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

Primary surface faulting across the Roman Theatre at Berniki, Sea of Galilee: new archaeoseismic and structural data

The Dead Sea Transform (DST) is a continental transform representing the boundary between Arabia and Sinai plates and accommodating a long-term slip rate of about 4-5 mm/a (e.g. Garfunkel et al., 2014). The DST shows the alternation of millennial periods of quiescence and seismic clusters, i.e., sequence of surface-rupturing earthquakes triggering each other in a short time laps. Seismic gaps suggest that presently several fault segments, including the Jordan Valley fault, are locked and strain is accumulating (Hamiel et al., 2016). We focus our efforts at the N tip of the Jordan Valley, at the Sea of Galilee (SOG) area, which is a subsiding basin bounded to the E by a left-lateral fault and to the W by the Tiberias normal fault, splaying at surface into several fault strands. In particular, we investigate the seismicity and paleoseismicity of the 8th century AD, when strong shocks clustered in time and space along this sector of the DST. Our investigation includes (Ferrario et al., 2015): i) re-interpretation of historical chronicles and available data; ii) analysis of a 0.5-m-resolution airborne Lidar of the entire SOG shores; iii) high-resolution seismic reflection profiles; iv) archaeoseismic and mesostructural surveys at two Roman sites in Tiberias, Berniki Theatre and the Southern City Gate (v) paleoseismological analysis. Preliminary results clearly map the strand of an active fault crossing the theatre, where a 60-cm vertical offset has been measured and dated by means of archaeological stratigraphy. A terrestrial Lidar survey, which is now in progress, will allow to measure with cm-accuracy the vertical and lateral components of coseismic displacement. We interpret the damage as primary surface faulting of one of the 8th century mainshocks. This interpretation is shading light on the \u201c749 AD event\u201d and contributing to the identification of the main faults which were activated during this event

Late Quaternary environmental evolution of the Como urban area (Northern Italy): A multidisciplinary tool for risk management and urban planning

The historical center of Como (Northern Italy) is prone to lake flooding and subsidence, due to the presence of unconsolidated silty sediments with poor mechanical properties. The sedimentary basin beneath the town contains over 180 m thickness of Late-Quaternary lacustrine, palustrine and alluvial deposits. The landscape evolution and the present-day environmental setting of the Como area have been reconstructed based on (i)more than 250 core logs and related geotechnical tests, (ii) detailed stratigraphic, sedimentological, paleobotanical and geotechnical analysis of several key boreholes, (iii) multi-year hydrogeological monitoring, (iv) estimation of subsidence rates and (v)integration of geomorphology, archeological findings and historical documents. Based on our environmental analysis, we derived an integrated geological and geomorphological model of the latest Pleistocene to Holocene local landscape evolution. This model was used to help design an engineering facility to mitigate flood hazards in the Como urban area. In 2012, we carried out investigations during a re-evaluation of the design parameters for the flood mitigation project at the Como lake-shore. The new campaign included seven boreholes, many in situ and laboratory tests, and four 14C dates. We found an organic silty unit, historical in age, with bad mechanical properties that was critical in the design of the flood mitigation project. We also obtained index properties for static and dynamic conditions, necessary for robust engineering planning. The results were used to update the project and better define future executive phases. Although the importance of acquiring independent experimental data is often overlooked, they can significantly improve the reliability of engineered systems, as demonstrated by the Como town case history