of producer take-back schemes
o Suboptimal treatment options

Finally the paper will examine what some of the paths forward might be, including research, voluntary initiatives and standard setting.

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