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

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

Strontium Isotope Analysis, the Neonatal Line, and Archaeological Caribou Herd Identity in Northwest Alaska

Rangifer tarandus is a keystone species in the Arctic and has shaped human land use in this region for tens of thousands of years. The migratory ecotype requires large landscapes and long migrations between summer and winter ranges to meet their nutritional needs. The extent to which these ranges have remained the same has been controversial and uncertain. Archaeological caribou herd identity is usually ascribed based on modern caribou herd distribution. However, no study has assessed the validity of the implicit assumption of multi-thousand years of range stasis. Given that a caribou herd’s distribution and landscape use may change in response to ecological or climatic changes, it is important to assess whether past and present calving ground locations may have shifted. In this study, we applied strontium isotope analysis to identify calving grounds of archaeological caribou from the pre-contact/historic Lake Kaiyak site (MIS-00032) near the calving grounds of the modern Western Arctic caribou herd (WAH). We found that the 87Sr/86Sr values of the molars were consistent with those predicted for WAH ranges. The dental enamel from the neonatal line (NNL), a pathological marker of birth, was consistent with the modern WAH calving grounds and early summer range. These results suggest that the archaeological specimens were WAH animals. Broadly, this supports the use of strontium isotope analysis of permanent molars with an emphasis on the NNL to determine the herd identity of ungulates in the archaeological record, which has important implications for archaeology and modern wild ungulate herd management.    Dans l’Arctique, le Rangifer tarandus est une espèce clé. Depuis des dizaines de milliers d’années, cette espèce façonne l’utilisation des terres de l’Arctique par l’être humain. Afin de répondre à ses besoins alimentaires, l’écotype migratoire a besoin de vastes paysages et de longues migrations entre les aires d’estivage et les aires d’hivernage. La mesure dans laquelle ces aires sont demeurées inchangées fait l’objet de controverses et d’incertitudes. En général, l’identité d’un troupeau de caribou archéologique est déterminée en fonction de la répartition d’un troupeau de caribou moderne. Cependant, aucune étude n’a évalué la validité de l’hypothèse implicite de la stase des aires de répartition sur plusieurs milliers d’années. Puisque la répartition d’un troupeau de caribou et l’utilisation du paysage peuvent changer en réponse aux changements écologiques ou climatiques, il est important d’évaluer si les lieux de mise bas, anciens et actuels, peuvent avoir changé. Dans le cadre de cette étude, nous avons utilisé l’analyse isotopique du strontium pour déterminer les aires de mise bas du caribou archéologique au site historique et préeuropéen de Lake Kaiyak (MIS-00032), près des aires de mise bas du troupeau de caribou moderne de l’Arctique de l’Ouest (WAH). Nous avons constaté que les valeurs 87Sr/86Sr des molaires coïncidaient avec celles prévues pour les aires du troupeau de l’Arctique de l’Ouest. L’émail dentaire de la ligne néonatale, un marqueur pathologique de la naissance, correspondait aux aires de mise bas et à l’aire estivale initiale du troupeau de caribou moderne de l’Arctique de l’Ouest. Ces résultats suggèrent que les spécimens archéologiques provenaient de bêtes du troupeau de l’Arctique de l’Ouest. De manière générale, ces données viennent appuyer l’utilisation de l’analyse isotopique du strontium des molaires permanentes mettant l’accent sur la ligne néonatale pour déterminer l’identité du troupeau d’ongulés des données archéologiques, ce qui a d’importantes implications pour la gestion du troupeau sauvage d’ongulés archéologiques et modernes.Северный олень (лат. Rangifer tarandus) – ключевой вид арктической фауны, на протяжении десятков тысяч лет определяющий землепользование человека в Арктике. Этой мигрирующей популяции нужен простор и большие расстояния для миграции между летним и зимним ареалами для удовлетворения своих потребностей в питании. Однако спорным остается вопрос насколько эти ареалы сохранились. Археологическая идентичность стада северных оленей обычно определяется на основе нынешнего распределения стада. Однако не проводились исследования, оценивающие обоснованность предположения о стазисе ареала, длившегося много тысяч лет. Учитывая, что распределение и использование ландшафта стадом может измениться в ответ на климатические изменения, важно оценить, могли ли измениться места отела в прошлом и в настоящее время. В этом исследовании мы использовали анализ изотопов стронция для археологического определения мест отела северных оленей из доконтактного/исторического участка на озере Кайяк (MIS-00032) недалеко от мест отела современного западно-арктического стада (WAH). Для анализа использовались образцы со стоянки на озере Каяк (MIS-00032) и стоянки возле мест отела современного Западного арктического стада (англ. Western Arctic caribou herd, WAH). Мы обнаружили, что соотношения изотопов стронция 87Sr/86Sr в коренных зубах соответствуют прогнозам для диапазонов WAH. Зубная эмаль неонатальной линии, патологический маркер рождения, соответствует современным местам отела WAH и раннему летнему ареалу. Исходя из этого, можно предположить, что археологические образцы являются животными WAH. В целом, это обосновывает использование анализа содержания стронция в постоянных коренных зубах с акцентом на зубную эмаль неонатальной линии для определения идентичности стада из археологических свидетельств, что имеет большое значение для археологии и современного управления стадом диких оленей

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 coprioritized 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