Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract 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

Levan based biodegradable hydrogel

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Therapeutic drug monitoring in Turkey: Experiences from Istanbul

Therapeutic drug monitoring (TDM) has assumed an important place in patient management in the last few decades. In this study, serum drug levels determined in 7759 specimens sent to the Department of Pharmacology and Clinical Pharmacology in 1994 and 1998 for TDM were retrospectively evaluated. Monitored drugs were carbamazepine, valproate, phenytoin, phenobarbital, digoxin, theophylline, and salicylate, The comparison of the results obtained for the relevant 2 years showed that there was a remarkable increase in the number of requests for TDM per year and in the rate of serum drug levels that were within therapeutic range. Serum antiepileptic drug level monitoring accounted for a major part of the data. Overall data suggest that the use of TDM in antiepileptic drugs is improving; conversely, digoxin and theophylline are still not being properly monitored. In this study, the results are discussed in the light of rational TDM criteria

Fluorene–Dithienothiophene-<i>S,S</i>-dioxide Copolymers. Fine-Tuning for OLED Applications

Three groups of fluorene–dithieno­[3,2-<i>b</i>;2′,3′-<i>d</i>]­thiophene-<i>S</i>,<i>S</i>-dioxides (DTT-<i>S</i>,<i>S</i>-dioxide) copolymers, each having four different ratios of DTT-<i>S</i>,<i>S</i>-dioxide (5, 15, 25, and 50%) were successfully synthesized through Suzuki coupling method. While the first group copolymers <b>P1</b> had direct connection of fluorene to the peripheral thiophenes of DTT-<i>S</i>,<i>S</i>-dioxide, second group copolymers <b>P2</b> had a thiophene extension between fluorene and DTT-<i>S</i>,<i>S</i>-dioxide, and in the third group, copolymers <b>P3</b>, fluorene had a connection with DTT-<i>S</i>,<i>S</i>-dioxide through the phenyl moiety of DTT. Absorbance and emission measurements of first two groups <b>P1</b> and <b>P2</b> displayed a regular bathochromic shift with increasing content of DTT-<i>S</i>,<i>S</i>-dioxide, which was more clearly observed in their solid state fluorescence measurements. Introduction of thiophene to the peripherals of the DTT-<i>S</i>,<i>S</i>-dioxide in copolymers <b>P2</b> caused even further bathochromic shift in absorbances and emissions. As the absorbance and emission of <b>P1</b> went up to 447 and 558 nm in solution, respectively, <b>P2</b> had them at 472 and 592 nm, respectively. In solid state, emissions of <b>P1</b> and <b>P2</b> even went further up to 585 and 646 nm, respectively. The bathochromic trend of <b>P1</b> and <b>P2</b> became opposite with absorbance and solid state emission of <b>P3</b>, which had a hypsochromic shift with increasing content of DTT-<i>S</i>,<i>S</i>-dioxide. Solid state emission of <b>P3</b>, particularly the copolymers having 5, 15 and 50% DTT-<i>S</i>,<i>S</i>-dioxide, covered a wide region between 400 and 675 nm. A spread of colors from light blue (border of white) to red through green and yellow was obtained with the OLED applications of the copolymers. Their optical and electronic band gaps varied between 2.17 and 2.99 eV and between 2.68 and 3.57 eV, respectively. While the highest quantum yield was obtained with <b>P2</b> (5%) as 0.66, the lowest was observed with <b>P2</b> (50%) as 0.03. Almost all of the polymers displayed good thermal stabilities. No weight loss was observed with the copolymers <b>P2</b> (5–15%) and <b>P3</b> up to 400 °C