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

Irrigation regimes and bio-stimulant application effects on yield and morpho-physiological responses of strawberry

In the Mediterranean region of Turkey, strawberry production is a vital part of the agricultural sector, providing high rates of employment and farm income. Optimizing water application an effective cultivation practices are of considerable importance in improving strawberry yield. In this study the response of strawberry a cultivar (Fragaria ananassa Duch. cv. Rubygem) to irrigation regimes and bio-stimulant (seaweed extract) use were investigated, by evaluating the yield and morpho-physiological parameters under high tunnel conditions in the Mediterranean environment. The amounts of irrigation water applied were 0.50, 0.75, 1.00 and 1.25 times the water surface evaporation, measured by a standard Class A pan, and the corresponding regimes were denoted as Ir50, Ir75, Ir100, and Ir125, respectively. There was a significant decrease in total berry yield and number of berries in the Ir50 irrigation regime. The maximum total berry yield was attained at Ir75 in both applications (585.7 g/plant and 521.9 g/plant under bio-stimulant and control applications, respectively). However, the results of Ir75, Ir100 and Ir125 did not reveal any significant yield benefit. The bio-stimulant application provided a significant, 17% increase, in berry yield. The stomatal conductance and leaf water potential were reduced as irrigation application rates decreased. Conversely, stomatal conductance and leaf water potential were statistically higher, 41 µmol·m-2·s-1 and 0.5 bar, respectively, after the use of the bio-stimulant, as it alleviated the negative effects of water stress. Bio-stimulant application also significantly increased fruit nitrogen content by approximately 14%. In conclusion, considering the irrigation regimes of strawberries grown under high tunnels in the Mediterranean environment, water use is recommended at around 274 mm (Ir75), along with bio-stimulant application for optimal yield. © 2018 Korean Society for Horticultural Science.Firat University Scientific Research Projects Management Unit: FBA-2016-5542This study was supported by the Coordination Unit of the Scientific Research Projects of the Çukurova University, project FBA-2016-5542, “Effects of Irrigation Regimes and Bio-stimulant on Yield and Morpho-Physiological Responses of Strawberry in High Tunnel Conditions”. The authors thank Dr Paul F. Reich (Paul.Reich@wdc. usda.gov), Geographer, Soil Science Division USDA-NRCS, USA, for th e English editing