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

Transient peat properties in two pond-peatland complexes in the sub-humid Western Boreal Plain, Canada

In the Canadian Western Boreal Plain (WBP), wetlands (ponds and peatlands) comprise up to 50% of the landscape and represent unique habitat where summer precipitation is often outpaced by evapotranspiration and hillslope groundwater position does not follow topography. In this sub-humid location, groundwater fluxes and stores in riparian peatlands influence pond water levels and root zone moisture sources for forested uplands. To accurately describe the transport and retention of water in peat, it is important to consider peat subsidence. This paper quantifies the amount and effect of seasonal subsidence in a riparian peatland in the Utikuma Lake region in north-central Alberta, Canada. Results demonstrate that the deep and poorly decomposed peat deposits are resistant to compression, and that thick (and persistent) ground frost hinders pore collapse (shrinkage) above the water table until late summer when the ground has thawed. Even then, subsidence is still limited to the top 50 cm and is not closely related to changes in peatland water table or pond water level. Thus the water balance of these ponds and riparian areas appears to be less sensitive to peat volume changes than it is to the persistence of a substantial frost layer well into the snow-free period

Opiate receptors within the blood-brain barrier mediate kappa agonist-induced water diuresis

Data suggest that kappa opioid agonist-induced water diuresis involves inhibition of vasopressin (AVP) secretion; however, it is not clear whether this action involves kappa receptors in the neurohypophysis or receptors behind the blood-brain barrier (BBB). We have investigated the site of action using three selective kappa agonists, BRL 52656 (S(-)-2-(1-pyrrolidinylmethyl)-1-(4-trifluoromethylphenyl) acetyl piperidine hydrochloride), BRL 53114 ((-)-1-(4-trifluoromethylphenyl) acetyl-2-(1-pyrrolidinymethyl)3,3- dimethyl piperidine hydrochloride) and BRL 52974 (4-(1-pyrrolidinylmethyl)5-(3,4-dichlorophenyl)acetyl-4,5,6,7-t etrahydroimidazo [4,5-c] pyridine), with varying abilities to cross the BBB. Chemical and functional assays indicate that BRL 52974 has limited ability to cross the BBB, whereas BRL 53114 and BRL 52656 can freely penetrate. BRL 52974 was significantly less potent than BRL 52656 and BRL 53114 in causing a water diuresis in conscious rats. The ED10S (i.v. doses to cause a positive free water clearance of 10 microliters/min.100 g) for BRL 52974, BRL 52656 and BRL 53114 were 181, 9 and 3.4 mg/kg, respectively. Furthermore, in dogs BRL 52656 and BRL 53114 but not BRL 52974 (30 micrograms/kg i.v.) were able to cause a significant water diuresis. The data demonstrate that opiate receptors behind the BBB are primarily involved in kappa agonist-induced water diuresis and possibly inhibition of AVP secretion

Spatial Variability and Lateral Location of Soil Moisture Monitoring Points on Cotton Mulched Drip Irrigation Field

Part 1: Decision Support Systems, Intelligent Systems and Artificial Intelligence ApplicationsInternational audienceThis experiment was conducted from April to September in 2009 in Baotou-lake Farm of Korla city, Xinjiang region, China. Two experiment schemes were designed for analyzing the spatial variability and lateral orientation of monitoring points for soil moisture. In scheme 1, 44 monitoring points were positioned with sampling depth of 0~60cm. In scheme 2, 20 monitoring points were placed with sampling depth of 0~80cm. Samples were taken in the whole cotton growing period before and after irrigation in both schemes. Statistical analyses including Q-Q test, descriptive statistics, t-test and geo-statistical analysis were performed to the soil moisture data. The results indicate that the increase of soil moisture can enhance their spatial variability. In drip-irrigated cotton cultivation, spatial variability of soil moisture resulted from the combination of several random variables and the structural factors such as climate, topography, soil form. Semi-variogram models belong to spherical model and the range of spherical model for soil moisture is about 9.40m~35.35m. The accuracy of the fitted model decreases as the soil moisture content increases. The monitoring points should be placed at the range of 0~0.475m from the drip tape and it is not suitable to place them at a farther place. It can be concluded that it is best to position the monitoring points at outward cotton row in consideration of management and soil moisture monitoring. The outcome of this study can be used for the proper design and placement of monitoring points for soil moisture