New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

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

Does size matter? Organisational slack and visibility as alternative explanations for environmental responsiveness

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN041821 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The role of risk in environment-related supplier initiatives

This paper extends previous literature on the greening of supply chains by giving explicit consideration to two main areas – the role of risk, and the motives for undertaking different sorts of environment-related supplier initiatives. A model is presented which describes the extent and type of environment-related supplier initiatives that may be undertaken by firms as a result of the interaction of the perceived losses to the firm associated with inaction, and the actual level of strategic purchasing in the firm

Analysing mapping and managing environmental impacts along supply chains

This article reports on research toward a pragmatic and credible means for analyzing, mapping, and managing environmental impacts along supply chains. The results of this research include a management tool called "ecological supply chain analysis" (EcoSCAn) that is presented here for the first time. Its structure bears a passing resemblance to that used in some streamlined life-cycle assessments, but its operation and purpose are quite different. The EcoSCAn tool frames a comparative environmental analysis of products capable of performing broadly equivalent functions. The analysis occurs over complete extended supply chains and within defined supply chain stages at a product level and, to some extent, at a site level. The results are mapped with data confidence indicators. A range of tactical and, where data quality is sufficient, strategic supply chain actions are prompted. Actions to mitigate environmental stress are possible in the absence of good quality data across entire product life cycles, although the extent to which management actions are limited is made plain