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

Development of novel intermetallic joints using thin film indium based solder by low temperature bonding technology for 3D IC stacking

Low temperature bonding technology was developed using In-alloy on Au at a low temperature below 200 °C forming robust intermetallics (IMC) joints with high remelting temperature (>300°C), so that after bonding, the IMC joints can withstand the subsequent processes without any degradation. Process parameters on the solder joint were optimized extensively in bonding and annealing process (temperature, time, and pressure). The joint fabricated at an optimal condition, which is 180°C for 45sec followed by annealing at 120°C for 12hrs, was evaluated in terms of microstructure and compositional observations by means of scanning electron microscope (SEM) and transmittance electron microscope (TEM). As a result, it was confirmed that the joint was completely occupied with the Au-In based IMC phases. And the re-melting temperature was measured as above 400°C by using Differential Scanning Calorimetery (DSC) and Thermo-Mechanical Analysis (TMA). This IMC joint showed a high bonding shear strength (>20MPa) and a ow electrical resistance (<100mΩ). Based on this study, the 3 stacked dice with 8×8 mm2 dies with ∼1700 I/Os of 80um solder bumps were fabricated in a chip to chip stacking method. It showed uniform bonding all over the die in each layer and the high bonding strength of ∼40 MPa and passed the 3 times reflow test at 260 °C. The IMC joint reliability was examined. After going through the multiple reflows at 260°C, the bonded samples exhibited no delaminating and nochanges in the bonding strength and the electrical resistance. © 2009 IEEE

The effect of transcranial direct current stimulation (tDCS) combined with cognitive training on EEG spectral power in adolescent boys with ADHD

Transcranial direct current stimulation (tDCS) is a possible alternative to psychostimulants in Attention-Deficit/Hyperactivity Disorder (ADHD), but its mechanisms of action in children and adolescents with ADHD are poorly understood. We conducted the first 15-session, sham-controlled study of anodal tDCS over right inferior frontal cortex (rIFC) combined with cognitive training (CT) in 50 children/adolescents with ADHD. We investigated the mechanisms of action on resting and Go/No-Go Task-based QEEG measures in a subgroup of 23 participants with ADHD (n, sham = 10; anodal tDCS = 13). We failed to find a significant sham versus anodal tDCS group differences in QEEG spectral power during rest and Go/No-Go Task performance, a correlation between QEEG and Go/No-Go Task performance, and changes in clinical and cognitive measures. These findings extend the non-significant clinical and cognitive effects in our sample of 50 children/adolescents with ADHD. Given that the subgroup of 23 participants would have been underpowered, the interpretation of our findings is limited and should be used as a foundation for future investigations. Larger, adequately powered randomized controlled trials should explore different protocols titrated to the individual and using comprehensive measures to assess cognitive, clinical, and neural effects of tDCS and its underlying mechanisms of action in ADHD

Outcome of Later-Onset Pompe Disease Identified Through Newborn Screening

Objective: To determine the outcomes of patients with later-onset Pompe disease (LOPD) identified through newborn screening (NBS). Study design: A prospective observational cohort study was conducted from the initiation of Pompe disease NBS by following subjects every 3-12 months for motor development and biochemical markers. Results: Between 2005 and 2018, 39 of 994 975 newborns evaluated were classified as having LOPD based on low acid α-glucosidase (GAA) activity but no cardiac involvement at the time of screening. As of December 2020, 8 of these 39 infants (21%) were treated with enzyme replacement therapy owing to persistent elevation of creatine kinase (CK), cardiac involvement, or developmental delay. All subjects' physical performance and endurance improved after treatment. Subjects carrying c.[752C>T;761C>T] and c.[546+5G>T; 1726G>A] presented a phenotype of nonprogressive hypotonia, muscle weakness, and impairment in physical fitness tests, but they have not received treatment. Conclusions: One-fifth of subjects identified through NBS as having LOPD developed symptoms after a follow-up of up to 15 years. NBS was found to facilitate the early detection and early treatment of those subjects. GAA variants c.[752C>T;761C>T] and c.[546+5G>T; 1726G>A] might not cause Pompe disease but still may affect skeletal muscle function