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

Isotopic fluid changes in a Neoproterozoic porphyry-epithermal system: The Uruguay mine, southern Brazil,

International audienceIdentifying the source, origin and time of emplacement of copper and gold deposits in the Neoproterozoic volcano-sedimentary and plutonic series of southern Brazil is a longstanding research goal. In this geological context, the Camaquã and Lavras do Sul areas are reported to be a post-collisional domain related to the Braziliano-Pan-African Orogenic Cycle. This study focused on the Uruguay open-pit mine through a detailed assessment of the mineralogy, geochemistry and (S, O, H and C) stable isotopes of pyrite, chalcopyrite, clay minerals and carbonates as veins or disseminated sulfides in sedimentary rocks. The results indicate that the Camaquã mine is a low-sulfidation epithermal-type deposit with sulfide precipitations related to a mixture of magmatic (δ34S = 1 to 4‰; δ18O: 3 to 9‰) and meteoric waters (δ18O = − 4 to − 12‰) and a temperature varying from 350 to 80 °C. Ore precipitation is associated with sequential sulfide crystallization exhausting the S magmatic source