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

Efeitos da calagem e da adubação potássica sobre características agronômicas e propriedades tecnológicas da fibra do algodoeiro Effects of liming and potassium fertilization on the agronomic characteristics and technological properties of the cotton fiber

Em latossolo roxo, ácido e de baixa fertilidade, do município de Guaíra (SP), implantou-se, em 1976, um ensaio permanente de calagem e adubação potássica com o algodoeiro, variedade IAC 18. Em esquema de parcelas subdivididas, o calcário dolomítico foi incorporado às parcelas nas doses de 0, 2, 4 e 6 t/ha no primeiro ano. O potássio foi aplicado anualmente, nas doses de 0, 50, 100 e 150 kg/ha de K2O, na forma de cloreto e na presença de doses constantes de N, P2O5 e, quando necessário, boro. No sexto ano (1981/82), reaplicou-se o calcário nas doses originais e, nos anos subseqüentes até 1985/86, utilizou-se a variedade IAC 20. No primeiro ciclo de calagem, o calcário alterou positivamente a massa de um capulho e deprimiu a de cem sementes. Ambas as características foram beneficiadas pela adubação potássica. Quanto às propriedades tecnológicas da fibra, o comprimento, a maturidade, o índice Micronaire e a tenacidade diminuíram com a calagem, enquanto a adubação potássica proporcionou melhoria apenas à uniformidade de comprimento e índice Micronaire. A porcentagem de fibra não foi afetada pela calagem e teve seus valores diminuídos pela ação do potássio. Os resultados do segundo ciclo de calagem confirmaram o efeito positivo do calcário sobre a massa de um capulho e da adubação potássica nessa característica e também na massa de cem sementes. Verificou-se, ainda, efeito depressivo do corretivo na porcentagem de fibra. Quanto às propriedades tecnológicas da fibra, a calagem se mostrou tão prejudicial como na primeira fase, enquanto o uso do potássio continuou concorrendo para aumentar a uniformidade de comprimento, o índice Micronaire e a maturidade da fibra. Essa prática deprimiu os valores de tenacidade da fibra. Em nenhum dos dois ciclos, verificou-se interação entre calagem e adubação potássica.<br>The effects of liming and potassium fertilization on the agronomic characteristics and technological properties of the cotton fiber were studied in a permanent trial on a Dystrophic Dusky Red Latosol, acid, of low fertility during growing seasons of 1976/77 to 1985/86. A split-plot design was used, dolomitic limestone being applied on the plots at the levels of 0, 2, 4 and 6 t/ha, while the doses of 0, 50, 100 and 150 kg/ha of K(2)0, corresponded to the subplots. Lime was applied in the first year, and the experiment was conducted and reapplicated during 1981/82, while potassium was furnished annualy, at planting time, in mixture with NK fertilizers. Liming caused an increase in the mass of bolls and reduced the mass of seed, length, length uniformity, Micronaire index, maturity and fiber strength. Potassium fertilization caused an increase in mass of bolls and seeds, length uniformity, Micronaire index, maturity and fiber strength, when was applied, on the last, the correction of the Pressley values. Anyone interaction between lime and potassium was observed