Circularity in Practice: Review of Main Current Approaches and Strategic Propositions for an Efficient Circular Economy of Materials

This paper aims to summarize, propose, and discuss existing or emerging strategies to shift towards a circular economy of materials. To clarify the landscape of existing circular practices, a new spectrum is proposed, from product-based strategies, where entire products go through several life cycles without being reprocessed, to material-based approaches, extracting, recycling, and reprocessing materials from the waste flow. As refillable packaging does not lose any functionality or value, when re-used through many life cycles, product-based strategies are globally extremely efficient and must be promoted. It appears however that their implementation is only possible at the scale of individual products such as packaging containers, relying on the cooperation of involved companies and consumers. It appears more and more urgent to focus as well on a more systematic and flexible material-oriented scheme. The example of circular glass recycling is a success in many countries, and technologies become nowadays available to extend such practices to many other materials, such as rigid plastics. An ideal would be to aim at an economy of materials that would imitate the continuous material cycle of the biosphere. Technological and business strategies are presented and discussed, aiming at a relevant impact on circularity.

PHOTOPOLYMERIZED COMPOSITIONS AND LIGHT SOURCES FOR DENTAL PRACTICE (REVIEW)

The review presents an analysis of articles published for the period 2005-2021. in top-rated publications devoted to the research results in the field of creating light-curing (photopolymerizable) compositions for use in dental practice. The information concerning the main ingredients of the compositions: di (meth) acrylate monomers, fillers, pigments, and photoinitiators is summarized. A comparative assessment of light sources, which determine the curing efficiency of materials of such a functional purpose, is presented. The results of a patent search, in the PatentScope database, are presented. For the period 2000-2021. have been identified 692 patents, which are related to the creation of dental photopolymer composites.

P-BN42 Percutaneous cholecystostomy - A practice review

Background Percutaneous cholecystostomy (PC) is performed occasionally in a highly selected group of patients with variable outcomes. The World Society of Emergency Surgery (WSES) updated guidelines(2020) has recommended PC as a treatment modality in patients admitted with ‘acute calculous cholecystitis’(ACC) with who are not fit for surgery, including septic patients and those who show no improvement on conservative management within 48 hours. An audit was organised to review our patient selection for PC in the last 5 years in comparison to the latest WSES recommendations. Methods A retrospective observational study was conducted using a prospectively collected hospital database on patients who underwent PC between March 2016 and March 2021 in a teaching hospital. The patient cohort who underwent PC were compared and analysed against the set WSES guidelines. Results Some 23 patients were included. The median age was 82 years (range-61-90), with 13 females (56.5%) and 10 males (43.5%).19/23(82.6%) patients were at risk of sepsis on presentation, with two or more amber flag symptoms, whereas 4/23(17.4%) patients presented with confirmed sepsis. 19/23 (82.6%) were deemed unfit for surgery against 4/23 who were deemed fit based on the surgeons assessment. Patients unfit for surgery were treated with antibiotics following a diagnosis of ACC. The median time for patients to undergo PC from admission was 4 days. The 30-day mortality rate was 13 % (n = 3/23). Conclusions The study has demonstrated that our current practice for managing patients admitted with ACC and performing PC are mostly in line with the WSES guidelines. Considering individuals presentation and the surgeons clinical judgement into account, the practice was also likely impacted by COVID-19 the global pandemic. Further clinical studies may be required to determine specific patient groups who would benefit from PC.

Marijuana’s Changing Legal Landscape and Its Implications for Adolescent Psychiatrists: A Report from California

Background Objectives: Thirty-three states and the District of Columbia (DC) have enacted some form of legalized cannabis or cannabinoid for medical conditions (MMJ), 11 of them and DC for recreational use. It has become critical for psychiatrists and other mental health professionals working with adolescents to be aware of diversion of marijuana (MJ) to youth and subsequent potential adverse effects in environments with widely different regulations. The experience of two office-based psychiatrists in California (the first state to legalize MMJ) through case presentations and an informal practice review illustrate the role that diverted MMJ plays in the clinical presentation of youth for psychiatric care, highlighting clinical implications and guidelines for treators as states legalize MJ for adult recreational use. Methods: Two child and adolescent psychiatrists practicing in California over the last twenty years report on their experiences working with adolescent patients and their families during the period of legalized MMJ. After a comprehensive literature review, they report their clinical observations and make recommendations for treators of adolescents. Discussion: There is general confusion among adolescents and their parents about MJ and MMJ. There is a lack of clear regulatory guidelines and a need for better clinical training for prescribing physicians. Diversion of MMJ to teens during periods of legalization of medical marijuana is common in states where it has been not legislated or regulated sufficiently to provide effective safeguards. This lax approach is demonstrated by our case reports and clinical review. Similar experiences have been reported elsewhere. Increased problems with diversion are expected as legalization efforts continue. Professionals and their organizations need to become more active in advocating policies to protect youth from potential harm related to cannabis use and abuse and carefully evaluate its use among their teen patients.

Implementing multidisciplinary tumor boards in oncology: a narrative review

The healthcare industry compares unfavorably with other ultra-safe industries such as aviation and nuclear power plants, which address complexity by reducing the vulnerability of a single person and promoting teams and strong systems. A multidisciplinary tumor board (MTB) is an evidence-based organizational approach to implementing a more effective concept in oncology practice. Studies addressing the correlation between MTBs and cancer outcomes show promising results, and other potential benefits are also addressed. The objectives of this article are to define and characterize MTBs in modern oncology practice, review the current literature on MTBs effectiveness and address challenges to the implementation and maintenance of MTBs. In this commentary-type narrative review, the authors present their opinions and, whenever possible, substantiate recommendations by citing supportive literature.

A New Effort to Diversify Faculty: Postdoc-to-Tenure Track Conversion Models

Calls to diversify the professoriate have been ongoing for decades. However, despite increasing numbers of scholars from underrepresented racial minority groups earning doctorates, actual progress in transitioning to faculty has been slow, particularly across STEM disciplines. In recent years, new efforts have emerged to recruit faculty members from underrepresented racial minority groups (i.e., African American/Black, Hispanic/Latinx, and/or Native American/Native Hawaiian/Indigenous) through highly competitive postdoctoral programs that allow fellows the opportunity to transition (or “convert”) into tenure-track roles. These programs hybridize some conventional aspects of the faculty search process (e.g., structured interview processes that facilitate unit buy-in) along with novel evidence-based practices and structural supports (e.g., proactive recruitment, cohort communities, search waivers, professional development, enhanced mentorship, financial incentives). In this policy and practice review, we describe and synthesize key attributes of existing conversion programs at institutional, consortium, and system levels. We discuss commonalities and unique features across models (N = 38) and draw specific insights from postdoctoral conversion models developed within and across institutions in the University System of Maryland (USM). In particular, experience garnered from a 10-year-old postdoc conversion program at UMBC will be highlighted, as well as the development of an additional institutional model aimed at the life sciences, and a state-system model of faculty diversification with support from a NSF Alliances for Graduate Education and the Professoriate (AGEP) grant.

Effectiveness of Take-Home Naloxone Programs in Athletic Training: An Evidence-to-Practice Review

The number of opioid overdoses (ODs) has risen in recent years and has become more complex due to the co-involvement of both prescription and illicit opioid drug use. Provisional programs for take-home naloxone (a medication designed to rapidly reverse opiate OD symptoms) kits have been distributed to combat this potentially fatal epidemic. Although there is strong evidence to support the efficacy of naloxone in the reversal of opiate OD, there is limited evidence to support the efficacy of take-home naloxone (THN) kits. The purpose of this evidence-to-practice review was to summarize a systematic review on the efficacy of THN programs. The authors aimed to include studies of THN programs that both trained opioid users in OD prevention and reported on OD outcomes. The Bradford Hill criteria (strength of association, temporality, consistency, specificity, dose-response relationship, biological plausibility, coherence, experimental evidence, and analogy) and five additional criteria (measure cost-effectiveness, absence of negative consequences, feasibility of implementation/expansion/ coverage, unanticipated benefits, and special populations) was used as dependent variables to determine the impact of public health intervention where randomized control trials (RCTs) are not ethically feasible or operationally practical. All 22 studies included provided empirical support using the Bradford Hill Criteria for community based THN programs. Despite being unable to deduce whether death would have occurred without the administration of THN, the studies combined accounted for an estimated 2316 successful opioid OD reversals. Thus, there is a strong association between THN administration and overdose survival. Additionally, there was a low rate of adverse events: withdrawal symptoms (2.8%), vomiting (2.2%), agitation (2.1%), seizures (0.1%). Consequently, we recommend that athletic trainers include opioid crisis management equipment and procedures in a site-specific policies manual. Clinical relevance is highly dependent on patient population and geographic location, considering 90% of reversed ODs were heroin induced. Application to individuals in organized sport is minimal, but nonetheless, individuals who are prescribed opioids for pain management should be candidates for THN programs. Athletic trainers and guardians of minors prescribed opioid medications should be educated on dispensing medication, best practices for opioid crisis management, and distribution of naloxone/THN.

Opioid Medication Use and Education Following Sports Medicine Procedures: An Evidence-to-Practice Review

According to the Centers for Disease Control (CDC), illicit and prescription drug overdoses are responsible for 128 deaths every day in the United States. In 2018, 70% of all overdose related deaths involved opioids. Efforts to minimize the opioid epidemic focus on community education, research, partnership, and healthcare support. Under the CDC guidelines, current practices include monitoring trends of drug use and drug related deaths, conducting research to recognize areas in need of improvement and to analyze effectiveness of current treatments, partner with community organizations and healthcare systems that deal firsthand with opioid users, and educate the public on drug use, misuse, and overdoses. People are commonly uneducated on the proper use and disposal of their prescription opioids. Consistent and appropriate communication among surgeons and their patients can decrease this risk associated with prescription drugs. The purpose of this evidence-to-practice review was to summarize a systematic review on the current data and findings related to postoperative opioid prescribing and consumption behaviors after a common sports medicine operation. The guiding systematic review explored several ways to reduce the risk of patients developing opioid dependence and abuse due to physicians overprescribing opioids. First, educating each patient about pain management during pre- and postoperative phases, how to store opioids safely, and how to dispose of opioids properly need to be created to help reduce the risk of the patient abusing opioids. Secondly, having the prescribing provider create an extensive history that reveals any red flags for opioid abuse for each patient. Thirdly, the prescribing provider should prescribe the lowest dose and shortest regimen to limit the number of opioids left over. These protocols may help slow the current opioid epidemic.