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

On the densities of certain bounded diffusion processes

A comprehensive outline is presented for obtaining the Laplace transforms of the transition probability density functions and of the first-passage-time densities for one-dimensional time-homogeneous diffusion processes in the presence of absorbing and/or reflecting boundaries. In particular, the Laplace transform of the transition probability density function in the presence of pairs of reflecting boundaries are explicitly obtained. Symmetric diffusion processes are then specifically considered and explicit closed-form relations are then obtained for the hyperbolic diffusion process in the presence of absorbing and/or reflecting boundaries. The special cases of the Brownian motion and of the Hongler process are finally analyzed

Serpentes do Município de Viçosa, Mata Atlântica do Sudeste do Brasil

Apresentamos aqui, com base em exemplares depositados em coleções científicas, uma lista das espécies de serpentes do Município de Viçosa, localizado em uma porção da Mata Atlântica do Estado de Minas Gerais, Sudeste do Brasil. Trinta e quatro espécies foram confirmadas em Viçosa. Outras duas possuem registros duvidosos e cinco espécies que foram registradas em municípios vizinhos poderiam também ocorrer em Viçosa. Informações sobre distribuição e história natural das serpentes são apresentadas, baseadas em dados da literatura científica e observações esporádicas na área de estudo. Podemos considerar que de maneira generalizada a fauna de serpentes de Viçosa é constituída por espécies com condições de utilizar ambientes antropizados, mas algumas são dependentes dos fragmentos florestais ainda existentes. Estudos de campo ainda são necessários para aprimorar o conhecimento sobre a riqueza de espécies de serpentes nos fragmentos florestais, para confirmar a presença das espécies com registros incertos e ocorrência potencial em Viçosa, e para investigar a possibilidade de declínio populacional daquelas espécies sem registros há mais de uma década