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

Presentations of finite simple groups: a computational approach

All nonabelian finite simple groups of rank $n$ over a field of size $q$, with the possible exception of the Ree groups $^2G_2(3^{2e+1})$, have presentations with at most $80$ relations and bit-length $O(\log n +\log q)$. Moreover, $A_n$ and $S_n$ have presentations with 3 generators$,$ 7 relations and bit-length $O(\log n)$, while \SL(n,q) has a presentation with 7 generators, $2 5$ relations and bit-length $O(\log n +\log q)

Remarks on proficient groups. Dedicated to the memory of Karl Gruenberg

If a finite group G has a presentation with d generators and r relations, it is well-known that r ? d is at least the rank of the Schur multiplier of G; a presentation is called efficient if equality holds. There is an analogous definition for proficient profinite presentations. We show that many perfect groups have proficient presentations. Moreover, we prove that infinitely many alternating groups, symmetric groups and their double covers have proficient presentations