Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

BACKGROUND: Diabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR).

OBJECTIVES: The primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP?

ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) for efficacy but other designs also used.

REVIEW METHODS: Systematic review and economic modelling.

RESULTS: The Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO.

LIMITATION: The current evidence is insufficient to recommend PRP for severe NPDR.

CONCLUSIONS: There is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005408.

FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Lost in Transition? Emerging forms of residential architecture in Kathmandu

Kathmandu has been the last few cities in the world which retained its medieval urban culture up until twentieth century. Various Hindu and Buddhist religious practices shaped the arrangement of houses, roads and urban spaces giving the city a distinctive physical form, character and a unique oriental nativeness. In recent decades, the urban culture of the city has been changing with the forces of urbanisation and globalisation and the demand for new buildings and spaces. New residential design is increasingly dominated by distinctive patterns of Western suburban ideal comprising detached or semi-detached homes and high rise tower blocks. This architectural iconoclasm can be construed as a rather crude response to the indigenous spaces and builtform. The paper attempts to dismantle the current tension between traditional and contemporary 'culture' (and hence society) and housing (or builtform) in Kathmandu by engaging in a discussion that cuts across space, time and meaning of building. The paper concludes that residential architecture in Kathmandu today stands disoriented and lost in the transition.

Tailoring Plasmonic Metamaterials for Ultrasenstive Detection of Mercury Trace Contaminants via Molecular Logic Gates

Structural and functional information encoded in DNA combined with unique properties of nanomaterials could be of use for the construction of novel biocomputational circuits and intelligent biomedical nanodevices. However, at present their practical applications are still limited by either low reproducibility of fabrication, modest sensitivity, or complicated handling procedures. Here, we demonstrate the construction of label-free and switchable molecular logic gates (AND, INHIBIT, and OR) that use specific conformation modulation of a guanine- and thymine-rich DNA, while the optical readout is enabled by the tunable metamaterials which serve as a substrate for surface enhanced Raman spectroscopy (MetaSERS). Our MetaSERS-based DNA logic is simple to operate, highly reproducible, and can be stimulated by ultra-low concentration of the external inputs, enabling an extremely sensitive detection of mercury ions down to 2×10-4 ppb, which is four orders of magnitude lower than the exposure limit allowed by United States Environmental Protection Agency

Influence of trace substances on methanation catalysts used in dynamic biogas upgrading

The aim of this work was to study the possible deactivation effects of biogas trace ammonia concentrations on methanation catalysts. It was found that small amounts of ammonia led to a slight decrease in the catalyst activity. A decrease in the catalyst deactivation by carbon formation was also observed, with ammonia absorbed on the active catalyst sites. This was via a suppression of the carbon formation and deposition on the catalyst, since it requires a higher number of active sites than for the methanation of carbon oxides. From the paper findings, no special pretreatment for ammonia removal from the biogas fed to a methanation process is required.

Impact of age, various forms of cataract, and visual acuity on whole-field scotopic sensitivity screening for glaucoma in rural Taiwan.

OBJECTIVE: To evaluate the impact of age, various forms of cataract, and visual acuity on whole-field scotopic sensitivity screening for glaucoma in a rural population. DESIGN: Clinic-based study with population-based recruitment. SETTING: Jin Shan Township near Taipei, Taiwan. SUBJECTS: Three hundred forty-six residents (ages, > or = 40 years) of Jin Shan Township. INTERVENTIONS: Whole-field scotopic testing, ophthalmoscopy with dilation of the pupils, cataract grading against photographic standards, and screening visual field testing in a random one-third subsample. MAIN OUTCOME MEASURES: Whole-field scotopic sensitivity (in decibels) and diagnostic status as a case of glaucoma, glaucoma suspect, or normal. RESULTS: Participants in Jin Shan Township did not differ significantly in the rate of blindness, low visual acuity, or family history of glaucoma from a random sample of nonrespondents. Scotopic sensitivity testing detected 100% (6/6) of subjects with open-angle glaucoma at a specificity of 80.2%. The mean +/- SE scotopic sensitivity for six subjects with open-angle glaucoma (32.78 +/- 1.51 dB) differed significantly from that of 315 normal individuals (38.51 +/- 0.22 dB), when adjusted for age and visual acuity (P = .05, t test). With linear regression modeling, factors that correlated significantly with scotopic sensitivity were intraocular pressure, screening visual field, best corrected visual acuity, presence of cortical cataract, and increasing age. CONCLUSIONS: Although cataract affects the whole-field scotopic threshold, it appears that scotopic testing may be of value in field-based screening for glaucoma.

Institutional Hybridity in Public Sector Reform: Replacement, Blending, or Layering of Administrative Paradigms

Despite an abundance of studies on hybridization and hybrid forms of organizing, scholarly work has failed to distinguish consistently between specific types of hybridity. As a consequence, the analytical category has become blurred and lacks conceptual clarity. Our paper discusses hybridity as the simultaneous appearance of institutional logics in organizational contexts, and differentiates the parallel co-existence of logics from transitional combinations (eventually leading to the replacement of a logic) and more robust combinations in the form of layering and blending. While blending refers to hybridity as an ‘amalgamate’ with original components that are no longer discernible, the notion of layering conceptualizes hybridity in a way that the various elements, or clusters thereof, are added on top of, or alongside, each other, similar to sediment layers in geology. We illustrate and substantiate such conceptual differentiation with an empirical study of the dynamics of public sector reform. In more detail, we examine the parliamentary discourse around two major reforms of the Austrian Federal Budget Law in 1986 and in 2007/2009 in order to trace administrative (reform) paradigms. Each of the three identified paradigms manifests a specific field-level logic with implications for the state and its administration: bureaucracy in Weberian-style Public Administration, market-capitalism in New Public Management, and democracy in New Public Governance. We find no indication of a parallel co-existence or transitional combination of logics, but hybridity in the form of robust combinations. We explore how new ideas fundamentally build on – and are made resonant with – the central bureaucratic logic in a way that suggests layering rather than blending. The conceptual findings presented in our article have implications for the literature on institutional analysis and institutional hybridity.

Detecting obfuscated malware using reduced opcode set and optimised runtime trace

The research presented, investigates the optimal set of operational codes (opcodes) that create a robust indicator of malicious software (malware) and also determines a program’s execution duration for accurate classification of benign and malicious software. The features extracted from the dataset are opcode density histograms, extracted during the program execution. The classifier used is a support vector machine and is configured to select those features to produce the optimal classification of malware over different program run lengths. The findings demonstrate that malware can be detected using dynamic analysis with relatively few opcodes.

A study of singular integral operators with shift

Nesta tese, consideram-se operadores integrais singulares com a acção extra de um operador de deslocacamento de Carleman e com coeficientes em diferentes classes de funções essencialmente limitadas. Nomeadamente, funções contínuas por troços, funções quase-periódicas e funções possuíndo factorização generalizada. Nos casos dos operadores integrais singulares com deslocamento dado pelo operador de reflexão ou pelo operador de salto no círculo unitário complexo, obtêm-se critérios para a propriedade de Fredholm. Para os coeficientes contínuos, uma fórmula do índice de Fredholm é apresentada. Estes resultados são consequência das relações de equivalência explícitas entre aqueles operadores e alguns operadores adicionais, tais como o operador integral singular, operadores de Toeplitz e operadores de Toeplitz mais Hankel. Além disso, as relações de equivalência permitem-nos obter um critério de invertibilidade e fórmulas para os inversos laterais dos operadores iniciais com coeficientes factorizáveis. Adicionalmente, aplicamos técnicas de análise numérica, tais como métodos de colocação de polinómios, para o estudo da dimensão do núcleo dos dois tipos de operadores integrais singulares com coeficientes contínuos por troços. Esta abordagem permite também a computação do inverso no sentido Moore-Penrose dos operadores principais. Para operadores integrais singulares com operadores de deslocamento do tipo Carleman preservando a orientação e com funções contínuas como coeficientes, são obtidos limites superiores da dimensão do núcleo. Tal é implementado utilizando algumas estimativas e com a ajuda de relações (explícitas) de equivalência entre operadores. Focamos ainda a nossa atenção na resolução e nas soluções de uma classe de equações integrais singulares com deslocamento que não pode ser reduzida a um problema de valor de fronteira binomial. De forma a atingir os objectivos propostos, foram utilizadas projecções complementares e identidades entre operadores. Desta forma, as equações em estudo são associadas a sistemas de equações integrais singulares. Estes sistemas são depois analisados utilizando um problema de valor de fronteira de Riemann. Este procedimento tem como consequência a construção das soluções das equações iniciais a partir das soluções de problemas de valor de fronteira de Riemann. Motivados por uma grande diversidade de aplicações, estendemos a definição de operador integral de Cauchy para espaços de Lebesgue sobre grupos topológicos. Assim, são investigadas as condições de invertibilidade dos operadores integrais neste contexto.

A Prosodia de Bento Pereira: contributos para o estudo lexicográfico e filológico

O presente trabalho tem por objecto de estudo o conjunto lexicográfico da Prosodia de Bento Pereira e a recuperação do seu texto. Foi feito o registo integral do texto dicionarístico em suporte digital, totalmente editável. Neste trabalho apresenta-se o estudo da obra no que respeita às suas características lexicográficas e percurso bibliográfico. Dilucida-se ainda o percurso editorial deste conjunto dicionarístico, sobre o qual têm subsistido algumas discrepâncias. A observação do léxico português deste conjunto editorial ocupa uma boa parte deste trabalho. Trata-se de um corpus de grandes dimensões que é constituído por 46 067 formas portuguesas não lematizadas e com numerosas variantes gráficas. Apresentam-se alguns dados estatísticos dos subcorpora português e latino. A confrontação destes corpora permite ainda a observação de testemunhos de relatinização do português e de transferência de sufixos latinos muito produtivos. Observam-se também alguns aspectos do léxico português que assinalam o seu percurso diacrónico. São feitas anotações relativas à formação de palavras através da crescente disponibilidade do sistema sufixal.

Educar (para) o pensar : desenvolvimento de competências reflexíveis em professores e alunos do 1º CEB : contributos da "Filosofia para Crianças"

O presente estudo inscreve-se na área científica da Formação de Professores, incidindo, particularmente, na compreensão do processo de desenvolvimento das competências reflexivas percebidas como factor de promoção do seu próprio desenvolvimento profissional e pessoal, do desenvolvimento da capacidade de pensar dos seus alunos, da revalorização dos processos curriculares de ensino-aprendizagem e de inovação dos contextos educacionais. Num contexto de complexidade, incerteza e mudança, importa repensar estratégias de formação de professores e de alunos para que possam constituir-se como fatores potenciadores do desenvolvimento da competência reflexiva. Estratégias que convocam, quer o professor, quer o aluno, para um tipo de questionamento de maior exigência reflexiva e consideradas potenciadoras do pensamento crítico, criativo e de cuidado com o outro, numa perspetiva educativa centrada no cuidar, que valoriza a dimensão humana, a atuação responsável, ética e solidária, em todos os planos da vida. Neste estudo propomo-nos retomar algumas das estratégias de formação já configuradas no movimento Filosofia para Crianças e que se constituíram como um programa de formação em contexto, no qual se procurou aprofundar e compreender as múltiplas dimensões e modos como interatuam os diferentes participantes da relação educativa em práticas curriculares reconfiguradas à luz dos pressupostos que sustentam este estudo. Do ponto de vista metodológico, a investigação inscreve-se num paradigma de natureza qualitativa e interpretativa, de matriz hermenêutica e ecológica, configurando uma abordagem de tipo complexo, e com características de estudo de caso, que considera indispensável a participação ativa do sujeito na construção do conhecimento próprio, bem como o carácter de imprevisibilidade e de recursividade das condições e subsistemas em que tal ocorre. No sentido de construir uma visão integrada do objeto em estudo, foram desenvolvidos procedimentos específicos (mixed-methods), nomeadamente análise documental, entrevista semiestruturada, observação participante e inquirição por questionário. O estudo, que decorreu na região centro do país, envolveu 5 professoras do 1.º Ciclo do Ensino Básico, 100 alunos do mesmo nível de ensino e os seus pais/encarregados de educação, inquiridos através de questionário e desenvolveu-se em duas fases. A primeira destinou-se à formação teórico-prática das professoras e, na segunda, foram desenvolvidas sessões práticas de Filosofia para Crianças com os alunos. Os portfolios reflexivos construídos pelos participantes e pela investigadora principal constituíram outra fonte da informação recolhida no estudo empírico. Os resultados do estudo situam-se a quatro níveis: no que respeita aos saberes básicos, ao perfil de competência dos professores, à sua formação e às estratégias e recursos considerados como potenciadores de um pensar de mais elevada qualidade. Quanto ao primeiro nível, o presente estudo releva o carácter estruturante e epistémico de aprender a pensar (bem), salientando que este se processa numa maior amplitude e profundidade dos conteúdos da própria reflexão, às quais subjaz uma visão ampla de cidadania planetária e socialmente comprometida, evidenciando uma ampliação do quadro referencial dos saberes básicos e considerados imprescindíveis para a educação dos cidadãos. A um segundo nível, salienta-se a exigência de um perfil de competência profissional que permita aos professores desenvolver nos seus alunos um pensar de qualidade e, simultaneamente, melhorar a sua própria competência reflexiva. Neste sentido, o estudo aponta para a continuidade das respostas que têm vindo a ser equacionadas por vários autores nacionais e internacionais que, ao abordarem a problemática da formação, do conhecimento profissional e do desenvolvimento identitário dos professores, têm acentuado a importância dos modelos crítico-reflexivos da formação e de uma supervisão ecológica, integradora, não standard e humanizada, no desenvolvimento das sociedades contemporâneas. Conforme os dados sugerem, admite-se que a formação integral dos cidadãos passa pela inclusão e interligação de diferentes áreas do conhecimento que, concertada e complementarmente, possam contribuir para o desenvolvimento da sensibilidade, do pensamento crítico e criativo, de uma cultura da responsabilidade e de uma atitude ética mais ativa e interventiva. Neste sentido, reafirma-se a importância de um trajeto formativo que promova a efetiva articulação entre teoria e a prática, o diálogo crítico-reflexivo entre saberes científicos e experiência, que focalize o profissional na sua praxis e saliente a sua conexão com o saber situado em contexto vivencial e didático- -pedagógico. Realça-se a pertinência de dinâmicas formativas que, a exemplo de “comunidades de investigação/aprendizagem”, na sua aceção de redes de formação que, na prossecução de projetos e propósitos comuns, incentivam a construção de itinerários próprios e de aprendizagens individuais, mobilizando processos investigativos pessoais e grupais. Evidencia-se a valorização de práticas promotoras da reflexão, do questionamento, da flexibilidade cognitiva como eixos estruturadores do pensamento e da ação profissional e como suporte do desenvolvimento profissional e pessoal, corroborando a importância dos processos transformadores decorrentes da experiência, da ação e da reflexão sobre ela. Finalmente, no que respeita às estratégias e recursos, os dados permitem corroborar a riqueza e o potencial do uso de portfolios reflexivos no desenvolvimento de competências linguísticas, comunicacionais, reflexivas e meta-reflexivas e o entendimento de que o processo de construção da identidade profissional ocorre e desenha-se numa dinâmica reflexiva- -prospetiva (re)confirmadora ou (re)configuradora de ideias, convicções, saberes e práticas, ou seja, identitária. De igual modo, a investigação releva a importância da construção de portfolios, por parte dos alunos, para o desenvolvimento da qualidade do seu pensamento, sublinhando-se o seu carácter inovador nesta área. Evidencia-se, ainda, a diversidade de estratégias que respeitem os interesses, necessidades e expectativas dos alunos e o seu contexto de vida, tal como o recurso a materiais diversificados que, atentos ao conteúdo da mensagem, possibilitem a autonomia do pensamento, o exercício efetivo da reflexão crítica e do questionamento, na sua articulação com as grandes questões que sempre despertaram a curiosidade humana e cuja atualidade permanece. Materiais e recursos que estabeleçam o diálogo entre razão e imaginação, entre saber e sensibilidade, que estimulem o envolvimento dos alunos na resolução de problemas e na procura conjunta de soluções e na construção de projetos individuais na malha dos projetos comuns. Reafirma-se, pois, a importância da humanização do saber, a educação pensada como vivência solidária de direitos e deveres. Uma perspetiva educacional humanista que assenta nas trajetórias de vida, na recuperação de experiências pessoais e singulares, que procura compreender a identidade como um processo em (re)elaboração permanente. O presente estudo integra-se na rede de cooperação científica Novos saberes básicos dos alunos no século XXI, novos desafios à formação de professores sendo que, e na linha das investigações produzidas neste âmbito, destaca que o alargamento das funções do professor do 1.º Ciclo do Ensino Básico, que colocando a tónica da ação pedagógica no como se aprende e para quê e na possibilidade de aprender e incorporar o imprevisível, incide no desenvolvimento de um conjunto de capacidades que vão para além das tradicionalmente associadas ao ensinar a ler, escrever e contar. Releva-se, pois, a pertinência da criação de ambientes educativos nos quais professores e alunos entreteçam, conjunta e coerentemente, conhecer, compreender, fazer, sentir, dizer, ver, ouvir e (con)viver em prol de uma reflexão que nos encaminhe no sentido de ser(mos) consciência.

Control design for multicast-aware class-based networks

The expectations of citizens from the Information Technologies (ITs) are increasing as the ITs have become integral part of our society, serving all kinds of activities whether professional, leisure, safety-critical applications or business. Hence, the limitations of the traditional network designs to provide innovative and enhanced services and applications motivated a consensus to integrate all services over packet switching infrastructures, using the Internet Protocol, so as to leverage flexible control and economical benefits in the Next Generation Networks (NGNs). However, the Internet is not capable of treating services differently while each service has its own requirements (e.g., Quality of Service - QoS). Therefore, the need for more evolved forms of communications has driven to radical changes of architectural and layering designs which demand appropriate solutions for service admission and network resources control. This Thesis addresses QoS and network control issues, aiming to improve overall control performance in current and future networks which classify services into classes. The Thesis is divided into three parts. In the first part, we propose two resource over-reservation algorithms, a Class-based bandwidth Over-Reservation (COR) and an Enhanced COR (ECOR). The over-reservation means reserving more bandwidth than a Class of Service (CoS) needs, so the QoS reservation signalling rate is reduced. COR and ECOR allow for dynamically defining over-reservation parameters for CoSs based on network interfaces resource conditions; they aim to reduce QoS signalling and related overhead without incurring CoS starvation or waste of bandwidth. ECOR differs from COR by allowing for optimizing control overhead minimization. Further, we propose a centralized control mechanism called Advanced Centralization Architecture (ACA), that uses a single state-full Control Decision Point (CDP) which maintains a good view of its underlying network topology and the related links resource statistics on real-time basis to control the overall network. It is very important to mention that, in this Thesis, we use multicast trees as the basis for session transport, not only for group communication purposes, but mainly to pin packets of a session mapped to a tree to follow the desired tree. Our simulation results prove a drastic reduction of QoS control signalling and the related overhead without QoS violation or waste of resources. Besides, we provide a generic-purpose analytical model to assess the impact of various parameters (e.g., link capacity, session dynamics, etc.) that generally challenge resource overprovisioning control. In the second part of this Thesis, we propose a decentralization control mechanism called Advanced Class-based resource OverpRovisioning (ACOR), that aims to achieve better scalability than the ACA approach. ACOR enables multiple CDPs, distributed at network edge, to cooperate and exchange appropriate control data (e.g., trees and bandwidth usage information) such that each CDP is able to maintain a good knowledge of the network topology and the related links resource statistics on real-time basis. From scalability perspective, ACOR cooperation is selective, meaning that control information is exchanged dynamically among only the CDPs which are concerned (correlated). Moreover, the synchronization is carried out through our proposed concept of Virtual Over-Provisioned Resource (VOPR), which is a share of over-reservations of each interface to each tree that uses the interface. Thus, each CDP can process several session requests over a tree without requiring synchronization between the correlated CDPs as long as the VOPR of the tree is not exhausted. Analytical and simulation results demonstrate that aggregate over-reservation control in decentralized scenarios keep low signalling without QoS violations or waste of resources. We also introduced a control signalling protocol called ACOR Protocol (ACOR-P) to support the centralization and decentralization designs in this Thesis. Further, we propose an Extended ACOR (E-ACOR) which aggregates the VOPR of all trees that originate at the same CDP, and more session requests can be processed without synchronization when compared with ACOR. In addition, E-ACOR introduces a mechanism to efficiently track network congestion information to prevent unnecessary synchronization during congestion time when VOPRs would exhaust upon every session request. The performance evaluation through analytical and simulation results proves the superiority of E-ACOR in minimizing overall control signalling overhead while keeping all advantages of ACOR, that is, without incurring QoS violations or waste of resources. The last part of this Thesis includes the Survivable ACOR (SACOR) proposal to support stable operations of the QoS and network control mechanisms in case of failures and recoveries (e.g., of links and nodes). The performance results show flexible survivability characterized by fast convergence time and differentiation of traffic re-routing under efficient resource utilization i.e. without wasting bandwidth. In summary, the QoS and architectural control mechanisms proposed in this Thesis provide efficient and scalable support for network control key sub-systems (e.g., QoS and resource control, traffic engineering, multicasting, etc.), and thus allow for optimizing network overall control performance.

Sustainability study of the application of geosynthetic clay liners in hostile and aggressive environments

This paper discusses the sustainable performance of geosynthetic clay liners (GCLs) which are popularly specified as “leachate retaining” or as “water proofing” membranes in the geo-environmental construction industry. Geosynthetic clay liners (GCLs) are composite matting comprising of bentonite clay with two covering geosynthetics. These are innovative labour saving construction material, developed over the last three decades. The paper outlines the variety of Geosynthetic Clay Liners (GCLs) can be classified essentially into two distinctly different forms viz; (a) air dry (< 8% m/c) with granular or powdered bentonite or (b) bentonite cake factory prehydrated to a moisture content (~40% m/c) beyond its shrinkage limit and vacuum extruded as a clay cake to enhance its sustainable performance. The dominant mineral in bentonite clay is the three-layered (2:1) clay mineral montmorillonite. High quality bentonites need to be used in the GCL manufacture. Sodium montmorillonite has the desired characteristic of high swelling capacity, high cation exchange capacity and the consequently very low hydraulic conductivity, providing the basis for the hydraulic sealing medium in GCLs. These encapsulate the active montmorillonite clay minerals which depend on the water and chemical balance between the sealing element and the surrounding geo environment. Quantitative mineralogical analyses and an assessment of the adsorbed cation regime, diffusion coefficients and clay leachate compatibility must necessarily be an integral part of the site appraisal to ensure acceptable long term sustainability and performance. Factors influencing the desired performance of bentonite in the GCLs placed in difficult construction and hostile chemical environments are discussed in this paper. Accordingly, the performance specifications for GCLs are identified and the appropriateness of enhancing the cation exchange capacity with polymer treatment and the need for factory prehydration of the untreated sodium bentonite is emphasised. The advantage of factory prehydrating the polymer treated bentonite to fluid content beyond its shrinkage limit and subsequently factory processing it to develop laminated clay is to develop a GCL that has enviable sealing characteristics with a greater resistance to geochemical attack and cracking. Since clay liners are buried in the ground as base liners, capping layer or as structural water proofing membrane, they can easily avoid strict quality and performance monitoring being “out of sight, out of mind!”. It is very necessary that barrier design for leachate containment must necessarily be in accordance with legislative requirement Assessment of long term hydraulic conductivities and clay-leachate compatibility assessment is deemed necessary. The derogatory factors affecting the sustainable performance of the bentonite in GCLs placed in difficult construction and hostile chemical environments are discussed. Sustainability concepts incorporated in waste management practice must aim to achieve 100% recycling and fully implement the handling of solid waste in developing countries with relatively lower labour costs.