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

Water deficit and nitrogen nutrition of crops. A review

Among the environmental factors that can be modified by farmers, water and nitrogen are the main ones controlling plant growth. Irrigation and fertilizer application overcome this effect, if adequately used. Agriculture thus consumes about 85% of the total fresh water used worldwide. While only 18% of the world’s cultivated areas are devoted to irrigated agriculture, this total surface represents more than 45% of total agricultural production. These data highlight the importance of irrigated agriculture in a framework where the growing population demands greater food production. In addition, tighter water restrictions and competition with other sectors of society is increasing pressure to diminish the share of fresh water for irrigation, thus resulting in the decrease in water diverted for agriculture.The effect of water and nutrient application on yield has led to the overuse of these practices in the last decades. This misuse of irrigation and fertilizers is no longer sustainable, given the economic and environmental costs. Sustainable agriculture requires a correct balance between the agronomic, economic and environmental aspects of nutrient management. The major advances shown in this review are the following: (1) the measurement of the intensity of drought and N deficiency is a prerequisite for quantitative assessment of crop needs and management of both irrigation and fertilizer application. The N concentration of leaves exposed to direct irradiance allows both a reliable and high-resolution measurement of the status and the assessment of N nutrition at the plant level. (2) Two experiments on sunflower and on tall fescue are used to relate the changes in time and irrigation intensity to the crop N status, and to introduce the complex relationships between N demand and supply in crops. (3) Effects of water deficits on N demand are reviewed, pointing out the high sensitivity of N-rich organs versus the relative lesser sensitivity of organs that are poorer in N compounds. (4) The generally equal sensitivities of nitrifying and denitrifying microbes are likely to explain many conflicting results on the impact of water deficits on soil mineral N availability for crops. (5) The transpiration stream largely determines the availability of mineral N in the rhizosphere. This makes our poor estimate of root densities a major obstacle to any precise assessment of N availability in fertilized crops. (6) The mineral N fluxes in the xylem are generally reduced under water deficit and assimilation is generally known to be more sensitive to water scarcity. (7) High osmotic pressures are maintained during grain filling, which enables the plant to recycle large amounts of previously assimilated N. Its part in the total grain N yield is therefore generally higher under water deficits. (8) Most crop models currently used in agronomy use N and water efficiently but exhibit different views on their interaction

Reviews on drag reducing polymers

Polymers are effective drag reducers owing to their ability to suppress the formation of turbulent eddies at low concentrations. Existing drag reduction methods can be generally classified into additive and non-additive techniques. The polymer additive based method is categorized under additive techniques. Other drag reducing additives are fibers and surfactants. Non-additive techniques are associated with the applications of different types of surfaces: riblets, dimples, oscillating walls, compliant surfaces and microbubbles. This review focuses on experimental and computational fluid dynamics (CFD) modeling studies on polymer-induced drag reduction in turbulent regimes. Other drag reduction methods are briefly addressed and compared to polymer-induced drag reduction. This paper also reports on the effects of polymer additives on the heat transfer performances in laminar regime. Knowledge gaps and potential research areas are identified. It is envisaged that polymer additives may be a promising solution in addressing the current limitations of nanofluid heat transfer applications