Moral courage in the workplace: moving to and from the desire and decision to act

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72135/1/j.1467-8608.2007.00484.x.pd

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

Cost and feasibility of stimulating tight gas reservoirs with chemical explosives

Long, continuous, cylindrical charges of high explosives are considered as alternatives to nuclear explosives or massive hydraulic fracturing for the stimulation of gas production in tight gas formations. The calculational method was that used previously for nuclear stimulation; it was verified by comparison of the calculated and observed gas production from Rulison. The calculations indicate that charges of high explosives 24 inches in diameter and 2000 feet in length (the height assumed for the gas-bearing sands) detonated in four wells per section would be comparable in cost and effectiveness to estimates for one well stimulated by three 100-kiloton nuclear explosions. Stimulation by high explosives would require special development of the explosives (probably with ammonium nitrate as the base) to be suitably sensitive, temperature-resistant, and compatible with the gas-reservoir rocks; the required work appears to be straightforward, however. Comparative field testing is required to determine the optimum method (chemical or nuclear explosives or hydraulic fracturing) for a given region and to confirm that gas can be produced profitably for between 25 nd 80 er Mcf. (auth

Resistance to antibiotics and biocides among non-fermenting Gram-negative bacteria

ObjectiveTo investigate the antibiotic and biocide susceptibilities of clinical isolates of rarely encountered Gram-negative, non-fermenting bacteria.MethodsThirty Gram-negative non-fermenting bacterial strains were isolated from blood cultures of oncology patients. These were studied for their resistance to 11 antibiotics. Their susceptibilities to seven biocides used in hospitals were also examined.ResultsIsolates of Stenotrophomonas maltophilia and Ochrohadrum anthropi were generally resistant to at least five of the antibiotics, whereas isolates ofComamonas acidivorans, Flavohaderium oryzihabitans, Aeromonas hydrophila, Sphingobacterium spiritivorum, Acinetobacter junii and Acinetobacter lwoffi were generally sensitive to at least nine of the antibiotics. Trovafloxacin and trimethoprim—sulfamethoxazole were the most effective antibacterial agents tested, with 0% and 7%, respectively, of isolates being resistant, whereas 63% of isolates were resistant to aztreonam. Some isolates, sensitive to meropenem and/or ceftazidime in vitro, possessed very high MBC/MIC ratios for these β-lactams. Two out of three biocides used in hospital pharmacies showed lethal activity towards all strains tested when used at less than one-third of their recommended in-use concentration. Proceine 40 failed to give a 5 log reduction in bacterial cell number for the isolates tested when used at its ‘in-use’ concentration. A concentration of >500 mg/L chlorhexidine was required to achieve a 5 log reduction for the same isolates.ConclusionsWe have examined the antibiotic susceptibilities of non-fermenting Gram-negative bacterial strains isolated from immunocompromised patients. Despite being sensitive to certain antibiotics in vitro, some isolates were still able to cause serious bacteremia. We have also reported for the first time the susceptibilities of non-fermenting Gram-negative bacteria to common biocides used in hospital infection control, and have shown that some strains are able to persist at the ‘in-use’ concentration of particular biocides. It is therefore important to study further this particular group of organisms, and, in particular, to examine whether there exists a link between resistance to antibiotics and resistance to biocides