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

Sazonalidade e horário de atividade de abelhas Euglossinae (Hymenoptera, Apidae), em florestas de terra firme na Amazônia Central Seasonality and daily activity of Euglossinae bees (Hymenoptera, Apidae) in terra firme forest in Central Amazonia

<abstract language="eng">Euglossinae bee fauna of two areas of terra firme forest near Manaus, Amazonas, Brazil was compared. Over a twelve-month period collections were done fortnightly, between 7:00 a.m and 5:00 p.m, using traps with eight kinds of scent baits. The traps were placed in the understory and in tree crowns. The majority of species and specimens was most active between August-December, near the beginning of the rainy season in this region. The bees were most active from 9:00 a.m. until 4:00 p.m., while air temperatures were between 24.5-27ºC, but there was a decline in this activity when air temperature varied above or below of this range. There were differences in the seasonality and in the daily activity patterns for the two areas studied but these differences were not significative

Aspectos biológicos e morfológicos de Mimallo amilia (Lepidoptera: Mimallonidae) em folhas de Eucalyptus urophylla Biological and morphological aspects of Mimallo amilia (Lepidoptera: Mimallonidae) in Eucalyptus urophylla leaves

A biologia de Mimallo amilia Cramer (Lepidoptera: Mimallonidae) foi estudada em folhas de Eucalyptus urophylla em laboratório a 25 ± 2 ºC, 60 ± 10% de umidade relativa e fotoperíodo de 12 horas de luz e 12 horas de escuro. Essa espécie teve duração da fase larval de 34,88 dias e cinco estádios larvais. Houve mortalidade de lagartas no primeiro, terceiro e quarto estádios com 5,00; 7,89; e 14,28%, respectivamente. Os períodos de pré-pupa e de pupa foram de 4,33 ± 0,33 e 3,90 ± 0,23 e de 18,78 ± 0,69 e 18,82 ± 0,41 dias para machos e fêmeas, respectivamente. Cada fêmea de M. amilia depositou 4,86 ± 0,48 posturas com 19,84 ± 1,76 ovos por postura. O período de incubação dos ovos foi de 8,60 ± 0,24 dias, com viabilidade de 88,63%. A longevidade de adultos foi de 5,66 ± 0,61 e 9,22 ± 0,79 dias, com envergadura das asas de 42,70 ± 0,32 e 49,70 ± 0,17 mm para machos e fêmeas, respectivamente, e razão sexual de 0,56. As lagartas dessa espécie apresentaram tamanho de 0,90 ± 0,01 mm no primeiro estádio a 4,40 ± 1,42 mm no último.<br>The biology of Mimallo amilia Cramer (Lepidoptera: Mimallonidae) was studied on Eucalyptus urophylla leaves in laboratory conditions (25 ± 2ºC, 60 ± 10% relative humidity and 12L:12D photoperiod). This species showed 33.88 day for the larval stage with five larval instars. Larval mortality occurred during first, third and fourth instars with 5.00, 7.89 and 14.28%, respectively. Pre-pupa and pupa stages lasted 4.33 ± 0.33 and 3.90 ± 0.23, and 18.78 ± 0.69 and 18.82 ± 0.41 days for males and females, respectively. Each female laid 4.86 ± 0.48 egg masses with 19.84 ± 1.76 eggs per egg mass. Incubation period lasted 8.60 ± 0.24 days with 88.63%. egg viability. Adult longevity was 5.66 ± 0.61 and 9.22 ± 0.79 days with adult wingspan of 42.70 ± 0.32 and 49.70 ± 0.17 mm for males and females, respectively, with 0.56 sex ratio. Length of this species' caterpillars was 0.90 ± 0.01 mm at the first instar and 4.40 ± 1.42 mm at the last instar

Alterações hepáticas em codornas japonesas submetidas à intoxicação prolongada por aflatoxina B1 Hepatic changes in japanese quail after long term intoxication by aflatoxin B1

O objetivo do presente trabalho foi estudar os efeitos da aflatoxina B1 (AFB1) sobre as vísceras (fígado, baço e moela) de codornas poedeiras japonesas, em condições de exposição a baixas doses, tendo em vista que são poucos os dados de toxicidade de longa duração nesta espécie. Assim, foram constituídos 4 grupos formados, cada um, por 6 codornas de linhagem comercial, as quais receberam rações contendo AFB1 nas concentrações de 0 (controle), 25, 50 e 100mg.kg-1, durante 168 dias. As aves do grupo 100mg kg_1 apresentaram fígados com peso relativo médio menor (p < 0,05) do que o controle. Alterações histológicas foram constatadas apenas no fígado, sendo que todas as amostras provenientes das codornas intoxicadas apresentaram degeneração vacuolar macrogoticular, sugestivas de metamorfose gordurosa moderada a severa, particularmente nos grupos que receberam ração com os maiores níveis de AFB1 (50 e 100mg.kg-1). A hiperplasia de ductos biliares foi observada somente no grupo alimentado com 100mg.kg-1. Os resultados indicaram que a AFB1, a partir de 50mg.kg-1, pode ocasionar lesões hepáticas significativas em codornas de postura, em condições de exposição prolongada.<br>The aim of the present record was to study the effects of aflatoxin B1 (AFB1) on selected viscera (liver, spleen and gizzard) of laying Japanese quail under conditions of low level exposure, in view of the little information regarding the long term toxicity on this specie. Thus, four experimental groups of six commercial quails were constituted and given rations containing either 0 (controls), 25, 50 or 100mg aflatoxin B1 (AFB1)/kg feed, during 168 days. When compared to controls, birds from group 100mg.kg-1 presented low relative liver weight (p < 0.05). Histological changes were observed only in the livers, and all samples from quail exposed to AFB1 revealed moderate to severe hepatic cell vacuolation with fatty change, particularly in birds from groups receiving highest levels of toxin (50 and 100mg.kg-1). Bile duct hyperplasia occurred only in the birds exposed to 100mg.kg-1 of AFB1. The results indicated that long term administration of AFB1 at levels above 50mg.kg-1 can cause significant hepatic lesions in Japanese quail