Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists

The Earth’s mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists’ education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references

Electrical stimulation of wrist and fingers for sensory and functional recovery in acute hemiplegia

Objective: To investigate the effects of a short-term electrical stimulation in conjunction with neurodevelopmental exercises on sensory and functional recovery of hemiparetic upper limb in acute stroke patients

Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists.

The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references

An Atom Probe Study of Kappa Carbide Precipitation and the Effect of Silicon Addition

The influence of silicon on K-carbide precipitation in lightweight austenitic Fe-30Mn-9Al-(0.59-1.56)Si-0.9C-0.5Mo cast steels was investigated utilizing transmission electron microscopy, 3D atom-probe tomography, X-ray diffraction, ab initio calculations, and thermodynamic modeling. Increasing the amount of silicon from 0.59 to 1.56 pct Si accelerated formation of the K-carbide precipitates but did not increase the volume fraction. Silicon was shown to increase the activity of carbon in austenite and stabilize the K-carbide at higher temperatures. Increasing the silicon from 0.59 to 1.56 pct increased the partitioning coefficient of carbon from 2.1 to 2.9 for steels aged 60 hours at 803 K (530 °C). The increase in strength during aging of Fe-Mn-Al-C steels was found to be a direct function of the increase in the concentration amplitude of carbon during spinodal decomposition. The predicted increase in the yield strength, as determined using a spinodal hardening mechanism, was calculated to be 120 MPa/wt pct Si for specimens aged at 803 K (530 °C) for 60 hours and this is in agreement with experimental results. Silicon was shown to partition to the austenite during aging and to slightly reduce the austenite lattice parameter. First-principles calculations show that the Si-C interaction is repulsive and this is the reason for enhanced carbon activity in austenite. The lattice parameter and thermodynamic stability of K-carbide depend on the carbon stoichiometry and on which sublattice the silicon substitutes. Silicon was shown to favor vacancy ordering in K-carbide due to a strong attractive Si-vacancy interaction. It was predicted that Si occupies the Fe sites in nonstoichiometric K-carbide and the formation of Si-vacancy complexes increases the stability as well as the lattice parameter of K-carbide. A comparison of how Si affects the enthalpy of formation for austenite and K-carbide shows that the most energetically favorable position for silicon is in austenite, in agreement with the experimentally measured partitioning ratios