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

Maternal serum pregnancy-associated plasma protein-A concentration at 11–14 weeks of gestation and preeclampsia risk of women with common congenital anatomic uterine abnormalities

To evaluate maternal serum pregnancy-associated plasma protein-A (PAPP-A) levels at 11–14 weeks of gestation and preeclampsia risk in women with common congenital anatomic uterine abnormalities (AUAs). First trimester screening markers were compared between 12 AUA pregnancies, 60 age matched controls and 12 cases of early preeclampsia. PAPP-A level and birth weight were significantly lower in AUA compared to control and early preeclampsia group (p<.001). Preeclampsia was absent in the AUAs pregnancies group. Birth weight were similar in AUA group when we compared AUA and control group regarding weeks of gestation at delivery and lower but not significantly, when we compared AUA and early preeclampsia group. Our findings suggest that AUA pregnancies are associated with low first trimester maternal serum PAPP-A concentrations not predictive of susceptibility to preeclampsia.Impact statement What is already known on this subject? During first trimester screening for preeclampsia based on maternal pregnancy-associated plasma protein A (PAPP-A) levels, various parameters are used, such as the somatometric characteristics of pregnant woman, single or multiple pregnancy, smoking status, family history, diabetes, hypertension and measurement of blood pressure and uterine artery Dopplers. What do the results of this study add? Our pioneer study revealed that there is drastic difference in PAPP-A concentration in women with common anatomic uterine abnormalities (AUAs), in comparison with their age matched control women with normal uterus. What are the implications of these findings for clinical practice and further research? Based on our results, uterine anatomical deviations, is another factor which must be taken in account for preeclampsia risk calculation and further clinical consultation and follow up in those pregnancies. Lower PAPP-A levels in AUA cases is a weak predictor of susceptibility to preeclampsia and could be associated to smaller placental size rather than poor placentation and in future research the calculation of the uterine cavity functional dimension may lead to a more accurate clinical assessment

COVID-19 Vaccination and Mental Health Outcomes among Greek Adults in 2021: Preliminary Evidence

Existing research on the association between COVID-19 vaccination and quantitatively measured mental health outcomes is scarce. We conducted a cross-sectional telephone survey on a random sample of 1039 adult Greek citizens in June 2021. Among the participants, 39.6% were vaccinated with two doses, 23.1% with one dose, 21.4% were planning to become vaccinated later, and 8.1% refused vaccination. Compared to those fully vaccinated, those against vaccination (“deniers”) and those who planned to do so later on (“not vaccinated yet”) had significantly higher scores across three stress, anxiety, and depression construct scales. Our findings suggest an association between COVID-19 vaccination status and mental health

The effect of an interdisciplinary Greek traditional dance programme on Middle School students’ goal orientation and anxiety

The aim of the study was to investigate the effect of an interdisciplinary program of Greek folk dance, with topics from history and geography on Middle School students’ goal orientation and anxiety level. The sample consisted of 260 students (134 boys & 126 girls). The experimental group (n=144) followed the interdisciplinary four-week program (two lessons per week) while the control group (n=126) followed the corresponding typical physical education program. For the data collection, the questionnaire used was the “Goal orientation” by Papaioannou, Milosis, Kosmidou, and Tsiggilis (2002) and the Greek version (Kakkos & Zervas, 1996) of “Competitive State Anxiety Inventory-2” (Martens et al., 1990). The students filled in the questionnaires before and after their participating in each program. Descriptive statistics, reliability analysis, and Repeated Measures ANOVA were used. Results showed that a. Cronbach’s alpha was satisfactory. b. Τhe experimental group decreased significantly the levels of “ego-strengthening” and “ego-protection”, and on the contrary significantly increase the “personal development”, and “social acceptance”. c. Experimental group’s boys and girls decreased their “ego-strengthening” and “ego-protection”, and enhanced their “personal development” and “social acceptance” more than their control group peers. d. The experimental group decreased the levels of somatic and cognitive anxieties and increased significantly their self-confidence. e. male students increased their self-confidence more than female students. These findings support the view that an interdisciplinary program of traditional Greek dance with issues from history and geography enable us to reduce the rates of ego-strengthening, ego-protection, somatic and cognitive anxiety while simultaneously increases students’ personal development, social acceptance, and self-confidenc

Susceptibility of β-Thalassemia Heterozygotes to COVID-19

Background: β-Thalassemia is the most prevalent single gene blood disorder, while the assessment of its susceptibility to coronavirus disease 2019 (COVID-19) warrants it a pressing biomedical priority. Methods: We studied 255 positive COVID-19 participants unvaccinated against severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2), consecutively recruited during the last trimester of 2020. Patient characteristics including age, sex, current smoking status, atrial fibrillation, chronic respiratory disease, coronary disease, diabetes, neoplasia, hyperlipidemia, hypertension, and β-thalassemia heterozygosity were assessed for COVID-19 severity, length of hospitalization, intensive care unit (ICU) admission and mortality from COVID-19. Results: We assessed patient characteristics associated with clinical symptoms, ICU admission, and mortality from COVID-19. In multivariate analysis, severe-critical COVID-19 was strongly associated with male sex (p = 0.023), increased age (p &lt; 0.001), and β-thalassemia heterozygosity (p = 0.002, OR = 2.89). Regarding the requirement for ICU care, in multivariate analysis there was a statistically significant association with hypertension (p = 0.001, OR = 5.12), while β-thalassemia heterozygosity had no effect (p = 0.508, OR = 1.33). Mortality was linked to male sex (p = 0.036, OR = 2.09), increased age (p &lt; 0.001) and β-thalassemia heterozygosity (p = 0.010, OR = 2.79) in multivariate analysis. It is worth noting that hyperlipidemia reduced mortality from COVID-19 (p = 0.008, OR = 0.38). No statistically significant association of current smoking status with patient characteristics studied was observed. Conclusions: Our pilot observations indicate enhanced mortality of β-thalassemia heterozygotes from COVID-19

Polybrominated diphenyl ethers (PBDEs) in background air around the Aegean: implications for phase partitioning and size distribution

The occurrence and atmospheric behavior of tri- to deca-polybrominated diphenyl ethers (PBDEs) were investigated during a 2-week campaign concurrently conducted in July 2012 at four background sites around the Aegean Sea. The study focused on the gas/particle (G/P) partitioning at three sites (Ag. Paraskevi/central Greece/suburban, Finokalia/southern Greece/remote coastal, and Urla/Turkey/rural coastal) and on the size distribution at two sites (Neochorouda/northern Greece/rural inland and Finokalia/southern Greece/remote coastal). The lowest mean total (G + P) concentrations of ∑7PBDE (BDE-28, BDE-47, BDE-66, BDE-99, BDE-100, BDE-153, BDE-154) and BDE-209 (0.81 and 0.95 pg m−3, respectively) were found at the remote site Finokalia. Partitioning coefficients, KP, were calculated, and their linear relationships with ambient temperature and the physicochemical properties of the analyzed PBDE congeners, i.e., the subcooled liquid pressure (PL°) and the octanol-air partition coefficient (KOA), were investigated. The equilibrium adsorption (PL°-based) and absorption (KOA-based) models, as well as a steady-state absorption model including an equilibrium and a non-equilibrium term, both being functions of log KOA, were used to predict the fraction Φ of PBDEs associated with the particle phase. The steady-state model proved to be superior to predict G/P partitioning of BDE-209. The distribution of particle-bound PBDEs across size fractions 7.2 μm indicated a positive correlation between the mass median aerodynamic diameter and log PL° for the less brominated congeners, whereas a negative correlation was observed for the high brominated congeners. The potential source regions of PBDEs were acknowledged as a combination of long-range transport with short-distance sources.Granting Agency of the Czech Republic (312334); Czech Ministry of Education, Youth, and Sports (LO1214--LM2015051); Izmir Institute of Technology Scientific Research Foundation (2013IYTE14); European Union FP7 (262254 ACTRIS

Adaptação e validade do "Questionário de Satisfação da Classe de Actividade Física" (PACSQ) no contexto da dança educacional grega

Satisfaction is a contributing factor to increasing participation in sports activities, especially due to the fact that it is linked to behavioral procedures responsible for causing positive feelings to people involved. The aim of this study was to confirm the “Physical Activity Class Satisfaction Questionnaire” in a Greek educational dancing context. The internal consistency of the questionnaire has also been examined. The sample of the study consisted of 482 participants, 184 males, and 298 females. All participants have attended Greek traditional dance courses in dancing associations among Greece. The scale consists of 45 questions which constitute nine factors. The following statistical analyses were carried out: Questionnaire’s validity and reliability were examined via exploratory factor analysis and confirmatory factor analysis. Reliability analysis was conducted to examine the internal cohesion of the factors.&nbsp; Descriptive statistics have been calculated to broadly examine the degree of satisfaction. Results’ analysis arrived at the following conclusion: a. The Greek version of the questionnaire has shown stable stationary psychometric properties, which partially support its use in the Greek dancing context. b. Correlations among subscales indicated a related factor model supporting the construct validity of the scale.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;La satisfacción es un factor que contribuye a aumentar la participación en las actividades deportivas, principalmente porque está vinculada a procedimientos conductuales responsables de generar sentimientos positivos en las personas involucradas. El objetivo de este estudio fue confirmar el "Cuestionario de Satisfacción de La Clase de Educación Física" en un contexto educativo de danza griega. También se examinó la coherencia interna del cuestionario. La muestra del estudio consistió en 482 participantes, 184 de los cuales eran hombres y 298 eran mujeres. Todos los participantes asistieron a cursos de danza tradicional griega en diferentes asociaciones de danza en Grecia. La escala consta de 45 preguntas que constituyen nueve factores. Se realizaron los siguientes análisis estadísticos: La validez y fiabilidad del cuestionario se examinaron mediante un análisis de factores exploratorios y un análisis de factores confirmatorios. Se llevó a cabo un análisis de fiabilidad para examinar la cohesión interna de los factores. Se calcularon estadísticas descriptivas para examinar ampliamente el grado de satisfacción. El análisis de los resultados llegó a la siguiente conclusión: a) La versión griega del cuestionario mostró propiedades psicométricas estacionarias estables, que apoyan parcialmente su uso en el contexto de la danza griega. b) Las correlaciones entre las subescalas indicaban un modelo de factor relacionado que soporta la validez de la construcción de escalas.A satisfação é um fator que contribui para aumentar a participação nas atividades desportivas, principalmentepor estar ligada a procedimentos comportamentais responsáveis por gerarem sentimentos positivos nas pessoas envolvidas. O objetivo deste estudo foi confirmar o “Questionário de Satisfação da Aula de Educação Física” num contexto educacional grego de dança. A consistência interna do questionário também foi examinada. A amostra do estudo foi composta por 482 participantes, sendo que 184 eram homens e 298 eram mulheres. Todos os participantes frequentaram cursos de dança tradicional grega em diferentes associações de dança na Grécia. A escala é composta por 45 questões que constituem nove fatores. Foram realizadas as seguintes análises estatísticas: A validade e confiabilidade do questionário foram examinadas através de uma análise de fatores exploratória e uma análise de fatores confirmatória. A análise de confiabilidade foi conduzida para examinar a coesão interna dos fatores. Foram calculadas estatísticas descritivas para examinaramplamente o grau de satisfação. A análise dos resultados chegou à seguinte conclusão: a) A versão grega do questionário mostrou propriedades psicométricas estacionárias estáveis, que suportam parcialmente o seu uso no contexto da dança grega. b) As correlações entre as subescalas indicaram um modelo de fator relacionado que suporta a validade de construção da escala

Adaptação e validade do "Questionário de Satisfação da Classe de Atividade Física" (PACSQ) no contexto de dança educacional grega

Satisfaction is a contributing factor to increasing participation in sports activities, especially since it is linkedto behavioural procedures responsible for causing positive feelings to people involved. The aim of this study was to confirm the “Physical Activity Class Satisfaction Questionnaire”in a Greek educational dancing context. The internal consistency of the questionnaire has also been examined. The sample of the study consisted of 482 participants, 184 male and 298 females. All participants have attended Greek traditional dance courses in dancing associations among Greece. The scale consists of 45 questions which constitute nine factors. The following statistical analyses were carried out: Questionnaire’s validity and reliability were examined via an exploratory factor analysis and a confirmatory factor analysis. Reliability analysis was conducted to examine the internal cohesion of the factors. Descriptive statistics have been calculated to broadly examine the degree of satisfaction. Results’ analysis arrived at the following conclusion:a. The Greek version of the questionnaire has shown stablestationary psychometric properties, which partially support its use in the Greek dancing context. b. Correlations among subscales indicated a related factor model supporting the construct validityof the scale.La satisfacción es un factor que contribuye a aumentar la participación en las actividades deportivas, principalmente porque está vinculada a procedimientos conductuales responsables de generar sentimientos positivos en las personas involucradas. El objetivo de este estudio fue confirmar el "Cuestionario de Satisfacción de La Clase de Educación Física" en un contexto educativo de danza griega. También se examinó la coherencia interna del cuestionario. La muestra del estudio consistió en 482 participantes, 184 de los cuales eran hombres y 298 eran mujeres. Todos los participantes asistieron a cursos de danza tradicional griega en diferentes asociaciones de danza en Grecia. La escala consta de 45 preguntas que constituyen nueve factores. Se realizaron los siguientes análisis estadísticos: La validez y fiabilidad del cuestionario se examinaron mediante un análisis de factores exploratorios y un análisis de factores confirmatorios. Se llevó a cabo un análisis de fiabilidad para examinar la cohesión interna de los factores. Se calcularon estadísticas descriptivas para examinar ampliamente el grado de satisfacción. El análisis de los resultados llegó a la siguiente conclusión: a) La versión griega del cuestionario mostró propiedades psicométricas estacionarias estables, que apoyan parcialmente su uso en el contexto de la danza griega. b) Las correlaciones entre las subescalas indicaban un modelo de factor relacionado que soporta la validez de la construcción de escalas.A satisfação é um fator que contribui para aumentar a participação nas atividades desportivas, principalmentepor estar ligada a procedimentos comportamentais responsáveis por gerarem sentimentos positivos nas pessoas envolvidas. O objetivo deste estudo foi confirmar o “Questionário de Satisfação da Aula de Educação Física” num contexto educacional grego de dança. A consistência interna do questionário também foi examinada. A amostra do estudo foi composta por 482 participantes, sendo que 184 eram homens e 298 eram mulheres. Todos os participantes frequentaram cursos de dança tradicional grega em diferentes associações de dança na Grécia. A escala é composta por 45 questões que constituem nove fatores. Foram realizadas as seguintes análises estatísticas: A validade e confiabilidade do questionário foram examinadas através de uma análise de fatores exploratória e uma análise de fatoresconfirmatória. A análise de confiabilidade foi conduzida para examinar a coesão interna dos fatores. Foram calculadas estatísticas descritivas para examinaramplamente o grau de satisfação. A análise dos resultados chegou à seguinte conclusão: a) A versão grega do questionário mostrou propriedades psicométricas estacionárias estáveis, que suportam parcialmente o seu uso no contexto da dança grega. b) As correlações entre as subescalas indicaram um modelo de fator relacionado que suporta a validade de construção da escala

Bioinformatic Analysis of the BCL-xL/BCL2L1 Interactome in Patients with Pancreatic Cancer

Objectives: The aim of the present study was to analyze the differential gene expression of BCL-xL/BCL2L and the associated genetic, molecular, and biologic functions in pancreatic ductal adenocarcinoma (PDAC) by employing advanced bioinformatics to investigate potential candidate genes implicated in the pathogenesis of PDAC. Materials and Methods: Bioinformatic techniques were employed to build the gene network of BCL-xL, to assess the translational profile of BCL-xL in PDAC, assess its role in predicting PDAC, and investigate the associated biologic functions and the regulating miRNA families. Results: Microarray data extracted from one dataset was incorporated, including 130 samples (PDAC: 69; Control: 61). In addition, the expression level of BCL-xL was higher in PDAC compared to control samples (p p Conclusions: The current findings unveil the biological implications of BCL-xL in PDAC and the related molecular functions and miRNA families