Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract 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

Screening and isolation of halophilic bacteria producing industrially important enzymes

Halophiles are excellent sources of enzymes that are not only salt stable but also can withstand and carry out reactions efficiently under extreme conditions. The aim of the study was to isolate and study the diversity among halophilic bacteria producing enzymes of industrial value. Screening of halophiles from various saline habitats of India led to isolation of 108 halophilic bacteria producing industrially important hydrolases (amylases, lipases and proteases). Characterization of 21 potential isolates by morphological, biochemical and 16S rRNA gene analysis found them related to Marinobacter, Virgibacillus, Halobacillus, Geomicrobium, Chromohalobacter, Oceanobacillus, Bacillus, Halomonas and Staphylococcus genera. They belonged to moderately halophilic group of bacteria exhibiting salt requirement in the range of 3-20%. There is significant diversity among halophiles from saline habitats of India. Preliminary characterization of crude hydrolases established them to be active and stable under more than one extreme condition of high salt, pH, temperature and presence of organic solvents. It is concluded that these halophilic isolates are not only diverse in phylogeny but also in their enzyme characteristics. Their enzymes may be potentially useful for catalysis under harsh operational conditions encountered in industrial processes. The solvent stability among halophilic enzymes seems a generic novel feature making them potentially useful in non-aqueous enzymology

Investigating the adverse impacts of rural roads using a fuzzy multicriteria approach

Rural roads contribute significantly to the living conditions of rural populations. However, they also lead to detrimental impacts on physical and social environments. In this context, the present study proposes a novel fuzzy multicriteria approach that amalgamates fuzzy TOPSIS and an improved fuzzy weighted average method to assess the negative impacts on physical and social environments, due to rural road construction. The approach offers a structured comprehension and incorporates detailed criteria that reflect the adverse effects. The attributes identified and assessed in this study are air quality, vegetation cover status, noise pollution, transmissible disease, habits/behaviour, safety and security, and road accidents. The approach includes both qualitative and quantitative data from focus group discussions. The results presented here are essential to identify corrective actions, promote effective distribution of funds, and facilitate effective decisionmaking for sustainable rural development

Kharif crops selection for sustainable farming practices in the rajasthan-india using multiple attribute-based decision-making

Sustainability of agricultural practices depends on economic, environmental, and social conditions. The Rajasthan state of India has arid climatic conditions where kharif crops are commonly grown. In this work, the four major criteria are considered such as the farm area, crop yield per unit area, the cost prices, and the market sales price. Merged analytic hierarchy process (AHP) and entropy techniques have been employed to give reasonable weight coefficients for the objective and subjective weights to each criterion. Multiple attribute-based decision-making models (MADM) have been developed using three proven techniques, namely the Exprom2, the technique for order of preference by similarity to ideal solution (TOPSIS), and the VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR). The crop Pennisetum glaucum emerged as the most productive kharif crop in the arid climatic conditions of Rajasthan, India under the given criteria. The sensitivity analysis of the three methods identifies the most significant criteria and validates that Pennisetum glaucum is the first ranked crop despite the interchange of the weights. The methodology used in this study may be applied across the globe to select appropriate crops for maximizing the profit, optimizing the natural resources, and promoting sustainable agricultural practices. This study may be used to enhance the agricultural gross domestic product (GDP) to make the agriculturalists self-sufficient and to help the state policymakers in making effective regional policies

Geographic information system-based mapping of air pollution & emergency room visits of patients for acute respiratory symptoms in Delhi, India (March 2018-February 2019)

Background & objectives: Studies assessing the spatial and temporal association of ambient air pollution with emergency room visits of patients having acute respiratory symptoms in Delhi are lacking. Therefore, the present study explored the relationship between spatio-temporal variation of particulate matter (PM)2.5 concentrations and air quality index (AQI) with emergency room (ER) visits of patients having acute respiratory symptoms in Delhi using the geographic information system (GIS) approach. Methods: The daily number of ER visits of patients having acute respiratory symptoms (less than or equal to two weeks) was recorded from the ER of four hospitals of Delhi from March 2018 to February 2019. Daily outdoor PM2.5 concentrations and air quality index (AQI) were obtained from the Delhi Pollution Control Committee. Spatial distribution of patients with acute respiratory symptoms visiting ER, PM2.5 concentrations and AQI were mapped for three seasons of Delhi using ArcGIS software. Results: Of the 70,594 patients screened from ER, 18,063 eligible patients were enrolled in the study. Winter days had poor AQI compared to moderate and satisfactory AQI during summer and monsoon days, respectively. None of the days reported good AQI (<50). During winters, an increase in acute respiratory ER visits of patients was associated with higher PM2.5 concentrations in the highly polluted northwest region of Delhi. In contrast, a lower number of acute respiratory ER visits of patients were seen from the 'moderately polluted' south-west region of Delhi with relatively lower PM2.5 concentrations. Interpretation & conclusions: Acute respiratory ER visits of patients were related to regional PM2.5 concentrations and AQI that differed during the three seasons of Delhi. The present study provides support for identifying the hotspots and implementation of focused, intensive decentralized strategies to control ambient air pollution in worst-affected areas, in addition to the general city-wise strategies