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

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Reversal of age-induced seed deterioration through priming in Vegetable crops-A ReviewVegetables play a vital role in human diet as well as in improving farm income. Good quality of seed is the basic input for success in vegetable production programme. However, age-induced seed deterioration of vegetable crops is an inexorable phenomenon which gets in the way of successful vegetable production. As such seed deterioration caused by ageing and its repair during early germination determine the success or failure of vegetable production system. Seed deterioration can be defined as the loss of quality, viability and vigour either due to ageing or effect of adverse environmental factors. While as ageing may be considered as progressive decline in biological functions accompanied by an increased risk of degenerative changes and death over time. The rate of deterioration rapidly increases with increase in seed moisture content, storage duration or temperature of storage. Loss of seed viability following ageing has been attributed to a series of metabolic defects that accumulate in embryonic and non-embryonic structures. At the cellular level, seed ageing is associated with various alterations including loss of membrane integrity, solute leakage, reduced energy metabolism, impairment of RNA (protein synthesis), and DNA degradation. Seed priming treatment i.e. slowly imbibing and then re-drying of seeds accomplished by soaking of seeds in a solution of low water potential, has been shown to reinvigourate the aged seeds. The reversal of ageing effects by seed priming has been explained by reduction of malondialdehyde (MDA) and free radicals production and maintenance of antioxidant activities due to DNA repair and favorable metabolic balance.Not Availabl

Melorheostosis with renal arterio-venous malformation: A case report with review of literature

Melorheostosis, also known as Leri′s disease and flowing periosteal hyperostosis, is a rare cause of pain and stiffness in a limb. The appearance is of "candle greasing" down one side of one or several bones of the body. We describe a case referred to tertiary care center with suspicion of renal cell carcinoma with diffuse bone metastasis. After reassessment, the patient was diagnosed melorheostosis with renal AV malformation. He was reassured about the benign nature of the disease and is asymptomatic

Effect of Fruitlet Thinning on Apple Production and Quality under High Density Plantation

This study, conducted within the Experimental Block of the Division of Fruit Science at SKUAST-K, Shalimar, India, was aimed to thin 5-year-old Fuji Zehn Aztec apple plants. The research was carried out during the years 2020 and 2021and implemented a Randomized Complete Block Design with 11 treatments, including control and various other thinning methods. Chemical and hand thinning were practised at the 12 mm king fruitlet diameter stage. Among the treatments, T9 (NAA+BA@15+140ppm) demonstrated significant results, with the highest trunk girth increment (0.41 cm), annual shoot extension growth (65.46 cm), leaf area (34.71 cm2), fruit drop (39.26%), and the   least reduction in return bloom (52.22%). Additionally, T9 resulted in maximum fruit length (79.98 mm), fruit diameter (89.00 mm), fruit weight (224.90 g), fruit volume (197.86 cm3), Soluble Solid concentration (15.87%), SSC : acidity (40.08), total sugar content (11.07%), anthocyanin content (7.14 mg/100g), ascorbic acid content (6.94 mg/100g), and received the highest organoleptic rating score (4.87). However, the highest yield (21.97 kg/tree), yield efficiency (1.50 kg/cm2), fruit firmness (8.36 kg/cm2), hue angle (68.57°), and acidity (0.59%) were recorded in the control group. Notably, T1 (Hand thinning @ 2 fruitlets retained per cluster) achieved the highest fruit retention (97.97%) and the maximum leaf-to-fruit ratio (27.50). These findings shed light on the potential benefits and trade-offs associated with different fruitlet thinning methods in high-density apple plantations. Understanding these effects can aid orchard management practices to optimize both production and fruit quality

Nutrient Changes in Berries of “Anab-e-Shahi” and “Perllete” Varieties of Grapes with Advancing Phenology in the Growing Season

Understanding how nutrients accumulate and change throughout the developmental stages according to the BBCH scale can be a very effective technique for developing fertilization programmes for high-quality, marketable grape production. Accordingly, the macro- and micronutrient concentrations at different growth stages were analyzed for two commercial grape cultivars, viz., “Anab-e-Shahi” and “Perlette”, by using an extended BBCH scale. The results show nitrogen content was reduced during the sampling period (D1 to D6) from 1.76 percent to 1.09 percent. Potassium concentration in developing berries kept on increasing from 0.15%, at principal growth stage 7 with BBCH code 73 (D1), to 0.26% at principal growth stage 8 code 89 (D6). The lowest phosphorus content of 253.88 ppm and the highest of 338.43 ppm were found in growth stages D1 and D6, respectively. The berry Ca however showed an increase first and thereafter decreased to 225.18 ppm at harvest. Mg content also recorded a similar trend from stages D1 to D6 of the BBCH scale and decreased to 116.08 ppm at D6. B and Cu concentrations increased from D1 to D6, and Mn and Zn increased first and decreased thereafter until harvest. No specific trend was recorded in Fe concentration. The concentration of nutrients in berries at different developmental stages can be used as the standard reference for growing berries using proper fertilization