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

Network fault tolerant voltage-source-converters for high-voltage applications

This paper discusses network fault tolerant voltage-source-converters for high-voltage applications

The UK Environmental Change Network: Emerging trends in the composition of plant and animal communities and the physical environment

This review identifies the major trends in physical, chemical and biological data between 1993 and 2007 at the 12 terrestrial sites in the United Kingdom Environmental Change Network (ECN) and assesses the effectiveness of the programme. Temperature and precipitation increased and sulphur (S) deposition decreased across the network. There were also significant local trends in nitrogen (N) deposition. The decreasing S deposition was associated with increasing pH of rainfall and soils and there was widespread evidence of soil pH showing recovery from acidification. Warm-adapted butterfly species tended to increase at northern, upland sites, consistent with an effect of increasing temperatures. In contrast, carabid beetle species associated with cooler northern and upland areas showed declining populations. The increasing trend in precipitation may account for a decline in ruderal plant species in the lowlands, reversing an increase associated with drought in the early part of the time series. There was no general shift in the composition of plant communities which might reflect rising soil pH. This may reflect the slow dynamics of plant community processes or a distinction between pH trends at the surface and lower soil horizons. The ECN is effective in detecting trends in a range of different variables at contrasting sites. Its strength is the ability to monitor causes and consequences of environmental change in the same programme, improving the ability to attribute causes of change, which is essential to developing conservation policy and management in the 21st century

Ethical Subjectivity and Politics in Organizations: A Case of Health Care Tendering.

This paper examines the relationship between ethics and politics in organizations with a specific focus on ethical subjectivity - that is, how people at work constitute themselves as subjects in relation to both their conduct and their sense of ethical responsibility to others. To investigate this we consider those ethics that were politically mobilized when five clinical partners tendered to buy out the medical practice in which they worked. We provide a detailed reading of a letter of complaint written by one of the partners and sent to their employer - a letter we consider to be a deliberate, political, ethically motivated and overt act of resistance. Drawing on the ethical philosophy of Emmanuel Levinas we argue that the practice of ethics is characterized by a tension where ethical commitments and realpolitik come crashing together. The implication we draw from this is that in organizations the ethical subject is always a political subject; the one who takes action in response to the call of the ethical demand. It is answering the call to political action by the ethical subject - a subject prepared to act in response to the experience of injustice while not resting easy on their own ethical righteousness - that provides an affirmative possibility for researching and theorizing ethics within a critical framework.21 page(s

Recognition of Robinsonian dissimilarities

Robinsonian dissimilarities, Order compatible with a dissimilarity, Divide-and-conquer algorithm,