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

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

Inter-comparison of temperature-based reference crop evapotranspiration methods

This paper investigates the evaluation and possibility of recalibrating temperature-based methods for estimating reference crop evapotranspiration (ETr) at a station in Tamil Nadu. Seven temperature-based evapotranspiration methods namely Thronthwaite, Blaney-Criddle, Romanenko, Hamon, Hargreaves, Linacre, and Kharrufa methods were evaluated and compared with each other and with a standard method in estimating ETr in the selected region. All the seven methods were developed in countries other than India and hence, the empirical coefficients in the equations in each method need to be recalibrated to make them applicable to climatic conditions of the study area in India. In the present study, FAO Modified Penman method was used as the standard method for evaluation and altering the coefficients in the above temperature-based ETr methods, such that these seven methods can then be used to determine the ETr in the selected region. The evaluation was first made using the original values of the coefficients involved in each equation. All the equations were recalibrated and the coefficients in each method were calculated afresh to be appropriate to the climatic data of the study area in India. The results show that, large bias existed when the original coefficients were used for the determination of ETr. Regression equations were developed to correct the differences in magnitude of evapotranspiration. When recalibrated coefficients were substituted, all the seven methods improved the estimation of the ETr for the region. With properly recalibrated values of the coefficients, Blaney-Criddle, Thronthwaite, and Hamon methods can be recommended for estimating ETr in the study region, as far as temperature-based methods are concerned

Inter-comparison of radiation -based reference crop evapotranspiration methods

This paper investigates the evaluation and inter comparison of evapotranspiration models with data from a station in Tamil Nadu, India. In the present study cross comparison of the best or representative equation forms selected from each category namely (1) temperature-based methods, and (2) radiation-based methods ware made along with FAO Modified Penman method. Six representative empirical ETr equation selected from the two categories, namely Blaney-Criddly, Hamon, and Kharrufa (temperature-based), Doorenbos and Puitt, Jensen-Haise, and McGuinness and Bordne (radiation-based) were evaluated and compared. All the equations are recalibrated and the constants in each equation are redefined for the data from the selected station. The result shows that, large bias existed when the original constants were used for the determination of ETr. Regression equations were developed to correct the differences in magnitude of evapotranspiration. When recalibrated constant values were substituted for the original constant values, all the six methods have improved in the estimation of the ETr for the region. Based on the closeness in ETr value to that of FAO Modified Penman method and r2 value, radiation-based methods namely Doorenbos-Pruitt and Jensen-Haise can be recommended for estimating ETr in the study area than using temperature-based methods

Inter-comparison of radiation -based reference crop evapotranspiration methods

This paper investigates the evaluation and inter comparison of evapotranspiration models with data from a station in Tamil Nadu, India. In the present study cross comparison of the best or representative equation forms selected from each category namely (1) temperature-based methods, and (2) radiation-based methods ware made along with FAO Modified Penman method. Six representative empirical ETr equation selected from the two categories, namely Blaney-Criddly, Hamon, and Kharrufa (temperature-based), Doorenbos and Puitt, Jensen-Haise, and McGuinness and Bordne (radiation-based) were evaluated and compared. All the equations are recalibrated and the constants in each equation are redefined for the data from the selected station. The result shows that, large bias existed when the original constants were used for the determination of ETr. Regression equations were developed to correct the differences in magnitude of evapotranspiration. When recalibrated constant values were substituted for the original constant values, all the six methods have improved in the estimation of the ETr for the region. Based on the closeness in ETr value to that of FAO Modified Penman method and r2 value, radiation-based methods namely Doorenbos-Pruitt and Jensen-Haise can be recommended for estimating ETr in the study area than using temperature-based methods

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Not AvailableBanana is known to have high content of polyphenols, polysaccharides and tannins which inhibits polymerase chain reaction (PCR) while detecting the viral pathogens. Multiple-step nucleic acid (NA) extraction protocols are common, but more expensive, time consuming, laborious, and may lead to cross contamination. A simple extraction protocol (SEP) for preparing viral NA from leaves and aphids for detection of BBTV by PCR was developed. Inclusion of sodium sulphite and polyvinylpyrrolidone in the extraction buffer minimized the interferences due to polyphenols and polysaccharides, and an homogenization step has increased the percent detection from plants exhibiting various types of symptoms over virus release protocols reported previously. The detection efficacy for the template obtained in this SEP was comparable with that of templates obtained with a CTAB method and a commercial DNA extraction kit for NA extract preparation. The sensitivity test in PCR showed that this assay could detect 0.1 pg/μl plasmid DNA which is equivalent to 1 × 104 copies. Virus could be detected using SEP from freeze dried as well as CaCl2 dried samples of BBTV infected banana leaves. This methodology provides quality PCR product for direct sequencing suitable for identification and characterization of BBTV. The NA extract prepared by SEP is suitable for BBTV detection in quantitative PCR using SYBR Green chemistry and loop-mediated isothermal amplification assay. This protocol is sensitive, rapid, less prone to contamination, economical, and has potential for large-scale application in surveys, surveillance, quarantine, and certification programmes.Not Availabl

Molecular Characterization of Geographically Different Banana Bunchy Top Virus (BBTV)Isolates in India.

India is the largest producer of banana in the world, with a total production of 23.20 million tonnes from an area of 0.64 million hectares [13]. Banana is affected by many bacterial, viral, and fungal pathogens and they cause a significant yield loss [7]. Banana bunchy top disease (BBTD) caused by Banana bunchy top virus (BBTV) is a very serious disease in India. Since the 1970s, BBTD has devastated large plantations of cv. Virupakshi (AAB), an elite cultivar also known as "Hill Banana" in lower Pulney hills, Tamil Nadu State, India. The area under cultivation of this banana cultivar has been reduced from 18,000 to 2,000 ha (Kesavamoorthy [10] due to BBTD). A recent survey made during May 2009, in Pulney hills, Dindigul district of Tamil Nadu recorded 14-72% incidence of BBTD (Selvarajan unpublished). This increased incidence could be due to continuous propagation of bananas as intercrop in coffee plantations, planting new plantations with suckers from infected mother plants and the presence of banana black aphid vector (Pentalonia nigronervosa) round the year.Banana bunchy top disease (BBTD) caused by Banana bunchy top virus (BBTV) is one of the most devastating diseases of banana and poses a serious threat for cultivars like Hill Banana (Syn: Virupakshi) and Grand Naine in India. In this study, we have cloned and sequenced the complete genome comprised of six DNA components of BBTV infecting Hill Banana grown in lower Pulney hills, Tamil Nadu State, India. The complete genome sequence of this hill banana isolate showed high degree of similarity with the corresponding sequences of BBTV isolates originating from Lucknow, Uttar Pradesh State, India, and from Fiji, Egypt, Pakistan, and Australia. In addition, sixteen coat protein (CP) and thirteen replicase genes (Rep) sequences of BBTV isolates collected from different banana growing states of India were cloned and sequenced. The replicase sequences of 13 isolates showed high degree of similarity with that of South Pacific group of BBTV isolates. However, the CP gene of BBTV isolates from Shervroy and Kodaikanal hills of Tamil Nadu showed higher amino acid sequence variability compared to other isolates. Another hill banana isolate from Meghalaya state had 23 nucleotide substitutions in the CP gene but the amino acid sequence was conserved. This is the first report of the characterization of a complete genome of BBTV occurring in the high altitudes of India. Our study revealed that the Indian BBTV isolates with distinct geographical origins belongs to the South Pacific group, except Shervroy and Kodaikanal hill isolates which neither belong to the South Pacific nor the Asian group.Not Availabl

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 coprioritized 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