Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study.

BACKGROUND: Digital health and telemedicine are potentially important strategies to decrease health care's environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. OBJECTIVE: This study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants. METHODS: We conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States. RESULTS: The median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. CONCLUSIONS: These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector's carbon footprint.

Analysis on influencing factors of carbon emissions from China's pulp and paper industry and carbon peaking prediction.

China's pulp and paper industry (CPPI) has been always the main carbon emission source in recent years. However, the analysis on influencing factors of carbon emissions from this industry is insufficient. To address the issue, the CO2 emissions from CPPI are estimated in the period of 2005-2019, the driving factors of CO2 emissions are investigated by the logarithmic mean Divisia index (LMDI) method, the decoupling state of economic growth and CO2 emissions is determined by Tapio decoupling model, and finally, future CO2 emissions are predicted under four scenarios by the STIRPAT model to explore the potential of carbon peaking. The results show that CPPI exhibits a rapid increase and a fluctuating downward trend in CO2 emissions during the period of 2005-2013 and 2014-2019, respectively. The main promoting and inhibiting factors to the increase of CO2 emission are per capita industrial output value and energy intensity, respectively. There are five decoupling states of CO2 emissions and economic growth during the study period, and the CO2 emissions exhibit a weak decoupling state with the industrial output value growth in most years of the study period. It is very difficult to realize the carbon peaking goal by 2030 under the baseline and fast development scenarios. Therefore, efficient low carbon and strong low-carbon development policies are necessary and urgent for the realization of carbon peaking goal and the sustainable development of CPPI.

In the era of globalization, can renewable energy and eco-innovation be viable for environmental sustainability in BRICS economies?

Although energy is a necessary component of production and hence a contaminant, the environmental effect varies depending on the type of energy used. Renewable sources of energy can provide ecological advantages, particularly when contrasted with fossil fuels, which emit high levels of CO2 emissions. Thus, the research explores the impact of eco-innovation (ECO), green energy (REC), and globalization (GLOB) on the ecological footprint (ECF) in the BRICS nations using the panel nonlinear autoregressive distributed lag (PNARDL) technique between 1990 and 2018. The empirical results indicate that there is cointegration in the model. The results from the PNARDL show that a positive shift in renewable energy, eco-innovation, and globalization decreases the ecological footprint, while positive (negative) shifts in non-renewable energy and economic growth intensify the ecological footprint. The paper suggests several policy recommendations based on these results.

Does the frequency of stochastic convergence in per capita ecological footprint matter?

Among the environmental economics research issues, the issue of convergence has received quite a lot of attention, which is also known as stationary analysis. In this research strand, whether shocks to the time series variable are permanent or temporary is tested via the unit root tests. In this study, based on the theory and empirical works of stochastic convergence, we evaluate the convergence for the BASIC member countries, including Brazil, South Africa, India, and China. We use a variety of methodologies to see whether the convergence of ecological footprint holds for these countries or not. We first use the wavelet decomposition technique to decompose the series into the short run, middle run, and long run, and then we run several unit root tests to confirm the stationarity property of the series. The methodologies implemented in this study allow us to apply econometric tests to the original series as well as to the decomposed series. The results of panel CIPS test demonstrate that the null hypothesis of unit root could be rejected for the short run but not for the middle and long run, implying that long-lasting impact might prevail due to any shocks to the ecological footprint in the middle and long run. The results for individual countries varied.

Study on temporal and spatial differentiation of biocapacity in Shenyang from a multi-scale perspective.

Biocapacity of a region exhibits spatial differences owing to the limitations of regional scale and natural conditions. Based on the multi-scale perspective, we comprehensively studied and analyzed the temporal and spatial differences of the biocapacity of a region in an attempt to establish the groundwork for optimizing urban development and its utilization framework. By adopting the ecological footprint model along with multi-scale difference evaluation method, the municipal and county scales are incorporated into a unified analysis framework in this paper, thereby facilitating the exploration of the temporal and spatial differences in the biocapacity of Shenyang-a city in China-from 2005 to 2019. The results demonstrated that: 1) At the municipal scale, the biocapacity per capita fluctuated between 1.35 hm2/person and 2.22 hm2/person. It revealed an "up-down-up" trend, which appeared consistent with the Kuznets cycle; at the county scale, the biocapacity depicted spatial differences, while those of downtown and surrounding districts/counties developed a two-level ascending hierarchical structure. 2) The time series of footprint size and depth first ascended and then declined, and can be classified into four types: closed type, inverted U-type, S-type, and M-type. Among them, S-type and M-type have the phenomenon of over-utilizing the stock capital. 3) For a long time, the regional difference of biocapacity has mostly dwelt on two scales with an evident scale effect, and the biocapacity of Liaozhong District was the worst.

Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area.

INTRODUCTION: Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations. MATERIALS AND METHODS: Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions-total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation. RESULTS: Eighty patients were included. Face-to-face consultations would have resulted in 6699km (4162 miles) of travel (83.7km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1kg CO2e while face-to-face consultation emitted 0.5kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112h (1.4h/patient). CONCLUSIONS: Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener. LEVEL OF EVIDENCE: 3.

Health care's response to climate change: a carbon footprint assessment of the NHS in England.

BACKGROUND: Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world. METHODS: A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type. FINDINGS: In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS. INTERPRETATION: This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions. FUNDING: Wellcome Trust.

Environmentally sustainable dermatology.

In 2017, health and social care organizations contributed 6.3% of carbon emissions in England. Efforts to reduce the environmental footprint of the National Health Service (NHS) have been broadly focused on reducing demand, through prevention and patient empowerment, and modifying supply side factors by focusing on lean care systems and low carbon alternatives. This narrative review concentrates on supply side factors to identify sustainable practices with a focus on actions that could be implemented in dermatology departments. For this study, a literature review was conducted In MEDLINE in April 2020. The search terms included 'environmental sustainability' and 'climate change' with 'dermatology', 'telemedicine', 'NHS', 'surgery' and 'operating theatres'. Out of 95 results, 20 were deemed relevant to the review. Although the review showed that there is clearly growing interest in environmental sustainability, the identified literature lacked examples of comprehensive implementation and evaluation of initiatives. The literature discussed distinct areas including transport, waste management and procurement as part of a lean healthcare system. A number of papers highlighted the potential contribution of carbon-reducing actions without citing verifiable outcome data. This narrative review highlights the need for detailed environmental impact assessments of treatment options in dermatology, in tandem with economic analysis. In conclusion, we have identified a clear need for evidence-based guidance setting out implementable actions with identifiable benefits achievable within local clinical teams. This will require engagement between clinicians, patients and healthcare organizations.

Dynamic evolution analysis of the factors driving the growth of energy-related CO2 emissions in China: An input-output analysis.

In recent years, the global greenhouse effect caused by excessive energy-related carbon emissions has attracted more and more attention. In this paper, we studied the dynamic evolution of factors driving China's energy-related CO2 emissions growth from 2007 to 2015 by using energy consumption method and input-output analysis and used the IO-SDA model to decompose the energy carbon emissions. Within the research interval, the results showed that (1) on the energy supply-side, the high carbon energy represented by raw coal was still the main factor to promote the growth of energy-related CO2 emissions. However, the optimization of energy consumption structure is conducive to reducing emissions. Specifically, the high carbon energy represented by raw coal exhibited a downward trend in promoting the increment of energy-related CO2 emissions, while the clean energy represented by natural gas showed an upward trend in promoting the increment of CO2 emissions. It is worth noting that there is still a lot of room for optimization of China's energy consumption structure to reduce emissions. (2) On the energy demand-side, the final demand effect is the main driving force of the growth of carbon emissions from fossil energy. Among them, the secondary industry plays a major role in the final demand effect. The "high carbonization" of the final product reflects the characteristics of China's high energy input in the process of industrialization. At the same time, since the carbon emission efficiency of the tertiary industry and the primary industry is better than that of the secondary industry, actively optimizing the industrial structure is conducive to slowing down the growth of carbon emission brought by the demand effect. (3) The input structure effect is the main restraining factor for the growth of energy carbon emissions, while the energy intensity effect has a slight driving effect on the growth of energy carbon emissions. The results show that China's "extensive" economic growth model has been effectively reversed, but the optimization of fossil energy utilization efficiency is still not obvious, and there is still a large space to curb carbon emissions by improving fossil energy utilization efficiency in the future.

Impact of a Scalable, Multi-Campus "Foodprint" Seminar on College Students' Dietary Intake and Dietary Carbon Footprint.

BACKGROUND: Dietary patterns affect both human health and environmental sustainability. Prior research found a ten-unit course on food systems and environmental sustainability shifted dietary intake and reduced dietary carbon footprint among college students. This research evaluated the impact of a similar, more scalable one-unit Foodprint seminar taught at multiple universities. METHODS: We used a quasi-experimental pre-post nonequivalent comparison group design (n = 176). As part of the Menus of Change University Research Collaborative, research was conducted at three university campuses in California over four academic terms. All campuses used the same curriculum, which incorporates academic readings, group discussions, and skills-based exercises to evaluate the environmental footprint of different foods. The comparison group comprised students taking unrelated one-unit courses at the same universities. A questionnaire was administered at the beginning and end of each term. RESULTS: Students who took the Foodprint seminar significantly improved their reported vegetable intake by 4.7 weekly servings relative to the comparison group. They also reported significantly decreasing intake of ruminant meat and sugar-sweetened beverages. As a result of dietary shifts, Foodprint seminar students were estimated to have significantly decreased their dietary carbon footprint by 14%. CONCLUSIONS: A scalable, one-unit Foodprint seminar may simultaneously promote environmental sustainability and human health.

Quantifying national responsibility for climate breakdown: an equality-based attribution approach for carbon dioxide emissions in excess of the planetary boundary.

BACKGROUND: This analysis proposes a novel method for quantifying national responsibility for damages related to climate change by looking at national contributions to cumulative CO2 emissions in excess of the planetary boundary of 350 ppm atmospheric CO2 concentration. This approach is rooted in the principle of equal per capita access to atmospheric commons. METHODS: For this analysis, national fair shares of a safe global carbon budget consistent with the planetary boundary of 350 ppm were derived. These fair shares were then subtracted from countries' actual historical emissions (territorial emissions from 1850 to 1969, and consumption-based emissions from 1970 to 2015) to determine the extent to which each country has overshot or undershot its fair share. Through this approach, each country's share of responsibility for global emissions in excess of the planetary boundary was calculated. FINDINGS: As of 2015, the USA was responsible for 40% of excess global CO2 emissions. The European Union (EU-28) was responsible for 29%. The G8 nations (the USA, EU-28, Russia, Japan, and Canada) were together responsible for 85%. Countries classified by the UN Framework Convention on Climate Change as Annex I nations (ie, most industrialised countries) were responsible for 90% of excess emissions. The Global North was responsible for 92%. By contrast, most countries in the Global South were within their boundary fair shares, including India and China (although China will overshoot soon). INTERPRETATION: These figures indicate that high-income countries have a greater degree of responsibility for climate damages than previous methods have implied. These results offer a just framework for attributing national responsibility for excess emissions, and a guide for determining national liability for damages related to climate change, consistent with the principles of planetary boundaries and equal access to atmospheric commons. FUNDING: None.