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Bariatric surgery is the most effective treatment for obesity but is invasive and associated with serious complications. Endoscopic sleeve gastroplasty (ESG) is a less invasive weight loss procedure to reduce the stomach volume by full-thickness sutures. ESG has been adopted in many countries, but implementation at Scandinavian centres has not yet been documented. We performed a clinical pilot trial at a Norwegian centre with the primary objective to assess the feasibility of the ESG procedure.
We included the first 10 patients treated with ESG at a Norwegian centre in a single-arm pilot study. The eligibility criteria were either a body mass index (BMI) of 40-49.9 kg/m2, BMI 35-39.9 kg/m2 and at least one obesity-related comorbidity, or BMI 30-34.9 kg/m2 and type 2 diabetes. Patient follow-up resembled the scheme used for bariatric surgery at the center, including dietary plans and outpatient visits.
All procedures were technically successful except for one patient who had adhesions between the stomach and anterior abdominal wall, related to a prior hernia repair, resulting in less-than-intended stomach volume reduction. Mean total body weight loss (TBWL) after 26 and 52 weeks was 12.2% (95% CI 8.1-16.2) and 9.1% (95% CI 3.3 - 15.0). One patient experienced a minor suture-induced diaphragmatic injury, which was successfully managed conservatively.
This first Scandinavian clinical trial of ESG, documenting the implementation of the procedure at a Norwegian center, demonstrated acceptable feasibility and safety, with large variations in individual weight loss during the 52-week follow-up period.

This study began with the increasing importance of ESG through sustainable management evaluation across all industries, predicting market demand through the ESG management paradigm and financial environment changes in the global industry, and establishing international strategies for the construction industry. Compared to other industries, the construction industry is in the early stages of ESG formation, and it is unclear how to expand its base by establishing evaluation system standards such as innovation of individual services, interaction of social capital, and definition of stakeholders. Currently, some large construction companies in the construction industry are publishing sustainability management reports at the group level, but given the recently strengthened global sustainability of ESG by GRI Standards, efficient analysis of global construction markets and strategic orders are needed. Therefore, this study focuses on assessing the sustainability strategies and directions of the construction industry from an ESG perspective. To this end, sustainability issues and insights, as well as global issues in Korea and the worldwide construction sector, were analyzed. The analysis showed that global construction companies were highly interested in business management approaches, such as safety and health, as critical issues regarding the construction industry\'s sustainability strategy. In contrast, South Korean construction companies prioritize business values such as value creation, fair trade, and win-win. Both global and South Korean construction companies have been working on greenhouse gas reduction and energy sustainability. Regarding other issues, cultivating construction specialists, enhancing the job training system, and limiting serious accidents and safety mishaps were all significant from a social standpoint among South Korean construction companies. Conversely, global construction companies appeared to focus on issues related to ethical and environmental management from an organizational standpoint.

BACKGROUND: Endoscopic bariatric therapies (EBT) has emerged as an effective treatment in the management of the patient with obesity. Unfortunately, most procedures involve only the restriction of gastric volume without altering the underlying metabolism. The objective of this study was to investigate the practicability and limitations of the metabolic altering procedures: \"One anastomosis gastric bypass (OAGB)\" with \"natural orifice transluminal endoscopic surgery (NOTES)\" on human cadavers.
METHODS: We performed OAGB with NOTES approach in 3 human cadavers. The steps of the procedure can be divided as follows: step 1, endoscopic sleeve gastroplasty (ESG); step 2, trans-gastric access to peritoneal cavity; step 3, identification of suitable loop of jejunum; step 4, introduction of the jejunal loop into the stomach; step 5, creation of the gastro-jejunostomy with lumen-apposing metal stent (LAMS); step 6, gastric pylorus occlusion with overstitch.
RESULTS: We performed OAGB with NOTES in 3 human cadavers with bypassed bilio-pancreatic limb of 55, 75, and 105 cm from the pylorus. The average weight for the cadavers was 64.9 kg (61.2-71.7 kg). The mean procedure time was 157 min. The optimal bypassed length for the procedure was 105 cm.
CONCLUSIONS: This study has provided proof-of-principle in a pre-clinical cadaveric model that NOTES approach can be used to perform OAGB and, therefore, merits additional evaluation and consideration in surviving porcine model.

The environmental commitment of healthcare stakeholders is poorly described despite the sector pollution and the social needs of more sustainable behaviors. A cross-sectional study comparing the environment commitment of US publicly traded companies producing healthcare equipment (HE), healthcare companies (H), and large capitalization corporates (LC) was designed. Using a financial database, the 20 largest US publicly traded companies by market capitalization were selected for each cohort. The last available sustainability report was investigated, aiming to assess (1) the year and the method of dissemination of the last report; (2) the adhesion to environmental standards; (3) the presence of environmental policies, quantitative targets, and tracking; (4) the third-party evaluations about company environmental sustainability. HE companies published sustainability reports in time (p = 0.048), usually as standalone reports (p < 0.001). Half of HE companies adhered to standards, less than the control groups (p < 0.001). HE companies had an acceptable environmental policy, improving over the time and posing targets, similarly to control groups (p > 0.05). The number of companies reporting quantitative targets/tracking about carbon footprint, water, and renewable energy managements differed among the three cohorts (p = 0.013, p = 0.013, and p < 0.001, respectively), with HE cohort achieving the lowest rates (70%, 70%, and 50%, respectively). Carbon neutrality and all renewable energy statements were rare among HE companies (10% and 5% of companies, p < 0.007). In HE, CDP (The Carbon Disclosure Project) scores were lower than controls (p < 0.001). US publicly traded companies producing healthcare equipment demonstrated to be far less committed to environmental sustainability than healthcare companies and large capitalization corporates. Level of evidence: IV.

We investigate the role of sectors on the performance of smart beta products during the COVID-19 crisis. Cross-sectional differences in excess returns (versus a market capitalized portfolio) are driven by strong exposures to COVID-19-related industry rotation, rather than to long-term structural causes.