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

SURFED -- an Interactive Editor for Free-Form Surfaces

An editor is described for creating and modifying free-form surfaces. A modular system was developed in order to provide the researchers with a facility for communicating design ideas and new mathematical forms through an interactive graphical interface to a computer based model. To achieve this it was necessary to invent a new graphical construct called a `spider'for inputing three-dimensional parameters. This experimental system has the essential features of a large-scale implementation, with the capability of utilizing many new surface forms that have not yet been tried in actual application

Impacts of meso-scale watershed development in Andhra Pradesh (India) and their implications for designing and implementing improved WSD policies and programs

Watershed Development (WSD) programs in rainfed dryland agriculture in India have been introduced in an effort to promote more sustainable management of the surface and groundwater resources, and to improve the livelihoods of farmers. This paper outlines the planned research for a project exploring the impacts of WSD at the meso-scale (~100 km2). The aim of the project is to develop and apply integrated models to assess cost effectiveness and water-related equity outcomes of stakeholder defined WSD scenarios; and to integrate and apply, in collaboration with project partners, the knowledge arising from the project at local, state and national policy levels

Integrated assessment of meso-level watershed development: progress of an integrated evaluation project in Andhra Pradesh

In Sarala, C. (Ed.). Proceedings of the 3rd International Conference on Hydrology and Watershed Management (ICHWAM-2010), with a focal theme on climate change - water, food and environmental security, 3-6 February 2010. Vol.2. Hyderabad, India: Jawaharlal Nehru Technological University, Institute of Science and Technology, Centre for Water ResourcesThe issue of scale has become paramount for the effective evaluation of WSD programs. Shile terms vary from state to state, the following definitions have been adopted for this study and are deemed appropriate for Andhra Pradesh. Micro scale - less than 1500 hectares; Meso scale 1500 - 10000 hectares; Macro level over 10000 hectares (including basin level investigations). There is a need for a meso-scale benefit and cost evaluation of the WSD programs so that unintended impacts are avoided and that the implementation of programs is improved. Operating at a meso-scale will also provide more effective opportunities to link and address micro and macro scale biophysical and institutional issues. This project will integrate environmental, economic, social, equity and dimensions at meso levels to help ensure that WSD contributes positively to the Indian government's sustainable livelihoods goal and provide the foundations for a resilient and sustainable WSD. Success will not only be determined by spatial scale (e.g. micro versus meso) but will also be determined by the disciplinary scale of analysis (e.g. focusing on short term economic efficiency alone runs considerable risk of ignoring longer term trends in natural and social capital). This paper describes early progress on developing such an evaluation model

Do diagnostic segmental nerve root blocks in chronic low back pain patients with radiation to the leg lack distinct sensory effects? A preliminary study.

Contains fulltext : 50873.pdf (publisher's version ) (Closed access)BACKGROUND: The present preliminary study documents the effects of a selective nerve root block (SNB) with short or long acting local anaesthetic compared with baseline measurements in patients with chronic low back pain radiating to the leg with maximum pain in one dermatome (L4). METHODS: Ten consecutive patients underwent 20 controlled SNBs at L4 with ropivacaine 0.25% and lidocaine 1% in a prospective, randomized, double blind, crossover fashion. Baseline measurements included sensory function (assessed by pinprick on both unaffected and painful leg) and pain (Verbal Numeric Rating Scale; VNRS, 0-10). A change in size of areas with altered sensory function >10% and a VNRS change of 2 points were considered clinically significant. P-values<0.05 were considered statistically significant. RESULTS: Asymptomatic hypoaesthesia, variable in extent and non-dermatomal in distribution, was present in seven patients at baseline. It appeared to be more extensive and distal with longer duration of pre-existing pain. SNB produced no consistent changes in extent and distribution of hypoaesthetic areas. Change in VNRS did not correlate with the extent of pre-block or post-block hypoaesthesia. No differences in effects were found between lidocaine and ropivacaine. CONCLUSIONS: Pre-block assessment of sensory function is essential to assess the net effect of SNBs. In this small study group, SNBs failed to demonstrate uniform or distinct effects on sensory function