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

A twofold genetic increase of ACE expression has no effect on the development of spontaneous hypertension

BACKGROUND: To study the regulation of a naturally occurring genetic variant of high angiotensin-converting enzyme (ACE) gene (Ace in rat) expression, i.e., the Ace allele of the normotensive Wistar-Kyoto (WKY) rat, in the hypertensive background of stroke-prone spontaneously hypertensive (SHRSP) rats. METHODS: We analyzed a congenic strain termed SHRSP.WKY-Ace derived from SHRSP in which a chromosomal fragment of rat chromosome 10 including Ace was replaced by the WKY locus. We compared blood pressures by radiotelemetry, measured plasma ACE activity, tissue ACE messenger RNA (mRNA) and enzyme activities in lung, kidney, and left ventricle (LV) of the heart in adult animals. RESULTS: Congenic animals demonstrated a twofold increase in plasma ACE activity in comparison to SHRSP (P < 0.05) and thus similar levels to WKY. The increased tissue expression of ACE mRNA and enzyme activities in lung, kidney, and LV observed in WKY were similarly found in congenic animals when compared to SHRSP (P < 0.05, respectively). Systolic and diastolic blood pressures were not different between congenic and SHRSP animals. Analysis of renin in plasma and angiotensin peptides in LV tissues indicated the induction of compensatory mechanisms by downregulation of renin and angiotensin I (Ang I) concentrations in congenic animals. CONCLUSIONS: We demonstrated that genetically determined high ACE expression linked to WKY Ace remains unchanged in the hypertensive background of SHRSP.WKY-Ace. Our data indicate that buffering mechanisms in the renin-angiotensin system contribute to the finding that the development of spontaneous hypertension is not affected, despite an average twofold higher expression of ACE in congenic animals

Nano-ZnO film photocatalysts in bench-scale continuous-flow mineralization of olive mill waste contaminants in water

Olive oil milling, widely practiced in Mediterranean countries, including Palestine, yields the so-called olive mill waste water (OMWW) or Zebar (Zibar). The waste contains minerals and organic materials (including phenols and polyphenols) which undergo continuous oxidation and cause environmental hazards if not well managed. This work basically aims at purifying surface waters, intentionally pre-contaminated with OMWW organic contaminants. Fate of other mineral ions present in the contaminated water is also investigated. ZnO nanoparticles, deposited as films onto glass reactor bottom (165 cm2 area), are described as catalyst for photodegradation of the organic contaminants, in a continuous flow reaction mode (gravity fed, typically at flow rate 3.5 mL/min). Two types of ZnO materials, namely commercial ZnO onto glass (C–ZnO/Glass) and synthetic ZnO supported onto clay and deposited on glass (Syn–ZnO/Clay/Glass), have been examined. The Syn–ZnO/Clay/Glass catalyst is slightly more efficient in removing organic contaminants (~ 43%), compared to the C–ZnO/Glass (41%) in 30 h. Different reaction parameters have been investigated, such as waste dilution factor, exposure duration, pH and catalyst recovery and reuse