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

Ideological Views in the History of Greek Philosophy

This research studies the most important beliefs of the Greek philosophers. I classified it into three chapters; The first chapter is about emanation theory, its metaphysical roots and causes of its evolution. I also pointed out its succession and collapse in accordance to the system of sense, mind, nature, and the Holy statute. In the second chapter, I discussed the issue of the mind, pointing out their extent of exaggeration by believing that god is the mind which can actively create, exist, die and disappear. In addition, I pointed out that neither the sense nor the mind is the single source of knowledge. I indicated in the second section of this chapter what is mind for Muslims, pointing out what it means, its limits, and how knowledge happens, explaining that revelation is the only source of ever lasting knowledge. I also explain in totality the collapse of their words. In the third chapter, I pointed out in totality the most important beliefs of the philosophers; such as atheism, idol worship, and their words that with monotheism together with their beliefs the world age long. In addition, their in The Holy Names and Attributes. I also discussed the philosophers stand regarding the books about angles, fairies, prophets, scriptures, resurrection and fait. In the side columns, I indicated the most Important beliefs of the Muslim philosophers in this regard. This research aims at to reflect the important beliefs of the Greek philosophers, present and paraphrase them in accordance to the understanding of the Sunni and People Sect; because many are not behaving in this way. Some of the results I obtained include: 1. Showing the sources of the emanation theory of metaphysics, its intellectual roots, its succession and collapse in the mind and sense including the statute. 2. The deviation of the Greek's philosophical intellect in understanding the brain, exalting up to superstitious and illusion levels without no logical, sensible or written reference. 3. For their belief in the sense and mind as sources of knowledge, they have to belief in what Prophet Mohammed (SAW) has brought of the revelation in order to confirm it by mind and sense. 4. The beliefs of the Muslim philosophers in many religious issues is an imitation of the beliefs the Greek philosophers. Their belief in the worship of stars the world age long, and rejection of attributes and awareness of Allah (SWT) and their rejection of resurrection, are similar things. 5. The Greek philosophers are the most divergent and different nations in their beliefs and intellects. This is an indication of their inconsistency and shake. 6. Their beliefs contradict the mind and common nature as well contradicting the true revelation. 7. They lack a clear or acceptable guidance for the wise for their beliefs, and intellects are non-sensible, non-mindful. They are mere fragile sayings and claims that collapse in non-serious discussions

Ideological Views in the History of Greek Philosophy

This research studies the most important beliefs of the Greek philosophers. I classified it into three chapters; The first chapter is about emanation theory, its metaphysical roots and causes of its eVol.ution. I also pointed out its succession and collapse in accordance to the system of sense, mind, nature, and the Holy statute_ In the second chapter, I discussed the issue of the mind, pointing out their extent of exaggeration by believing that god is the mind which can actively create, exist, die and disappear. In addition, I pointed out that neither the sense nor the mind is the single source of knowledge. I indicated in the second section of this chapter what is mind for Muslims, pointing out what it means, its limits, and how knowledge happens, explaining that revelation is the only source of ever lasting knowledge. I also explain in totality the collapse of their words. In the third chapter, I pointed out in totality the most important beliefs of the philosophers; such as atheism, idol worship, and their words that with monotheism together with their beliefs the world age long. In addition, their in The Holy Names and Attributes. I also discussed the philosophers stand regarding the books about angles, fairies, prophets, scriptures, resurrection and fait. In the side columns, I indicated the most Important beliefs of the Muslim philosophers in this regard. This research aims at to reflect the important beliefs of the Greek philosophers, present and paraphrase them in accordance to the understanding of the Sunni and People Sect; because many are not behaving in this way. Some of the results I obtained include: 1. Showing the sources of the emanation theory of metaphysics, its intellectual roots, its succession and collapse in the mind and sense including the statute. 2. The deviation of the Greek's philosophical intellect in understanding the brain, exalting up to superstitious and illusion levels without no logical, sensible or written reference. 3. For their belief in the sense and mind as sources of knowledge, they have to belief in what Prophet Mohammed , SAW, has brought of the revelation in order to confirm it by mind and sense. 4. The beliefs of the Muslim philosophers in many religious issues is an imitation of the beliefs the Greek philosophers. Their belief in the worship of stars the world age long, and rejection of attributes and awareness of Allah , SWT, and their rejection of resurrection, are similar things. 5. The Greek philosophers are the most divergent and different nations in their beliefs and intellects. This is an indication of their inconsistency and shake. 6. Their beliefs contradict the mind and common nature as well contradicting the true revelation. 7. They lack a clear or acceptable guidance for the wise for their beliefs, and intellects are non-sensible, non-mindful. They are mere fragile sayings and claims that collapse in non-serious discussions

The impact of stimuli on affect in persons with dementia.

OBJECTIVE: To examine how presentation of different stimuli impacts affect in nursing home residents with dementia. METHOD: Participants were 193 residents aged 60 to 101 years from 7 Maryland nursing homes who had a diagnosis of dementia (derived from the medical chart or obtained from the attending physician). Cognitive functioning was assessed via the Mini-Mental State Examination (MMSE), and data pertaining to activities of daily living were obtained through the Minimum Data Set. Affect was assessed using observations of the 5 moods from Lawton’s Modified Behavior Stream. Baseline observations of affect were performed for comparisons. During the study, each participant was presented with 25 predetermined engagement stimuli in random order over a period of 3 weeks. Stimuli were categorized as live social, simulated social, manipulative, work/task-related, music, reading, or individualized to the participant’s self-identity. The dates of data collection were 2005–2007. RESULTS: Differences between stimulus categories were significant for pleasure (F(6,144) = 25.137, P < .001) and interest (F(6,144) = 18.792, P < .001) but not for negative affect. Pleasure and interest were highest for the live social category, followed by self-identity and simulated social stimuli for pleasure, and for manipulative stimuli in terms of the effect on interest. The lowest levels of pleasure and interest were observed for music. Participants with higher cognitive function had significantly higher pleasure (F(1,97) = 6.27, P < .05). Although the general trend of the impact of the different categories was similar for different levels of cognitive function, there were significant differences in pleasure in response to specific stimuli (interaction effect: F(6,92) = 2.31, P < .05). Overall, social stimuli have the highest impact on affect in persons with dementia. CONCLUSIONS: The findings of the present study are important, as affect is a major indicator of quality of life and this study is the first to systematically examine the impact of specific types of stimuli on affect. As live social stimuli are not always readily available, particularly in busy nursing home environments, simulated social stimuli can serve as an effective substitute, and other stimuli should have a role in the activity tool kit in the nursing home. The relative ranking of stimuli was different for interest and pleasure. The findings demonstrate the differential effect of presentation of different types of stimuli on the affect of persons with dementia, and that, while the impact is greater on persons with higher levels of cognitive function, there is a different effect of varying stimuli even in persons with MMSE scores of 3 or lower. Future research should attempt to ascertain a person’s degree of interest in stimuli prior to developing an intervention

Can Agitated Behavior of Nursing Home Residents With Dementia Be Prevented With the Use of Standardized Stimuli?

OBJECTIVES: To assess the relative effect of different types of stimuli on agitated behaviors of nursing home residents with dementia. DESIGN: Repeated-measures design with randomized assignment of conditions. SETTING: Seven Maryland nursing homes. PARTICIPANTS: One hundred eleven nursing home residents with a diagnosis of dementia who exhibited agitation. INTERVENTION: Different types of stimuli (music, social stimuli, simulated social stimuli, and individualized stimuli based on the person\u27s self-identity) were presented. MEASUREMENTS: Agitation was directly observed and recorded using the Agitation Behavior Mapping Instrument. RESULTS: All stimulus categories were associated with significantly less physical agitation than baseline observations, and all except for manipulative stimuli were associated with significantly less total agitation. Live social stimuli were associated with less agitation than music, self-identity, work, simulated social, and manipulative stimulus categories. Task and reading stimulus categories were each associated with significantly less agitation than work, simulated social, and manipulative stimulus categories. Music and self-identity stimuli were associated with less agitation than simulated social and manipulative stimuli. CONCLUSION: Providing stimuli offers a proactive approach to preventing agitation in persons with dementia, with live social stimuli being the most successful

Modeling of Photovoltaic Solar Array under Different levels of partial shadow Conditions

Different methods of configuration have been formulated regarding photovoltaic solar power by employing several techniques. This has been done because of the varying conditions so that the loss of power can be minimized. The main factor which decreases energy output of the photovoltaic PV solar systems is partial shadowing. The way the energy output of partially shadowed arrays varies with the system configuration used, has been studied extensively. A huge degree of disorder still exists, particularly with respect to the best modularity grade for these systems. There are two distinct sub-divisions in the systems implemented in the reconfiguration mechanism: reconfigurable solar arrays, and a switching matrix to do a reconfiguration. Using different methods, the proportions of shadowing obstructions were noted to allow for calculation of the likely shadowing losses. The outcomes of this paper on modeling and monitoring are used to evaluate the photovoltaic system with respect to shadowing losses with different levels and their reliance on the system configuration are selected. It has been found that power loss because of varying conditions is majorly due to the decrease in radiance occurring on the photovoltaic array and can be avoided through selecting the suitable configuration and connection. The simulation results show that the output characteristics of the simulator presented better results with that proposed model

The Comprehensive Process Model of Engagement

BACKGROUND: Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy. OBJECTIVE: The Comprehensive Process Model of Engagement was examined, in which environmental, personal, and stimulus characteristics impact the level of engagement. METHODS: : Participants were 193 residents of 7 Maryland nursing with a diagnosis of dementia. Stimulus engagement was assessed via the Observational Measure of Engagement, measuring duration, attention, and attitude to the stimulus. Twenty-five stimuli were presented, which were categorized as live human social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. RESULTS: All stimuli elicited significantly greater engagement in comparison to the control stimulus. In the multivariate model, music significantly increased engagement duration, whereas all other stimuli significantly increased duration, attention, and attitude. Significant environmental variables in the multivariate model that increased engagement were: use of the long introduction with modeling (relative to minimal introduction), any level of sound (especially moderate sound), and the presence of between 2 and 24 people in the room. Significant personal attributes included Mini-Mental State Examination scores, activities of daily living performance and clarity of speech, which were positively associated with higher engagement scores. CONCLUSIONS: Results are consistent with the Comprehensive Process Model of Engagement. Personal attributes, environmental factors, and stimulus characteristics all contribute to the level and nature of engagement, with a secondary finding being that exposure to any stimulus elicits engagement in persons with dementia