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

Redução na dose do herbicida aplicado em pós-emergência associada a espaçamento reduzido da cultura de soja para controle de Brachiaria plantaginea Reduced post-emergence herbicide rate associated with soybean reduced row spacing to control Brachiaria plantaginea

A integração de certas práticas de manejo ao controle químico de plantas daninhas pode permitir a redução da dose do herbicida a ser aplicado, sem alterar significativamente os níveis de controle das plantas daninhas e rendimento de grãos de soja. Dessa forma, o objetivo do presente trabalho foi de avaliar a redução da dose recomendada da mistura formulada dos herbicidas fluazifop-p-butyl + fomesafen aplicados em condições de pós-emergência das palntas daninhas, associada à variação no espaçamento entre linhas da cultura de soja, sobre o controle de papuã (Brachiaria plantaginea) e o rendimento final de grãos da cultura. O experimento foi realizado na EEA/UFRGS, em Eldorado do Sul-RS, na estação de crescimento de 1997/98. O cultivar de soja testado foi o BR 16, em semeadura direta. Como tratamentos, utilizaram-se três espaçamentos entre linhas (20, 40 e 60 cm) e cinco doses do herbicida [fluazifop-p-butyl (200 g L-1) + fomesafen (250 g L-1)], aplicado na dose recomendada comercialmente de 1,0 L ha-1 (100%) e com reduções da dose (75, 50 e 25% da dose recomendada), mais a testemunha. Avaliou-se visualmente o controle de papuã aos 8 e 17 dias após as aplicações do herbicida, bem como a fitomassa seca de papuã e o rendimento de grãos da cultura. Os resultados evidenciaram que, para infestação moderada de papuã, o espaçamento entre linhas não tem efeito sobre o seu controle quando o herbicida é utilizado na dose recomendada. Para aplicações tardias, o espaçamento de 40 cm permite reduzir a dose do herbicida em até 50% sem afetar o controle de papuã e em 75% sem diminuir o rendimento de grãos da soja. A redução na dose do herbicida está condicionada à época de aplicação e ao espaçamento entre linhas; com espaçamentos reduzidos, é importante que as aplicações sejam feitas precocemente, a fim de garantir que quantidade suficiente de produto atinja as plantas daninhas.<br>Integration of certain crop management practices with chemical weed control could allow a rate reduction of the herbicide to be applied, without significant changes in weed control levels and soybean grain yields. This research aimed to evaluate reduction in the recommended rate of a formulated mixture of fluazifop-p-butyl plus fomesafen, associated with reduction in soybean row width, on alexandergrass (Brachiaria plantaginea) control and crop grain yield. The experiment was conducted at EEA/UFRGS, Eldorado do Sul-RS, during the growing season of 1997/98. Soybean cultivar tested was BR 16, sowed under a no-till system. The treatments consisted of three row widths (20, 40 and 60 cm), and five rates of the herbicide mixture [fluazifop-p-butyl (200 g L-1) + fomesafen (250 g L¹)], applied at the recommended rate of 1.0 L ha-1 (100%) and reduced rates (75, 50, and 25% of the recommended rate) plus a check. Alexandergrass control was visually evaluated at 8 and 17 days after herbicide applications, by obtaining its dry matter weight, as well as the soybean grain yield. The results showed that, for a moderate alexandergrass infestation, soybean row width does not affect weed control when the herbicide is sprayed at the recommended rate. For late herbicide applications, 40 cm row width allows a reduction of herbicide rate up to 50%, without affecting alexandergrass control and a decrease up to 75% of the herbicide rate, without reducing soybean grain yield; reduction of herbicide rate is conditioned to application time and row width used; with reduced row widths application must be performed earlier so that a sufficient amount of the product reaches the weeds