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

Hipoxia perinatal, un problema de salud real

In 2006, OMS reported that about one-third of death in children under 5 years is in the first week of birth, involved in 2004, 2.8 million of death. While an OMS report in 2008, the mortality of perinatal asfhyxia in Colombia was about 7%. The newest report from 15 to 20% of the newborn that have asfhyxia during this moment or in a short period near, death during neonatal period and those who survived, 25% have permanent neurological damage. One of the quality standard about Health Service is to recognize the population caractheristic, those evidence guarantees the required information with the purpose about right decision taking a measure designed to improve diagnostic and prognostic of that population

Factores que pueden influir en el rendimiento académico de estudiantes de Bioquímica que ingresan en el programa de Medicina de la Universidad del Rosario-Colombia

Introducción. El análisis del rendimiento académico de los estudiantes que ingresan a una institución de educación superior, así como los factores que pueden estar influyendo en él, genera respuestas a los interrogantes que corrientemente se hacen las personas involucradas en los procesos educativos y permite proponer soluciones para mejorar el desempeño de los estudiantes universitarios. Sujetos y métodos. Se determinó la asociación entre el rendimiento académico de los estudiantes en el primer nivel de Bioquímica, con los factores de tipo académico y demográfico; se utilizaron dos métodos de análisis: el primero, numérico, de acuerdo con los promedios de las notas parciales y finales; el segundo, categorizado como éxito (? 3,0) o fracaso (< 3,0), de acuerdo con el promedio de la nota definitiva de la asignatura. Resultados. Se encontró una asociación positiva y estadísticamente significativa entre los resultados de las pruebas de estado generales y específicas (ciencias naturales y matemáticas), el estatus de becario institucional y el ingreso directo a la carrera sin realizar cursos preuniversitarios, con el rendimiento académico en Bioquímica. Factores como el colegio en el cual realizaron la educación secundaria y la ciudad de procedencia no afectaron significativamente el rendimiento en ninguno de los análisis aplicados. Conclusiones. El rendimiento académico en Bioquímica se ve afectado directamente por factores que involucran las competencias individuales de los estudiantes, pero no por factores demográficosIntroduction. The analysis of the students' academic achievement in a higher education institution together with the different factors that affect the student's performance generates answers to the questions that the people involved in the teaching process commonly ask themselves. This analysis is therefore, an excellent way to find and propose solutions in order to improve the student's performance. Subjects and methods. The association between the students' academic performance and the academic and demographic factors was determined in the first level of Biochemistry. Two methodologies were used for this purpose. The first one, a numerical analysis based on the partial and final grades, and a second categorical method based on the final success (? 3.0) or failure (< 3.0) on the subject. Results. A positive and statistically significant correlation was found when the academic performance in Biochemistry, the general and specific results of the state test (natural sciences and mathematics), the institutional scholarship status and entering the Medicine program without pre-university courses was analyzed. Factors, such as coming from different schools and the city of origin, do not affect significantly the performance in any of the analyses. Conclusions. Academic performance in Biochemistry is directly affected by factors involving the individual student's skills while the demographical factors are not involved

Factores que pueden influir en el rendimiento académico de estudiantes de Bioquímica que ingresan en el programa de Medicina de la Universidad del Rosario-Colombia Factors that influence the academic performance in Biochemistry students who have started the Medicine program of Rosario University-Colombia

Introducción. El análisis del rendimiento académico de los estudiantes que ingresan a una institución de educación superior, así como los factores que pueden estar influyendo en él, genera respuestas a los interrogantes que corrientemente se hacen las personas involucradas en los procesos educativos y permite proponer soluciones para mejorar el desempeño de los estudiantes universitarios. Sujetos y métodos. Se determinó la asociación entre el rendimiento académico de los estudiantes en el primer nivel de Bioquímica, con los factores de tipo académico y demográfico; se utilizaron dos métodos de análisis: el primero, numérico, de acuerdo con los promedios de las notas parciales y finales; el segundo, categorizado como éxito (&ge; 3,0) o fracaso (Introduction. The analysis of the students' academic achievement in a higher education institution together with the different factors that affect the student's performance generates answers to the questions that the people involved in the teaching process commonly ask themselves. This analysis is therefore, an excellent way to find and propose solutions in order to improve the student's performance. Subjects and methods. The association between the students' academic performance and the academic and demographic factors was determined in the first level of Biochemistry. Two methodologies were used for this purpose. The first one, a numerical analysis based on the partial and final grades, and a second categorical method based on the final success (&ge; 3.0) or failure (< 3.0) on the subject. Results. A positive and statistically significant correlation was found when the academic performance in Biochemistry, the general and specific results of the state test (natural sciences and mathematics), the institutional scholarship status and entering the Medicine program without pre-university courses was analyzed. Factors, such as coming from different schools and the city of origin, do not affect significantly the performance in any of the analyses. Conclusions. Academic performance in Biochemistry is directly affected by factors involving the individual student's skills while the demographical factors are not involved

Factores que pueden influir en el rendimiento académico de estudiantes de Bioquímica que ingresan en el programa de Medicina de la Universidad del Rosario-Colombia

Introducción. El análisis del rendimiento académico de los estudiantes que ingresan a una institución de educación superior, así como los factores que pueden estar influyendo en él, genera respuestas a los interrogantes que corrientemente se hacen las personas involucradas en los procesos educativos y permite proponer soluciones para mejorar el desempeño de los estudiantes universitarios. Sujetos y métodos. Se determinó la asociación entre el rendimiento académico de los estudiantes en el primer nivel de Bioquímica, con los factores de tipo académico y demográfico; se utilizaron dos métodos de análisis: el primero, numérico, de acuerdo con los promedios de las notas parciales y finales; el segundo, categorizado como éxito (? 3,0) o fracaso (< 3,0), de acuerdo con el promedio de la nota definitiva de la asignatura. Resultados. Se encontró una asociación positiva y estadísticamente significativa entre los resultados de las pruebas de estado generales y específicas (ciencias naturales y matemáticas), el estatus de becario institucional y el ingreso directo a la carrera sin realizar cursos preuniversitarios, con el rendimiento académico en Bioquímica. Factores como el colegio en el cual realizaron la educación secundaria y la ciudad de procedencia no afectaron significativamente el rendimiento en ninguno de los análisis aplicados. Conclusiones. El rendimiento académico en Bioquímica se ve afectado directamente por factores que involucran las competencias individuales de los estudiantes, pero no por factores demográficosIntroduction. The analysis of the students' academic achievement in a higher education institution together with the different factors that affect the student's performance generates answers to the questions that the people involved in the teaching process commonly ask themselves. This analysis is therefore, an excellent way to find and propose solutions in order to improve the student's performance. Subjects and methods. The association between the students' academic performance and the academic and demographic factors was determined in the first level of Biochemistry. Two methodologies were used for this purpose. The first one, a numerical analysis based on the partial and final grades, and a second categorical method based on the final success (? 3.0) or failure (< 3.0) on the subject. Results. A positive and statistically significant correlation was found when the academic performance in Biochemistry, the general and specific results of the state test (natural sciences and mathematics), the institutional scholarship status and entering the Medicine program without pre-university courses was analyzed. Factors, such as coming from different schools and the city of origin, do not affect significantly the performance in any of the analyses. Conclusions. Academic performance in Biochemistry is directly affected by factors involving the individual student's skills while the demographical factors are not involved

Factores que pueden influir en el rendimiento académico de estudiantes de Bioquímica que ingresan en el programa de Medicina de la Universidad del Rosario-Colombia

Introducción. El análisis del rendimiento académico de los estudiantes que ingresan a una institución de educación superior, así como los factores que pueden estar influyendo en él, genera respuestas a los interrogantes que corrientemente se hacen las personas involucradas en los procesos educativos y permite proponer soluciones para mejorar el desempeño de los estudiantes universitarios. Sujetos y métodos. Se determinó la asociación entre el rendimiento académico de los estudiantes en el primer nivel de Bioquímica, con los factores de tipo académico y demográfico; se utilizaron dos métodos de análisis: el primero, numérico, de acuerdo con los promedios de las notas parciales y finales; el segundo, categorizado como éxito (≥ 3,0) o fracaso (< 3,0), de acuerdo con el promedio de la nota definitiva de la asignatura. Resultados. Se encontró una asociación positiva y estadísticamente significativa entre los resultados de las pruebas de estado generales y específicas (ciencias naturales y matemáticas), el estatus de becario institucional y el ingreso directo a la carrera sin realizar cursos preuniversitarios, con el rendimiento académico en Bioquímica. Factores como el colegio en el cual realizaron la educación secundaria y la ciudad de procedencia no afectaron significativamente el rendimiento en ninguno de los análisis aplicados. Conclusiones. El rendimiento académico en Bioquímica se ve afectado directamente por factores que involucran las competencias individuales de los estudiantes, pero no por factores demográfico

GLACE survey: OSIRIS/GTC tuneable filter Hα imaging of the rich galaxy cluster ZwCl 0024.0+1652 at z = 0.395. I. Survey presentation, TF data reduction techniques, and catalogue

The cores of clusters at 0 ≲ z ≲ 1 are dominated by quiescent early-type galaxies, whereas the field is dominated by star-forming late-type galaxies. Clusters grow through the accretion of galaxies and groups from the surrounding field, which implies that galaxy properties, notably the star formation ability, are altered as they fall into overdense regions. The critical issues for understanding this evolution are how the truncation of star formation is connected to the morphological transformation and what physical mechanism is responsible for these changes. The GaLAxy Cluster Evolution Survey (GLACE) is conducting a thorough study of the variations in galaxy properties (star formation, AGN activity, and morphology) as a function of environment in a representative and well-studied sample of clusters. To address these questions, the GLACE survey is making a deep panoramic survey of emission line galaxies (ELG), mapping a set of optical lines ([O ii], [O iii], Hβ andHα/[N ii] when possible) in several galaxy clusters at z ~ 0.40, 0.63, and 0.86. Using the tunable filters (TF) of the OSIRIS instrument at the 10.4 m GTC telescope, the GLACE survey applies the technique of TF tomography: for each line, a set of images are taken through the OSIRIS TF, each image tuned at a different wavelength (equally spaced), to cover a rest frame velocity range of several thousand km s-1 centred on the mean cluster redshift, and scanned for the full TF field of view of an 8 arcmin diameter. Here we present the first results of the GLACE project, targeting the Hα/[N ii] lines in the intermediate-redshift cluster ZwCl 0024.0+1652 at z = 0.395. Two pointings have been performed that cover ~2 × rvir. We discuss the specific techniques devised to process the TF tomography observations in order to generate the catalogue of cluster Hα emitters, which contains more than 200 sources down to a star formation rate (SFR) ≲1 M⊙/yr. An ancillary broadband catalogue is constructed, allowing us to discriminate line interlopers by means of colour diagnostics. The final catalogue contains 174 unique cluster sources. The AGN population is distinguished using different diagnostics and found to be ~37% of the ELG population. The median SFR of the star-forming population is 1.4 M⊙/yr. We studied the spatial distribution of ELG and confirm the existence of two components in the redshift space. Finally, we exploited the outstanding spectral resolution of the TF, attempting to estimate the cluster mass from ELG dynamics, finding M200 = (4.1 ± 0.2) × 1014 M⊙ h-1, in agreement with previous weak-lensing estimates

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013