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

Cold-induced elevation of forearm vascular resistance is inversely related to birth weight

Fetal growth retardation has been linked to elevated blood pressure in adult life. This association between birth weight and blood pressure is present in childhood and is amplified with age. However, the mechanisms that underlie this association are largely unknown. We examined the relationship between birth weight and forearm vascular resistance and forearm blood flow in children aged 9?12.7 years. A total of 58 children were randomly selected from a cohort of 1610 born at the University Hospital of the West Indies in Jamaica where adequate antenatal and delivery records were available. Blood pressure, heart rate and forearm blood flow (by venous occlusion plethysmography) were measured at rest and after cold pressor and mental arithmetic tests. There was a significant inverse correlation between birth weight and the change in the vascular resistance for the cold pressor test (r=-0.47; P<0.001) and the mental arithmetic stress test (r=-0.26; P=0.05). The log ratio of vascular resistance under stress to resting decreased by 0.289 units per kg of birth weight (95% CI: 0.145?0.434; P=0.0002). Lower birth weight is associated with increased vascular responsiveness. Increased vascular resistance might be one mechanism linking fetal growth to subsequent elevated blood pressure

Microorganisms persist at record depths in the subseafloor of the Canterbury Basin

The subsurface realm is colonized by microbial communities to depths of >1000 meters below the seafloor (m.b.sf.), but little is known about overall diversity and microbial distribution patterns at the most profound depths. Here we show that not only Bacteria and Archaea but also Eukarya occur at record depths in the subseafloor of the Canterbury Basin. Shifts in microbial community composition along a core of nearly 2 km reflect vertical taxa zonation influenced by sediment depth. Representatives of some microbial taxa were also cultivated using methods mimicking in situ conditions. These results suggest that diverse microorganisms persist down to 1922 m.b.sf. in the seafloor of the Canterbury Basin and extend the previously known depth limits of microbial evidence (i) from 159 to 1740 m.b.sf. for Eukarya and (ii) from 518 to 1922 m.b.sf. for Bacteria