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

Precipitação esperada, em diferentes níveis de probabilidade, na região de Dourados, MS Dependable rainfall, using different levels of probability, in Dourados, MS, Brazil

O objetivo deste trabalho foi determinar a precipitação pluviométrica esperada, em diferentes níveis de probabilidade, na região de Dourados, MS. O estudo, realizado para períodos decendiais, quinzenais e mensais, baseou-se em dados diários de precipitação de 17 anos. As séries foram ajustadas a uma distribuição mista e a aderência dos dados verificada pelo teste de Kolmogorov-Smirnov. Os parâmetros da distribuição gama foram estimados pelo método da máxima verossimilhança. Houve ajuste dos dados para todos os períodos. Através da distribuição acumulada mista foram gerados valores de precipitação esperada para períodos de retorno de 2, 3, 4, 5, 8, 10, 12 e 17 anos. Os resultados obtidos permitem que se adotem valores criteriosos de precipitação no dimensionamento de sistemas de irrigação implantados na região de Dourados. O uso da precipitação média para este fim não é recomendado, pois pode resultar em projetos subdimensionados.<br>The aim of this work was to determine the dependable rainfall using different levels of probability in Dourados, Mato Grosso do Sul State, Brazil. This study was conducted for intervals of 10, 15 and 30 days, based on daily data of rainfall for 17 years. Series were adjusted to a mixed distribution and a non-parametric test Kolmogorov-Smirnov was used . The parameters of gama distribution were estimated by the method maximum likelihood. Data were adjusted to all periods. Based on the accumulated mixed distribution were generated values of rainfall for periods return of 2, 3, 4, 5, 10, 12 and 17 years. Results allow irrigation personal to adopt criterions values of rainfall for designing irrigation projects near Dourados-MS. The average rainfall should not be used because it may result in under estimation of the rainfall

Estimativa do consumo de água na cultura da cenoura (Daucus carota, L.) v. nantes superior, para a região de piracicaba, através do método do balanço hídrico Estimation of carrot water consumption (Daucus carota, L.) t. nantes superior, in piracicaba county through the water balance methodology

O presente trabalho teve como objetivo estimar a demanda hídrica da cultura da cenoura (Daucus carota, L.) cv. Nantes Superior, pelo método do balanço hídrico sob condições de campo, para a região de Piracicaba, Estado de São Paulo (22&deg; 42' 30" S; 47&deg; 30' 00" W, à 560 metros de altitude). Os valores de evapotranspiração máxima obtidos pelo método do balanço hídrico foram correlacionados com os valores de evapotranspiração de referência estimados pelo método de Penman, objetivando a determinação do coeficiente de cultura. O consumo total de água considerando-se um ciclo vegetativo de 101 dias foi de 365 mm, gerando um consumo médio de 3,61 mm/dia. Nesta situação, o coeficiente de cultura médio encontrado foi de 1,1.<br>To estimate the evapotranspiration of a carrot crop (Daucus carota, L.) v. Nantes Superior, under field conditions, in Piracicaba (22&deg; 42' 30" S; 47&deg; 30' 00" W, at 560 m.), maximum evapotranspiration was determinated by the water balance method and correlated to the reference evapotranspiration estimated by Penman's method, in order to obtain the crop coefficient. The total water consumption of the vegetative cycle (101 days) was about 365 mm, with a mean of 3,61 mm/dia. In this situation the mean crop coefficient was 1.1