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

Supernova Remnants Interacting with Molecular Clouds: X-Ray and Gamma-Ray Signatures

The giant molecular clouds (MCs) found in the Milky Way and similar galaxies play a crucial role in the evolution of these systems. The supernova explosions that mark the death of massive stars in these regions often lead to interactions between the supernova remnants (SNRs) and the clouds. These interactions have a profound effect on our understanding of SNRs. Shocks in SNRs should be capable of accelerating particles to cosmic ray (CR) energies with efficiencies high enough to power Galactic CRs. X-ray and γ-ray studies have established the presence of relativistic electrons and protons in some SNRs and provided strong evidence for diffusive shock acceleration as the primary acceleration mechanism, including strongly amplified magnetic fields, temperature and ionization effects on the shock-heated plasmas, and modifications to the dynamical evolution of some systems. Because protons dominate the overall energetics of the CRs, it is crucial to understand this hadronic component even though electrons are much more efficient radiators and it can be difficult to identify the hadronic component. However, near MCs the densities are sufficiently high to allow the γ-ray emission to be dominated by protons. Thus, these interaction sites provide some of our best opportunities to constrain the overall energetics of these particle accelerators. Here we summarize some key properties of interactions between SNRs and MCs, with an emphasis on recent X-ray and γ-ray studies that are providing important constraints on our understanding of cosmic rays in our Galaxy

Development of targeted viral vectors for cardiovascular gene therapy

No abstract available