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

Development plan for an advanced drilling system with real-time diagnostics (Diagnostics-While-Drilling)

This proposal provides the rationale for an advanced system called Diagnostics-while-drilling (DWD) and describes its benefits, preliminary configuration, and essential characteristics. The central concept is a closed data circuit in which downhole sensors collect information and send it to the surface via a high-speed data link, where it is combined with surface measurements and processed through drilling advisory software. The driller then uses this information to adjust the drilling process, sending control signals back downhole with real-time knowledge of their effects on performance. The report presents background of related previous work, and defines a Program Plan for US Department of Energy (DOE), university, and industry cooperation

Advanced Drilling through Diagnostics-White-Drilling

A high-speed data link that would provide dramatically faster communication from downhole instruments to the surface and back again has the potential to revolutionize deep drilling for geothermal resources through Diagnostics-While-Drilling (DWD). Many aspects of the drilling process would significantly improve if downhole and surface data were acquired and processed in real-time at the surface, and used to guide the drilling operation. Such a closed-loop, driller-in-the-loop DWD system, would complete the loop between information and control, and greatly improve the performance of drilling systems. The main focus of this program is to demonstrate the value of real-time data for improving drilling. While high-rate transfer of down-hole data to the surface has been accomplished before, insufficient emphasis has been placed on utilization of the data to tune the drilling process to demonstrate the true merit of the concept. Consequently, there has been a lack of incentive on the part of industry to develop a simple, low-cost, effective high-speed data link. Demonstration of the benefits of DWD based on a high-speed data link will convince the drilling industry and stimulate the flow of private resources into the development of an economical high-speed data link for geothermal drilling applications. Such a downhole communication system would then make possible the development of surface data acquisition and expert systems that would greatly enhance drilling operations. Further, it would foster the development of downhole equipment that could be controlled from the surface to improve hole trajectory and drilling performance. Real-time data that would benefit drilling performance include: bit accelerations for use in controlling bit bounce and improving rock penetration rates and bit life; downhole fluid pressures for use in the management of drilling hydraulics and improved diagnosis of lost circulation and gas kicks; hole trajectory for use in reducing directional drilling costs; and downhole weight-on-bit and drilling torque for diagnosing drill bit performance. In general, any measurement that could shed light on the downhole environment would give us a better understanding of the drilling process and reduce drilling costs

Simultaneous measurement of endogenous cortisol, cortisone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in nails by use of UPLC-MS-MS

Steroid hormone concentrations are mostly determined by using different body fluids as matrices and applying immunoassay techniques. However, usability of these approaches may be restricted for several reasons, including ethical barriers to invasive sampling. Therefore, we developed an ultra-performance LC-MS-MS method for high-throughput determination of concentrations of cortisol, cortisone, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS) in small quantities of human nails. The method was validated for linearity, limits of detection and quantification, recovery, intra and interassay precision, accuracy, and matrix effect. Samples from 10 adult women were analyzed to provide proof-of-principle for the method's applicability. Calibration curves were linear (r (2)?14% for all analytes) and accuracy (relative error (%) -8.3% to 12.2% for all analytes). The median (pg mg(-1), range) hormone concentrations were 69.5 (36-158), 65 (32-133), 212 (50-1077), and 246 (115-547) for cortisol, cortisone, DHEA, and DHEAS, respectively. This method enables measurement of cortisol, cortisone, DHEA, and DHEAS in small quantities of human nails, leading to the development of applications in endocrinology and beyond