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

Mermithid and microsporidan parasitism of blackflies (Diptera: Simuliidae) in the vicinity of Churchill Falls, Labrador

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Effect of six-weekly harvests on the yield, chemical composition and dry matter degradability of Panicum maximum and Stylosanthes hamata in Nigeria

The dry matter (DM) yield and degradability of 6-week-old harvests of tropical forages were measured over a season. The forages were nitrogen-fertilized Guinea grass (Panicum maximum, NFG), unfertilized Guinea grass (UFG), Verano stylo (Stylosanthes hamata,VS), a Guinea grassVerano stylo mixture (GSM) and Guinea grass in the grassVerano stylo mixture (GGSM). Six-week-old forages were made possible through a cutting regime, which produced four harvests in the growing season. The DM yields of the forages differed significantly (P < 0·001) and showed a significant reduction (P < 0·01) across the season. Crude protein and neutral-detergent fibre concentrations were significantly (P < 0·01) different between the forages but there was no difference between harvests. The DM degradability of the forages at all harvests were significantly (P < 0·001) different with differences in the soluble fraction (a), degradable fraction (b), potential degradability (PD) and effective degradability (ED), but rate of degradability (c) did not show any significant difference between the forages. Significant (P < 0·01) differences were found between harvests for b and PD, and for the interaction between forage and harvest for b, PD and ED but were not found for the a and c fractions. Both the PD and ED values of all the forages fell with advancing harvests. Although the 6-week-old harvests of forage were found not to influence the characteristic reduction in yield of tropical grasses over time, it is concluded that such a management system could be used to obtain forage of relatively high nutritive value during the growing season