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

Multi-epoch imaging polarimetry of the SiO masers in the extended atmosphere of the Mira variable TX Cam

We present a time series of synoptic images of the linearly polarized ν = 1, J = 1-0 SiO maser emission toward the Mira variable, TX Cam. These data comprise 43 individual epochs at an approximate biweekly sampling over an optical pulsation phase range of φ = 0.68 to φ = 1.82. The images have an angular resolution of ∼500 μas and were obtained using the Very Long Baseline Array (VLBA), operating in the 43 GHz band in spectral-line, polarization mode. We have previously published the total intensity time series for this pulsation phase range; this paper serves to present the linearly polarized image sequence and an associated animation representing the evolution of the linear polarization morphology over time. We find a predominantly tangential polarization morphology, a high degree of persistence in linear polarization properties over individual component lifetimes, and stronger linear polarization in the inner projected shell than at larger projected shell radii. We present an initial polarization proper motion analysis examining the possible dynamical influence of magnetic fields in component motions in the extended atmospheres of late-type, evolved stars. © 2009 The American Astronomical Society. All rights reserved. Printed in the U.S.A