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Recycling is a common policy response to problems of waste, particularly in developed countries. Understanding what influences whether and how well people recycle is important for optimising recycling outcomes. Behaviour is complex, and understanding it fully requires drawing on insights from many disciplines. However past reviews of recycling behaviour research have revealed that the field is currently fragmented into single discipline endeavours, and highly concentrated around psychological approaches. The objective of this paper was to conduct a systematic review of current published knowledge from a wide range of disciplines on what influences households recycling behaviour. The resulting factors were systematically synthesised to produce a comprehensive multi-level hierarchy of potentially influencing factors. The process also revealed potential directions for future research to improve the field’s understanding of the influences on recycling behaviour, and the ability to develop more effective interventions that address waste and recycling issues.

To address the global problem of single-use plastic waste, tailored behavior change interventions need to be developed which respond to the way different audiences think and act. The current study adopted a behavior-based segmentation approach, underpinned by the theory of normative social behavior and empirical testing, to better understand plastic consumption and the effect of existing media communications. Using a sample of 1001 respondents, Two-Step Cluster Analysis identified two key consumer types: ���Plastic Avoiders��� and ���Plastic Users.��� The two groups differed significantly on demographic characteristics, media use/exposure, and theoretical constructs. The most important predictors of group membership were self-efficacy and work status. An experiment involving pre-existing environmental media communications revealed that perceptions, intentions, and behaviors were influenced differently across the two audiences. The findings suggest that mobilizing existing media content may provide a cost-effective way for environmental communicators to increase their public impact while avoiding unintended consequences.

Purpose: To determine what behaviours are critical to prioritising worker safety and establishing a safety culture within construction workplaces, as well as the drivers and barriers of those behaviours. Method: We used a rapid review methodology to review the existing research evidence on behaviours related to construction safety culture, as well as consulting subject-matter experts in a practice review.Findings: Behaviours related to safety compliance, risk identification, reporting, and speaking up were identified as important in both the evidence and practice reviews. Drivers and barriers of these behaviours can be categorised according to individual, organisational, or sector levels.Conclusions: The key behaviours identified in the evidence and practice review provide a critical foundation to developing a safety culture in construction workplaces.

Plastic reduction policies are important for addressing plastic pollution however, the success of such policies relies on establishing new social norms. This study advances knowledge on public expressions of social norms by exploring the interplay between news media and social media in response to a new environmental policy. It is the first study to explore this phenomenon with the explicit aim of identifying and comparing information related to social norms. A content analysis was conducted in relation to the 2018 Australian supermarket plastic bag ban. Results demonstrate how social norms related to a new policy are created, reinforced and expressed in the contemporary media landscape. The interaction between news media and social media offers a window into public expressions of social norms, where social media provides a platform for civic participation in a public and real-time environment in which users can challenge the dominant narrative presented by the news media.

All nurses with any responsibility for hemodialysis need to know and understand the clinical ramifications of water treatment and dialysate preparation. Although some hemodialysis programs may have full-time technical staff who operate and test the water treatment and dialysate preparation systems, many programs rely on nursing staff for the day-to-day operation and testing of these systems. It is critical for all staff members to work together to keep patients safe. This article details reasons safe water and dialysate are critical for patients on hemodialysis and reviews components of water treatment systems, dialysate concentrate preparation, and monitoring and testing necessary to assure that both water and dialysate are safe for patient use. Integrated hemodialysis systems (i.e., those that combine water treatment and dialysate preparation and delivery in an individual machine "package") are also described.

Effective oral delivery is difficult for many protein drugs, as high-molecular-weight proteins do not easily cross the mucosal membrane and degradation in the gastrointestinal tract is common. Thus, alternative routes of delivery that often require delivery devices are utilized for administration of protein drug, including injection, inhalation, and implants. The protein may be in contact with the device surface during shipping and storage, as well as through delivery. Mechanical stresses on the protein, such as agitation, will increase the contact of the protein with the device surface, as well as with the air at the air/water interface, potentially leading to increased aggregation and reduced efficacy. In some cases, the device may be treated with lubricants that may also affect protein stability. The various stressors on proteins in devices will be discussed along with potential consequences and mitigation strategies.

This study empirically examines how future park recreation is related to enduring societal trends. An online panel of 927 participants was surveyed regarding anticipated park recreation par...

Transitioning to a circular economy depends on transforming the behaviour of both producers and consumers. Product labelling schemes are regularly offered as a solution to support those shifts. While numerous labelling schemes and related research on the effectiveness of individual schemes exist, it remains unclear how impactful labelling is in supporting circular economy outcomes. The emergence of behavioural public policy presents new opportunities for knowledge translation in this field. This study provides a systematic, succinct overview of evidence using a rapid review methodology, identifying and summarising existing systematic reviews or reports. A comprehensive search was undertaken in three databases of publications between 2000 and 2019, yielding 4,875 citations. Following screening by two independent reviewers, 10 reviews were included. Several key drivers and barriers for adopting product labelling schemes among consumers and businesses were identified. The existing evidence provides limited support for the impact of labelling schemes on behaviour, the environment, and business. Overall, results indicate that eco-labels on their own are an information-based communication tool that is unlikely to create significant shifts in consumer choices or production. Conditions required for schemes to have optimal impact and recommendations to amplify impact drawing on behavioural science are discussed.

Realising energy efficiency opportunities in new commercial office buildings is an easier task than retrofitting older, mid-tier building stock. As a result, a number of government programs aim to support retrofits by offering grants, upgrades, and energy audits to facilitate energy efficiency opportunities. This study reports on a state government program in Victoria, Australia, where the uptake of such offerings was lower than expected, prompting the program team to consider whether targeting facilities managers (FMs), rather than building owners, might be a better way of delivering the program. The influences and practices of FMs that impact on their ability to be advocates for energy efficiency were explored. The results revealed that complex building ownership arrangements, poor communication skills, isolation from key decision making processes, a lack of credible business cases and information, split incentives, and the prospect of business disruptions can all impact on FMs’ ability to drive organizational change. Future program efforts should continue to interrogate the social context of retrofits in mid-tier buildings, including other influences and influencers beyond FMs, and adapt accordingly.

Interim evaluations of government programs can sometimes reveal lower than expected outcomes, leading to the question of how adjustments can be made while the program is still underway. Although adaptive management frameworks can provide a practical roadmap to address this question, a lack of successful learnings and poor implementation have hampered the progress and wider application of adaptive management. Using a case study involving an energy efficiency government program targeting low-income households, this article provides supporting evidence on how adaptive management can be facilitated and applied. Factors such as proactive and responsive leadership, establishing a research-practice interface, and recognizing the skills, expertise, and contributions of multiple stakeholders guided adjustments to the program, and later paved the way for longer-term organizational learning that impacted how other programs are delivered. Implications for knowledge and practice, and a discussion of the challenges faced in the program, advance current thinking in adaptive management.

A lack of small and medium enterprise (SME) engagement in environmental practices has caused stakeholders to advocate several different approaches to encourage organisational change. While program investment and research has been dedicated to developing and implementing external drivers, at least two internal factors have not been given sufficient research attention when it comes to the uptake of environmental initiatives among SMEs. These are: the strength of embedded habits and routines, and whether or not a business is indeed ready to embrace change. We take these factors into account and show how a habit discontinuity approach with an emphasis on timing may foster greater engagement and uptake of environmental initiatives among SMEs. Alternatives and limitations are considered and a conceptual framework is introduced to guide research and future interventions.

Responsive regulation asserts that regulatory enforcement actions are likely to be more effective in promoting compliance when they respond to a duty holder's motives, capabilities, and external pressures. However, operationalizing responsive approaches that also possess qualities of consistency and transparency remains a challenge for environmental management authorities. This study applied a mixed-method qualitative approach to capture the responsive decision making influences on government environment protection officers in a field context when engaging with different duty holders. These insights then informed compliance narratives across a series of business behavior segments to guide more consistent, transparent and responsive decision making among environment protection officers. Our findings revealed how different constellations of observations, interactions and displays of willingness and ability impact the choice of regulatory responses. Challenges encountered in applying responsive regulation in practice involved difficulties ascertaining business capability, identifying causal links between response strategies and compliance outcomes, and how the use of discretion can impact on consistent and transparent decision making.

It is critical for all staff members to work together to keep patients safe. Nephrology nurses with responsibility for hemodialysis (HD) need to know and understand the clinical ramifications of water treatment and dialysate preparation. Although some HD programs may have full-time technical staff who operate and test the water treatment and dialysate preparation systems, many programs rely on nursing staff members for the dayto- day operation and testing of these systems. This article details the reasons safe water and dialysate are critical for patients on HD; and reviews components of water treatment systems, dialysate concentrate preparation, and the monitoring and testing necessary to assure that both water and dialysate are safe for patient use. Integrated HD systems (i.e., those that combine water treatment and dialysate preparation and delivery in an individual machine "package") are also described.

We've read with interest the recent Hart et al . article1 regarding breast-implant patients that developed anaplastic large cell lymphoma (ALCL). The report of two cases of ALCL clearly adds to the collective data suggesting a possible association between implant surface type and the post-implantation development of ALCL. However, we must point out a serious mistake in the “Implant Surface Texture” section. The authors state: “Due to the apparent association between ALCL and textured Silastic (Dow Corning, Midland, MI) elastomer implants and the lack of association with implant type (saline vs silicone), the inflammatory response may be attributable to the implant cover.” This inappropriately implicates Dow Corning breast implants with the development of ALCL when, in fact, there are no published reports indicating such an association. We suspect the authors inadvertently used the …

Recognising the potential conservation impact, zoos regularly ask their visitors to undertake pro-wildlife behaviour. This paper presents the results of two studies undertaken to address the question: how often during a visit should visitors be asked? Study 1 sought to a) determine individuals' personal thresholds and b) the point where the number of different behaviours requested began affect visitors' experiences. Study 2 sought the same, but focused on requests for the same behaviour. Results suggest that few respondents' personal thresholds were crossed (2.5% in Study 1 and 9% in Study 2). In neither study did many respondents (2.5% in Study 1 and 2.8% in Study 2) feel that the number of requests negatively affect their overall zoo experience. While there are caveats, we conclude that there appears little cause for concern about asking zoo visitors on multiple occasions to act in support of wildlife. Indeed, such requests may improve experiences.

Despite significant advances in the day-to-day management of patients receiving hematopoietic stem cell transplantations, including the introduction of new antiviral drugs, cytomegalovirus (CMV) infection continues to be a major cause of morbidity and mortality. The aim of this article is to undertake a literature-based review of foscarnet in this therapeutic setting and to align current best-published evidence with recent recommendations presented at the European Conference on Infections in Leukaemia. Ganciclovir remains the mainstay of CMV infection/disease antiviral management protocols. However, approximately a third of patients develop severe neutropenia and others become resistant to ganciclovir, and thus, a reasonably large proportion of patients are not able to receive and/or continue with this medication. Foscarnet is a suitable option as both pre-emptive therapy or for the treatment of active disease in these patients. Randomized trials have demonstrated that foscarnet is equally effective when compared with ganciclovir for pre-emptive treatment of CMV infections: the outcome was comparable with ganciclovir in terms of control of antigenemia and survival rates. There is a paucity of information for its use in the prophylaxis of CMV, although preliminary data show that it was effective in some patients at high risk of CMV reactivation. The main adverse events associated with foscarnet are renal impairment, serum electrolyte and hemoglobin disturbances, seizures and local genital irritation/ulceration. Foscarnet is a well-established antiviral option in immunocompromised patients, and it is usually administered as a second-line option to ganciclovir. In patients receiving hematopoietic stem cell transplantation, it has proven efficacy when used pre-emptively to treat CMV reactivation, as an alternative to and also in combination with ganciclovir.

This paper invokes the theory of planned behavior (TPB) as a diagnostic tool to explain an existing public education program’s limited success at improving river water quality in the City of Perth, Western Australia. A reflective, client-driven research approach was used. A facilitated expert workshop defined an environmental problem (excess nutrients leaving gardens and entering waterways) and a desired behavior (residents purchasing environmentally sensitive fertilizer) to address the problem. A TPB-based belief elicitation survey captured respondents’ beliefs regarding the desired behavior. The findings suggest respondents were aware of the links between purchasing environmentally sensitive fertilizer and river water quality. However, this behavior is compromised by the challenges in identifying appropriate products, product quality concerns, and cost. Viewing the content of a public education program through the lens of the TPB reveals insights into how and why the program fell short in achieving one of its key behavioral change goals.

Zoos have some choice about which pro-wildlife behaviors to ask their visitors to do, but with this freedom comes the difficult task of choosing behaviors that are appropriate, effective, and that do not affect visitors’ experiences. This paper presents attributes of pro-wildlife behaviors that emerged from self-completed questionnaires administered to 114 zoo visitors. Questions sought to elicit attributes that visitors felt should be considered in the behavior selection process. The results say that behaviors should: have an on-site option; be new, or if known, include new learning that underpins why they are needed; be easy to do; and have a clear link between the behavior and how it helps wildlife. Respondents also made comments about specific behaviors as well as how behaviors should or should not be requested. We suggest that visitors’ perspectives be incorporated into pro-wildlife behavior selection in zoos, and we propose that these findings may be relevant beyond zoos.

Applying Ajzen's (1991) theory of planned behaviour to inform a persuasive communication intervention involves a number of phases of field research. While the initial belief elicitation phase is theoretically necessary to inform all subsequent phases, it is often undervalued due to its formative nature. To assess the importance of the elicitation phase, research was undertaken at two national parks to identify the beliefs underlying visitor use of alternative transportations systems (ATS) that have been introduced to reduce the pressures created by growing vehicle numbers. Results indicate that although visitors at the two parks share some beliefs, others are site‐specific. Persuasive communication aimed at encouraging visitor use of ATS at the two parks would therefore need to potentially target different beliefs. The research demonstrates that the elicitation phase was a critical first step in the context of this study, as beliefs cannot be intuited or assumed to be transferable among different...

Documenting the rate of rupture of silicone breast implants appears to be deceptively easy. Largely because of the phenomenon of "silent rupture," it isn't. The authors explore the various technical biases (selection, misclassification, and confounding) and methodological problems that have plagued much of the research conducted to date. By means of a series of illustrations, they argue that explantation has limited utility. Noninvasive techniques have to be used to gather the proper type of data on the timing and frequency of these events. Only with the proper incidence data will researchers be able to identify better the different mechanisms underlying implant rupture and the relative importance of each. The authors recommend that better and standardized definitions of implant rupture be developed, that greater recognition be given to the technical biases and a greater effort be made to eliminate them from investigations of implant rupture, and that more research be conducted by multidisciplinary teams. Because of the growing awareness of the complexity of this issue, the authors also recommend that properly constituted advisory teams be used to provide comprehensive oversight of future research projects from beginning to end.

While nurses may not routinely service the water treatment system or mix the dialysate, they are responsible for understanding all of the clinical ramifications of water treatment and dialysate preparation for hemodialysis as a part of the entire dialysis treatment picture. Although the water treatment system has historically been in the technicians' domain, knowing the technical aspects is important for the entire team to work together to ensure patient safety and well-being. This article describes the composition of water treatment systems for hemodialysis, as well as the monitoring and testing necessary to assure that both water and dialysate are safe for patient use.

A variety of silicone materials have been prepared, many possessing excellent properties including chemical and thermal stability, low surface tension, hydrophobicity, and gas permeability. These characteristics helped originate the use of silicones in the medical field, and are key to the materials’ reported biocompatibility and biodurability. Since the 1960s, silicones have enjoyed expanded medical application and today are one of the most thoroughly tested and important biomaterials.

Overall, we believe that bundling of payments to dialysis facilities is positive for home dialysis. The incentive for higher utilization of home therapies comes down to the fact that, with treatments for all modalities being paid at the same rate, providers will see that home modalities cost less than facility-based treatments. The adjustment for home training treatments is certainly helpful, but it is not incentive enough on its own. From our perspective, one of the biggest financial incentives for home dialysis and more frequent dialysis therapies is that these patients are statistically known to spend less time in the hospital, over time costing taxpayers and the ESRD Program less money. We will continue to encourage CMS to consider the overall cost implications of more frequent dialysis. We are hopeful that when hospitalization costs are accounted for, CMS will do even more to encourage the use of these modalities.

Quality must be designed into medical devices, including into their raw materials and components. Operating according to the critical principles of medical device good manufacturing practices ensures that the silicone tubing incorporated into devices has the highest standards of quality and safety.

The discussion explored and expanded on the issues raised by Dasselaar et al in their review of the measurement of relative blood volume (RBV) changes during dialysis (NDT 2005). Dialysis machines incorporating blood volume monitoring and control are widely available in Europe. The use of continuous blood volume monitoring (CBVM) to help establish dry weight; problems with CBVM due to connection and use of single needle dialysis; the physiological processes that cause RBV changes during eating, exercise and posture changes; and the application of blood volume based biofeedback control were discussed by participants from ten countries. The 'take-home' messages from the discussion were that CBVM can assist in setting target weight, but must be used together with traditional measures and experience. Biofeedback control may help to achieve symptom-free dialysis, but staff should be prepared to monitor patients systematically for several weeks to obtain individualised settings. Users of CBVM should be aware of factors that can alter the central haematocrit leading to apparent changes in RBV. Practical guidelines should be developed to help staff interpret CBVM data effectively.