Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparative cytogenetics of eight species of Cycloramphus (Anura, Cycloramphidae)

Several aspects of the biology of Cycloramphus species of the Atlantic Forest are still poorly known, which makes it difficult to understand their historical relationships. Therefore, we were stimulated to promote a comparative cytogenetic analysis of several species of the genus Cycloramphus. The study of Cycloramphus acangatan, C. boraceiensis, C. brasiliensis, C. carvalhoi, C. eleutherodactylus, C. fuliginosus, C. lutzorum, and C. rhyakonastes, revealed that these eight species share a diploid number 2n=26. Cycloramphus fuliginosus presented the most distinct karyotype, due to the presence of subtelocentric chromosomes in pairs 1 and 4. The main diagnostic feature observed in the other species was the presence of one pair of telocentric chromosomes in C. boraceiensis, C. carvalhoi, and C. eleutherodactylus, while the remaining species presented karyotypes composed exclusively of biarmed chromosomes. Constitutive heterochromatin was predominantly located in pericentromeric regions in all species, although additional C-bands detected on telomeric and/or interstitial regions were partially species-specific. Silver staining revealed Ag-NORs located on the pair 6 in six species, whereas C. acangatan presented it on pair 1 and a multiple pattern was observed in C. fuliginosus with three Ag-NOR bearing chromosomes. Fluorescent in situ hybridization using rDNA probe was performed in specimens of C. eleutherodactylus from Parana, C. lutzorum, and C. rhyakonastes, which did not reveal inactive NOR. Despite the apparent highly conserved diploid number, data on the karyotype microstructure characterize the cytogenetic profile of the genus and may contribute to clarify the phylogenetic relationships among Cycloramphus, the Cycloramphinae, or even the family Cycloramphidae. (C) 2011 Elsevier GmbH. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP