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

A temporal gate for viral enhancers to co-opt Toll-like-Receptor transcriptional activation pathways upon acute infection

Viral engagement with macrophages activates Toll-Like-Receptors (TLRs) and viruses must contend with the ensuing inflammatory responses to successfully complete their repli- cation cycle. To date, known counter-strategies involve the use of viral-encoded proteins that often employ mimicry mechanisms to block or redirect the host response to benefit the virus. Whether viral regulatory DNA sequences provide an opportunistic strategy by which viral enhancer elements functionally mimic innate immune enhancers is unknown. Here we find that host innate immune genes and the prototypical viral enhancer of cytomegalovirus (CMV) have comparable expression kinetics, and positively respond to common TLR ago- nists. In macrophages but not fibroblasts we show that activation of NF κ B at immediate- early times of infection is independent of virion-associated protein, M45. We find upon virus infection or transfection of viral genomic DNA the TLR-agonist treatment results in signifi- cant enhancement of the virus transcription-replication cycle. In macrophage time-course infection experiments we demonstrate that TLR-agonist stimulation of the viral enhancer and replication cycle is strictly delimited by a temporal gate with a determined half-maximal time for enhancer-activation of 6 h; after which TLR-activation blocks the viral transcription- replication cycle. By performing a systematic siRNA screen of 149 innate immune regulato- ry factors we identify not only anticipated anti-viral and pro-viral contributions but also new factors involved in the CMV transcription-replication cycle. We identify a central convergent NF κ B-SP1-RXR-IRF axis downstream of TLR-signalling. Activation of the RXR component potentiated direct and indirect TLR-induced activation of CMV transcription-replication cycle; whereas chromatin binding experiments using wild-type and enhancer-deletion virus revealed IRF3 and 5 as new pro-viral host transcription factor interactions with the CMV en- hancer in macrophages. In a series of pharmacologic, siRNA and genetic loss-of-function experiments we determined that signalling mediated by the TLR-adaptor protein MyD88 plays a vital role for governing the inflammatory activation of the CMV enhancer in macro- phages. Downstream TLR-regulated transcription factor binding motif disruption for NF κ B,AP1 and CREB/ATF in the CMV enhancer demonstrated the requirement of these inflam- matory signal-regulated elements in driving viral gene expression and growth in cells as well as in primary infection of neonatal mice. Thus, this study shows that the prototypical CMV enhancer, in a restricted time-gated manner, co-opts through DNA regulatory mimicry elements, innate-immune transcription factors to drive viral expression and replication in the face of on-going pro-inflammatory antiviral responses in vitro and in vivo and; suggests an unexpected role for inflammation in promoting acute infection and has important future im- plications for regulating latency

Efectos del PREDA Audiovisual (PREDA-AV) en la Deshonestidad Académica y sus actitudes

Depto. de Investigación y Psicología en EducaciónFac. de EducaciónFALSEsubmitte

Expansion and application of the PREDA material and its effects on Academic Dishonesty and its attitudes

La Deshonestidad Académica (DA) es una de las grandes dificultades que está teniendo la universidad en la formación de futuros profesionales. El objetivo del trabajo fue ampliar el material PREDA con una nueva unidad sobre el software empleado para la detección del plagio y analizar analizar el efecto de todo el PREDA en la percepción de la DA en estudiantes universitarios. La muestra total es de 472 estudiantes universitarios de la UCM y la UDIMA de 15 asignaturas diferente, tanto de grado como de máster. Los resultados indican que no existe un efecto significativo de las estrategías en la percepción de la DA. Sin embargo, el grupo de estudiantes que se expuso al material diseñado y que fue trabajado en el aula presenta una mejora en la percepción de la DA. El material diseñado puede ser empleado para tratar el tema de la DA al interior del aula.Academic Dishonesty (AD) is one of the great difficulties that the university is having in the training of future professionals. The objective of the work was to expand the PREDA material with a new unit on the software used to detect plagiarism and to analyze the effect of all the PREDA on the perception of AD in university students. The total sample is 472 university students from the UCM and the UDIMA of 15 different subjects, both undergraduate and master's degrees. The results indicate that there is no significant effect of the strategies on the perception of AD. However, the group of students who were exposed to the material designed and worked on in the classroom presented an improvement in the perception of AD. The material designed can be used to deal with the subject of AD in the classroom.Depto. de Investigación y Psicología en EducaciónFac. de EducaciónFALSEVicerrectorado de Calidad - UCMunpu