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

Observation of inclined EeV air showers with the radio detector of the Pierre Auger Observatory

International audienceWith the Auger Engineering Radio Array (AERA) of the Pierre Auger Observatory, we have observed the radio emission from 561 extensive air showers with zenith angles between 60o and 84o. In contrast to air showers with more vertical incidence, these inclined air showers illuminate large ground areas of several km2 with radio signals detectable in the 30 to 80 MHz band. A comparison of the measured radio-signal amplitudes with Monte Carlo simulations of a subset of 50 events for which we reconstruct the energy using the Auger surface detector shows agreement within the uncertainties of the current analysis. As expected for forward-beamed radio emission undergoing no significant absorption or scattering in the atmosphere, the area illuminated by radio signals grows with the zenith angle of the air shower. Inclined air showers with EeV energies are thus measurable with sparse radio-antenna arrays with grid sizes of a km or more. This is particularly attractive as radio detection provides direct access to the energy in the electromagnetic cascade of an air shower, which in case of inclined air showers is not accessible by arrays of particle detectors on the ground

Erratum: Combined fit of spectrum and composition data as measured by the Pierre Auger Observatory

We present a combined fit of a simple astrophysical model of UHECR sources to both the energy spectrum and mass composition data measured by the Pierre Auger Observatory. The fit has been performed for energies above 5 ⋅ 10(18) eV, i.e. the region of the all-particle spectrum above the so-called ankle feature. The astrophysical model we adopted consists of identical sources uniformly distributed in a comoving volume, where nuclei are accelerated through a rigidity-dependent mechanism. The fit results suggest sources characterized by relatively low maximum injection energies, hard spectra and heavy chemical composition. We also show that uncertainties about physical quantities relevant to UHECR propagation and shower development have a non-negligible impact on the fit results

An Indication of anisotropy in arrival directions of ultra-high-energy cosmic rays through comparison to the flux pattern of extragalactic gamma-ray sources

International audienceA new analysis of the data set from the Pierre Auger Observatory provides evidence for anisotropy in the arrival directions of ultra-high-energy cosmic rays on an intermediate angular scale, which is indicative of excess arrivals from strong, nearby sources. The data consist of 5514 events above with zenith angles up to 80° recorded before 2017 April 30. Sky models have been created for two distinct populations of extragalactic gamma-ray emitters: active galactic nuclei from the second catalog of hard Fermi-LAT sources (2FHL) and starburst galaxies from a sample that was examined with Fermi-LAT. Flux-limited samples, which include all types of galaxies from the Swift-BAT and 2MASS surveys, have been investigated for comparison. The sky model of cosmic-ray density constructed using each catalog has two free parameters, the fraction of events correlating with astrophysical objects, and an angular scale characterizing the clustering of cosmic rays around extragalactic sources. A maximum-likelihood ratio test is used to evaluate the best values of these parameters and to quantify the strength of each model by contrast with isotropy. It is found that the starburst model fits the data better than the hypothesis of isotropy with a statistical significance of 4.0σ, the highest value of the test statistic being for energies above . The three alternative models are favored against isotropy with 2.7σ–3.2σ significance. The origin of the indicated deviation from isotropy is examined and prospects for more sensitive future studies are discussed