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

Stress--modulated remodelling of a non--homogeneous body

none2D. AMBROSI; A. GUILLOU AND E.S. DI MARTINOAmbrosi, DAVIDE CARLO; A. GUILLOU AND E. S., DI MARTIN

WebGIS based on spatio-temporal hot spots: an application to oto-laryngo-pharyngeal diseases

We present a web geo-spatial framework for analyzing and continuously monitoring the spatio-temporal evolution of disease hot spots for detecting spatial areas with high concentrations of events in a geographic information system (GIS). To detect the hot spots, we adopt Extended Fuzzy C-Means algorithm. Each event is given by the geo-positional coordinates of the place of residence of the patient. The analyst can insert event data directly on the map or digitizing the address of the residence of the patient and using geo-coding services for locating the event. In our experiments, the data consist of geo-referenced patterns corresponding to the residence of patients in the district of Naples (Italy) submitted to a surgical intervention concerning the oto-laryngo-pharyngeal apparatus between the years 2008 and 2012. The results show the presence of two greatest hot spots: the first covers a geographical area that affects the city of Naples, the second covers parts of various towns around the famous vulcan Vesuvius, respectively.We present a web geo-spatial framework for analyzing and continuously monitoring the spatio-temporal evolution of disease hot spots for detecting spatial areas with high concentrations of events in a geographic information system (GIS). To detect the hot spots, we adopt Extended Fuzzy C-Means algorithm. Each event is given by the geo-positional coordinates of the place of residence of the patient. The analyst can insert event data directly on the map or digitizing the address of the residence of the patient and using geo-coding services for locating the event. In our experiments, the data consist of geo-referenced patterns corresponding to the residence of patients in the district of Naples (Italy) submitted to a surgical intervention concerning the oto-laryngo-pharyngeal apparatus between the years 2008 and 2012. The results show the presence of two greatest hot spots: the first covers a geographical area that affects the city of Naples, the second covers parts of various towns around the famous vulcan Vesuvius, respectively

Fluid-structure Interaction within a Layered Aortic Arch Model

The response of wall stress to the elasticity of each layer in the aorta wall was investigated to understand the role of the different elastic properties of layers in the aortic dissection. The complex mechanical interaction between blood flow and wall dynamics in a three-dimensional arch model of an aorta was studied by means of computational coupled fluid-structure interaction analysis. The results show that stresses in the media layer are highest in three layers and that shear stress is concentrated in the media layer near to the adventitia layer. Hence, the difference in the elastic properties of the layers could be responsible for the pathological state in which a tear splits across the tunica media to near to the tunica adventitia and the dissection spreads along the laminar planes of the media layer where it is near the adventitia layer