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

Innovations in Starch-Based Film Technology

Edible and biodegradable films can offer great potential to enhance food quality, safety and stability. The unique advantages of edible films and coatings may lead to new product developments, such as individual packaging of particulate foods, carriers for different additives, and nutrient supplements (Vermeiren et al., 1999). Composite films can be formulated to combine the advantages of each component. Proteins and polysaccharides provide the supporting matrix and are good barriers to gases, while lipids provide a good barrier to water vapor (Krochta and De Mulder Johnston, 1997). Over the last few years, there has been a renewed interest in biodegradable films and films made from renewable and natural polymers such as starch (Lawton, 1996; Vicentini et al., 2005). Several studies have been done to analyze the properties of starch-based films (Lawton and Fanta, 1994; Lourdin et al., 1995; Arvanitoyannis et al., 1998; Garcia et al., 1998a, 1998b, 2000a, 2000b, 2001; Mali et al., 2002; Vicentini et al., 2005). The use of a biopolymer such as starch can be an interesting solution because this polymer is quite cheap, abundant, biodegradable and edible. Amylose is responsible for the film-forming capacity of the starches. Starches are polymers that naturally occur in a variety of botanical sources such as wheat, corn, potatoes and tapioca or cassava. It is a renewable resource widely available and can be obtained from different by-products of harvesting and raw material industrialization.Fil: Garcia, Maria Alejandra. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos; ArgentinaFil: Rojas, Ana Maria Luisa. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Laurindo, J.B.. Universidade Federal de Santa Catarina; BrasilFil: Romero Bastida, C.A.. Instituto Politécnico Nacional; MéxicoFil: Grossmann, M.V.E.. Universidade Estadual de Londrina; BrasilFil: Martino, Miriam Nora. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos; ArgentinaFil: Flores, S.. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; ArgentinaFil: Zamudio Flores, P.B.. Instituto Politécnico Nacional; MéxicoFil: Mali, S.. Universidade Estadual de Londrina; BrasilFil: Zaritzky, Noemi Elisabet. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos; ArgentinaFil: Sobral, P.. Universidade de São Paulo; BrasilFil: Famá, L.. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; ArgentinaFil: Bello Pérez, L.A.. Instituto Politécnico Nacional; MéxicoFil: Yamashita, F.. Universidade Estadual de Londrina; BrasilFil: Beleia, A. del P.. Universidade Estadual de Londrina; Brasi