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

jointed with composite patch

Stress intensity factors are numerically investigated for interfacial edge crack between two dissimilar composite plates jointed with single side composite patch. Variation of stress intensity factor under Mode I loading condition is examined for different material models and fiber orientation angles of composite plates and patch. ANSYS 12.1 finite element analysis software is used to obtain displacements of crack surfaces in the numerical solution and repaired plates are modeled in three dimensions. Obtained results are presented in the form of graphs. It is found that fiber orientation angle of composites is an effective parameter on interfacial stress intensity factor

Visual discrimination of screen-detected persistent from transient subsolid nodules: An observer study - Fig 3

<p><b>(a)</b> Correctly identified transient lesion with a probability score of ≤ 40 by all four observers. <b>(b)</b> Correctly identified persistent lesion with a probability score of ≥ 80 by all four observers. <b>(c)</b> Incorrectly identified lesion by majority of observers: transient lesion, but scored as persistent (probability score ≥ 60). <b>(d)</b> Incorrectly identified lesion by majority of observers: persistent lesion, but scored as transient (probability score ≤ 40).</p

Reading workstation.

<p>The morphological features to be scored are listed on the left side of the monitor display. Lower-left corner has two text fields to enter the probability (0–100) and any comments. A magnified axial view of the nodule under evaluation is centered in the middle of the display. Coronal/sagittal projections are available on the right side of the screen, display size of the three projections was interchangeable. Processing tools such as windowing and magnification as well the full 3D CT dataset were available at any time.</p

Receiver Operating Characteristic (ROC) curves for the average of all four observers.

<p>A_z (Area Under the Curve) and 95% confidence interval in parenthesis.</p

Visual discrimination of screen-detected persistent from transient subsolid nodules: An observer study - Fig 4

<p><b>(a)</b> A transient lesion with disagreement (2 versus 2) among observers. <b>(b)</b> A persistent lesion with disagreement (2 versus 2) among observers.</p

Receiver Operating Characteristic (ROC) curves for observer 1, 2, 3 and 4 to predict the persistence of the subsolid lesions ≥ 10 mm.

<p>A_z (Areas Under the Curve) and 95% confidence interval in parenthesis, obs = observer.</p

Univariate analyses.

<p>Table describes morphological features with at least 2 observers in which the feature is seen significantly different between transient (T) and persistent (P) subsolid nodules using Chi-square. The total number of included nodules after exclusion is 172.</p