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

Synthetic sex pheromone of citrus leafminer in Brazilian citrus groves Feromônio sexual sintético do minador-dos-citros em pomares brasileiros de citros

The objective of this work was to determine the best conditions of use of the synthetic sex pheromone of Phyllocnistis citrella Stainton for monitoring this species in citrus groves in northeastern Brazil. Pheromone doses (0.0, 0.1, 1, 10 and 100 &#956;g) and longevity (1, 15, 29, 43 and 57-day-old lures) and trap height (0.5, 1.5 and 2.5 m), color (green, red, and white) and model influence on P. citrella males capture were evaluated. The doses of 10 and 100 &#956;g of the synthetic sex pheromone - a 3:1 blend of (Z,Z,E)-7,11,13-hexadecatrienal and (Z,Z)-7,11-hexadecadienal - attracted the greatest number of P. citrella males. Traps baited with these two both dosages continued to capture P. citrella males at a comparable rate for over eight weeks in citrus groves. Although there was no significant decrease in activity of both dosages until 57 days of exposure to the environment, the higher dose, as time passed, attracted significantly more P. citrella males than the lower dose. There were no significant differences in male capture in traps with synthetic sex pheromone placed at 1.5 and 2.5 m height, wich had the better results. Trap color and model did not affect male capture.<br>O objetivo deste trabalho foi determinar as melhores condições de uso do feromônio sexual sintético de Phyllocnistis citrella Stainton para o monitoramento dessa espécie em pomares de citros no Nordeste do Brasil. Foram avaliados: doses (0,0, 0,1, 1, 10 e 100 &#956;g), duração (1, 15, 29, 43 e 57 dias de exposição do feromônio sexual sintético), altura de instalação (0,5, 1,5 e 2,5 m), cor (verde, vermelha e branca) e modelo de armadilha na captura de machos de P. citrella. As doses de 10 e 100 &#956;g do feromônio sintético - proporção de 3:1 da mistura de Z,Z,E-7,11,13-hexadecatrienal e (Z,Z)-7,11-hexadecadienal - atraíram o maior número de machos de P. citrella. Armadilhas contendo a mistura feromonal nessas duas doses capturaram machos de P. citrella por mais de oito semanas em pomares de citros. Embora nenhuma das duas doses tenha sofrido decréscimo na atividade por até 57 dias de exposição ao ambiente, com o passar do tempo a maior dose atraiu significativamente mais machos de P. citrella que a menor dose. Não houve diferença significativa na captura de machos nas armadilhas com o feromônio sexual instaladas a 1,5 e 2,5 m de altura, as quais apresentaram os melhores resultados. O modelo e a cor das armadilhas não afetaram a captura dos machos