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

In Today's World, Is It Worth Performing Flood Frequency Analysis Using Observed Streamflow Data?

Flood Frequency Analysis (FFA) is a process to relate the magnitude of extreme streamflows to their frequency of occurrence through distribution functions, and the results of FFA are useful in design flood estimation for various hydraulic structures. The FFA relies primarily on actual observed streamflow data (Qobts) and certain underlying assumptions that form the basis of FFA's philosophy. In today's world, Qobts time series are available for most river basins; however, it is an indubitable reality that Qobts do not satisfy the necessary requirements. Therefore, an alternative doctrine is needed to create such a dataset. This paper provides an overview of the limitations of utilising Qobts along with its drivers and suggests a surrogate mechanism to perform FFA in today's world

An introduction to climate change impacts on water resources and adaptation

In Nagothu, U. S.; Gosain, A. K.; Palanisami, Kuppannan (Eds.). Water and climate change: an integrated approach to address adaptation challenges. New Delhi, India: Macmilla

Regional scale hydrologic modeling for prediction of water balance, analysis of trends in streamflow and variations in streamflow: The case study of the Ganga River basin

Study region: Ganga River basin. Study focus: The availability of freshwater has been recognized as a global issue, and the reliable evaluation and quantification of it within the basin is necessary to bolster the sustainable management of water. For this purpose a basin-scale SWAT model of the Ganga River basin has been developed. New hydrologic insights for the region: Model validation showed that simulated results were consistent with the observed data in reproducing the seasonal dynamics of surface water and suggest that the model is capable of reproducing the hydrological features of the basin including the snow melt. However, there are large variations in both temporal and spatial distribution of the hydrological components. Statistical methods have been used for detecting trends and critical changes in streamflow. It has been found that although the streamflow from the snow fed areas has increased, the stream flow in the lower reaches and the non-perennial tributaries have declined significantly. This decline can be attributed to both anthropogenic and exogenous changes. The study also establishes that there has been a substantial reduction in overall water resources availability with respect to Virgin. This information sets the yardstick to the restoration of the hydrological and environmental health of the basin and can lead to better management of water resources under scarcity. Keywords: Surface water modeling, SWAT, Ganga River basin, Hydrologic modeling, Trend tes

Water valuation at basin scale with application to western India

A parsimonious hydro-economic model for a data scarce dryland area is presented. It features a basin level decentralized water allocation mechanism which is adapted to incorporate sustainable water use and to deal with the externalities from upstream-downstream linkages. We formulate the profit maximization problem of various agents in a basin, each identifying a sub-basin, who operate within the boundaries of a spatially explicit model that describes the dominant hydrological processes. We address issues of non-convexities and non-steady state conditions and elicit the dependence of a decentralized water allocation on geophysical properties of the basin. In particular, the approach describes how the competition between the drying and drainage functions of sub-basins in dryland areas manifests itself in the optimal valuation of water. The application to an area of over 500,000k