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

Extension across the Indian-Arabian plate boundary: the Murray Ridge

Seismic reflection profiles from the Murray Ridge in the Gulf of Oman, northwest Indian Ocean, show a significant component of extension across the predominantly strike-slip Indian–Arabian plate boundary. The Murray Ridge lies along the northern section of the plate boundary, where its trend becomes more easterly and thus allows a component of extension. The Dalrymple Trough is a 25 km wide, steep-sided half graben, bounded by large faults with components of both strike-slip and normal motion. The throw at the seabed of the main fault on the southeastern side of the half grabenr eaches 1800 m. The northwest side of the trough is delineated by a series of smaller antithetic normal faults. Wide-angle seismic, gravity and magnetic models show that the Murray Ridge and Dalrymple Trough are underlain by a crystalline crust upto 17 km thick, which may be continental in origin. Any crustal thinning due to extension is limited, and no new crust has been formed. We favour a plate model in which the Indian–Arabian plate boundary was initially located further west than the Owen Fracture Zone, possibly along the Oman continental margin, and suggest that during the Oligocene–Early Miocene Indian Ocean plate reorganization, the plate boundary moved to the site of the present Owen Fracture Zone and that motion further west ceased. At this time, deformation began along the Murray Ridge, with both the uplift of basement highs, and subsidence in the trough stilting the lowest sedimentary unit. Qalhat Seamount was formed at this time. Subsequent sediments were deposited unconformably on the tilted lower unit and then faulted to produce the present basement topography. The normal faulting was accompanied by hanging-wall subsidence, footwall uplift, and erosion. Flat-lying recent sediments show that the major vertical movements have ceased, although continuing earthquakes show that some faulting is still active along the plate boundary