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

Dengue Virus Induces the Release of sCD40L and Changes in Levels of Membranal CD42b and CD40L Molecules in Human Platelets

Platelets are considered as significant players in innate and adaptive immune responses. The adhesion molecules they express, including P-selectin, CD40L, and CD42b, facilitate interactions with many cellular effectors. Upon interacting with a pathogen, platelets rapidly express and enhance their adhesion molecules, and secrete cytokines and chemokines. A similar phenomenon occurs after exposure of platelets to thrombin, an agonist extensively used for in vitro activation of these cells. It was recently reported that the dengue virus not only interacts with platelets but possibly infects them, which triggers an increased expression of adhesion molecule P-selectin as well as secretion of IL-1β. In the present study, surface molecules of platelets like CD40L, CD42b, CD62P, and MHC class I were evaluated at 4 h of interaction with dengue virus serotype 2 (DENV-2), finding that DENV-2 induced a sharp rise in the membrane expression of all these molecules. At 2 and 4 h of DENV-2 stimulation of platelets, a significantly greater secretion of soluble CD40L (sCD40L) was found (versus basal levels) as well as cytokines such as GM-CSF, IL-6, IL-8, IL-10, and TNF-α. Compared to basal, DENV-2 elicited more than two-fold increase in these cytokines. Compared to the thrombin-induced response, the level generated by DENV-2 was much higher for GM-CSF, IL-6, and TNF-α. All these events induced by DENV end up in conspicuous morphological changes observed in platelets by confocal microscopy and transmission electron microscopy, very different from those elicited by thrombin in a more physiological scenery

Biodiversidad de la sierra de La Macarena, Meta, Colombia. Parte I. Ríos Guayabero medio, bajo Losada y bajo Duda

Resultados parciales de los Convenios de Cooperación suscritos entre el Instituto de Investigación de Recursos Biológicos Alexander von Humboldt y la Corporación para el Desarrollo Sostenible del Área de Manejo Especial de La Macarena-Cormacarena (N° 18-096 y 17-194 Instituto Humboldt) y PE.GDE. 1.4.8.1.18.014 del 2018 y PE.GDE. 1.4.7.17.030 del 2017 Cormacarena), correspondientes a la “Evaluación de la biodiversidad acuática del río Guayabero, sierra de La Macarena, Meta. Fases I y II”

Diversidad biológica y cultural del sur de la Amazonia colombiana

La gran cuenca amazónica compartida por Brasil, Colombia, Perú, Bolivia, Venezuela, Ecuador y las tres Guyanas, contiene una de las mayores riquezas biológicas y culturales del planeta y es considerada parte de la seguridad ecológica global. Constituye el 45% de los bosques tropicales del mundo, es una de las áreas silvestres más extensas y de mayor reserva de agua dulce del planeta, su sistema hídrico es el mayor tributario de todos los océanos, alberga aún, cerca de 379 grupos étnicos y en cuanto a endemismo, no existe otra región que se le aproxime. En Colombia, la Amazonia a lo largo de la historia ha sufrido distintos procesos de intervención antrópica: la conquista; la colonización; el auge del caucho y la quina; la explotación maderera, petrolera; la implementación de cultivos de uso ilícito y de sistemas productivos no aptos a las condiciones del medio natural; entre otros, son procesos que han socavado tanto los recursos biológicos como los culturales. Conscientes de la problemática actual de la Amazonia así como de la importancia que reviste para el mundo y para el país, la Corporación para el Desarrollo Sostenible del Sur de la Amazonia –Corpoamazonia– y el Instituto de Investigación de Recursos Biológicos Alexander von Humboldt –IAvH-, firmaron en el año 2004 un convenio con el n de aunar esfuerzos para formular el plan de acción en biodiversidad en la región sur de la Amazonia colombiana (departamentos de Caquetá, Putumayo y Amazonas). El plan de acción, busca posicionar la biodiversidad en el desarrollo regional y contribuir a un mayor conocimiento y a unas mejores prácticas de conservación y utilización sostenible de los recursos biológicos y culturales de este importante espacio geográfico. Desarrolla a escala regional, la Política Nacional en Biodiversidad y la Propuesta Técnica de Plan de Acción Nacional en Biodiversidad – Biodiversidad siglo XXI -

Floral associations of cyclocephaline scarab beetles

The scarab beetle tribe Cyclocephalini (Coleoptera: Scarabaeidae: Dynastinae) is the second largest tribe of rhinoceros beetles, with nearly 500 described species. This diverse group is most closely associated with early diverging angiosperm groups (the family Nymphaeaceae, magnoliid clade, and monocots), where they feed, mate, and receive the benefit of thermal rewards from the host plant. Cyclocephaline floral association data have never been synthesized, and a comprehensive review of this ecological interaction was necessary to promote research by updating nomenclature, identifying inconsistencies in the data, and reporting previously unpublished data. Based on the most specific data, at least 97 cyclocephaline beetle species have been reported from the flowers of 58 plant genera representing 17 families and 15 orders. Thirteen new cyclocephaline floral associations are reported herein. Six cyclocephaline and 25 plant synonyms were reported in the literature and on beetle voucher specimen labels, and these were updated to reflect current nomenclature. The valid names of three unavailable plant host names were identified. We review the cyclocephaline floral associations with respect to inferred relationships of angiosperm orders. Ten genera of cyclocephaline beetles have been recorded from flowers of early diverging angiosperm groups. In contrast, only one genus, Cyclocephala, has been recorded from dicot flowers. Cyclocephaline visitation of dicot flowers is limited to the New World, and it is unknown whether this is evolutionary meaningful or the result of sampling bias and incomplete data. The most important areas for future research include: 1) elucidating the factors that attract cyclocephalines to flowers including floral scent chemistry and thermogenesis, 2) determining whether cyclocephaline dicot visitation is truly limited to the New World, and 3) inferring evolutionary relationships within the Cyclocephalini to rigorously test vicarance hypotheses, host plant shifts, and mutualisms with angiosperms

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era