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

THE CHEMICAL STRUCTURE OF CONDUCTING POLYHETEROCYCLIC FILMS : XPS STUDIES

La caractérisation de films polymères conducteurs à base de pyrrole et de thiophène a été entreprise par spectroscopie des photoélectrons excités aux rayons X. Les anneaux aromatiques sont essentiellement liés par leurs carbones α, néanmoins des effets de désordre en proportion importante peuvent apparaître. Les anions mis en solution pour la préparation ou pour le cyclage électrochimique des films ne sont pas toujours retrouvés tels quels dans les polymères conducteurs. Ce n'est que dans les premiers stades de l'oxydation du polypyrrole neutre que le dopage s'effectue par l'extraction homogène de charges du pyrrole polymérisé. En régime de dopage élevé, l'atome d'azote du pyrrole est un centre réactif de déhydrogénation et d'oxydation.X-ray photoemission spectroscopy is used to characterize conducting pyrrole and thiophene polymer films. The results are essentially in agreement with α linking of the aromatic rings, but very significant degrees of disorder may occur. Not always is the anion dissolved in the electrolyte for the preparation or for electrochemical cycling of the films found as such in the conducting polymer. Only in the very early stage of oxidation does the doping of neutral polypyrrole proceed by homogeneous charge extraction from the polymeric pyrrole subsystem. At higher doping levels, the N atom of the pyrrole ring provides a reactive site for dehydrogenation and oxygenation reactions

MAGNETIC PROPERTIES OF THE SUPERCONDUCTING POLYMERS (SN)x AND (SNBr0.4)x

L'aimantation du polymère supraconducteur (SN)x a été étudiée en fonction du champ magnétique et de la température sur un échantillon (SN)x de qualité inférieure. Cependant il y a des différences quantitatives significatives dans les résultats obtenus sur (SNBr0,4)x.The magnetization of superconducting (SN)x has been studied as a function of magnetic field and temperature for a good quality (SN)x sample. The results are similar to previous data obtained on poorer quality (SN)x. However, there are significant quantitative différences from the results on (SNBr0.4)x

CHARACTERIZATION OF POLYPYRROLE

En utilisant les polymères β, β' diméthylpyrrole pour réduire le désordre de structure, il a été possible d'interpréter les résultats de diffraction électronique et de proposer une structure idéale pour le poly-pyrrole neutre. Les données de XPS ont été utilisées pour mettre en évidence quelques écarts à cette structure idéale qui ont été vus dans quelques films. L'origine de quelques uns de ces défauts est reliée au mécanisme de polymérisation. On montre que la structure plane de la chaîne joue un rôle important dans la grande conductivité des polymères pyrrole, qui paraît être due à des porteurs sans spins, peut-être associés à des bipolarons.Using β, β' dimethylpyrrole polymers to reduce the structural disorder it has been possible to interpret the results of electron diffraction data and to propose an idealized structure for neutral polypyrrole. XPS data have been used to define some of the deviations from this ideal structure that are seen in actual films and the origin of some of these defects is related to the mechanism of polymerization. The planarity of the chain structure is shown to be important for high conductivity in pyrrole polymers which appears to involve spinless carriers perhaps associated with bipolarons