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

Dynamic characterization of Cu-Zr binary bulk metallic glasses (A Molecular Dynamics Study)

In the present study, molecular dynamics simulation employing embedded atom method (EAM) potential is performed to investigate the formation and characterization of CuZr bulk metallic glasses (BMGs). To elucidate the effect of component concentration of three samples of BMGs including Cu25-Zr75, Cu50-Zr50 and Cu75-Zr25 that are formed by melt quenching. The local structure of BMGs is analyzed by means of radial distribution function (RDF) and local atomic number density Ď . The mechanical behavior of three compositions is investigated using uniaxial compressive loading at a constant strain rate, It is revealed from the results that yield strength increases with increasing Cu-concentration. Thermal expansion of CuZr BMGs is examined and variation in length and volume is measured. The analysis revealed that Cu25-Zr75 and Cu50-Zr50 exhibited the typical expansion behavior while Cu75-Zr25 showed an anomalous behavior.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author