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

Differential glycosylation of gelatinase B from neutrophils and breast cancer cells.

An inverse correlation between dispersal ability and genetic differentiation among populations of a species is frequently observed in the marine environment. We investigated the population genetic structure of the free-living marine nematode Pellioditis marina. A total of 426 bp of the mitochondrial cytochrome oxidase subunit 1 (COI) gene were surveyed on a geographical scale of approximately 100 km during spring 2003. Nematodes were collected from 2 coastal locations in Belgium, and from 2 estuaries and a saltwater lake (Lake Grevelingen) in The Netherlands. Molecular variation was assessed with the single-strand conformation polymorphism (SSCP) method. In total, 32 different haplotypes were observed, and sequence divergence among 452 individuals ranged from 0.2 to 10.6%. We discovered 4 distinct mitochondrial lineages, with low divergences within the lineages (0.2 to 1.6%) and high divergences between the lineages (5.1 to 10.6%). The nuclear ribosomal ITS (internal transcribed spacer) region showed concordant phylogenetic patterns, suggesting that nematode species diversity may be considerably underestimated. Analysis of molecular variance (AMOVA) indicated a strong genetic differentiation among populations. The Lake Grevelingen population was clearly differentiated from all other populations, but genetic structuring was also significant within the Westerschelde and was correlated with gradients in salinity and pollution. The observed population genetic structure is in accordance with the limited active dispersal capacity of P. marina, but is at variance with its significant potential for passive dispersal. We therefore suggest that autecological characteristics, including short generation time, high colonization potential and local adaptation, may be at the basis of this nematode’s population genetic structure