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

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

Development of a pulsed MIG system for fully automatic multipass welding

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MALDI-TOF-MS for rapid detection of staphylococcal Panton-Valentine leukocidin

Toxin-producing Gram-positive bacteria are responsible for emerging and life-threatening infections in humans worldwide. Both rapid toxin detection and adapted therapy are essential to limit the morbidity due to such toxins, especially staphylococcal Panton-Valentine leukocidin (PVL). Here we describe the use of a mass spectrometry profile generated by matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) followed by ClinProTools (TM) 2.0 software analysis to find a reproducible model able to identify PVL in Staphylococcus aureus strains. Eighty-one S. aureus strains were used and tested for the presence of PVL, toxic shock syndrome toxin (TSST-1) and mecA genes. The peak at 4448 mass-to-charge ratio (m/z) was the most relevant peak to differentiate between PVL-producing and non-PVL-producing S. aureus. A model using only this peak had an overall recognition capability of 100% and an overall cross-validation of 77.07%. Prospective evaluation of the model allowed two cases of PVL-producing strains to be detected within a few minutes during the time of care and before polymerase chain reaction (PCR) results. Our study represents a proof of concept for the use of such rapid technology as a point-of-care method to identify potential lethal toxin quickly. We believe that such a rapid method will be timely to help change the therapeutic strategy and could be used in the future for other pathogens and infectious diseases

Pulsed MIG Improving fusion characteristics

SIGLEAvailable from British Library Document Supply Centre- DSC:3106.129(TPRD/M--1530/N85) / BLDSC - British Library Document Supply CentreGBUnited Kingdo