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

State of nature

For the first time ever, the UK’s wildlife organisations have joined forces to undertake a health check of nature in the UK and its Overseas Territories. 60% of the 3,148 UK species we assessed have declined over the last 50 years and 31% have declined strongly. Half of the species assessed have shown strong changes in their numbers or range, indicating that recent environmental changes are having a dramatic impact on nature in the UK. Species with specific habitat requirements seem to be faring worse than generalist species. A new Watchlist Indicator, developed to measure how conservation priority species are faring, shows that their overall numbers have declined by 77% in the last 40 years, with little sign of recovery. Of more than 6,000 species that have been assessed using modern Red List criteria, more than one in 10 are thought to be under threat of extinction in the UK. Our assessment looks back over 50 years at most, yet there were large declines in the UK’s wildlife prior to this, linked to habitat loss. The UK’s Overseas Territories hold a wealth of wildlife of huge international importance and over 90 of these species are at high risk of global extinction. There is a lack of knowledge on the trends of most of the UK’s species. As a result, we can report quantitative trends for only 5% of the 59,000 or so terrestrial and freshwater species in the UK, and for very few of the 8,500 marine species. Much needs to be done to improve our knowledge. What we do know about the state of the UK’s nature is often based upon the efforts of thousands of dedicated volunteer enthusiasts who contribute their time and expertise to monitoring schemes and species recording. The threats to the UK’s wildlife are many and varied, the most severe acting either to destroy valuable habitat or degrade the quality and value of what remains. Climate change is having an increasing impact on nature in the UK. Rising average temperatures are known to be driving range expansion in some species, but evidence for harmful impacts is also mounting. The full report is online: www.rspb.org.uk/stateofnature We should act to save nature both for its intrinsic value and for the benefits it brings to us that are essential to our wellbeing and prosperity. Targeted conservation has produced inspiring success stories and, with sufficient determination, resources and public support, we can turn the fortunes of our wildlife around. The State of Nature report serves to illustrate that with shared resolve and commitment we can save nature

Identification of environmental factors that promote intestinal inflammation

Genome-wide association studies have identified risk loci linked to inflammatory bowel disease (IBD)1-a complex chronic inflammatory disorder of the gastrointestinal tract. The increasing prevalence of IBD in industrialized countries and the augmented disease risk observed in migrants who move into areas of higher disease prevalence suggest that environmental factors are also important determinants of IBD susceptibility and severity. However, the identification of environmental factors relevant to IBD and the mechanisms by which they influence disease has been hampered by the lack of platforms for their systematic investigation. Here we describe an integrated systems approach, combining publicly available databases, zebrafish chemical screens, machine learning and mouse preclinical models to identify environmental factors that control intestinal inflammation. This approach established that the herbicide propyzamide increases inflammation in the small and large intestine. Moreover, we show that an AHR-NF-κB-C/EBPβ signalling axis operates in T cells and dendritic cells to promote intestinal inflammation, and is targeted by propyzamide. In conclusion, we developed a pipeline for the identification of environmental factors and mechanisms of pathogenesis in IBD and, potentially, other inflammatory diseases