Surgery, innovation, research and sustainable development

In the healthcare sector, surgery (especially in the operating theatre) is responsible for emission of greenhouse gases, which is a source of global warming. The goal of this largely quantitative assessment is to address three questions on carbon footprint associated with surgery, the role of primary and secondary prevention prior to surgical procedures, and incorporation of the carbon footprint into judgment criteria in research and surgical innovations. It appears that while the impact of surgery on global warming is undeniable, its extent depends on means of treatment and geographical location. Before and after an operation, primary, secondary and tertiary prevention accompanied by surgical sobriety (avoiding unnecessary or unjustified actions) can be virtuous in terms of sustainable development. However, the sanitary benefits of these actions are often opposed to environmental benefit, which has yet to be satisfactorily assessed. Lastly, the carbon footprint has yet to be incorporated into research protocols or the innovations under development. This should impel us not only to sensitize the different healthcare actors to relevant issues, but also to improve working conditions.

Reducing the carbon footprint of operating rooms through education on the effects of inhalation anesthetics on global warming: A retrospective study

Environmental concerns, especially global warming, have prompted efforts to reduce greenhouse gas emissions. Healthcare systems, including anesthesia practices, contribute to these emissions. Inhalation anesthetics have a significant environmental impact, with desflurane being the most concerning because of its high global warming potential. This study aimed to educate anesthesiologists on the environmental impact of inhalation anesthetics and assess changes in awareness and practice patterns, specifically reducing desflurane use. This study included data from patients who underwent surgery under general anesthesia 1 month before and after education on the effects of inhalation anesthetics on global warming. The primary endpoint was a change in inhalational anesthetic use. Secondary endpoints included changes in carbon dioxide equivalent (CO2e) emissions, driving equivalent, and medical costs. After the education, desflurane use decreased by 50%, whereas sevoflurane use increased by 50%. This shift resulted in a reduction in the overall amount of inhalational anesthetics used. The total CO2e and driving-equivalent values decreased significantly. The cost per anesthesia case decreased, albeit to a lesser extent than expected. Education on the environmental impact of inhalation anesthetics has successfully altered anesthesiologists' practice patterns, leading to reduced desflurane usage. This change has resulted in decreased CO2e emissions and has had a positive effect on mitigating global warming. However, further research is required to assess the long-term impact of such education and the variability in practice patterns across different institutions.

Designing a circular carbon and plastics economy for a sustainable future

The linear production and consumption of plastics today is unsustainable. It creates large amounts of unnecessary and mismanaged waste, pollution and carbon dioxide emissions, undermining global climate targets and the Sustainable Development Goals. This Perspective provides an integrated technological, economic and legal view on how to deliver a circular carbon and plastics economy that minimizes carbon dioxide emissions. Different pathways that maximize recirculation of carbon (dioxide) between plastics waste and feedstocks are outlined, including mechanical, chemical and biological recycling, and those involving the use of biomass and carbon dioxide. Four future scenarios are described, only one of which achieves sufficient greenhouse gas savings in line with global climate targets. Such a bold system change requires 50% reduction in future plastic demand, complete phase-out of fossil-derived plastics, 95% recycling rates of retrievable plastics and use of renewable energy. It is hard to overstate the challenge of achieving this goal. We therefore present a roadmap outlining the scale and timing of the economic and legal interventions that could possibly support this. Assessing the service lifespan and recoverability of plastic products, along with considerations of sufficiency and smart design, can moreover provide design principles to guide future manufacturing, use and disposal of plastics.

Critical transitions in the Amazon forest system

The possibility that the Amazon forest system could soon reach a tipping point, inducing large-scale collapse, has raised global concern1-3. For 65 million years, Amazonian forests remained relatively resilient to climatic variability. Now, the region is increasingly exposed to unprecedented stress from warming temperatures, extreme droughts, deforestation and fires, even in central and remote parts of the system1. Long existing feedbacks between the forest and environmental conditions are being replaced by novel feedbacks that modify ecosystem resilience, increasing the risk of critical transition. Here we analyse existing evidence for five major drivers of water stress on Amazonian forests, as well as potential critical thresholds of those drivers that, if crossed, could trigger local, regional or even biome-wide forest collapse. By combining spatial information on various disturbances, we estimate that by 2050, 10% to 47% of Amazonian forests will be exposed to compounding disturbances that may trigger unexpected ecosystem transitions and potentially exacerbate regional climate change. Using examples of disturbed forests across the Amazon, we identify the three most plausible ecosystem trajectories, involving different feedbacks and environmental conditions. We discuss how the inherent complexity of the Amazon adds uncertainty about future dynamics, but also reveals opportunities for action. Keeping the Amazon forest resilient in the Anthropocene will depend on a combination of local efforts to end deforestation and degradation and to expand restoration, with global efforts to stop greenhouse gas emissions.

Evidence of human influence on Northern Hemisphere snow loss

Documenting the rate, magnitude and causes of snow loss is essential to benchmark the pace of climate change and to manage the differential water security risks of snowpack declines1-4. So far, however, observational uncertainties in snow mass5,6 have made the detection and attribution of human-forced snow losses elusive, undermining societal preparedness. Here we show that human-caused warming has caused declines in Northern Hemisphere-scale March snowpack over the 1981-2020 period. Using an ensemble of snowpack reconstructions, we identify robust snow trends in 82 out of 169 major Northern Hemisphere river basins, 31 of which we can confidently attribute to human influence. Most crucially, we show a generalizable and highly nonlinear temperature sensitivity of snowpack, in which snow becomes marginally more sensitive to one degree Celsius of warming as climatological winter temperatures exceed minus eight degrees Celsius. Such nonlinearity explains the lack of widespread snow loss so far and augurs much sharper declines and water security risks in the most populous basins. Together, our results emphasize that human-forced snow losses and their water consequences are attributable-even absent their clear detection in individual snow products-and will accelerate and homogenize with near-term warming, posing risks to water resources in the absence of substantial climate mitigation.

A unified explanation for the morphology of raised peatlands

Raised peatlands, or bogs, are gently mounded landforms that are composed entirely of organic matter1-4 and store the most carbon per area of any terrestrial ecosystem5. The shapes of bogs are critically important because their domed morphology4,6,7 accounts for much of the carbon that bogs store and determines how they will respond to interventions8,9 to stop greenhouse gas emissions and fires after anthropogenic drainage10-13. However, a general theory to infer the morphology of bogs is still lacking4,6,7. Here we show that an equation based on the processes universal to bogs explains their morphology across biomes, from Alaska, through the tropics, to New Zealand. In contrast to earlier models of bog morphology that attempted to describe only long-term equilibrium shapes4,6,7 and were, therefore, inapplicable to most bogs14-16, our approach makes no such assumption and makes it possible to infer full shapes of bogs from a sample of elevations, such as a single elevation transect. Our findings provide a foundation for quantitative inference about the morphology, hydrology and carbon storage of bogs through Earth's history, as well as a basis for planning natural climate solutions by rewetting damaged bogs around the world.

Integrated global assessment of the natural forest carbon potential

Forests are a substantial terrestrial carbon sink, but anthropogenic changes in land use and climate have considerably reduced the scale of this system1. Remote-sensing estimates to quantify carbon losses from global forests2-5 are characterized by considerable uncertainty and we lack a comprehensive ground-sourced evaluation to benchmark these estimates. Here we combine several ground-sourced6 and satellite-derived approaches2,7,8 to evaluate the scale of the global forest carbon potential outside agricultural and urban lands. Despite regional variation, the predictions demonstrated remarkable consistency at a global scale, with only a 12% difference between the ground-sourced and satellite-derived estimates. At present, global forest carbon storage is markedly under the natural potential, with a total deficit of 226 Gt (model range = 151-363 Gt) in areas with low human footprint. Most (61%, 139 Gt C) of this potential is in areas with existing forests, in which ecosystem protection can allow forests to recover to maturity. The remaining 39% (87 Gt C) of potential lies in regions in which forests have been removed or fragmented. Although forests cannot be a substitute for emissions reductions, our results support the idea2,3,9 that the conservation, restoration and sustainable management of diverse forests offer valuable contributions to meeting global climate and biodiversity targets.

Ending extreme poverty has a negligible impact on global greenhouse gas emissions

Growing consumption is both necessary to end extreme poverty1and one of the main drivers of greenhouse gas emissions2, creating a potential tension between alleviating poverty and limiting global warming. Most poverty reduction has historically occurred because of economic growth3-6, which means that reducing poverty entails increasing not only the consumption of people living in poverty but also the consumption of people with a higher income. Here we estimate the emissions associated with the economic growth needed to alleviate extreme poverty using the international poverty line of US $2.15 per day (ref. 7). Even with historical energy- and carbon-intensity patterns, the global emissions increase associated with alleviating extreme poverty is modest, at 2.37 gigatonnes of carbon dioxide equivalent per year or 4.9% of 2019 global emissions. Lower inequality, higher energy efficiency and decarbonization of energy can ease this tension further: assuming the best historical performance, the emissions for poverty alleviation in 2050 will be reduced by 90%. More ambitious poverty lines require more economic growth in more countries, which leads to notably higher emissions. The challenge to align the development and climate objectives of the world is not in reconciling extreme poverty alleviation with climate objectives but in providing sustainable middle-income standards of living.

Nitrous Oxide Use in Australian Health Care: Strategies to Reduce the Climate Impact

Nitrous oxide is a useful inhaled analgesic. Due to its high global warming potential and ozone-depleting properties, the nitrous oxide emissions related to health care are being increasingly scrutinized. In this narrative review, we will discuss the clinical uses of nitrous oxide relevant to anesthetists, in addition to its contribution as a greenhouse gas. Using available data from Australia, we will explore potential strategies for reducing the impact of those emissions, which are likely to be applicable in other countries. These include destruction of captured nitrous oxide, minimizing nitrous oxide waste and reducing clinical use. Anesthesia clinicians are well placed to raise awareness with colleagues and consumers regarding the environmental impact of nitrous oxide and to promote cleaner alternatives. Reducing use is likely to be the most promising reduction strategy without large-scale changes to infrastructure and subsequent delay in action.

Widespread retreat of coastal habitat is likely at warming levels above 1.5 °C

Several coastal ecosystems-most notably mangroves and tidal marshes-exhibit biogenic feedbacks that are facilitating adjustment to relative sea-level rise (RSLR), including the sequestration of carbon and the trapping of mineral sediment1. The stability of reef-top habitats under RSLR is similarly linked to reef-derived sediment accumulation and the vertical accretion of protective coral reefs2. The persistence of these ecosystems under high rates of RSLR is contested3. Here we show that the probability of vertical adjustment to RSLR inferred from palaeo-stratigraphic observations aligns with contemporary in situ survey measurements. A deficit between tidal marsh and mangrove adjustment and RSLR is likely at 4 mm yr-1 and highly likely at 7 mm yr-1 of RSLR. As rates of RSLR exceed 7 mm yr-1, the probability that reef islands destabilize through increased shoreline erosion and wave over-topping increases. Increased global warming from 1.5 °C to 2.0 °C would double the area of mapped tidal marsh exposed to 4 mm yr-1 of RSLR by between 2080 and 2100. With 3 °C of warming, nearly all the world's mangrove forests and coral reef islands and almost 40% of mapped tidal marshes are estimated to be exposed to RSLR of at least 7 mm yr-1. Meeting the Paris agreement targets would minimize disruption to coastal ecosystems.

Future emergence of new ecosystems caused by glacial retreat

Glacier shrinkage and the development of post-glacial ecosystems related to anthropogenic climate change are some of the fastest ongoing ecosystem shifts, with marked ecological and societal cascading consequences1-6. Yet, no complete spatial analysis exists, to our knowledge, to quantify or anticipate this important changeover7,8. Here we show that by 2100, the decline of all glaciers outside the Antarctic and Greenland ice sheets may produce new terrestrial, marine and freshwater ecosystems over an area ranging from the size of Nepal (149,000 ± 55,000 km2) to that of Finland (339,000  ±  99,000  km2). Our analysis shows that the loss of glacier area will range from 22 ± 8% to 51 ± 15%, depending on the climate scenario. In deglaciated areas, the emerging ecosystems will be characterized by extreme to mild ecological conditions, offering refuge for cold-adapted species or favouring primary productivity and generalist species. Exploring the future of glacierized areas highlights the importance of glaciers and emerging post-glacial ecosystems in the face of climate change, biodiversity loss and freshwater scarcity. We find that less than half of glacial areas are located in protected areas. Echoing the recent United Nations resolution declaring 2025 as the International Year of Glaciers' Preservation9 and the Global Biodiversity Framework10, we emphasize the need to urgently and simultaneously enhance climate-change mitigation and the in situ protection of these ecosystems to secure their existence, functioning and values.

Sustainability, Collective Self-Regulation, and Human-Nature Interdependence

Like any organism, humanity constructs its niche and adapts to the rest of nature by modifying available materials around them. In the era that some have dubbed the "Anthropocene," human niche construction has gone so far as to threaten the planetary climate system. The central question of sustainability is how humanity can collectively self-regulate niche construction, that is, humanity's relationship with the rest of nature. In this article, we argue that to resolve the collective self-regulation problem for sustainability, sufficiently accurate and relevant aspects of causal knowledge about the functioning of complex social-ecological systems need to be cognized, communicated, and collectively shared. More specifically, causal knowledge about human-nature interdependence-how humans interact with each other and the rest of nature-is critical for coordinating cognitive agents' thoughts, feelings, and actions for the greater good without falling into the trap of free riding. Here, we will develop a theoretical framework to consider the role of causal knowledge about human-nature interdependence in collective self-regulation for sustainability, review the relevant empirical research primarily focusing on climate change, and take stock of what is currently known and what we need to investigate in the future.

Subsurface fertilization boosts crop yields and lowers greenhouse gas emissions: A global meta-analysis

The subsurface application (SA) of nitrogenous fertilizers is a potential solution to mitigate climate change and improve food security. However, the impacts of SA technology on greenhouse gas (GHG) emissions and agronomic yield are usually evaluated separately and their results are inconsistent. To address this gap, we conducted a meta-analysis synthesizing 40 peer-reviewed studies on the effects of SA technology on GHG and ammonia (NH₃) emissions, nitrogen uptake (NU), crop yield, and soil residual NO₃-N in rice paddies and upland cropping system. Compared to the surface application of N, SA technology significantly increased rice yields by 32 % and crop yield in upland systems by 62 %. The largest SA-induced increases in crop yield were found at low N input rates (<100 kg Nha^-1) in rice paddies and medium N input rates (100-200 kg Nha^-1) in upland systems, suggesting that soil moisture is a key factor determining the efficiency of SA technology. SA treatments increased yields by more at reduced fertilizer rates (~30 % less N), a shallow depth (<10 cm), and with urea in both cropping systems than at the full (recommended) N rate, a deeper depth (10-20 cm), and with ammonical fertilizer. SA treatments significantly increased NU in rice paddies (34 %) and upland systems (18 %), and NO₃-N (40 %) in paddyland; however, NO₃-N decreased (28 %) in upland conditions. Ammonia mitigation was greater in paddyland than in upland conditions. SA technology decreased the carbon footprint (CF) in paddyland by 29 % and upland systems by 36 %, and overall by 33 %. Compared with broadcasting, SA significantly reduced CH₄ emissions by 16 %, N₂O emissions by 30 %, and global warming potential (GWP) by 10 % in paddy cultivation. Given SA increased grain yield and NU while reducing NH₃, CF, and GWP, this practice provides dual benefits - mitigating climate change and ensuring food security.

Future temperature extremes threaten land vertebrates

The frequency, duration, and intensity of extreme thermal events are increasing and are projected to further increase by the end of the century^1,2. Despite the considerable consequences of temperature extremes on biological systems^3-8, we do not know which species and locations are most exposed worldwide. Here we provide a global assessment of land vertebrates' exposures to future extreme thermal events. We use daily maximum temperature data from 1950 to 2099 to quantify future exposure to high frequency, duration, and intensity of extreme thermal events to land vertebrates. Under a high greenhouse gas emission scenario (Shared Socioeconomic Pathway 5-8.5 (SSP5-8.5); 4.4 °C warmer world), 41.0% of all land vertebrates (31.1% mammals, 25.8% birds, 55.5% amphibians and 51.0% reptiles) will be exposed to extreme thermal events beyond their historical levels in at least half their distribution by 2099. Under intermediate-high (SSP3-7.0; 3.6 °C warmer world) and intermediate (SSP2-4.5; 2.7 °C warmer world) emission scenarios, estimates for all vertebrates are 28.8% and 15.1%, respectively. Importantly, a low-emission future (SSP1-2.6, 1.8 °C warmer world) will greatly reduce the overall exposure of vertebrates (6.1% of species) and can fully prevent exposure in many species assemblages. Mid-latitude assemblages (desert, shrubland, and grassland biomes), rather than tropics^9,10, will face the most severe exposure to future extreme thermal events. By 2099, under SSP5-8.5, on average 3,773 species of land vertebrates (11.2%) will face extreme thermal events for more than half a year period. Overall, future extreme thermal events will force many species and assemblages into constant severe thermal stress. Deep greenhouse gas emissions cuts are urgently needed to limit species' exposure to thermal extremes.

Achieving Net Zero-An Illustration of Carbon Emissions Reduction with A New Meta-Inverse DEA Approach

To achieve the goal of limiting global warming to 1.5 °C above preindustrial levels, net-zero emissions targets were proposed to assist countries in planning their long-term reduction. Inverse Data Envelopment Analysis (DEA) can be used to determine optimal input and output levels without sacrificing the set environmental efficiency target. However, treating countries as having the same capability to mitigate carbon emissions without considering their different developmental stages is not only unrealistic but also inappropriate. Therefore, this study incorporates a meta-concept into inverse DEA. This study adopts a three-stage approach. In the first stage, a meta-frontier DEA method is adopted to assess and compare the eco-efficiency of developed and developing countries. In the second stage, the specific super-efficiency method is adopted to rank the efficient countries specifically focused on carbon performance. In the third stage, carbon dioxide emissions reduction targets are proposed for the developed and developing countries separately. Then, a new meta-inverse DEA method is used to allocate the emissions reduction target to the inefficient countries in each of the specific groups. In this way, we can find the optimal CO₂ reduction amount for the inefficient countries with unchanged eco-efficiency levels. The implications of the new meta-inverse DEA method proposed in this study are twofold. The method can identify how a DMU can reduce undesirable outputs without sacrificing the set eco-efficiency target, which is especially useful in achieving net-zero emissions since this method provides a roadmap for decision-makers to understand how to allocate the emissions reduction targets to different units. In addition, this method can be applied to heterogeneous groups where they are assigned to different emissions reduction targets.

Connectedness and spillover effects of US climate policy uncertainty on energy stock, alternative energy stock, and carbon future

Global warming is pressuring policymakers to change climate policies in shifting the global economy onto a net-zero pathway. While financial assets are responsive to policy changes and development, climate change policies are becoming increasingly unpredictable, making policy decision less certain. This study investigates connectedness and spillover effects of US climate policy uncertainty on energy stocks, alternative energy stocks, and carbon emissions futures. We analyzed spillover and connectedness before and after the Paris Agreement. We employed monthly frequency data from August 2005 to March 2021 and applied DY (2012) method and MGARCH approach. We found that world energy stocks and carbon emissions futures are connected to US climate policy uncertainty. Uncertainty in climate policy and world energy stocks act as information transmitters in return spillover, while global alternative energy and carbon market are shock receivers. On volatility spillover, climate policy uncertainty, energy stocks, and carbon emissions future are shocks transmitters, while alternative energy stocks are receivers. We observe increase in connectedness following the Paris Agreement suggesting strengthened global efforts in tackling climate change. DCC and ADCC estimations revealed spillover effects of climate policy on futures returns and volatilities of world energy stocks and carbon emissions futures and the shocks could be transmitted through to the energy sector. During period of uncertainty in US climate policy, carbon allowances can potentially serve as a safe haven for energy stocks and provide downside protection for alternative energy stocks, hence hedging against climate transition risks.

Cleaner air is adding to global warming

Satellites capture fall in light-blocking pollution.

Global benefits of non-continuous flooding to reduce greenhouse gases and irrigation water use without rice yield penalty

Non-continuous flooding is an effective practice for reducing greenhouse gas (GHG) emissions and irrigation water use (IRR) in rice fields. However, advancing global implementation is hampered by the lack of comprehensive understanding of GHGs and IRR reduction benefits without compromising rice yield. Here, we present the largest observational data set for such effects as of yet. By using Random Forest regression models based on 636 field trials at 105 globally georeferenced sites, we identified the key drivers of effects of non-continuous flooding practices and mapped maximum GHGs or IRR reduction benefits under optimal non-continuous flooding strategies. The results show that variation in effects of non-continuous flooding practices are primarily explained by the UnFlooded days Ratio (UFR, that is the ratio of the number of days without standing water in the field to total days of the growing period). Non-continuous flooding practices could be feasible to be adopted in 76% of global rice harvested areas. This would reduce the global warming potential (GWP) of CH₄ and N₂ O combined from rice production by 47% or the total GWP by 7% and alleviate IRR by 25%, while maintaining yield levels. The identified UFR targets far exceed currently observed levels particularly in South and Southeast Asia, suggesting large opportunities for climate mitigation and water use conservation, associated with the rigorous implementation of non-continuous flooding practices in global rice cultivation.