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

Remote Sensing for Monitoring Surface Water Quality Status and Ecosystem State in Relation to the Nutrient Cycle: A 40-Year Perspective

Delineating accurate nutrient fluxes and distributions in multimedia environments requires the integration of vast amounts of information. Such nutrient flows may be related to atmospheric deposition, agricultural runoff, and urbanization effect on surface and groundwater systems. Two types of significant undertakings for nutrient management have been in place for sustainable development. While many environmental engineering technologies for nutrient removal have been developed to secure tap water sources and improve the drinking water quality, various watershed management strategies for eutrophication control are moving to highlight the acute need for monitoring the dynamics and complexities that arise from nutrient impacts on water quality status and ecosystem state, both spatially and temporally. These monitoring methods and data are associated with local point measurements, air-borne remote sensing, and space-borne satellite images of spatiotemporal nutrient distributions leading to the generation of accurate environmental patterns. Within this context, several key water quality constituents, including total nitrogen, total phosphorus, chlorophyll-a concentration, colored dissolved organic matter (dissolved organic carbon or total organic carbon), harmful algal blooms (e.g., cyanobacterial toxins or microcystin concentrations), and descriptors of ecosystem states, such as total suspended sediment (or turbidity), transparency (e.g., Secchi disk depth), and temperature, will be of major concern. Considering the advancements, challenges, and accomplishments related to remote sensing technologies in the past four decades, we present a thorough literature review of contemporary state-of-the-art technologies of remote sensing platforms and sensors that may be employed to support essential scientific missions, and provide an in-depth discussion and new insight into various inversion methods (or models) to improve the estimation accuracy. In this study, the spectrum of these remote sensing technologies and models is first divided into groups based on chronological order associated with different platforms and sensors, although some of them may be subject to mission-oriented arrangements. Case-based and location-based studies were cited, organized, and summarized to further elucidate tracks of application potential that support future, forward-looking, cost-effective, and risk-informed nutrient management plans. The comprehensive reviews presented here should echo real-world observational evidence by using integrated sensing, monitoring, and modeling techniques to improve environmental management, policy analysis, and decision making

Search for the supersymmetric partner of the top quark in pp\u304 collisions at 1as=1.8 TeV

We report on a search for the supersymmetric partner of the top quark (top squark) produced in tt\u304 events using 110 pb-1 of pp\u304 collisions at 1as = 1.8 TeV recorded with the Collider Detector at Fermilab. In the case of a light top squark, the decay of the top quark into a top squark plus the lightest supersymmetric particle (LSP) could have a significant branching ratio. The observed events are consistent with standard model tt\u304 production and decay. Hence, we set limits on the branching ratio of the top quark decaying into a top squark plus LSP, excluding branching ratios above 45% for a LSP mass up to 40 GeV/c2