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

An algorithm to form balanced and diverse groups of students

We share the details of a simple algorithm which groups students based on diversity in gender and race while keeping the group average CGPA nearly equal. Application on simulated and actual class profiles gave multiple-feasible solutions within seconds, with a maximum absolute deviation in group average CGPA of 0.03/4.00 or lower. (C) 2009 Wiley Periodicals, Inc. Comput Appl Eng Educ 19: 582-590, 2011; View this article online at wileyonlinelibrary.com/journal/ca

Otitis externa - The clinical pattern in a tertiary institution in Singapore

Annals of the Academy of Medicine Singapore272215-218AAMS

Public and private healthcare services utilization by non-institutional elderly in Hong Kong: Is the inverse care law operating?

<b>Objectives</b> To assess the factors associated with healthcare services utilization by the non-institutional elderly across five types of service utilization (Western medicine doctors in Government clinics, private Western medicine doctors, Chinese medicine practitioners, Emergency Units, and hospitalization).<p></p> <b>Methods </b>A secondary data analysis of a territory-wide cross-sectional survey collected by the Government among a representative sample of 4812 elderly (aged 60 and above) in Hong Kong.<p></p> <b>Results</b> Our analysis, based on Anderson's behavioral framework, shows that need factors (relating to actual or perceived illness and diseases) are significantly related to the healthcare services utilization examined. However, enabling factors, such as monthly household income per capita, play a significant role in determining the utilization. Although the lower-income elderly consult more Government clinics and less private clinics than the more affluent, they have a lower total utilization of healthcare services despite having significantly greater healthcare needs.<p></p> <b>Conclusions </b>This suggests a mismatch of need and supply within the mixed economy of private and public healthcare services and suggests the existence of an 'inverse care law' in Hong Kong amongst elderly citizens. The findings raise concerns of inequities in Hong Kong's healthcare system, raising implications for future healthcare reforms

Kinetic and stoichiometric characterization for efficient enhanced biological phosphorus removal (EBPR) process at high temperatures

A recently reported stable and efficient EBPR system at high temperatures around 30 degrees C has led to characterization of kinetic and stoichiometric parameters of the Activated Sludge Model no. 2d (ASM2d). Firstly, suitable model parameters were selected by identifiability analysis. Next, the model was calibrated and validated. ASM2d was found to represent the processes well at 28 and 32 degrees C except in polyhyroxyalkanoate (PHA) accumulation of the latter. The values of the kinetic parameters for PHA storage (q(PHA)), polyphosphate storage (q(PP)) and growth (mu(PAO)) of polyphosphate-accumulating organisms (PAOs) at 28 and 32 degrees C were found to be much higher than those reported by previous studies. Besides, the value of the stoichiometric parameter for the requirement of polyphosphate for PHA storage (Y-PO4) was found to decrease as temperature rose from 28 to 32 degrees C. Values of two other stoichiometric parameters, i.e. the growth yield of heterotrophic organisms (Y-H) and PAOs (Y-PAO), were high at both temperatures. These calibrated parameters imply that the extremely active PAOs of the study were able to store PHA, store polyphosphate and even utilize PHA for cell growth. Besides, the parameters do not follow the Arrhenius correlation due to the previously reported unique microbial clade at 28 and 32 degrees C, which actively performs EBPR at high temperatures

Insulin-like growth factor binding proteins (IGFBPs) and IGFBP-related protein 1-levels in cerebrospinal fluid of children with acute lymphoblastic leukemia

Journal of Clinical Endocrinology and Metabolism8441283-1287JCEM

Perspective from health professionals on delivery of sub-acute care in Hong Kong: A qualitative study in a health system

Objectives The perception and understanding of health professionals of the role of sub-acute care in the health system will have an impact on the potential effectiveness in preventing unnecessary hospitalization. This study aims to explore the perceived role and quality of sub-acute care services in the context of Hong Kong from the perspective of health service providers and to identify barriers to effectiveness.Methods Seven focus groups were conducted and the discussion was led by a guide covering three main areas: definition/component/role of sub-acute, difficulties in the sub-acute care services provision, and suggestion for further improvement in the provision of sub-acute care.Results The participants highlighted the positive role of sub-acute to promote patient's health and quality of life so as to reduce unnecessary hospitalization. The potential barriers in the sub-acute care identified were interrelated and focused mainly on systemic issues including lack of service coordination, specialist input and resources. The participants also suggested a number of practical ways to improve the quality of sub-acute care services.Conclusions The findings showed a need for further improvement in the process of sub-acute care by developing operation guideline and re-evaluating the allocation of resources to support the sub-acute care provision.Sub-acute care Communication barrier Health professionals Healthcare system