Plant communities of Italy. The vegetation prodrome

The Vegetation Prodrome of Italy was promoted in 2012 by the Italian "Ministry of Environment, Land and Sea Protection", in collaboration with the "Italian Society of Botany", to provide a comprehensive and systematic catalogue and description of Italian plant communities. The Prodrome that is presented in this paper is the first full organic synthesis of the vegetation of Italy at the alliance syntaxonomic level. It fulfils several needs, the main one being a unified and comprehensive national framework that may make an important contribution to the definition of the European Vegetation Prodrome. Syntaxonomy, as well as taxonomy, is sometimes based on considerations that may in part diverge: several authors tend to favour models that are divisive or aggregative to a greater or lesser extent in terms of flora, biogeography and ecology. These different points of view stimulate the scientific debate and allow the adoption of a framework that is more widely supported. The Prodrome includes 75 classes, 2 subclasses, 175 orders, 6 suborders and 393 alliances. The classes were grouped into nine broad categories according to structural, physiognomic and synecological elements rather than to syntaxonomic criteria. The rank, full valid name, any synonymies and incorrect names are provided for each syntaxon. The short declaration highlights the physiognomy, synecology, syndynamics and distribution of the plant communities that belong to the syntaxon. The Prodrome of the Italian Vegetation is linked to the European Strategy for Biodiversity, the European Habitats Directive and the European Working Groups related to the ecosystems and their services. In addition to basic applications, the Prodrome can be used as a framework for scientific research related to the investigation of the relationships between plant communities and the environmental factors that influence their composition and distribution

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

One-muscle strabismus surgery: A review

Proper management of a patient with small to moderate horizontal deviations continues to be challenging for the strabismus surgeon. The use of one-muscle surgery for comitant strabismus has been controversial because of concerns that it may result in a significant number of undercorrections and/or ocular incomitance. Recent literature on unilateral rectus muscle surgery has shown that this surgery is a safe and effective procedure for small and moderate angle horizontal deviations. It has the advantage of limiting surgery to one eye, reducing operative time and possible cost to the family, and leaving other muscles untouched in case repeat surgery is necessary. Larger studies need to be done in the future; however, this surgery should be considered as a primary approach in the treatment of small to moderate angle esotropia

Practice patterns in the management of amblyopia: A survey study

Purpose: To characterize current practice preferences of pediatric ophthalmologists in the management of amblyopia and whether these are influenced by demographic variables. Methods: A 10-question survey was distributed to all pediatric ophthalmologists and fellows attending the Annual Joseph H. Calhoun Pediatric Ophthalmology Forum at Wills Eye Hospital in 2016. The questionnaire consisted of demographic information and clinical management of amblyopia using clinical scenarios commonly encountered in pediatric ophthalmology practice. Results: Of the 133 pediatric ophthalmologists who attended, 74 completed the survey, all of which were included in the data analysis. Seventy-six percent of respondents prescribed refractive correction to a 3 year old with untreated anisometropic amblyopia prior to initiating occlusion therapy. For a child with coexisting exotropia, 57% recommended refractive and occlusion therapy until significant visual improvement, then surgery; however, 30% would perform surgery earlier. Fifty-seven percent stopped occlusion therapy at 10 years of age or older. Sixty-four percent estimated a patient patching compliance rate of 50% to 75%. There was no significant relationship (P < .05) between any of the demographic variables, indicating that no group was more or less likely to respond to the question in any way. Conclusions: This study highlights the lack of a unified approach to certain aspects of amblyopia management. Physician-related demographic variables did not significantly affect clinical decision-making; however, variation did exist among respondents, a finding that warrants further investigation

A phytosociological analysis of the formations of Ulex europaeus L. of the North-Western Apennines (Italy)

We here present a phytosociological study of the formations of Ulex europaeus present in the North-Western Apennines, in the Regions of Liguria and Tuscany, that have been included in the new association Cytiso villosi-Ulicetum europaei

We are not ready to use breast milk eye drops for infants with eye discharges

We were interested to read the paper by Sugimura et al, which evaluated the safety and efficacy of breast milk eye drops in infants up to six months of age with eye discharges. The authors reported that they found these as effective as sodium azulene sulphonate hydrate 0.02% and noted that eye discharge improved in 76.8% of patients without any adverse events. Although these results seem to be promising, we believe that there are some issues that warrant further clarification

Visual improvement in amblyopic eye following treatment-induced vision loss in dominant eye with uveal melanoma

Objective: To determine the frequency and amount of visual improvement in amblyopic eyes of adults following visual loss in the dominant eye resulting from treatment of uveal melanoma. Methods and analysis: Retrospective case series of adult patients with amblyopia and dominant eye visual loss resulting from treatment of uveal melanoma. Review of best-corrected visual acuity (BCVA) in each eye (amblyopia eye vs melanoma eye) at date first seen and over time following treatment of uveal melanoma. BCVA in each eye was graded as improved (>2 logarithm of minimal angle of resolution (logMAR) lines) or unimproved (<2 logMAR lines). Results: Twenty-one patients that met the inclusion criteria. Mean age at presentation was 56 years (range 39-73 years). Following treatment of the uveal melanoma and decline of BCVA in the dominant, the BCVA in the amblyopic eye improved in 11/21 (52%; 95% CI 30% to 74 %) patients. The degree of visual loss in the melanoma eye was to the level of the amblyopic eye or worse in 14 patients. In this group, BCVA improved in the amblyopic eye in 9/14 (64%; 95% CI 35% to 87 %) patients. Of these nine with improved eyes, the mean starting visual acuity was logMAR 0.6 (20/80) with mean improvement of logMAR 0.4 (4 lines\ub10.13 (range 0.2-0.6). Eight of nine eyes achieved a BCVA of 20/25 (n=3) or 20/20 (n=5). Conclusion: Visual acuity in the amblyopic eye of adults can improve following visual loss in the contralateral dominant eye associated with treatment for uveal melanoma