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

Quaternary atoll development : new insights from the two-dimensional stratigraphic forward modelling of Mururoa island (central Pacific ocean).

International audienceKnowledge about the Quaternary evolution of mid-ocean atolls comes mainly from drilling and field observations carried out on a number of Pacific carbonate islands. However, little is known about the early to mid Pleistocene atoll development history, especially at margin and foreslope settings. Using previous field and subsurface data from Mururoa Atoll and a process-based modelling software (DIONISOS), a two-dimensional forward stratigraphic model of atoll development is proposed for the past 1·8 million years (Myr). Observational data from vertical to inclined coring, seismic and bathymetric surveys indicate that, from approximately 0·45 to 0·40 million years before present (Ma), carbonate deposition at Mururoa Atoll resulted in a series of mostly prograding reef units. The model is first constrained at the base by the shape and topography of the pre-Quaternary basement. A number of sensitivity tests were performed to define the respective influence of variant parameters. The best-fit development scenario that accounts for the overall geometry and stratigraphic architecture of the Quaternary sediment packages is obtained by using the sea-level curve by Miller et al. (2005), uniform subsidence rate of 105 m Myr−1, and carbonate production rates gradually increasing from 0·50 to 8 mm yr−1 between 1·80 Ma and the present. Additional controlling parameters include subaerial erosion (at a constant rate of 0·25 m/kyr), wave-energy and sediment-transport processes. The stratigraphic forward model predicts a succession of three distinct types of carbonate systems that have developed since the earliest Pleistocene: toe of slope systems from 1·80 Ma to about 0·80 Ma, open-platform systems from 0·80 Ma to 0·50 Ma, and framework-reef systems from about 0·50 Ma to the present. The development of these different systems is most likely to be controlled by climate and changes in sea-level cycles. During the low-amplitude 41 kyr cycle periods of the earliest Pleistocene, ambient conditions were not conducive to framework-reef growth; shallow-water carbonate sedimentation was dominantly gravity-driven, operating along the platform foreslopes only. During the Mid-Pleistocene Climate Transition, narrow, open-platform units have developed at the upper parts of the pre-Quaternary basement flanks. With the onset of the high-amplitude 100 kyr sea-level modes and climate restoration, reef frameworks started to be generated. These models from Mururoa agree with a number of previous studies suggesting that most of the true framework reefs were not initiated prior to 0·50 Ma. Mururoa Atoll is demonstrated to be a robust analogue for providing more realistic interpretations of the development history of Pacific atolls. Further modelling with three-dimensional DIONISOS could generate better predictions by taking into account hydrodynamic and transport parameters more accurately