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

RISE-UP: Resilience in urban planning for climate uncertainty: Empirical insights and theoretical reflections from case studies in Amsterdam and Mumbai

Climate change is one of the main drivers of uncertainty in urban planning, but only a few studies systematically address these uncertainties, especially in the long term. Urban resilience theory presents principles to manage uncertainty but largely focuses on individual urban systems rather than complex interdependent dynamics. Further, most planning and resilience theory originates from the Global North and is unsuitable for capturing the dynamics of the Global South. This study uses an exploratory multi-case analysis towards developing an enhanced understanding of urban planning for climate uncertainty. We argue that long-term urban planning for climate uncertainty can benefit from systematically integrating resilience principles. We use a two-step qualitative research approach: (1) To propose a conceptual framework connecting urban resilience principles, approaches to urban planning under uncertainty and planning responses in urban systems. (2) To use the conceptual framework to analyse climate-related planning responses in two contrasting case studies in the Global North (GN) and Global South (GS) (Amsterdam and Mumbai). We conclude with four propositions towards an enhanced understanding of urban planning for climate uncertainty by drawing upon the empirical insights from the two case studies.System EngineeringTransport and Logistic

Zooming into Socio-economic Inequalities: Using Urban Analytics to Track Vulnerabilities – A Case Study of Helsinki

The Covid19 crisis has highlighted once more that socio-economic inequalities are a main driver of vulnerability. Especially in densely populated urban areas, however, these inequalities can drastically change even within neighbourhoods. To better prepare for urban crises, more granular techniques are needed to assess these vulnerabilities, and identify the main drivers that exacerbate inequality. Machine learning techniques enable us to extract this information from spatially geo-located datasets. In this paper, we present a prototypical study on how Principal Component Analysis (PCA) to analyse the distribution of labour and residential characteristics in the urban area of Helsinki, Finland. The main goals are twofold: 1) identify patterns of socio-economic activities, and 2) study spatial inequalities. Our analyses use a grid of 250x250 meters that covers the whole city of Helsinki, thereby providing a higher granularity than the neighbourhood-scale. The study yields four main findings. First, the descriptive statistical analysis detects inequalities in the labour and residential distributions. Second, relationships between the socio-economic variables exist in the geographic space. Third, the first two Principal Components (PCs) can extract most of the information about the socio-economic dataset. Fourth, the spatial analyses of the PCs identify differences between the Eastern and Western areas of Helsinki, which persist since the 1990s. Future studies will include further datasets related to the distribution of urban services and socio-technical indicators.Transport and LogisticsSystem Engineerin

Machine learning for spatial analyses in urban areas: a scoping review

The challenges for sustainable cities to protect the environment, ensure economic growth, and maintain social justice have been widely recognized. Along with the digitization, availability of large datasets, Machine Learning (ML) and Artificial Intelligence (AI) are promising to revolutionize the way we analyze and plan urban areas, opening new opportunities for the sustainable city agenda. Especially urban spatial planning problems can benefit from ML approaches, leading to an increasing number of ML publications across different domains. What is missing is an overview of the most prominent domains in spatial urban ML along with a mapping of specific applied approaches. This paper aims to address this gap and guide researchers in the field of urban science and spatial data analysis to the most used methods and unexplored research gaps. We present a scoping review of ML studies that used geospatial data to analyze urban areas. Our review focuses on revealing the most prominent topics, data sources, ML methods and approaches to parameter selection. Furthermore, we determine the most prominent patterns and challenges in the use of ML. Through our analysis, we identify knowledge gaps in ML methods for spatial data science and data specifications to guide future research.Transport and LogisticsSystem Engineerin

A data-driven approach to analyse the co-evolution of urban systems through a resilience lens: A Helsinki case study

Urban areas are dynamic systems, in which different infrastructural, social and economic subsystems continuously co-evolve. As such, disruptions in one system can propagate to another. However, open challenges remain in (i) assessing the long-term implications of change for resilience and (ii) understanding how resilience propagates throughout urban systems over time. Despite the increasing reliance on data in smart cities, few studies empirically investigate long-term urban co-evolution using data-driven methods, leading to a gap in urban resilience assessments. This paper presents an approach that combines Getis-ord Gi* statistical and correlation analyses to investigate how cities recover from crises and adapt by analysing how the spatial patterns of urban characteristics and their relationships changed over time. We illustrate our approach through a study on Helsinki’s road infrastructure, socioeconomic system and built-up area from 1991 to 2016, a period marked by a major socioeconomic crisis. By analysing this case study, we provide insights into the co-evolution over more than two decades, thereby addressing the lack of longitudinal studies on urban resilience.Transport and LogisticsSystem Engineerin

Can green roofs help with stormwater floods? A geospatial planning approach

Increasing urbanization, impervious space, and the impact of climate change are threatening the future of cities. Nature-based solutions, specifically urban green infrastructures, are seen as a sustainable strategy to increase resilience against extreme weather events, including the escalating occurrence of stormwater runoff flooding. Consequently, urban planners and decision-makers have pushed their efforts toward implementing green infrastructure solutions to reduce the impact of stormwater floods. Among others, green roofs help store water and decrease stormwater runoff impacts on a local scale. This research aims to investigate the effect of surface permeability and green roof implementation on reducing stormwater flooding and subsequently provide urban planners with evidence-based geospatial planning recommendations to improve urban resilience in Helsinki. First, we modeled the current impact of stormwater flooding using the Arc-Malstrom model in Helsinki. The model was used to identify districts under high stormwater flood risk. Then, we zoomed in to a focus area and tested a combination of scenarios representing four levels of green roof implementation, two levels of green roof infiltration rates under 40-, 60-, 80-, 100 mm precipitation events on the available rooftops. We utilized open geographic data and geospatial data science principles implemented in the GIS environment to conduct this study. Our results showed that low-level implementation of green roofs with low retention rates reduces the average flood depth by only 1 %. In contrast, the maximum green roof scenario decreased most of the average flood depth (13 %) and reduced the number of vulnerable sites. The proposed methodology can be used for other cities to develop evidence-based plans for green roof implementations.Transport and LogisticsSystem Engineerin

Effects of topology on water distribution systems resilience

Water Distribution Systems (WDSs) are critical infrastructures for providing water to sustain life and human activities. Some recent trends, such as climate change, urbanization, and increasing system interdependence, have led to more frequent threats, with detrimental effects on WDSs. In recent years, resilience has been considered an effective approach to address those threats, for which it is difficult to estimate the likelihood and consequences (Henry and Ramirez-Marquez, 2012). In the literature, two approaches were used to assess WDS resilience. On the one hand, performance-based metrics were used to quantify the impacts of disruptions on the WDS. Specifically, recovery functions were developed to model the time-continuous system response following a disruption, during periods of loss and restoration of performance (Cassottana et al., 2019). On the other hand, indexes based on system attributes were developed to classify WDSs and identify structural vulnerabilities. For example, algebraic connectivity, clustering coefficient, and average path length were used as proxies for robustness, redundancy, and efficiency, respectively (Yazdani et al., 2011). However, those approaches were applied separately, and the relationship between the performance of WDSs and their attributes is still unknown. Hence, the question arises from the above analysis on how to identify the key structural factors determining the resilience of a WDS. The goal of this research is to understand how and to what extent different network topologies determine different performance losses and recovery behaviors given increasing magnitude of disruption, i.e., pipe breakdown. To this end, we consider different network topologies as case studies and vary their structural attributes, e.g., water source head and tank capacity. We then simulate disruption scenarios of increasing magnitude and model the resulting system performance by means of recovery functions for the assessment of resilience. The estimated parameters of these functions are useful for characterizing different system responses, including severe or limited performance losses and fast or slow recoveries. By systematically varying the network topologies and the structural attributes, the function parameters could be in turn associated with key structural factors. We find that, while increasing the WDS supply capacity results in limited performance loss in terms of satisfied demand for water, increasing the reserve capacity improves the robustness of the system by delaying the loss of performance. This analysis will inform the design of resilient water networks based on their topology and unique attributes.System Engineerin

Quantitative Assessment of System Response during Disruptions: An Application to Water Distribution Systems

The resilience of water distribution systems (WDSs) has gained increasing attention in recent years. Various performance loss and recovery behaviors have been observed for WDSs subject to disruptions. However, a model for their characterization, which could provide further insight for resilience assessment and enhancement, is still lacking. Here, the authors develop a recovery function to model WDS performance over time following a disruption. This function is useful to compare system responses under different disruption and recovery scenarios and supports the identification of areas for improvement within various aspects of the resilience of a WDS. The proposed model was applied to two benchmark networks. Different scenarios were analyzed in which one node at a time was disrupted and two recovery strategies were implemented. It was found that the developed model supports the implementation of tailored strategies to improve WDS resilience according to the location of the disruption, therefore enhancing the efficient allocation of resources. Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.System Engineerin

Robust post-disaster route restoration

Route restoration is considered to be a task of foremost priority in disaster relief. In this paper, we propose a robust optimization approach for post-disaster route restoration under uncertain restoration times. We present a novel decision rule based on restoration time ordering that yields optimal restoration sequencing and propose conditions for complexity reduction in the model and prove probability bounds on the satisfaction of these conditions. We implement our models in a realistic study of the 2015 Gorkha earthquake in Nepal.System Engineerin