Egg Parasitoids of Proconiini (Hemiptera: Cicadellidae) in Northwestern Mexico, with Description of a New Species of Gonatocerus (Hymenoptera: Mymaridae)

Nine species of Mymaridae and Trichogrammatidae parasitic on eggs of Proconiini sharpshooters (Cicadellidae: Cicadellinae) were collected in northwestern Mexico in relation to neoclassical biological control efforts against glassy-winged sharpshooter, Homalodisca vitripennis (Germar), in California. Gonatocerus chula Triapitsyn and Bernal sp. n., which belongs to the ater species group of Gonatocerus Nees (Mymaridae), is described. Specimens of G. chula sp. n. were reared from eggs of the smoke-tree sharpshooter, Homalodisca liturata Ball, on jojoba [Simmondsia chinensis (Link) C. K. Schneider] leaves collected in central Sonora state, Mexico. Also given are new data on other egg parasitoids of Homalodisca spp. and Oncometopia spp. in Sinaloa and Sonora states, Mexico, including Gonatocerus atriclavus Girault, G. morrilli (Howard), and G. novifasciatus Girault, and the Trichogrammatidae Burksiella sp(p)., Ittys sp., Pseudoligosita sp., Ufens ceratus Owen, and U. principalis Owen. For the first time, a species of Ittys is recorded from eggs of Proconiini, and U. principalis from Mexico. Colonies of G. atriclavus, G. novifasciatus and Pseudoligosita sp. were successfully established in a quarantine laboratory at University of California, Riverside, on eggs of the glassy-winged sharpshooter. These three parasitoid species had never been reared under laboratory conditions. In addition, seven species of Proconiini were collected in central and northwestern Mexico: Cyrtodisca major (Signoret), Homalodisca insolita (Walker), H. liturata Ball, Oncometopia sp. cf. clarior (Walker), O. sp. cf. trilobata Melichar, O. (Similitopia) sp., and Phera centrolineata (Signoret). Oncometopia sp. cf. clarior, O. sp. cf. trilobata, and O. (Similitopia) sp. appeared to be undescribed species

Design and implementation of the web : linguistic and ethnographic atlas of Colombia

The Atlas Lingüístico y Etnográfico de Colombia (Linguistic and Ethnographic Atlas of Colombia), known by “ALEC” is a compilation of popular speaking Spanish of the populations of Colombia; such research was carried out for more than fifty years. The result of this work is a collection of thematic maps organized in six volumes and its supplements in analog format. In that sense was created the project entitles “Interactive ALEC” which main objective is to develop a digital and interactive web version of the ethnographic and Linguistic Atlas of Colombia (1983) and its supplements. In this way the Corpus linguistics research group belonging to the Institute Caro y Cuervo and the research group NIDE of the Universidad Distrital “Francisco José de Caldas” have been working together in the design and development of the Atlas Web, that allows the visualization and consulting of the spatial information contained in the volume III of the analog ALEC Atlas, applying concepts of Geographical Information Systems and web cartography. Therefore, the objective of this paper is to show the process of design and development of the web prototype of the ALEC as a collection of static and dynamic maps, which show spatial information, combined with multimedia content, taking into account that in addition to all maps, the total compendium includes images, illustrations, photographs, audio and text comments. Likewise, the interactive ALEC is a good example of how to use geo-technology tools nowadays, because they are essential for the dissemination of geo linguistic information through internet, achieving more access and distribution of the Atlas web

Maize Domestication and Anti-Herbivore Defences: Leaf-Specific Dynamics during Early Ontogeny of Maize and Its Wild Ancestors

As a consequence of artificial selection for specific traits, crop plants underwent considerable genotypic and phenotypic changes during the process of domestication. These changes may have led to reduced resistance in the cultivated plant due to shifts in resource allocation from defensive traits to increased growth rates and yield. Modern maize (Zea mays ssp. mays) was domesticated from its ancestor Balsas teosinte (Z. mays ssp. parviglumis) approximately 9000 years ago. Although maize displays a high genetic overlap with its direct ancestor and other annual teosintes, several studies show that maize and its ancestors differ in their resistance phenotypes with teosintes being less susceptible to herbivore damage. However, the underlying mechanisms are poorly understood. Here we addressed the question to what extent maize domestication has affected two crucial chemical and one physical defence traits and whether differences in their expression may explain the differences in herbivore resistance levels. The ontogenetic trajectories of 1,4-benzoxazin-3-ones, maysin and leaf toughness were monitored for different leaf types across several maize cultivars and teosinte accessions during early vegetative growth stages. We found significant quantitative and qualitative differences in 1,4-benzoxazin-3-one accumulation in an initial pairwise comparison, but we did not find consistent differences between wild and cultivated genotypes during a more thorough examination employing several cultivars/accessions. Yet, 1,4-benzoxazin-3-one levels tended to decline more rapidly with plant age in the modern maize cultivars. Foliar maysin levels and leaf toughness increased with plant age in a leaf-specific manner, but were also unaffected by domestication. Based on our findings we suggest that defence traits other than the ones that were investigated are responsible for the observed differences in herbivore resistance between teosinte and maize. Furthermore, our results indicate that single pairwise comparisons may lead to false conclusions regarding the effects of domestication on defensive and possibly other traits

Radon (222Rn) outgassing in San Juan volcanic tubes during the Cumbre Vieja eruption 2021, and preliminary values in the new volcanic tubes

Comunicación oral presentada en el 1st European Meeting on Geomicrobiology of volcanic caves. días 2-3 de marzo de 2023 celebrado en la Casa de la Ciencia-CSIC de SevillaDuring the eruption at Cumbre Vieja ridge (La Palma, Canary Islands, 2021) a radon (222Rn) detector (CORENTIUM Pro alpha particles counter) was emplaced inside the “Las Palomas” lava tube (San Juan eruption, 1949). In addition, a CO2 meter logger was emplaced to determine relationships between the 2021 eruption and radon plus CO2 inner fluxes. There is a geostructural relationship between the 1949 and 2021 eruptions, probably connected by a previous fault, shown the volcanic vents’ alignment trending NW-SE. In October 2021, the radon and CO2 loggers were moved to the upper part of the lava tube, in the San Juan volcanic vent (Llano del Banco hollow dyke). Once the eruption ended (in early 2022) both loggers were placed in one newly formed lava tube, and data will be collected in February 2023. Preliminary results show daily average radon values ranging between 2 - 9 Bq/m3, although sporadic peaks of about 270 and 650 Bq/m3 were recorded related to volcano-tectonic earthquakes and volcanic intensity. In general, basaltic eruptions of alkaline affinity show low radon values due to the low concentration in the magma body of uranium and related chemical elements (Th, Ra, etc.). Geochemical analysis of emitted lavas shows a U concentration of about 1 to 5 ppm (μg/g) and Th 9.5 ppm. Summer values of Rn increased up to 3 KBq/m3, related to the climate conditions instead of volcanic activity.This study was funded by the project CSIC 20223PAL002 “Investigación Geológica de la Erupción de 2021 en Cumbre Vieja” and partially by the project FAMRAD (PID2020-113407RB-I00): Geochemical modeling of seismic prediction from endogenous gas emission (222Rn, CO2, CH4), and earthquakes by using radioactive caves and boreholes in the Alhama de Murcia fault.N

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

El Derecho Argentino frente a la pandemia y post-pandemia COVID-19. TOMO II

La Facultad de Derecho de la Universidad Nacional de Córdoba no podía permanecer indolente frente a la conmoción que, durante este año 2020, ha provocado en el mundo la pandemia de COVID-19. Como comunidad educativa advertíamos que la prioridad máxima era lograr la continuidad de la labor de nuestra Casa de Estudios, para garantizar a nuestros alumnos del grado y del posgrado, el ejercicio de su derecho a estudiar, continuando y en algunos casos iniciando sus estudios, a pesar de las condiciones adversas que se vivían. Con esa finalidad convocamos a los profesores titulares de todas las cátedras y eméritos y consultos que quisieran hacerlo, a sumarse con sus aportes a esta construcción colectiva, que aborda los temas que nos ocupan desde las diversas perspectivas de las distintas áreas del mundo jurídico. Y la desinteresada respuesta positiva no se hizo esperar. Prueba de ello es este libro cuyas dimensiones, tanto en lo cuantitativo como en lo cualitativo, superaron las expectativas iniciales. La jerarquía de los autores que generosamente han participado con sus contribuciones, en algunos casos en forma individual y en otros acompañados por sus equipos de colaboradores, permiten prever que esta obra ha de brindar elementos de juicio de gran utilidad para continuar construyendo el mundo jurídico, dentro de la pandemia y después de ella.ÍNDICE GENERAL. TOMO II. DERECHO CONSTITUCIONAL. "Emergencias, orden constitucional y COVID-19 en Argentina" por Antonio María Hernández. "Una constitución para todas las épocas. Algunas notas sobre el Derecho Constitucional en tiempo de pandemia" por Guillermo E. Barrera Buteler, Magdalena I. Álvarez, José M. Pérez Corti y Victorino Solá. Pandemia y constitución en la Argentina actual. Reflexiones desde la Cátedra “B” de Derecho Constitucional Facultad de Derecho. Universidad Nacional de Córdoba. I. Introducción. Breves comentarios sobre este texto y “lo constitucional” en los tiempos actuales en Argentina por Andrés Rossetti. II. Nociones sobre el Cuidado y el Modo de Ser en el Mundo por Marta Faur. III. Impacto de la pandemia en la dicotomía público/privado en Argentina por Claudio E. Guiñazú. IV. Preocupaciones constitucionales en tiempos de pandemia: desigualdad y emergencia. La necesidad de repensar los mecanismos decisorios por Romina Verri. V. Derechos laborales y gremiales de los trabajadores estatales durante la emergencia sanitaria por Félix A. López Amaya. VI. La coordinación intergubernamental frente al COVID-19 en experiencias de países federales por Marcelo Bernal. "Cuando el centro está afuera de la figura. -República, desequilibrio de poderes y emergencia-" por Pablo Riberi. "Pandemia y estado de excepción" por Miguel Ángel Ortiz Pellegrini. DERECHO PENAL. "La emergencia sanitaria en contextos de encierro carcelario" por Carlos Julio Lascano. "COVID-19 y cárceles argentinas" por Gustavo A. Arocena. DERECHO INTERNACIONAL PUBLICO. "La confrontación entre Estados Unidos de América y China en tiempos de COVID-19 y el Derecho Internacional Público" por Zlata Drnas de Clément. "El rol del principio de cooperación internacional durante la pandemia y en el período post-COVID 19" por María Alejandra Sticca. "COVID-19, crímenes internacionales y amenazas a la paz: ¿integran las pandemias el ámbito material de la responsabilidad de proteger?" por Luciano Pezzano. "Incidencia de la pandemia covid 19 en derechos fundamentales. Las organizaciones internacionales y la seguridad de los estados" por Christian G. Sommer, María Pilar Llorens, Oscar Benítez y Guillermo Costilla. DERECHO INTERNACIONAL PRIVADO. "El COVID-19 y la cooperación jurídica internacional" por Adriana Dreyzin de Klor. "El COVID-19 y las nuevas formas de celebración del matrimonio" por Carlos E. Echegaray de Maussion. "Pandemia y solicitudes de retorno de menores por traslados ilícitos en sustracción de niños: ¿es la COVID-19 una excepción de riesgo grave?" por Myriam Diana Lucero. "Justicia, aislamiento y videoconferencia la experiencia del Derecho Internacional Privado en desandar barreras: guía de buenas prácticas de la conferencia de La Haya 2019" por Carolina Harrington. "Restitución internacional de niños. La excepción de grave riesgo y COVID-19" por Laura Martina Jeifetz. "El Derecho Internacional Privado y el desafío frente a los grupos más vulnerables en el marco del COVID-19" por Cristina Britos. "La responsabilidad social empresaria de las empresas multinacionales como herramienta para enfrentar la pandemia COVID-19" por Candela Noelia Villegas. DERECHO ADMINISTRATIVO. "Los deberes cívicos frente a la pandemia COVID 19" por José Luis Palazzo. "Importancia del rol y la gestión del Poder Judicial en tiempos de coronavirus – COVID-19" por Domingo J. Sesin y Daniela S. Sosa. DERECHO DEL TRABAJO Y DE LA SEGURIDAD SOCIAL. "Las relaciones laborales en la emergencia" por Carlos Alberto Toselli.Fil: Hernández, Antonio María. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Barrera Buteler, Guillermo Eduardo. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Álvarez, Magdalena I. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Pérez Corti, José M. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Solá, Victorino. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Rossetti, Andrés. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Faur, Marta. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Guiñazú, Claudio E. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Verri, Romina. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: López Amaya, Félix A. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Bernal, Marcelo. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Bernal, Marcelo. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales. Centro de Estudios Avanzados; Argentina.Fil: Riberi, Pablo. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Ortiz Pellegrini, Miguel Ángel. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Lascano, Carlos Julio. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Arocena, Gustavo A. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Drnas de Clément, Zlata. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Sticca, María Alejandra. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Pezzano, Luciano. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Universidad Nacional de Córdoba. Facultad de Ciencias Sociales; Argentina.Fil: Sommer, Christian G. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Sommer, Christian G. Universidad Católica de Córdoba. Facultad de Derecho. Instituto de Derechos Humanos; Argentina.Fil: Llorens, María Pilar. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Benítez, Oscar. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Costilla, Guillermo. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Salas, Graciela R. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Mortarotti, Pablo César. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Mortarotti, Pablo César. Universidad Católica de Córdoba; Argentina.Fil: Mortarotti, Pablo César. Universidad Siglo 21; Argentina.Fil: Dreyzin de Klor, Adriana. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Dreyzin de Klor, Adriana. Universidad Blas Pascal; Argentina.Fil: Lucero, Myriam Diana. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Harrington, Carolina. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Jeifetz, Laura Martina. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Britos, Cristina. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Villegas, Candela Noelia. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Villegas, Candela Noelia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba; Argentina.Fil: Zavatti, Adriana M. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Bottiglieri, María G. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Fernández, Flavia. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Gordillo Reinalde, Laura Andrea. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Palazzo, José Luis. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Sesin, Domingo J. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Sosa, Daniela S. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Giménez, Laura E. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Tello Roldan, María Cecilia. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Toselli, Carlos Alberto. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Echegaray de Maussion, Carlos E. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina

Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe

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