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

Waves in high-speed plasmoids in the magnetosheath and at the magnetopause

Plasmoids, defined here as plasma entities with a higher anti-sunward velocity component than the surrounding plasma, have been observed in the magnetosheath in recent years. During the month of March 2007 the Cluster spacecraft crossed the magnetopause near the subsolar point 13 times. Plasmoids with larger velocities than the surrounding magnetosheath were found on seven of these 13 occasions. The plasmoids approach the magnetopause and interact with it. Both whistler mode waves and waves in the lower hybrid frequency range appear in these plasmoids, and the energy density of the waves inside the plasmoids is higher than the average wave energy density in the magnetosheath. When the spacecraft are in the magnetosphere, Alfvenic waves are observed. Cold ions of ionospheric origin are seen in connection with these waves, when the wave electric and magnetic fields combine with the Earth's dc magnetic field to yield an E x B/B-2 drift speed that is large enough to give the ions energies above the detection threshold

Waves in high-speed plasmoids in the magnetosheath and at the magnetopause

Plasmoids, defined here as plasma entities with a higher anti-sunward velocity component than the surrounding plasma, have been observed in the magnetosheath in recent years. During the month of March 2007 the Cluster spacecraft crossed the magnetopause near the subsolar point 13 times. Plasmoids with larger velocities than the surrounding magnetosheath were found on seven of these 13 occasions. The plasmoids approach the magnetopause and interact with it. Both whistler mode waves and waves in the lower hybrid frequency range appear in these plasmoids, and the energy density of the waves inside the plasmoids is higher than the average wave energy density in the magnetosheath. When the spacecraft are in the magnetosphere, Alfvenic waves are observed. Cold ions of ionospheric origin are seen in connection with these waves, when the wave electric and magnetic fields combine with the Earth's dc magnetic field to yield an E x B/B-2 drift speed that is large enough to give the ions energies above the detection threshold