Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Soundscapes in Arab cities: a systematic review and research agenda

In the context of Arab cities, this study explores the intricate interplay between cultural, historical, and environmental elements that shape their unique soundscapes. The paper aims to shed light on this underrepresented field of study by employing a three-fold research approach: systematic review, a comprehensive literature review, and the formulation of a future research agenda. The first part of the investigation focuses on research productivity in the Arab world regarding soundscape studies. An analysis of publication trends reveals that soundscape research in Arab cities is still an emerging area of interest. Critical gaps in the existing body of literature are identified, highlighting the importance of addressing these gaps within the broader context of global soundscape research. The second part of the study delves into the distinctive features that inform the soundscapes of Arab cities. These features are categorized into three overarching groups: (i) cultural and religious life, (ii) daily life, and (iii) heritage and history, by exploring these factors, the study aims to elucidate the multifaceted nature of Arab urban soundscapes. From the resonating calls to prayer and the vibrant ambiance of traditional cafes to the bustling markets and architectural characteristics, each factor contributes to the auditory tapestry that defines Arab cities. The paper concludes with a forward-looking research agenda, proposing sixteen key questions organized into descriptive and comparative categories. These questions emphasize the need for a more profound understanding of sound perception, sources, and the impact of urban morphology on the soundscape. Additionally, they highlight the need for interdisciplinary research, involving fields such as urban planning, architecture, psychology, sociology, and cultural studies to unravel the complexity of Arab urban soundscapes

Canonical and non canonical Hedgehog pathway in the pathogenesis of multiple myeloma

The Hedgehog (Hh)-pathway is required for cell-fate determination during the embryonic life, as well as cell growth and differentiation in the adult organism, where the inappropriate activation has been implicated in several cancers. Here, we demonstrate that Hh-signaling plays a significant role in growth and survival of multiple myeloma (MM) cells. We observed that CD138(+) MM cells express Hh-genes and confirmed Smoothened (Smo)-dependent Hh-signaling in MM using a novel synthetic Smo-inhibitor, NVP-LDE225 (Novartis), which decreased MM cell viability by inducing specific down-regulation of Gli1 and Ptch1, hallmarks of Hh-activity. Additionally, we detected a nuclear localization of Gli1 in MM cells, which is completely abrogated by Forskolin, a Gli1 modulating compound, confirming Smo-independent mechanisms leading to Hh-activation in MM. Finally, we identified that bone-marrow stromal cells (BMSCs) are a source of Shh-ligand, although they are resistant to Hh-inhibitor due to defective Smo expression and Ptch1 up-regulation. Further in vitro as well as in vivo studies showed anti-tumor efficacy of NVP-LDE225 in combination with Bortezomib. All together, our data demonstrate activation of both canonical and non canonical Hh-pathway in MM, thus providing the rationale for testing Hh-inhibitors in clinical trials, in order to improve MM patient outcome