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

Cosmic-muon characterization and annual modulation measurement with Double Chooz detectors

A study on cosmic muons has been performed for the two identical near and far neutrino detectors of the Double Chooz experiment, placed at ∼120 and ∼300 m.w.e. underground respectively, including the corresponding simulations using the MUSIC simulation package. This characterization has allowed us to measure the muon flux reaching both detectors to be (3.64 ± 0.04) × 10-4 cm-2s-1 for the near detector and (7.00 ± 0.05) × 10-5 cm-2s-1 for the far one. The seasonal modulation of the signal has also been studied observing a positive correlation with the atmospheric temperature, leading to an effective temperature coefficient of αT = 0.212 ± 0.024 and 0.355 ± 0.019 for the near and far detectors respectively. These measurements, in good agreement with expectations based on theoretical models, represent one of the first measurements of this coefficient in shallow depth installations