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

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

Evaluation of vegetated filter strips for attenuation of pollutants resulting from military activities

Master of ScienceDepartment of Biological & Agricultural EngineeringStacy L. HutchinsonA field study was conducted at Fort Riley, Kansas from late spring to early winter of 2007 to investigate the ability of vegetated filter strips (VFS) to attenuate pollutants resulting from military activities, the impact of different management practices (i.e. burning and mowing) on VFS performance, and the effects of vegetation on hydrological components of VFS, especially infiltration and runoff. Two native tallgrass VFS sites, each comprising three plots, located in the military training area of Fort Riley were used for this study. Fifteen rainfall events were simulated on each site along with overland application of water containing nitrogen (N), phosphorous (P) and sediment. At the end of the season both VFS were managed by mowing or burning and a final rainfall simulation was done. Variables including rainfall, infiltration, runon, runoff, above ground biomass density, pollutant concentrations of runon and runoff, and soil moisture were measured and used in the data analysis. Hydrograph development, water balance, and mass balance calculations were carried out in order to calculate the pollutant trapping efficiencies (PTE) of the VFS. Statistical analysis was done by fitting several regression models. Mean comparisons were also done for variables and variance was decomposed into time, plot and site effects at an alpha = 0.05. Results showed that on average the VFS attenuated 84 % of total nitrogen, 24 % of total phosphorous and 95 % of sediments. Regression models showed that infiltration percentage and biomass density have a positive correlation with PTE. Runoff volume and PTE were negatively correlated. Soil moisture was negatively correlated with infiltration and time to runoff. With increasing biomass density, percentage of water infiltrating and time of concentration increased. Management practices, especially burning, tended to reduce PTE. Also, both management practices reduced infiltration percentage and time of concentration. PTE reduced with intensifying rainfall and increased when rainfall faded off. Phosphorous was the most sensitive pollutant for intense storm conditions followed by nitrogen, while sediment was comparatively insensitive

XVII th World Congress of the International Commission of Agricultural and Biosystems Engineering (CIGR) WATER REDISTRIBUTION WITHIN THE POTATO ROOT ZONE FOLLOWING IRRIGATION CSBE100225 -Presented at ASABE's 9th International Drainage Symposium (IDS)

ABSTRACT: Monitoring crop water uptake and soil water movement within the root zone is critical for designing drainage systems. The objective of this study was to monitor the water movement within the root zone after the soil was fully saturated by irrigation. This experiment was conducted in Winkler, Manitoba, in a potato field instrumented with 15 Time Domain Reflectometry (TDR) miniprobes embedded in a vertical plane within the root zone for each replicate. The TDR miniprobes were installed at five different depths (0.1, 0.2, 0.4, 0.6, and 0.8 m) and at three different radial distances (0.15, 0.3, 0.45 m) from the base of the potato plant. Three such replicates of TDR probes were installed at vertical planes located one meter apart. A 5 m by 5 m area was blocked off, and 50 mm depth of water was applied to bring the soil to saturation within this area. The initial water content measurement prior to this irrigation event and at periodic intervals thereafter was carried out over a four-day period. In general, the volumetric water content showed an increasing trend with depth during the four-day period. However, with time, the water content decreased in every layer except the deepest layer indicating upward movement of water from below the root zone. The results also showed that moisture depletion in the upper layers of soil was replenished overnight. The overnight increase in water content within the root zone can be attributed to capillary rise of water from below the root zone as well as hydraulic lift caused by the potato plants. Hydraulic lift is a phenomenon in which the plant roots act as a conduit, for water transport from deeper layers of soil to the drier shallower layers within the rootzone. This process is enhanced further in the absence of transpiration during the night. This paper presents evidence of this phenomenon in potato plants

Diagnostic dilemma of proximal ulnar artery aneurysm

A 67-year-old lady presented to the vascular clinic with (8 × 4) cm pulsatile swelling in her right medial forearm and had congenital high-flow AV fistula in the same arm ligated in the antecubital fossa 2 years earlier. MR angiogram failed to make a definitive diagnosis and conventional angiogram was also inconclusive. As she became more symptomatic consequently, underwent surgical procedures. The finding was a large proximal ulnar artery aneurysm. The aneurysm was excised and artery was ligated. Proximal ulnar artery aneurysms are rarely reported in the literature. Thus, this case presents a diagnostic challenge in persistent flow despite the large thrombus

A case of mycotic infrarenal abdominal aortic aneurysm after bacillus Calmette-Guérin immunotherapy for bladder cancer and a review of the literature

A 69-year-old patient presented with a 9-month history of constitutional symptoms and a 3-week history of increasing abdominal and back pain. He had a history of bacillus Calmette-Guérin immunotherapy for bladder cancer 9 months earlier. An infrarenal mycotic aneurysm was detected by positron emission tomography-computed tomography. His abdominal aorta was reconstructed using a tube graft tailored from a bovine pericardium sheet. We chose this graft because of its acellular nature and reduced risk of postoperative infection. The culture from the aortic wall yielded acid fast bacilli, and he was treated with antituberculosis medication. His postoperative recovery was uneventful, except for chylous ascites

Changes in prostaglandin and nitric oxide levels in the hyperdynamic circulation following liver resection

10.1046/j.1440-1746.2000.02295.xJournal of Gastroenterology and Hepatology (Australia)158895-901JGHE

Post-radioembolization yttrium-90 PET/CT-part 1: Diagnostic reporting

10.1186/2191-219X-3-56EJNMMI Research311-2

Post-radioembolization yttrium-90 PET/CT-part 2: Dose-response and tumor predictive dosimetry for resin microspheres

10.1186/2191-219X-3-57EJNMMI Research311-2