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

Transcriptome patterns and blood physiology associated with homing success of sockeye salmon during their final stage of marine migration

To better understand the mechanisms that lead to marine mortality of homing adult sockeye salmon (Oncorhynchus nerka), gill and blood biopsies were used in combination with biotelemetry to demonstrate how survival to freshwater entry is related to gene expression and physiological indices of stress. Microarray analysis of gene expression indicated multiple biological processes, including immune and stress responses, protein biosynthesis, and metabolism. Quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) analysis indicated fish with upregulation of genes related to stress and infection had higher marine survival compared with fish without this genomic signature. We proposed that higher marine survival of potentially stressed and immune compromised fish can be explained by stressed and infected fish being highly motivated to enter fresh water, leading to enhanced marine survival. However, once in a river, stressed and immune compromised fish could suffer higher mortality because of premature river entry. Overall, this study supports the idea that infection and stress are important biological processes influencing behaviour and fate of sockeye salmon during homing migrations