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

Chaperonins in Rhodobacter sphaeroides and Pisum sativum

SIGLEAvailable from British Library Document Supply Centre- DSC:DX175868 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Morfologia e anatomia foliar de Bauhinia curvulha Benth. (Leguminosae-Caesalpinioideae)

Foi realizado o estudo morfológico e anatômico da folha de Bauhinia cumula Benth., espécie de cerrado. As observações foram feitas em folhas adultas, tratadas segundo a metodologia usual utilizada em anatomia vegetal. Foi observado que a espécie apresenta as seguintes características: folhas bilobadas cuja incisão foliar chega próximo à região motora; um par de estipulas membranáceas; um par de nectários extraflorais, localizadaos na base do pulvino proximal; a venação possui padrão acródomo; o pecíolo, que possui dois pulvinos, um proximal e um distai, apresenta epiderme contendo grande quantidade de tricomas tecto res simples e glândulas; a lâmina foliar é anfiestomática com predomínio de estômatos dos tipos anomocítico e paracítico; a epiderme adaxial é monoestratificada, subpapilosa, desprovida de tricomas tectores simples e glândulas; a epiderme abaxial é subpapilosa, apresentando numerosos tricomas tectores simples e glândulas; e o mesofilo é formado predominantemente por parênquima paliçádico.<br>A morphological and anatomical study of Bauhinia curvula Benth. leaf, a cerrado spe-cies, was perfomed. The observations, in grown up leaves, prepared according to the costumary methodology used in plant anatomy, showed the following characteristics of the species: bilobed leaves with foliar incision close to the motor region; one pair of membranaceous stipules; one pair of extrafloral nectaries located on the basis of the proximal pulvinus; acrodromous patterns of leaf venetion; the petiole, which has two pulvinus, one proximal and one distal, has an epidermis containing large quantities of simple tector trichomes and glands; the leaf blade, amphiestomatic, with predominance of anomocytic and paracytic stomata; the adaxial epidermis uniserial, sub papillose, without tector trichomes and glands; the abaxial epiderms, sub-papillose, presents a high number of simple trichomes and glands; and the mesophyll with a basic composition of palisadic parenchyma