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

Graphene Oxide-PES-Based Mixed Matrix Membranes for Controllable Antibacterial Activity against Salmonella typhi and Water Treatment

The present work is focused on preparation, characterization, and antibacterial activity evaluation of graphene oxide/polyethersulfone mixed matrix filtration membranes. Graphene oxide (GO) was synthesized via improved Hummer’s method and characterized by XRD, FTIR, and SEM. FT-IR spectra showed the presence of carboxylic acid and hydroxyl groups on GO nanosheets. Different concentrations of the synthesized GO at 0.25, 0.5, and 1.0 wt. % were incorporated in polyethersulfone (PES) matrix via phase inversion method to fabricate GO-PES membranes. Increasing porosity and formation of wider, finger-like channels were observed with increased GO concentrations relative to pristine membranes as evident from scanning electron microscopy (SEM) micrographs of the fabricated membranes. However, membranes prepared with 1 wt. % GO appear to contain aggregation and narrowing of pore morphology. GO-incorporated membranes demonstrated enhanced flux, water-retaining capacities, and wettability as compared to pristine PES membranes. Shake flask and colony counting methods were employed to carry out antibacterial testing of synthesized GO and fabricated GO-PES membranes against Salmonella typhi (S. typhi)—a gram-negative bacteria present in water that is known as causative agent of typhoid. Synthesized GO showed significant reduction up to 70.8% in S. typhi cell count. In the case of fabricated membranes, variable concentrations of GO are observed to significantly influence the percentage viability of S. typhi, with reduction percentages observed at 41, 60, and 69% for 0.25, 0.5, and 1.0 wt. % GO-incorporated membranes relative to 17% in the case of pristine PES membranes. The results indicate a good potential for applying GO/PES composite membranes for water filtration application

COVID-19-related intracranial imaging findings: a large single-centre experience.

AIM To describe the neuroradiological changes in patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS A retrospective review was undertaken of 3,403 patients who were confirmed positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and admitted to Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK between 1 March 2020 and 31 May 2020, and who underwent neuroimaging. Abnormal brain imaging was evaluated in detail and various imaging patterns on magnetic resonance imaging MRI were identified. RESULTS Of the 3,403 patients with COVID-19, 167 (4.9%) had neurological signs or symptoms warranting neuroimaging. The most common indications were delirium (44/167, 26%), focal neurology (37/167, 22%), and altered consciousness (34/167, 20%). Neuroimaging showed abnormalities in 23% of patients, with MRI being abnormal in 20 patients and computed tomography (CT) in 18 patients. The most consistent neuroradiological finding was microhaemorrhage with a predilection for the splenium of the corpus callosum (12/20, 60%) followed by acute or subacute infarct (5/20, 25%), watershed white matter hyperintensities (4/20, 20%), and susceptibility changes on susceptibility-weighted imaging (SWI) in the superficial veins (3/20, 15%), acute haemorrhagic necrotising encephalopathy (2/20, 10%), large parenchymal haemorrhage (2/20, 10%), subarachnoid haemorrhage (1/20, 5%), hypoxic-ischaemic changes (1/20, 5%), and acute disseminated encephalomyelitis (ADEM)-like changes (1/20, 5%). CONCLUSION Various imaging patterns on MRI were observed including acute haemorrhagic necrotising encephalopathy, white matter hyperintensities, hypoxic-ischaemic changes, ADEM-like changes, and stroke. Microhaemorrhages were the most common findings. Prolonged hypoxaemia, consumption coagulopathy, and endothelial disruption are the likely pathological drivers and reflect disease severity in this patient cohort