Search

To compare costs between two different eye drop delivery modalities: multidose bottles and single-use minims.Retrospective cohort study.Monthly dilating eye drop costs and quantities (tropicamide 1%, phenylephrine 2.5%, cyclopentolate 1%) were studied over a 2-year period between April 2013 and March 2015 at 2 tertiary ophthalmic centres (Royal Alexandra Hospital [RAH, Edmonton] and Rockyview General Hospital [RGH, Calgary]). In April 2014, RAH switched its dilating eye drop practice from predominantly multidose bottles to single-use minims, whereas RGH continued using predominantly multidose bottles. Eye drop volume and total and per-patient eye drop costs were quantified at RAH before switching (pre-intervention) and after (post-intervention) using an interrupted time-series analysis with RGH as a control. A counterfactual analysis was also performed. Significance was obtained using independent t-testing.After switching to single-use minims, RAH experienced changes in the following: an increase in single-use minims as a proportion of total eye drop utilization (from 5.6% to 89.1%; p = 0.001), an increase in total eye drop cost by $2117 per month (95% confidence interval [CI], $1354-$2880; p0.001), an increase in per-patient costs by $984 per 1000 patients per month (95% CI, $674-$1293). Contrastingly, RGH did not experience similar changes. Ultimately, the cost of switching to single-use minims was $22 481 (95% CI, $7830-$31 336) over a 12-month period.If safe eye drop practices are enforced via proper protocols, the use of multidose bottles may be a more cost-effective option than single-use minims for routine clinical practice.

Unlike simple forward-viewing endoscopes such as gastroscope or colonoscope, duodenoscope houses much more complex design to fulfil its function. This design differences leave duodenoscopes more prone to contamination from inadequate disinfection process and potential dissemination of pathogens. Recent reports on dissemination of infection through the duodenoscope mandated an overhaul of duodenoscope utilization including development of a disposable duodenoscope. This article reviews the current state of disposable duodenoscope development, including reported early efficacy as well as its future direction and utilization.

Ureteroscopy is the most common surgical modality for stone treatment. Reusable flexible ureteroscopes are delicate instruments that require expensive maintenance and repairs. Multiple single use ureteroscopes have been developed recently to combat the expensive and time-intensive sterilization and repair of ureteroscopes. Although multiple studies have looked at different aspects of reusable and single use ureteroscopes, there is significant heterogeneity in performance measures and cost between the 2 categories, and neither has a clear advantage. Both can be used successfully, and individual and institution level factors should be considered when deciding which ureteroscope to use.

Introduction Office cystoscopy is one of the most frequently performed procedures by a urologist. However, single-use cystoscopes remain quite undeveloped. Ambu® has developed single-use broncoscopes, rhinolaryngoscopes and duodenoscopes. Recently, they released a single-use cystoscope. In this study, we performed a benchtop and initial clinical assessment of the Ambu® aScope™ (4) Cysto single-use cystoscope. Methods Ten new, never-used Ambu® aScope™ (4) Cysto single-use cystoscopes were assessed for optical performance, maximal tip flexion and irrigation flow rate with empty working channel, 365μm laser fiber, 0.035in hydrophilic-tipped wire, 1.9Fr nitinol basket and a 1.8mm flexible stent grasper. All cystoscopes were then fully flexed 25 times in each direction, and maximal flexion angles were re-measured with and without instruments. Optical resolution, distortion, and depth of field was measured and compared to our reusable digital flexible cystoscopes. Assessment of clinical use was performed for inpatient bedside procedures using a Likert feedback survey and the NASA Task-Load-Index. Results Maximal upward flexion exceeded 200○ and 160○ for all working instruments in upward and downward flexion. Downward flexion demonstrated different flexion between instrument groups in pre- and post-cycling (p

Background : The spread of duodenoscope-related infections has led to the recognition that reprocessing of duodenoscopes using high-level disinfection (HLD), if done perfectly, narrowly meets the advised thresholds of endoscope decontamination. In 2019, the US Food and Drug Administration (FDA) recommended a transition to duodenoscopes designed to pose less risk, including the use of disposable duodenoscopes. The EXALT Model-D™ single-use duodenoscope (EXALT) has been shown to be substantially equivalent to reusable duodenoscopes for clinical use. The objective of this study was to estimate the cost-effectiveness of EXALT in the United States Healthcare system. Methods : A cost-effectiveness model was developed comparing HLD, culture-and-quarantine (CQ), Ethylene oxide sterilization (ETO), and EXALT in a simulated cohort undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. Published information was leveraged describing clinical estimates, infectious outbreaks, and hospital costs. Results : In a base analysis, HLD was the least costly ($962), and EXALT was the costliest ($3,000), but yielded the most QALYs (0.0172 incremental QALYs). The incremental cost-effectiveness ratio was $38,461 for ETO gas sterilization and $62,185 for EXALT. However, with the availability of device-specific reimbursement for EXALT in the US in the form of transitional pass-through payment (TPT) and new technology add-on payment (NTAP), EXALT provided the highest cost-savings to the hospital versus alternative strategies by maintaining QALY gains while decreasing estimated net costs. Probabilistic sensitivity analyses showed EXALT to be preferred compared to HLD over a range of willingness-to-pay. Conclusion : EXALT is a viable and cost-effective strategy that should be strongly considered for ERCP.

Zusammenfassung Hintergrund Die Thermo-Pulsation (LipiFlow®, Johnson & Johnson, Santa Ana, CA, USA) wurde zur Behandlung der Meibom-Drüsen-Dysfunktion (MDD) empfohlen und in mehreren Studien für nützlich befunden. Ziel dieser Studie war es, die Wirksamkeit der Methode an sich und im Vergleich zur täglichen Lidrandmassage in einer nichtuniversitären Einrichtung darzustellen. Methoden Eine nicht verblindete, Single-center-Interventionsstudie, die die Thermo-Pulsation mit einer Lidrandmassage zur Behandlung von MDD vergleicht: 30 Patienten wurden im Zuge der täglichen Sprechstunde rekrutiert. Die Symptome (OSDI) und die Augenoberfläche (NIK-BUT, Farnkraut-Test, Tränenmeniskus, LIPKO-Falten, Meibographie, Meibomian-Gland-Evaluator) wurden vor der Behandlung untersucht.; 15 Patienten (9 Frauen) unterzogen sich der Thermo-Pulsation (einmalige Sitzung), während 15 Patienten (8 Frauen) 3 Monate lang eine Lidrandmassage (1-mal täglich) nach Anweisung für 3 Monate durchführten. Ergebnisse Vor den beiden Behandlungsmethoden bestanden keine Unterschiede in oben genannten Parametern, ebenfalls waren Geschlecht und Alter normverteilt. Nach der Behandlung verbesserten sich zwar in beiden Gruppen die subjektiven als auch die objektiven Kriterien, allerdings im Thermo-Pulsation-Arm signifikant stärker. Insbesondere ist die eingeschränkte Compliance von 30 % im Lidrandmassagearm zu beachten. Sicherheitsparameter wie Visus und IOD blieben bei allen Patienten unauffällig. Schlussfolgerungen Eine einzige Sitzung der Thermo-Pulsation führte in ihrer Wirksamkeit und ihrem Sicherheitsprofil nach 3 Monaten im Vergleich zu einer 1‑mal täglichen Lidrandmassage zu signifikant besseren Ergebnissen. Zu beachten sind allerdings die hohen Kosten für die Patienten, da die zu applizierenden Aktivatoren als Einmalprodukte zu behandeln sind.

INTRODUCTION Sate of the art on the indications, methods of implementation and medico-economic considerations of reusable flexible ureteroscopes (URSr) vs single use (URSuu)? METHOD Review of the literature (Pubmed) on reusable and single-use ureteroscopes, as well as on the expertise of our center. A PubMed search and narrative review of the data was performed in July 2021. Only articles in French or English were selected. RESULTS The URSr and URSuu have similar technical characteristics and are suitable for the exploration of the upper urinary excretory tract: treatment of stones of the kidney

Objective To test the anesthetic effect of a bupivacaine liposome injectable suspension (BLIS), used in a multiple-dose manner for up to 5 consecutive days. Study design Prospective, randomized, experimental study. Animals A total of 30 male and female Sprague–Dawley rats (Rattus norvegicus), aged 97 (75–130) days and weighing 337.2 (219.6–465.9) g, mean (range). Methods Rats were assigned to one of five BLIS vial groups, in which drug was administered from a newly opened vial or 1, 2, 3 and 4 days after the vial was opened. The vials were refrigerated between uses. A 14 gauge needle attached to an injection plug was used to puncture each vial once and was not removed; BLIS was withdrawn from the injection plug in a multiple-dose fashion. A dose rate of 0.4 mL kg−1 was administered subcutaneously into the left pelvic limb paw. Antinociception was evaluated using a paw pressure test on both injected and uninjected paws before (time 0, baseline) and 1, 24, 48 and 72 hours after injection. Results Age of BLIS vial had no significant effect on anesthetic efficacy (p = 0.97). Across all groups, paw withdrawal latency averaged 5.23 ± 0.24 seconds at baseline (before BLIS injection), increased to 16.45 ± 0.65 seconds at 1 hour after BLIS injection, declined to 7.50 ± 0.76 seconds at 24 hours after BLIS injection, and further declined thereafter (p Conclusions and clinical relevance BLIS single-use vials retained efficacy when used up to 5 days in a multiple-dose fashion. Because anesthetic effects declined substantially after 24 hours, multimodal pain management remains important for providing analgesia care.

Objectives: To determine which flexible ureterorenoscopy program would be most cost-efficient in our center, a cost efficiency analysis and a formula to assess cost efficiency feasibility of a hybr...

AIM AND OBJECTIVE The aim of this cross-sectional population-based clinical study was to assess the effect of single use of three different mouthrinses on the level of salivary Streptococcus mutans of 8 to 10-year-old Saudi children. MATERIALS AND METHODS Convenient samples of 52 Saudi children aged 8-10 years were randomly allocated into four groups of 13 each. Saliva samples were collected to assess the level of S. mutans at baseline before rinsing with the assigned mouthrinse or control. Three mouthrinses, Avalon Avohex, Listerine Miswak, and Optima Aloe Dent Mouthrinse, were randomly distributed to the children. Each participant was instructed to rinse for 2 minutes using 10 mL of the assigned mouthrinse. Saliva samples were collected after rinsing and colony forming unit (CFU) of S. mutans per mL of saliva was calculated. Statistical analysis was performed to compare S. mutans count at baselines and postintervention values of each experimental group and control using paired t-test and one-way ANOVA. All statistical analyses were set at a significance level of p 0.05) in bacterial count was seen in Avalon Avohex group. CONCLUSION A single-time rinse of chlorhexidine extract mouthrinse for 2 minutes effectively reduced the number of S. mutans of 8 to 10-year-old Saudi children. CLINICAL SIGNIFICANCE Rinsing with chlorhexidine extract mouthrinse should be considered as a potential method in prevention of dental caries in children.

Purpose Medical masks have inferior filtration efficiency and fit to filtering facepiece respirators (FFRs) but are widely used in healthcare and the community. These masks are intended for disposal after use but in the event of mask shortage re-use after reprocessing may be an option. We investigated eight reprocessing methods that each involved washing or soaking in liquid, are likely to eliminate respiratory viruses, and are safe and available in most community and healthcare settings. Methods Three brands of EN 14683 standards-compliant commercial medical mask were each reprocessed 10 times by one of eight methods. We measured filtration efficiency for poly-dispersed sodium chloride particles and pressure differential. Results Compared with new medical masks, reprocessed masks had significantly reduced filtration efficiency. The reduction was mild-moderate (6.5–25.8%) after warm water wash, hot water soak or boiling water soak; and moderate-large (24.1–51.5%) after detergent, soap or laundry machine wash, or bleach soak. There were mixed and minor changes in pressure differential. Most reprocessed standards-compliant masks had better filtration efficiency than new non-standard commercial masks and then cotton and cotton-polyester mix fabric samples, even triple-layered fabrics. Conclusions High-quality commercial medical masks reprocessed 10 times by water immersion methods had better filtration efficiency than new non-standard masks and washable fabrics. These findings have particular relevance for community and low-resource healthcare settings.

To assess whether the introduction of single use flexibles ureteroscopes (su-fURS) at our high-volume centre had an advantageous impact on the turn-over and breakage rates of reusable fURS (re-fURS). We analysed re-fURS number of usages and breakages at our centre between February 2015 and December 2018. We recorded the number of usages for analysed scope between the first usage until a breakage requiring reconditioning. Usage count was restarted following each reconditioning episode. Since su-fURS (Lithovue, Boston Scientific, USA) were introduced at our center in September 2016, we had the chance to compare different re-fURS life cycles according to both su-fURS availability and usage intensity (i.e., number of su-fURS used during each re-fURS life cycle). We then explored the relationship between su-fURS usage intensity and reusable scope survival (i.e., number of utilizations before any breakage requiring reconditioning) using locally weighted scatterplot smoothing (LOWESS) approach. Five different re-fURSs were employed at our centre, for a total of 1820 usages and 40 breakages requiring reconditioning. The overall mean (SD) number of usages before breaking was 40 (22). After su-fURS introduction, mean (SD) re-fURS number of usages increased from 35 (22) to 49 (20), (+ 40%, p = 0.02). The relationship between su-fURS usage intensity and reusable scopes survival showed a linear survival increase after 10 or more su-fURS scopes were used per life cycle. The life cycle of re-fURS increased by 40% after the introduction of su-fURS. Ten or more used su-fURS per life cycle were associated with increased re-fURS survival.

Antimicrobial nonwovens for single use applications (e.g., diapers, sanitary napkins, medical gauze, etc.) are of utmost importance as the first line of defense against bacterial infections. However, the utilization of petrochemical nondegradable polymers in such nonwovens creates sustainability-related issues. Here, sustainable poly(hydroxybutyrate) (PHB) and e-poly-l-lysine (e-PLL) submicro- and microfiber-based antimicrobial nonwovens produced by a novel industrially scalable process, solution blowing, have been proposed. In such nonwovens, e-PLL acts as an active material. In particular, it was found that most of e-PLL is released within the first hour of deployment, as is desirable for the applications of interest. The submicro- and microfiber mat was tested against C. albicans and E. coli, and it was found that e-PLL-releasing microfibers result in a significant reduction of bacterial colonies. It was also found that e-PLL-releasing antimicrobial submicro- and microfiber nonwovens are safe for human cells in fibroblast culture. Mechanical characterization of these nonwovens revealed that, even though they are felt as soft and malleable, they possess sufficient strength, which is desirable in the end-user applications.

Objective: Traditional negative pressure wound therapy (tNPWT) systems can be large and cumbersome, limiting patient mobility and adversely affecting quality of life. PICO™, a no canister single-use system, offers a lightweight, portable alternative to tNPWT, with improved clinical performance. The aim of this study was to determine the potential mechanism(s) of action of single-use NPWT (sNPWT) versus tNPWT. Approach: sNPWT and tNPWT were applied to an in vivo porcine excisional wound model, following product use guidelines. Macroscopic, histological, and biochemical analyses were performed at defined healing time points to assess multiple aspects of the healing response. Results: Wounds treated with single-use negative pressure displayed greater wound closure and increased reepithelialization versus those treated with traditional negative pressure. The resulting granulation tissue was more advanced with fewer neutrophils, reduced inflammatory markers, more mature collagen, and no wound filler-associated foreign body reactions. Of note, single-use negative pressure therapy failed to induce wound edge epithelial hyperproliferation, while traditional negative pressure therapy compromised periwound skin, which remained inflamed with high transepidermal water loss; features not observed following single-use treatment. Innovation: Single-use negative pressure was identified to improve multiple aspects of healing versus traditional negative pressure treatment. Conclusion: This study provides important new insight into the differing mode of action of single-use versus traditional negative pressure and may go some way to explaining the improved clinical outcomes observed with single-use negative pressure therapy.

Objective: The objective was to compare water flosser and regular floss in the efficacy of plaque removal in patients after single use. Materials and Methods: A randomized controlled clinical trial was conducted to compare the plaque removal efficacy of water flosser and regular floss. Eighty three subjects who met the inclusion criteria were recruited from dental clinic. Silness and Löe plaque index was measured for all the subjects prior to and after the intervention by an examiner who was blind to the type of aid used. The type of floss used was randomly assigned to each side of the oral cavity; unflavored waxed regular floss (oral B) used on one side, while a water flosser (Waterpik® Cordless Plus Water Flosser) was used on the other side. A trained investigator used either unflavored waxed regular floss or water flosser as assigned. Paired t-test was used to compare between the two groups. Results: The mean plaque scores at baseline were 1.10(±0.38) and 0.94(±0.38) respectively for regular floss and water flosser. The mean plaque scores were 0.12(±0.13) and 0.12(±0.15) respectively for regular floss and water flosser. There was no statistically significant difference in the plaque scores (p = 0.58) between the groups after the use of respective interdental aids. There was a statistically significant difference in the plaque scores before and after use of interdental aids for both the groups (p

A large amount of non-infected plastic wastes are being generated at the healthcare facilities all over the world. However, only a small fraction is recycled. Conventionally, the used plastics are either disposed in landfills or inadequately incinerated. These practices impart an adverse effect on our environment. Plastics are indispensable part of the medical sector owing to their high versatility. The outbreak of COVID-19 clearly showed the growing demand for single use plastics. Hence, completely avoiding plastics can be challenging at this point of time. Recycling of plastics is undoubtedly a solution to solve the crisis of plastic pollution. Medical plastic recycling is limited mainly due to difficulties involved in sorting or cleaning. Recycling medical plastic wastes is possible only through proper coordination between healthcare sector and recycling industries. New recycling technologies are to be adopted in a sustainable manner. Moreover, the plastics used in medical applications should be designed such that recycling is possible. This review highlights the downside of medical wastes and discusses the recycling potential of commonly used medical plastics. © 2021 Kingfa Scientific and Technological Co. Ltd.

Foreign body aspiration can be a life-threatening emergency and it is uncommon entity in adults. For foreign body extraction, rigid bronchoscopy is superior to flexible bronchoscopy for operative manipulation. However, in view of maxillofacial trauma, rigid bronchoscopy is a risk for patient. Herein we describe our successful experience using single use flexible bronchoscopy with retrieval basket in removal of huge foreign body aspiration in a polytrauma patient.

Background and Aims: Expert endoscopists previously reported ERCP outcomes for the first commercialized single-use duodenoscope. We aimed to document usability of this device by endoscopists with different levels of ERCP experience. Methods: Fourteen “expert” (>2000 lifetime ERCPs) and 5 “less-expert” endoscopists performed consecutive ERCPs in patients without altered pancreaticobiliary anatomy. Outcomes included ERCP completion for the intended indication, rate of crossover to another endoscope, device performance ratings, and serious adverse events. Results: Two hundred ERCPs including 81 (40.5%) with high complexity (American Society for Gastrointestinal Endoscopy grades 3-4) were performed. Crossover rate (11.3% vs 2.5%, P =.131), ERCP completion rate (regardless of crossovers) (96.3% vs 97.5%, P =.999), median ERCP completion time (25.0 vs 28.5 minutes, P =.130), mean cannulation attempts (2.8 vs 2.8, P =.954), and median overall satisfaction with the single-use duodenoscope (8.0 vs 8.0 [range, 1.0-10.0], P =.840) were similar for expert versus less-expert endoscopists, respectively. The same metrics were similar by procedural complexity except for shorter median completion time for grades 1 to 2 versus grades 3 to 4 (P Conclusions: In consecutive ERCPs including high complexity procedures, endoscopists with varying ERCP experience had good procedural success and reported high device performance ratings. (Clinical trial registration number: NCT04223830.)

Introdução: A toxina botulínica do tipo A tem sido utilizada amplamente como opção terapêutica para o bruxismo. Todavia, é importante discutir o seu efeito nos parâmetros ósseos e musculares. Objetivo: Conhecer, através de revisão integrativa de literatura, os possíveis efeitos adversos da administração terapêutica da toxina botulínica sobre parâmetros ósseos e musculares em modelos animais e humanos. Método: Foi realizada uma busca por artigos nas bases de dados Lilacs, PubMed, Scielo e Google Acadêmico, tendo como descritores os termos “botulinum toxin and bone and masticatory muscles”, na língua inglesa e os termos toxina botulínica e osso e músculos mastigatórios, em português. A inclusão dos artigos nesta revisão obedeceu a critérios de inclusão e exclusão. Resultados: Foram encontrados 283 artigos nas bases de dados consultadas, sendo 261 artigos excluídos por título, e nenhum artigo foi excluído por resumoe após sua leitura na íntegra. Um total de 22 artigos fizeram parte desta revisão. Conclusão: Estudos em ratos apontam para alterações esqueléticas e musculares após administração da BTX-A, mesmo comuso único, o que pode resultar em perda óssea a curto e longo prazo e, assim, potencializar problemas futuros. Mais estudos controlados randomizados deveriam ser realizados em humanos para melhores esclarecimentos sobresos efeitos da BTX-A nas estruturas ósseas.

The manufacture of single-use plastic items uses fossil fuels, and releases greenhouse gases. Plastic waste is also harmful to humans and wildlife. Recent attention towards the regulation or elimination of plastic straws has led to the development of many alternatives to single-use plastic straws, some intended to be disposed of immediately after use, and others to be cleaned and reused. Unfortunately, anecdotes are widespread of inferior sensory experiences from such alternatives, with straws either losing stability when wet, imparting negative flavor properties to a beverage, or feeling unpleasant in the mouth. Despite such reports, little formal research exists categorizing these alternatives. Here, we examine popular choices for straw materials in a focus group (n = 9) and in a consumer sensory test (n = 102), as well as testing the durability of straws when soaked in water. Cornstarch straws offered the most similar sensory experience to plastic, whereas options such as paper, wheat, pasta, and rice straws all scored low on mouthfeel and flavor liking, with off-flavors commonly reported in beverages consumed with these straws. A Kano analysis (n = 193) to determine the factors consumers find essential in drinking straws confirmed the most important to be that no flavors were imparted to beverages when used. Finally, a consumer survey (n = 579) confirmed that straw consumers primarily use them out of default availability; most use them only if they are given without asking, and most would readily give up plastic straws, but may be unfamiliar with other options. PRACTICAL APPLICATION: Plastic straws contribute to waste and result in the release of greenhouse gases in their manufacture. Despite this, they provide a superior sensory experience compared to other options. Here, we review aspects of this experience, along with consumers motivations for using straws.

An electrocardiogram (ECG), the recording of the electrical activity in the heart, is the most commonly performed cardiac test. It is carried out in a variety of clinical settings in hospitals and primary care, and its use is standard practice among high-risk, critically ill patients, and those who have undergone cardiac surgery. ECG recording is classified into two main categories: monitoring and diagnostic. 12-lead ECGs, which require electrodes to be placed on the chest and each limb, are used for diagnostic purposes, whereas 3- or 5-lead ECGs are used for rhythm monitoring. Cross-infection can arise from reusing ECG cables, even if they have been cleaned. Surgical site infection is a particular risk in patients who have undergone coronary artery bypass grafting, because ECG wires are placed on the chest close to the incision site. Single-use ECG leads, such as the Kendall DL™ ECG cable and lead wire system, reduce the risk of cross-contamination between patients and free nursing time for patient care because they are discarded after use and do not have to be cleaned and disinfected for use with another patient.

Plastic pollution is ubiquitous in the environment. One initiative that tackles this global environmental problem is the “Plastic Free July,” a worldwide campaign encouraging consumers to reduce th...

Introduction: Single-use flexible ureteroscopes are an increasingly popular alternative to reusable ureteroscopes. In this study, we performed a benchtop examination of the physical and optical pro...

Flexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries. Materials and Methods: an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed. Results: Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars. Conclusion: single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.

To evaluate the total cost of outpatient flexible cystoscopy associated with reusable device purchase, maintenance, and reprocessing, and to assess potential cost benefits of single-use flexible cystoscopes. Cost data regarding the purchasing, maintaining, and reprocessing of reusable flexible cystoscopes were collected using a micro-costing approach at a high-volume outpatient urology clinic. We estimated the costs to facilities with a range of annual procedure volumes (1000–3000) performed with a fleet of cystoscopes ranging from 10 to 25. We also compared the total cost per double-J ureteral stent removal procedure performed using single-use flexible cystoscopes versus reusable devices. The cost associated with reusable flexible cystoscopes ranged from $105 to $224 per procedure depending on the annual procedure volume and cystoscopes available. As a practice became more efficient by increasing the ratio of procedures performed to cystoscopes in the fleet, the proportion of the total cost due to cystoscope reprocessing increased from 22 to 46%. For ureteral stent removal procedures, the total cost per procedure using reusable cystoscopes (range $165–$1469) was higher than that using single-use devices ($244–$420), unless the annual procedure volume was sufficiently high relative to the number of reusable cystoscopes in the fleet (≥ 350 for a practice with ten reusable cystoscopes, ≥ 700 for one with 20 devices). The cost of reprocessing reusable cystoscopes represents a large fraction of the total cost per procedure, especially for high-volume facilities. It may be economical to adopt single-use cystoscopes specifically for stent removal procedures, especially for lower-volume facilities.

Single-use disposable digital flexible ureterorenoscope has become an attractive option to reusable scope with many advantages. Currently available single-use digital fURS have outer shaft diameter above 9 Fr which requires large access sheath insertion and sometimes double J stent placement. Recently, 7.5 Fr single-use digital fURS is introduced in market by Pusen. Objective of this study is to compare two Pusen single-use scopes in the clinical setting: 7.5 Fr Uscope PU3033A and 9.5 Fr Uscope PU3022A. 30 patients, having renal stones

Purpose The purpose of this technologic analysis was to evaluate single-use negative pressure wound therapy (sNPWT) devices. Approach Published literature regarding negative pressure wound therapy, particularly focusing on single-use or disposal devices, was reviewed. Varied features of devices currently available in the United States were drawn from use instructions published by individual manufacturers. Safety information regarding sNPWT was derived from the Manufacturer and User Facility Device Experience (MAUDE) Database. Conclusions Single-use or disposable negative pressure wound therapy devices provide a safe and effective alternative to traditional negative pressure wound therapy. These devices promote healing of select open wounds and reduce complication rates in closed surgical incisions, when used in accordance with manufacturer guidelines. They may be used in any setting, but they are designed for use in home care and may be applied as a primary treatment option or following a course of traditional negative pressure wound therapy.

Successful enteral feeding depends on patent enteral feeding tubes to permit trouble-free entry of nutritional formula into the alimentary tract. However, tube clogs can be a challenging complication of enteral feeding. This report addresses questions about using a papain-based enzyme solution to unclog enteral feeding tubes, including any effects that papain may have on patients and if solution use should be contraindicated in patients on ketogenic diets. The gastrointestinal tract is not permissive for significant papain activity and papain absorbed into the blood would likely be neutralized by antiproteases. In vitro examinations do not suggest toxic effects of papain in vivo, and those recognized in the latter setting are due to papain loads that exceed those used to unclog enteral feeding tubes. Allergies to papain occur infrequently and are probably attributable to an immunoglobulin E-mediated reaction to this enzyme. Although the amount of carbohydrate consumed upon single use of the unclogging solution is very low, a provider should decide whether using the papain-based enzyme solution for enteral feeding purposes is appropriate in patients who practice ketogenic diets. The benefits of using the papain-based enzyme solution to unclog enteral feeding tubes appear to outweigh any risks associated with its use.

Background and Aims Multidrug-resistant infectious outbreaks associated with duodenoscopes have been documented internationally. Single-use duodenoscopes, disposable distal ends, or distal end cap sealants could eliminate or reduce exogenous patient-to-patient infection associated with ERCP. Methods This document reviews technologies that have been developed to help reduce or eliminate exogenous infections because of duodenoscopes. Results Four duodenoscopes with disposable end caps, 1 end sheath, and 2 disposable duodenoscopes are reviewed in this document. The evidence regarding their efficacy in procedural success rates, reduction of duodenoscope bacterial contamination, clinical outcomes associated with these devices, safety, and the financial considerations are discussed. Conclusions Several technologies discussed in this document are anticipated to eliminate or reduce exogenous infections during endoscopy requiring a duodenoscope. Although disposable duodenoscopes can eliminate exogenous ERCP-related risk of infection, data regarding effectiveness are needed outside of expert centers. Additionally, with more widespread adoption of these new technologies, more data regarding functionality, medical economics, and environmental impact will accrue. Disposable distal end caps facilitate duodenoscope reprocessing; postmarketing surveillance culture studies and real-life patient infection analyses are important areas of future research.

Objective: Single-use negative pressure wound therapy (sNPWT) following closed surgical incisions has a demonstrable effect in reducing surgical site complications (SSC). However, there is little health economic evidence to support its widespread use. We sought to evaluate the cost-effectiveness of sNPWT compared with standard care in reducing SSCs following closed surgical incisions. Method: A decision analytic model was developed to explore the total costs and health outcomes associated with the use of the interventions in patients following vascular, colorectal, cardiothoracic, orthopaedic, C-section and breast surgery from the UK National Health Service (NHS) and US payer perspective over a 12-week time horizon. We modelled complications avoided (surgical site infection (SSI) and dehiscence) using data from a recently published meta-analysis. Cost data were sourced from published literature, NHS reference costs and Centers for Medicare and Medicaid Services. We conducted subgroup analysis of patients with diabetes, an American Society of Anesthesiologists (ASA) score ≥3 and body mass index (BMI) ≥30kg/m2. A sensitivity analysis was also conducted. Results: sNPWT resulted in better clinical outcomes and overall savings of £105 per patient from the UK perspective and $637 per patient from the US perspective. There were more savings when higher-risk patients with diabetes, or a BMI ≥30kg/m2 or an ASA≥3 were considered. We conducted both one-way and probabilistic sensitivity analysis, and the results suggested that this conclusion is robust. Conclusion: Our findings suggest that the use of sNPWT following closed surgical incisions saves cost when compared with standard care because of reduced incidence of SSC. Patients at higher risk should be targeted first as they benefit more from sNPWT. This analysis is underpinned by strong and robust clinical evidence from both randomised and observational studies.

Objective Identify types of food packaging used in school nutrition programs and competing priorities, barriers, and facilitators for sustainable packaging waste use and recovery. Design Qualitative interviews (n = 20) and structured kitchen observations were conducted. Setting Data were collected from 3 school districts in Northern Colorado. Participants Three nutrition program directors, 14 kitchen managers, and 3 sustainability staff. Phenomenon of Interest Barriers and facilitators for sustainable food packaging waste practices among school nutrition programs. Analysis Interviews were recorded and transcribed, followed by inductive content analysis to identify themes. Results Commonly used food packaging included cardboard, aluminum, paper, plastic, and styrofoam. Four competing priorities were identified as impacting school nutrition programs’ ability to reduce or recover food packaging: serving line speed, labor, food quality, and cost. One key barrier was that school staff had difficulty understanding the total system impact of their food packaging use and recovery decisions. Conclusions and Implications Food packaging is commonly used in school nutrition programs, and participants felt that its use offered key benefits, such as facilitating faster serving lines. More research is needed to quantify the direct and indirect impacts of packaging waste reduction and recovery in school nutrition programs.

Background and ObjectiveDouble J (JJ) ureteric stenting represents one of the most significant causes of patient discomfort and dissat-isfaction following endourological procedures. At our institution, a large tertiary referral centre for complex stones, standard JJ stent removal was previously undertaken with a flexible cystoscope (FC) in the endoscopy department by a doctor. The pathway was prone to delays through capacity constraints and prioritization being given to cancer investigations. The Isiris® is a single-use stent removal system consisting of a ‘camera on chip’ disposable FC with an integrated grasper. We examine the feasibility of a nurse-led stent removal service using Isiris®, performed as an office-based procedure, and its effect on waiting times. Material and MethodsA specialist stone nurse undertook training in FC approved by the British Association of Urological Surgeons (BAUS) and the British Association of Urological Nurses (BAUN). Once competency was reached, a nurse-led service was offered to patients in the outpatient setting. A prospective database from April 2018 to March 2020 was maintained to include patient data for stent removals in the nurse-led clinic using Isiris®. This was compared to a retrospective dataset of FC and stent removal between July 2016 and December 2016, per-formed by a doctor in the endoscopy department. The delays in stent removal compared to the ‘ideal’ stent removal date (planned date plus or minus 3 days tolerance allowed) were compared between the two pathways. ResultsThe specialist nurse undertook BAUS theory training and competency was reached using an approved BAUS/BAUN competency package. 414 stent removals were booked in the nurse group, of which 395 were undertaken. 291 of 395 (74%) patients in the nurse removal Isiris® group had their stent removed on time, whereas only 16 of 54 (30%) patients had their stents removed on time in the FC stent removal group. A delay of more than 21 days was seen in 22% of FC group vs only 2% in the nurse-led Isiris® group. Both planned removal and actual stent dwell time were longer in the FC group compared to Isiris® group (p < 0.0001). There were no major complications with the use of Isiris® for stent removal in the nurse-led clinic. ConclusionThis study has demonstrated that it is feasible to introduce a nurse-led stent removal service. The introduction of this service using the Isiris® system has led to a reduction in delays of stent removal, which is likely to trans-late into significant quality of life improvement for patients and economic benefits for the healthcare system.

Introduction: The anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch (AHG-CDCXM) assay has been used to assess the presence of donor-specific antibodies (DSA) in recipient’s serum before kidney transplantation. The flow cytometric crossmatch (FCXM) assay was first introduced as an additional test. The aim of this study was to clinically validate the single use of the FCXM assay. Methods: This study compared the outcomes of a cohort of kidney transplant patients that underwent FCXM only (FCXM group) versus a cohort of kidney transplant patients that underwent AHG-CDCXM (control group). Results: Ninety-seven patients in the FCXM group and 98 controls were included. All crossmatches in the control group were negative. One patient in the FCXM group had a positive B cell crossmatch. One year after transplantation, there were no significant differences in patient survival (p = 0.591) and graft survival (p = 0.692) between the groups. Also, no significant difference was found in the incidence of Banff ≥ 1A acute cellular rejection episodes (p = 0.289). However, acute antibody-mediated rejections occurred in 3 controls (p = 0.028). Conclusion: The results showed that discontinuing the AHG-CDCXM assay does not modify the clinical outcomes in a 1-year follow-up. Resumo Introdução: O ensaio de prova cruzada por citotoxicidade dependente do complemento antiglobulina humana (AHG-CDCXM - do inglês anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch) tem sido usado para avaliar a presença de anticorpos específicos contra o doador (DSA - do inglês donor-specific antibodies) no soro do receptor antes do transplante renal. O ensaio de prova cruzada por citometria de fluxo (CFXM) foi introduzido pela primeira vez como um teste adicional. O objetivo deste estudo foi validar clinicamente o uso único do ensaio CFXM. Métodos: Este estudo comparou os resultados de uma coorte de pacientes de transplante renal que foram submetidos apenas ao CFXM (grupo CFXM) contra uma coorte de pacientes de transplante renal submetidos ao AHG-CDCXM (grupo controle). Resultados: Foram incluídos noventa e sete pacientes no grupo CFXM e 98 controles. Todas as provas cruzadas no grupo controle foram negativas. Um paciente no grupo CFXM teve uma prova cruzada positiva para células B. Um ano após o transplante, não houve diferenças significativas na sobrevida do paciente (p = 0,591) e na sobrevida do enxerto (p = 0,692) entre os grupos. Também não foi encontrada diferença significativa na incidência de episódios de rejeição aguda celular (p = 0,289) segundo critério de Banff ≥ 1A. No entanto, rejeições agudas mediadas por anticorpos ocorreram em 3 controles (p = 0,028). Conclusão: Os resultados mostraram que a interrupção do ensaio AHG-CDCXM não modifica os desfechos clínicos em um acompanhamento de 1 ano.

Panagiota Naoum,1 Sotiria Palioura,2 Vasiliki Naoum,1 Nikos Nomikos,1 Konstantina Bachtalia,1 Konstantinos Zisis,1 Kostas Athanasakis,1,3 John Kyriopoulos1 1Institute for Health Economics, Athens, Greece; 2Athens Vision Eye Institute, Athens, Greece; 3Department of Public Health Policy, School of Public Health, University of West Attica, Athens, GreeceCorrespondence: Panagiota NaoumInstitute for Health Economics, Aldou Manoutiou 10, Athens, 11521, GreeceTel +30 210 6455562Email yiota_n87@yahoo.grPurpose: To estimate the net cost effect associated with the real-world practice of repeated use of designated single-use medical devices (SUDs) versus their proper single use in cataract surgery in Greece.Design: A cost-benefit analysis model was constructed in the form of a decision tree.Methods: A digital expert panel was assembled in order to estimate the probabilities of intraoperative and postoperative complications associated with single and repeated use of SUDs. Unit costs for the management of each complication were obtained from the official Greek bulletins. A Monte Carlo-type sensitivity analysis was performed to assess the robustness of the results.Results: Based on the probabilities of complications attained from the expert panel, repeated use of SUDs is associated with a higher chance of complications compared to single use, which results in higher cost of complication management. Under the healthcare sector perspective, the total expected cost per cataract surgery is 1,403.98€ (1,244.20€ the initial cost of cataract surgery plus 159.78€ the cost of adverse events) in the case of single use, while for repeated use the total cost is 1,486.29€ (1,146.86€ + 339.43€, respectively) and, thus, repeated use of SUDs in cataract surgery results in 82.31€ higher expected cost per patient compared to their single use. Moreover, the societal perspective analysis indicated even higher additional costs in the case of SUD reuse (108.24€).Conclusion: Repeated use of SUDs in cataract surgery is not appropriate, it jeopardizes patient safety and carries a legal liability for the reuser. The present study, which is the first to attach a monetary value to the common yet questionable practice of SUD reuse, shows that it is not cost beneficial. Therefore, it is expected that the results will have implications in policy formulations to improve the delivery of cataract healthcare.Keywords: cataract, cataract surgery, single-use devices, SUDs

Bidi Stick is a single use electronic cigarette (e-cigarette) launched in 2020 by Bidi Vapor.1 Distributed and sold online and in retail stores in the USA,2 the brand’s popularity is growing, with Bidi Stick sales comprising 28% of the disposable e-cigarette market in the fourth quarter of 2020.1 3 In their recent campaign ‘Bidi Cares,’ Bidi Vapor presents their company as the industry leader in environmental consciousness, protection, and care. Central to their marketing is greenwashing , a technique in which products or brands are portrayed as eco-friendly or natural.4–6 Cigarette7–10 and e-cigarette advertising11–14 have both leveraged greenwashing tactics, including cigarette advertisements (predominantly Natural American Spirit) describing their products as ‘natural,’ ‘additive-free,’ ‘organic;’15 16 using nature-related imagery;7–9 17 and highlighting pro-environment corporate social responsibility activities (eg, anti-litter campaigns)7–10 and e-cigarette advertisements touting their products as better for the environment than cigarettes14 and organic or natural.13 Although greenwashing tactics do not make explicit claims about a product’s health benefits or risk profile, they have nonetheless been linked to reduced harm perceptions18–26 and youth appeal.27 28 While analysing media surveillance for an …

Background and study aims Despite its widespread adoption, colonoscope still has its limitations. Advancement is often limited by the looping of colon. The isolation of SARS-CoV-2 in stool raises concern for the risk of disease transmission. A single-use robotic colonoscope, the NISInspire-C System, that features a balloon-suction anchorage mechanism was developed to address these. Methods The NISInspire-C balloons are designed to provide anchorage for straightening of the colon during advancement. Angulation at the bending section is tendon-wire driven by servo mechanisms integrated into a robotic control console. This was a pilot, prospective trial to evaluate the safety and feasibility of this system. Healthy volunteers underwent examination with the NISInspire-C, followed by the conventional colonoscope. The procedure time, cecal intubation rates (CIR), complications, and level of pain were measured. Results A total of 19 subjects underwent the examination. The cecal intubation rate was 89.5 % (17/19) and the overall time-to-cecum was 26.3 minutes (SD: 17.9 mins). There were no procedure-related complications. Polyps were detected in seven of 19 (36.8 %) subjects during the NISInspire-C procedure. Three more subjects were found to have adenomatous polyps with the conventional colonoscope. There was minimal variation in level of pain during the procedures with the two colonoscopes. Conclusion The single-use robotic colonoscope NISInspire-C is a safe and feasible alternative to the conventional colonoscope. Further technical refinement is needed to improve the CIR. This study was limited by its small sample size.

Introduction and Objective: Single-use flexible ureteroscopes have the benefit of decreasing infection transmission, avoiding sterilization need, and no maintenance cost. Primary objective was to c...

Background Endolaser probes have been designed and sold for single-use only. However, in Brazil, they are not included in the list of single-use medical products that are prohibited from being reprocessed and could potentially be reused if safety requirements are accomplished. Therefore, this study aimed to determine and compare the quality, safety and costs of reprocessed versus original single-use endolaser probes of a specific brand and model. Methods The study, conducted at a university hospital in Sao Paulo, Brazil, was divided in two phases. The first one tested the feasibility, sterility and physical integrity of ten reprocessed laser probes. In the second phase, all vitrectomy procedures using endolaser probes (reprocessed and original ones) from August 2017 to October 2019 were evaluated. The operated cases were followed for any signs of infection and number of defective probes for each group were counted. The cost of acquiring a new probe and for all reprocessing stages were evaluated and quantified in US dollars($). Results Microbiologic, residual ethilen oxide and microscopic evaluation of integrity of reprocessed laser probes were all within acceptable range. The second phase of this study included 590 endolaser probes, of which 375 were original and 215 were reprocessed. Functionality rates differed significantly between groups. Among the original probes, 373 (99.47%) were functioning and 2 (0.53%) were non-functioning. Among the reprocessed ones, 201 (93.5%) were functioning and 14 (6.5%) were non-functioning (p Conclusions Our study showed that a single cycle endolaser probe reprocessing was safe and efficient, not associated with increase in endophthalmitis rate and proved to be significantly cost-effective, even considering a greater malfunction rate when compared to the original devices.

Single-use plastic waste have become ubiquitous in the natural environment globally. In Ghana, the drinking water sector has become heavily dependent on packaged water in the form of sachet and bottled water. This has resulted in increased generation of single-use plastic waste littered in the natural environment. Waste sachets, though still major a challenge, have received some attention over the years in terms of identifying solutions for sustainable management. On the other hand, limited studies have focused on waste plastic bottles in terms of their generation, disposal and options for sustainable management. This study sought to explore the socio-demographic and attitudinal drivers of bottled water consumption in Ayawaso West Municipal Area located in the Greater Accra Region of Ghana. The results showed that increasing income levels, perceptions of hygiene and safety as well as convenience were the main factors driving the patronage of bottled water. Bottled water consumption is expected to continue to rise in coming years in response to rising income levels. Residents showed willingness to engage in waste segregation of their plastics however limited waste collection systems are available to support this. It is important to prioritize the waste plastic bottles in the waste management agenda and offer households waste collection options that will make segregation of waste worthwhile and sustainable.

As local governments wade into policy arenas that extend beyond their traditional set of responsibilities – including those associated with sustainability and climate change – they are often compel...

Aim: Surgical site infection (SSI) is a common complication following emergency laparotomy, occurring in around 25% of patients in UK practice. The adoption of single-use negative-pressure dressings (SUNPDs) has been proposed as a prophylactic method of reducing the rate of SSI. The primary aim of the randomized controlled trial (RCT) described herein is to determine if a SUNPD reduces SSI at 30 days after an emergency laparotomy. Method: The Single Use Negative pRessure dressing for Reduction In Surgical site infection following Emergency laparotomy (SUNRRISE) study is an international, multicentre, pragmatic, phase III RCT with internal feasibility phase. As stated, the primary aim is to determine if a SUNPD reduces SSI at 30 days postoperatively. Patients will be randomized in a 1:1 ratio to receive either a SUNPD or a dressing of the surgeon's preference. Outcome assessors will be blinded to treatment allocation. The primary outcome measure is SSI within 30 days of surgery as defined by the US Centers for Disease Control criteria. A total of 840 patients will be required to detect a relative reduction of 40% in SSI rates (from 25% to 15%) with 90% power accounting for a 20% attrition rate. Discussion: SUNRRISE is an international, multicentre RCT evaluating the prophylactic use of SUNPD in primary closed emergency laparotomy wounds for the reduction of SSI. Our hypothesis is that a SUNPD is superior to the surgeon's preference of dressing in reducing SSIs at 30 days. The findings may influence dressing choice following emergency abdominal surgery in the future.

Marine plastic litter, mostly comprising single-use plastics, has been recognised as one of the world’s most urgent environmental concerns, and Vietnam has been ranked as one of the top five countries polluting the ocean with plastic waste. This paper examines Hanoi as a case study on single-use plastic by households, investigating the daily generation of single-use plastic waste through a survey, assessing existing policy gaps through a policy review, and providing recommendations on improving management along the supply chain in Vietnam. At almost 27 times a week on average, plastic shopping bags were found to be the most prevalent single-use plastic used by households, followed by wrap/film, straws, coffee cups with plastic lids, cutlery, takeout containers, food packaging, party cups, bottles for water and beverages, and other items. Plastic shopping bags and food packaging are used more often in rural areas than in urban areas. These bags also have a high rate (68.65%) of temporary reuse as kitchen bin liners, a habit that may be difficult to change over the short term. Apart from some components of plastic bottles and packaging that are sold for recycling, most single-use plastic waste is disposed in landfills. Policies are in place to address plastic issues, such as a tax on plastic bags and source separation, but implementation is inconsistent. A behaviour-based combination of top-town and bottom-up approaches along the entire supply chain is recommended to improve existing policy gaps in Vietnam.

Objective:We quantitatively assessed the fit failure rate of N95 respirators according to the number of donning/doffing and hours worn.Design:Experimental study.Setting:A tertiary-care referral center in South Korea.Participants:In total, 10 infection control practitioners participated in the fit test.Methods:The first experiment comprised 4 consecutive 1-hour donnings and fit tests between each donning. The second experiment comprised 2 consecutive 3-hour donnings and fit tests between each donning. The final experiment comprised fit tests after an 1-hour donning or a 2-hour donning.Results:For 1-hour donnings, 60%, 70%, and 90% of the participants had fit failures after 2, 3, and 4 consecutive donnings, respectively. For 3-hour donnings, 50% had fit failure after the first donning and 70% had failures after 2 consecutive donnings. All participants passed the fit test after refitting whenever fit failure occurred. The final experiment showed that 50% had fit failure after a single use of 1 hour, and 30% had fit failure after a single use of 2 hours.Conclusions:High fit-failure rates were recorded after repeated donning and extended use of N95 respirators. Caution is needed for reuse (≥1 time) and extended use (≥1 hour) of N95 respirators in high-risk settings such as those involving aerosol-generating procedures. Although adequate refitting may recover the fit factor, the use of clean gloves and strict hand hygiene afterward should be ensured when touching the outer surfaces of N95 respirators for refitting.

The SARS-CoV-2 pandemic has demonstrated both positive and negative effects on the environment. Major concerns over personal hygiene, mandated and ease in lockdown actions and slackening of some policy measures have led to a massive surge in the use of disposable personal protective equipment (PPE) and other single-use plastic items. This generated an enormous amount of plastic waste from both healthcare and household units, and will continue to do so for the foreseeable future. Apart from the healthcare workers, the general public have become accustomed to using PPE. These habits are threatening the land and marine environment with immense loads of plastic waste, due to improper disposal practices across the world, especially in developing nations. Contaminated PPE has already made its way to the oceans which will inevitably produce plastic particles alongside other pathogen-driven diseases. This study provided an estimation-based approach in quantifying the amount of contaminated plastic waste that can be expected daily from the massive usage of PPE (e.g. facemasks) because of the countrywide mandated regulations on PPE usage. The situation of Bangladesh has been analysed and projections revealed that a total of 3.4 billion pieces of single-use facemask, hand sanitizer bottles, hand gloves and disposable polyethylene bags will be produced monthly, which will give rise to 472.30 t of disposable plastic waste per day. The equations provided for the quantification of waste from used single-use plastic and PPE can be used for other countries for rough estimations. Then, the discussed recommendations will help concerned authorities and policy makers to design effective response plans. Sustainable plastic waste management for the current and post-pandemic period can be imagined and acted upon.

Single use plastics pose environmental and socioeconomic problems in our life and ecosystems. After a 14 year attempt, Kenya successfully adopted a plastic bag ban for secondary packaging in August 2017. Globally, the impact of plastic bag policies are limited or not documented. Using a questionnaire survey, this study explored consumer consciousness towards the ban, reusable bag usage behavior, and estimated plastic bag consumption before the ban. Results indicate that the ban has favorable support of about 67% from consumers. The perceptions towards cleanliness and waste management were different between urban and rural respondents. This highlighted differences in awareness creation and enforcement of the ban. Behaviorally, ownership of reusable bags tripled to 12 bags per household. Plastic reusable bags were the most owned and most discarded bags within 6 months. Moreover, a report estimates that 300 million bags (8.3–6.7 bags person−1 y−1) were consumed annually in 2005 and 2017 before the ban, the current study estimates the ban potential eliminates about 6.2 billion bags (138 bags capita−1 y−1) from the waste stream. It is thus important to incorporate usage frequency, reusable bags standards, waste and health factors in policy formulation. Proper usage of reusable bags prevents waste and lowers their environmental burden.

Background To describe the incidence, clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices. The recommended sterilization process as well as safety measures are discussed. Methods Medical charts of patients who developed endophthalmitis after PPV were retrospectively reviewed and reported in a descriptive manner. Cases undergoing PPV for preexisting endophthalmitis or open globe injury were excluded. Data collection included patient demographics, operative details, ocular findings, microbiological profiles, treatment modalities, and visual outcomes. Results Over the past thirteen years, a total of 12,989 pars plana vitrectomy operations were included. In total, 13 eyes of 13 cases (0.10%) experienced endophthalmitis after vitrectomy. These occurred in 3 cases (0.11%) using 20-gauge vitrectomy compared to 8 cases (0.09%) using 23-gauge vitrectomy and 2 cases (0.18%) using 25-gauge vitrectomy. There were no statistically significant differences between the 20-gauge and microincisional vitrectomy surgery (MIVS) group (P = 0.64), and the 23- and 25-gauge approach (P = 0.34). Causative pathogens were positive by culture in 5 cases (45%): 3 g-positive cases, 1 g-negative case, and 1 fungus case. Conclusions The rate of endophthalmitis in patients who underwent 23-gauge PPV was comparable to those who underwent 25-gauge PPV. With our standardized protocol for instrument sterilization, endophthalmitis rates in those undergoing PPV using recycled single-use instruments were within the range of previously published results in which vitrectomy tools were disposed of after one use.

Purpose Prevalence of past 30-day tobacco and marijuana use are highest among young adults in the U.S., and comorbid use of these products is common. However, it is unclear whether the use of one product precedes the other—an important consideration, given the new climate surrounding marijuana legalization and the popularity of e-cigarette products. Methods Six-panel cross-lagged regression models, with 6 months between each panel/wave, were used to model bidirectional paths between past 30-day use and comorbid use of marijuana and tobacco products from 2014 to 2017 among young adults (N = 5,221 college students, aged 18–25 years). Results Combustible tobacco use and e-cigarette use were prospectively associated with greater risk of future marijuana use while controlling for the stability of use over time, age, race/ethnicity, and sex. Marijuana use was prospectively associated with greater risk of future combustible tobacco and e-cigarette use. Comorbid use was common, but while the odds of comorbid use decreased with increasing age, odds of tobacco use increased. Conclusions More young adults may be consolidating their use than are successfully ceasing their tobacco or marijuana use as they mature through young adulthood. Although we observed decreases in comorbid use of combustible tobacco with marijuana and e-cigarettes with marijuana, we simultaneously observed strong stability in single use of these products over time. Taken together, these results should help structure interventions specific to young adults that target use and comorbid use in early young adulthood to discourage initiation, encourage cessation, and curb subsequent escalation in later young adulthood.