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 relationship between the X-ray and radio components in the compact steep-spectrum quasar 3c 48

Peer reviewe

The cool wake around 4c 34.16 as seen by XMM-Newton

Peer reviewe

An online clinical decision tool to screen for vertebral fragility fractures (Vfrac) in older women presenting with back pain in general practice: protocol for a feasibility study in preparation for a future cluster randomised controlled trial

Summary: This feasibility study for a future definitive randomized trial assesses the use and acceptability of a new clinical decision tool to identify risk of a vertebral fracture and those who should be referred for spinal radiography in women aged 65 or over presenting to primary care with back pain. Purpose: Approximately 12% of older adults have vertebral fragility fractures, but currently fewer than one-third are diagnosed, potentially limiting access to bone protection treatment. Vfrac is a vertebral fracture screening tool which classifies individuals into high or low risk of having a vertebral fracture, allowing targeting of spinal radiographs to high-risk individuals. The objective of this study was to investigate the feasibility of conducting a cluster randomized controlled trial to evaluate the use of an online version of Vfrac in primary care. Methods: The study will run in six general practices, with three given the Vfrac tool for use on older women (> 65 years) consulting with back pain and three using standard clinical processes for managing such back pain. Anonymised data covering a 12-month period will be collected from all sites on consultations by older women with back pain. Focus groups will be undertaken with healthcare professionals and patients on whom the tool was used to understand the acceptability of Vfrac and identify factors that impact its use. These patients will be sent a paper version of the Vfrac questionnaire to self-complete at home. Outputs of the self-completion Vfrac (high versus low risk) will be compared with the face-to-face Vfrac (high versus low risk), and agreement assessed using Cohen’s kappa. Results: This study will evaluate the use and acceptability of Vfrac within primary care and determine if data on resource use can be collected accurately and comprehensively. Conclusions: This article describes the protocol of the Vfrac feasibility study. Trial registration: ISRCTN18000119 (registered 01/03/2022) and ISRCTN12150779 (registered 10/01/2022)

Chaperone‐mediated coupling of subunit availability to activation of flagellar Type III secretion

Bacterial flagellar subunits are exported across the cell membrane by the flagellar Type III Secretion System (fT3SS), powered by the proton motive force (pmf) and a specialized ATPase that enables the flagellar export gate to utilize the pmf electric potential (ΔΨ). Export gate activation is mediated by the ATPase stalk, FliJ, but how this process is regulated to prevent wasteful dissipation of pmf in the absence of subunit cargo is not known. Here, we show that FliJ activation of the export gate is regulated by flagellar export chaperones. FliJ binds unladen chaperones and, by using novel chaperone variants specifically defective for FliJ binding, we show that disruption of this interaction attenuates motility and cognate subunit export. We demonstrate in vitro that chaperones and the FlhA export gate component compete for binding to FliJ, and show in vivo that unladen chaperones, which would be present in the cell when subunit levels are low, sequester FliJ to prevent activation of the export gate and attenuate subunit export. Our data indicate a mechanism whereby chaperones couple availability of subunit cargo to pmf-driven export by the fT3SS

LOFAR 150-MHz observations of the Boötes field: catalogue and source counts

We present the first wide area (19 deg2), deep (≈120–150 μJy beam−1), high-resolution (5.6 × 7.4 arcsec) LOFAR High Band Antenna image of the Boötes field made at 130–169 MHz. This image is at least an order of magnitude deeper and 3–5 times higher in angular resolution than previously achieved for this field at low frequencies. The observations and data reduction, which includes full direction-dependent calibration, are described here. We present a radio source catalogue containing 6 276 sources detected over an area of 19 deg2, with a peak flux density threshold of 5σ. As the first thorough test of the facet calibration strategy, introduced by van Weeren et al., we investigate the flux and positional accuracy of the catalogue. We present differential source counts that reach an order of magnitude deeper in flux density than previously achieved at these low frequencies, and show flattening at 150-MHz flux densities below 10 mJy associated with the rise of the low flux density star-forming galaxies and radio-quiet AGN

LOFAR 150-MHz observations of the Boötes field: catalogue and source counts

We present the first wide area (19 deg$^2$), deep ($\approx120-150$ {\mu}Jy beam$^{-1}$), high resolution ($5.6 \times 7.4$ arcsec) LOFAR High Band Antenna image of the Bo\"otes field made at 130-169 MHz. This image is at least an order of magnitude deeper and 3-5 times higher in angular resolution than previously achieved for this field at low frequencies. The observations and data reduction, which includes full direction-dependent calibration, are described here. We present a radio source catalogue containing 6276 sources detected over an area of $19$\,deg$^2$, with a peak flux density threshold of $5\sigma$. As the first thorough test of the facet calibration strategy, introduced by van Weeren et al., we investigate the flux and positional accuracy of the catalogue. We present differential source counts that reach an order of magnitude deeper in flux density than previously achieved at these low frequencies, and show flattening at 150 MHz flux densities below 10 mJy associated with the rise of the low flux density star-forming galaxies and radio-quiet AGN

LOFAR 150-MHz observations of the Boötes field: catalogue and source counts

We present the first wide area (19 deg2), deep (≈120–150 μJy beam−1), high-resolution (5.6 × 7.4 arcsec) LOFAR High Band Antenna image of the Boötes field made at 130–169 MHz. This image is at least an order of magnitude deeper and 3–5 times higher in angular resolution than previously achieved for this field at low frequencies. The observations and data reduction, which includes full direction-dependent calibration, are described here. We present a radio source catalogue containing 6 276 sources detected over an area of 19 deg2, with a peak flux density threshold of 5σ. As the first thorough test of the facet calibration strategy, introduced by van Weeren et al., we investigate the flux and positional accuracy of the catalogue. We present differential source counts that reach an order of magnitude deeper in flux density than previously achieved at these low frequencies, and show flattening at 150-MHz flux densities below 10 mJy associated with the rise of the low flux density star-forming galaxies and radio-quiet AGN