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

Reverse Shock Emission Revealed in Early Photometry in the Candidate Short GRB 180418A

International audienceWe present observations of the possible short GRB 180418A in $\gamma$-rays, X-rays, and in the optical. Early optical photometry with the TAROT and RATIR instruments show a bright peak ($\approx$ 14.2 AB mag) between $T+28$ and $T+90$ seconds that we interpret as the signature of a reversal shock. Later observations can be modeled by a standard forward shock model and show no evidence of jet break, allowing us to constrain the jet collimation to $\theta_j> 7^\circ$. Using deep late-time optical observations we place an upper limit of $r>24$ AB mag on any underlying host galaxy. The detection of the afterglow in the \textit{Swift} UV filters constrains the GRB redshift to $z<1.3$ and places an upper bound on the $\gamma$-ray isotropic equivalent energy $E_{\rm{\gamma,iso}} < 3 \times 10^{51}$ erg. The properties of this GRB (e.g. duration, hardness ratio, energetic, and environment) lie at the intersection between short and long bursts, and we can not conclusively identify its type. We estimate that the probability that it is drawn from the population of short GRBs is 10\%-30\%