On the Production Testing of Memristor Ratioed Logic (MRL) Gates

Abstract This paper focuses on the production testing of Memristor Ratioed Logic (MRL) gates. MRL is a family that uses memristors along with CMOS inverters to design logic gates. Two-input NAND and NOR gates are investigated using the stuck at fault model for the memristors and the five-fault model for the transistors. Test escapes may take place while testing faults in the memristors. Therefore, two solutions are proposed to obtain full coverage for the MRL NAND and NOR gates. The first is to apply scaled input voltages and the second is to change the switching threshold of the CMOS inverter. In addition, it is shown that test speed and order should be taken into consideration. It is proven that three ordered test vectors are needed for full coverage in MRL NAND and NOR gates, which is different from the order required to obtain 100% coverage in the conventional NAND and NOR CMOS designs

Nano selenium treatment effects on thyroid hormones, immunity and antioxidant status in rabbits

[EN] The present study was conducted to compare the effect of Nano-Selenium (Nano-Se) and sodium selenite (SSe) on antioxidant enzyme activity, immunity and thyroid activity of growing New Zealand White (NZW) rabbits. In this study, 72 male rabbits (5 wk old) were divided randomly into 3 groups (24 rabbits each). The first group served as a placebo; in groups 2 and 3, each rabbit was intramuscularly injected once a week with 4 mL solution of Nano-Se or SSe, respectively, for a 2-mo period. The solution was adjusted to provide 30 μg Se/kg/live body weight. Results showed that Nano-Se treatment significantly (P<0.0001) increased in superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione (GSH) more than control, but decreased significantly each of glutathione disulphide (GSSG) and nitric oxide (NO) levels in serum. Likewise, supplementation of SSe increased (P<0.0001) GPx activity and significantly decreased both malondialdehyde (MDA) and GSSG levels more than control. Nano-Se significantly enhanced serum IgG and IgM more than SSe and control groups. Serum aspartate aminotransferase increased (P<0.0001) due to Nano-Se treatment as compared to control and SSe, although the lowest (P<0.0001) activity of alanine aminotransferase was recorded due to SSe supplementation. Nano-Se treatment increased (P<0.0001) both T3 and T4 concentrations more than other groups. Furthermore, administration of Nano-Se increased SOD, GPx, GSH, total antioxidant capacity (TAC) and adenosine triphosphate (ATP) in liver tissue of growing rabbits, while it decreased MDA and 8-hydroxy-2’deoxyguanosine (8-oHdG) levels in liver tissue compared with control. Also, SSe showed an increase (P<0.0001) in GSH, and ATP, but significantly decreased TAC and MDA levels compared with control. It can be concluded that Nano-Se supplementation significantly enhanced the activity of antioxidant enzymes in both serum and liver tissues, with a greater positive influence on immunoglobulin production and thyroid activity in growing NZW rabbits than SSe.Eid, SY.; El-Zaher, HM.; Emara, SS.; Farid, OA.; Michael, MI. (2019). Nano selenium treatment effects on thyroid hormones, immunity and antioxidant status in rabbits. World Rabbit Science. 27(2):93-100. https://doi.org/10.4995/wrs.2019.11251SWORD93100272Abd-Allah S., Hashem K.S. 2015. Selenium nanoparticles increase the testicular antioxidant activity and spermatogenesis in male rats as compared to ordinary selenium. Int. J. Adv. Res., 3: 792-802. https://doi.org/10.22038/ijbms.2018.26023.6397Abu-Qare A., Abou-Donia, M. 2000. Increased 8-hydroxy-2'- deoxyguanosine, a biomarker of oxidative DNA damage in rat urine following a single dermal dose of DEET (N, N-diethylm-toluamide), and permethrin, alone and in combination. Toxicol. Lett., 117: 151-60. https://doi.org/10.1016/S0378-4274(00)00257-5AOAC. 2000. Official Methods of Analysis of AOAC International, Gaithersburg MA, USA. Association of Official Analytical chemist.Aurthor J.R., Beckett G.J. 1999. Thyroid function. Br. Med. Bull. 55: 658-668.Awadeh F.T., Kincaid J.R., Johnson K.A. 1998. Effect of level and source of dietary selenium on concentrations of thyroid hormones and immunoglobulins in beef cows and calves. J. Anim. Sci. 76: 1204-1215.Bickhardt K., Ganterm M., Sallmann P. 1999. Investigation of the manifestation of vitamin E and selenium deficiency in sheep and goats. Dtsch. Tierarztl. Wochenschr., 106: 242-247.Changguang L., Jingui Z., Jinyu L. 2013. Effects of different sources and supplemental dosages of selenium on growth performance, immunity and thyroid hormones. China Feed, 21: 007Dercksen D.P., Counotte G.H., Hazebroek M.K., Arts W., Van R.T. 2007. Selenium requirements of dairy goats. Tijdschr. Diergeneeskd, 132: 468-471.Effraimidis G., Wiersinga M. 2014. Mechanisms in endocrinology: Autoimmune thyroid disease: Old and new players. Eur. J. Endocrinol., 170: 241-252.Everett S.A., Dennis M.F., Tozer G.M., Prise V.E., Wardman P., Stratford M.R. 1995. Nitric oxide in biological fluids: analysis of nitrite and nitrate by high-performance ion chromatography. J. Chromatogr. A, 706: 37-42. https://doi.org/10.1016/0021-9673(95)00078-2.Ganong W.F. 2001. The thyroid gland: In: Review of Medical Physiology. New York: Lange Medical Books/McGraw-Hill, 307-321.Goldberg D.M., Spoone R.J. 1983. Assay of glutathione reductase In: Bergmeyen H.V. (ed). Methods of enzymatic analysis. Florida: Verlag Chemie Deerfield Beach, 258-265.Habig W., Pabst M., Jakoby W. 1974. Glutathione S-transferases: the first enzymatic step in mercapturic acid formation. J. Biol. Chem. 249: 7130-7139.Hao X., Ling Q., Hong F. 2014. Effects of dietary selenium on the pathological changes and oxidative stress in loach (Paramisgurnus dabryanus). Fish Physiol. Biochem., 40: 1313-1323. https://doi.org/10.1007/s10695-014-9926-7.Holmgren A., Johansson C., Berndt C., Lonn M.E., Hudemann C., Lillig C.H. 2005. Thiol redox control via thioredoxin and glutaredoxin systems. Biochem. Soc. Trans., 33: 1375-1377.Huang B., Zhang J., Hou J., Chen C. 2003. Free radical scavenging efficiency of nano-Se in vitro. Free Radic. Biol. Med., 35: 805-813. https://doi.org/10.1016/S0891-5849(03)00428-3Jayatilleke E., Shaw S. 1993. A high-performance liquid chromatographic assay for reduced and oxidized glutathione in biological samples. Anal. Biochem., 214: 452-457.Jia X., Li N., Chen J. 2005. A subchronic toxicity study of elemental Nano-Se in Sprague-Dawley rats. Life Sci., 76: 1989-2003. https://doi.org/10.1016/j.lfs.2004.09.026Kasai H. 2002. Chemistry-based studies on oxidative DNA damage: formation, repair, and mutagenesis. Free Radic. Biol. Med., 33: 450-456.Karatepe M. 2004. Simultaneous determination of ascorbic acid and free malondialdehyde in human serum by HPLC-UV. Chromatographic Line, 12: 362-365.Köhrle J., Gartner R. 2009. Selenium and thyroid. Best. Pract. Res. Clin. En. 23: 815-827. https://doi.org/10.1016/j.beem.2009.08.002Köhrle J., Jakob F., Contempré B., Dumont J.E. 2007. Selenium, the thyroid, and the endocrine system. Endocrinol. Rev., 26: 944-984. https://doi.org/10.1210/er.2001-0034Koracevic D., Koracevic G., Djordjevic V., Andrejevic S., Cosic V. 2001. Method for the measurement of antioxidant activity in human fluids. J. Clin. Pathol., 54: 356-361.Kumar N., Garg A.K., Mudgal V. 2008. Effect of different levels of selenium supplementation on growth rate, nutrient utilization, blood metabolic profile, and immune response in lambs. Biol. Trace Elem. Res., 126: 44-56.Lawrence R.A., Burk R.F. 1976. Glutathione peroxidase activity in selenium deficient rat liver. Biochem. Biophys. Res. Commun.,71: 952-958.Liao C.D, Hung WL, Jan K.C, Yeh A.I, Ho C.T, Hwang L.S. 2010. Nano/sub-microsized lignan glycosides from sesame meal exhibit higher transport and absorption efficiency in Caco-2 cell monolayer. Food Chem., 119: 896-902. http://doi.org/10.1016/j.foodchem.2009.07.056Liu H.Y., Jiang Y., Luo W. 2006. A simple and rapid determination of ATP, ADP and AMP concentrations in pericarp tissue of litchi fruit by high performance liquid chromatography. Food Technol. Biotech., 44: 531-534.Lodovici M., Casalini C., Briani C., Dolara P. 1997. Oxidative liver DNA damage in rats treated with pesticide mixtures. Toxicology, 117: 55-60.Marin-Guzman J, Mahan D.C, Pate J.L. 2000. Effect of dietary selenium and vitamin E on spermatogenic development in boars. J. Anim .Sci., 78: 1536-1543.Mohapatra P., Swain R. K., Mishra S. K., Behera T., Swain P., Mishra S. S., Behura N.C., Sabat S.C., Sethy K., Dhama K., Jayasankar P. 2014. Effects of dietary nano-selenium on tissue selenium deposition, antioxidant status and immune functions in layer chicks. Int. J. Pharmacol., 10: 160-167. https://doi.org/10.3923/ijp.2014.160.167Montgomery J.B., Wichtel J.J., Wichtel M.G., McNiven M.A., McClure J.T., Markham F., Horohov D.W. 2012. Effects of selenium source on measures of selenium status and immune function in horses. Canad. J. Vet. Res., 76: 281-291.Nasirpour M., Sadeghi A.A., Chamani M. 2017. Effects of nano-selenium on the liver antioxidant enzyme activity and immunoglobulins in male rats exposed to oxidative stress. J. Livestock Sci., 8: 81-87.NRC. 1977. Nutrient requirements of rabbits. National Research Council, Natl. Acad. Press, Washington, DC, USA.Paglia D.E., Valentine W.N. 1967. Studies on the quantitative and qualitative characterization of erythrocyte glutathione peroxidase. J. Lab. Clin. Med, 70: 158-169.Papadoyannis L.N., Samanidou V.F., Nitsos C.C. 1999. Simultaneous determination of nitrite and nitrate in drinking water and human serum by high-performance anionexchange chromatography and UV detection. J. Liq. Chrom. Rel. Techno., 22: 2023-2041.Qin S., Chen F., Guo Y., Huang B., Zhang J., Ma J. 2014. Effects of nano-selenium on kidney selenium contents, glutathione peroxidase activities and GPx-1 mRNA expression in mice. Adv. Mater. Res., 1051: 383-387. https://doi.org/10.4028/www.scientific.net/AMR.1051.383Qin F., Chen F., Zhao F., Jin T., Ma J. 2016. Effects of Nanoselenium on Blood Biochemistry, Liver Antioxidant Activity and GPx-1 mRNA Expression in Rabbits. In: International Conference on Biomedical and Biological Engineering'. Atlantis Press. p.166-171. https://doi.org/10.2991/bbe-16.2016.28.Rezaeian-Tabrizi M., Sadeghi A.A. 2017. Plasma antioxidant capacity, sexual and thyroid hormones levels, sperm quantity and quality parameters in stressed male rats received nanoparticle of selenium. Asian Pac. J. Reprod., 6: 29-34.Sadeghian S., Kojouri G.A., Mohebbi A. 2012. Nanoparticles of selenium as species with stronger physiological effects in sheep in comparison with sodium selenite. Biol. Trace Elem. Res., 146: 302-308. https://doi.org/10.1007/s12011-011-9266-8SAS. 2000. SAS/STAT User's Guide (Release 9.4). SAS Inst. Inc., Cary NC, USA.Shi L.G., Yang R., Yue W., Xun W., Zhang C., You-she E., Lei S. 2010. Effect of elemental nano-selenium on semen quality, glutathione peroxidase activity, and testis ultrastructure in male Boer goats. Anim. Reprod. Sci., 118: 248-254. https://doi.org/10.1016/j.anireprosci.2009.10.003Shi L.G., Xun W. J., Yue W. B., Zhang C. X., Ren Y.S., Liu Q., Wang Q., Shi L. 2011. Effect of sodium selenite, Se-yeast and nano-elemental selenium on growth performance, Se concentration and antioxidant status in growing male goats. Small Rumin. Rese., 96: 49-52. https://doi.org/10.1016/j.smallrumres.2010.11.005Stadlober M., Sager M., Irgolic K. 2001. Identification and Quantification of Selenium Compounds in Sodium Selenite Supplemented Feeds by HPLC-ICP-MS. Die Bodenkultur., 5.Sun Y., Oberley L.W., Li Y. 1988. A Simple Method for Clinical Assay of Superoxide Dismutase. Clin. Chem., 34: 479-500.Wang H., Zhang J., Yu H. 2007. Elemental selenium at nano size possesses lower toxicity without compromising the fundamental effect on selenoenzymes: Comparison with selenomethionine in mice. Free Radic. Biol. Med., 42: 1524-1533.Zhang J.S., Gao X.Y., Zhang L.D., Bao Y.P. 2001. Biological effects of a nano red elemental selenium. Biofactors, 15: 27-38. https://doi.org/10.1002/biof.5520150103Zhang J.S., Wang X.F., Xu T.W. 2008. Elemental selenium at nano size (Nano-Se) as a potential chemopreventive agent with reduced risk of selenium toxicity: Comparison with Semethylselenocysteine in mice. Toxicol. Sci. 101: 22-31. https://doi.org/10.1093/toxsci/kfm221Zhou X., Wang Y. 2011. Influence of dietary nano elemental selenium on growth performance, tissue selenium distribution, meat quality, and glutathione peroxidase activity in Guangxi Yellow chicken. Poult. Sci., 90: 680-686. https://doi.org/10.3382/ps.2010-00977Zhu, F., Zhu, L., Sun, J., Meng, X., Zou, L., 2010. Effects of dietary supplemental nano-se levels on liver selenium content and antioxidant abilities in hens. Chin. J. Vet. Sci., 30: 1537-1539

The ligational behavior of a phenolic quinolyl hydrazone towards copper(II)- ions

<p>Abstract</p> <p>Background</p> <p>The heterocyclic hydrazones constitute an important class of biologically active drug molecules. The hydrazones have also been used as herbicides, insecticides, nematocides, redenticides, and plant growth regulators as well as plasticizers and stabilizers for polymers. The importance of the phenolic quinolyl hydrazones arises from incorporating the quinoline ring with the phenolic compound; 2,4-dihydroxy benzaldehyde. Quinoline ring has therapeutic and biological activities whereas, phenols have antiseptic and disinfectants activities and are used in the preparation of dyes, bakelite and drugs. The present study is planned to check the effect of the counter anions on the type and geometry of the isolated copper(II)- complexes as well as the ligational behavior of the phenolic hydrazone; 4-[(2-(4,8-dimethylquinolin-2-yl)hydrazono)methyl] benzene-1,3-diol; (H₂L).</p> <p>Results</p> <p>A phenolic quinolyl hydrazone (H₂L) was allowed to react with various copper(II)- salts (Cl‾, Br‾, NO₃‾, ClO₄‾, AcO‾, SO₄^2-). The reactions afforded dimeric complexes (ClO₄‾, AcO‾ ), a binuclear complex (NO₃‾ ) and mononuclear complexes (the others; Cl‾, Br‾, SO₄^2-). The isolated copper(II)- complexes have octahedral, square pyramid and square planar geometries. Also, they reflect the strong coordinating ability of NO₃‾, Cl‾, Br‾, AcO‾ and SO₄^2-anions. Depending on the type of the anion, the ligand showed three different modes of bonding <it>viz</it>. (NN)⁰for the mononuclear complexes (<b>3, 4, 6</b>), (NO)^-with O- bridging for the dimeric complexes (<b>1, 5</b>) and a mixed mode [(NN)⁰+ (NO)^-with O- bridging] for the binuclear nitrato- complex (<b>2</b>).</p> <p>Conclusion</p> <p>The ligational behavior of the phenolic hydrazone (H₂L) is highly affected by the type of the anion. The isolated copper(II)- complexes reflect the strong coordinating power of the SO₄^2-, AcO‾, Br‾, Cl‾ and NO₃‾ anions. Also, they reflect the structural diversity (octahedral, square pyramid and square planar) depending on the type of the counter anion.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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

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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Prognostic indicators in acute burned patients–a review

Burn trauma is in need for prognostic indicators or admission scores. This aims for realistic documentation of the burn injury, expectation of the prognosis, and to facilitate a patient stratification to evaluate therapeutic strategies. A computer search through different medical websites was performed looking for articles correlating prognosis with different burn indices. These were carefully summarized and analyzed for this review. Variable studies were found related to that issue; the reliable indicators found had been classified as general or specific. All of them had certain clinical importance, but limitations are a common feature. All the listed indices are useful to serve in the only special clinical situations. We couldn't claim that they are actual prognostic indicator in burn victims. We believe that we still lack the proper prognostic indicator in burn patients. Researchers are invited for more effort to organize a more reliable prognostic indicator and scoring system for burn patients