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

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

Development of efficient testing methods and cohesive zone models for analyzing fatigue-driven delamination in 3D laminated composite structures

The overall purpose of this Ph.D. thesis is to contribute to the reliable design of composite structures subjected to fatigue-driven delamination. The aim is motivated by a wish to reduce the amount of experimental testing needed in the dimensioning of real components and to anticipate the mechanical response of layered structures undergoing fatigue delamination. In order to extend the general applicability of the existing methods, experimental data of 3D delamination propagation has been generated, as well as an efficient identification of the crack propagation direction and an accurate means of calculating the energy release rate in three-dimensional structures have been developed. Moreover, a benchmark test for fatigue-driven 3D crack growth has been used for model validation, and a full characterization, at the coupon level, of the interlaminar properties of the demonstrator material has been performed. The developed fatigue method provides accurate predictions for the fatigue benchmark testsL’objectiu general d’aquesta tesi doctoral és contribuir al disseny fiable d’estructures de materials compòsits en capes sotmeses a delaminació provocada per la fatiga. Per una banda, es pretén reduir la quantitat de proves experimentals necessàries en el procés de disseny de components i, per l’altra, anticipar la resposta mecánica de les estructures que pateixen delaminació a fatiga. Per tal d’ampliar l’aplicabilitat dels mètodes existents, s’han generat dades experimentals de propagació de la delaminació en 3D, un mètode eficaç d’identificació de la direcció de propagació d’esquerda i un mitjà precís de calcular l’energia disponible per a la fractura en estructures tridimensionals. A més, s’ha dut a terme una campanya experimental de l’assaig validador i s’ha realitzat una caracterització completa de les propietats interlaminars del material validador a nivell de proveta. El mètode de fatiga desenvolupat proporciona prediccions precises per als assajos de referènci

Cine structural forum

Iniciada hace varios años, la idea ha ido evolucionando. Desde la presentación de un primer ciclo basado en los videos de formación técnica de Intemac, hasta la coexistencia de los mismos con objetos traídos desde la obra y un texto complementario dialogado con los profesores conductores, en el que participan profesores de la asignatura distribuidos entre el alumnado. El resultado pretende ser una enseñanza complementaria (no sustitutiva) que amplíe y afiance conocimientos de una forma lúdica, proactiva y dinámica pero sin perder rigor docente ni transmisión de conocimiento profesional. Tiene cabida cualquier temática y nivel (de grado a postgrado) La idea respalda el título mediante una estética de celuloide, el acceso a sala sólo mediante entrada doble que se corta para control (o puntuación extra incentivadora) y la entrega de un vaso con palomitas (que haya acomodador con linterna es ya opcional).Started some years ago, the idea has evolved since the submission of a first cycle based on the technical training videos of Intemac, up to the coexistence of the same with objects brought from the work and a supplementary text dialog with teachers conductors, which involved a subject teacher distributed among the student body. The result is intended to be a supplementary education (not as a substitute) to expand and strengthen knowledge in an entertaining way, proactive and dynamic but without losing rigor or teaching transmission of professional knowledge. It has accommodate any theme and level (grade to graduate school) The idea supports the title through an aesthetic of celluloid, room access only through dual input that is cut to control (or score extra incentive) and the delivery of a glass with popcorn (which has valet with flashlight is already optional)

Thermal analysis of metal organic precursors for functional oxide preparation: thin films versus powders

The thermal decomposition of several metal organic precursors, used in the preparation of YBa2Cu3O7−x superconducting coated conductors (Cu acetate, Cu, Y and Ba trifluoroacetates and Ce propionate) is analyzed by means of several thermoanalytical techniques (TG/DTA, MS and DSC). In all cases, the metal organic precursors deposited as thin films decompose differently than powders from the same precursors. In thin films, decomposition is facilitated by the easier transport of reactive gas from the surrounding atmosphere and by the easier out-diffusion of volatile products. Consequently, films decompose at lower temperature and are more sensitive to the presence of any residual reactive gas in the furnace. Good thermal contact with the substrate is also shown to minimize overheating in films and avoid combustion processes that are otherwise often observed during the thermal decomposition of powders. Finally, the formation and stability of intermediate products towards the oxide formation, such as metal fluorides, differs in films because of the easier gas exchange. With respect to powders, these compounds are much less stable in films, where their decomposition temperature can be lowered by several hundreds of degrees Celsius. While in some cases the behaviour of films can be predicted by analyzing varying masses of precursor powders, this is not always the case. Therefore, thermal analysis carried out on films is recommended to avoid erroneous conclusions about materials preparation drawn from powdersWe acknowledge the financial support from MICINN (MAT2011-28874-C02-01 and -02, Consolider Project NANOSELECT: CSD2007-00041), EU project EUROTAPES, (EUFP7 NMPLA2012280432) and by the Generalitat de Catalunya (Pla de Recerca 2009SGR-185, 2009-SGR-770 and XaRMAE). H. Eloussifi acknowledges financial support from the Tunisian Ministry of Higher Education and Scientific Researc

Melting temperature of YBa2Cu3O7 x and GdBa2Cu3O7 x at subatmospheric partial pressure

The melting temperature, Tm, of YBa2Cu3O7−x and GdBa2Cu3O7−x superconductor ceramic compounds has been measured by differential thermal analysis (DTA) over a large oxygen partial pressure range of five orders of magnitude (2·10−5 < PO2 < 1 bar). It is shown that the DTA peak and endset temperatures are closer to Tm than the onset temperature. Correct measurement of Tm requires low heating rates and subatmospheric pressure conditions to avoid temperature shifts due to local oxygen overpressure and kinetic effectsThis work was funded by the Spanish Programa Nacional de Materiales through projects MAT2014-51778-C2-1-R and MAT2014-51778-C2-2-R. We also acknowledge: the Center of Excellence award Severo OchoaSEV-2015-0496, SGR753 and SGR948 from the Generalitat of Catalunya, the European Union through projects Eurotapes (EU-FP7 NMP-LA-2012-280432) and Ultrasupertape (ERC ADG-2014-669504), and the Universitat de Girona (MPCUdG2016/059

An efficient methodology for the experimental characterization of mode II delamination growth under fatigue loading

Crack growth rate curves provide information about the delamination resistance of composite materials under cyclic loading. The existing methodologies for mode II fatigue testing using three-point bending end-notched flexure (3-ENF) under constant cyclic displacement conditions yield discontinuous delamination growth rate curves, therefore requiring a batch of several specimens to be tested under different severity conditions in order to fully characterize the crack growth. This work describes a variable cyclic displacement test procedure that, in combination with the real time monitoring of the specimen's compliance, allows the crack growth rate to be measured for the desired range of severities with a single specimen, thus avoiding any human intervention during the tes

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

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 coprioritized 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