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

Can one identify two unital JB*-algebras by the metric spaces determined by their sets of unitaries?

Let M and N be two unital JB∗-algebras and let U(M) and U(N) denote the sets of all unitaries in M and N, respectively. We prove that the following statements are equivalent: A) M and N are isometrically isomorphic as (complex) Banach spaces; B) M and N are isometrically isomorphic as real Banach spaces; C) there exists a surjective isometry Δ:U(M)→U(N). We actually establish a more general statement asserting that, under some mild extra conditions, for each surjective isometry Δ:U(M)→U(N), we can find a surjective real linear isometry Ψ:M→N which coincides with Δ on the subset eiMsa. If we assume that M and N are JBW∗-algebras, then every surjective isometry Δ:U(M)→U(N) admits a (unique) extension to a surjective real linear isometry from M onto N. This is an extension of the Hatori–Molnár theorem to the setting of JB∗-algebras

Exploring new solutions to Tingley’s problem for function algebras

In this note we present two new positive answers to Tingley's problem in certain subspaces of function algebras. In the first result we prove that every surjective isometry between the unit spheres, S(A) and S(B), of two uniformly closed function algebras A and B on locally compact Hausdorff spaces can be extended to a surjective real linear isometry from A onto B. In a second part we study surjective isometries between the unit spheres of two abelian JB*-triples represented as spaces of continuous functions of the form CT0(X) := {a2C0(X) :a(�t) =�a(t) for every (�;t)2T�X}; where X is a (locally compact Hausdorff) principal T-bundle and T denotes the unit sphere of C. We establish that every surjective isometry ∆ :S(CT0(X))!S(CT0(Y))admits an extension to a surjective real linear isometry between these two abelian JB*-triples