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

Chapter VII. Olympic Ideals versus the Performance Imperative: The History of Canada’s Anti-Doping Policies

The Modern Olympic Games have always been plagued by the fundamental tension that exists between Baron Pierre de Coubertin’s original, lofty vision for the Games and the realities of modern, competitive sport. Throughout the twentieth century, this opposition has grown as the forces of modernity have increasingly permeated more and more aspects of the Olympic Games, but nowhere is the tension between de Coubertin’s original aspirations and the cold, calculated pursuit of victory more evident ..

The Making of the Manifesto

By turning to Marx's and Engels' correspondence, their writing projects from 1841 through to February 1848, and some later scholarly work, we can construct an illuminating account that not only shows the theoretical, political, and strategic debates, conflicts and, eventually, animosities out of which the Manifesto emerged, but also permits one to appreciate the full extent to which the form and content of the Manifesto are the result of intense intellectual and political battles fought by Marx, Engels, and their supporters as they tried to direct and lead the fledgling communist movement of the 1840s. The Manifesto was ultimately a collective effort of people who were trying to understand the prevailing social conditions so they could change them; to see this more precisely allows us to demystify and 'de-reify' it as a source of eternal truths, and return it to its proper place in the annals of the struggle for socialism as one of many documents - a key one to be sure -constructed within, and thus influenced by, a particular set of historical circumstances