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

Natural radionuclides content and radioactive series disequilibrium in drinking waters from Balkans region

Natural radioactivity of drinking water with various geological origin in Balkans region has been studied. Collected water samples are analyzed for total alpha and total beta activities and specific alpha- and gamma-emitting radionuclides content using low-background proportional counting and alpha and gamma-spectrometry techniques. Obtained activity concentrations of U-238, U-234, U-235, Ra-226, Th-232, and K-40 in water samples and radioactive disequilibrium between members of the natural radioactive series, based on the isotopic ratios, has been discussed

State of elements of the environment in the broader area of former uranium mines in the catchment of the Trgoviski Timok

Mineral field ”Janja” extends over the Southwest slope of Stara Planina Mt., eastward from the village of Kalna in the belt of beech-fir forests. Exploitation of uranium used to be performed in three mines within this area, i.e. ”Mezdreja”, ”Gabrovnica”, and ”Srneći Do”, which are now closed down. One of the consequences of mining around these mines is partial degradation of natural balance. The greatest part of the terrain consists of granite, whereas metamorphic rocks are at the periphery. A geological survey with respect to the concentration of natural radioactive elements in the soil within the area of aforementioned mines has been conducted once so far. Alluvial sediment, ground and surface waters, as well as disposal were also examined. During the field study, radioactivity was measured and the methods of emanation and hydro-geochemical assessment were used, which was followed by collecting of samples for laboratory examination. The state of elements of the environment within the surveyed area is presented hereinafter on the basis of the existing data, having in mind that exploitation of uranium may disrupt natural balance in the long run. [Projekat Ministarstva nauke Republike Srbije, br. 37008: Održivo gazdovanje ukupnim potencijalima šuma u Republici Srbiji

Interleukin-6 and procalcitonin as biomarkers in mortality prediction of hospitalized patients with community acquired pneumonia

Introduction: Community acquired pneumonia (CAP) may present as life-threatening infection with uncertain progression and outcome of treatment. Primary aim of the trial was determination of the cut-off value of serum interleukin-6 (IL-6) and procalcitonin (PCT) above which, 30-day mortality in hospitalized patients with CAP, could be predicted with high sensitivity and specificity. We investigated correlation between serum levels of IL-6 and PCT at admission and available scoring systems of CAP (pneumonia severity index-PSI, modified early warning score-MEWS and (Confusion, Urea nitrogen, respiratory rate, Blood pressure, ≥65 years of age-CURB65). Methods: This was prospective, non-randomized trial which included 101 patients with diagnosed CAP. PSI, MEWS and CURB65 were assessed on first day of hospitalization. IL-6 and PCT were also sampled on the first day of hospitalization. Results: Based on ROC curve analysis (AUC ± SE = 0.934 ± 0.035; 95%CI(0.864-1.0); P = 0.000) hospitalized CAP patients with elevated IL-6 level have 93.4% higher risk level for lethal outcome. Cut-off value of 20.2 pg/ml IL-6 shows sensitivity of 84% and specificity of 87% in mortality prediction. ROC curve analysis confirmed significant role of procalcitonin as a mortality predictor in CAP patients (AUC ± SE = 0.667 ± 0.062; 95%CI(0.546-0.789); P = 0.012). Patients with elevated PCT level have 66.7% higher risk level for lethal outcome. As a predictor of mortality at the cut-off value of 2.56 ng/ml PCT shows sensitivity of 76% and specificity of 61.8%. Conclusions: Both IL-6 and PCI are significant for prediction of 30-day mortality in hospitalized patients with CAP. Serum levels of IL6 correlate with major CAP scoring systems

Terrestrial radioactivity of the Jabal Eghei area in southern Libya and assessment of the associated environmental risks

Activity concentrations of main terrestrial radioisotopes Ra-226, Th-232 and K-40 were measured in geological samples collected in Libyas Jabal Eghei area, in order to contribute to the establishment of a baseline map of the environmental radioactivity levels and to estimate the associated environmental risk to the population. Activity concentrations ranged from 22 to 5256 Bq kg(1) for Ra-226, from 11 to 221 Bq kg(1) for Th-232 and from 132.0 to 2304 Bq kg(1) for K-40. Using these results, representative risk factors were calculated: the total absorbed gamma dose rate in air (ranged from 25.5 to 2434.3 nGy h(1) with a mean value of 251.8 nGy h(1)), the radium equivalent activity (555281 Bq kg(1), with the mean value of 537 Bq kg(1)), external hazard index (0.14914.24, with a mean value of 1.451) and annual outdoor effective dose (31.32985.4 Sv, with a mean value of 308.9 Sv). Accordingly, the radiation risk is above the world average, mainly as the consequence of discovered uranium anomalies