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

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

Comparative Analysis of Tsunami Recovery Strategies in Small Communities in Japan and Chile

The Sendai Framework for Disaster Risk Reduction emphasizes the need to rebuild better after a disaster to ensure that the at-risk communities can withstand a similar or stronger shock in the future. In the present work, the authors analyzed the reconstruction paths through a comparative analysis of the perspective of a community in Japan and another in Chile, and their respective local governments. While both countries are at risk to tsunamis, they follow different reconstruction philosophies. Data was gathered through key informant interviews of community members and local government officials, by adapting and modifying the Building Resilience to Adapt to Climate Extremes and Disasters (BRACED) 3As framework to a tsunami scenario. The 3As represent anticipatory, adaptive, and absorptive capacities as well as transformative capacities and respondents were asked to rate this according to their perspectives. It was found that while both communities perceive that much is to be done in recovery, Kirikiri has a more holistic and similar perspective of the recovery with their government officials as compared to Dichato. This shows that community reconstruction and recovery from a disaster requires a holistic participation and understanding

Survey Tool for Rapid Assessment of Socio-Economic Vulnerability of Fishing Communities in Vietnam to Climate Change

Climate change will likely affect the effectiveness of future management of coastal ecosystems, impacting communities that reside within the coastal area. In order to formulate appropriate adaptation counter-measures it is important to understand the actual vulnerability of the communities that depend on these ecosystems. The present research proposes a tool for assessing the vulnerability of coastal communities to climate change by combining survey results with secondary and observed data available from national and local governments. The study focused on fisheries, given that they constitute the source of livelihood for many communities in developing countries such as Vietnam. The results showed that two coastal wards in Binh Thuan province, Vietnam, are highly vulnerable to the impacts of climate change, mainly because of their dependence on fisheries and the topography of the area. The seasonality of their source of livelihood affects the adaptive capacity of residents, making it less likely that they will be able to successfully adapt to changes in fishery resources that could be brought about by climate change. The results also showed that the communities are particularly vulnerable to sea level rise, given that they are both located in the immediate vicinity of the sea and are particularly low in elevation

Human neocortical expansion involves glutamatergic neuron diversification

The neocortex is disproportionately expanded in human compared with mouse1,2, both in its total volume relative to subcortical structures and in the proportion occupied by supragranular layers composed of neurons that selectively make connections within the neocortex and with other telencephalic structures. Single-cell transcriptomic analyses of human and mouse neocortex show an increased diversity of glutamatergic neuron types in supragranular layers in human neocortex and pronounced gradients as a function of cortical depth3. Here, to probe the functional and anatomical correlates of this transcriptomic diversity, we developed a robust platform combining patch clamp recording, biocytin staining and single-cell RNA-sequencing (Patch-seq) to examine neurosurgically resected human tissues. We demonstrate a strong correspondence between morphological, physiological and transcriptomic phenotypes of five human glutamatergic supragranular neuron types. These were enriched in but not restricted to layers, with one type varying continuously in all phenotypes across layers 2 and 3. The deep portion of layer 3 contained highly distinctive cell types, two of which express a neurofilament protein that labels long-range projection neurons in primates that are selectively depleted in Alzheimer’s disease4,5. Together, these results demonstrate the explanatory power of transcriptomic cell-type classification, provide a structural underpinning for increased complexity of cortical function in humans, and implicate discrete transcriptomic neuron types as selectively vulnerable in disease