The perceptions and adoption of environmentally sustainable practices among anesthesiologists-a qualitative study.

PURPOSE: Previous surveys of anesthesiologists showed that despite a strong interest in implementing environmentally sustainable anesthetic practices, less than a third do so. Qualitative understanding of the capability, opportunity, and motivational factors that influence "green" behavior will inform the design of effective interventions to promote environmentally sustainable practices in the operating room (OR). METHODS: We conducted 23 semistructured interviews with anesthesiologists, with data saturation achieved. Applying the Behavior Change Wheel, interview questions addressed "capability," "opportunity," and "motivation" determinants of behavior. RESULTS: Preference for sevoflurane and syringe reuse were most commonly cited as existing environmentally sustainable anesthetic practices. Several participants reported lack of knowledge and feedback as impediments to sustainable anesthetic practices. Reported physical barriers included inadequate recycling facilities and abundance of supplies. Interviewees also discussed the importance of habitual behavior in improving skill sets and reducing cognitive load required to perform environmentally sustainable practices. General awareness of environmental issues and aggregation of marginal gains were reasons for environmentally sustainable measures in the OR. Organizational practice and culture played a significant role in the propagation of sustainable anesthetic practices, with senior staff often carrying a greater influence. While the majority preferred a top-down approach to effect change, others favored the use of incentives. CONCLUSION: This study provides insight into the factors that influence the adoption of environmentally sustainable practices in the OR. Measures to promote these practices include education and training, feedback on efforts, engagement of senior anesthetists as role models and for change management, environmental restructuring, and policy designs that balance a top-down vs bottom-up approach to influencing change.

RéSUMé: OBJECTIF: Des enquêtes antérieures auprès d'anesthésiologistes ont montré que, malgré un vif intérêt pour la mise en œuvre de pratiques anesthésiques durables sur le plan environnemental, moins d'un tiers les mettent en pratique. La compréhension qualitative de la capacité, des possibilités et des facteurs de motivation qui influencent les comportements « verts ¼ éclairera la conception d'interventions efficaces pour promouvoir des pratiques durables sur le plan environnemental en salle d'opération. MéTHODE: Nous avons mené 23 entretiens semi-structurés avec des anesthésiologistes, avec une saturation des données atteinte. En appliquant la roue du changement de comportement, les questions d'entrevue portaient sur les déterminants du comportement liés à la « capacité ¼, à l'« occasion ¼ et à la « motivation ¼. RéSULTATS: La préférence pour le sévoflurane et la réutilisation des seringues ont été le plus souvent citées comme des pratiques anesthésiques durables. Plusieurs participants ont signalé que le manque de connaissances et de rétroaction constituait un obstacle à des pratiques anesthésiques durables. Parmi les obstacles physiques signalés, mentionnons l'insuffisance des installations de recyclage et l'abondance des fournitures. Les personnes interrogées ont également discuté de l'importance du comportement habituel pour améliorer les compétences et réduire la charge cognitive requise pour mettre en œuvre des pratiques durables. La prise de conscience générale des questions environnementales et l'agrégation des gains marginaux étaient les raisons citées pour lesquelles des mesures écologiquement viables ont été prises en salle d'opération. La pratique organisationnelle et la culture ont joué un rôle important dans la diffusion de pratiques anesthésiques durables, les cadres supérieurs ayant souvent une plus grande influence. Alors que la majorité préférerait une approche descendante pour apporter des changements, d'autres étaient en faveur de l'utilisation d'incitatifs. CONCLUSION: Cette étude donne un aperçu des facteurs qui influencent l'adoption de pratiques durables sur le plan environnemental en salle d'opération. Les mesures visant à promouvoir ces pratiques comprennent l'éducation et la formation, la rétroaction sur les efforts, l'engagement des anesthésistes plus établis ou senior en tant que modèles et gestionnaires du changement, la restructuration environnementale et la conception de politiques qui équilibrent une approche descendante vs une approche ascendante pour influencer le changement.

Sensitivity analysis for the SimpleTreat model to simulate fate of chemicals in sewage treatment plants.

SimpleTreat 3.1 predicts the distribution and elimination of chemicals by sewage treatment. The model is used as the default calculation in EUSES 2.0 to estimate exposure concentration in the receiving water, soil and air. A sensitivity analysis was performed to rank input parameters according to their influence on model predictions. Triclosan was selected for the base case. The sewage flow, degradation rates and parameters describing the raw sewage were shown to be the most sensitive inputs. The pH and dissociation constant are very sensitive parameters when working with ionisable compounds. Variation in certain input parameters was propagated through the model to yield greater variation in output parameters with a maximum ratio of 4.0. SimpleTreat 3.1 is a steady state model describing a highly non-steady system. A large variability in the most sensitive parameters is expected within a single sewage plant and parameters should therefore be selected to cover this variability.

Changes in pesticide adsorption with time at high soil to solution ratios.

Adsorption of six pesticides (2,4-D, dicamba, fluroxypyr, fluazifop-P, metsulfuron-methyl and flupyrsulfuron-methyl) in nine contrasting soils was measured using two techniques: (i) a classical batch method and (ii) a centrifugation method that allowed the measurement of adsorption at a realistic soil to solution ratio after one and seven days. Although the batch method gived significantly higher values of Kd than the centrifugation method for the more strongly sorbed molecules in the more sorptive soils, it tended to give lower adsorption coefficients compared to the centrifugation method when adsorption was lower. Discrepancies between the two methods were probably mainly due to the vigorous shaking applied in the batch technique that artificially enhances the availability of adsorption sites. This implies that shortly after application, more pesticide may be present in the soil solution and thus be available for degradation, plant uptake or leaching than will be predicted from adsorption coefficient determined using the batch method. Adsorption significantly increased between one and seven days and the extractability of total residues decreased with time. The increase in adsorption was not directly related to the level of adsorption although it was more important in soils containing more organic carbon (p=0.022). These results confirm the importance of time-dependent processes and the necessity to include them in risk assessment procedures. The centrifugation technique is a useful method to measure adsorption of pesticides at realistic soil moisture contents and seems to be an adequate technique to characterise the fraction of pesticide that is available for leaching at a given time after application.

Adsorption of ionisable pesticides in soils.

Understanding the fate of a pesticide in soil is fundamental to the accurate assessment of its environmental behaviour and vital in ensuring the safe use of new and existing products. Ionisable pesticides comprise a significant proportion of both existing and new active substances registered for use in agriculture worldwide. This group of pesticides includes chemicals that are frequently found in groundwater and surface waters in many different countries. Despite this, approaches to predict the influence of soil properties on the behaviour of ionisable pesticides in soils are poorly developed. Current regulatory assessments frequently default to methods developed for nonionic chemicals, although it is evident that ionisable compounds do not often react like neutral molecules. This review presents the state of knowledge on the adsorption of ionisable pesticides in soils. It first introduces the issues concerning adsorption and the characteristics of this particular kind of chemical. The mechanisms postulated for the adsorption of ionisable pesticides are then described: these are hydrophobic partitioning, ionic exchange, charge transfer, ligand exchange, cation or water bridging, and the formation of bound residues. Relatively little experimental evidence is available, and we are still unable to determine the quantitative contribution of each process in a particular situation. Knowledge is still lacking concerning phenomena occurring at the surfaces of soil particles. Measurements do not allow determination of the operative pH at the surface of soil particles or in microenvironments, and the influence of ionic strength or competition effects is difficult to assess. Subsequently, the review focuses on the influence of soil properties on adsorption and on potential to predict the behaviour of ionisable pesticides in soils. Unlike hydrophobic compounds, adsorption of ionisable pesticides is highly sensitive to variation in pH. This relationship mainly derives from the different proportion of ionic and neutral forms of the pesticide present at each pH level but also from the presence of surfaces with pH-dependent charges in soils. Soil organic matter generally promotes adsorption, although a negative influence has sometimes been reported. Clay and oxides can also play a significant role in some cases. So far, no modelling approach has been applied successfully to a range of ionisable pesticides to predict their adsorption in soils. The standardization of experimental settings and the application of approaches specific to a particular class of pesticide or different type of soil might be necessary to describe the complexity of interactions among ionisable molecules. Degradation of ionisable pesticides is influenced by soil pH in a particular way that relates to changes in sorption, changes in composition and activity of the microbial community, and to shifts in the balance between different degradative mechanisms.

Antisense abrogation of DENN expression induces apoptosis of leukemia cells in vitro, causes tumor regression in vivo and alters the transcription of genes involved in apoptosis and the cell cycle.

We previously reported that messenger RNA expression of DENN (differentially expressed in normal and neoplastic cells) is considerably higher in cancer cell lines than in normal cells. In our present study, we established that certain cancer cell lines express conspicuously higher levels of the 2 DENN isoforms in contrast to the 2 pro-apoptotic IG20 isoforms. Antisense DENN oligodeoxynucleotide treatment of K36 cells in vitro induced extensive apoptosis, while antisense DENN silencing of K36 tumor-bearing mice caused significant tumor regression in vivo. Compared to wild-type murine embryonic fibroblasts, antisense treatment of NFkappaB and TNFR1 KO cells resulted in markedly more pronounced cell death, whereas antisense-treated TNFalpha and TNFR2 knockouts exhibited less prominent apoptosis. Cell viability and apoptosis were authenticated by flow cytometry, membrane integrity, TUNEL, annexin V assays, histology and electron microscopy. Antisense abrogation of DENN expression culminated in upregulated expression of TNFR2, TRAIL and Fas, but downregulation of TNFalpha, TNFR1 and cyclin D3. Conversely, DENN overexpression stimulated cell proliferation and led to upregulated TRPM2 and cyclin B1, but diminished expression of Fas, TNFR2, TRAIL and Egr-1. The participation of TNFalpha, TNFR1, TNFR2 and Fas in the inhibition of DENN expression was also demonstrated. These data support the anti-apoptotic and cell survival role of DENN, especially in malignant cells, and its interaction with specific genes and proteins involved in the apoptotic and cell cycle pathways.

Clinical update--the teeth and the maxillary sinus: the mutual impact of clinical procedures, disease conditions and their treatment implications. Part 3. But doctor, my ear hurts.

Temporomandibular disorders (TMD) can present as an array of symptoms that can mimic both odontogenic and ear, nose, and throat (ENT) disorders. Dentists need to be alert to the possibility of primary ENT disorders in patients who present with TMD symptoms, as should ENT physicians be familiar with the clinical presentation of TMD, especially in those patients who present with ENT symptoms but no sign of ENT disease.