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

The influence of energy-restriction on accumulation of Heligmosomoides polygyrus (Nematoda) in outbred CD-1 mice in free-running arenas

The influence of energy restriction on the transmission dynamics of a direct life cycle nematode, Heligmosomoides polygyrus, within free-running arena Systems has to date remained unexplored. Indoor populations of CD-1 outbred mice were established for 12 weeks in arenas and fed either energy-suffi ci ent (ES) or energy-restricted (ER-20% réduction in metabolizable energy) diets. Infection was introduced to ail arenas following 3 weeks of diet treatment. Contrary to previous findings, the mice fed the ER diets compensated for the deficiency by increasing food consumption and thus, while early in the experiment energy restriction was evident, dietary effects were no longer observed after 6 weeks. Worm burdens, measured at 4 time points over the course of the experiment, were higher in mice fed the ES diets. Although mice fed the ER diets had greater contact with infected areas, the mice fed the ES diets increased the duration of behaviours that heighten ingestion of the parasite - self and allogrooming. Dietary effects on behaviour were observed only after infection was introduced and were more pronounced in the durations of individual bouts rather than in overall durations or time budgets. Nesting bouts were prolonged in mice in the ER arenas perhaps as a means of thermoregulation to counteract the combined effects of infection and energy restriction. The duration of exploratory bouts was also higher in the ER mice possibly due to an inability to receive or process information in their environment. Social interactions, predominantly involving sniffing, increased after infection was introduced, supporting the rôle of odour in communicating infection status in same-sex conspecifics. Together these results provide a more comprehensive ethogram of mice in a semi-natural setting and highlight those behaviours where adaptive plasticity allows response to dietary and infection stresses

Nematode lungworms of two species of anuran amphibians: Evidence for co-adaptation

Genetic studies have indicated that some parasite species formerly thought to be generalists are complexes of morphologically similar species, each appearing to specialize on different host species. Studies on such species are needed to obtain ecological and parasitological data to address whether there are fitness costs in parasitizing atypical host species. We examined whether lungworms from two anuran host species, Lithobates sylvaticus and Lithobates pipiens, differed in measures of infection success in L. pipiens recipient hosts. We also determined if the worms from the two host species were sources of genetically resolvable species of morphologically similar nematodes. Sequences of internal transcribed spacer and lsrDNA regions of adult lungworms from each host species indicated that worms from L. sylvaticus matched Rhabdias bakeri, whereas worms from L. pipiens matched Rhabdias ranae. Our work suggested that these morphologically similar species are distant non-sibling taxa. We infected male and female metamorphs experimentally with lungworm larvae of the two species. We observed higher penetration, higher prevalence and higher mean abundance of adult worms in lungs of male and female metamorphs exposed to R. ranae larvae than in lungs of metamorphs exposed to R. bakeri larvae. Furthermore, metamorphs exposed to R. ranae larvae carried larger adult female worms in their lungs. Some variation in infection measures depended on host sex, but only for one parasite species considered. Overall, the differential establishment and reproductive potential of R. ranae and R. bakeri in L. pipiens suggests co-adaptation

Food and environmental parasitology in Canada:A network for the facilitation of collaborative research

Parasitic diseases are of considerable public health significance in Canada, particularly in rural and remote areas. Food- and water-borne parasites contribute significantly to the overall number of parasitic infections reported in Canada. While data on the incidence of some of these diseases are available, knowledge of the true burden of infection by the causative agents in Canadians is somewhat limited. A number of centers of expertise in Canada study various aspects of parasitology, but few formal societies or networks of parasitologists currently exist in Canada, and previously none focused specifically on food or environmental transmission. The recently established Food and Environmental Parasitology Network (FEPN) brings together Canadian researchers, regulators and public health officials with an active involvement in issues related to these increasingly important fields. The major objectives of the Network include identifying research gaps, facilitating discussion and collaborative research, developing standardized methods, generating data for risk assessments, policies, and guidelines, and providing expert advice and testing in support of outbreak investigations and surveillance studies. Issues considered by the FEPN include contaminated foods and infected food animals, potable and non-potable water, Northern and Aboriginal issues, zoonotic transmission, and epidemiology