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.

To compare the effects of testosterone on intraocular pressure (IOP), retinal nerve ber layer thickness (RNFL), ganglion cell complex (GCC), macular thickness (MT), and ocular blood ow between female-tomale transgender (FMT) persons who use testosterone and healthy women and healthy men. MethodThe study included 39 eyes of 20 FMT(group 1), 40 eyes of 20 healthy women (group 2), and 42 eyes of 21 healthy men (group 3). In all subjects, RNFL, GCC, MT were measured by optical coherence tomography (OCT). Ocular blood ow was measured by Colour Doppler Ultrasonography in all subjects. ResultsIOP levels in FMT were signi cantly higher than men (p = 0.02). Para superior (Sup), Para inferior (Inf) and Peri nasal (Nas) thickness in FMT were signi cantly higher than the group 2 (p = 0.02, p = 0.03, p = 0.01). Peri Sup thickness in FMT was signi cantly higher than group 3 (p = 0.01). Peri Inf thickness in FMT was signi cantly higher than group 2 and 3 (p = 0.03, p = 0.002). Mean thickness of RNFL Inf in FMT was signi cantly higher than the group 2 and 3 (p = 0.03, p = 0.03). Avg GCC, Inf GCC in FMT were signi cantly higher than group 2 (p = 0.02, p = 0.005). In correlation test, systole/diastole ratio(S/D) in Ophthalmic artery (OA) (r = 0.504, p = 0.028) and Inf RNLF thickness (r = 0.485, p = 0.035) were positively correlated with the serum levels of testosterone in FMT. ConclusionsWe found that the use of supraphysiologic testosterone dose increased IOP and the thickness of macula, RNFL and GCC in FMT. Serum testosterone level was positively correlated with S/D ratio in the OA.

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Introduction. Assigned female at birth transgender people go through a gender-affirming hormone therapy using testosterone. We aimed to define the histological changes in the removed ovaries of these patients and investigate the correlation of these changes to factors like chronological age and duration of hormone therapy. Methods. The ovaries of 84 patients who had at least 6 months of testosterone therapy before surgery were examined. Tunica albuginea thickness, cortical thickness, and number of different stages of follicles were recorded. Results. The mean age was 27.2 ± 4.9 years. Testosterone duration 25.8 ± 13.1 months. The mean tunica albuginea thickness was 356.4 ± 152.6 µm. The mean cortical thickness was 799.6 ± 245.6 µm. The number of primordial (C1) follicles was 18.03 ± 13.6 and antral (C3) follicles was 3.1 ± 1.9 per cm². When grouped as using therapy under or over 2 years the groups did not have differences in histological findings. Hormone duration did not correlate with histological findings except for a positive correlation with atretic follicle number. However, age was negatively correlated with number of follicles at all stages except atretic follicles and positively correlated with cortical thickness ( P < .05). Conclusion. Testosterone therapy induces multifollicularity, stromal hyperplasia, and luteinization in some patients. Hormone duration did not correlate with ovarian histology whereas chronological age did suggesting an effect of age on ovarian reserve rather than duration of hormone therapy.