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

Effect of surface treatment and glazing in the two-body wear resistance of a hybrid ceramic after polymeric staining application

The present study evaluated the wear resistance of the characterization layer applied over a hybrid ceramic with different surface treatments against a zirconia antagonist. Eighty hybrid ceramic discs were prepared, polished and distributed in eight groups, according to the surface treatment before characterization and presence of a glaze layer (P, polished specimens–used as a reference; PG, polished specimens with glaze; E, acid etching; EG, acid etching + glaze; A, sandblasting; AG, sandblasting + glaze; S, self-etching silane; SG, self-etching silane + glaze). The specimens were subjected to physiological wear simulation with zirconia applicators (n = 10). The parameters for the wear simulation were: 15 N, horizontal movement of 6 mm, 1.7 Hz and 5000 cycles in distilled water. With the aid of a contact profilometer, Rz roughness parameter was analyzed in different periods of evaluation (after 0, 10, 100, 500, 1000 and 5000 cycles). Rz mean values were statistically analyzed using 3-way ANOVA (surface treatment × glaze presence × number of cycles), followed by Tukey test (α = 5%). ANOVA showed statistically significant differences among the groups considering the wear depth. And, significant interaction between the factors. However, as isolated factors, only surface treatment and number of cycles affected the staining wear rate (p < 0.05). Acid etching followed by glaze application was the most durable surface treatment to maintain the external staining on the hybrid ceramic surface when subjected to the two-body wear test

The incidence of acute kidney injury and its association with mortality in patients diagnosed with COVID-19 followed up in intensive care unit

Introduction: The kidneys are some of the most frequently affected organs during coronavirus disease 2019 (COVID-19). This multicenter study evaluated the incidence of and risk factors for acute kidney injury (AKI) in COVID-19 patients followed up in intensive care unit (ICU) and its association with mortality. Methods: Three hundred twenty-eight patients diagnosed with COVID-19 and hospitalized in ICU were included. Risk factors associated with AKI and mortality were evaluated. Results: Eighty-eight patients (27.9%) were diagnosed with AKI. AKI was significantly associated with older age, higher baseline creatinine level, lower albumin level, and coexistence of cardiovascular disease and chronic obstructive pulmonary disease. Mortality in the entire study group was significantly associated with AKI, older age, requirement of invasive mechanical ventilation, higher neutrophil level, lower lymphocyte, and albumin levels. Conclusion: AKI is frequently seen during the course of COVID-19 and is associated with high mortality. Identifying AKI-related risk factors appears essential in the management of COVID-19 patients. © 2022 International Society for Apheresis and Japanese Society for Apheresis

Discovery of an Ultra-faint Stellar System near the Magellanic Clouds with the DECam Local Volume Exploration Survey

We report the discovery of a new ultra-faint stellar system found near the Magellanic Clouds in the DECam Local Volume Exploration Survey. This new system, DELVE J0155-6815 (DELVE 2), is located at a heliocentric distance of D o˙ = 71 4 kpc, which places it at a 3D physical separation of 12 3 kpc from the center of the Small Magellanic Cloud and 28 -3 +4, kpc from the center of the Large Magellanic Cloud (LMC). DELVE 2 is identified as a resolved overdensity of old (τ > 13.3 Gyr) and metal-poor ( dex) stars with a projected half-light radius of and an absolute magnitude of M V =-{2.1} {-0.5} {+0.4}, mag. The size and luminosity of DELVE 2 are consistent with both the population of recently discovered ultra-faint globular clusters and the smallest ultra-faint dwarf galaxies. However, its photometrically derived age and metallicity would place it among the oldest and most metal-poor globular clusters in the Magellanic system. In the absence of spectroscopic measurements of the system's metallicity dispersion and internal kinematics, we are unable to conclusively classify this system at this time. DELVE 2 is detected in Gaia DR2 with a clear proper-motion signal, with multiple blue horizontal-branch stars near the centroid of the system with proper motions consistent with the systemic mean. We measure the system proper motion to be μ α δ, μ δ = 1.02 -0.25 {+0.24}, -{0.85}_{-0.19} {+0.18}) mas yr-1. We compare the spatial position and proper motion of DELVE 2 with simulations of the accreted satellite population of the LMC and find that it is very likely to be associated with the LMC. © 2021. The American Astronomical Society. All rights reserved.Immediate accessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Two Ultra-Faint Milky Way Stellar Systems Discovered in Early Data from the DECam Local Volume Exploration Survey

We report the discovery of two ultra-faint stellar systems found in early data from the DECam Local Volume Exploration survey (DELVE). The �rst system, Centaurus I (DELVE J123