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

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

Time Variability of crustal attenuation during the Amatrice-Visso-Norcia earthquake sequence in the Central Apennines (Italy)

Over the last decade our work has been mostly about reducing uncertainties over spectral measurements in seismology (e.g. Malagnini and Munafò, 2018; Malagnini and Dreger, 2016; Munafò et al., 2016; Akinci et al., 2014). Here we measure time-domain peak values from narrow bandpass-filtered time histories and transform them into spectral estimates by using the theoretical results of Random Vibration Theory (Cartwright and Longuet-Higgins, 1956) and the Parseval Theorem. We develop a novel approach to quantify time domain fluctuations of highfrequency seismic attenuation and apply it to a massive data set of seismic waveforms from the Central Apennines in Italy, which includes recordings spanning the recent earthquake sequence of Amatrice-Visso-Norcia (2016-2017). Our observations show that the crustal seismic wave propagation in the region is strongly affected by transients triggered by the main events. The time varying attenuation is probably due to the associated migration of crustal fluids, in addition to seasonal oscillations related to precipitation-induced variations of crustal stresses. We also observe oscillation periods in the attenuation time series corresponding to solid Earth tides. Sensitivity to tides is stronger in the aftermath of the mainshocks, indicating an important role played by rock damage.SubmittedWashington7T. Variazioni delle caratteristiche crostali e precursori sismic

Comprehensive assessments of Parkfield earthquake source estimates: a look into model variability

We investigate source parameters and scaling of repeating and non-repeating earthquakes occurring on the Parkfield segment of the San Andreas Fault (SAF) taking into account model, or epistemic variability due to method, We will compute source corner frequency and stress drop using multi-taper spectral analysis of P and S waves, inversion for source, path and site, and coda envelope methods using data from the borehole High Resolution Seismic Network (HRSN). The result of this analysis will be compared to estimates obtained from the Nadeau and Johnson (1998) asperity loading model, as well as finite-source models of earthquakes form M 1.8 to 6.0 (Dreger et al., 2007; Uchide and Ide, 2010). One objective is to compare source parameters derived from each method with estimated uncertainties usign identical data set to evaluate the variability and resolution of source parameters. The result of such analysis give us insights into the underlying mechanics of faulting and the earthquake process. This poster presents results using the multiple-taper coda method.PublishedSan Francisc

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