Feasibility study for a safety back-up cryopreservation facility. Independent expert report: July 2017

This study was commissioned by Bioversity International, the International Potato Center (CIP) and the Global Crop Diversity Trust with financial support from Australia, Germany and Switzerland to investigate the feasibility of establishing a safety back-up facility for cryopreserved collections of crops that are vegetatively propagated or have recalcitrant seeds. The independent Expert Group investigated the state of crop cryopreservation in 26 institutes and collated information on field and in vitro collections around the world. The Study highlights the advantages of cryopreservation for conservation of clonal/recalcitrant seed crop collections and recommends that a major global effort is done to facilitate its wide-scale implementation and to overcome major practical constraints. In addition, a safety back-up is required to accommodate 5,000-10,000 accessions arising from on-going cryopreservation activities

Solar Neutrinos: What We Have Learned

The four operating solar neutrino experiments confirm the hypothesis that the energy source for solar luminosity is hydrogen fusion. However, the measured rate for each of the four solar neutrino experiments differs significantly (by factors of 2.0 to 3.5) from the corresponding theoretical prediction that is based upon the standard solar model and the simplest version of the standard electroweak theory. If standard electroweak theory is correct, the energy spectrum for \b8 neutrinos created in the solar interior must be the same (to one part in $10^5$) as the known laboratory \b8 neutrino energy spectrum. Direct comparison of the chlorine and the Kamiokande experiments, both sensitive to \b8 neutrinos, suggests that the discrepancy between theory and observations depends upon neutrino energy, in conflict with standard expectations. Monte Carlo studies with 1000 implementations of the standard solar model confirm that the chlorine and the Kamiokande experiments cannot be reconciled unless new weak interaction physics changes the shape of the \b8 neutrino energy spectrum. The results of the two gallium solar neutrino experiments strengthen the conclusion that new physics is required and help determine a relatively small allowed region for the MSW neutrino parameters.Comment: LaTeX file, 19 pages. For hardcopy with figures contact [email protected]. Institute for Advanced Study number AST 93/6

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

Accurate prediction of anastomotic leakage after colorectal surgery using plasma markers for intestinal damage and inflammation

BACKGROUND: Anastomotic leakage is a frequent and life-threatening complication after colorectal surgery. Early recognition of anastomotic leakage is critical to reduce mortality. Because early clinical and radiologic signs of anastomotic leakage are often nonspecific, there is an urgent need for accurate biomarkers. Markers of inflammation and gut damage might be suitable, as these are hallmarks of anastomotic leakage. STUDY DESIGN: In 84 patients undergoing scheduled colorectal surgery with primary anastomosis, plasma samples were collected preoperatively and daily after surgery. Inflammatory markers, C-reactive protein; calprotectin; and interleukin-6, and intestinal damage markers, intestinal fatty acid binding protein; liver fatty acid binding protein; and ileal bile acid binding protein, were measured. Diagnostic accuracy of single markers or combinations of markers was analyzed by receiver operating characteristic curve analysis. RESULTS: Anastomotic leakage developed in 8 patients, clinically diagnosed at median day 6. Calprotectin had best diagnostic accuracy to detect anastomotic leakage postoperatively. Highest diagnostic accuracy was obtained when C-reactive protein and calprotectin were combined at postoperative day 3, yielding sensitivity of 100%, specificity of 89%, positive likelihood ratio = 9.09 (95% CI, 4.34-16), and negative likelihood ratio = 0.00 (95% CI, 0.00-0.89) (p < 0.001). Interestingly, preoperative intestinal fatty acid binding protein levels predicted anastomotic leakage at a cutoff level of 882 pg/mL with sensitivity of 50%, specificity of 100%, positive likelihood ratio = infinite (95% CI, 4.01-infinite), and negative likelihood ratio = 0.50 (95% CI, 0.26-0.98) (p < 0.0001). CONCLUSIONS: Preoperative intestinal fatty acid binding protein measurement can be used for anastomotic leakage risk assessment. In addition, the combination of C-reactive protein and calprotectin has high diagnostic accuracy. Implementation of these markers in daily practice deserves additional investigation