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

Gas exchange and photosynthetic pigments in bell pepper irrigated with saline water

ABSTRACT The tools that evaluate the salinity effects on plants have great relevance as they contribute to understanding of the mechanisms of tolerance. This study aimed to evaluate gas exchanges and the contents of photosynthetic pigments in bell peppers cultivated with saline solutions (0, 1, 3, 5, 7 and 9 dS m-1) prepared using two sources: NaCl and a mixture of Ca, Mg, K, Na and Cl salts, in randomized blocks with a 6 x 2 factorial scheme and 4 replicates, totaling 48 experimental plots. The net photosynthesis (A), stomatal conductance (gs), transpiration (E), internal CO2 concentration (Ci), instantaneous carboxylation efficiency (A/Ci) and water use efficiency (WUE), besides chlorophyll a, b and carotenoids were evaluated. The gas exchange parameters were efficient to indicate the effects of salinity. All photosynthetic pigments decreased with increased electrical conductivity, and the chlorophyll a is the most sensitive to salinity, while the water use efficiency increased with the increment of electrical conductivity

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved