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

Dense Nuclear Matter Equation of State from Heavy-Ion Collisions

The nuclear equation of state (EOS) is at the center of numerous theoretical and experimental efforts in nuclear physics. With advances in microscopic theories for nuclear interactions, the availability of experiments probing nuclear matter under conditions not reached before, endeavors to develop sophisticated and reliable transport simulations to interpret these experiments, and the advent of multi-messenger astronomy, the next decade will bring new opportunities for determining the nuclear matter EOS, elucidating its dependence on density, temperature, and isospin asymmetry. Among controlled terrestrial experiments, collisions of heavy nuclei at intermediate beam energies (from a few tens of MeV/nucleon to about 25 GeV/nucleon in the fixed-target frame) probe the widest ranges of baryon density and temperature, enabling studies of nuclear matter from a few tenths to about 5 times the nuclear saturation density and for temperatures from a few to well above a hundred MeV, respectively. Collisions of neutron-rich isotopes further bring the opportunity to probe effects due to the isospin asymmetry. However, capitalizing on the enormous scientific effort aimed at uncovering the dense nuclear matter EOS, both at RHIC and at FRIB as well as at other international facilities, depends on the continued development of state-of-the-art hadronic transport simulations. This white paper highlights the role that heavy-ion collision experiments and hadronic transport simulations play in understanding strong interactions in dense nuclear matter, with an emphasis on how these efforts can be used together with microscopic approaches and neutron star studies to uncover the nuclear EOS

Dense nuclear matter equation of state from heavy-ion collisions

International audienceThe nuclear equation of state (EOS) is at the center of numerous theoretical and experimental efforts in nuclear physics. With advances in microscopic theories for nuclear interactions, the availability of experiments probing nuclear matter under conditions not reached before, endeavors to develop sophisticated and reliable transport simulations to interpret these experiments, and the advent of multi-messenger astronomy, the next decade will bring new opportunities for determining the nuclear matter EOS, elucidating its dependence on density, temperature, and isospin asymmetry. Among controlled terrestrial experiments, collisions of heavy nuclei at intermediate beam energies (from a few tens of MeV/nucleon to about 25 GeV/nucleon in the fixed-target frame) probe the widest ranges of baryon density and temperature, enabling studies of nuclear matter from a few tenths to about 5 times the nuclear saturation density and for temperatures from a few to well above a hundred MeV, respectively. Collisions of neutron-rich isotopes further bring the opportunity to probe effects due to the isospin asymmetry. However, capitalizing on the enormous scientific effort aimed at uncovering the dense nuclear matter EOS, both at RHIC and at FRIB as well as at other international facilities, depends on the continued development of state-of-the-art hadronic transport simulations. This white paper highlights the essential role that heavy-ion collision experiments and hadronic transport simulations play in understanding strong interactions in dense nuclear matter, with an emphasis on how these efforts can be used together with microscopic approaches and neutron star studies to uncover the nuclear EOS