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

Waermeuebergangskoeffizient unter natuerlichen Klimabedingungen

SIGLEAvailable from Informationszentrum Raum und Bau (IRB), Stuttgart (DE) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Crecimiento inicial de Palo de Rosa (Aniba rosaeodora Ducke) en distintos ambientes de fertilidad Growth of initial Rosewood (Aniba rosaeodora Ducke) in different environnement of fertility

Los estudios de requerimientos nutricionales son de gran importancia para identificar aquellos más importantes en el desarrollo fisiológico y crecimiento de plántulas. Con el objetivo de evaluar las exigencias nutricionales y los efectos de la omisión de macronutrientes en el crecimiento de plántulas de Aniba rosaeodora; se realizó un experimento en el vivero del INPA-Amazonas-Brasil teniendo como substrato un suelo Podozolico Rojo de baja disponibilidad de nutrientes. Se utilizaron 8 tratamientos bajo la técnica del nutriente faltante: Control (Suelo con macronutrientes), Suelo natural, y la omisión de un macronutriente por vez (-N, -P, -K, -Ca, -Mg, -S). Se evaluaron las siguientes características: tasa de crecimiento relativo (TCR), Tasa de asimilación neta (TAN), peso de la materia seca de la parte aérea (MSPA) y de las raíces (MSR), contenido de nutrientes en las hojas, concluyendo que el N, Mg y Ca, demostraron ser limitantes al crecimiento en suelo con pequeña disponibilidad; Las plántulas de A. rosaeodora presentaron un bajo requerimiento nutricional para el P, K y S. La omisión de Ca y N perjudica TCR de la especie. Los elementos más importantes para la MSPA fueron el Ca y el Mg; actuando el Mg más en el área foliar; por otro lado la omisión de azufre favorece la absorción de macronutrientes (N, P, K, Ca, Mg).<br>Studies of nutritional requirements are of great importance for identifying the most important nutrients in physiologic development and seedling growth. A greenhouse pot experiment was conducted at INPA to evaluate the mineral nutritional demands and the effects of macronutrient omission in the plant growth of Aniba rosaeodora Ducke. The following treatments were used: Complete (fertilization with N, P, K, Ca, Mg, S, B and Zn), Standard (nature soil), Complete without N, Complete without P, Complete without K, Complete without Ca, Complete without Mg, and Complete without S. An Ultisoil with low nutrient availability was used as a substratum. The following characteristics were evaluated, relative growth rate (RGR), net assimilation rate (NAR), plant height, diameter, dry matter production of the aerial part (DMPAP) and amount of nutrient in the dry matter of leaves. We concluded from the results that: low availability of N, Ca and Mg constraints the growth of the Aniba rosaeodora plants. Seedlings of A. rosaeodora required little P, K and S. The omission of Ca and N harmed the RGR of the species. The most important elements for DMPAP were Ca and Mg; the Mg acting more in the leaf area; on the other hand, the omission of sulfur favored the macronutrient absorption (N, P, K, Ca, Mg)