On the use of modelling antagonistic enzymes to aid in temporal programming of pH and PVA–borate gelation

Feedback through enzyme reactions creates new possibilities for the temporal programming of material properties in bioinspired applications, such as transient adhesives; however, there have been limited attempts to model such behavior. Here, we used two antagonistic enzymes, urease in watermelon seed powder and esterase, to temporally control the gelation of a poly(vinyl alcohol)–borate hydrogel in a one-pot formulation. Urease produces base (ammonia), and esterase produces acid (acetic acid), generating a pH pulse, which was coupled with reversible complexation of PVA. For improved understanding of the pulse properties and gel lifetime, the pH profile was investigated by comparison of the experiments with kinetic simulations of the enzyme reactions and relevant equilibria. The model reproduced the general trends with the initial concentrations and was used to help identify conditions for pulse-like behaviour as the substrate concentrations were varied

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

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 Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

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

Improving mechanical and electrical properties of Cu/SAC305/Cu solder joints under electromigration by using Ni nanoparticles doped flux

The electromigration (EM) degrades the structural, mechanical and electrical properties of solder joints. An effort has been made to investigate the effects of the Ni nanoparticles (NP) doped flux on the mechanical properties and electrical resistance of SAC305 solder joints subjected to EM. SAC305 solder joints were prepared using NP-doped flux. A current density of 3 × 103 A/cm2 was applied to the joints at a constant temperature of 150 °C. Tensile tests were performed before and after the EM tests. Results reveal that after the addition of Ni NP-doped flux, the mechanical strength improved before and after EM. After EM, the fracture path for doped solder joint did not migrate to the cathode side as compared to un-doped solder. Ni NP also improved the electrical resistance and lifetime of the solder joint. The use of Ni NP-doped flux thus minimized the effects of EM and improved the mechanical and electrical performance of the solder joints

Effect of Cobalt Doping on the Microstructure and Tensile Properties of Lead Free Solder Joint Subjected to Electromigration

Rapid Cu diffusion is one of the main causes of electromigration (EM) failure in lead-free solder joints. In this study, an effort has been made to investigate the detrimental effects of EM on microstructure and mechanical performance of solder joint by introducing Co nanoparticles (NP) doped flux at the interface between SAC305 solder and copper substrate. EM tests were conducted on un-doped SAC305 and Co-doped SAC305 solder joints for different time intervals, with the maximum duration of 1128 h. A DC current was applied to the both types of solder joints to achieve a current density of 1 × 104 A/cm2. EM tests were performed in an oil bath maintained at a constant temperature of 80 °C. It is found that Co-doped flux significantly reduced the formation of cracks and voids at the cathode interface. Co atoms entered into the lattice of Cu6Sn5 leading to the formation of (Cu, Co)6Sn5. This thermodynamically stabilized the interfacial intermetallic (IMC) layers both at the anode and cathode sides and suppressed the change in their thickness. The average anodic growth rate of (Cu, Co)6Sn5 interfacial IMC in the doped sample was about one order of magnitude lower compared with that of Cu6Sn5 in the un-doped samples. Co-NP also improved the tensile strength considerably before and after EM. The report suggests that the reliability of solder joint during EM can be improved by using Co-NP doped flux