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

Galaxy populations in massive galaxy clusters to z = 1.1 : colour distribution, concentration, halo occupation number and red sequence fraction

We study the galaxy populations in 74 Sunyaev–Zeldovich effect selected clusters from the South Pole Telescope survey, which have been imaged in the science verification phase of the Dark Energy Survey. The sample extends up to z ∼ 1.1 with 4 × 1014M ≤ M200 ≤ 3 × 1015M . Using the band containing the 4000 Å break and its redward neighbour, we study the colour–magnitude distributions of cluster galaxies to ∼m∗ + 2, finding that: (1)The intrinsic rest frame g − r colour width of the red sequence (RS) population is ∼0.03 out to z ∼ 0.85 with a preference for an increase to ∼0.07 at z = 1, and (2) the prominence of the RS declines beyond z ∼ 0.6. The spatial distribution of cluster galaxies is well described by the NFW profile out to 4R200 with a concentration of cg = 3.59+0.20 −0.18, 5.37+0.27 −0.24 and 1.38+0.21 −0.19 for the full, the RS and the blue non-RS populations, respectively, but with ∼40 per cent to 55 per cent cluster to cluster variation and no statistically significant redshift or mass trends. The number of galaxies within the virial region N200 exhibits a mass trend indicating that the number of galaxies per unit total mass is lower in the most massive clusters, and shows no significant redshift trend. The RS fraction within R200 is (68 ± 3) per cent at z = 0.46, varies from ∼55 per cent at z = 1 to ∼80 per cent at z = 0.1 and exhibits intrinsic variation among clusters of ∼14 per cent. We discuss a model that suggests that the observed redshift trend in RS fraction favours a transformation time-scale for infalling field galaxies to become RS galaxies of 2–3 Gyr