Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract 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

Study of Incident Drag Response of Hyperloop Pod Based on Change in Aerodynamic Brake Plate Orientation

The idea for the Hyperloop has received significant attention, with expectations of it becoming a revolutionary and potentially the fastest mode of land transportation on the planet. The low-pressure tube through which the pod travels at expected speeds close to Mach 1.0, presents a unique case among other transport models, and as such, braking of the pod is of critical importance if passenger safety protocols are to be maintained. The high-speed flow around the pod exerts high adverse pressure gradients on the pod surface, resulting in boundary layer separation, increasing drag and affecting the acceleration of the pod. Numerical simulations have shown that the placement of an aerodynamic brake plate on the pod surface at the point at which boundary layer separation occurs provides the necessary drag required for safe deceleration. This study was aimed to find the best angle for the aerodynamic brake positioned at a fixed point on the pod, allowing for the maximum generation of drag, using numerical simulations. After various trials, it was observed that angling the brake 15 backwards while increasing its length to keep incident brake profile constant, the drag value obtained was the highest.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author