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

A measurement of the photonuclear interactions of 180 GeV muons in iron: The tilecal system of the ATLAS collaboration

The energy spectrum and the cross section of photonuclear interactions of 180 GeV muons in iron were measured at the CERN SPS using prototype modules of the ATLAS hadron calorimeter. The differential cross section (NA/A)vdσ/dv for a muon fractional energy loss v = ΔEμ/Eμ was measured in the range 0.1<v<1. The integrated cross section (NA/A) ∫0.1 1 vdσ/dv is (0.26 ± 0.03stat ±.03stat) · 10-6 cm2g-1 in agreement with the theoretical prediction of 0.267 · 10-6 cm-2g-1. The best adjustment of the data to the theory is achieved for the value of σγN = (115 ± 18stat ± 15syst)μb of the photon-nucleon cross section for photons with energies in the range from 18 to 180 GeV