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

Improvement of GOCE-Based Global Geopotential Models for Gravimetric Geoid Modeling in Turkey

This study investigates the contribution of global geopotential models which are calculated with GOCE satellite mission data to the improvement of gravimetric geoid models in Turkey. In this context, direct (DIR), time-wise (TIM), space-wise (SPW), and GOCO satellite-only model series were considered. The research was carried out in two parts. The first part includes the validation of models in each series at 100 homogeneously distributed GNSS/leveling stations over the country utilizing spectrally enhanced geoid heights to determine the best performing model and its optimal expansion degree. According to obtained statistics, the TIM-R6 model was selected as the best model with an optimal expansion degree of 204. In the second part, the TIM-R6 model up to 204 degree/order was linearly blended with EGM2008 to obtain an improved version up to 360 degree/order of expansion. To clarify the contribution of the linearly blended model to the improvement of the regional geoid model, the gravimetric geoid models were computed adopting TIM-R6 up to 204 degree/order and its improved version up to 360 degree/order as reference models. To further emphasize the contribution of the GOCE mission’s data, the gravimetric geoid computations were repeated relying on EGM2008 up to 204 and 360 degrees of expansions, since EGM2008 does not contain GOCE data. In addition, we computed gravimetric geoids based on another combined model that includes GOCE mission data, the EIGEN-6C4 model. The calculated regional geoids were compared to each other and validated using GNSS/leveling data set. The obtained results revealed a ∼23% improvement in regional geoid model accuracy when the blended GOCE-based geopotential model was used as a reference. In addition, the results of this study presented the significance of GOCE contribution to mapping the gravity field in Turkey. The best accuracy obtained from this study was 7.7 cm for the Turkey geoid

Soil Moisture Prediction from Remote Sensing Images Coupled with Climate, Soil Texture and Topography via Deep Learning

Soil moisture (SM) is an important biophysical parameter by which to evaluate water resource potential, especially for agricultural activities under the pressure of global warming. The recent advancements in different types of satellite imagery coupled with deep learning-based frameworks have opened the door for large-scale SM estimation. In this research, high spatial resolution Sentinel-1 (S1) backscatter data and high temporal resolution soil moisture active passive (SMAP) SM data were combined to create short-term SM predictions that can accommodate agricultural activities in the field scale. We created a deep learning model to forecast the daily SM values by using time series of climate and radar satellite data along with the soil type and topographic data. The model was trained with static and dynamic features that influence SM retrieval. Although the topography and soil texture data were taken as stationary, SMAP SM data and Sentinel-1 (S1) backscatter coefficients, including their ratios, and climate data were fed to the model as dynamic features. As a target data to train the model, we used in situ measurements acquired from the International Soil Moisture Network (ISMN). We employed a deep learning framework based on long short-term memory (LSTM) architecture with two hidden layers that have 32 unit sizes and a fully connected layer. The accuracy of the optimized LSTM model was found to be effective for SM prediction with the coefficient of determination (R2) of 0.87, root mean square error (RMSE) of 0.046, unbiased root mean square error (ubRMSE) of 0.045, and mean absolute error (MAE) of 0.033. The model’s performance was also evaluated concerning above-ground biomass, land cover classes, soil texture variations, and climate classes. The model prediction ability was lower in areas with high normalized difference vegetation index (NDVI) values. Moreover, the model can better predict in dry climate areas, such as arid and semi-arid climates, where precipitation is relatively low. The daily prediction of SM values based on microwave remote sensing data and geophysical features was successfully achieved by using an LSTM framework to assist various studies, such as hydrology and agriculture

Differences in Poly(ADP-ribose) Polymerase1-(PARP1-) and Proliferative Cell Nuclear Antigen (PCNA) Immunoreactivity in Patients Who Experienced Successful and Unsuccessful Microdissection Testicular Sperm Extraction Procedures

Purpose: The aim of this study is to evaluate expression of deoxyribonucleic acid (DNA) synthesis and repair markers in testicular tissues of azoospermic men in whom sperm retrieval could and could not be achieved as a result of microdissection testicular sperm extraction (micro-TESE) procedure

Comparison of smoking habits, knowledge, attitudes and tobacco control interventions between primary care physicians and nurses

Background Primary care providers are uniquely positioned to initiate smoking cessation. We aimed to evaluate knowledge levels about the health effects of smoking and attitudes toward smoking and tobacco control activities among primary care providers. Methods In the cross-sectional and primary care-based study, self-administered surveys modified from the WHO Global Health Professional Survey 5A steps of smoking cessation practice (Ask, Advise, Assess, Assist and Arrange) were provided to primary care physicians (PCPhs) and nurses (PCNs). Results Respondents included 1182 PCPhs and 1063 PCNs. The proportions of current and former smokers were significantly higher among PCPhs than among PCNs (34.4 vs. 30.7 % and 14.0 vs. 10.1 %, respectively; both P < 0.001). We observed that 77.2 % of PCPhs and 58.4 % of PCNs always or rarely practiced an “Ask” step about their patients’ smoking status (P < 0.001). One-third of PCPhs (33.8 %) stated that they always practiced an “Ask” step, whereas only 27.6 % of PCNs always did so in their practice (P < 0.001). A small minority of primary care providers had advised patients to quit smoking, although there was a significant difference in this between PCNs and PCPhs (8.4 vs. 15.6 %; P < 0.001). Most PCPhs considered themselves competent in advising about smoking interventions, but only a minority of PCNs did so (75.1 vs. 17.3 %; P < 0.001). Among barriers to tobacco intervention measures, lack of time was the item most commonly cited by PCPhs, whereas low patient priority was most commonly cited by PCNs (35.9 and 35.7 %; P < 0.001). Conclusions Smoking intervention practice by primary care nurses was quite low. Lack of time and low patient priority were identified as barriers by primary care providers. Strategies by which primary care providers could improve tobacco control should be established

Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study

Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM

Vaccine hesitancy and refusal among parents: An international ID-IRI survey

Introduction: Although vaccines are the safest and most effective means to prevent and control infectious diseases, the increasing rate of vaccine hesitancy and refusal (VHR) has become a worldwide concern. We aimed to find opinions of parents on vaccinating their children and contribute to available literature in order to support the fight against vaccine refusal by investigating the reasons for VHR on a global scale. Methodology: In this international cross-sectional multicenter study conducted by the Infectious Diseases International Research Initiative (ID-IRI), a questionnaire consisting of 20 questions was used to determine parents' attitudes towards vaccination of their children. Results: Four thousand and twenty-nine (4,029) parents were included in the study and 2,863 (78.1%) were females. The overall VHR rate of the parents was found to be 13.7%. Nineteen-point three percent (19.3%) of the parents did not fully comply with the vaccination programs. The VHR rate was higher in high-income (HI) countries. Our study has shown that parents with disabled children and immunocompromised children, with low education levels, and those who use social media networks as sources of information for childhood immunizations had higher VHR rates (p &lt; 0.05 for all). Conclusions: Seemingly all factors leading to VHR are related to training of the community and the sources of training. Thus, it is necessary to develop strategies at a global level and provide reliable knowledge to combat VHR

Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis:results of Haydarpasa-II study

WOS: 000353295400011PubMed ID: 25634680Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis

A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience

Objective: The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP)

Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study

Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM. Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB). Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any firstline drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0: 34-13: 42), respectively. Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing