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

Abstract 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

Does the Local Application of Teriparatide Prevent Medication-related Osteonecrosis of the Jaw after Tooth Extraction in Rats?

Systemic Teriparatide treatment in patients with medication-related osteonecrosis of the jaw (MRONJ) has shown promising results in clinical studies. I hypothesized that local application of PTH (1-34) on an acellular collagen sponge (ACS) following tooth extraction would lower the incidence of MRONJ. In rat model of MRONJ, the maxillary molars were extracted then the extraction sockets were filled with ACS+PTH (1-34), ACS or left unfilled. The extraction sites were assessed clinically for bone exposure, and then underwent analysis by microCT and histology. The ACS+PTH (1-34) group had a significantly lower incidence of bone exposure and less exposed bone area (0. pM.Sc

Emîr Mencek Paşa el-Yûsufî'nin şiirinde tasvir

Çalışmamızda Osmanlı döneminde yaşayan Suriyeli şair Emir Mencek Paşa'nın şiirlerinde tasvir konusu ele alınmıştır. Çalışmamız giriş ve iki bölümden oluşmaktadır. Çalışmanın giriş bölümünde edebî, ilmî, siyasi ve ictimaî olarak şairin yaşadığı dönem ele alınırken birinci bölümde şairin hayatı ve edebî kişiliği, ikinci bölümde ise şairin şiirlerinde tasvir incelenmiştir.In our study, the subject of depiction is discussed in the poems of the Syrian poet Emir Mencek Pasha who lived in the Ottoman period. Our study consists of an introduction and two parts. In the introductory part of the study, the period of the poet's life as literary, scientific, political and ictimaî is discussed

Osteogenic Differentiation of Periodontal Ligament Stem Cells Seeded on Equine-Derived Xenograft in Osteogenic Growth Media

Background and Objectives: The duration of bone turnover is critical, and different time points help in identifying the optimal endpoint of treatment duration. However, investigating the combination of xenograft and stem cells to allow tissue regeneration within an ideal time duration remains an under-investigated topic. The current study aimed to assess the impact of equine-derived xenograft bone blocks in assisting the human periodontal ligament stem cells (PDLSCs) to demonstrate osteogenic differentiation (collagen type 1 expression and calcium deposition) within an osteogenic growth media. Materials and Methods: Human PDLSCs were acquired commercially and seeded onto xenograft bone blocks. After the 14th and 21st day of culture, enzyme-linked immunoassay (ELISA) was utilized for the detection and quantification of levels of collagen type I, while the mineralization assessment (deposition of calcium) was conducted by staining the PDLSCs with Alizarin Red S (ARS). The statistical comparison between the means and standard deviations of study groups were evaluated using analysis of variance (ANOVA). Results: ELISA assessment revealed an upsurge in the expression of collagen type I for PDLSCs cultured with xenograft after 14 and 21 days compared to the controls (intergroup comparisons significant at p < 0.05). Similar findings were obtained for mineralization assessment and on ARS staining. PDLSCs cultured with xenograft bone blocks presented an increased deposition of calcium compared to their control counterparts (intergroup comparisons significant at p < 0.05). Conclusions: PDLSCs embedded in xenograft bone blocks inside an osteogenic growth medium demonstrated greater osteogenic differentiation potential after 14 and 21 days. This superior osteogenic differentiation capability was evident by increased collagen type I expression and more significant calcium deposition at the 14th and 21st days after culture

Structural Relationships between Learning Emotion and Knowledge Organization and Management Processes in Distance Learning Environments: “An Applied Study”

The widespread adoption and expansion of distance learning necessitates the consideration of issues related to learning passion, which is the strong desire of learners towards a specific activity of high value and meaning that enables the use of relevant cognitive and behavioral strategies to acquire, store, apply, share, use, absorb, and create knowledge. The current study aimed to measure learners’ practices of learning emotion processes, knowledge management, and organization in distance learning environments using tangible indicators. The study utilized a descriptive correlational approach to identify the effects of the study variables, including learning emotion (harmonious passion—emotional obsession), on knowledge management through the mediating role of self-regulation in distance learning environments. The results show that learners’ practices of learning emotion processes, knowledge management, and organization in distance learning environments were higher than average, and there was a significant correlation between emotion, self-regulation, and knowledge management. Additionally, learning emotion (harmonious passion and emotional obsession) had a statistically significant effect on self-organization processes and knowledge management. Structural equation modeling analysis confirmed the validity of the proposed path model, indicating that self-regulation plays a crucial role in mediating the relationship between emotion and knowledge management in distance learning environments

Clinical, Radiographic, and Inflammatory Peri-Implant Parameters around Narrow Diameter Implant Crowns among Prediabetic and Non-Diabetic Subjects

Background and Objectives: To compare the clinical, radiographic, and inflammatory peri-implant parameters around narrow diameter implants (NDI) supported single and splinted crowns in non-diabetics and prediabetes. Materials and Methods: The clinical and radiographic parameters and the levels of IL-6 and TNF-α in the peri-implant crevicular fluid (PICF) of narrow diameter single (NDISCs) and splinted (NDISPs) crown implants were assessed both in non-diabetics and participants with prediabetes. The glycemic state of the patient was assessed using glycated hemoglobin (HbA1c) levels. The peri-implant soft tissue indices (Plaque index (PI), bleeding on probing (BoP), probing depth (PD)) and marginal bone loss were recorded and compared between the groups. Success of the prosthesis was assessed by the frequency of technical complications and patient satisfaction. Inter-group comparison was performed using ANOVA (one-way analysis of variance) while the normal distribution of dependent variables was calculated using Shapiro–Wilk. A p-value of less than 0.05 was considered to be statistically significant. Results: Sixty participants (30 non-diabetics and 30 with prediabetes) with a total of 178 (118 NDISCs and 60 NDISPs) platform-switched NDIs were a part of the study. Of the 118 NDISCs, 56 were placed in the non-diabetic individuals and 62 were placed in the prediabetes group whereas 30 NDISPs each were placed in both the study groups. The clinical parameters of PI, BoP and PD in the single crown and splinted crown groups showed comparable results. However, a statistically significant difference (p-value of less than 0.05) in PI, BoP and PD and in the values of IL-6 and TNF-α was found when a comparison was made between the non-diabetes and prediabetes group. A total of 91% of the patients were satisfied with the esthetics of the implants while 79% of the patients showed satisfaction with function. Conclusions: All the clinical and radiographic parameters were statistically similar in both single and splinted types of narrow diameter implants. However, the bone loss, probing depth, plaque index, and levels of inflammatory markers were statistically higher in prediabetes as compared to non-diabetes implying that a slight hyperglycemic state impacts peri-implant health

The Camel Site reliefs — an investigation of the site’s original layout and use

The Camel Site, near Sakākā, is a monumental rock art site in northern Arabia with twenty life-sized reliefs of camels and equids.A chronological assessment showed that the site was in use in the sixth millennium BC, and was repeatedly revisited over aprolonged period, perhaps spanning several centuries. Using aerial photography and 3D models, we reconstructed the originallayout of the site. Our results show that the site was probably designed to be approached via one of two main viewpoints thatallowed maximum visibility of the reliefs, and that the location of individual reliefs was chosen for best visibility in the afternoonsun. Reliefs were carved across two tiers, up to a height of c.9 m, giving the site a monumental character. Analysis of individualreliefs, including the use of high-resolution 3D models of eroded reliefs, shows that the reliefs can be grouped by stylistic/technological criteria and that styles changed over time.Reliefs of equids may be linked to a pre-Neolithic tradition of depicting wild equids in the rock art. Faunal remains recovered atthe site included remains of equids found alongside lithic artefacts and beads of various materials. Evidence of possible on-siteprocessing and cooking of equids suggests that the symbology of equids, and perhaps camels, probably extended beyond theirdepiction in the reliefs

Life-sized Neolithic camel sculptures in Arabia: A scientific assessment of the craftsmanship and age of the Camel Site reliefs

International audienceThe life-sized, naturalistic reliefs at the Camel Site in northern Arabia have been severely damaged by erosion. This, coupled with substantial destruction of the surrounding archaeological landscape, has made a chronological assessment of the site difficult. To overcome these problems, we combined results from a wide range of methods, including analysis of surviving tool marks, assessment of weathering and erosion patterns, portable Xray fluorescence spectrometry, and luminescence dating of fallen fragments. In addition, test excavations identified a homogenous lithic assemblage and faunal remains that were sampled for radiocarbon dating. Our results show that the reliefs were carved with stone tools and that the creation of the reliefs, as well as the main period of activity at the site, date to the Neolithic. Neolithic arrowheads and radiocarbon dates attest occupation between 5200 and 5600 BCE. This is consistent with measurements of the areal density of manganese and iron in the rock varnish. The site was likely in use over a longer period and reliefs were reworked when erosion began to obscure detailed features. By 1000 BCE, erosion was advanced enough to cause first panels to fall, in a process that continues until today. The Camel Site is likely home to the oldest surviving large-scale (naturalistic) animal reliefs in the world