Informed Consent in Complementary and Alternative Medicine

The objective of this study was to examine complementary and alternative medicine (CAM) practitioners' (i) attitudes toward informed consent and (ii) to assess whether standards of practice exist with respect to informed consent, and what these standards look like. The design and setting of the study constituted face-to-face qualitative interviews with 28 non-MD, community-based providers representing 11 different CAM therapeutic modalities. It was found that there is great deal of variability with respect to the informed consent process in CAM across providers and modalities. No unique profession-based patterns were identified. The content analysis yielded five major categories related to (i) general attitude towards the informed consent process, (ii) type and amount of information exchange during that process, (iii) disclosure of risks, (iv) discussions of alternatives, and (v) potential benefits. There is a widespread lack of standards with respect to the practice of informed consent across a broad range of CAM modalities. Addressing this problem requires concerted and systematic educational, ethical and judicial remedial actions. Informed consent, which is often viewed as a pervasive obligation is medicine, must be reshaped to have therapeutic value. Acknowledging current conceptions and misconception surrounding the practice of informed consent may help to bring about this change. More translational research is needed to guide this process

Environmental impacts of using desalinated water in concrete production in areas affected by freshwater scarcity

Up to 500 litres of water may be consumed at the batching plant per cubic meter of ready mix concrete, if water for washing mixing trucks and equipment is included. Demand for concrete is growing almost everywhere, regardless of local availability of freshwater. The use of freshwater for concrete production exacerbates stress on natural water resources. In water-stressed coastal countries such as Israel, desalinated seawater (DSW) is often used in the production of concrete. However, the environmental impacts of this practice have not yet been assessed. In this study the effect of using DSW on the water and carbon footprints of concrete was investigated using life cycle assessment. Water footprint results highlight the benefits of using DSW rather than freshwater to produce concrete in Israel. In contrast, because desalination is an energy intensive process, using DSW increases the greenhouse gas intensity of concrete. Nevertheless, this increase (0.27 kg CO2e/m3 concrete) is small, if compared to the life cycle greenhouse gas emissions of concrete. Our results show that using untreated seawater in the mix (transported by truck from the coast) in place of DSW, would be beneficial in terms of water and carbon footprints if the batching plant were located less than 13 km from the withdrawal point. However, use of untreated seawater increases steel reinforcement corrosion, resulting in loss of structural integrity of the reinforced concrete composite. Sustainability of replacing steel with non-corrosive materials should be explored as a way to reduce both water and carbon footprints of concrete

Bottled Water: An Evidence-Based Overview of Economic Viability, Environmental Impact, and Social Equity

This paper considers bottled water with respect to the three pillars of sustainability: economic viability, environmental impacts, and social equity. Per-capita consumption of bottled water has been growing steadily and is the fastest-growing sector of the packaged beverages industry, with expected annual growth of 10% until 2026. Most bottled water is sold in PET containers, and various impacts are evident along all phases of the product lifecycle. This paper reviews market trends and forecasts, lifecycle estimates of energy consumption, associated air pollution and GHG emissions, water footprint, and waste generation. Concerns around human and ecosystem health due to pollution, land use changes, storage conditions, microplastics, and leaching from containers are described, as well as local environmental benefits from companies’ efforts to preserve the quality of their source water. Growing awareness of the cumulative negative impacts of bottled water have pushed the industry to voluntarily improve its performance. Yet, as growth continues, further actions should focus on stricter regulation and on the provision of more sustainable, affordable, available, and trusted alternatives. Gaps remain in knowledge of the effects of bottled water over its full life cycle

Autophosphorylation restrains the apoptotic activity of DRP-1 kinase by controlling dimerization and calmodulin binding

DRP-1 is a pro-apoptotic Ca(2+)/calmodulin (CaM)-regulated serine/threonine kinase, recently isolated as a novel member of the DAP-kinase family of proteins. It contains a short extra-catalytic tail required for homodimerization. Here we identify a novel regulatory mechanism that controls its pro-apoptotic functions. It comprises a single autophosphorylation event mapped to Ser308 within the CaM regulatory domain. A negative charge at this site reduces both the binding to CaM and the formation of DRP-1 homodimers. Conversely, the dephosphorylation of Ser308, which takes place in response to activated Fas or tumour necrosis factor-α death receptors, increases the formation of DRP-1 dimers, facilitates the binding to CaM and activates the pro-apoptotic effects of the protein. Thus, the process of enzyme activation is controlled by two unlocking steps that must work in concert, i.e. dephosphorylation, which probably weakens the electrostatic interactions between the CaM regulatory domain and the catalytic cleft, and homodimerization. This mechanism of negative autophosphorylation provides a safety barrier that restrains the killing effects of DRP-1, and a target for efficient activation of the kinase by various apoptotic stimuli

Taxonomy of uncertainty in environmental life cycle assessment of infrastructure projects

Environmental life cycle assessment (LCA) is increasingly being used to evaluate infrastructure products and to inform their funding, design and construction. As such, recognition of study limitations and consideration of uncertainty are needed; however, most infrastructure LCAs still report deterministic values. Compared to other LCA subfields, infrastructure LCA has developed relatively recently and lags in adopting uncertainty analysis. This paper presents four broad categories of infrastructure LCA uncertainty. These contain 11 drivers focusing on differences between infrastructure and manufactured products. Identified categories and drivers are: application of ISO 14040/14044 standards (functional unit, reference flow, boundaries of analysis); spatiotemporal realities underlying physical construction (geography, local context, manufacturing time); nature of the construction industry (repetition of production, scale, and division of responsibilities); and characteristics of infrastructure projects (agglomeration of other products, and recurring embodied energy). Infrastructure products are typically large, one-off projects with no two being exactly alike in terms of form, function, temporal or spatial context. As a result, strong variability between products is the norm and much of the uncertainty is irreducible. Given the inability to make significant changes to an infrastructure project ex-post and the unique nature of infrastructure, ex-ante analysis is of particular importance. This paper articulates the key drivers of infrastructure specific LCA uncertainty laying the foundation for future refinement of uncertainty consideration for infrastructure. As LCA becomes an increasingly influential tool in decision making for infrastructure, uncertainty analysis must be standard practice, or we risk undermining the fundamental goal of reduced real-world negative environmental impacts