BACKGROUND:Mortality rates among surgical patients in Africa are double those of surgical patients in high-income countries. Internationally, there is a call to improve access to and safety of surgical and perioperative care. Perioperative research needs to be coordinated across Africa to positively impact perioperative mortality.

METHODS:

The aim of this study was to determine the top 10 perioperative research priorities for perioperative nurses in Africa, using a research priority-setting process. A Delphi technique with 4 rounds was used to establish consensus on the top 10 perioperative research priorities. In the first round, respondents submitted research priorities. Similar research priorities were amalgamated into single priorities when possible. In round 2, respondents ranked the priorities using a scale from 1 to 10 (of which 1 is the first/highest priority, and 10 is the last/lowest priority). The top 20 (of 31) were determined after round 2. In round 3, respondents ranked their top 10 priorities. The final round was an online discussion to reach consensus on the top 10 perioperative research priorities.

RESULTS:

A total of 17 perioperative nurses representing 12 African countries determined the top research priorities, which were: (1) strategies to translate and implement perioperative research into clinical practice in Africa, (2) creating a perioperative research culture and the tools, resources, and funding needed to conduct perioperative nursing research in Africa, (3) optimizing nurse-led postoperative pain management, (4) survey of operating theater and critical care resources, (5) perception of, and adherence to sterile field and aseptic techniques among surgeons in Africa (6) surgical staff burnout, (7) broad principles of infection control in surgical wards, (8) the role of interprofessional communication to promote clinical teamwork when caring for surgical patients, (9) effective implementation of the surgical safety checklist and measures of its impact, and (10) constituents of quality nursing care.

CONCLUSIONS:

These research priorities provide the structure for an intermediate-term research agenda for perioperative research in Africa.

There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis.Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism.Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and $73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and $75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality.For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.

Abstract Increasing ultraviolet (UV) radiation is causing oxidative stress that accounts for growth and yield losses in the present era of climate change. Plant hormones are useful tools for minimizing UV-induced oxidative stress in plants, but their putative roles in protecting tomato development under UVC remain unknown. Therefore, we investigated the underlying mechanism of pre-and post-kinetin (Kn) treatments on tomato plants under UVC stress. The best dose of Kn was screened in the preliminary experiments, and this dose was tested in further experiments. UVC significantly decreases growth traits, photosynthetic pigments, protein content, and primary metabolites (proteins, carbohydrates, amino acids) but increases oxidative stress biomarkers (lipid peroxidation, lipoxygenase activity, superoxide anion, hydroxyl radical, and hydrogen peroxide) and proline content. Treatment of pre-and post-kinetin spraying to tomato plants decreases UVC-induced oxidative stress by restoring the primary and secondary metabolites’ (phenolic compounds, flavonoids, and anthocyanins) status and upregulating the antioxidant defense systems (non-enzymatic antioxidants as ascorbate, reduced glutathione, α-tocopherol as well as enzymatic antioxidants as superoxide dismutase, catalase, ascorbate peroxidase, glutathione peroxidase, glutathione-S-transferase, and phenylalanine ammonia-lyase). Thus, the application of Kn in optimum doses and through different modes can be used to alleviate UVC-induced negative impacts in tomato plants.

Graphical abstract

A library of fungi previously recovered from the gastrointestinal tract (GIT) of several fresh, commercially sourced Australian mullet fish was re-profiled for production of a rare class of phenylpropanoid piperazine alkaloids (chrysosporazines) using an integrated platform of; (i) miniaturized 24-well plate cultivation profiling (MATRIX), (ii) UPLC-DAD and UPLC-QTOF-MS/MS (GNPS) chemical profiling, and; (iii) precursor directed biosynthesis to manipulate in situ biosynthetic performance and outputs; to detect two new fungal producers of chrysosporazines. Chemical analysis of an optimized PDA solid phase cultivation of Aspergillus sp. CMB-F661 yielded the new regioisomeric chrysosporazine T (1) and U (2), while precursor directed cultivation amplified production and yielded the very minor new natural products azachrysosporazine T1 (3) and U1 (4), and the new unnatural analogues neochrysosporazine R (5) and S (6). Likewise, chemical analysis of an optimized M1 solid phase cultivation of Spiromastix sp. CMB-F455 lead to the GNPS detection of multiple chrysosporazines and brasiliamides, and the isolation and structure elucidation of chrysosporazine D (7) and brasiliamide A (8). Access to new chrysosporazine regioisomers facilitated structure activity relationship investigations to better define the chrysosporazine P-glycoprotein (P-gp) inhibitory pharmacophore, which is exceptionally potent at reversing doxorubrin resistance in P-gp over expressing colon carcinoma cells (SW600 Ad300).

Pimprinine and streptochlorin are indole alkaloids derived from marine or soil microorganisms. In our previous study, they were promising lead compounds due to their potent bioactivity in preventing many phytopathogens, but further structural modifications are required to improve their antifungal activity. In this study, pimprinine and streptochlorin were used as parent structures with the combination strategy of their structural features. Three series of target compounds were designed and synthesized. Subsequent evaluation for antifungal activity against six common phytopathogenic fungi showed that some of thee compounds possessed excellent effects, and this is highlighted by compounds 4a and 5a, displaying 99.9% growth inhibition against Gibberella zeae and Alternaria Leaf Spot under 50 μg/mL, respectively. EC50 values indicated that compounds 4a, 5a, 8c, and 8d were even more active than Azoxystrobin and Boscalid. SAR analysis revealed the relationship between 5-(3′-indolyl)oxazole scaffold and antifungal activity, which provides useful insight into the development of new target molecules. Molecular docking models indicate that compound 4a binds with leucyl-tRNA synthetase in a similar mode as AN2690, offering a perspective on the mode of action for the study of its antifungal activity. These results suggest that compounds 4a and 5a could be regarded as novel and promising antifungal agents against phytopathogens due to their valuable potency.

Cultural heritage buildings are prone to failures when subjected to seismic events, and recent earthquakes worldwide resulted in many losses of these buildings. Therefore, there is a need for methodologies for assessing their seismic safety that should be based on enough knowledge of the building. Here, dynamic investigation by dynamic identification testing and dynamic monitoring increase significantly the level of knowledge about the assessed building. The dynamic identification tests give global information about the dynamic properties like natural frequencies that are useful in calibrating and updating a numerical model of the building that could be used in the seismic safety evaluation. Dynamic monitoring gives the dynamic properties’ evolution in time and may be used as an early warning tool able to send alarms when meaningful changes in dynamic properties are observed. This chapter gives some considerations on the different investigation activities of dynamic identification, dynamic monitoring, numerical model updating, and seismic safety assessment of cultural heritage buildings. As an application, the case study of the historic Mallorca cathedral is discussed.

SummaryBackground
The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs.
Methods
First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score.
Findings
In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings.
Interpretation
The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.
Funding
National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.

Equine influenza is an important cause of respiratory disease in equids. The causative virus; EIV, is highly variable and can evolve by accumulation of mutations, particularly in the haemagglutinin (HA) gene. Currently, H3N8 is the sole subtype circulating worldwide with Florida clade 1 (FC1) is most prevalent in the Americas and FC2 in Asia and Europe. In Egypt, EIV was detected in two occasions: subtype H7N7 in 1989 and subtype H3N8 (FC1) in 2008. No data is available on the circulation pattern of EIV during the last decade despite frequent observation of suspected cases.

Fishpond sediments are rich in organic carbon and nutrients; thus, they can be used as potential fertilizers and soil conditioners. However, sediments can be contaminated with toxic elements (TEs), which have to be immobilized to allow sediment reutilization. Addition of biochars (BCs) to contaminated sediments may enhance their nutrient content and stabilize TEs, which valorize its reutilization. Consequently, this study evaluated the performance of BCs derived from Taraxacum mongolicum Hand-Mazz (TMBC), Tribulus terrestris (TTBC), and rice straw (RSBC) for Cu, Cr, and Zn stabilization and for the enhancement of nutrient content in the fishpond sediments from San Jiang (SJ) and Tan Niu (TN), China. All BCs, particularly TMBC, reduced significantly the average concentrations of Cr, Cu, and Zn in the overlying water (up to 51% for Cr, 71% for Cu, and 68% for Zn) and in the sediments pore water (up to 77% for Cr, 76% for Cu, and 50% for Zn), and also reduced metal leachability (up to 47% for Cr, 60% for Cu, and 62% for Zn), as compared to the control. The acid soluble fraction accounted for the highest portion of the total content of Cr (43–44%), Cu (38–43%), and Zn (42–45%), followed by the reducible, oxidizable, and the residual fraction; this indicates the high potential risk. As compared with the control, TMBC was more effective in reducing the average concentrations of the acid soluble Cr (15–22%), Cu (35–53%), and Zn (21–39%). Added BCs altered the metals acid soluble fraction by shifting it to the oxidizable and residual fractions. Moreover, TMBC improved the macronutrient status in both sediments. This work provides a pathway for TEs remediation of sediments and gives novel insights into the utilization of BC-treated fishpond sediments as fertilizers for crop production.