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

End use energy consumption data base: transportation sector

The transportation fuel and energy use estimates developed a Oak Ridge National Laboratory (ORNL) for the End Use Energy Consumption Data Base are documented. The total data base contains estimates of energy use in the United States broken down into many categories within all sectors of the economy: agriculture, mining, construction, manufacturing, commerce, the household, electric utilities, and transportation. The transportation data provided by ORNL generally cover each of the 10 years from 1967 through 1976 (occasionally 1977 and 1978), with omissions in some models. The estimtes are broken down by mode of transport, fuel, region and State, sector of the economy providing transportation, and by the use to which it is put, and, in the case of automobile and bus travel, by the income of the traveler. Fuel types include natural gas, motor and aviation gasoline, residual and diesel oil, liuqefied propane, liquefied butane, and naphtha- and kerosene-type jet engine fuels. Electricity use is also estimated. The mode, fuel, sector, and use categories themselves subsume one, two, or three levels of subcategories, resulting in a very detailed categorization and definitive accounting

Comparison of operational energy intensities and consumption of pipelines versus coastal tankers: US Gulf coast to northeast coast routes

This report is a comparative analysis of operational energy intensities and consumption for pipeline shipments versus coastal tanker and tanker-barge movements of light petroleum products from the US Gulf Coast to US East Coast Mid-Atlantic states. It has been prepared for the Office of Transportation Programs of the US Department of Energy (DOE) as part of a project designed to develop energy conservation strategies in the areas of modal shifts and energy materials transport. It also answers an expressed interest of DOE's Office of Competition as to whether energy penalties are being paid in this region by the shipment of this oil by tanker rather than pipeline. Detailed estimates are made of the 1977 energy intensities (EIs) for tankers and the two major pipelines serving these routes; these are the Colonial pipeline (from Houston) and the Plantation pipeline (from Baton Rouge). Estimates of potential operational energy savings gained from diverting these shipments from tankers to pipelines are figured from these EIs plus 1977 tanker short-ton volumes for these products. Also estimated for these diversions are additional savings of petroleum available through shifts from the fuel oil used to power tankers, to the other energy sources used by pipelines (e.g., coal, which is burned by the utilities serving them). Table 1 indicates that these tanker volumes have been large and steady as a whole; however, individual origin ports have had substantial variations since the 1973 Arab oil embargo. Indirect energy requirements of the two modes are not included in this analysis because the methodology for calculating them is still an unresolved research area (e.g., diagreements exist as to how much supporting-infrastructure energy usage should be included for a mode)

Recurrent incarceration of the gravid uterus

Incarceration of the gravid uterus is a rare phenomenon, associated with maternal and fetal morbidity and mortality. A 37-year-old gravida 2 para 1 develops a recurrent incarceration in her second pregnancy. Therefore, examination and follow-up early in the next pregnancy is advised

Natural analogues of radionuclide migration Reconnaissance study sites (May 1985-March 1986)

SIGLEAvailable from British Library Document Supply Centre- DSC:7570.286(FLPU--86-6) / BLDSC - British Library Document Supply CentreGBUnited Kingdo