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

Use of inflammatory molecules to predict the occurrence of fever in onco-hematological patients with neutropenia

Febrile neutropenia remains a frequent complication in onco-hematological patients, and changes in the circulating level of inflammatory molecules (IM) may precede the occurrence of fever. The present observational prospective study was carried out to evaluate the behavior of plasma tumor necrosis factor alpha (TNF-α), soluble TNF-α I and II receptors (sTNFRI and sTNFRII), monocyte chemoattractant protein-1 [MCP-1 or chemokine (c-c motif) ligand 2 (CCL2)], macrophage inflammatory protein-1α (MIP-1α or CCL3), eotaxin (CCL11), interleukin-8 (IL-8 or CXCL8), and interferon-inducible protein-10 (IP-10 or CXCL10) in 32 episodes of neutropenia in 26 onco-hematological patients. IM were tested on enrollment and 24-48 h before the onset of fever and within 24 h of the first occurrence of fever. Eight of 32 episodes of neutropenia did not present fever (control group) and the patients underwent IM tests on three different occasions. sTNFRI levels, measured a median of 11 h (1-15) before the onset of fever, were significantly higher in patients presenting fever during follow-up compared to controls (P = 0.02). Similar results were observed for sTNFRI and CCL2 levels (P = 0.04 for both) in non-transplanted patients. A cut-off of 1514 pg/mL for sTNFRI was able to discriminate between neutropenic patients with or without fever during follow-up, with 65% sensitivity, 87% specificity, and 93% positive predictive value. Measurement of the levels of plasma sTNFRI can be used to predict the occurrence of fever in neutropenic patients

Caracterização química e mineralogia de solos antrópicos (terras pretas de índio) na amazônia central

Na Amazônia brasileira é comum a ocorrência de sítios arqueológicos. Frequentemente, observa-se que as ações humanas nesses sítios promoveram modificações significativas em muitas das características físicas, morfológicas e químicas dos solos desses ambientes, tornando-os muito diferentes dos solos adjacentes, especialmente nas áreas de terra firme da região. Embora muitos estudos tenham sido conduzidos visando compreender a magnitude dessas modificações e seus reflexos na gênese dos solos influenciados, muitas questões precisam ser mais bem compreendidas, sobretudo as relacionadas com a mineralogia desses solos. Este estudo teve como objetivo avaliar as características químicas, a composição mineralógica das frações argila e areia e o grau de pedogênese de cinco perfis de solos com horizonte A antrópico (Au), em ambientes de terra firme e várzea, localizados na Bacia Sedimentar do Amazonas, entre Coari e Manaus-AM. Amostras de solos foram coletadas, preparadas e submetidas às análises químicas de rotina e caracterizadas quanto aos teores de carbono oxidável e aos teores de Si, Fe, Al e P; adicionalmente, efetuou-se a identificação dos minerais presentes nas frações argila e areia, por meio de difratometria de raios X. Os resultados mostraram que as modificações promovidas pela atividade humana levaram à melhoria da fertilidade do solo, resultando em solos com acidez moderada, elevados teores de Ca2+ e de P disponíveis e baixos teores de Al3+ trocável. Esses resultados também revelaram teores muito elevados de P-total nos horizontes antrópicos, variando entre 1.630 e 8.840 mg kg-1 de P2O5. A mineralogia da fração argila dos solos antrópicos de terra firme revelou dominância de caulinita, além da ocorrência de gibbsita, de goethita e de óxidos de titânio (anatásio). O perfil de várzea, além de caulinita e goethita, apresentou também minerais do tipo 2:1 na fração argila. A mineralogia da fração areia dos solos estudados revelou dominância de quartzo, independentemente do ambiente. A fração magnética é composta por maghemita e hematita. Constatou-se, portanto, significativa riqueza química nos horizontes antrópicos, bem como diferenças na composição mineralógica desses horizontes