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

Relações entre o teor de fenóis totais e o ciclo das galhas de Cecidomyiida e em Aspidosperm a spruceanum Müll. Arg. (Apocynaceae) Relationships between phenolic contents and a Cecidomyiidae gall cycle in Aspidosperma spruceanum Müll. Arg. (Apocynaceae)

Alterações morfológicas detectadas em diversas espécies vegetais em função da indução de galhas são comumente acompanhadas de mudanças químicas importantes para o estabelecimento e manutenção do sistema galhador-planta hospedeira. O estudo da variação do teor de fenóis totais e sua relação com o desenvolvimento das galhas no sistema Aspidosperma spruceanum-Cecidomyiidae foi realizado ao longo de um ano, no qual foram detectados pelo menos dois ciclos de vida dos insetos indutores. O nível de infestação foliar foi alto, atingindo 87%, e os Cecidomyiidae tiveram a região internervural como sítio preferencial de oviposição. A variação sazonal no conteúdo de fenóis totais nas amostras de folhas sadias e galhadas foi primariamente relacionada às condições abióticas e muito embora este teor tenha atingido o máximo de 10 mg EAT g-1, indicando um ambiente químico celular não favorável à indução e a sua sobrevivência, o indutor de A. spruceanum supera esta barreira química, podendo ainda ser favorecido pela proteção contra inimigos naturais propiciada pelos fenólicos.<br>Morphological alterations detected in several plant species due to gall induction are commonly followed by chemical changes fundamental to the establishment and maintenance of the host plant-gall maker system. The study of phenolic contents variation and its relation to gall development in Aspidosperma spruceanum-Cecidomyiidae system through a year-time detected two insect life cycles. The level of infestation was high, getting up to 87%, and the Cecidomyiidae preferentially oviposited in internervural region. Seasonal variation in phenolic contents in healthy and galled leaves detected in A. spruceanum was primarily related to abiotic conditions. Even though the levels of phenolic contents might get a maximum of 10 mg EAT g-1, which indicated a non stimulating cell chemical environment to gall induction and herbivore survivorship, A. spruceanum gall maker surpassed this chemical barrier, and might also be favored by the chemical protection against its natural enemies, that phenolic contents might confer