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

Rendimento de grãos da soja em função do arranjo de plantas Soybean yield response to plant arrangement

A identificação do arranjo de plantas que resulte em menor competição intraespecífica permite melhor aproveitamento dos recursos disponíveis para o crescimento e rendimento de grãos da soja. O experimento foi conduzido na Estação Experimental Agronômica da UFRGS em Eldorado do Sul, RS, na estação de crescimento 2000/01, objetivando avaliar como o arranjo de plantas de soja modifica a competição intraespecífica e de que forma isto se reflete no rendimento de grãos e seus componentes. Utilizou-se a cultivar 'BRS 137' (semiprecoce, determinada) em semeadura direta. O delineamento experimental foi de blocos casualizados com parcelas sub-subdivididas e quatro repetições. Os tratamentos constaram de dois regimes hídricos (irrigado e não irrigado); dois espaçamentos entre linhas (20 e 40cm), e três populações de plantas (20, 30 e 40 plantas.m-2). O rendimento de grãos foi afetado pela irrigação e pela interação espaçamento e população. O tratamento irrigado (5015kg.ha-1) apresentou rendimento de grãos 18% superior ao não irrigado (4253kg.ha-1). A maior taxa de enchimento de grãos (TEG), que resultou no maior peso do grão, explica o maior rendimento obtido no tratamento irrigado. O arranjo de plantas que proporcionou maior rendimento de grãos foi a associação do espaçamento de 20 cm com a população de 20 plantas.m-2, obtendo-se 5014kg.ha-1 em comparação a 4322kg.ha-1 em 40cm de espaçamento. Houve decréscimo linear no rendimento com o aumento da população de plantas no espaçamento reduzido (20cm). Estes resultados são conseqüência do maior número de ramos, nós férteis e de legumes férteis.m-2 obtidos. O arranjo com 20cm de espaçamento e 20 plantas.m-2 amenizou a competição intraespecífica, resultando em maior rendimento de grãos.<br>Plant arrangement that decrease interplant competition can improve soybean growth and yield by better use of resources. The experiment was performed at the Agronomic Experimental Station of the Universidade Federal do Rio Grande do Sul, in Eldorado do Sul, Rio Grande do Sul, Brazil, in the 2000/01 growing season. The objectives were to evaluate how soybean plant arrangement modify the interplant competition and the effect in grain yield and yield components. The cultivar tested was 'BRS 137'(early, determinate), in no-till planting. The treatments were arranged in a split-plot randomized complete-block design,whith four replications. The treatments tested were two water availability (with and without irrigation) , two row spacing (20 and 40cm) and three population levels (20, 30 and 40 plants.m-2). The grain yield was affected by irrigation and by the interaction of row spacing and population. The irigated treatment (5015kg.ha-1) had grain yield 18% higher than the non irigated (4253kg.ha-1). The larger grain filling rate (GFR), resulted in larger seed weight, and explain, the greater yield in the irrigated treatment. The plant arrangemnt of 20 cm row spacing with the population of 20 plantas.m-2 provided the better results (5014kg.ha-1 compared to 4322 kg.ha-1 in 40 cm row spacing). There is a linear decrease in grain yield with the increase in plant population with reduced row spacing (20cm). These results can be explained by more branche number, fertil nodes and fertil pods.m-2 obtained. The arrangement of 20cm row spacing and 20 plants.m-2, attenuated the interplant competition resulting in larger grain yield