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

Synthetic and biopolymeric microgels: Review of similarities and difference in behaviour in bulk phases and at interfaces

This review discusses the current knowledge of interfacial and bulk interactions of biopolymeric microgels in relation to the well-established properties of synthetic microgels for applications as viscosity modifiers and Pickering stabilisers. We present a timeline showing the key milestones in designing microgels and their bulk/ interfacial performance. Poly(N-isopropylacrylamide) (pNIPAM) microgels have remained as the protagonist in the synthetic microgel domain whilst proteins or polysaccharides have been primarily used to fabricate biopolymeric microgels. Bulk properties of microgel dispersions are dominated by the volume fraction ( ) of the microgel particles, but is difficult to pinpoint, as addressed by many theoretical models. By evaluating recent experimental studies over the last five years, we find an increasing focus on the analysis of microgel elasticity as a key parameter in modulating their packing at the interfaces, within the provinces of both synthetic and biopolymeric systems. Production methods and physiochemical factors shown to influence microgel swelling in the aqueous phase can have a significant impact on their bulk as well as interfacial performance. Compared to synthetic microgels, biopolymer microgels show a greater tendency for polydispersity and aggregation and do not appear to have a core-corona structure. Comprehensive studies of biopolymeric microgels are still lacking, for example, to accurately determine their inter- and intra- particle interactions, whilst a wider variety of techniques need to be applied in order to allow comparisons to real systems of practical usage

Single nucleotide polymorphisms predisposing to asthma in children of Mauritian Indian and Chinese Han ethnicity

Our objective was to investigate the distributions of six single nucleotide polymorphisms (SNPs) MS4A2 E237G, MS4A2 C-109T, ADRB2 R16G, IL4RA I75V,IL4 C-590T, and IL13 C1923T in Mauritian Indian and Chinese Han children with asthma. This case-control association study enrolled 382 unrelated Mauritian Indian children, 193 with asthma and 189 healthy controls, and 384 unrelated Chinese Han children, 192 with asthma and 192 healthy controls. The SNP loci were genotyped using polymerase chain reaction (PCR)-restriction fragment length polymorphism for the Chinese Han samples and TaqMan real-time quantitative PCR for the Mauritian Indian samples. In the Mauritian Indian children, there was a significant difference in the distribution of IL13 C1923T between the asthma and control groups (P=0.033). The frequency of IL13 C1923T T/T in the Mauritian Indian asthma group was significantly higher than in the control group [odds ratio (OR)=2.119, 95% confidence interval=1.048-4.285]. The Chinese Han children with asthma had significantly higher frequencies ofMS4A2 C-109T T/T (OR=1.961, P=0.001) and ADRB2 R16G A/A (OR=2.575, P=0.000) than the control group. The IL13 C1923T locus predisposed to asthma in Mauritian Indian children, which represents an ethnic difference from the Chinese Han population. TheMS4A2 C-109T T/T and ADRB2 R16G A/Agenotypes were associated with asthma in the Chinese Han children