Group Formation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68807/2/10.1177_104649647300400206.pd

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 evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Comparison between Glidescope, Airtraq and Macintosh laryngoscopy for emergency endotracheal intubation in intensive care unit: Randomized controlled trial

Background: Emergency endotracheal intubation in intensive care is a major challenge that can be associated with life-threatening complications. The aim of this study was to evaluate the success of the first attempt of endotracheal intubation and incidence of complications using Macintosh laryngoscopy, Airtraq or Glidescope during emergency intubation in intensive care. Patients and methods: One hundred twenty adult intensive care patients of ASA physical status III and IV who required emergency endotracheal intubation were randomly allocated into 3 groups. Group M (40 patients) were intubated using Macintosh laryngoscopy. Group G (40 patients) were intubated using Glidescope. Group A (40 patients) were intubated using Airtraq. The primary outcome was the success of the first attempt of endotracheal intubation. Secondary outcomes included the number of intubation attempts, duration of intubation, glottic view as assessed by Cormack-Lehane grade (C&L grade) and incidence of complications. Results: Success of the first attempt of endotracheal intubation was significantly higher in both groups G and A compared to group M (p  0.05). The C&L grade was significantly better in both groups G and A compared to group M (p < 0.05). No statistically significant difference between the three groups in HR or MAP. The incidence of oxygen desaturation was significantly more in group M compared to groups G and A. No statistically significant difference between the 3 studied groups regarding the incidence of other complications. Conclusion: Both Glidescope and Airtraq have higher first attempt success rate with a better glottic view and less incidence of oxygen desaturation than Macintosh laryngoscopy during emergency intubation in intensive care. Keywords: Macintosh, Glidescope, Airtraq, Emergency intubation, Intensive car

18-month progestogen-only contraception during breast-feeding in Libyan women

This study was undertaken to evaluate the efficacy and the influence of progestogen-only contraceptives (POCs) in postpartum lactating mothers over a period of 18-months. 250 mothers were randomised to either the study groups or the control group. In the study groups, 100 mothers were given an oral progestogen pill; lynestrenol and another 100 mothers were assigned to injectable progestogens; depot medroxy-progesterone acetate (DMPA) and norethisterone oenanthate (NET EN), 50 each.The control group (n=50) was given nonhormonal methods.There was no contraceptive failure or negative influence on lactation among the medication groups.There were no significant differences between the groups with respect to the continuation rates and to the adverse effects that led to premature discontinuation. In conclusion, POCs can be used by lactating mothers effectively and safely for at least 18 months.Therefore, the wide use of these methods should be recommended if the international targets to protect, promote and support breast-feeding as well as family planning are to be achieved

Enhancing the performance of photovoltaic panels by water cooling

The objective of the research is to minimize the amount of water and electrical energy needed for cooling of the solar panels, especially in hot arid regions, e.g., desert areas in Egypt. A cooling system has been developed based on water spraying of PV panels. A mathematical model has been used to determine when to start cooling of the PV panels as the temperature of the panels reaches the maximum allowable temperature (MAT). A cooling model has been developed to determine how long it takes to cool down the PV panels to its normal operating temperature, i.e., 35 °C, based on the proposed cooling system. Both models, the heating rate model and the cooling rate model, are validated experimentally. Based on the heating and cooling rate models, it is found that the PV panels yield the highest output energy if cooling of the panels starts when the temperature of the PV panels reaches a maximum allowable temperature (MAT) of 45 °C. The MAT is a compromise temperature between the output energy from the PV panels and the energy needed for cooling