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

Neogene planktonic foraminiferal biostra-tigraphy of Nile Delta

This investigation deals with the litho-and biostratigraphy of the Middle Miocene and Pliocene subsurface successions of the Nile Delta region, Egypt. Fifty planktonic foraminiferal species have been recorded from the Abu Madi-1 well. The stratigraphical distribution of these planktonic Foraminifera in the studied well permits recognition of four zones. The Globorotalia mayeri Zone of Middle Miocene ; the Sphaeroidinellopsis seminulina -subdehiscens, the Globorotalia puncticulata Zones of Early Pliocene and the Globigeri-noides obliquus extremus Zone of Middle Pliocene. These zones are correlated with zones elsewhere in the world. The Miocene/Pliocene boundary is found to be marked by a distinct unconformity due to the missing of the Late Miocene «evapo-ritic phase». The paleoecology of the studied rock units and their planktonic foraminifera are interpreted.Ce travail étudie le Miocène moyen et le Pliocène reconnu en sondage dans le delta du Nil (Egypte). La distribution stratigraphique des Foraminifères planctoniques permet de reconnaître les quatre biozones suivantes : L. à Globorotalia mayeri (Miocène moyen) L. à Sphaeroidinellopsis seminulina-subdehiscens L. à Globorotalia puncticulata et L. à Globigerinoides obliquus extremus du Pliocène. La limite Mio-Pliocène est marquée par une discordance : absence de dépôt du Miocène supérieur (phase évaporitique). Une interprétation paléoécologique des formations étudiées est fournie à partir des Foraminifères planctoniques.Abdou H.F., Abdel-Kireem M.R., Samir A.M. Neogene planktonic foraminiferal biostra-tigraphy of Nile Delta. In: Géologie Méditerranéenne. Tome 11, numéro 1-2, 1984. C.A.M. IXe colloque africain de micropaléontologie. Paris, Museum d'Histoire Naturelle, du 3 au 6 octobre 1983. pp. 193-205