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

Some aspects of 475deg.C embrittlement in fecralloy steel

SIGLELD:9091.9F(MPD/NBS--193). / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Elastoplastic deformation of 316 stainless steel under tensile loading at elevated temperatures

The response of 316 stainless steel has been examined under uniaxial tensile loading during a range of tests carried out between 20 °C and 650 °C. In-situ neutron diffraction was used to measure internal elastic strain in subsets of differently oriented crystallites within the polycrystal aggregate. This allowed the determination of diffraction elastic constants. Further, results have been compared with predictions from a slip-based elasto-plastic self-consistent model. Good agreement is obtained during both conventional slip and when dynamic strain aging (DSA) is evidenced. The quality of agreement was reduced in the higher temperature regime, where it is expected that other mechanisms become active

DINS measurements on VESUVIO in the Resonant Detector configuration: proton mean kinetic energy of water

Deep Inelastic Neutron Scattering ( DINS) measurements have been performed on a liquid water sample at two different temperatures and pressures. The experiments were carried out using the VESUVIO spectrometer at the ISIS spallation neutron source. This experiment represents the first DINS measurement from water using the Resonance Detector configuration, employing yttrium-aluminum-perovskite scintillator and a U-238 analyzer foil. The maximum energy of the scattered neutrons was about 70 eV, allowing to access an extended kinematic space with energy and wave vector transfers at the proton recoil peak in the range 1 eV <= h omega <= 20 eV and 25 angstrom(-1) <= q <= 90 angstrom(-1), respectively. Comparison with DINS measurements on water performed in the standard Resonance Filter configuration indicates the potential advantages offered by the use of Resonance Detector approach for DINS measurements at forward scattering angles

Evaluation of a Child Sexual Abuse Prevention Program

A half-million children are believed to be sexually abused each year in the United States. In 1995, the American Medical Association declared sexual assault a silent violent epidemic. The majority of efforts to stop child sexual abuse have focused on punishing abusers and treating victims and their families; prevention programs are uncommon and rely on educating children to report sexual abuse. This case study describes the evaluation of the first public health campaign designed to target adults for prevention. A baseline assessment of attitudes, awareness, knowledge, and policies was conducted in Vermont to identify facilitators and barriers to adult prevention of child sexual abuse. These included predisposing factors (50% of vermont residents did not know the characteristics of an abuser), enabling factors (60% of Vermont residents did not know where to refer someone who may have sexual behavior problems), and reinforcing factors (when focus group participants knew an abuser, they were less likely to take action). This process guided the intervention, which included a broad-based media campaign targeting adults; a one-to-one communications strategy that provided information to agencies working with families at risk and a toll-free helpline for adults in an abuse situation; and a systems change strategy designed to educate decision-makers and leaders. Program evaluation measures included a random-digit dial survey, focus groups, a survey of Vermont decision-makers, and other data sets. The successes and limitations of these interventions, both as strategies in themselves and as data sources for evaluation, are discussed