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

Determination of the SO/PHI-HRT wavefront degradation using multiple defocused images

The Polarimetric and Helioseismic Imager on board the Solar Orbiter mission (SO/PHI) offers refocusing capabilities to cope with the strongly varying thermal environment of the optical system along the spacecraft's elliptical orbit. The series of images recorded during in-flight focus calibrations can be employed for phase diversity analyses. In this work we infer the wavefront degradation caused by the thermo-optical effects in the High Resolution Telescope (HRT) from images taken during the fine and coarse focus scans performed in the commissioning phase of the instrument. The difference between these two series of images are mainly related to the employed defocused step (smaller for the fine scans) and the signal-to-noise ratio (higher for the coarse scans). We use the retrieved wavefronts to reconstruct the original scene observed during the calibration of the instrument. We applied a generalized phase diversity algorithm that allowed us to use several images taken with different amounts of defocus to sense the wavefront degradation caused by the instrument. The algorithm also uses information from both the inferred wavefront and the series of images to restore the solar scene We find that most of the retrieved Zernike coefficients tend to converge to the same value when increasing the number of images employed for PD for both the fine and the coarse focusing scans. The restored scenes also show signs of convergence, and the merit function is minimized more as $K$ increases. Apart from a defocus, the inferred wavefronts are consistent for the two datasets ($For the fine scan images, the quiet-sun contrast improves from$4.5\,$for the original focused image up to about$10\,$. For the coarse scan images, the contrast of the restored scene is as high as$11\,$

The Polarimetric and Helioseismic Imager on Solar Orbiter

This paper describes the Polarimetric and Helioseismic Imager on the Solar Orbiter mission (SO/PHI), the first magnetograph and helioseismology instrument to observe the Sun from outside the Sun-Earth line. It is the key instrument meant to address the top-level science question: How does the solar dynamo work and drive connections between the Sun and the heliosphere? SO/PHI will also play an important role in answering the other top-level science questions of Solar Orbiter, as well as hosting the potential of a rich return in further science. SO/PHI measures the Zeeman effect and the Doppler shift in the FeI 617.3nm spectral line. To this end, the instrument carries out narrow-band imaging spectro-polarimetry using a tunable LiNbO_3 Fabry-Perot etalon, while the polarisation modulation is done with liquid crystal variable retarders (LCVRs). The line and the nearby continuum are sampled at six wavelength points and the data are recorded by a 2kx2k CMOS detector. To save valuable telemetry, the raw data are reduced on board, including being inverted under the assumption of a Milne-Eddington atmosphere, although simpler reduction methods are also available on board. SO/PHI is composed of two telescopes; one, the Full Disc Telescope (FDT), covers the full solar disc at all phases of the orbit, while the other, the High Resolution Telescope (HRT), can resolve structures as small as 200km on the Sun at closest perihelion. The high heat load generated through proximity to the Sun is greatly reduced by the multilayer-coated entrance windows to the two telescopes that allow less than 4% of the total sunlight to enter the instrument, most of it in a narrow wavelength band around the chosen spectral line

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions. © Copyright