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

Caracterização elétrica e microestrutural de cerâmicas varistoras de baixa tensão à base de ('SN IND.1-x''TI IND.x')'O IND.2' e 'SN''O IND.2' dopados com 'CO''O' e 'NB IND.2''O IND.5'

O desenvolvimento de dispositivos varistores de baixa tensão tem atraído grande interesse uma vez que os equipamentos eletrônicos modernos, de uso doméstico, necessitam de sistemas não-lineares com tensão de ruptura da ordem de 100 V/cm para proteção contra sobrecarga de tensão. Neste sentido, cerâmicas a base de (Sn1-xTix)O2 (0,5<x<10% mol) dopadas com 1% mol CoO, 0,05% mol Nb2O5 e 0,05 e 0,1% mol Cr2O3 foram preparadas pelo método de mistura de óxidos, visando sua utilização como varistores de baixa tensão, com tamanho de grãos, condutividade, coeficiente de não-linearidade () e tensão de ruptura (ER) controlados. Foram investigadas a influência dos dopantes e da temperatura de calcinação em relação á microestrutura e as propriedades elétricas destas cerâmicas. Foram utilizadas medidas de área superficial, TG, XRD e Método de Rietveld, espectroscopia eletrônica de absorção na região do UV-Vis, FEG e TEM a fim de caracterizar os pós preparados. Observou-se a formação de solução sólida entre o TiO2 e o SnO2 a partir de 1000oC. O TiO2 mostrou-se efetivo quanto ao favorecimento do crescimento dos grãos dos sistemas sinterizados. Os sistemas com maiores concentrações de TiO2 apresentaram elevada resistividade, que pode estar relacionada à baixa mobilidade eletrônica deste óxido (TiO2) quando comparada ao SnO2. Análises de EDX e a caracterização elétrica por I-V e C-V indicaram que o Ti também seja responsável pela formação da barreira de potencial na região de contorno de grãos, formando provavelmente uma segunda fase rica em Ti e Co. A adição de Cr ao sistema contendo 1% mol de TiO2 favoreceu a formação da barreira de potencial na região de contorno de grão. Os sistemas contendo menores concentrações de TiO2 (0,5 e 1,0% mol) apresentaram valores de ER de 410 e 617 V/cm, respectivamente, indicando características...The development of low-voltage varistor devices has attracted much attention since modern electronic equipments require for non-linear systems with breakdown voltages around 100 V/cm for protection against voltage surges. Therefore, (Sn1-xTix)O2-based ceramics with 0.5<x<10% mol, doped with 1% mol CoO, 0.05% mol Nb2O5 and 0.05 and 0.1% mol Cr2O3, were prepared by mechanical mixing, aiming to the synthesis of low-voltage varistors with controlled grain size, conductivity, nonlinearity coefficient (a) and breakdown voltage (ER). The influence of the additives and of the calcination temperature on the microstructure development and on the electrical properties of these ceramics was investigated. The prepared powders were characterized by means of surface area measurements, TG, XRD and Rietveld refinement, UVVis absorption spectroscopy, FEG and TEM. The solid solution between the TiO2 and the SnO2 was observed to start around 1000oC. It was established that TiO2 enhances the grain growth and increases the resistivity of the studied compositions. The high resistivity could be related to the low electronic mobility of this oxide (TiO2) when compared to that of SnO2. The acquisition of IV and C-V curves for electrical characterization, along with EDX analysis, indicated that TiO2 is also responsible for the potential barrier formation in the grain boundary region, maybe due to the formation of a secondary phase rich in Ti and Co. The addition of Cr to the system containing 1% mol TiO2 enhanced the formation of the potential barrier in the grain boundary region. The systems with minor TiO2 concentrations (0.5 and 1.0% mol) presented ER values of 410 and 617 V/cm, respectively, displaying a varistor behavior suitable for low-voltage applications. The microstructure and electric properties of SnO2-based systems containing seed-grains of SnO2+1% mol of CoO and SnO2+1% mol of CuO,...(Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Caracterização elétrica de cerâmicas à base de SnO2 dopadas com Mn, Nb e Cr

A influência do Cr na condutividade elétrica e propriedades microestruturais de cerâmicas à base de SnO2-Mn-Nb foi investigada. Também foi estudada a influência do método de preparação nas características dos pós precursores cerâmicos e nas propriedades e características das cerâmicas resultantes. Sistemas SnO2-Mn-Nb com concentrações variadas de Cr foram preparados pelo método convencional de mistura de óxidos e pelo método Pechini (rota orgânica). Foram utilizadas medidas de área superficial (método BET), difração de raios X, espectroscopia vibracional no infravermelho e microscopia eletrônica de varredura a fim de caracterizar os pós preparados. Análises de condutividade elétrica e impedância complexa confirmaram uma diminuição da condutividade em função do aumento da concentração de Cr também relacionado a esta segregação que limita a passagem de corrente pelo contorno de grão. Os sistemas preparados pelo método Pechini mostraram-se mais resistivos nas curvas I-V em relação aos sistemas preparados por mistura de óxidos. A adição de Cr levou a uma diminuição do coeficiente de não-linearidade uma vez que o Cr parece segregar no contorno de grão, diminuindo o tamanho de grão, levando a uma microestrutura porosa e conseqüentemente degradando as propriedades varistoras dos sistemas.The influence of Cr in the electrical conductivity and in microstuctural properties of SnO2-based ceramics was studied. In addition, the influence of preparation method in the characteristics of ceramics precursor powders and in the characteristics and properties of the resultant ceramics was investigated. SnO2-Mn-Nb systems with varied Cr concentration were prepared by the conventional method of mixture of oxides and by Pechini method (organic route). Surface area measurements (BET method), X-ray diffraction, infrared spectroscopy and scanning electronic microscopy were utilized to characterize the prepared powders. Analysis of electrical conductivity and complex impedance confirm a decrease of conductivity as a function of the increase of Cr concentration also related to this segregation that limits the current passage by the grain boundary. The systems prepared by Pechini method turned out to be more resistive in the I-V curves than systems prepared by mixture of oxides. The Cr addition led to a decrease of non-linear coefficient since the Cr seem to segregate on grain boundary, decreasing the grain size, leading to a porous microstructure and, consequently, degraded of varistors properties of systems.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Temperature dependence of fractal dimension of grain boundary region in SnO2 based ceramics

Fractal dimensions of grain boundary region in doped SnO2 ceramics were determined based on previously derived fractal model. This model considers fractal dimension as a measure of homogeneity of distribution of charge carriers. Application of the derived fractal model enables calculation of fractal dimension using results of impedance spectroscopy. The model was verified by experimentally determined temperature dependence of the fractal dimension of SnO2 ceramics. Obtained results confirm that the non-Debye response of the grain boundary region is connected with distribution of defects and consequently with a homogeneity of a distribution of the charge carriers. Also, it was found that C-T-1 function has maximum at temperature at which the change in dominant type of defects takes place. This effect could be considered as a third-order transition

The effect of Cr concentration and preparation method on the microstructure and electrical characterization of SnO2-based ceramics

This paper reports a study of the influence of Cr concentration and preparation method in the electrical conductivity and microstructure of SnO2-based powders doped with Mn and Nb, prepared by an organic route (Pechini method) and a mixture of oxides. All the samples were compacted into discs and sintered at 1300 °C for 3h, resulting in ceramics with relative density varying between 81 and 99%. The powders were morphologically characterized by X-ray diffraction and their specific surface area was determined by N2 adsorption/desorption isotherms. Electrical conductivity characterization indicated that the conductivity decreases as Cr concentration increases, probably due to Cr segregation at grain boundaries, which reduces grain size, increasing the number of resistive boundaries, thus limiting the passage of current

Aspects of solid state formation and properties of Sn(0.9)Ti(0.1)O(2) system doped with CoO and Nb(2)O(5)

The effect of calcination temperature during the formation of the solid solution Sn(0.9)Ti(0.1)O(2) doped with 1.00 mol % CoO and 0.05 mol % Nb(2)O(5) is presented. The structural characteristics of this system were studied using X-ray diffraction, and the changes in phase formation were analyzed using the Rietveld method. With an increase in calcination temperature, there is increasing miscibility of Ti into the (Ti,Sn)O(2) phase and near 1000 degrees C, and the remaining TiO(2) (anatase) was transformed into the rutile phase. The sintering process, monitored using dilatometry, suggests two mass transport mechanisms, one activated close to 900 degrees C associated with the presence of TiO(2) (anatase) and the second mechanism, occurring between 1200 and 1300 degrees C, is attributed to a faster grain boundary diffusion caused by oxygen vacancies. (C) 2008 International Centre for Diffraction Data

Effect of seed addition on SnO2-based varistors for low voltage application

The effect of seed addition on the microstructure and non-ohmic properties of the SnO2 + 1%CoO + 0.05%Nb2O5 ceramic-based system was analyzed. Two classes of seeds were prepared: 99% SnO2 + 1%CuO and 99% SnO2 + 1%CoO (mol%); both classes were added to the ceramic-based system in the amount of 1%, 5%, and 10%. The two systems containing 1% of seeds resulted in a larger grain size and a lower breakdown voltage. The addition of 1% copper seeds produces a breakdown voltage (V b) of ∼ 37 V and a leakage current (fic) of 29 μA. On the other hand, the addition of 1% cobalt seeds produced a breakdown voltage of 57 V and a leakage current of 70 μA. Both systems are of great technological interest for low voltage varistor applications, by means of appropriate strategies to reduce the leakage current. Using larger amounts of seeds was not effective since the values of breakdown voltage in both cases are close to a system without seeds. To our knowledge, there are no reports in the literature regarding the use of seeds in the SnO2 system for low voltage applications. A potential barrier model which illustrates the formation of oxygen species (O′2(ads), O′ads, and O″ads) at the expense of clusters near the interface between grains is proposed. © 2012 The American Ceramic Society