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

Aeschylus' Septem Contra Thebas Text and commentary

SIGLELD:D49606/84 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Geology as a control on landslides on the Isle of Wight : an overview

The Cretaceous and Palaeogene sedimentary rocks that crop out on the Isle of Wight are highly prone to landsliding and the island offers an important field laboratory wherein to investigate a number of the different types of failure. Many of these landslides represent a significant engineering hazard, with several urban areas requiring remedial work and planning constraints (e.g. The Undercliff and Seagrove Bay) to aid development. Previous studies have thoroughly investigated the major landslides in the Undercliff area around Ventnor and presented a mechanism for that massive failure. This overview of the landslides throughout the Isle of Wight by the British Geological Survey was completed as part of the multidisciplinary survey of the surface geology, structure, geophysical response and offshore interpretations of the island between 2007 and 2010. The survey has collected new observational data on the extensive coastal landslides, as well as the distribution, nature and mechanism of failure of the lesser-studied inland examples