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Aims The aim of this study was to determine whether the sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in patients undergoing spinal surgery. Patients and Methods A single-centre, interventional, two arm, parallel group randomised controlled trial was undertaken, involving 407 patients who underwent elective spinal surgery. For 203 patients, the skin was disinfected before surgery using PVI (10% [w/w (1% w/w available iodine)] in 95% industrial denatured alcohol, povidone iodine; Videne Alcoholic Tincture) twice, and for 204 patients using PVI once followed by CHG (2% [w/v] chlorhexidine gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint). The primary outcome measure was contamination of the wound determined by aerobic and anaerobic bacterial growth from samples taken after disinfection. Results The detection of viable bacteria in any one of the samples taken after disinfection (culture-positive) was significantly lower in the group treated with both PVI and CHG than in the group treated with PVI alone (59 (29.1%) versus 85 (41.7%), p = 0.009; odds ratio 0.574; 95% confidence interval, 0.380 to 0.866). Conclusions Antisepsis of the skin with the sequential application of PVI and CHG more effectively reduces the contamination of a surgical wound than PVI alone. Cite this article: Bone Joint J 2017;99-B:1354–65.

Although the United Nations’ Sustainable Development Goals (SDGs) advocate, through SDG 4 and SDG 10, equitable quality education and the reduction of inequalities within and between countries, respectively, few studies have examined how inequalities in regional sustainability influence higher education. Therefore, this study aims to examine the relationship between regional sustainability and higher education in China using fixed-effects panel modelling. A systematic force framework showing how regional sustainability drives higher education was constructed from economic, social, and environmental perspectives, and the endogeneity in the process of how regional sustainability affects higher education was explored by introducing one-year lagged values as instrumental variables. Our results show that regional sustainability has a significant impact on higher educational attainment in China, with differing effects in the eastern, central, and western regions, respectively. In central China, economic sustainability plays a significant positive role in higher educational attainment; in the western region, economic and social sustainability have stronger positive effects, while environmental sustainability has significantly negative effects. In terms of policy implications, our findings can be used to support regional development policies to promote regional higher education.

Nearly three billion people in low- and middle-income countries (LMICs) rely on polluting fuels, resulting in millions of avoidable deaths annually. Polluting fuels also emit short-lived climate forcers and greenhouse gases (GHGs). Liquefied petroleum gas (LPG) and grid-based electricity are scalable alternatives to polluting fuels but have raised climate and health concerns. Here, we compare emissions and climate impacts of a business-as-usual household cooking fuel trajectory to four large-scale transitions to gas and/or grid electricity in 77 LMICs. We account for upstream and end-use emissions from gas and electric cooking, assuming electrical grids evolve according to the 2022 World Energy Outlook’s “Stated Policies” Scenario. We input the emissions into a reduced-complexity climate model to estimate radiative forcing and temperature changes associated with each scenario. We find full transitions to LPG and/or electricity decrease emissions from both well-mixed GHG and short-lived climate forcers, resulting in a roughly 5 millikelvin global temperature reduction by 2040. Transitions to LPG and/or electricity also reduce annual emissions of PM2.5 by over 6 Mt (99%) by 2040, which would substantially lower health risks from Household Air Pollution. Primary input data was collected from the following sources: Baseline household fuel choices - WHO household energy database (https://www.nature.com/articles/s41467-021-26036-x) End-use emissions - US EPA lifecycle assessment of household fuels (https://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=339679&Lab=NRMRL&simplesearch=0&showcriteria=2&sortby=pubDate&timstype=Published+Report&datebeginpublishedpresented) Upstream emissions - Argonne National Labs GREET Model (https://greet.es.anl.gov/index.php) Current and future population estimates - UNECA (http://data.un.org/Explorer.aspx?d=EDATA) Input data was processed by defining household fuel choice scenarios, estimating national household fuel consumption based on these scenarios, and applying fuel-specific emission factors to create country-specific emission pathways. These emission pathways were input into the FaIR model (https://zenodo.org/record/5513022#.Yt_jfHbMLb0) which generated additional data for each scenario including time series of pollution concentrations, radiative forcing, and temperature changes. All data is provided in CSV format. Nothing proprietary is required. 

Variation in food resources can result in dramatic fluctuations in the body condition of animals dependent on those resources. Decreases in body mass can disrupt patterns of energy allocation and impose stress, thereby altering immune function. In this study we investigated links between changes in body mass of captive cane toads (Rhinella marina), their circulating white blood cell populations, and their performance in immune assays. Captive toads that lost weight over a 3-month period had increased levels of monocytes and heterophils and reduced levels of eosinophils. Basophil and lymphocyte levels were unrelated to changes in mass. Because individuals that lost mass had higher heterophil levels but stable lymphocyte levels, the ratio of these cell types was also higher, partially consistent with a stress response. Phagocytic ability of whole blood was higher in toads that lost mass, due to increased circulating levels of phagocytic cells. Other measures of immune performance were unrelated to mass change. These results highlight the challenges faced by invasive species as they expand their range into novel environments which may impose substantial seasonal changes in food availability that were not present in the native range. Individuals facing energy restrictions may shift their immune function towards more economical and general avenues of combating pathogens.

Twenty-minute neighbourhoods highlight the importance of well-connected and mixed-used neighbourhoods and communities with proximate access to employment, essential services, public transport, and open spaces. Shorter distances together with re-prioritised public spaces encourage more active transport choices, resulting in public health benefits and reduced environmental pollution. Higher liveability brought about by mixed-use developments enables people to have equitable access to local facilities, amenities, and employment opportunities, promoting vibrancy, social cohesion, and intergenerational connections. The attributes of 20-minute neighbourhoods also combine to create places, that are acknowledged as friendly for all ages, address changing needs across the life course, and provide better support for the ageing population. Furthermore, there are indications that 20-minute neighbourhoods may be more resilient against many of the negative impacts of stringent public health protocols such as those implemented in periods of lockdown during the Covid-19 pandemic. In this article, we evaluate and compare planning policies and practices aimed at establishing 20-minute neighbourhoods in Melbourne (Australia) and Scotland (the UK). Using case studies, we discuss similarities and differences involved in using place-based approaches of 20-minute neighbourhoods to address 21st-century challenges in key areas of health and wellbeing, equity, environmental sustainability, and community resilience.

Abstract As the part of a study to develop buparvaquone (BPQ) formulations for the treatment of cutaneous leishmaniasis, the topical delivery of BPQ and one of its prodrugs from a range of formulations was evaluated. In previous studies, BPQ and its prodrugs were shown to be potent antileishmanials in-vitro, with ED50 values in the nanomolar range. 3-Phosphono-oxymethyl-buparvaquone (3-POM-BPQ) was the most potent antileishmanial and was chosen, together with the parent drug, for further investigation. The ability of the parent and prodrug formulations to cross human and murine skin was tested in-vitro using the Franz diffusion cells. Formulations intended for topical application containing either BPQ or 3-POM-BPQ were developed using excipients that were either acceptable for topical use (GRAS or FDA inactive ingredients) or currently going through the regulatory process. BPQ was shown to penetrate both human epidermal membranes and full thickness BALB/c skin from a range of formulations (gels, emulsions). Similarly, 3-POM-BPQ penetrated full-thickness BALB/c skin from several gel formulations. In-vitro binding studies showed that BPQ bound melanin in a dose-dependent manner and preferably bound to delipidized skin over untreated BALB/c skin (on a weight to weight basis). The results confirm that BPQ and its prodrug 3-POM-BPQ can penetrate the skin from several formulations, making them potentially interesting candidates for further investigation of topical formulations using in-vivo models of cutaneous leishmaniasis.

There is growing recognition that children and young people have valuable contributions to make within their schools and communities. This special issue, which focuses specifically on the notion of ‘pupil voice’, brings together a collection of articles and reports presented and developed as part of the 2004–06 ESRC seminar series ‘Engaging critically with pupil voice’ (RES-451–26–0165). The seminar series brought together representatives reflecting a range of practices and research that can be identified as ‘pupil voice’, with the aim of identifying ‘pupil voice’ activities, delineating key advances, gaps and debates in theory, methodology and ethics. The series helped advance records and forums through which ‘pupil voice’ work is documented and can be further developed. This journal considers cross-disciplinary research and practice which explores the complexities of ‘voice’ in varying contexts and how ‘voice’ can be used in school improvement initiatives.

A key determinant and outcome of successful environmental education is ‘pro-environmental behavior’, i.e., behavior that involves conscious action to mitigate adverse environmental impacts at personal or community level, e.g., reducing resource consumption and waste generation, avoiding toxic substances, and organizing community awareness initiatives. However, some theorists have sought to move away from rationalist models of behavioral modification, towards holistic pedagogical initiatives that seek to develop action competence. In light of the global push towards achievement of the Sustainable Development Goals (SDGs), emerging evidence suggests that education initiatives should foster action competence so students may be equipped to contribute to sustainable development as part of their education. The UNESCO Education for Sustainable Development (ESD) Roadmap 2030 has also identified key priority areas to strengthen ESD in formal curricula. This article reports two informal environmental education initiatives for promoting action competence and pro-environmental behaviors in school-aged children. The authors recommend that formal education settings (e.g., schools) should incorporate self-directed, free-choice project-based learning to augment environmental education programs and promote students’ action competence for contribution to attainment of SDGs. To this end, we propose a Free-Choice Project-based Learning for Action Competence in Sustainable Development (ACiSD) Curriculum, comprising six implementation dimensions, namely: (1) project duration and teaming arrangements, (2) topic selection, (3) student support, (4) teacher support, (5) learning environments, and (6) digital access and equity. For each implementation dimension, we recommend action steps to help educators implement this curriculum in their own educational settings, with the aid of an illustrative worked example.