Mysterious plastic bronchitis: a little-known disease in medical practice

The article presents a clinical case of a 51-year-old patient first seeking medical care with complaints of paroxysmal cough bringing up bronchial casts. The diagnosis of plastic bronchitis was verified. The disease which has not been well described in the literature, difficulty of verifying the underlying diagnosis due to polysymptomatic clinical presentation characterized by the mortality rate of 50–80%, COVID-19 coinfection, resistance to therapy, and little concern of medical specialists determine the relevance and value of this clinical case. © 2023 Authors. All rights reserved.

Mysterious plastic bronchitis: a little-known disease in medical practice

The article presents a clinical case of a 51-year-old patient first seeking medical care with complaints of paroxysmal cough bringing up bronchial casts. The diagnosis of plastic bronchitis was verified. The disease which has not been well described in the literature, difficulty of verifying the underlying diagnosis due to polysymptomatic clinical presentation characterized by the mortality rate of 50-80%, COVID-19 coinfection, resistance to therapy, and little concern of medical specialists determine the relevance and value of this clinical case.

International Residents' Perspectives on Education and Challenges in Microsurgery Training

Objective Microsurgery remains an integral component of the surgical skillset and is essential for a diversity of reconstructive procedures. The apprenticeship also requires overcoming a steep learning curve, among many challenges. The method of microsurgical training differs depending on the countries' regions and resources of their health care system. Methods The Journal of Hand and Microsurgery leadership held an international webinar on June 19, 2021, consisting of a panel of residents from 10 countries and moderated by eminent panelists. This inaugural event aimed to share different experiences of microsurgery training on a global scale, identifying challenges to accessing and delivering training. Results Residents shared various structures and modes of microsurgical education worldwide. Areas of discussion also included microsurgical laboratory training, simulation training, knowledge sharing, burnout among trainees, and challenges for female residents in microsurgical training. Conclusion Microsurgical proficiency is attained through deliberate and continued practice, and there is a strong emphasis globally on training and guidance. However, much remains to be done to improve microsurgical training and start acting on the various challenges raised by residents.Copyright © 2022. Society of Indian Hand & Microsurgeons. All rights reserved.

Design for an Intelligent Waste Classifying System: A Case Study of Plastic Bottles

The use of plastic bottles has become a significant environmental concern, and recycling them has become a priority. Small and medium-sized recycling companies must collect and categorize large volumes of plastic bottles and sell them to larger recycling firms, a process that is time-consuming, costly, and labor-intensive. This manual sorting process can pose health risks, particularly during the COVID-19 pandemic, and can affect worker productivity. To address these issues, this study proposes the development of an automated conveyor belt system that can rapidly and accurately separate plastic bottles by type. The system utilizes an opaque and transparent plastic bottle separation platform, which saves time, cost, and manpower. This system design provides recycling SMEs with a competitive advantage by serving as a practical application model and a prototype with an easy-to-use concept. Key tools employed in this research include product design development (PDD), Kansei engineering, manufacturing process design, controlling system, and fault tree analysis (FTA). The light sensors are critical components in the separation process, detecting the opacity or transparency of the bottles' surfaces. The proposed prototype's reliability will be assessed by FTA, which considers all potential failures. This study contributes to the body of knowledge surrounding the integration of conveyor systems and provides valuable information for businesses seeking to optimize their sorting processes. The guidelines developed in this study can serve as a starting point for further research on the integration of conveyors in waste sorting plants. © 2013 IEEE.

CATALYTIC PYROLYSIS OF DISCARDED COVID-19 MASKS OVER SEPIOLITE

This research aims to develop a new strategy to valorize wasted COVID-19 masks based on pyrolysis to convert them into useful products. First, surgical and FFP2 masks were thermally pyrolyzed at temperatures of 450–550 ºC with the purpose of determining gas, liquid (oil) and solid (char) yields. At low temperatures, solid yield was high, while at high temperatures the gas product was enhanced. The highest yield of liquid was found at an operating temperature of 500 ºC in both surgical and FPP2 masks pyrolysis. The liquid product yields were 59.08% and 58.86%, respectively. Then, the volatiles generated during thermal pyrolysis of residual masks were cracked over sepiolite as catalyst at a temperature of 500 ºC. The catalytic pyrolysis increased the yield of gas product (43.89% against 39.52% for surgical masks and 50.53% against 39.41% for FFP2 masks) and decreased the viscosity of the liquid product. Finally, the effect of sepiolite regeneration and reuse in consecutive pyrolysis tests was examined. Results showed that, with the higher regeneration-reuse of sepiolite, the catalyst was degraded obtaining a liquid product with higher molecular mass. This effect was hardly noticeable in the case of FFP2 masks. © 2022 International Multidisciplinary Scientific Geoconference. All rights reserved.

Exploring Plastic-Management Policy in China: Status, Challenges and Policy Insights

Plastic pollution is recognized as one of the most urgent global environmental concerns. China is the top producer and consumer of plastics and creates the most plastic waste globally. To evaluate policy options to control plastic pollution in China, we first reviewed the relevant policies and action plans in place. Then, we examined plastic-material flows and changes at the national level based on officially published data to evaluate the current situation and efficacy of policies at the macro-level. Results showed that 2016, the start of the 13th Five-Year Plan, was a pivotal year in the history of China's plastic policies tackling plastic issues nationally and internationally. Since 2016, the growth trend in the production and consumption of plastic products has slowed and the recycling rate has risen, surpassing 30% in 2021. To further tackle plastic pollution, key suggestions with important policy implications were provided, covering better integration of policies, the combined management of vertical–horizontal governance, tracking-system implementation, the introduction of a quality-certification system, the development of behaviour-based consumer-oriented solutions, the promotion of stakeholder collaboration, and the need for appropriate post-COVID-19 policies.

Impact of the Covid-19 Pandemic on Pediatric Surgery at a Central Referral Hospital in Malawi

Introduction: The COVID-19 pandemic has disrupted health care systems worldwide, but the specific impact on pediatric surgery in low-and-middle-income countries has received little attention. This study evaluated the changes in pediatric surgical case volume at a central referral hospital in Malawi from 2019 through 2021 to quantify the impact of COVID-19. Method(s): We retrospectively reviewed all pediatric surgical cases performed at our institution from May-August 2019, 2020, and 2021. These months were chosen because they coincided with the first major wave of COVID cases in Malawi in 2020. We compared the number of cases performed per week between years and analyzed case numbers by specialty (general, orthopedic, plastic, neurosurgery, ENT, and urology). Result(s): A total of 1032 procedures were performed. There was a 32% reduction in case volume between 2019 to 2020 (344 to 235 cases, 19.5 vs 13.8 per week, p=0.04), with a subsequent 93% increase from 2020 to 2021 (235 to 435 cases, 13.8 vs 26.4 per week, p<0.001). The most significantly impacted specialties were ENT and plastics, both with 78% fewer procedures in 2020 compared with 2019, and a subsequent 4-fold and 22-fold increase in cases from 2020 to 2021, respectively (Chi-Square;p=0.007 and p<0.001). Orthopedic and Neurosurgical case numbers were impacted the least, with reductions ranging from 22% to 35%. Conclusion(s): The COVID-19 pandemic significantly reduced the number of pediatric surgical cases performed at the central referral hospital in Malawi across all specialties, thereby further limiting essential surgical services to an already marginalized patient population.

Gaps between Attitudes and Behavior in the Use of Disposable Plastic Tableware (DPT) and Factors Influencing Sustainable DPT Consumption: A Study of Hong Kong Undergraduates

Total waste from human activities, including waste plastics, is huge in Hong Kong. In particular, as a result of the prevention and control measures implemented during the COVID-19 pandemic, take-away meals increased tremendously in Hong Kong, generating disposable plastic tableware (DPT). Although Hong Kong has a charging scheme for plastic bags, it does not have a scheme for plastic tableware. Therefore, this study aimed to understand the attitudes and behavior of people in Hong Kong toward DPT. Our study focused on undergraduate students in Hong Kong, given that they will play a significant role in the future of environmental sustainability. The attitudes and behavior of Hong Kong undergraduate students toward DPT were examined through an online survey with 385 respondents. A multiple stepwise regression was conducted to investigate whether cognitive attitude formation factors could explain the sustainable attitudes formed by undergraduate students in Hong Kong. The survey results revealed that most undergraduates considered DPT to be one of the major causes of environmental damage in Hong Kong;however, many of them, particularly those who strongly agreed with this statement, said that the problem of DPT did not affect their quality of life. The regression analysis showed that imposing a DPT charge would be the most significant driver to reduce its use. The research findings identified gaps between attitudes and behavior regarding the use of DPT and the factors influencing sustainable DPT consumption.

Hand Surgery in New Zealand.

Hand surgery in New Zealand has steadily grown from its origins in plastic surgery and orthopaedic surgery into its own discipline. There has been much progress and innovation in hand surgery that has originated from New Zealand and this review acknowledges the historical figures and events that have led to our present position. The current and future directions of hand surgery in our country are also discussed. As a small and remote country, we are very fortunate to have close relationships with other international hand societies. Through these relationships and the efforts of committed regional hand surgeons, the art and science of hand surgery in New Zealand continues to progress.

Microplastics from face masks: A potential hazard post Covid-19 pandemic.

The tremendous use of plastic products to averse the infection rate during Covid-19 pandemic has developed great pressure on the management and disposal systems of plastic waste. The compulsory use of face masks to curb the infection and prevent transmission of the virus has led to addition of millions of face masks into the terrestrial and marine environment. The current study attempts to assess and quantify the rate of infection in coherence with the annual usage of face masks in various nations across the globe. The ecological footprint of the plastic waste generated from used and discarded face masks along with their potential impacts have also been discussed. The current study has quantified the total annual face masks across thirty-six nations to be more than 1.5 million ton. The total estimated figure for annual plastic waste and microplastics in all these nations was ∼4.2 million tonnes and 9774 thousand tonnes, which emerges as a great threat to the global efforts towards reduction of plastic usage. The emergence of Covid-19 pandemic has modified the living habits with new enterprises being set up for Covid essential products, but the associated hazard of these products has been significantly ignored. Hence this study attempts to present a quantitative baseline database towards interpretation and understanding of the hazards associated with microplastics and increased dependence on plastic products.

The Impact of COVID-19 on Plastic Surgery Residents Across the World: A Country-, Region-, and Income-level Analysis.

BACKGROUND: The COVID-19 pandemic has upended graduate medical education globally. We investigated the COVID-19 impact on learning inputs and expected learning outputs of plastic surgery residents across the world. METHODS: We administered an online survey capturing training inputs before and during the pandemic and retrieved residents' expected learning outputs compared with residents who completed their training before COVID. The questionnaire reached residents across the world through the mobilization of national and international societies of plastic surgeons. RESULTS: The analysis included 412 plastic surgery residents from 47 countries. The results revealed a 44% decline (ranging from - 79 to 10% across countries) and an 18% decline (ranging from - 76 to across 151% countries) in surgeries and seminars, respectively, per week. Moreover, 74% (ranging from 0 to 100% across countries) and 43% (ranging from 0 to 100% across countries) of residents expected a negative COVID-19 impact on their surgical skill and scientific knowledge, respectively. We found strong correlations only between corresponding input and output: surgeries scrubbed in with surgical skill (ρ = -0.511 with p < 0.001) and seminars attended with scientific knowledge (ρ = - 0.274 with p = 0.006). CONCLUSIONS: Our ranking of countries based on their COVID-19 impacts provides benchmarks for national strategies of learning recovery. Remedial measures that target surgical skill may be more needed than those targeting scientific knowledge. Our finding of limited substitutability of inputs in training suggests that it may be challenging to make up for lost operating room time with more seminars. Our results support the need for flexible training models and competency-based advancement. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Lack of behavioral effect of surgical mask leachate on the Asian shore crab Hemigrapsus sanguineus: Implications for invasion success in polluted coastal waters.

The COVID-19 pandemic generated a new source of plastic mass pollution, i.e. surgical masks, that preferentially accumulate in intertidal environments. Made of polymers, surgical masks are likely to leach additives and impact local intertidal fauna. As typical endpoints of complex developmental and physiological functions, behavioral properties are non-invasive key variables that are particularly studied in ecotoxicological and pharmacological studies, but have, first and foremost, adaptive ecological significance. In an era of ever-growing plastic pollution, this study focused on anxiety behaviors, i.e. startle response, scototaxis (i.e. preference for dark or light areas), thigmotaxis (i.e. preference for moving toward or away from physical barriers), vigilance and level of activity, of the invasive shore crab Hemigrapsus sanguineus in response to leachate from surgical masks. We first showed that in the absence of mask leachates H. sanguineus is characterized by a short startle time, a positive scototaxis, a strong positive thigmotaxis, and an acute vigilance behavior. Specifically, a significantly higher level of activity was observed in white areas, in contrast to the lack of significant differences observed in black areas. Noticeably, the anxiety behaviors of H. sanguineus did not significantly differ after a 6-h exposure to leachate solutions of masks incubated in seawater for 6, 12, 24, 48 and 96 h. In addition, our results were consistently characterized by a high inter-individual variability. This specific feature is discussed as an adaptive behavioral trait, which - through the observed high behavioral flexibility - increases H. sanguineus resilience to contaminant exposures and ultimately contribute to its invasion success in anthropogenically-impacted environments.

Plastic surgery online, how accessible are our units?

BACKGROUND: The Covid-19 pandemic has highlighted the importance of remote patient and professional communication. This has been especially important for highly specialised and regionally-based specialties such as plastic surgery. The aim of this study was to review how UK plastic surgery units represent themselves online and their phone accessibility. PATIENTS AND METHODS: UK plastic surgery units were identified using the BAPRAS website and their websites and telephone accessibility assessed. RESULTS: Whilst a minority of units have clearly invested heavily in ensuring comprehensive webpages, nearly a third have no dedicated webpage at all. We found significant variation in quality and user-friendliness of online resources both for patients and for other healthcare professionals, with less than a quarter of units providing comprehensive contact details, emergency referral guidance, or information about changes to services due to Covid-19, to highlight a few areas. Communication with the BAPRAS website was also poor with less than half of web-links connecting to correct and relevant webpage and only 13.5% of phone numbers connecting directly to a useful plastic surgery number. In the phone component of our study we found that 47% of calls to 'direct' numbers went to voicemail but wait-times were significantly less than going through hospital switchboards and connections were more accurate. CONCLUSION: In a world where a business' credibility is so heavily based on their online appearance and, in an increasingly online era of medicine, we hope that this study may be a resource for units to improve their web-based resources and prompt further research in enhancing patient experience online.

Sustainable management of drinking plastic straws is required to reduce plastic pollution: Are we using them more during COVID-19?

Nowadays, single-use plastic pollution attracts the attention of scholars, policymakers, and practitioners. In addition to personal protective equipment (PPEs) waste during the COVID-19 pandemic, other unpreceded plastic wastes such as packaging from online shopping and food delivery, viruses confirmatory testing, and drinking straws also contributed to pollution and worsened around the globe. This perspective aimed to provide insights into drinking plastic straws as an important source of plastic pollution. Literature searches confirmed that drinking plastic straws, unlike PPEs, have not been researched whether it is an important contributor to pollution or not during the COVID-19 pandemic. Thus, research on the pollution level of this plastic waste and its association with COVID-19 is required. Drinking straw producers and users require adequate strategies and management of this plastic pollution and more widespread rules and regulations to prevent environmental implications and health risks. This study can usefully give highlights for environmentalists, solid waste management experts, policymakers, and governments by describing the environmental impact and raising health risks of drinking plastic straw pollution.

Valorization of hazardous plastic wastes into value-added resources by catalytic pyrolysis-gasification: A review of techno-economic analysis

Plastic waste pollution has grown exponentially since the 1950s. This situation was exacerbated when the volume of personal protective equipment (PPE)-based plastic waste surged after the COVID-19 pandemic. Plastic waste management such as landfills and incineration have adverse effects on the environment and human health due to the leaching of hazardous chemicals and the emission of toxic gases. Modern solutions such as biodegradable plastics and green brick technology are expensive and not well developed to valorize the current accumulation of plastic waste. This has led to the emergence of thermal degradation processes, which is faster and more realistic to solve the PPE-based plastic waste buildup. Pyrolysis and gasification systems to valorize plastic waste into hydrocarbons and fuels are discussed and compared with examples respectively. Scoping review approach is employed to conduct this study. To further increase the value of the final product of plastic waste management, the integrated pyrolysis system to upcycle plastic waste to carbon nanomaterials (CNMs) and the factors affecting the production of non-condensable gases are critically reviewed. The importance of feedstock composition, catalyst type, pyrolysis operating condition (including gas condition and temperature profiles) based on various studies is discussed. The potential and limitation of an integrated pyrolysis system are assessed from kinetic analysis, economic analysis and life-cycle assessment. This review is expected to contribute to the industrial-scale development of sustainable upcycling of plastic waste and enhance the production of desirable gas components for CNM synthesis for environmental sustainability.

Plastic or plastic-free life: From formation to removal.

Microplastics (MPs) and nanoplastics (NPs) have caused global environmental concerns due to their ubiquitous existence in our surrounding environment and the potential threats posed to the ecosystem and human health. This review aims to extend current knowledge on the formation and degradation of MPs and NPs. The paper presents the potential sources of MPs and NPs including plastic containers, textiles, cosmetics, personal care products, COVID-19 wastes, and other plastic products. Once in the natural environment, the fragmentation and degradation of plastic wastes are thought to be initiated by physical, chemical, and biological factors. The corresponding degradation mechanism will be presented in the present review. Given the plastic life and environment, humans are inevitably exposed to MPs and NPs through ingestion, inhalation, and dermal contact. The potential risks MPs/NPs pose to humans will be also discussed in our study. Currently, the relevance of MP/NP exposure to human health outcomes is still controversial and not yet fully understood. Deciphering the translocation and degradation of plastics in the human body will be helpful to reveal their potential organotoxicity. In this case, available approaches to alleviate MP/NP pollution and advanced strategies to reduce MP/NP toxicity in humans are recommended to build a plastic-free life.

Effect of the COVID-19 Pandemic on Global Interest in Plastic Surgery.

Introduction: Due to the SARS-CoV-2 (COVID-19) pandemic, many elective surgeries were canceled, including most aesthetic plastic surgery procedures. Although studies have shown COVID-19's effect on plastic surgery in the United States, no study to date has examined the international interest in plastic surgery procedures after the start of the COVID-19 pandemic. Thus, we sought to find this effect using the Google Trends tool. Material and Methods: The most common cosmetic procedures and top countries with the highest plastic surgery volume were selected from the International Society of Plastic Surgeons report and used as the search terms for Google Trends. Weekly search data from each procedure and country were collected from March 18, 2018 to March 13, 2022, split into 2 periods according to the start of the US COVID-19 lockdown, and compared. Results: Among the countries, the United States had the most plastic surgery interest after the COVID-19 pandemic, with India and Mexico closely following. On the other hand, Russia and Japan had the fewest changes in procedure interest. Regarding specific procedures, interest in breast augmentation, forehead lift, injectable filler, laser hair removal, liposuction, microdermabrasion, and rhytidectomy increased in all countries after the COVID-19 pandemic. Conclusions: After COVID-19, there has been increasing interest in almost all plastic surgery procedures globally, especially nonsurgical procedures and facial plastic surgery, with the greatest increases in the United States, India, and Mexico. These results can help inform plastic surgeons which procedures to focus on and which devices or technologies to invest in that are specific to their country.

Improving Access to Extracranial-Intracranial Bypass Surgery in Border Hispanic Communities Utilizing Collaborative Approach Between Plastics and Neurological Surgery

INTRODUCTION: Hispanic patients such as those with Moyamoya disease are less likely to receive surgical revascularization therapy due to inequities in access (1). Our institution is a located in the Southern Texas- Mexico border region serving a largely Hispanic population. We previously referred patients for EC-IC bypass to other quaternary-care centers in Texas. While referrals were already challenging due to distance, mixed immigration status, and poor socioeconomic background of many patients;COVID-19 further exacerbated this problem with restriction of elective surgical volume. METHOD(S): A consecutive series of EC-IC bypasses performed by authors (SKD and MDLG) were retrospectively reviewed. Baseline clinical, perioperative radiographic, and post-operative outcomes were studied. All patients were offered option of a referral to a quaternary-care centers and also given local option for performing bypass surgery. Further, patients met preoperatively with both the plastic and neurological surgeon. Ultimately, decision was made by patient. RESULT(S): A total of 6 craniotomies for EC-IC bypass were performed during the study period. The diagnoses included Moyamoya in 5 cases and symptomatic intracranial atherosclerosis in one. All patients were Hispanic, female, and nonsmokers with mean age of 35.6 years. Mean preoperative HBa1c was 7.9, preoperative LDL was 82, and mean preoperative hemoglobin was 11.3. Direct bypass was performed in 40% of cases. Mean OR time was 3 hours and 7 minutes. CONCLUSION(S): We have found collaboration between plastic and neurological surgery for surgical revascularization is feasible and improved access to care for Hispanic Moyamoya disease patients residing in a border community.