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

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

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

Pollen Morphology In The Tribe Nigelleae (Ranunculaceae): A Worldwide Palynological Investigation Into The Species

The pollen morphology of many collections of taxa of the tribe Nigelleae from the family Ranunculaceae which occur worldwide is presented in this study. A total of 88 specimens from 21 taxa, some of which were recently proposed, belonging to the genera Komarojjia, Garidella, and Nigella of Nigelleae were examined using light microscopy (LM) and scanning electron microscopy (SEM). In the tribe, the pollen type is mostly trizonocolpate, but in many taxa and specimens, both trizonocolpate and non-trizonocolpate types occur together. The pollen grains are small to medium (25-53.75 mu m x 20-55 mu m) in size and oblate to prolate in shape. The exine pattern at the mesocolpium in all the taxa investigated is similar: micro-echinate in LM and micro-echinate-punctate in SEM. The colpus membrane in Komaroffia and Ntgella is micro-echinate in both LM and SEM. In Garidella, it is micro-echinate in LM but echinate (spinulose) in SEM. In this study, multivariate analyses, principal component analysis (PCA). and unweighted pair group method with arithmetic mean (UPGMA). were used to evaluate relationships between the genera and species within the tribe with respect to pollen morphology. PCA results show three main groups in the tribe: Gartdella. Komaroffia, and Mgella. Moreover, the UPGMA tree also chiefly supports generic segregation into the smaller genera. An overall synthesis of the pollen characteristics of the three genera is provided and discussed.Wo

Polygala Turcica (Polygalaceae), a New Species from E Turkey, and a New Identification Key to Turkish Polygala

Polygala turcica Donmez & Ugurlu (Polygalaceae) is described and illustrated as a new species from Kars province in E Turkey. It is similar to P. peshmenii Eren & al., but is clearly isolated from the other species of Polygala sect. Polygala with respect to habit and morphological characters. Morphology, including that of pollen, is discussed with respect to taxonomic value. The conservation status of the new species is assessed. A new identification key is provided for all Polygala species known from Turkey

Evaluation Of Antioxidant Activity Of Crataegus Species Collected From Different Regions Of Turkey

Crataegus species (Rosaceae), known as "Howthorn" have found special medicinal use for the treatment of mild heart diseases. This work aims to measure the antioxidant capacities of various Crataegus species growing in Turkey. In this study, the flowers and leaves from 52 samples belonging to 17 taxa of 14 Crataegus species naturally growing in Turkey have been investigated for their antioxidant activity/capacity. Four different methods (CUPRAC, FRAP, ABTS/Persulfate and Folin: FCR assays) were used for determination of the antioxidant capacities of the samples. The leaves and the flowers of the plants were studied separately. Samples representing the same species collected from different locations were studied separately. The results have indicated that the samples differing by some minor morphological characteristics exhibit considerably different antioxidant capacities. Among the flower samples, the most effective species was C. x sinaica Boiss. nothosubsp. sinaica and among the leaf samples C. pentagyna Waldst and Kit. ex. Willd. were the most active. Generally, C. monogyna Jacq. samples have exhibited markedly high antioxidant activity. Moreover, the species collected from Bolu district (surrounded by several forests and lakes) have shown significantly high activity regardless of the species differences among the samples.Wo

Phenylethanoid Glycosides from Phlomis integrifolia Hub.-Mor

Two new phenylethanoid glycosides integrifoliosides A (2) and B (3), along with a known phenylethanoid glycoside alyssonoside (1) and a flavone glucoside chrysoeriol-7-O--d-glucopyranosid

Past, Present, And Future Geographic Range Of An Oro-Mediterranean Tertiary Relict: The Juniperus Drupacea Case Study

Juniperus drupacea is a unique relict species found in the mountains of southern Greece, southern Turkey, and western Syria and Lebanon. The aim of this study was to describe the natural range of this juniper by determining the current locations of its populations and to predict a theoretical range for the species based on current, past, and future climatic conditions. We used data from the literature, herbarium materials, and our unpublished field notes (about 500 georeferenced points in total) to determine the current natural distribution of J. drupacea (realized niche). To predict suitable conditions with the program MaxEnt, we used data from the WordClim database, which allowed estimation of the potential niche. The potential niche of J. drupacea was much wider during the Last Glacial Maximum (LGM) and was severely restricted during the Eemian interglacial period. Depending on the climate scenario, this species could become endangered in the future due to climate changes. Considering the relatively restricted geographic range of J. drupacea and the decreasing numbers of localities where it is found, conservation strategies should be adopted to allow for preservation of its genetic and morphological diversity.WoSScopu

Macular Evaluation wıth Spectral Domain Type Optic Coherence Tomography in Eyes with Acute Nonarteritic Ischemic Optic Neuropathy at the Presentation Visit

PURPOSE: To evaluate the macula with spectral domain type optic coherence tomography (OCT) in eyes with acute nonarteritic anterior ischemic optic neuropathy (NAION) at the presentation visit. METHODS: Medical charts of the 133 patients who received the diagnosis of acute NAION between January 2008 and July 2014 at the Neuro-ophthalmology unit of Dokuz Eylul University were reviewed retrospectively. Sixtythree patients within 30 days of symptom onset with available baseline spectral domain type macular OCT were included in this study. Clinical and macular characteristics of the affected eye were assessed and compared to the fellow eyes. RESULTS: Sixty-three eyes of 63 patients comprised the study group. Twenty one study eyes (33.3%) had normal posterior pole, 22 (34.9%) some evidence of subretinal fluid, 10 (15.8%) vitreomacular adhesion, five (7%) age-related macular degeneration related changes, four (6%) epiretinal membrane and one (1%) previous grid laser scars. On the other hand, 41 of 63 the fellow eyes (65%) had normal posterior pole, ten (15.8%), vitreomacular adhesion, seven (10.7%), age-related macular degeneration related changes, three (4%) epiretinal membrane and two (3%) other type of changes. OCT scan passing through the fovea exhibited 10 or more hyperreflective dots in 10 (15%) of the study eyes whereas two of the fellow eyes (3.2%) had 10 or more hyperreflective dots. CONCLUSION: Macular OCT can be a part of the routine neuroophthalmologic examination in patients with acute NAION not only to show the NAION related changes such as the subretinal fluid accumulation but also to identify the other coexistent macular abnormalities