Sustainability across the medical device lifecycle : a scoping review

Medical devices are instrumental in servicing the healthcare sector and promoting well-being in modern societies. However, their production and use contribute significantly to greenhouse gas emissions, thus causing indirect harm to global health. With a share of approximately 4.4% of global emissions, the healthcare sector exhales CO2 throughout its value chain; sources of this range from direct electricity consumption and water heating in healthcare facilities to the supply chains delivering healthcare services and products. Within this context, the environmental impact of medical devices is present across their production, distribution, usage, and eventual disposal. Each step in the lifecycle of medical devices consumes energy and natural resources, and the end product, after its often single use, is discarded, generating plastic or electronic waste. This study aims to present the key findings from a scoping review of academic research on the topic, which focuses on reducing the environmental impact of medical devices and equipment. The review, conducted according to the PRISMA checklist for scoping reviews, examined 41 studies and categorised them based on the lifecycle stages of medical devices (design and development, manufacturing, usage, and end of life) and the sustainability aspects (economic, environmental, and social) discussed by the authors. The findings suggest that while efforts have been made to enhance economic and environmental sustainability throughout the design, development, and usage of medical devices, there is still room for improvement in mitigating their ecological impact at the end of their lifecycle and maximising their social impact by design

The hidden hand of asymptomatic infection hinders control of neglected tropical diseases : a modeling analysis

Neglected tropical diseases are responsible for considerable morbidity and mortality in low-income populations. International efforts have reduced their global burden, but transmission is persistent and case-finding-based interventions rarely target asymptomatic individuals. Methods We develop a generic mathematical modeling framework for analyzing the dynamics of visceral leishmaniasis in the Indian sub-continent (VL), gambiense sleeping sickness (gHAT), and Chagas disease and use it to assess the possible contribution of asymptomatics who later develop disease (pre-symptomatics) and those who do not (non-symptomatics) to the maintenance of infection. Plausible interventions, including active screening, vector control, and reduced time to detection, are simulated for the three diseases. Results We found that the high asymptomatic contribution to transmission for Chagas and gHAT and the apparently high basic reproductive number of VL may undermine long-term control. However, the ability to treat some asymptomatics for Chagas and gHAT should make them more controllable, albeit over relatively long time periods due to the slow dynamics of these diseases. For VL, the toxicity of available therapeutics means the asymptomatic population cannot currently be treated, but combining treatment of symptomatics and vector control could yield a quick reduction in transmission. Conclusions Despite the uncertainty in natural history, it appears there is already a relatively good toolbox of interventions to eliminate gHAT, and it is likely that Chagas will need improvements to diagnostics and their use to better target pre-symptomatics. The situation for VL is less clear, and model predictions could be improved by additional empirical data. However, interventions may have to improve to successfully eliminate this disease

Everyday diagnostic work in the histopathology lab : CSCW perspectives on the utilization of data-driven clinical decision support systems

In this paper we present an ethnographic study of the work of histopathologists as they grapple with the twin innovations of transitioning to digital biopsy images and the prospective adoption of an AI-based clinical decision support system (CDSS). We explore how they are adapting to the former and their expectations of the latter. The study’s ethnomethodologically-informed ethnography approach brings to light some key issues regarding the nature of diagnostic work, and accountability and trust that are central to the successful adoption of technological innovations in clinical settings

The diversity of the antimicrobial resistome of lake Tanganyika increases with the water depth

The presence of antimicrobial resistance genes (ARGs) in the microbiome of freshwater communities is a consequence of thousands of years of evolution but also of the pressure exerted by anthropogenic activities, with potential negative impact on environmental and human health. In this study, we investigated the distribution of ARGs in Lake Tanganyika (LT)'s water column to define the resistome of this ancient lake. Additionally, we compared the resistome of LT with that of Lake Baikal (LB), the oldest known lake with different environmental characteristics and a lower anthropogenic pollution than LT. We found that richness and abundance of several antimicrobial resistance classes were higher in the deep water layers in both lakes. LT Kigoma region, known for its higher anthropogenic pollution, showed a greater richness and number of ARG positive MAGs compared to Mahale. Our results provide a comprehensive understanding of the antimicrobial resistome of LT and underscore its importance as reservoir of antimicrobial resistance. In particular, the deepest water layers of LT are the main repository of diverse ARGs, mirroring what was observed in LB and in other aquatic ecosystems. These findings suggest that the deep waters might play a crucial role in the preservation of ARGs in aquatic ecosystems

Book Review of Polygamy, policy and postcolonialism in English marriage law; a critical feminist analysis by Naqvi, Z. B.

Zainab Naqvi’s exploration of polygamy makes a significant contribution to an issue largely overlooked in contemporary literature on the treatment of diverse forms of marriage within English law. Drawing on new empirical data and case law analysis, Naqvi delves into the intersections between postcolonialism and human rights within the context of polygamous marriages. She critiques the treatment of women in such marriages under English law, situating this treatment effectively and powerfully within imperialist and orientalist discourses

Nonparametric classification with missing data

We introduce a new nonparametric framework for classification problems in the presence of missing data. The key aspect of our framework is that the regression function decomposes into an anova-type sum of orthogonal functions, of which some (or even many) may be zero. Working under a general missingness setting, which allows features to be missing not at random, our main goal is to derive the minimax rate for the excess risk in this problem. In addition to the decomposition property, the rate depends on parameters that control the tail behaviour of the marginal feature distributions, the smoothness of the regression function and a margin condition. The ambient data dimension does not appear in the minimax rate, which can therefore be faster than in the classical nonparametric setting. We further propose a new method, called the Hard-thresholding Anova Missing data (HAM) classifier, based on a careful combination of a k-nearest neighbour algorithm and a thresholding step. The HAM classifier attains the minimax rate up to polylogarithmic factors and numerical experiments further illustrate its utility

Thermonuclear explosions on neutron stars reveal the speed of their jets

Relativistic jets are observed from accreting and cataclysmic transients throughout the Universe, and have a profound impact on their surroundings . Despite their importance, their launch mechanism is not known. For accreting neutron stars, the speed of their compact jets can reveal whether the jets are powered by magnetic fields anchored in the accretion flow or in the star itself , but so far no such measurements exist. These objects can show bright explosions on their surface due to unstable thermonuclear burning of recently accreted material, called type-I X-ray bursts , during which the mass-accretion rate increases . Here, we report on bright flares in the jet emission for a few minutes after each X-ray burst, attributed to the increased accretion rate. With these flares, we measure the speed of a neutron star compact jet to be , much slower than those from black holes at similar luminosities. This discovery provides a powerful new tool in which we can determine the role that individual system properties have on the jet speed, revealing the dominant jet launching mechanism. [Abstract copyright: © 2024. The Author(s), under exclusive licence to Springer Nature Limited.

Cut-out stencils in fourteenth-century painting : Giotto and his workshop in the arena chapel

The use of cut-out stencils (templates/patroni) by Giotto in the making of the Arena chapel frescoes has not been systematically investigated. Following a review of the literature, I argue that paper cut-out stencils were utilised quite extensively by Giotto’s workshop in the Arena chapel, at least for the heads, opening avenues for further research

Voters' expectations in constituency elections without local polls

How do voters form accurate expectations about the strength of political candidates in constituency elections if there are no reliable constituency polls available? We argue that voters can use national election polls and past election results to increase the accuracy of their expectations. A survey experiment during the German federal election of 2021 confirms that the provision of national election polls and past results increases the accuracy of voters’ expectations. The analysis further shows that voters leverage the information to update their beliefs. The results have relevant implications for debates about belief formation in low-information environments

A systematic review of dramatherapy interventions used to support adults with psychosis

Psychiatric treatment of psychosis often comprises therapeutic and psychotropic combinations. Dramatherapy is often utilised in health services with this population, particularly when clients struggle to engage with talking therapies because of complex presentations, experience preverbal trauma, neurodiversity challenges and/or communication difficulties. Dramatherapy as a therapeutic intervention is recognised by health regulating bodies but as yet has not yet been systematically reviewed. To synthesise existing peer-reviewed empirical research literature and gather evidence regarding dramatherapy used to support adults with psychosis; To collate and understand the intervention methods of dramatherapy as a treatment to support adults experiencing psychosis; To assess the effect of dramatherapy on adults with psychosis, by collating qualitative and quantitative outcome measures, where reported in included research. Literature was sourced through database searches (CINAHL, EMBASE, COCHRANE, PsycINFO, PubMed, Scopus, and APA PsycNet) and hand searches. 8541 papers were screened, and 11 met inclusion criteria for synthesis. Findings related to aims were narratively synthesised, before being thematically analysed. Participant characteristics of age, gender, ethnicity, and socio-economic background were heterogeneous. Participants across studies often had multiple diagnoses, and unknown complexities making recovery through standard treatment unachievable. Presentations included episodes of psychosis, schizophrenia, and dual-diagnoses of mental health challenges and intellectual difficulties. Positive effects found the use of dramatherapy include: New perspectives; Improved relationships; Ability to make choices with reduced anxiety; Understanding of self; Reduced psychotic symptoms. Quantitative data substantiated qualitative findings, and effect indicated changes in social functioning, behaviours, and symptoms following dramatherapy intervention. Systematic findings will support practitioners to implement evidence-based practice and to improve treatment provision for adults with psychosis. Further methodologically sound research into the field is encouraged to advance understanding of dramatherapy interventions for adults with psychosis. [Abstract copyright: Copyright © 2024 Elsevier B.V. All rights reserved.