The Danger of Chlorhexidine in Lignocaine Gel

This article describes a case of anaphylaxis secondary to chlorhexidine during urethral catheterisation. Despite little evidence for the use of antiseptic lubricants in preventing catheter-associated urinary tract infections, the distribution and use of such products continues to be widespread. Chlorhexidine-free lubricating gel is widely available and should be used for urological procedures wherever possible

Beyond recycling: an LCA-based decision-support tool to accelerate Scotland's transition to a circular economy

Resources and waste strategies have recently seen a shift in focus from weight-based recycling targets to impact-driven policies. To support this transition, numerous decision-support tools were developed to help identify waste streams with the highest impacts. However, the majority of these tools focus solely on greenhouse gas emissions and show a narrow picture of the overall environmental impacts. Furthermore, they cover burdens associated with direct waste management activities and hence fall short when it comes to highlighting the substantial benefits that can be achieved by preventing waste in the first place. This paper quantitatively demonstrates the necessity to adopt impact-based targets that go beyond estimating the greenhouse gas emissions of waste and highlights the substantial benefits of waste reduction and prevention. Using a state-of-the-art waste environmental footprint tool, the paper quantifies the overall environmental impacts of Scotland's household waste and shows how targeting ‘heavy’ materials does not necessarily have the highest overall environmental benefit. Results show that embodied environmental impacts of household waste dominate the total environmental burdens, contributing more than 90% to the whole life cycle impacts, and hence policymakers should prioritise interventions that aim at waste reduction and prevention. Moreover, our analysis shows that food and textile wastes are high-priority materials in Scotland, with the largest contribution to overall environmental burdens; up to 42% and 30%, respectively. Considering the overall environmental impacts of specific waste materials will enable policymakers to develop more granular and targeted interventions to accelerate our transition to a sustainable circular economy

Bedside rationing by general practitioners: A postal survey in the Danish public healthcare system

<p>Abstract</p> <p>Background</p> <p>It is ethically controversial whether medical doctors are morally permitted to ration the care of their patients at the bedside. To explore whether general practitioners in fact do ration in this manner we conducted a study within primary care in the Danish public healthcare system. The purpose of the study was to measure the extent to which general practitioners (GPs) would be willing to factor in cost-quality trade-offs when prescribing medicine, and to discover whether, and if so to what extent, they believe that patients should be informed about this.</p> <p>Methods</p> <p>Postal survey of 600 randomly selected Danish GPs, of which 330 responded to the questionnaire. The Statistical Package for the Social Sciences (SPSS, version 14.0) was used to produce general descriptive statistics. Significance was calculated with the McNemar and the chi-square test. The main outcome measures of the study were twofold: an assessment of the proportion of GPs who, in a mainly hypothetical setting, would consider cost-quality trade-offs relevant to their clinical decision-making given their economic impact on the healthcare system; and a measure of the extent to which they would disclose this information to patients.</p> <p>Results</p> <p>In the hypothetical setting 95% of GPs considered cost-quality trade-offs relevant to their clinical decision-making given the economic impact of such trade-offs on the healthcare system. In all 90% stated that this consideration had been relevant in clinical decision-making within the last month. In the hypothetical setting 55% would inform their patients that they considered a cost-quality trade-off relevant to their clinical decisions given the economic impact of such trade-offs on the healthcare system. The most common reason (68%) given for not wanting to inform patients about this matter was the belief that the information would not prove useful to patients. In the hypothetical setting cost-quality trade-offs were considered relevant significantly more often in connection with concerns about costs to the patient (86%) than they were in connection with concerns about costs to the healthcare system (55%; p < 0.001).</p> <p>Conclusion</p> <p>Although readiness to consider cost-quality trade-offs relevant to clinical decisions is prevalent among GPs in Denmark, only half of GPs would disclose to patients that they consider this relevant to their clinical decision-making. The results of this study raise two important ethical problems. First, under Danish law physicians are required to inform patients about all equal treatments. The fact that only a few GPs would inform their patients about all of the relevant treatments therefore seems to contravene Danish law. Second, it is ethically controversial that physicians act as economic gatekeepers.</p

Theta dependence of SU(N) gauge theories in the presence of a topological term

We review results concerning the theta dependence of 4D SU(N) gauge theories and QCD, where theta is the coefficient of the CP-violating topological term in the Lagrangian. In particular, we discuss theta dependence in the large-N limit. Most results have been obtained within the lattice formulation of the theory via numerical simulations, which allow to investigate the theta dependence of the ground-state energy and the spectrum around theta=0 by determining the moments of the topological charge distribution, and their correlations with other observables. We discuss the various methods which have been employed to determine the topological susceptibility, and higher-order terms of the theta expansion. We review results at zero and finite temperature. We show that the results support the scenario obtained by general large-N scaling arguments, and in particular the Witten-Veneziano mechanism to explain the U(1)_A problem. We also compare with results obtained by other approaches, especially in the large-N limit, where the issue has been also addressed using, for example, the AdS/CFT correspondence. We discuss issues related to theta dependence in full QCD: the neutron electric dipole moment, the dependence of the topological susceptibility on the quark masses, the U(1)_A symmetry breaking at finite temperature. We also consider the 2D CP(N) model, which is an interesting theoretical laboratory to study issues related to topology. We review analytical results in the large-N limit, and numerical results within its lattice formulation. Finally, we discuss the main features of the two-point correlation function of the topological charge density.Comment: A typo in Eq. (3.9) has been corrected. An additional subsection (5.2) has been inserted to demonstrate the nonrenormalizability of the relevant theta parameter in the presence of massive fermions, which implies that the continuum (a -> 0) limit must be taken keeping theta fixe

Evaluating the use of citizens' juries in food policy: a case study of food regulation

BACKGROUND Deliberative engagement techniques and citizens’ juries are touted as means of incorporating the public into policy decision-making, managing community expectations and increasing commitment to public health policy. This paper reports a study to examine the feasibility of citizens’ juries as a means of collecting data to inform public health policy related to food regulation through evaluation of the conduct of a citizens’ jury. METHODS A citizens’ jury was conducted with a representative sample of 17 South Australians to explore their willingness to consider the proposition that food and drink advertising and/or sponsorship should be banned at children’s sporting events. RESULTS The results showed that, in relation to the central proposition and evaluation data from the jury, opinion on the proposition remained comparatively stable. Most jurors indicated that they thought that food and drink sponsorship and/or advertising at children’s sporting events would have little or no effect on altering children’s diet and eating habits, with the proportion increasing during the jury process. Jurors were given evaluation sheets about the content of the jury and the process of the citizens’ jury to complete at the end of the session. The evaluation of the citizens’ jury process revealed positive perceptions. The majority of jurors agreed that their knowledge of the issues of food and drink sponsorship in children’s sport had increased as a result of participation in the citizens’ jury. The majority also viewed the decision-making process as fair and felt that their views were listened to. One important response in the evaluation was that all jurors indicated that, if given the opportunity, they would participate in another citizens’ jury. CONCLUSIONS The findings suggest that the citizens’ jury increased participant knowledge of the issue and facilitated reflective discussion of the proposition. Citizens’ juries are an effective means of gaining insight into public views of policy and the circumstances under which the public will consider food regulation; however a number of issues need to be considered to ensure the successful conduct of a citizens’ jury.Julie Henderson, Elizabeth House, John Coveney, Samantha Meyer, Rachel Ankeny, Paul Ward and Michael Calna

Material flows accounting for Scotland shows the merits of a circular economy and the folly of territorial carbon reporting

Abstract Background It is essential that the human race limits the environmental damage created by our consumption. A realistic pathway to limiting consumption would be to transition to a system where materials are conserved and cycled through the economy as many times as possible and as slowly as possible, greatly reducing the greenhouse gas intensive processes of resource extraction, resource processing and waste management. Material flow analysis (MFA) is a method used to understand how materials are consumed within a nation. In this study, we attempt a MFA for Scotland which links carbon emissions to material consumption using data directly based on the mass of materials used in the Scottish economy. It is the first time such an analysis has been conducted for an economy in its entirety. Research aims This study aims to create a detailed material flow account (MFA) for Scotland, compare the environmental impacts and possible policy implications of different future material consumption scenarios and consider two materials, steel and neodymium, in detail. Results The model estimated that 11.4 Mg per capita of materials are consumed per year in Scotland, emitting 10.7 Mg CO2e per capita in the process, of which, 6.7 Mg CO2e per capita falls under territorial carbon accounting. Only the circular economy scenario for 2050 allowed for increases in living standards without increases in carbon emissions and material consumption. This result was mirrored in the steel and neodymium case studies—environmental impacts can be minimised by a national strategy that first reduces use, and then locally reuses materials. Conclusions Material consumption accounts for a large proportion of the carbon emissions of Scotland. Strategic dematerialisation, particular of materials such as steel, could support future efforts to reduce environmental impact and meet climate change targets. However, policy makers should consider consumption carbon accounting boundaries, as well as territorial boundaries, if carbon savings are to be maximised. This is because imports and recyclate sent abroad can have significant effect on the carbon emissions from material consumption. We demonstrate that the more circular an economy is, the smaller the difference between global and territorial carbon emissions, and therefore that climate change targets based solely on territorial carbon emissions create perverse incentives. The study also found that there could be areas of economic development which are compatible with environmental aims, based around encouraging reprocessing activities in developed nations

MOESM1 of Material flows accounting for Scotland shows the merits of a circular economy and the folly of territorial carbon reporting

Additional file 1. C impact of materials model including the full model, sensitivity analysis and sources used in this study

A pragmatic and industry-oriented framework for data quality assessment of environmental footprint tools

Environmental footprinting, underpinned by systematic life-cycle thinking, is increasingly seen as a critical concept for designing policies to fight climate change. The holistic nature of a life-cycle approach, built using the principles of Life Cycle Assessment (LCA), enables policy makers to understand the potential impacts and benefits of policy options. Although LCA is a widely used and well-established method, methodological aspects such as the quality of background data, model uncertainty, and comparison against existing literature are not usually communicated effectively to wider audiences, in particular policy makers. This paper introduces a novel hybrid data quality assessment method in the context of a case study based on the Scottish Waste Environmental Footprint Tool, a newly developed environmental life-cycle thinking tool. It offers an accessible method to present results of the data quality assessment of environmental models to policy makers and helps identify areas of improvements in future upgrades