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

Stable isotope ratio analysis of lactose as a possible potential geographical tracer of milk

With the aim of evaluating the power of the stable isotope ratio analysis of milk lactose as a possible geographic tracer, one hundred and twenty (120) samples of authentic milk from different European countries (Italy, Germany, Austria, France, Spain) were analyzed. The lactose of each was separated and fermented to obtain the alcohol which was analyzed to determine the stable isotope ratios (D/H)I, (D/H)II and δ13C. The δ13C values showed a close correlation with the diet followed by the animal (C3 and/or C4 plants) while the (D/H)I ratio was more correlated with the δ18O of drinking water and therefore with the geographical origin of the milk. Significant differences were found in the (D/H)II ratio of alcohol obtained from the same lactose through the use of different yeasts. The analysis of the δ18O of the bulk milk and of the water drunk by the animals showed how the two parameters are closely correlated with each other with differences that can vary according to the type of farm (grazing or not). The method reported here has been validated by two different European laboratories in terms of repeatability and reproducibilit

Integrated full-scale solar CPC/UV-LED–filtration system as a tertiary treatment in a conventional WWTP for agricultural reuse purposes

Today, the emergence of increasingly restrictive treatment and reuse policies make the implementation of full-scale tertiary treatment, capable of improving the quality of water, a priority. Full-scale TiO2 photocatalysis systems are resulting in a promising option, since TiO2 is commercially available. However, questions such as how to work continuously during day/night irradiation cycle, or the removing of TiO2 in outlet flow are still unresolved. In this work, a full-scale system integrating a solar CPC/UV-LED step combined with commercial microfiltration membranes was installed in a conventional WWTP for agricultural reuse purposes. After optimization, 0.5 g/L of catalyst and combined SOLAR + UV-LED showing the highest pharmaceutical removal percentages, while a self-designed UV-LED included in the own reaction tank resulting in higher efficiencies compared with commercial lamps. Longer membrane surface area decreased fouling problems in the system. However, 60 min of irradiation time was necessary to reach the most restrictive water quality values according with (EU 2020/741). After optimization step, total costs were reduced by 45%. However, it was shown that a reduction in operating and maintenance costs, along with the development of more effective and economical commercial filtration membranes is a key factor; therefore, working on these aspects is essential in the treated water cost reductionThe work included in this article is part of the strategic project Ris3MUR DIRELMIVID (EXP: 2120SAE00078), funded by the Consejería de Empresa, Industria y Portavocía, within the framework of the European Regional Development Fund 2014–2020Peer reviewe

Carbon nanotubes/chitin nanowhiskers aerogel achieved by quaternization-induced gelation

Organic aerogels from polysaccharides such as cellulose and chitin are of particular importance because they utilize renewable feedstocks. In this article, the aerogels were prepared through the self-assembly of chitin nanowhiskers previously modified. The surface of chitin nanowhiskers was rendered cationic through two reactions. A first reaction between hydroxyl groups of chitin and 2-chloroethyl isocyanate and a second reaction between the chloride groups of isocyanate anchored to the surface and 1-methylimidazole. This modification led to stable aqueous suspensions of the chitin nanowhiskers with gelation and rheological properties. Additionally, chitin nanowhiskers aerogels containing modified carbon nanotubes were obtained. The addition of modified carbon nanotubes provoked a change in the morphology of the hydrogels and as a consequence, the rheological properties of the hydrogel are modified as well. In contrast from previous procedures, this method has not required any kind of solvent exchange or high pressure in order to obtain the final materials