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

Isolated photochemical reaction centers from bacteriochlorophyll b - containing organisms

Optical, ESR and pulsed laser spectroscopic examination of isolated bacteriochlorophyll (BChl) b-containing reaction centers (RCs) demonstrates that their composition (1 P960 : 2 bacteriopheophytin (BPh) b : 2 cyt c 558 : 2 cyt c 553 : BChl/BPh = 2) and their mechanism for charge separation are very similar to those in BChl a-containing RCs; however, P960/sup +/, the oxidized form of the primary electron donor, is apparently not a symmetrical dimer of BChl b. The ''primary'' electron acceptor (X) is a quinone-iron complex, and I, the intermediary electron carrier between P960 and X, is BPh which interact(s) strongly with one or more of the other components in the RC. Comparison of the optical spectra of isolated RCs of the BChl b-containing bacteria, Rhodopseudomonas viridis and Thiocapsa pfennigii, with those of their intact cells shows that the BPh in the RC is not generated during the isolation procedure