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

Calculation of Tritium Release from Pb-17Li Samples

THE TRANSPORT OF TRITIUM IN LIQUID PB-17LI HAS BEEN INVESTIGATED FOR DIFFERENT TYPES OF CAPSULES AND DIFFERENT METHODS OF TRITIUM EXTRACTION. EQUATIONS DESCRIBING THE TRITIUM RELEASE PROCESS HAVE BEEN SET UP AND SOLVED, AND TIME-DEPENDENT EXPRESSIONS OF THE OUTCOMING TRITIUM FLUX HAVE BEEN DERIVED FOR CLOSED CAPSULES CONTAINING STAGNANT OR MOVING PB-17LI AND FOR CAPSULES WHERE A HE+0.1% FLUSH GAS SWEEPS THE GAS PHASE ABOVE THE LIQUID PB-17LI OR BUBBLES THROUGH IT.NA-NOT AVAILABL

Seismic analyses of the Double Closure Plate Sub-Plate for the ITER Electron Cyclotron Upper Launcher during the Vacuum Vessel baking scenario

The Double Closure Plate Sub-Plate (DCPSP) was introduced in the Electron Cyclotron Upper Launcher (EC UL) design in order to minimize the openings exposing the interior of the Port Plug (PP) to the port cell; avoiding thus the near environment activation in case of maintenance or intervention on the In-Vessel (IV) components. The load combination Vacuum Vessel (VV) baking + Seismic level 2 is considered as one of the most relevant accidental events in terms of structural conformity affecting the DCPSP. The modal analysis of the DCPSP shows that the natural frequencies are far from the peaks of the ITER reference spectra at the PP flange. Therefore, the feasibility of analyzing the seismic event by using a static method, as a replacement of the Response Spectrum approach, is also investigated. Next, the results due to the seismic event are combined with those produced by loads on the DCPSP that occur during the VV baking scenario. The comparison of the categorized stresses and the allowable design limits showed that the mechanical integrity of the DCPSP is preserved during this load combination

Design status of the double Closure Plate Sub-Plate concept for the ITER Electron Cyclotron Upper Launcher

The Closure Plate Sub-Plate (CPSP), which defines the border between ex-vessel and in-vessel components of the Electron Cyclotron Upper Launcher (EC UL), bundles the waveguides into a sub-assembly which can be manipulated separately from the UL Port Plug (PP). The primary CPSP functions are to provide transmission line feedthroughs, support and alignment of the attached waveguides, neutron and gamma shielding, and Tritium/vacuum containment. The double CPSP concept, which is divided into In-vessel Waveguides CPSP and Thermal Isolation CPSP, was recently introduced in order to minimize the openings that expose the interior of the plug, to avoid the near environment activation in case of maintenance or intervention on the in-vessel components. This paper reports the most recent status of the CPSP as well as the analyses carried out to validate the design for normal operation. The fluid-dynamic analyses show that the power dissipated due to mm-wave transmission can be properly removed with an acceptable mass flow producing admissible values of pressure drop and temperature rise in the cooling systems. The results obtained in the thermo-mechanical simulation, validated using the ASME code, shows that the CPSP design is capable of withstanding the expected loads taking place during normal operation