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

Post-extubation Croup in Pediatric Cardiovascular Surgery: A Case Series at La Cardio-IC

Introducción: El Croup post extubación es una complicación frecuente en pacientes pediátricos que requieren intubación orotraqueal para la realización de procedimientos bajo anestesia general. Objetivo general del estudio describir las características demográficas y clínicas de los pacientes pediátricos llevados a cirugía cardiaca entre junio de 2020 hasta octubre de 2020 que presentaron croup postextubación durante el post operatorio atendidos en la Cardio-IC. Metodología: Estudio descriptivo retrospectivo tipo serie de casos. Se utilizó un muestreo no probabilístico y de manera consecutiva se seleccionaron 16 pacientes pediátricos que cumplieron con los criterios de inclusión y de exclusión. La descripción de las variables preoperatorias, intraoperatorias y post operatorias definidas para el estudio, se realizó con frecuencias, porcentajes, medidas de tendencia central (promedio, desviación estándar, mediana) y cuartiles. Resultados: Los pacientes objeto de estudio, se caracterizaron por tener un promedio de edad de 18 ±22 meses, con una mediana de 9 meses, el peso fue 8±4,5 kg y la talla de 71,4±16,4 cms; no hubo diferencias en cuento al género (50% femenino y 50% masculino), la mayoría de pacientes un 44% fueron clasificados con un riesgo preoperatorio de 3 según la escala de Rachs-1. En el postoperatorio se determinó para el grupo de estudio, un tiempo total de ventilación mecánica de 155±142 horas con una mediana de 102 horas; y el requerimiento de reintubación fue del 44% en 7 pacientes. Conclusión: El Croup postoperatorio en pacientes sometidos a cirugía cardiovascular pediátrica es una complicación que puede comprometer la evolución y el pronóstico postoperatorios. La identificación de factores predisponentes, el manejo adecuado intraoperatorio y la implementación de un método diagnóstico y seguimiento estandarizado y objetivo, son fundamentales para prevenir, identificar y tratar a tiempo esta complicación.Introduction: Post-extubation Croup is a common complication in pediatric patients who require orotracheal intubation for procedures under general anesthesia. The general objective of the study is to describe the demographic and clinical characteristics of pediatric patients undergoing cardiac surgery between June 2020 and October 2020 who presented with post-extubation croup during the postoperative period and were treated at Cardio-IC. Methodology: A retrospective descriptive case series study was conducted. A non-probabilistic consecutive sampling method was used to select 16 pediatric patients who met the inclusion and exclusion criteria. The description of the preoperative, intraoperative, and postoperative variables defined for the study was performed using frequencies, percentages, measures of central tendency (mean, standard deviation, median), and quartiles. Results: The patients included in the study had an average age of 18 ±22 months, with a median of 9 months. The average weight was 8±4.5 kg and the height was 71.4±16.4 cms. There were no gender differences (50% female and 50% male). Most patients (44%) were classified as having a preoperative risk of 3 according to the Rachs-1 scale. In the postoperative period, the study group had a total mechanical ventilation time of 155±142 hours with a median of 102 hours. The reintubation rate was 44% in 7 patients. Conclusion: Postoperative Croup in pediatric patients undergoing cardiovascular surgery is a complication that can compromise postoperative recovery and prognosis. Identifying predisposing factors, proper intraoperative management, and implementing a standardized and objective diagnostic and follow-up method are essential to prevent, identify, and timely treat this complication

Memoria del segundo congreso internacional sobre paz, democracia y desarrollo.

Los textos presentados reflejan el espíritu del encuentro que los reunió. Juntos expresan un ejercicio de interdisciplinariedad, pluralidad, debate de ideas, y difusión de diferentes puntos de vista, sobre temas relacionados con la cultura de paz, la violencia, el desarrollo y la democracia. Y contribuyen a la comprensión sobre los límites, heterogeneidades y lagunas del proceso de instauración y consolidación de las instituciones democráticas de los países de América Latina. También analizan la marginación, la desigualdad, la inequidad, la violencia, la inseguridad cotidiana y otros asuntos relacionados con la falta de recursos y opciones para los habitates de la región

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity—GoPA! 2015 and 2020 Surveys

Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world’s population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world’s population live in countries where PA promotion capacity should be significantly improved. Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.</jats:p

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Notes for genera – Ascomycota

Knowledge of the relationships and thus the classification of fungi, has developed rapidly with increasingly widespread use of molecular techniques, over the past 10--15 years, and continues to accelerate. Several genera have been found to be polyphyletic, and their generic concepts have subsequently been emended. New names have thus been introduced for species which are phylogenetically distinct from the type species of particular genera. The ending of the separate naming of morphs of the same species in 2011, has also caused changes in fungal generic names. In order to facilitate access to all important changes, it was desirable to compile these in a single document. The present article provides a list of generic names of Ascomycota (approximately 6500 accepted names published to the end of 2016), including those which are lichen-forming. Notes and summaries of the changes since the last edition of `Ainsworth Bisby's Dictionary of the Fungi' in 2008 are provided. The notes include the number of accepted species, classification, type species (with location of the type material), culture availability, life-styles, distribution, and selected publications that have appeared since 2008. This work is intended to provide the foundation for updating the ascomycete component of the ``Without prejudice list of generic names of Fungi'' published in 2013, which will be developed into a list of protected generic names. This will be subjected to the XIXth International Botanical Congress in Shenzhen in July 2017 agreeing to a modification in the rules relating to protected lists, and scrutiny by procedures determined by the Nomenclature Committee for Fungi (NCF). The previously invalidly published generic names Barriopsis, Collophora (as Collophorina), Cryomyces, Dematiopleospora, Heterospora (as Heterosporicola), Lithophila, Palmomyces (as Palmaria) and Saxomyces are validated, as are two previously invalid family names, Bartaliniaceae and Wiesneriomycetaceae. Four species of Lalaria, which were invalidly published are transferred to Taphrina and validated as new combinations. Catenomycopsis Tibell Constant. is reduced under Chaenothecopsis Vain., while Dichomera Cooke is reduced under Botryosphaeria Ces. De Not. (Art. 59)