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

Growth hormone releasing peptides Physiological studies in man

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN022815 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Microbial water quality and sedimentary faecal sterols as markers of sewage contamination in Kuwait

Microbial water quality and concentrations of faecal sterols in sediment have been used to assess the degree of sewage contamination in Kuwait's marine environment. A review of microbial (faecal coliform, faecal streptococci and Escherichia coli) water quality data identified temporal and spatial sources of pollution around the coastline. Results indicated that bacterial counts regularly breach regional water quality guidelines. Sediments collected from a total of 29 sites contained detectable levels of coprostanol with values ranging from 29 to 2420 ng g−1 (dry weight). Hot spots based on faecal sterol sediment contamination were identified in Doha Bay and Sulaibikhat Bay, which are both smaller embayments of Kuwait Bay. The ratio of epicoprostanol/coprostanol indicates that a proportion of the contamination was from raw or partially treated sewage. Sewage pollution in these areas are thought to result from illegal connections and discharges from storm drains, such as that sited at Al-Ghazali

Comprehensive screening of eight known causative genes in congenital hypothyroidism with gland-in-situ

Context: lower thyroid-stimulating hormone (TSH) screening cut-offs have doubled the ascertainment of congenital hypothyroidism (CH), particularly cases with a eutopically-located gland-in-situ (GIS). Although mutations in known dyshormonogenesis genes, or the thyroid-stimulating hormone receptor (TSHR) underlie some cases of CH with GIS, systematic screening of these eight genes has not previously been undertaken.Objective: to evaluate the contribution and molecular spectrum of mutations in eight known causative genes (TG, TPO, DUOX2, DUOXA2, SLC5A5, SLC26A4, IYD and TSHR) in CH cases with GIS.Patients, Design and Setting: we screened forty-nine CH cases with GIS from thirty-four ethnically diverse families, using next-generation sequencing. Pathogenicity of novel mutations was assessed in silico.Results: twenty-nine cases harbored likely disease-causing mutations. Monogenic defects (nineteen cases) most commonly involved TG (twelve), TPO (four), DUOX2 (two) and TSHR (one case). Ten cases harboured triallelic (digenic) mutations: TG and TPO (one); SLC26A4 and TPO (three) and DUOX2 and TG (six cases). Novel variants overall included fifteen TG, six TPO, and three DUOX2 mutations. Genetic basis was not ascertained in twenty patients, including fourteen familial cases.Conclusions: the aetiology ofCHwith GIS remains elusive, with only59%attributable to mutations in TSHR or known dyshormonogenesis-associated genes in a cohort enriched for familial cases. Biallelic TG or TPO mutations most commonly underlie severe CH. Triallelic defects are frequent, mandating future segregation studies in larger kindreds to assess their contribution to variable phenotype. A high proportion (~41%) of unsolved or ambiguous cases suggests novel genetic aetiologies that remain to be elucidated- See more at: http://press.endocrine.org/doi/10.1210/jc.2016-1879#sthash.8M832MqP.dpu

Comprehensive screening of eight known causative genes in congenital hypothyroidism with gland-in-situ

Context: lower thyroid-stimulating hormone (TSH) screening cut-offs have doubled the ascertainment of congenital hypothyroidism (CH), particularly cases with a eutopically-located gland-in-situ (GIS). Although mutations in known dyshormonogenesis genes, or the thyroid-stimulating hormone receptor (TSHR) underlie some cases of CH with GIS, systematic screening of these eight genes has not previously been undertaken.Objective: to evaluate the contribution and molecular spectrum of mutations in eight known causative genes (TG, TPO, DUOX2, DUOXA2, SLC5A5, SLC26A4, IYD and TSHR) in CH cases with GIS.Patients, Design and Setting: we screened forty-nine CH cases with GIS from thirty-four ethnically diverse families, using next-generation sequencing. Pathogenicity of novel mutations was assessed in silico.Results: twenty-nine cases harbored likely disease-causing mutations. Monogenic defects (nineteen cases) most commonly involved TG (twelve), TPO (four), DUOX2 (two) and TSHR (one case). Ten cases harboured triallelic (digenic) mutations: TG and TPO (one); SLC26A4 and TPO (three) and DUOX2 and TG (six cases). Novel variants overall included fifteen TG, six TPO, and three DUOX2 mutations. Genetic basis was not ascertained in twenty patients, including fourteen familial cases.Conclusions: the aetiology ofCHwith GIS remains elusive, with only59%attributable to mutations in TSHR or known dyshormonogenesis-associated genes in a cohort enriched for familial cases. Biallelic TG or TPO mutations most commonly underlie severe CH. Triallelic defects are frequent, mandating future segregation studies in larger kindreds to assess their contribution to variable phenotype. A high proportion (~41%) of unsolved or ambiguous cases suggests novel genetic aetiologies that remain to be elucidated- See more at: http://press.endocrine.org/doi/10.1210/jc.2016-1879#sthash.8M832MqP.dpu