National-scale modelling of N leaching in organic and conventional horticultural crop rotations - policy implications

A method is presented to model N leaching in crop rotations on a national scale. Representative crop rotations for different regions and soil types are used in the cross-disciplinary, plant, soil, environment & economics model EU-Rotate_N. By comparing contrasting farming systems (organic and conventional) in the UK, their strengths and weaknesses in delivering environmental and economic sustainability can be assessed. Modelling results show that the annual leaching in different horticultural rotations and UK regions, using median weather, is within the range of 13-88 kg N/ha/year for organic and 54-130 kg N /ha/year for conventional. The weighted annual average figures are 39 kg N/ha/year for organic and 81 kg N/ha/year for conventional, respectively. It is concluded that organic horticultural rotations, with a current share of 6.1% already contribute to lower overall N losses from agriculture. However, on a UK national scale, only a large share of organic land use (e.g. >50%) has a large effect on reducing N losses. Similar reductions are also predicted by substantial cuts in conventional N inputs, giving a policy choice if pollution from agriculture steps up further on the political agenda

Minimising carbon and financial costs of steam sterilisation and packaging of reusable surgical instruments

Background: The aim of this study was to estimate the carbon footprint and financial cost of decontaminating (steam sterilization) and packaging reusable surgical instruments, indicating how that burden might be reduced, enabling surgeons to drive action towards net-zero-carbon surgery. Methods: Carbon footprints were estimated using activity data and prospective machine-loading audit data at a typical UK in-hospital sterilization unit, with instruments wrapped individually in flexible pouches, or prepared as sets housed in single-use tray wraps or reusable rigid containers. Modelling was used to determine the impact of alternative machine loading, opening instruments during the operation, streamlining sets, use of alternative energy sources for decontamination, and alternative waste streams. Results: The carbon footprint of decontaminating and packaging instruments was lowest when instruments were part of sets (66-77 g CO2e per instrument), with a two- to three-fold increase when instruments were wrapped individually (189 g CO2e per instrument). Where 10 or fewer instruments were required for the operation, obtaining individually wrapped items was preferable to opening another set. The carbon footprint was determined significantly by machine loading and the number of instruments per machine slot. Carbon and financial costs increased with streamlining sets. High-temperature incineration of waste increased the carbon footprint of single-use packaging by 33-55 per cent, whereas recycling reduced this by 6-10 per cent. The absolute carbon footprint was dependent on the energy source used, but this did not alter the optimal processes to minimize that footprint. Conclusion: Carbon and financial savings can be made by preparing instruments as part of sets, integrating individually wrapped instruments into sets rather than streamlining them, efficient machine loading, and using low-carbon energy sources alongside recycling

The carbon footprint of surgical operations: a systematic review

Summary of background data and objectives: Operating theatres are typically the most resource-intensive area of a hospital, 3–6 times more energy-intensive than the rest of the hospital and a major contributor of waste. The primary objective of this systematic review was to evaluate existing literature calculating the carbon footprint of surgical operations, determining opportunities for improving the environmental impact of surgery. Methods: A systematic review was conducted in accordance with PRISMA guidelines. The Cochrane Database, Embase, Ovid MEDLINE, and PubMed were searched and inclusion criteria applied. The study endpoints were extracted and compared, with the risk of bias determined. Results: A total of 4604 records were identified, and 8 were eligible for inclusion. This review found that the carbon footprint of a single operation ranged 6–814 kg carbon dioxide equivalents. The studies found that major carbon hotspots within the examined operating theatres were electricity use, and procurement of consumables. It was possible to reduce the carbon footprint of surgery through improving energy-efficiency of theatres, using reusable or reprocessed surgical devices and streamlining processes. There were significant methodological limitations within included studies. Conclusions: Future research should focus on optimizing the carbon footprint of operating theatres through streamlining operations, expanding assessments to other surgical contexts, and determining ways to reduce the footprint through targeting carbon hotspots

Evaluating sustainability: a retrospective cohort analysis of the Oxfordshire therapeutic community

Background: Therapeutic communities (TCs) could reduce the health care use of people with personality disorder (Davies S, Campling P and Ryan K, Psychiatrist 23:79–83, 1999; Barr W, Kirkcaldy A, Horne A, Hodge S, Hellin K and Göpfert M, J Ment Health 19:412–421, 2010) and in turn reduce the financial and environmental costs of services. Our hypothesis is that 3 years following entry to a TC service, patients have reduced subsequent health care use and associated reductions in financial costs and carbon footprint. Methods: A retrospective 4-year cohort study examined changes in health care use following entry to the Oxfordshire TC service. Comparative analysis was undertaken on a treated (n = 40) and a control group (referred but who declined treatment; n = 45). Financial costs and carbon footprint of health care use were calculated using national tariffs and standard carbon conversion factors. Mean changes in these outcomes were compared over 1, 2 and 3 years and adjusted for costs and carbon footprints in the year prior to joining the TC service. Results: Compared to baseline, the group receiving TC care had greater reductions in financial costs and carbon footprint associated with A&E attendances (p = 0.04) and crisis mental health appointments (p = 0.04) than the control group. There were significantly greater reductions in carbon footprint for all secondary health care use, both physical and mental health care, after 3 years (p = 0.04) in the TC group. Conclusions: TC services may have the potential to reduce the financial cost and carbon footprint of health car

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract 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

The carbon footprint of waste streams in a UK hospital

A number of studies have estimated the carbon footprint of healthcare provision in a variety of contexts, but the emission factors used to account for associated waste vary widely and are not healthcare specific. The aim of this study was to estimate and compare the carbon footprint of hospital waste streams. A process-based carbon footprint of hospital waste was estimated in accordance with the Greenhouse Gas Accounting Sector Guidance for Pharmaceutical Products and Medical Devices, using activity data based on waste streams found at three hospitals in one UK National Health Service organisation. This study estimates that the carbon footprint per t of hospital waste was lowest when it is recycled (21–65 kg CO2e), followed by low temperature incineration with energy from waste (172–249 kg CO2e). When the waste was additionally decontaminated using an autoclave prior to low temperature incineration with energy from waste, the carbon footprint was increased to 569 kg CO2e. The highest carbon footprint was associated with the disposal of waste via high temperature incineration (1074 kg CO2e/ t). NHS data show that the financial cost of waste streams mirror that of the carbon footprint. In conclusion, it is possible to use the carbon footprint of hospital waste streams to derive emission factors for specific waste disposal options. This may inform the optimal processing of healthcare waste in the future

Global health security: the wider lessons from the west African Ebola virus disease epidemic.

The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security--its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing