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

Assisted GNSS navigation in lunar missions

The trend towards autonomous operations will likely extend to include very high orbits and lunar missions. A basic asset for autonomy is the availability of a correct navigation solution. The possibilities offered by the use of GNSS, even at altitudes far higher than expected, are investigated in this paper, showing moderate availability of weak signals with frequent outages. Software receivers would be able to acquire the signals in this scenario, but decoding the navigation message – typically required in order to compute a fix - remains a very difficult task. An approach to obtain a solution, via the iunfrequent uplink of a limited part of the information included in the data message, is proposed and aalyzed, and the relevant requirements for the clock and orbit propagator on-board are discussed. This technique, based on a very moderate aiding, has the potential for saving operational costs related to ground support and tracking which are quite significant for these missions

Incidental findings in pancreas screening programs for high-risk individuals: Results from three European expert centers

Surgical oncolog

Feeding associations between capybaras Hydrochoerus hydrochaeris (Linnaeus) (Mammalia, Hydrochaeridae) and birds in the Lami Biological Reserve, Porto Alegre, Rio Grande do Sul, Brazil

Feeding associations between capybaras Hydrochoerus hydrochaeris (Linnaeus, 1766) and some bird species were registered in the Lami Biological Reserve, southern Brazil, through observations in a set of transects established in the five major vegetation types of the study area: shrubby and herbaceous swamps, wet grasslands, sandy grasslands and forests. Data included: date and time, vegetation type, bird species, number of individuals (birds and capybaras), type of prey consumed, foraging strategy of the birds and the behavior of the capybaras in relation to the presence of birds. Five species of birds were registered: Caracara plancus (Miller, 1777), Furnarius rufus (Gmelin, 1788), Machetornis rixosus (Vieillot, 1819), Milvago chimachima (Vieillot, 1816) and Molothrus bonariensis (Gmelin, 1789). The interactions were observed in the shrubby swamp (M. bonariensis), forest (C. plancus) and wet grassland (F. rufus, M. rixosus, M. chimachima). The foraging strategies were: (1) use of the capybara as a perch, hunting from its back (M. rixosus, M. bonariensis); (2) use of the capybara as a beater, hunting in the ground (F. rufus, M. rixosus, M. bonariensis); (3) foraging in the skin of the capybara, by picking the ectoparasites (C. plancus, F. rufus, M. chimachima). Strategies (1) and (2) were employed to catch arthropods flushed from the vegetation. Sometimes, capybaras lay down and exposed the abdomen and lateral areas of their bodies to facilitate cleaning by M. chimachima, but the presence of other bird species seemed to be neutral to capybaras.<br>Foram registradas associações alimentares entre capivaras Hydrochoerus hydrochaeris (Linnaeus, 1766) e aves na Reserva Biológica do Lami, sul do Brasil, por meio de observações em um conjunto de transecções estabelecidas nos cinco principais tipos de vegetação existentes na área: banhado arbustivo, banhado herbáceo, campo úmido, campo arenoso e mata. As informações coletadas foram: data, horário, tipo de vegetação, espécie de ave, número de indivíduos (para aves e capivaras), tipo de presa consumida e estratégia de forrageamento das aves e comportamento das capivaras em relação à presença das aves. Cinco espécies de aves foram registradas: Caracara plancus (Miller, 1777), Furnarius rufus (Gmelin, 1788), Machetornis rixosus (Vieillot, 1819), Milvago chimachima (Vieillot, 1816) and Molothrus bonariensis (Gmelin, 1789). As interações foram observadas no banhado arbustivo (M. bonariensis), na mata (C. plancus) e no campo úmido (F. rufus, M. rixosus, M. chimachima). As estratégias de forrageamento registradas foram: (1) uso da capivara como "poleiro"; (2) uso da capivara como "batedor"; (3) forrageio no pêlo da capivara, para captura de ectoparasitas. As estratégias (1) e (2) foram empregadas pelas aves para capturar artrópodos que saltavam da vegetação pela movimentação das capivaras. Foi observado que as capivaras, em algumas ocasiões, apresentavam comportamento de exposição do abdômen e partes laterais do corpo para facilitar a retirada de ectoparasitas por M. chimachima. A presença das demais espécies de aves não interferiu no comportamento das capivaras