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

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Caracterización antigénica de poblaciones de trypanosoma rangeliaisladasen ciclos de transmisión doméstica y silvestre en Colombia :

IP 1105-05-279-99Guhl. -- En: Mem inst Oswaldo Cruz. -- Vol. 96, no. 8 (nov. 201); p. 1043-1048. -- Molecular characterization;and diagnosis of trypanosoma cruzi and T. rangeli / FelipeGuhl,Carlos Jaramillo, Julio Cesar Carranza,;Gustavo Adolfo Vallejo. -- En: Archives of medical research. --No. 33 (2002); p. 362-370. -- kDNA markers;define two major trypanosoma rangeli lineages in latin America/Gustavo Adolfo Vallejo, Felipe Guhl, Julio;Cesar Carranza, Leyder Elena Lozano, Jorge L. Sanchez, Jose C.Jaramillo,Diego Gualtero, Nadia Castañeda,;Julio C. Silva, Mario Steindel. -- En: Acta tropica. -- No. 81(2002); p.77-82. -- Short technical reports:;Hybridization screening of very short PCR products for paleoepidemiological studies of chagas disease. -- En:;Biotechniques. -- No. 30 (Jan. 2001); p. 102-109. -- Parity betwen kinetoplast DNA and mini exon gene;sequences supports either clonal evolution or speciation in trypanosoma rangeli strains isolated from rhodnius;colombiensis, R. pallescens and R. prolixus in Colombia /Gustavo adolfo Vallejo, Felipe Guhl, Julio Cesar;Carranza, Jaime Moreno, Omar Triana, Edmundo Carlos Grisard. --En: Infection genetics and evolution. -- No.;67 (2002); p. 1-7. -- PONENCIA(S) EN CONGRESO: Caracterizacionantigenicade cepas trypanosoma rangeli;aisladas en ciclos de transmision domestica y silvestre enareasendemicasde Colombia / Carlos Alberto Aya,;Andrea Arevalo, Daniel Urrea, Jorge Garcia, Derly Yara, LeyderE. Lozano,Julio C. Carranza, Gustavo A. -- En:;ARTICULO(S) EN REVISTA: Amplification of a specific repetitiveDNA sequence for trypanosoma rangeli;identification and its potential application in epidemiologicalinvestigations / Nancy Vargas, Ricardo P.;Souto, Julio Cesar Carranza, Gustavo Adolfo Vallejo, Bianca Zingales. -- En: Experimental parasitology. -- No.;96 (2000); p. 147-159. -- Chagas disease and human migration /Felipe Guhl, Carlos Jaramillo, Gustavo Adolfo;Vallejo, Felipe Cardenas, A. Arroyo, Arthur Aufderheide. -'- Vol.95, no. 4(jul.-ago. 2000); p. 553-555. --;Differentiation and genetic analysis of rhodnius prolixusandrhodnius colombiensis by rDNA and RAPD;amplification / Carlos Jaramillo, Maria Fernanda Montaña,LydaRaquel Castro, Gustavo Adolfo Vallejo, Felipe;de la Universidad del Tolima / Julio Cesar Carranza M., LeyderElena Lozano, Gustavo Adolfo Vallejo. -- En:;Sistemas de Informacion Geografica, Sensores Remotos y GeneticaPoblacional de Vectores y Parasitos Aplicados;al Control de la Enfermedad de Chagas / Curso Taller Internacional Sistemas de Informacion Geografica,;Sensores Remotos y Genetica Poblacional de Vectores y ParasitosAplicadosal Control de la Enfermedad de;Chagas (2002 dic. 2-6 : Bogotá) ; Editores Felipe Guhl, CarlosJaramillo.'-- Bogotá : Universidad de Los;Andes, c2002. -- 224 p. : il., mapas, tablas ; 28 cm. -- ISBN9583437021.;Congreso Nacional de Ciencias Biologicas (37 : 2002 oct. 1-4 :San Juan dePasto). -- San Juan de Pasto :;Universidad de Nariño, 2002. -- 28 cm. -- MEMORIA(S): Laboratorio de investigaciones en parasitologia tropica

Sensitivity of South American tropical forests to an extreme climate anomaly

NERC Knowledge Exchange Fellowship (NE/V018760/1) to E.N.H.C.The tropical forest carbon sink is known to be drought sensitive, but it is unclear which forests are the most vulnerable to extreme events. Forests with hotter and drier baseline conditions may be protected by prior adaptation, or more vulnerable because they operate closer to physiological limits. Here we report that forests in drier South American climates experienced the greatest impacts of the 2015–2016 El Niño, indicating greater vulnerability to extreme temperatures and drought. The long-term, ground-measured tree-by-tree responses of 123 forest plots across tropical South America show that the biomass carbon sink ceased during the event with carbon balance becoming indistinguishable from zero (−0.02 ± 0.37 Mg C ha−1 per year). However, intact tropical South American forests overall were no more sensitive to the extreme 2015–2016 El Niño than to previous less intense events, remaining a key defence against climate change as long as they are protected.Publisher PDFPeer reviewe

DRAMATURGIA-Proyecto ADAE

Sitio web del proyecto de investigación "Análisis de la dramaturgia actual en español; Cuba, México, Argentina, España (ADAE1)". consultado el 25/04/2019.La finalidad del Proyecto es estudiar la dramaturgia que se escribe y representa actualmente, o sea, desde hace dos o tres décadas, en el ámbito de la lengua española.Ministerio de Economía y Competitividad (España), proyecto FFI2008-01536Peer reviewe

Sensitivity of South American tropical forests to an extreme climate anomaly

Funder: A Moore Foundation grant, Royal Society Global Challenges grant (Sensitivity of Tropical Forest Ecosystem Services to Climate Changes), CNPq grants (441282/2016-4, 403764/2012-2 and 558244/2009-2), FAPEAM grants 1600/2006, 465/2010 and PPFOR 147/2015, CNPq grants 473308/2009-6 and 558320/2009-0. European Research Council (ERC Advanced Grant 291585 – ‘T-FORCES’), the Gordon and Betty Moore Foundation (#1656 ‘RAINFOR’, and ‘MonANPeru’), the European Union’s Fifth, Sixth and Seventh Framework Programme (EVK2-CT-1999-00023 – ‘CARBONSINK-LBA’, 283080 – ‘GEOCARBON’, 282664 – ‘AMAZALERT), the Natural Environment Research Council (NE/ D005590/1 – ‘TROBIT’, NE/F005806/1 – ‘AMAZONICA’, E/M0022021/1 - ‘PPFOR’), several NERC Urgency and New Investigators Grants, the NERC/State of São Paulo Research Foundation (FAPESP) consortium grants ‘BIO-RED’ (NE/N012542/1), ‘ECOFOR’ (NE/K016431/1, 2012/51872-5, 2012/51509-8), ‘ARBOLES’ (NE/S011811/1, FAPESP 2018/15001-6), ‘SEOSAW’ (NE/P008755/1), ‘SECO’ (NE/T01279X/1), Brazilian National Research Council (PELD/CNPq 403710/2012-0), the Royal Society (University Research Fellowships and Global challenges Awards) (ICA/R1/180100 - ‘FORAMA’), the National Geographic Society, US National Science Foundation (DEB 1754647) and Colombia’s Colciencias. We thank the National Council for Science and Technology Development of Brazil (CNPq) for support to the Cerrado/Amazonia Transition Long-Term Ecology Project (PELD/441244/2016-5), the PPBio Phytogeography of Amazonia/Cerrado Transition Project (CNPq/PPBio/457602/2012-0), PELD-RAS (CNPq, Process 441659/2016-0), RESFLORA (Process 420254/2018-8), Synergize (Process 442354/2019-3), the Empresa Brasileira de Pesquisa Agropecuária – Embrapa (SEG: 02.08.06.005.00), the Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP (2012/51509-8 and 2012/51872-5), the Goiás Research Foundation (FAPEG/PELD: 2017/10267000329) the EcoSpace Project (CNPq 459941/2014-3) and several PVE and Productivity Grants. We also thank the “Investissement d’Avenir” program (CEBA, ref. ANR-10LABX-25-01), the São Paulo Research Foundation (FAPESP 03/12595-7) and the Sustainable Landscapes Brazil Project (through Brazilian Agricultural Research Corporation (EMBRAPA), the US Forest Service, USAID, and the US Department of State) for supporting plot inventories in the Atlantic Forest sites in Sao Paulo, Brazil. L.E.O.C.A. was supported by CNPq (processes 305054/2016-3 and 442371/2019-5). We thank to the National Council for Technological and Scientific Development (CNPq) for the financial support of the PELD project (441244/2016-5, 441572/2020-0) and FAPEMAT (0346321/2021). NE/B503384/1, NE/N012542/1 - ‘BIO-RED’, ERC Advanced Grant 291585 - ‘T-FORCES’, NE/F005806/1 - ‘AMAZONICA’, NE/N004655/1 - ‘TREMOR’, NERC New Investigators Awards, the Gordon and Betty Moore Foundation (‘RAINFOR’, ‘MonANPeru’), ERC Starter Grant 758873 -‘TreeMort’, EU Framework 6, a Royal Society University Research Fellowship, and a Leverhulme Trust Research Fellowship.The tropical forest carbon sink is known to be drought sensitive, but it is unclear which forests are the most vulnerable to extreme events. Forests with hotter and drier baseline conditions may be protected by prior adaptation, or more vulnerable because they operate closer to physiological limits. Here we report that forests in drier South American climates experienced the greatest impacts of the 2015–2016 El Niño, indicating greater vulnerability to extreme temperatures and drought. The long-term, ground-measured tree-by-tree responses of 123 forest plots across tropical South America show that the biomass carbon sink ceased during the event with carbon balance becoming indistinguishable from zero (−0.02 ± 0.37 Mg C ha−1 per year). However, intact tropical South American forests overall were no more sensitive to the extreme 2015–2016 El Niño than to previous less intense events, remaining a key defence against climate change as long as they are protected

Memorias del primer Simposio Nacional de Ciencias Agronómicas

Primer simposio nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

Sensitivity of South American tropical forests to an extreme climate anomaly

Funder: A Moore Foundation grant, Royal Society Global Challenges grant (Sensitivity of Tropical Forest Ecosystem Services to Climate Changes), CNPq grants (441282/2016-4, 403764/2012-2 and 558244/2009-2), FAPEAM grants 1600/2006, 465/2010 and PPFOR 147/2015, CNPq grants 473308/2009-6 and 558320/2009-0. European Research Council (ERC Advanced Grant 291585 - 'T-FORCES'), the Gordon and Betty Moore Foundation (#1656 'RAINFOR', and 'MonANPeru'), the European Union's Fifth, Sixth and Seventh Framework Programme (EVK2-CT-1999-00023 - 'CARBONSINK-LBA', 283080 - 'GEOCARBON', 282664 - 'AMAZALERT), the Natural Environment Research Council (NE/ D005590/1 - 'TROBIT', NE/F005806/1 - 'AMAZONICA', E/M0022021/1 - 'PPFOR'), several NERC Urgency and New Investigators Grants, the NERC/State of Sao Paulo Research Foundation (FAPESP) consortium grants 'BIO-RED' (NE/N012542/1), 'ECOFOR' (NE/K016431/1, 2012/51872-5, 2012/51509-8), 'ARBOLES' (NE/S011811/1, FAPESP 2018/15001-6), 'SEOSAW' (NE/P008755/1), 'SECO' (NE/T01279X/1), Brazilian National Research Council (PELD/CNPq 403710/2012-0), the Royal Society (University Research Fellowships and Global challenges Awards) (ICA/R1/180100 - 'FORAMA'), the National Geographic Society, US National Science Foundation (DEB 1754647) and Colombia's Colciencias. We thank the National Council for Science and Technology Development of Brazil (CNPq) for support to the Cerrado/Amazonia Transition Long-Term Ecology Project (PELD/441244/2016-5), the PPBio Phytogeography of Amazonia/Cerrado Transition Project (CNPq/PPBio/457602/2012-0), PELD-RAS (CNPq, Process 441659/2016-0), RESFLORA (Process 420254/2018-8), Synergize (Process 442354/2019-3), the Empresa Brasileira de Pesquisa Agropecuaria - Embrapa (SEG: 02.08.06.005.00), the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESP (2012/51509-8 and 2012/51872-5), the Goias Research Foundation (FAPEG/PELD: 2017/10267000329) the EcoSpace Project (CNPq 459941/2014-3) and several PVE and Productivity Grants. We also thank the "Investissement d'Avenir" program (CEBA, ref. ANR-10LABX-25-01), the Sao Paulo Research Foundation (FAPESP 03/12595-7) and the Sustainable Landscapes Brazil Project (through Brazilian Agricultural Research Corporation (EMBRAPA), the US Forest Service, USAID, and the US Department of State) for supporting plot inventories in the Atlantic Forest sites in Sao Paulo, Brazil. L.E.O.C.A. was supported by CNPq (processes 305054/2016-3 and 442371/2019-5). We thank to the National Council for Technological and Scientific Development (CNPq) for the financial support of the PELD project (441244/2016-5, 441572/2020-0) and FAPEMAT (0346321/2021). NE/B503384/1, NE/N012542/1 - 'BIO-RED', ERC Advanced Grant 291585 - 'T-FORCES', NE/F005806/1 - 'AMAZONICA', NE/N004655/1 - 'TREMOR', NERC New Investigators Awards, the Gordon and Betty Moore Foundation ('RAINFOR', 'MonANPeru'), ERC Starter Grant 758873 -'TreeMort', EU Framework 6, a Royal Society University Research Fellowship, and a Leverhulme Trust Research Fellowship.AbstractThe tropical forest carbon sink is known to be drought sensitive, but it is unclear which forests are the most vulnerable to extreme events. Forests with hotter and drier baseline conditions may be protected by prior adaptation, or more vulnerable because they operate closer to physiological limits. Here we report that forests in drier South American climates experienced the greatest impacts of the 2015–2016 El Niño, indicating greater vulnerability to extreme temperatures and drought. The long-term, ground-measured tree-by-tree responses of 123 forest plots across tropical South America show that the biomass carbon sink ceased during the event with carbon balance becoming indistinguishable from zero (−0.02 ± 0.37 Mg C ha−1 per year). However, intact tropical South American forests overall were no more sensitive to the extreme 2015–2016 El Niño than to previous less intense events, remaining a key defence against climate change as long as they are protected.</jats:p

Memorias del primer Simposio Nacional de Ciencias Agronómicas

Primer simposio nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano