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

Design solutions to coastal human-wildlife conflicts

Coastal areas can be a challenge for conservation due to multiple competing land uses including development, tourism, and extractive resource use. These multiple land uses often lead to human-wildlife conflicts. Here we propose that collaboration with industrial designers and architects has the potential to generate innovative and effective solutions to coastal human-wildlife conflicts. Many products for modifying animal behavior are already used by conservationists, such as barriers, corridors, and model predators. We propose that their effectiveness, quality, harmonization with local values, and integration with the designed human environment can be improved through collaboration with designers and architects. We illustrate this approach with a case study. We engaged in an industrial design- conservation collaboration focused on the design of multiple product proposals that would support a range of human-sea lion interactions in public parks and the fish market in Valdivia, Chile. The sea lions in Valdivia are a tourist attraction but also potentially dangerous. We produced images of seven proposed products of varying scales, facilitating a range of different sea lion- human interactions. Such collaborations can be useful for developing products that reduce human-wildlife conflicts and align conservation and management with local values. We urge researchers to publish conservation design proposals as well as tests of existing conservation products’ functionality, in order to improve conservation design practice around the world

Discovery of a blue whale feeding and nursing ground in southern Chile

After the extensive exploitation that reduced the Southern Hemisphere blue whale (Balaenoptera musculus) populations to less than 3% of its original numbers, studies on its recovery have been compounded by the inaccessibility of most populations and the extensive migrations between low and high latitudes, thus ensuring that knowledge about blue whale ecology and status remains limited. We report the recent discovery of, arguably, the most important blue whale feeding and nursing ground known to date in the Southern Hemisphere, which is located near the fjords off southern Chile. Through aerial and marine surveys (n = 7) 47 groups, comprising 153 blue whales including at least 11 mother-calf pairs, were sighted during the austral summer and early autumn of 2003. The implications of this discovery on the biological understanding and conservation of this endangered species are discussed

Dexamethasone-associated toxicity during induction chemotherapy for childhood acute lymphoblastic leukemia is augmented by concurrent use of daunomycin

Background: The goals of the current study were to examine the incidence and severity of toxicity resulting from dexamethasone and prednisone during induction therapy for children with precursor B-cell acute lymphoblastic leukemia (ALL) and to determine whether the addition of daunomycin affected toxicity.Methods: Medical records of patients with precursor B-cell ALL from January 1996 through June 2000 were reviewed retrospectively for toxicity during the 4-week induction phase and the 2 weeks after the induction phase.Results: One hundred seventy-six patients age \u3c 14 years were diagnosed with precursor B-cell ALL from January 1996 through June 2000. Of the 156 evaluable patients, 106 were treated with prednisone and 50 with dexamethasone. Fifty-two patients received steroids, L-asparaginase, and vincristine, whereas 104 high-risk patients received daunomycin in addition to these 3 agents. The incidence of gastritis was significantly higher among patients receiving dexamethasone (P = 0.01); incidence rates of hyperglycemia, hypertension, and myopathy were similar for all treatment groups. Dexamethasone led to more weight gain than did prednisone (+11.9% vs. +5.4%; P = 0.002). Serious infections were observed in 27 (25.5%) and 18 (36%) patients receiving prednisone and dexamethasone, respectively (P \u3c or = 0.2). Five patients, four of whom received prednisone and one of whom received dexamethasone, died of infection. The addition of daunomycin to treatment regimens increased overall toxicity (P \u3c 0.01). When daunomycin was included in treatment regimens, toxicity was greater among patients receiving dexamethasone; in contrast, when daunomycin was not included, toxicity was equal for both treatment groups. Regardless of daunomycin use, there was no difference in the incidence of serious infection between the two groups. ALL treatment was not compromised by steroid-related toxicity in either group.Conclusions: The addition of daunomycin led to a much larger increase in dexamethasone-related toxicity compared with the increase in prednisone-related toxicity. Although the use of daunomycin enhanced dexamethasone-related toxicity, this enhancement did not result in a higher mortality rate or the alteration of planned ALL therapy

Molecular characterization of Cysticercus tenuicollis of slaughtered livestock in Upper Egypt governorates

Objective: To present the molecular characterization of Cysticercus tenuicollis (C. tenuicollis) of Taenia hydatigena (T. hydatigena) from livestock isolates in Egypt, and to introduce a detailed image of C. tenuicollis infection in ruminant animals in Upper Egypt. Methods: The prevalence rates of C. tenuicollis infections among the slaughtered animals from different organs were determined using the amplification of sequencing of the MT-CO1 gene. Results: In the present study the infection rates of C. tenuicollis were found to be 16% and 19% in sheep and goat samples respectively. Firstly we report one larval stage of T. hydatigena detected in the camel liver in Egypt. C. tenuicollis infection manifested a higher prevalence in females than in males. Those above two years of age manifested a higher infection rate than younger animals. The preferred site for the infection was the omentum: a 70% preference in sheep and a 68% preference in goats. The molecular characterization using the MT-CO1 gene of isolates from sheep, goats and camels corresponded to T. hydatigena. For this study, molecular characterizations of T. hydatigena were done for the first time in Egypt. Molecular tools are of great assistance in characterizing the C. tenuicollis parasite especially when the morphological character cannot be detected, because the metacestodes are frequently confused with infection by the hydatid cyst, especially when these occur in the visceral organs. In the present study, C. tenuicollis manifested high identity in the goat and sheep samples, while differences were found more frequently in the camel samples (10 base pair). Conclusions: Clearly molecular diagnosis for C. tenuicollis infection significantly helps to differentiate it from such other metacestodes as hydatidosis, which manifests a completely different pathogenicity and requires different control programs

Changes in Phytochemical Compounds and Antioxidant Activity of Two Irradiated Sorghum (<i>Sorghum bicolor</i> (L.) Monech) Cultivars during the Fermentation and Cooking of Traditional Sudanese Asida

This study investigated the chemical changes of phytochemicals and antioxidant activity during the preparation of traditional Sudanese asida prepared from gamma-radiated (1.0 and 2.0 kGy) flour of two sorghum cultivars (Tabat and Wad Ahmed). For both cultivars, the irradiation process significantly (p 2O2 scavenging) were significantly increased in both the Tabat (85.0%, 3.8 mg AAE/g, and 84.6%, respectively) and the Wad Ahmed (89.6%, 3.9 mg AAE/g, and 83.1%, respectively) sorghum cultivar grains, particularly in those processed from 2.0 kGy-irradiated flour. A positive high correlation was observed between gamma radiation (2.0 kGy) and the antioxidant activity of asida prepared from both cultivars. In conclusion, traditional fermented asida obtained from irradiated flour showed high antioxidant activity in both sorghum cultivars

Improved outcome for children with acute lymphoblastic leukemia after risk-adjusted intensive therapy : A single-institution experience

Background and Objective: Because of the need for more comprehensive information on the least toxic and most effective forms of therapy for children with acute lymphoblastic leukemia (ALL), we reviewed our ex--perience in the treatment of children with ALL at King Faisal Specialist Hospital and Research Centre (KFSH&RC) and King Fahad National Center for Children&#x2032;s Cancer and Research (KFNCCC&R) over a period of 18 years with a focus on patient characteristics and outcome. Methods: During the period of 1981 to 1998, records of children with ALL were retrospectively reviewed with respect to clinical presentation, laboratory findings, risk factors, stratification, therapy and outcome. The protocols used in treatment included 4 local protocols (KFSH 81, 84, 87 and 90), and subsequently, Children&#x2032;s Cancer Group (CCG) protocols, and these were grouped as Era 1 (1981-1992) and Era 2 (1993-1998). Results: Of 509 children with ALL treated during this period, 316 were treated using local protocols and 193 using CCG protocols. Drugs used in Era 1 included a 4-drug induction using etoposid (VP-16) instead of L-asparaginase. Consolidation was based on high dose methotrexate (MTX) 1g/m 2 and maintenance was based on oral mercaptopurine (6-MP) and MTX with periodic pulses using intravenous teniposide (VM-26), Ara-C, L-asparaginase, adriamycin, prednisone, VP-16 and cyclophosphamide. International protocols were introduced in Era 2, which was also marked by intensification of early treatment, a wider selection of cytoreductive agents, and the alternating use of non-cross-resistant pairs of drugs during the post-remission period. The end-of-induc--tion remission rate improved from 90&#x0025; in Era 1 to 95&#x0025; in Era 2, which was of borderline statistical signifi--cance (P=.049). The 5-year event-free survival (EFS) improved from 30.6&#x0025; in Era 1 to 64.2&#x0025; in Era 2 (P&#60; .001). Improvement in outcome was achieved without any significant increase in morbidity or mortality, due to im--provement in both systemic therapy and supportive care. The most important independent prognostic factors were intensity of therapy, poor risk category assignment and CNS disease at diagnosis. Conclusion: Outcome in children with ALL has improved because of intensification of treatment protocols and better supportive care

Diverse pathways for climate resilience in marine fishery systems

Both the ecological and social dimensions of fisheries are being affected by climate change. As a result, policymakers, managers, scientists and fishing communities are seeking guidance on how to holistically build resilience to climate change. Numerous studies have highlighted key attributes of resilience in fisheries, yet concrete examples that explicitly link these attributes to social‐ecological outcomes are lacking. To better understand climate resilience, we assembled 18 case studies spanning ecological, socio‐economic, governance and geographic contexts. Using a novel framework for evaluating 38 resilience attributes, the case studies were systematically assessed to understand how attributes enable or inhibit resilience to a given climate stressor. We found population abundance, learning capacity, and responsive governance were the most important attributes for conferring resilience, with ecosystem connectivity, place attachment, and accountable governance scoring the strongest across the climate‐resilient fisheries. We used these responses to develop an attribute typology that describes robust sources of resilience, actionable priority attributes and attributes that are case specific or require research. We identified five fishery archetypes to guide stakeholders as they set long‐term goals and prioritize actions to improve resilience. Lastly, we found evidence for two pathways to resilience: (1) building ecological assets and strengthening communities, which we observed in rural and small‐scale fisheries, and (2) building economic assets and improving effective governance, which was demonstrated in urban and wealthy fisheries. Our synthesis presents a novel framework that can be directly applied to identify approaches, pathways and actionable levers for improving climate resilience in fishery systems

Diverse pathways for climate resilience in marine fishery systems

Includes authors from ICES.</p