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

Comparações florísticas e estruturais entre comunidades de Floresta Ombrófila Aberta com diferentes idades, no Município de Areia, PB, Brasil Floristic and structural comparisons of Ombrophilous Forest communities of different ages, in Areia Municipality, Paraíba State, Brazil

O presente estudo foi desenvolvido na Reserva Ecológica Estadual Mata do Pau-Ferro, localizada na Microrregião do Brejo Paraibano, Município de Areia. Com o objetivo de avaliar comparativamente a estrutura e a composição florística de floresta em trechos de diferentes idades, foram selecionadas seis capoeiras, assim caracterizadas: duas capoeiras de sete anos (C7); duas de 15 anos (C15) e duas de 20 anos (C20). Em cada uma das capoeiras foram plotados três transcectos medindo 4&times;35 m, nos quais foi efetuado o inventário do estrato arbustivo-arbóreo e da regeneração natural. Todos os indivíduos que apresentavam altura > 0,2 m foram identificados pelo nome popular, tomados o diâmetro ao nível do solo e a altura total. Foram amostrados 4.997 indivíduos, pertencentes a 40 famílias, 74 gêneros e 90 espécies, em uma área amostral total de 2.520 m². A área basal nas capoeiras de diferentes idades foi de 2,5; 11,5 e 37,6 m² ha-1 para C7, C15 e C20, respectivamente. As espécies que apresentaram os maiores Valores de Importância nos três grupos de capoeiras foram: Diplotropis purpurea (Rich) Amchoff, Machaerium aculeatum Raddi, Erytroxylum pauferrense Plowman, Albizia polycephala (Benth.) Killip, Verbesina diversifolia DC., Allophylus laevigatus Radlk, Guapira opposita (Vell.) Reitz, Malouetia cestroides Muell. Arg. e Talisia esculenta (A. St.-Hil.) Radlk. Constatou-se que há um aumento em complexidade das comunidades com o tempo após distúrbio, resultante do ingresso de novas espécies (aumento da riqueza), aumento da biomassa (área basal), densidade e eqüitabilidade. A estrutura da floresta de 20 anos aproxima-se do esperado para florestas maduras, com base na distribuição dos indivíduos entre classes de tamanho.<br>This study was conducted at Mata do Pau-ferro State Ecological Reserve, Brejo Paraibano, Areia, Paraiba. Six regenerating sites were selected to evaluate structure and floristic composition of the forest at different ages: two sites were seven years old (C7); two were 15 (C15) and two were 20 (C20). The shrub-tree stratum and natural regeneration were surveyed in three plots (4&times;35 m) at each site. All individuals > 0.2 m in height were identified by common name; diameter at ground level and total height were measured. We recorded 4997 individuals in 40 families, 74 genera and 90 species, in a total area of 2520 m². The basal area of the forest at different ages was 2.5, 11.5 and 37.6 m² ha-1 for C7, C15 e C20, respectively. The species with highest importance values at the three sites were: Diplotropis purpurea (Rich) Amchoff, Machaerium aculeatum Raddi, Erythroxylum pauferrense Plowman, Albizia polycephala (Benth.) Killip, Verbensina diversifolia DC., Allophylus laevigatus Radlk., Guapira opposita (Vell.) Reitz, Malouetia cestroides Muell. Arg. and Talisia esculenta (A. St.-Hil.) Radlk. We observed an increment in community complexity related to time after disturbance, resulting from incoming new species (higher richness), increased biomass (basal area), density and equitability. Our results indicate that the structure of the 20-year-old forest, as revealed by height-class distribution, is close to that expected for mature forests