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

"Adaptive response" - some underlying mechanisms and open questions

Organisms are affected by different DNA damaging agents naturally present in the environment or released as a result of human activity. Many defense mechanisms have evolved in organisms to minimize genotoxic damage. One of them is induced radioresistance or adaptive response. The adaptive response could be considered as a nonspecific phenomenon in which exposure to minimal stress could result in increased resistance to higher levels of the same or to other types of stress some hours later. A better understanding of the molecular mechanism underlying the adaptive response may lead to an improvement of cancer treatment, risk assessment and risk management strategies, radiation protection, e. g. of astronauts during long-term space flights. In this mini-review we discuss some open questions and the probable underlying mechanisms involved in adaptive response: the transcription of many genes and the activation of numerous signaling pathways that trigger cell defenses - DNA repair systems, induction of proteins synthesis, enhanced detoxification of free radicals and antioxidant production.Publisher PDFPeer reviewe

Butanol as a drop-in fuel: a perspective on production methods and current status

The rising fossil fuel prices as well as negative climatic conditions caused by fossil fuel emissions have prompted technologists and scientists to develop alternative value-added fuels. These fuels can be produced from renewable bio-based materials and have less negative impacts on the environment. Much attention has been drawn to advanced fuels such as bio-based butanol, which is considered a promising fuel compared to ethanol. Its properties such as low volatility, less ignition problems and high inter-solubility make it an ideal drop-in fuel for conventional vehicles. This type of fuel can be utilised either in pure or blended form with petrol or diesel. Conventionally, butanol is produced through the acetone–butanol–ethanol (ABE) process using mainly Clostridium species to ferment sugars obtained from biomass. This method makes use of sustainable/cost-effective bacteria that are easily accessible. Alternatively, butanol can be directly produced from bio-based ethanol through aldol condensation using metal oxides/hydroxyapatite catalysts. Catalyst synthesis involves short reaction times, but high reaction temperatures. This chapter highlights the use of butanol as a fuel, reviews different methods employed and discusses current status and potential for future prospect