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

Impact of exogenous tannin additions on wine chemistry and wine sensory character

Tannins are an important part of wine quality and are frequently added during winemaking. Tannin additives and their impact on wine are poorly documented. This work sought to characterize a range of enological tannins and their contribution to wine quality. Enological tannins were analysed for protein precipitable tannins and iron reactive phenolics. One tannin product was added to a Merlot wine during barrel ageing, at a range of concentrations from 60 to 300 mg/l. Condensed and hydrolysable tannins were added to Cabernet Sauvignon wine post-pressing at a recommended and excessive rate. Wines were analysed for anthocyanin, small and large polymeric pigment, precipitable tannin, iron reactive phenolics and sensory character. Enological tannins contained 12\u201348% tannin and recommended additions had little impact on wine tannin. High tannin additions were readily measured in the wines and were discriminated in sensory analysis with lower intensities of most parameters except brown colour, bitterness and earthy character. Recommended addition rates are too low to impact the measured tannin concentration of Merlot and Cabernet Sauvignon wines from Washington (USA). High enological tannin additions had a measureable impact on final wine had a negative impact on sensory character. Tannins are added to wines for a range of reasons and represent one of many input costs in an industry increasingly seeking efficiencies in response to global economic circumstances, over-supply and an ongoing price point squeeze. This research suggests many tannin additions may be unjustified and have limited or negative impacts on quality

Supplementary Material for: Inactivation of Macrophage Rab7 by Burkholderia cenocepacia

<p>Strains of the <i>Burkholderia cepacia </i>complex can survive within macrophages by arresting the maturation of phagocytic vacuoles. The bacteria preclude fusion of the phagosome with lysosomes by a process that is poorly understood. Using murine macrophages, we investigated the stage at which maturation is arrested and analyzed the underlying mechanism. Vacuoles containing <i>B. cenocepacia </i>strain J2315, an isolate of the transmissible ET12 clone, recruited Rab5 and synthesized phosphatidylinositol-3-phosphate, indicating progression to the early phagosomal stage. Despite the fact that the <i>B. cenocepacia</i>-containing vacuoles rarely fused with lysosomes, they could nevertheless acquire the late phagosomal markers CD63 and Rab7. Fluorescence recovery after photobleaching and use of a probe that detects Rab7-guanosine triphosphate indicated that activation of Rab7 was impaired by <i>B. cenocepacia, </i>accounting at least in part for the inability of the vacuole to merge with lysosomes. The Rab7 defect was not due to excessive cholesterol accumulation and was confined to the infected vacuoles. Jointly, these experiments indicate that <i>B. cenocepacia </i>express virulence factors capable of interfering with Rab7 function and thereby with membrane traffic.</p

A rat model of post‐traumatic stress syndrome causes phenotype‐associated morphological changes and hypofunction of the adrenal gland

Background: Rats exposed to chronic predator scent stress mimic the phenotype of complex post‐traumatic stress disorder (PTSD) in humans, including altered adrenal morphology and function. High‐ and low‐anxiety phenotypes have been described in rats exposed to predator scent stress (PSS). This study aimed to determine whether these high‐ and low‐anxiety phenotypes cor-relate with changes in adrenal histomorphology and corticosteroid production. Methods: Rats were exposed to PSS for ten days. Thirty days later, the rats’ anxiety index (AI) was assessed with an elevated plus‐maze test. Based on differences in AI, the rats were segregated into low‐ (AI ≤ 0.8, n = 9) and high‐ (AI &gt; 0.8, n = 10) anxiety phenotypes. Plasma corticosterone (CORT) concentrations were measured by ELISA. Adrenal CORT, desoxyCORT, and 11‐dehydroCORT were measured by high‐performance liquid chromatography. After staining with hematoxylin and eosin, adrenal his-tomorphometric changes were evaluated by measuring the thickness of the functional zones of the adrenal cortex. Results: Decreased plasma CORT concentrations, as well as decreased adrenal CORT, desoxyCORT and 11‐dehydroCORT concentrations, were observed in high‐ but not in low-anxiety phenotypes. These decreases were associated with increases in AI. PSS led to a significant decrease in the thickness of the zona fasciculata and an increase in the thickness of the zona intermedia. The increase in the thickness of the zona intermedia was more pronounced in low‐anxiety than in high‐anxiety rats. A decrease in the adrenal capsule thickness was observed only in low‐anxiety rats. The nucleus diameter of cells in the zona fasciculata of high‐anxiety rats was significantly smaller than that of control or low‐anxiety rats. Conclusion: Phenotype‐associated changes in adrenal function and histomorphology were observed in a rat model of complex post‐traumatic stress disorder. © 2021 by the authors. Licensee MDPI, Basel, Switzerland