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

Brazil and regional integration in South America: lessons from the EU's crisis

This paper introduces the idea of the EU as a 'model' of regional integration, linking it to the literature on Europe as a normative power. The second part discusses the influence of the EU model on regional cooperation and integration in South America. In particular, it focuses on the discursive use of the model in Brazilian foreign policy during the two tenures of President Luis Inacio Lula da Silva as a dominant rhetoric for the promotion of regional integration, especially in the case of the Mercado Común del Sur(Common Market of the South, MERCOSUR) and the Unión de Naciones Suramericanas (Union of South American Nations, UNASUR). The last part looks at the impact of the financial crisis on the 'deconstruction' of this ideal model of European integration and attempts to discern how this will influence the future discourse on regional cooperation integration in South America, and primarily in Brazil. To illustrate the shift that has occurred in Brazilian views of regionalism, this part also discusses the Brazilian support of a new form of regional integration, as embodied in the creation of CELAC, the Community of Latin American and Caribbean States

The Limits of Norm Promotion: The EU in Egypt and Israel/Palestine

Policy implications aside, assessing the EU’s involvement in the Mediterranean region necessitates a reconsideration of the impact and limits of the so-called ‘normative power’ upon which its approach has been based, implicitly or explicitly. This paper does so by examining the EU’s engagement with Egypt and the Israel-Palestine conflict; it sets out to challenge the notion that EU-style normative power alone is well-suited to promote democracy and regional cooperation, particularly in regions with diverging dynamics where the promotion of EU-associated norms may stumble upon European trade- and diplomacy-related interests. In this sense, it aims to enrich and inform the debates on ‘normative power Europe’ and Euro-Mediterranean relations

The limits of norm promotion: the EU in Egypt and Israel/Palestine

Policy implications aside, assessing the EU’s involvement in the Mediterranean region necessitates a reconsideration of the impact and limits of the so-called ‘normative power’ upon which its approach has been based, implicitly or explicitly. This paper does so by examining the EU’s engagement with Egypt and the Israel-Palestine conflict; it sets out to challenge the notion that EU-style normative power alone is well-suited to promote democracy and regional cooperation, particularly in regions with diverging dynamics where the promotion of EU-associated norms may stumble upon European trade- and diplomacy-related interests. In this sense, it aims to enrich and inform the debates on ‘normative power Europe’ and Euro-Mediterranean relations

Brazil’s Perceptions of the EU after Brexit: A weaker but desirable partner

International audienceThis chapter aims to assess how the Brexit process may have affected the perceptions of the EU by Brazilian political, intellectual and entrepreneurial elites, as well as by the mainstream online and print media. Speeches and reports are collected from the Brazilian government’s official websites, while media content is obtained through the Nexis database. The analysis is supported by semi-structured interviews with diplomatic officials in London and Brussels. Particular attention is paid to the following dimensions due to their saliency in the Brazil–EU agenda: economic/trade; migration/development; and political/security. Preliminary results suggest that Brazilian narratives of the EU are linked to the benefits of regionalism and the perception of the EU as a global (trade) power. Results contribute to a better understanding of how Brexit is reported to Brazilian audiences, and which narratives about the “new EU-27” are either reinforced or deconstructed due to the UK’s decision to leave the Union. The working hypothesis – that Brexit has not significantly changed the perception of the EU among Brazilian elites and media apart from the trade aspects – is by and large confirmed