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

Increased blood meal size and feeding frequency compromise Aedes aegypti midgut integrity and enhance dengue virus dissemination.

Aedes aegypti is a highly efficient vector for numerous pathogenic arboviruses including dengue virus (DENV), Zika virus, and yellow fever virus. This efficiency can in part be attributed to their frequent feeding behavior. We previously found that acquisition of a second, full, non-infectious blood meal could accelerate virus dissemination within the mosquito by temporarily compromising midgut basal lamina integrity; however, in the wild, mosquitoes are often interrupted during feeding and only acquire partial or minimal blood meals. To explore the impact of this feeding behavior further, we examined the effects of partial blood feeding on DENV dissemination rates and midgut basal lamina damage in Ae. aegypti. DENV-infected mosquitoes given a secondary partial blood meal had intermediate rates of dissemination and midgut basal lamina damage compared to single-fed and fully double-fed counterparts. Subsequently, we evaluated if basal lamina damage accumulated across feeding episodes. Interestingly, within 24 hours of feeding, damage was proportional to the number of blood meals imbibed; however, this additive effect returned to baseline levels by 96 hours. These data reveal that midgut basal lamina damage and rates of dissemination are proportional to feeding frequency and size, and further demonstrate the impact that mosquito feeding behavior has on vector competence and arbovirus epidemiology. This work has strong implications for our understanding of virus transmission in the field and will be useful when designing laboratory experiments and creating more accurate models of virus spread and maintenance

Comparison of acarological risk metrics derived from active and passive surveillance and their concordance with tick-borne disease incidence

Tick-borne diseases continue to threaten human health across the United States. Both active and passive tick surveillance can complement human case surveillance, providing spatio-temporal information on when and where humans are at risk for encounters with ticks and tick-borne pathogens. However, little work has been done to assess the concordance of the acarological risk metrics from each surveillance method. We used data on Ixodes scapularis and its associated human pathogens from Connecticut (2019–2021) collected through active collections (drag sampling) or passive submissions from the public to compare county estimates of tick and pathogen presence, infection prevalence, and tick abundance by life stage. Between the surveillance strategies, we found complete agreement in estimates of tick and pathogen presence, high concordance in infection prevalence estimates for Anaplasma phagocytophilum, Borrelia burgdorferi sensu stricto, and Babesia microti, but no consistent relationships between actively and passively derived estimates of tick abundance or abundance of infected ticks by life stage. We also compared nymphal metrics (i.e., pathogen prevalence in nymphs, nymphal abundance, and abundance of infected nymphs) with reported incidence of Lyme disease, anaplasmosis, and babesiosis, but did not find any consistent relationships with any of these metrics. The small spatial and temporal scale for which we had consistently collected active and passive data limited our ability to find significant relationships. Findings are likely to differ if examined across a broader spatial or temporal coverage with greater variation in acarological and epidemiological outcomes. Our results indicate similar outcomes between some actively and passively derived tick surveillance metrics (tick and pathogen presence, pathogen prevalence), but comparisons were variable for abundance estimates

Adding to the mix: a multilevel analysis of residential burglary

Environmental research on residential properties’ vulnerability to burglary usually focuses either on the houses that have been burgled or on the streets in which they are located. This research explores both house and street level in a fixed-effects model and, using tangible CPTED measures, takes a wider perspective to assess vulnerability to burglary. The results indicate that dwelling type, visibility and boundary height have significant effects, and that street type and indicators of antisocial behaviour also have strong effects. Furthermore, these street-level variables appear to strengthen some of the house-level vulnerabilities. We argue that both house and street levels should therefore be included in any assessment of the risk of burglary. Environmental research on residential properties’ vulnerability to burglary usually focuses either on the houses that have been burgled or on the streets in which they are located. This research explores both house and street level in a fixed-effects model and, using tangible CPTED measures, takes a wider perspective to assess vulnerability to burglary. The results indicate that dwelling type, visibility and boundary height have significant effects, and that street type and indicators of antisocial behaviour also have strong effects. Furthermore, these street-level variables appear to strengthen some of the house-level vulnerabilities. We argue that both house and street levels should therefore be included in any assessment of the risk of burglary.Environmental research on residential properties’ vulnerability to burglary usually focuses either on the houses that have been burgled or on the streets in which they are located. This research explores both house and street level in a fixed-effects model and, using tangible CPTED measures, takes a wider perspective to assess vulnerability to burglary. The results indicate that dwelling type, visibility and boundary height have significant effects, and that street type and indicators of antisocial behaviour also have strong effects. Furthermore, these street-level variables appear to strengthen some of the house-level vulnerabilities. We argue that both house and street levels should therefore be included in any assessment of the risk of burglary.glary usually focuses either on the houses that have been burgled or on the streets inwhich they are located. This research explores both house and street level in a fixed-effects model and, using tangible CPTED measures, takes a wider perspective toassess vulnerability to burglary. The results indicate that dwelling type, visibilityand boundary height have sign ificant effects, and that street type and indicators ofantisocial behavi our also have strong effects. Furthermore, these street-level vari-ables appear to strengthen some of the house-level vulnerabilities. We argue thatboth house and street levels should therefore be included in any assessment of therisk of burglar yCriminal Justice: Legitimacy, accountability, and effectivit