BACKGROUND: In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult decision, most commonly made after, repeated assessments, and triangulation of the resulting assessment data and one or more remediation attempts. Nevertheless, the underlying reasons for dismissal and the policies for remediation and dismissal may differ between training programmes. Such differences may however impact the chance of remediation success, the chance of dismissal and subsequent residents\' appeals.
METHODS: We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents\' dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents.
RESULTS: In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients\' health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases.
CONCLUSIONS: Residents\' appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices\' more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings.

Pressure from expanding populations has resulted in a need for protection, reclamation, and restoration of damaged land to productive, beneficial health uses. The objective of this investigation was to 1) compare land cover on the Department of Energy (DOE) Oak Ridge Reservation (ORR) with the surrounding region, 2) select an indicator to evaluate ORR\'s protection of ecological resources, and 3) develop and implement a method to compare the amount of the indicator on ORR with the regions using National Land Cover Database (NLCD). Data demonstrated that ORR has a higher % of forests (deciduous, coniferous, mixed) than the 10 km and 30 km areas surrounding ORR, suggesting that obligations are being met to protect the ecology and environment. The findings also indicate that the interior forest at ORR is fragmented more than is the interior forest in the 30 km buffer zone, suggesting a need for DOE and managers of other lands to take into consideration the importance of intact interior forest when developing land or planning roads. The study describes the basis for specific ecological parameters such as interior forest that are important to consider when planning and executing remediation, restoration, and other management actions.

Recalcitrant groundwater contamination is a common problem at hazardous waste sites worldwide. Groundwater contamination persists despite decades of remediation efforts at many sites because contaminants sorbed or dissolved within low-conductivity zones can back diffuse into high-conductivity zones, and therefore act as a continuing source of contamination to flowing groundwater. A review of the available literature on remediation of plume persistence due to back diffusion was conducted, and four sites were selected as case studies. Remediation at the sites included pump and treat, enhanced bioremediation, and thermal treatment. Our review highlights that a relatively small number of sites have been studied in sufficient detail to fully evaluate remediation of back diffusion; however, three general conclusions can be made based on the review. First, it is difficult to assess the significance of back diffusion without sufficient data to distinguish between multiple factors contributing to contaminant rebound and plume persistence. Second, high-resolution vertical samples are decidedly valuable for back diffusion assessment but are generally lacking in post-treatment assessments. Third, complete contaminant mass removal from back diffusion sources may not always be possible. Partial contaminant mass removal may nonetheless have potential benefits, similar to partial mass removal from primary DNAPL source zones.

Risk assessment provides a key input for determining the need for and extent of remedial actions necessary for sites contaminated with naturally occurring radioactive material or nuclear legacy sites. The choice of a modelling approach for risk assessment, and the corresponding toolsets should fit the assessment context, taking account of the complexity, and be clearly related to the questions to be addressed in the decision-making process. One of the objectives of Working Group 1 of IAEA Modelling and Data for Radiological Impact Assessments II (MODARIA II) Programme is to perform intermodel comparisons for case studies of selected sites, in particular, to help illustrate the applicability of different models and approaches as inputs to decision-making processes. This intercomparison exercise, which included the analysis of potential consequences on the management strategy for contaminated sites, has been performed for two sites: The former uranium mill tailings facility at Zapadnoe, Ukraine, and the phosphate processing facility at Tessenderlo, Belgium. Several models and computer codes have been used for one or both of these cases: AMBER, GoldSim, NORM And LegacY Site Assessment, Preliminary Remediation Goals (PRG)-dose compliance concentration calculator, and RESRAD-OFFSITE. The assessments explore the implications of using differing assessment frameworks and assumptions, as well as alternative modelling tools, on model outputs and as input for corresponding decisions on remediation strategy. This paper reviews both similarities and differences in the results of assessments performed using these different models. It discusses how different approaches can complement one another to help build confidence in the evidence base underpinning decisions. It also discusses the appropriateness of the different modelling approaches in a given assessment context. In one of the case studies in particular (Tessenderlo case study), the remediation strategy is essentially driven by the contamination of the site with heavy metals, such as cadmium. This has significant consequences on the choice of the most adequate approaches and scenarios for assessing the radiological risk and balancing their relative importance with other impacts. The development of a holistic approach to risk assessment is, therefore, highlighted.

The international community has come a long way in developing a consensus that the remediation and management of naturally occurring radioactive materials and nuclear legacy sites will benefit from the use of the framework for risk-informed decision-making. Such a framework should ideally integrate risk assessment and decision-making. The framework presented in this paper specifically addresses the needs and expectations in the wider socio-economic and environmental context, as well as a narrower human health context. The framework was demonstrated as part of the International Atomic Energy Agency\'s second Modelling and Data for Radiological Impact Assessments Programme. Three case studies, which have used or could use this integrative approach, are used for illustration. The first concerns remediation from uranium mining activities at Beaverlodge Lake in northern Saskatchewan, Canada, engaging stakeholders (also called \'interested parties\') in the decision-making process on further options. The second case study suggests how decision analysis could support the selection of the best option for waste disposal for uranium ore processing at Žirovski vrh, Slovenia, taking into account a potential landslide and migration of waste throughout the adjacent valley in the event of flooding. The third case study presents the process and results of radiological safety assessment of the Kepkensberg sludge basin in Tessenderlo area, Belgium both before and after the disposal of material from remediation of the nearby Winterbeek River. It illustrates how such assessments could interface with decision analysis for the purpose of supporting the regulatory decisions related to future approval of a waste disposal option. Results show that formal stakeholder engagement in decision analysis provides a strong contribution to objective, robust, and transparent decision-making not only for radiation protection area but also in others where health and environmental impacts are of concern. A number of recommendations for future work have also been made.

Despite the effective remediation efforts following the end of the metallurgic activity thirty years ago upstream the Lot River watershed, the levels of cadmium (Cd) accumulated in wild oysters from the downstream Gironde Estuary still exceed nowadays the admissible human consumption limit (5 mg/kg, d.w.). The main goal of this work is to quantify the role of sediments as long-term intra-estuarine sources or sinks of Cd and the transport of this contaminant towards the estuary mouth taking as case study the example of the highly turbid Gironde Estuary. The original estimation for the annual net fluxes of the suspended particulate matter ( [Formula: see text] and particulate Cd ( [Formula: see text] ) presented in this work between 1990 and 2020 indicates that 80% of the Cd discharged into the ocean is in dissolved form (Cdd). The values of [Formula: see text] vary proportionally to those of [Formula: see text] and ranged between 0.1 and 1.4 t/y, with a ten-year average decreasing from 0.8 to 0.6 t/y for the past 30 years. The differences between ten-year total (Cdp + Cdd) gross and net fluxes show that Cd has effectively been stored in estuarine sediments. This Cd storage was of about 43, 22 and 13 t for the 1990s, 2000s and 2010s, respectively. However, during years of low gross fluxes, estuarine sediments act as additional, secondary sources of bio-available/dissolved Cd into the water column, potentially relating to the continued observations of high Cd concentrations in wild oysters at the estuary mouth. In addition to the natural solubility of Cdp along the salinity and turbidity gradients of the estuary, natural and anthropogenic remobilization of bottom sediment particles further contribute to its mobilization from the particle phase, along with other numerous inorganic/organic pollutants. The mass balances presented in this work could support a new sediment management policy potentially more beneficial to the estuarine ecosystem.

To better protect public health from third-hand exposure to methamphetamine, it is important to understand the techniques and current practices used within the methamphetamine testing and decontamination industry in Australia. A survey was conducted focusing on business owners that advertised testing and/or remediation services online. They were also invited to participate in a follow-up phone interview upon completion. The survey demonstrated that testing and decontamination methods were highly varied, which was expected for an industry with no regulation. Most companies offered methamphetamine testing and remediation which could be a conflict of interest. Participants also shared personal experiences, including the conduct of other industry members, demonstrating both poor practice and/or the competitive nature of the business. Participating business owners were following Australian guidelines to the best of their ability, and many are advocates for regulation to be implemented within the industry. This would address the inconsistencies between companies and establish trust for industry members and the public. It would also provide significant public health protection, which is currently lacking. A more consistent approach to the testing and remediation of methamphetamine contamination, aided by regulation, would address the significant risk to public health caused by third-hand exposure to methamphetamine.

The uncertain fate and transport pathways of applied pesticides are the key hidden threats with respect to the safety and quality evaluation of foodstuffs in Bangladesh. The risk assessment of and uncertainty about applied pesticides are poorly explored due to weak regulatory systems, farmer ignorance, intensive agricultural practices, and lack of available research data on improper handling of pesticides on farming lands with poor phytosanitary management. However, increasing evidence suggests that the prevalence of pesticides in common foodstuffs is due to their uptake by crops and improper management of crop protection practices. Besides, the biotransformation of pesticides in common Bangladeshi food products is poorly understood. Several studies have reported higher concentrations of pesticides than allowed by European Union guidelines in Bangladeshi foodstuffs. However, to date, no systematic review with critical discussion on current research findings and knowledge gaps concerning fate, uncertainty, and health risks of pesticides in the foodstuffs of Bangladesh is published. Therefore, this review summarizes the findings of existing literature on pesticide residue in foodstuffs and points out the weaknesses in the regulatory system and risk assessments for highlighting the critical challenges to food safety in Bangladesh as compared to global food policy. In addition, strategies for the sustainable management of residual pesticides are also discussed.

A low-permeability locality with heterogeneous geology contaminated primarily by tetrachloroethene (PCE) present partially in the free phase in the unsaturated zone was treated on a pilot scale via direct push pneumatic fracturing combined with the hydraulic delivery of a remediation suspension consisting of milled iron, sulphidated nanosized zerovalent iron and sand in guar gum solution. Afterwards, a whey solution was injected into the fractures as a carbon source for bacteria. The unsaturated and saturated zones were treated. Long-term monitoring of the groundwater revealed that the abiotic reduction of PCE and trichloroethene was the dominant remediation processes for several months after the injections. A complex microbial consortium was developed that was capable of effective, long-term chlorinated ethenes (ClE) dechlorination. The consortium consisted mainly of Dehalococcoides but also of other anaerobic bacterial strains capable of partial dechlorination of ClE, including the sulphate-reducing bacteria; Geobacter and Desulfitobacterium. The average chlorine number in the groundwater decreased from 3.65 to 1.38 within 2.5 years after the injections, while the average ClE concentration increased from 13.5 to 31.5 mgL-1 because of the substantial acceleration of the ClE mass-transfer to the groundwater caused by the treatment. The remediation processes remained fully active for 2.5 years.

Many nations are faced with the need to remediate large contaminated sites following World War II, the Cold War, and abandoned industrial sites, and to return them to productive land uses. In the United States, the Department of Energy (DOE) has the largest cleanup challenge, and its Hanford Site in the state of Washington has the most extensive and most expensive cleanup task. Ideally, the risk to ecological resources on remediation sites is evaluated before, during, and after remediation, and the risk from, or damage to, ecological resources from contaminants should be lower following remediation. In this paper, we report the risk to ecological resources before, during, and as a consequence of remediation on contaminated units requiring cleanup, and then examine the causes for changes in risk by evaluating 56 cleanup evaluation units (EUs) at the Hanford Site. In this case, remediation includes a restoration phase. In general, the risk to ecological and eco-cultural resources is currently not discernible or low at most contaminated units, increases during remediation, and decreases thereafter. Remediation often causes physical disruption to ecosystems as it reduces the risk from exposure to contaminants. Most new remediation projects at the Hanford Site include ecological restoration. Ecological restoration results in the potential for the presence of higher quality resources after remediation than currently exists on these contaminated lands and facilities. Although counter-intuitive, our evaluation of the risk to ecological resources following remediation indicated that a significant percentage of units (61%) will be at increased risk in the post-remediation period. This increased risk is due to DOE\'s successful remediation and restoration that results in a higher percent of native vegetation and higher ecological value on the sites in the post-remediation period than before. These newly-created resources can then be at risk from post-remediation activities. Risks to these new higher quality resources include the potential for spread of invasive species and of noxious grasses used in previous cleanup actions, disruption of ecosystems (including those with state or federally listed species and unique ecosystems), compaction of soil, use of pesticides to control invasive species, and the eventual need for continued monitoring activities. Thus, by greatly improving the existing habitat and health of eco-receptors, and maintaining habitat corridors between high quality habitats, the ecological resources in the post-remediated units are at risk unless care is taken to protect them. Many of the negative effects of both remediation and future monitoring (or other future land uses) can be avoided by planning and management early in the remediation process. We suggest DOE and other agencies convene a panel of managers, remediation scientists, regulators, environmental and ecological scientists, Native Americans, economists, and the public to develop a generic list of performance metrics for the restoration phase of remediation, including evaluation of success, which could be applied across the DOE complex.