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

Optimal Design and Energy Management of a Hybrid Power Generation System Based on Wind/Tidal/PV Sources: Case Study for the Ouessant French Island

International audienceHybrid power generation systems have become a focal point to meet requirements of electric power demand. This kind of system combines several technologies and is considered as one of the appropriate options for supplying electricity in remote areas, such islands, where the electric utility is not available. It is one of the promising approaches due to its high flexibility, high reliability, higher efficiency, and lower costs for the same produced energy by traditional resources. Typically, hybrid power generation systems combine two or more conventional and renewable power sources. They will also incorporate a storage system. This chapter will focus on a typical hybrid power generation system using available renewables near the Ouessant French Island: wind energy, marine energy (tidal current), and PV. This hybrid system is intended to satisfy the island load demand. It will therefore explore optimal economical design and optimal power management of such kind of hybrid systems using different approaches: (1) Cascaded computation (linear programming approach); (2) Genetic algorithms-based approach; (3) Particle swarm optimization. In terms of economical optimization, different constraints (objective functions) will be explored for a given 25 years of lifetime; such as minimizing the Total Net Present Cost (TNPC), minimizing the Levelized Cost of Energy (LCE). The concept of reliability will also be explored to evaluate the hybrid system based on renewables to satisfy the island load requirements. In this chapter, the Equivalent Loss Factor (ELF) is considered

Environment and Land Use in the Wadi Faynan, Southern Jordan: the Third Season of Geoarchaeology and Landscape Archaeology (1998)

Reproduced with permission of the publisher. © 1999 Council for British Research in the Levant. Details of the publication are available at: http://www.cbrl.org.uk/Publications/publications_default.shtmThis report describes the third season of fieldwork by an interdisciplinary team of archaeologists and geographers working to reconstruct the landscape history of the Wadi Faynan in southern Jordan over the past 200,000 years. The particular focus of the project is the long-term history of inter-relationships between landscape and people, as a contribution to the study of processes of desertification and environmental degradation. The geomorphological and palaeoecological studies have now established the outline sequence of landform changes and climatic fluctuations in the late Pleistocene and Holocene. The complex field system WF4 has now been recorded in its entirety in terms of wall construction, surface artefacts, and hydrological features, as well as most of the outlying field systems. From these studies, in combination with the analysis of the surface artefacts, an outline sequence of the water utilization and managements strategies they represent and can now be discerned. Ethnoarchaeology is also being used to investigate the present-day populations of the study area, their interactions with their landscape and with neighbouring socio-economic groups, in part to yield archaeological signatures to aid the interpretation of the surface remains being gathered by the archaeological survey. Palynology is showing that Roman/Byzantine agriculture and mining severely impacted on the landscape in terms of deforestation; and geochemistry that Roman/Byzantine mining severely polluted the landscape, the effects of which are still apparent in the modem ecology of the study area