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

Common variants in Alzheimer’s disease and risk stratification by polygenic risk scores

Genetic discoveries of Alzheimer’s disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer’s disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer’s disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer’s disease

Interactions Among Fire, Insects and Pathogens in Coniferous Forests of the Interior Western United States and Canada

1 Natural and recurring disturbances caused by fire, native forest insects and pathogens have interacted for millennia to create and maintain forests dominated by seral or pioneering species of conifers in the interior regions of the western United States and Canada. 2 Changes in fire suppression and other factors in the last century have altered the species composition and increased the density of trees in many western forests, leading to concomitant changes in how these three disturbance agents interact. 3 Two- and three-way interactions are reviewed that involve fire, insects and pathogens in these forests, including fire-induced pathogen infection and insect attack, the effects of tree mortality from insects and diseases on fuel accumulation, and efforts to model these interactions. 4 The emerging concern is highlighted regarding how the amount and distribution of bark beetle-caused tree mortality will be affected by large-scale restoration of these fire-adapted forest ecosystems via prescribed fire. 5 The effects of fire on soil insects and pathogens, and on biodiversity of ground-dwelling arthropods, are examined. 6 The effects of fire suppression on forest susceptibility to insects and pathogens, are discussed, as is the use of prescribed fire to control forest pests