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

A radio tracking study of home range and movements of the marsupial Micoureus demerarae (Thomas) (Mammalia, Didelphidae) in the Atlantic forest of south-eastern Brazil

From August 2001 to July 2002 the home range and movements of seven Micoureus demerarae (Thomas, 1905) (three males and four females) were investigated using radio tracking in the União Biological Reserve, state of Rio de Janeiro, south-eastern Brazil. A total of 436 locations was obtained and home range estimated with fixed Kernel (95% of data points), and minimum convex polygon (MCP) methods, with 100 and 95% of data points. Male home ranges estimated by MCP (100%) ranged from 5.4-24.2 ha and females from 0.3-10.7 ha. Corresponding figures calculated with Kernel (95%) were 4-10.9 ha for males and 1.3-5.9 ha for females. Animals travelled on average 423 m/night, with males travelling significantly further (582.8 m/night) than females (335.1 m/night) (t test, t = 3.609, p = 0.001). We concluded that radio tracking produced much larger home ranges than those estimated with traditional live-trapping techniques, suggesting that the latter might underestimate ranging when the area covered with traps is relatively small (ca. 1 ha or less). Radio tracking also indicated that M. demerarae, although predominantly arboreal and weighting only ca. 130 g., has movements similar in magnitude to larger-sized terrestrial didelphimorph marsupials, such as Didelphis Linnaeus, 1758, Philander Linnaeus, 1758 and Metachirus (Desmarest, 1817).<br>No período de agosto de 2001 a julho de 2002 a área de uso e o movimento de sete Micoureus demerarae (Thomas, 1905) (três machos e quatro fêmeas) foram acompanhados, através de rádio-telemetria, na Reserva Biológica União, Rio de Janeiro, sudeste do Brasil. Foi obtido um total de 436 localizações e estimou-se a área de uso através dos métodos Kernel fixo (95% das localizações) e polígono mínimo convexo (PMC), com 100 e 95% das localizações. A área de uso dos machos estimada pelo PMC (100%) variou de 5,4-24,2 ha e fêmeas de 0,3-10,7 ha. Áreas calculadas com Kernel (95%) foram 4-10,9 ha para machos e 1,3-5,9 ha para fêmeas. Os animais locomoveram em média 423 m/noite, com machos se deslocando mais (582,8 m/noite) que as fêmeas (335,1 m/noite) (Teste t; t = 3,609; p = 0,001). Concluímos que o rádio rastreamento proporcionou áreas de uso superiores ao de estudos tradicionais realizados com capturas em armadilhas, sugerindo que pode haver uma subestimativa quando a área coberta com armadilhas é relativamente pequena (1 ha ou menos). O rádio-rastreamento também indicou que M. demerarae, embora seja predominantemente arborícola e pesa cerca de 130 g, possui movimentos semelhantes em magnitude a marsupiais terrestres de maior porte, como Didelphis Linnaeus, 1758, Philander Linnaeus, 1758 and Metachirus (Desmarest, 1817)