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 \u27single-use\u27 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

Categorical methods in graded ring theory

Let G be a group, R a G-graded ring and X a right G-set . We study functors between categories of modules graded by G-sets, continuing the work of [M]. As an application we obtain generalizations of Cohen-Montgomery Duality Theorems by categorical methods. Then we study when some functors introduced in [M] (which generalize some functors ocurring in [D1], [D2] and [NRV]) are separable. Finally we obtain an application to the study of the weak dimension of a group graded ring

Strategies for escape and rescue from underground coal mines

"Section 2 of the Mine Improvement and New Emergency Response Act of 2006 (2006 MINER Act), Public Law 109-236, [MINER Act 2006] directed operators of underground coal mines to improve accident preparedness and response. This report summarizes the findings of research conducted by the National Institute for Occupational Safety and Health (NIOSH) between December 2007 and March 2009 to identify the attributes of an improved escape and rescue system. This report focuses on specific guidelines for escape and rescue from underground coal mines during fire and explosion incidents and contains an investigation of United States and worldwide mine practices. The basic elements of a mine emergency response system (escape, rescue, and incident command) are addressed. Further, knowledge gaps, training, human behavior, and technology challenges are also identified. This report presents a strategy of self-escape and safe-rescue including incident command as an integrated system with consideration given to U.S. underground coal mine demographics. The findings are intended to facilitate the evolution of all miners' capabilities and support institutions so that they will have a greater chance of successfully managing abnormal incidents without injury or fatalities." - NIOSHTIC-2by Danrick W. Alexander, Susan B. Bealko, Michael J. Brnich, Kathleen M. Kowalski-Trakofler, Robert H. Peters."February 2010."Available on the internet at the cdc.giv website; verified 3-17-10.Includes bibliographical references (p. 47-51

Promoting the Readiness of Minors in Supplemental Security Income (PROMISE) [CFDA 84.418P]

Over the past two decades, New York State (NYS) has been actively and collaboratively engaged in systems change across three primary domains: 1) to develop a comprehensive employment system to reduce barriers to work and improve employment outcomes of individuals with disabilities; 2) to enhance the post-school adult outcomes of youth with disabilities, by collaboratively advancing evidence-based secondary transition practices at the regional, school district and individual student levels; and, 3) to support the return-to-work efforts of individuals with disabilities who receive Social Security Administration (SSA) disability benefits under the Supplemental Security Income (SSI) program and Social Security Disability Insurance (SSDI). These domains have been supported by numerous federal and state initiatives including: the US Department of Education’s Office of Special Education and Rehabilitation Services (OSERS)-sponsored Transition Systems Change grant; the SSA-sponsored State Partnership Initiative (NYWORKS); two Youth Transition Demonstrations (YTD); the Benefits Offset National Demonstration (BOND); and, three cycles of funding for the National Work Incentives Support Center (WISC); the US Department of Labor (DOL)-sponsored Work Incentive Grant, Disability Program Navigator Initiative, and Disability Employment Initiative; three rounds of funding from the Center for Medicaid and Medicare Services (CMS) for Medicaid Infrastructure Grants (MIG, NY Makes Work Pay); the NYS Education Department (NYSED) sponsored Model Transition Program (MTP); and three multi-year cycles of the statewide Transition Coordination Site network. Most recently, NYS has sponsored the Statewide Transition Services Professional Development Support Center (PDSC); the NYS Developmental Disability Planning Council (DDPC)-sponsored Transition Technical Assistance Support Program (T-TASP), NYS Work Incentives Support Center (NYS WISC), and NYS Partners in Policy Making (PIP); the NYS Office of Mental Health (OMH)-sponsored Career Development Initiative; and others. The growing statewide and gubernatorial emphasis on employment for New Yorkers with disabilities developed over the past two decades stemming from these initiatives, supported by service innovations and shared vision across state agencies and employment stakeholders, establishes a strong foundation for implementing and sustaining a research demonstration to “Promote the Readiness of Minors in Supplemental Security Income” (PROMISE). The NYS PROMISE will build upon NYS’ past successes and significantly support NYS in removing systems, policy and practice barriers for transition-age youth who receive SSI and their families. The NYS OMH through the Research Foundation for Mental Hygiene (RFMH), with their management partners the New York Employment Support System (NYESS) Statewide Coordinating Council (SCC) and Cornell University Employment and Disability Institute, along with the proposed research demonstration site community, join the NYS Governor’s Office in designing and implementing a series of statewide strategic service interventions to support the transition and employment preparation of youth ages 14-16 who receive SSI

Ergonomics processes: implementation guide and tools for the mining industry

"Research has shown that an ergonomics process that identifies risk factors, devises solutions to reduce musculoskeletal disorders (MSDs), and evaluates the effectiveness of the solutions can lower worker exposure to risk factors and MSDs and improve productivity. A review of the Mine Safety and Health Administration (MSHA) injury/illness database indicated that 46% of illnesses in 2004 were associated with repetitive trauma and 35% of nonfatal lost days involved material handling during 2001- 2004. Even though these statistics show that MSDs significantly contribute to occupational illnesses and injuries in the U.S. mining industry, few mining companies have implemented an ergonomics process. Despite the many unique challenges in the mining environment, three mining companies partnered with the MSD Prevention Team at the National Institute for Occupational Safety and Health's Pittsburgh Research Laboratory to demonstrate that an ergonomics process could be systematically implemented and effectively integrated with existing safety and health programs. Because these three mining companies were very different in organization, culture, and size, the ergonomics processes had to be modified to meet the needs of each company. A description of how these three companies applied ergonomics and the tools and training used to implement their processes is given. Prior to discussing the case studies, general information on the elements of an ergonomics process is provided.' - NIOSHTIC-21. Introduction: Ergonomics and risk management -- 2. Ergonomics processes: case studies -- 3. Process effectiveness -- 4. Implementation tools -- 5. Training -- References -- Appendix: Ergonomics processes: beyond traditional safety and health programsby Janet Torma-Krajewski, Lisa J. Steiner, Robin Burgess-Limerick."February 2009."Also available via the World Wide Web.Includes bibliographical references

Prediction of longwall methane emissions: an evaluation of the influence of mining practices on gas emissions and methane control systems

"The primary purpose of this field study was to predict the methane emission consequences of mining longwall panels of greater face width in the Pochontas No. 3 Coalbed in Virginia. Mines were to be increased from 229 to 305 m (750 to 1,000 ft). However, since historically high methane emissions from the longwall face and gobs were already being experienced, there was a concern for further increases in methane emission rates. If preferables from a safety perspective to be prepared in advance, either with increased ventilation airflow, or with additional methane drainage. The bleeder and methane drainage systems associated with the two study panels were also evaluated to fully characterize the methane liberation patterns and control system performance for each study area. " - NIOSHTIC-2William P. Diamond and Fred Garcia."October 1999."Includes bibliographical references (p. 32)

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

The Application of major hazard risk assessment (MHRA) to eliminate multiple fatality occurrences in the U.S. minerals industry

"Major Hazard Risk Assessment (MHRA) is used to help prevent major hazards, e.g., fire, explosion, wind-blast, outbursts, spontaneous combustion, roof instability and chemical and hazardous substances, etc., from injuring miners. The structured process associated with MHRA helps to characterize the major hazards and evaluate engineering, management and work process factors that impact how a mine mitigates its highest risk. The National Institute for Occupational Safety and Health (NIOSH) studied the application of this technique to US mining conditions through a field-oriented pilot project. Risk assessment teams used in the pilot project were primarily composed of mining company personnel. Ten case studies were performed over a wide cross-section of mines. These mines were representative of the important mining commodities in the US minerals industry, i.e. coal, metal, non-metal, and aggregate. Also, the sizes of the mines ranged from small to large and were located across the country. The ten case studies demonstrate that most US mines have the capability to successfully implement an MHRA and that the MHRA methodology produced additional prevention controls and recovery measures to lessen the risk associated with a select population of major mining hazards. The basic ingredient for a successful MHRA is the desire to become more proactive in dealing with the risks associated with events that can cause multiple fatalities. A successful outcome is marked by a thorough examination of existing prevention controls and recovery measures. When pressed to consider more controls to further mitigate the risk, a well-staffed risk assessment team was able to identify additional controls. For these mining operations, it was important to add additional controls, even if they were not required by existing mining regulations, to lower the risks associated with the major hazards under consideration. If a mining operation is not willing to commit its best people to an MHRA or will not provide them with sufficient time to see the process through to its conclusion, the MHRA output may prove to be useless. Additionally, if a mining operation is not prepared to discuss its major hazards in an open and honest fashion and to present the findings of the risk assessment in a written report, the MHRA output will be unclear, and attempts to monitor or audit important controls may not be possible. A MHRA is most effective when the mining operation possesses 1) a proper understanding of its hazards, 2) experience with informal and basic-formal risk assessment techniques, 3) proper facilities, machinery and equipment, 4) suitable systems and procedures that represent industry Best Practice, 5) appropriate organizational support with adequate staff, communications and training, 6) a formal and thorough plan for emergency response, and 7) a safety risk management approach that is promoted and supported at all levels of the organization." - NIOSHTIC-2by A. Iannacchione, F. Varley and T. Brady."October 2008."Also available via the World Wide Web.Includes bibliographical references (p. 121-122)

Full-scale testing of the float dust deposition meter

"Coal dust and float coal dust, produced during normal mining operations, in underground coal mines, are carried from the point of origin downstream by the ventilating air, where it deposits on the surfaces of the mine entry. In an explosion, this dust is lifted from the surfaces by the aerodynamic disturbances and, if of sufficient quantity, can continue to propagate the explosion. To prevent the surface coal dust from contributing, it must be inerted, typically by spreading pulverized limestone, i.e., rock dust, over the coal dust surface. To facilitate the dusting operation, the National Institute for Occupational Safety and Health (NIOSH), Pittsburgh Research Laboratory (PRL), developed an automated system that continuously monitors the accumulation of coal dust. This system could activate a rock-dusting machine that disperses rock dust into the ventilation air when dangerous deposits accumulate and deactivate the machine when sufficient inert has been deposited on top of the coal dust. The system consists of a microprocessor-controlled optical float dust deposition meter. This device measures the light intensity reflected from a deposited layer of dust. A standard cap lamp is used as a fixed- position light source. From the reflected light signal, the microprocessor determines the hazard level of the deposited layer and performs the appropriate action. " - NIOSHTIC-2Robert A. Cortese and Henry E. Perlee.Also available via the World Wide Web.Includes bibliographical references

New technology for coal mine roof support

"Roof falls continue to be the greatest single safety hazard faced by underground coal miners. During 1996-99, 44 coal miners lost their lives in rock falls, and nearly 2,400 were injured. In addition, nearly 6,000 noninjury roof collapses were reported. Roof supports are installed to protect the miners, but support system failures contributed to most of these incidents. Reducing the terrible toll taken by ground falls continues to be a major goal of research by the National Institute for Occupational Safety and Health (NIOSH). The purpose of these proceedings is to provide the mining community with a comprehensive survey of coal mine roof supports. Drawing on many years of research undertaken by the NIOSH Pittsburgh and Spokane Research Laboratories, this volume describes what types of support are available, how they work, and when they should be used. The major subjects covered include roof bolts, standing roof supports, cable supports, and longwall shields. Some special topics are also addressed, including an analysis of roof fall accident statistics, techniques for better skin control, materials handling considerations, and longwall mining through recovery rooms. This proceedings volume also contains information on several important new technologies, which are described here for the first time: - Guidelines for selecting roof bolt length, pattern, and capacity that were derived from statistical analysis of the roof fall experience at 37 underground mines; - A new design method for longwall tailgate supports; and - A technique for measuring loads developed within cable bolts. http://www.cdc.gov/niosh/mining/pubs/pdfs/2000-151-errata.pdf " - NIOSHTIC-2edited by Christopher Mark, Dennis R. Dolinar, Robert J. Tuchman, Thomas M. Barczak, Stephen P. Signer and Priscilla F. Wopat.NIOSHTIC no 20000874Includes bibliographical references