BACKGROUND: Both human health and the health systems we depend on are increasingly threatened by a range of environmental crises, including climate change. Paradoxically, health care provision is a significant driver of environmental pollution, with surgical and anesthetic services among the most resource-intensive components of the health system. OBJECTIVES: This analysis aimed to summarize the state of life cycle assessment (LCA) practice as applied to surgical and anesthetic care via review of extant literature assessing environmental impacts of related services, procedures, equipment, and pharmaceuticals. METHODS: A state-of-the-science review was undertaken following a registered protocol and a standardized, LCA-specific reporting framework. Three bibliographic databases (Scopus ® , PubMed, and Embase ® ) and the gray literature were searched. Inclusion criteria were applied, eligible entries critically appraised, and key methodological data and results extracted. RESULTS: From 1,316 identified records, 44 studies were eligible for inclusion. The annual climate impact of operating surgical suites ranged between 3,200,000 and 5,200,000 kg CO 2 e. The climate impact of individual surgical procedures varied considerably, with estimates ranging from 6 to 1,007 kg CO 2 e. Anesthetic gases; single-use equipment; and heating, ventilation, and air conditioning system operation were the main emissions hot spots identified among operating room-and procedure-specific analyses. Single-use equipment used in surgical settings was generally more harmful than equivalent reusable items across a range of environmental parameters. Life cycle inventories have been assembled and associated climate impacts calculated for three anesthetic gases (2-85 kg CO 2 e=MAC-h) and 20 injectable anesthetic drugs (0:01-3:0 kg CO 2 e=gAPI). DISCUSSION: Despite the recent proliferation of surgical and anesthesiology-related LCAs, extant studies address a miniscule fraction of the numerous services, procedures, and products available today. Methodological heterogeneity, external validity, and a lack of background life cycle inventory data related to many essential surgical and anesthetic inputs are key limitations of the current evidence base. This review provides an indication of the spectrum of environmental impacts associated with surgical and anesthetic care at various scales.

All PSP patients showed increased retention of the tracer in the basal ganglia, as expected. Binding was also present in asymptomatic SNCA duplication carriers and in an MSA case, which are not typically associated with pathological tau deposition. This suggests the possibility that [ C]PBB3 binds to alpha-synuclein. © 2017 International Parkinson and Movement Disorder Society.

The Indigenous population of Canada faces an increased burden of chronic disease, leading to decreased life expectancy. Physical activity is an important health behaviour that improves chronic disease risk factors and physical fitness. The objective of this systematic review was to evaluate physical activity interventions in the Indigenous population in Canada to determine effects on physical activity rates, physical fitness, and health outcomes. MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for peer-reviewed journal articles. Inclusion criteria were studies that examined a physical activity intervention delivered in Indigenous communities in Canada for adults over 18 years of age. Data was extracted and two authors independently rated quality of the evidence. Five studies were included in the narrative synthesis. Interventions were community-based, and three were multi-component interventions focused on preventing or managing type II diabetes. The interventions varied in their success in altering physical activity rates, with increases (n = 2), a decrease (n = 1), or non-significant changes reported (n = 2). No study reported any measure of physical fitness. BMI was reported in four studies, with only one reporting a significant decrease. Decreases in systolic blood pressure and total cholesterol were reported in two studies. There is limited evidence and a lack of robust interventions that examine the impacts of physical activity on health and fitness status in the Canadian Indigenous population. Validated, culturally relevant tools for measuring physical activity may aid in program evaluation and focused educational materials could better support population health initiatives.Trial registrationThe review protocol was registered prospectively with PROSPERO (registration number: CRD42017055363).

BackgroundChildren and youth are at increased risk of sustaining sport-related concussions. There is a need to develop age-specific tools to evaluate the effects of concussion. The objective of this study was to determine normative values for the Child Sport Concussion Assessment Tool (Child SCAT3) in child athletes and evaluate the symptom scoring agreement between the child and parent.MethodsChild SCAT3 was administered to ice hockey players enrolled in a regional minor hockey association. Statistical analyses were performed to evaluate the differences between child and parent reporting as well as those based on age.Results227 athletes (7–12 years of age) completed the Child SCAT3. 29 players reported a history of concussion. For the objective components, the average total Standard Assessment of Concussion adapted to a child version (SAC-C) score of 24.4 was made up by orientation (3.7), immediate memory (12.9), concentration (3.8) and delayed recall (3.9) sections. Average errors in the modified Balance Error Scoring System (BESS) were 1.6, tandem gait time 14.9 s and coordination score 0.95. For the subjective component, children reported an average of eight symptoms and a severity of 11; parents reported seven symptoms with a severity of 9. Overall, children reported higher symptom severity in comparison with their parents. In addition, parents significantly underestimated both physical and sleep-related symptoms in comparison with the children's scores.ConclusionsResults provide representative scores for the Child SCAT3 in young male ice hockey players. Clinicians should be aware that parents tend to underestimate their child's symptoms and symptom severity, particularly in the domains of physical symptoms and sleep. Encouraging objective symptom documentation with sleep or pain diaries, for example, may be useful for reliable clinical assessment in this age group.