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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Insights on the use of butyric acid, and nucleotides as feed additives in poultry: A review

Despite rising demand for chicken, laws and public uproar forced the industry to find alternatives to maintain flock health by outlawing antibiotic growth boosters. Incorporating a program that naturally improves or modifies the bird's immune response is one strategy. A tailored dietary supplement and/or feed additive can be used to modify immune function and achieve immunomodulation of the immune system. The best alternatives to antibiotic growth promoters (AGPs) may be the use of probiotics and organic acids. Probiotics provide advantages such as altering the host's metabolism, stimulating the immune system, excluding pathogens, enhancing nutrient absorption, and ultimately lowering the danger to human health. Nucleotide supplementation in the feed may enhance gut shape, digestive enzyme activity, and growth performance in broilers. In the current review, we would like to through the light on the use of c as ecofriendly animal feed additives

Insights on the use of butyric acid, and nucleotides as feed additives in poultry: A review

Despite rising demand for chicken, laws and public uproar forced the industry to find alternatives to maintain flock health by outlawing antibiotic growth boosters. Incorporating a program that naturally improves or modifies the bird's immune response is one strategy. A tailored dietary supplement and/or feed additive can be used to modify immune function and achieve immunomodulation of the immune system. The best alternatives to antibiotic growth promoters (AGPs) may be the use of probiotics and organic acids. Probiotics provide advantages such as altering the host's metabolism, stimulating the immune system, excluding pathogens, enhancing nutrient absorption, and ultimately lowering the danger to human health. Nucleotide supplementation in the feed may enhance gut shape, digestive enzyme activity, and growth performance in broilers. In the current review, we would like to through the light on the use of c as ecofriendly animal feed additives

On the use of multivariate analysis and land evaluation for potential agricultural development of the northwestern coast of Egypt

The development of the agricultural sector is considered the backbone of sustainable development in Egypt. While the developing countries of the world face many challenges regarding food security due to rapid population growth and limited agricultural resources, this study aimed to assess the soils of Sidi Barrani and Salloum using multivariate analysis to determine the land capability and crop suitability for potential alternative crop uses, based on using principal component analysis (PCA), agglomerative hierarchical cluster analysis (AHC) and the Almagra model of MicroLEIS. In total, 24 soil profiles were dug, to represent the geomorphic units of the study area, and the soil physicochemical parameters were analyzed in laboratory. The land capability assessment was classified into five significant classes (C1 to C5) based on AHC and PCA analyses. The class C1 represents the highest capable class while C5 is assigned to lowest class. The results indicated that about 7% of the total area was classified as highly capable land (C1), which is area characterized by high concentrations of macronutrients (N, P, K) and low soil salinity value. However, about 52% of the total area was assigned to moderately high class (C2), and 29% was allocated in moderate class (C3), whilst the remaining area (12%) was classified as the low (C4) and not capable (C5) classes, due to soil limitations such as shallow soil depth, high salinity, and increased erosion susceptibility. Moreover, the results of the Almagra soil suitability model for ten crops were described into four suitability classes, while about 37% of the study area was allocated in the highly suitable class (S2) for wheat, olive, alfalfa, sugar beet and fig. Furthermore, 13% of the area was categorized as highly suitable soil (S2) for citrus and peach. On the other hand, about 50% of the total area was assigned to the marginal class (S4) for most of the selected crops. Hence, the use of multivariate analysis, mapping land capability and modeling the soil suitability for diverse crops help the decision makers with regard to potential agricultural development. © 2020 by the authors