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

Deficiência nutricional em bastão-do-imperador (Etlingera elatior (Jack) R. M. Smith): efeito na produção de matéria seca e índices biométricos Nutritional deficiency in torch ginger (Etlingera elatior (Jack) R. M. Smith): effect on dry matter production and biometrical index

Neste trabalho, objetivou-se avaliar os efeitos de omissões de nutrientes na produção de matéria seca e nos parâmetros de crescimento do bastão-do-imperador. O trabalho foi realizado em casa de vegetação da área experimental do Departamento de Ciência do Solo da Universidade Federal de Lavras (Lavras, MG), no período de janeiro de 2007 a janeiro de 2008. O delineamento experimental foi inteiramente casualizados com quatro repetições e oito tratamentos: Solução Hoagland & Arnon completa, soluções nutritivas com as omissões de N, de P, de K, de Ca, de Mg, de S e de B. Foram avaliadas a altura das plantas, diâmetro das hastes, número de hastes, número de folhas por hastes e volume da raiz. Posteriormente, as plantas foram divididas em folhas, hastes, rizoma e raiz para determinação da massa de matéria seca de cada parte. A omissão de nutrientes afetou os parâmetros de crescimento das plantas e a produção de matéria seca. Observou-se que o bastão-do-imperador mostrou-se mais exigente em B, K, N, P e S na fase inicial de crescimento do que em Ca e Mg. A redução da matéria seca total das plantas foi influenciada na seguinte ordem: B > K > N > P > S > Mg > Ca.<br>The objective of this work was to evaluate the effect of simple and multiple nutrient omissions on the dry matter production and growth parameters of torch ginger plants. The experiment was carried out under greenhouse conditions at the Soil Science Department of Federal University of Lavras (Lavras-MG). The experiment was started in January 2007 and lasted for 12 months, following a completely randomized design, with four replicates and eight treatments: Complete Hoagland & Arnon nutrient solution, and nutrient solutions without N, P, K, Ca, Mg, S, and B. Plant height, stem diameter, number of stems, number of leaves per stem, and volume of root were evaluated. Subsequently the plants were divided into leaf + pseudostem, rhizome, root and tillers for dry matter determination. The nutrient omissions affected the growth parameters and dry matter production. It was observed that torch ginger is more demanding in B, K, N, P and S at the initial phase of growth rather than in Ca and Mg. The reduction of the total dry matter weight of the plants was affected in the following order: B> K> N> P> S> Mg> Ca