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

Sublethal Effects of Spinosad (Tracer®) on the Cotton Leafworm (Lepidoptera: Noctuidae)

The effects of sublethal concentrations of spinosad (Tracer®) on development, fecundity, and food utilization, in the cotton leafworm, Spodoptera littoralis (Boisd.) were investigated. The fourth-instar larvae were fed on castor bean leaves treated with LC25 (13.9 ppm) or LC50 (57.8 ppm) of spinosad. Pupation and pupal weight were significantly reduced in both LC25 and LC50 treatments, compared with those of the controls. The fecundity rates of females in either LC25 or LC50 treatment were also reduced, compared with the controls. The residual activity of spinosad, applied on cotton at labeled field- and subfield-rates (200 and 70 g active substance (a.s.)/ 200 l water, respectively), was examined against the fifth-instar larvae of S. littoralis. Feeding deterrent effects were significantly demonstrated in larvae that fed on leaves collected from field plots with residual deposits of spinosad at 3 and 7 days old after application (DAA). The residual activity of spinosad on feeding and other metabolic parameters was decreased after 21 DAA indicating that the chemical started to degrade under field conditions. A histological study on midgut from larvae that previously fed on leaves treated with a concentration corresponding to the labeled-field rate of spinosad showed some alterations occurred after 48 and 96 h of treatment, compared to the normal midgut from the controls. The histological alterations included degeneration in the epithelial lining of the midgut and in the peritrophic matrix. Such histopathological effects are presumed to be responsible for the reduction in growth and food utilization caused by spinosad. It is, therefore, concluded that spinosad has sublethal effects on S. littoralis that may affect population dynamics in the field via reductions in survival and reproduction

Euclid: Constraining linearly scale-independent modifications of gravity with the spectroscopic and photometric primary probes

International audienceThe future Euclid space satellite mission will offer an invaluable opportunity to constrain modifications to general relativity at cosmic scales. We focus on modified gravity models characterised, at linear scales, by a scale-independent growth of perturbations while featuring different testable types of derivative screening mechanisms at smaller nonlinear scales. We consider 3 specific models, namely Jordan-Brans-Dicke (JBD), the normal branch of Dvali-Gabadadze-Porrati (nDGP) gravity and $k$-mouflage (KM) gravity. We provide forecasts from spectroscopic and photometric primary probes by Euclid on the cosmological parameters and the extra parameters of the models, respectively, $\omega_{\rm BD}$, $\Omega_{\rm rc}$ and $\epsilon_{2,0}$, which quantify the deviations from general relativity. This analysis will improve our knowledge of the cosmology of these modified gravity models. The forecasts analysis employs the Fisher matrix method applied to weak lensing (WL); photometric galaxy clustering (GC$_{ph}$); spectroscopic galaxy clustering (GC$_{sp}$) and the cross-correlation (XC) between GC$_{ph}$ and WL. For the Euclid survey specifications we define three scenarios, characterised by different cuts in $\ell$ and $k$, to assess the constraining power of nonlinear scales. For each model we consider two fiducial values for the corresponding model parameter. In an optimistic setting at 68.3% confidence interval, with Euclid alone we find the following percentage relative errors: for $\log_{10}{\omega_{\rm BD}}$, with a fiducial value of $\omega_{\rm BD}=800$, 35% using GC$_{sp}$ alone, 3.6% using GC$_{ph}$+WL+XC and 3.3% using GC$_{ph}$+WL+XC+GC$_{sp}$; for $\log_{10}{\Omega_{\rm rc}}$, with a fiducial value of $\Omega_{\rm rc}=0.25$, we find respectively 90%, 20% and 17%; finally, for $\epsilon_{2,0}=-0.04$ respectively 5%, 0.15% and 0.14%. (abridged