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

Ceramic processing and multiferroic properties of the perovskite YMnO3-BiFeO3 binary system

International audienceThe perovskite (1-x)YMnO3-xBiFeO(3) binary system is very promising because of its multiferroic end members. Nanocrystalline phases have been recently obtained by mechanosynthesis across the system, and the perovskite structural evolution has been described. Two continuous solid solutions with orthorhombic Pnma and rhombohedral R3c symmetries were found, which coexist within a broad compositional interval of 0.5 <= x <= 0.9. This might be a polar-nonpolar morphotropic phase boundary region, at which strong phase-change magnetoelectric responses can be expected. A major issue is phase decomposition at moderate temperatures that highly complicates ceramic processing. This is required for carrying out a sound electrical characterization and also for their use in devices. We present here the application of Spark Plasma Sintering to the ceramic processing of YMnO3-BiFeO3 phases. This advanced technique, when combined with nanocrystalline powders, allowed densifying phases at reduced processing temperatures and times, so that perovskite decomposition was avoided. Electrical measurements were accomplished, and the response was shown to be mostly dominated by conduction. Nonetheless, the intrinsic dielectric permittivity was obtained, and a distinctive enhancement in the phase coexistence region was revealed. Besides, Rayleigh-type behavior characteristic of ferroelectrics was also demonstrated for all rhombohedral phases. Magnetic characterization was performed in this region, and antiferromagnetism was shown