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

Psephellus vanensis (Asteraceae), a new species from east Turkey

A new species, Psephellus vanensis A.Duran, Behçet & B.Dogan (Asteraceae) from Anatolia, Turkey, is described and illustrated. The species grows on the serpentine stony field of the village of Çaldıran in the district of Başkale (Van province) in eastern Anatolia. It is morphologically similar to Psephellus pyrrhoblepharus (Boiss.) Wagenitz. Diagnostic characters are discussed, and a key to the most similar species is provided. Ecology, conservation status and notes on biogeography of the species are also presented. In addition, the geographical distribution of the new species and other related species in Turkey is mapped

The 20th July 2017 Bodrum-Kos Tsunami Field Survey

The July 20, 2017 Bodrum-Kos Earthquake caused tsunami wave motions and damage in the south of Bodrum Peninsula, Turkey, and on Kos Island, Greece. Immediately after the earthquake, we conducted several post-tsunami field surveys including interviews in coastal zones impacted by the tsunami, i.e., the coastlines of Bodrum Peninsula, Karaada Islet and Akyaka Town in Gokova Bay, Turkey, and eastern Kos Island, Greece. We present observations and measurements to document the variation of the tsunami effects along the coast. The largest tsunami runup was about 1.9m and observed at the mouth of a small dry streambed at Gumbet Bay, Bodrum. No significant water motions were reported at the northern and western coasts of Bodrum Peninsula. The tsunami runup distribution along the coast of eastern Kos was overall regular, with runup not exceeding 1m except in the Port of Kos where a 1.5m tsunami runup was measured

The 20th July 2017 Bodrum–Kos tsunami field survey

Summarization: The July 20, 2017 Bodrum–Kos Earthquake caused tsunami wave motions and damage in the south of Bodrum Peninsula, Turkey, and on Kos Island, Greece. Immediately after the earthquake, we conducted several post-tsunami field surveys including interviews in coastal zones impacted by the tsunami, i.e., the coastlines of Bodrum Peninsula, Karaada Islet and Akyaka Town in Gökova Bay, Turkey, and eastern Kos Island, Greece. We present observations and measurements to document the variation of the tsunami effects along the coast. The largest tsunami runup was about 1.9 m and observed at the mouth of a small dry streambed at Gumbet Bay, Bodrum. No significant water motions were reported at the northern and western coasts of Bodrum Peninsula. The tsunami runup distribution along the coast of eastern Kos was overall regular, with runup not exceeding 1 m except in the Port of Kos where a 1.5 m tsunami runup was measured.Παρουσιάστηκε στο: Pure and Applied Geophysic

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies