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

Comparison between the Quantum Efficiency of a Y thin film and a Y smooth bulk

Advanced high brightness photo-injectors require photo-cathodes with fast response time, long lifetime and relatively high quantum efficiency. Metallic cathodes could satisfy these proprieties and in order to control the emitting material and its surface we produced an yttrium thin film, prepared by PLD (Pulsed Laser Deposition)

Photo-Emission Studies from Zn Cathodes under Plasma Phase

In this paper we report investigations of the electron emission from pure Zn cathodes irradiated by UV laser pulses of 23 ns (FWHM) at a wavelength of 248 nm (5 eV). The metal cathodes were tested in a vacuum photodiode chamber at 10-7 Pa. They were irradiated at normal incidence and the anode-cathode distance was set at 3 mm. The maximum applied accelerating voltage was 18 kV, limited by the electrical breakdown of the photodiode gap. Under the above experimental conditions a maximum applied electric field of 6 MV/m resulted. In the saturation regime, the measured quantum efficiency (QE) value increased with the accelerating voltage due to the plasma formation. The highest output current was achieved with 14 mJ laser energy, 18 kV accelerating voltage and its value was 12 A, corresponding to a global quantum efficiency (GQE) approximately of 1 x 10-4. The temporal quantum efficiency (TQE) was 1.0 x 10-4 at the laser pulse onset time, and 1.4 x 10-4 at the pulse tail. We calculated the target temperature at the maximum laser energy. Its value allowed us to obtain output pulses of the same laser temporal profile. Tests performed with a lower laser photon energy (4.02 eV) demonstrated a GQE of two orders of magnitude lower