Carbon savings potential of virtual care in obstructive sleep apnea and otitis media with effusion.

Objective: To determine the carbon savings potential of incorporating virtual care into surgical care pathways for pediatric patients with obstructive sleep apnea or otitis media with effusion. Methods: Pediatric patients with obstructive sleep apnea or otitis media with effusion were not enrolled, instead, a modeling cohort study design was used. This study utilized the British Columbia healthcare system and geography to model emissions. Care pathways were developed for pediatric patients with obstructive sleep apnea or otitis media with effusion requiring care at a tertiary pediatric center. Home addresses were located at the geographical center of the two most populated municipalities within each of the 10 most populated regional districts in 2020. Virtual visits replaced up to three clinically equivalent in-person visits. Emissions (kgCO2e) for transport and virtual visits were estimated. Population-weighted means and descriptive statistics were calculated. Results: Utilizing 1, 2, or 3 virtual visits in the obstructive sleep apnea care pathway yielded potential emissions savings of 19.9%, 39.9%, and 59.8% respectively. Integrating 1, 2, or 3 virtual visits into the otitis media with effusion care pathway produced potential emissions savings of 16.6%, 33.2%, and 49.7%, respectively. Integrating 3 virtual visits can save up to 2156.8 kgCO2e per patient. Conclusions: Appropriately conducting up to 50% of clinical encounters virtually for children with obstructive sleep apnea or otitis media with effusion reduced theoretical carbon emissions. For a single child, emission savings could reach over 2150 kgCO2e. Level of Evidence: Level 5.

Climate change and human health: Last call to arms for us.

Climate change, now the foremost global health hazard, poses multifaceted challenges to human health. This editorial elucidates the extensive impact of climate change on health, emphasising the increasing burden of diseases and the exacerbation of health disparities. It highlights the critical role of the healthcare sector, particularly anaesthesia, in both contributing to and mitigating climate change. It is a call to action for the medical community to recognise and respond to the health challenges posed by climate change.

Applied insight: studying reducing the carbon footprint of the drying process and its environmental impact and financial return.

Harnessing solar energy is one of the most important practical insights highlighted to mitigate the severe climate change (CC) phenomenon. Therefore, this study aims to focus on the use of hybrid solar dryers (HSDs) within an environmentally friendly framework, which is one of the promising applications of solar thermal technology to replace traditional thermal technology that contributes to increasing the severity of the CC phenomenon. The HSD, based on a traditional electrical energy source (HSTEE) and electrical energy from photovoltaic panels (HSPVSE), was evaluated compared to a traditional electrical (TE) dryer for drying some medicinal and aromatic plants (MAPs). This is done by evaluating some of the drying outputs, energy consumed, carbon footprint, and financial return at 30, 40, and 50°C. The best quality of dried MAP samples in terms of essential oil (EO, %) and microbial load was achieved at 40°C. The HSTEE dryer has reduced energy consumption compared to the TE dryer by a percentage ranging from 37% to 54%. The highest CO2 mitigated ratio using the HSTEE dryer was recorded in thyme, marjoram, and lemongrass samples, with values ranging from 45% to 54% at 30, 40, and 50°C. The highest financial return obtained from energy consumption reduction and carbon credit footprint was achieved at 50°C, with values ranging from 5,313.69 to 6,763.03 EGP/year (EGP ≈ 0.0352 USD) when coal was used as a fuel source for the generation of electricity. Moreover, the HSPVSE dryer achieved a 100% reduction in traditional energy consumption and then reduced CO2 emissions by 100%, which led to a 100% financial return from both energy reduction and carbon credit. The highest financial returns were observed at 50°C, with values ranging from 13,872.56 to 15,007.02, 12,927.28 to 13,984.43, and 11,981.99 to 12,961.85 EGP/year (EGP ≈ 0.0352 USD) for coal, oil, and natural gas, respectively. The HS dryers show potential for environmental conservation contribution; furthermore, earning money from energy savings and carbon credit could help improve the living standards and maximize benefits for stakeholders.

Handling 'carbon footprint' in orthopaedics.

INTRODUCTION: The National Health Service contributes 4%-5% of England and Wales' greenhouse gases and a quarter of all public sector waste. Between 20% and 33% of healthcare waste originates from a hospital's operating room, and up to 90% of waste is sent for costly and unneeded hazardous waste processing. The goal of this study was to quantify the amount and type of waste produced during a selection of common trauma and elective orthopaedic operations, and to calculate the carbon footprint of processing the waste. METHODS: Waste generated for both elective and trauma procedures was separated primarily into clean and contaminated, paper or plastic, and then weighed. The annual carbon footprint for each operation at each site was subsequently calculated. RESULTS: Elective procedures can generate up to 16.5kg of plastic waste per procedure. Practices such as double-draping the patient contribute to increasing the quantity of waste. Over the procedures analysed, the mean total plastic waste at the hospital sites varied from 6 to 12kg. One hospital site undertook a pilot of switching disposable gowns for reusable ones with a subsequent reduction of 66% in the carbon footprint and a cost saving of £13,483.89. CONCLUSIONS: This study sheds new light on the environmental impact of waste produced during trauma and elective orthopaedic procedures. Mitigating the environmental impact of the operating room requires a collective drive for a culture change to sustainability and social responsibility. Each clinician can have an impact upon the carbon footprint of their operating theatre.

Carbon reduction and water saving potentials for growing corrugated boxes for express delivery services in China.

Corrugated packaging for express grew by 90 times to 16.5 Mt y-1 in China, where 81% of recent global express delivery growth occurred. However, the environmental impacts of production, usage, disposal, and recycling of corrugated boxes under the entire supply chain remain unclear. Here, we estimate the magnitudes, drivers, and mitigation potentials of cradle-to-grave life-cycle carbon footprint (CF) and three colors of water footprints (WFs) for corrugated cardboard packaging in China. Over 2007 to 2021, CF, blue and gray WFs per unit package decreased by 45%, 60%, and 84%, respectively, while green WF increased by 23% with growing imports of virgin pulp and China's waste ban. National total CF and WFs were 21 to 102 folded with the scale effects. Only a combination of the supply chain reconstruction, lighter single-piece packaging, and increased recycling rate can possibly reduce the environmental footprints by 24 to 44% by 2035.

Building nutritionally meaningful classification for grocery product groups: the LoCard Food Classification process.

Analysing customer loyalty card data is a novel method for assessing nutritional quality and changes in a population's food consumption. However, prior to its use, the thousands of grocery products available in stores must be reclassified from the retailer's original hierarchical structure into a structure that is suitable for the use of nutrition and health research. We created LoCard Food Classification (LCFC) and examined how it reflects the nutritional quality of the grocery product groups. Nutritional quality was considered the main criterion guiding the reclassification of the 3574 grocery product groups. Information on the main ingredient of the product group, purpose of use, and carbon footprint were also used at the more granular levels of LCFC. The main challenge in the reclassification was a lack of detailed information on the type of products included in each group, and that some of the groups included products that have opposite health effects. The final LCFC has four hierarchical levels and it is openly available online. After reclassification, the product groups were linked with the Finnish food composition database, and the nutrient profile was assessed by calculating the Nutrient Rich Food Index (NRFI) for each product group. Standard deviation in NRFI decreased from 0.21 of the least granular level to 0.08 of the most granular level of LCFC indicating that the most granular level of LCFC has more homogeneous nutritional quality. Studies that apply LCFC to examine loyalty card data with health and environmental outcomes are needed to further demonstrate its validity.

Methodological guide for assessing the carbon footprint of external beam radiotherapy: A single-center study with quantified mitigation strategies.

Background and purposes: Data on the carbon footprint of external beam radiotherapy (EBRT) are scarce. Reliable and exhaustive data, including a detailed carbon inventory, are needed to determine effective mitigation strategies. Materials and methods: This study proposes a methodology for calculating the carbon footprint of EBRT and applies it to a single center. Mitigation strategies are derived from the carbon inventory, and their potential reductions are quantified whenever possible. Results: The average emission per treatment and fraction delivered was 489 kg CO2eq and 27 kg CO2eq, respectively. Patient transportation (43 %) and the construction and maintenance of linear accelerators (LINACs) and scanners (17 %) represented the most significant components. Electricity, the only energy source used, accounted for only 2 % of emissions.Derived mitigation strategies include a data deletion policy (reducing emissions in 30 years by 12.5 %), geographical appropriateness (-12.2 %), transportation mode appropriateness (-9.3 %), hypofractionation (-5.9 %), decrease in manufacturers' carbon footprint (-5.2 %), and an increase in machine durability (-3.5 %). Conclusion: Our findings indicate that a significant reduction in the carbon footprint of a radiotherapy unit can be achieved without compromising the quality of care.This study provides a methodology and a starting point for comparison and proposes and quantifies mitigation strategies, paving the way for others to follow.

Assessing the feasibility and sustainability of a surfactin production process: a techno-economic and environmental analysis.

Biosurfactants have been profiled as a sustainable replacement for chemical-based surfactants since these bio-based molecules have higher biodegradability. Few research papers have focused on assessing biosurfactant production to elucidate potential bottlenecks. This research aims to assess the techno-economic and environmental performance of surfactin production in a potential scale of 65m3, considering different product yields and involving the European energy crisis of 2021-2022. The conceptual design, simulation, techno-economic, and environmental assessments were done by applying process engineering concepts and software tools such as Aspen Plus v.9.0 and SimaPro v.8.3.3. The results demonstrated the high economic potential of surfactin production since the higher values in the market offset the low fermentation yields, low recovery efficiency, and high capital investment. The sensitivity analysis of the economic assessment elucidated a minimum surfactin selling price between 29 and 31 USD/kg of surfactin, while a minimum processing scale for economic feasibility between 4 and 5 kg/h is needed to reach an equilibrium point. The environmental performance must be improved since the carbon footprint was 43 kg CO2eq/kg of surfactin. The downstream processing and energy demand are the main bottlenecks since these aspects contribute to 63 and 25% of the total emissions. The fermentation process and downstream process are key factors for future optimization and research.

Carbon Neutral Hand Surgery: Simple Changes to Reduce Carbon Footprint.

Introduction: Rapid climate change poses a major challenge to healthcare. The operating room is especially responsible for carbon emission, with 20% to 70% of hospital waste traced back to the operating room. This literature review aims to suggest changes that can be made in hand surgery for a more sustainable practice. Methods: A literature search was conducted from PubMed, Medline, and other online search engines with the keywords "carbon footprint, environmental health, carbon neutral, plastic surgery, hand surgery, surgery." Results: "Reduce, Reuse, Recycle, Research, Rethink and Culture" was the framework used to recommend a more carbon neutral practice. In reduction, techniques such as cutting down oversupply of materials, adopting protocols to perform cases in ambulatory settings, and simple measures to reduce energy were identified as valuable methods. Modified sterilization techniques and reprocessing single-use devices were techniques identified for reuse and recycling involved single-stream recycling, staff training, and donation of basic surgical supplies. Research involved adopting data-driven programs for life cycle assessment of all equipment in the operating room, while the use of telemedicine and "green meetings' were suggested for rethinking. Finally, strategies to encourage a team approach to environmental responsibility were discussed. Conclusion: Carbon neutral practice must be implemented to safeguard sustainable and cost-effective operating rooms and healthcare systems. Hand surgery can pave the way for other specialties through the use of available resources to develop guidelines for carbon neutral practice. This requires active effort from hand surgeons to act as role models for other healthcare professionals.

Introduction : Les changements climatiques rapides constituent un défi majeur pour les soins de santé. La salle d'opération est particulièrement responsable de l'émission de carbone avec 20% à 70% des déchets hospitaliers rapportés aux salles d'opération. Cette revue de la littérature vise à suggérer les changements qui peuvent être apportés dans la chirurgie de la main pour une pratique plus durable. Méthodes : Une recherche bibliographique a été menée dans les bases de données PubMed, Medline et autres moteurs de recherche en ligne avec les mots-clés suivants : empreinte carbone, santé environnementale, carbone neutre, chirurgie plastique, chirurgie de la main et chirurgie. Résultats : « Réduire, Réutiliser, Recycler, Rechercher, Repenser et Culture ¼ a été le cadre utiliser pour recommander une pratique plus neutre en matière de carbone. Sous « réduction ¼, des techniques telles que des coupures dans l'excès d'approvisionnement en matériaux, l'adoption de protocoles permettant de traiter des cas en ambulatoire et des mesures simples pour réduire la consommation d'énergie sont des méthodes qui ont été jugées utiles. Des techniques de stérilisation modifiées et de retraitement de dispositifs à usage unique sont des techniques identifiées pour la réutilisation; le recyclage a impliqué une collecte en vrac, la formation du personnel et le don de fournitures chirurgicales de base. La recherche a nécessité d'adopter des programmes pilotés sur des données pour l'évaluation du cycle de vie de tout équipement de la salle de l'opération pendant que le recours à la télémédecine et aux réunions respectueuses de l'environnement était suggéré pour le thème « repenser ¼. Enfin, des stratégies visant à encourager une approche d'équipe envers la responsabilité environnementale ont été discutées. Conclusion : Une pratique carbone neutre doit être mise en œuvre pour protéger les salles d'opération durables et rentables ainsi que les systèmes de soins de santé. La chirurgie de la main peut ouvrir la voie à d'autres spécialités par l'utilisation des ressources disponibles afin d'élaborer des lignes directrices pour l'empreinte carbone de la pratique. Cela nécessite un effort de la part des chirurgiens de la main pour devenir des exemples pour les autres professionnels de santé.

Effect of a non-reactive absorbent with or without environmentally oriented electronic feedback on anesthesia provider's fresh gas flow rates: A greening initiative.

STUDY OBJECTIVE: To examine the effects of a non-reactive carbon dioxide absorbent (AMSORB® Plus) versus a traditional carbon dioxide absorbent (Medisorb™) on the FGF used by anesthesia providers and an electronic educational feedback intervention using Carestation™ Insights (GE HealthCare) on provider-specific change in FGF. DESIGN: Prospective, single-center cohort study set in a greening initiative. SETTING: Operating room. PARTICIPANTS: 157 anesthesia providers (i.e., anesthesiology trainees, certified registered nurse anesthetists, and solo anesthesiologists). INTERVENTIONS: Intervention #1 was the introduction of AMSORB® Plus into 8 Aisys CS2, Carestation™ Insights-enabled anesthesia machines (GE HealthCare) at the study site. At the end of week 6, anesthesia providers were educated and given an environmentally oriented electronic feedback strategy for the next 12 weeks of the study (Intervention #2) using Carestation™ Insights data. MEASUREMENTS: The dual primary outcomes were the difference in average daily FGF during maintenance anesthesia between machines assigned to AMSORB® Plus versus Medisorb™ and the provider-specific change in average fresh gas flows after 12 weeks of feedback and education compared to the historical data. MAIN RESULTS: Over the 18-week period, there were 1577 inhaled anesthetics performed in the 8 operating rooms (528 for intervention 1, 1049 for intervention 2). There were 1001 provider days using Aisys CS2 machines and 7452 provider days of historical data from the preceding year. Overall, AMSORB® Plus was not associated with significantly less FGF (mean - 80 ml/min, 97.5% confidence interval - 206 to 46, P = .15). The environmentally oriented electronic feedback intervention was not associated with a significant decrease in provider-specific mean FGF (-112 ml/min, 97.5% confidence interval - 244 to 21, P = .059). CONCLUSIONS: This study showed that introducing a non-reactive absorbent did not significantly alter FGF. Using environmentally oriented electronic feedback relying on data analytics did not result in significantly reduced provider-specific FGF.

Adherence to the Mediterranean Food Pattern and Carbon Footprint of Food Intake by Employees of a University Setting in Portugal.

BACKGROUND: The Mediterranean diet is characterized by the predominance of the consumption of fruit, vegetables, cereals, nuts, and pulses; consumption of olive oil as the main source of fat; regular but moderate consumption of win; moderate consumption of fish, dairy products, eggs, and white meats; and low consumption of red meat as well as sugar and sugary products. In addition to the reported health benefits, the Mediterranean diet has also been widely recognized as a sustainable food pattern. The objective of this study was to understand the relationship between the degree of adherence to the Mediterranean diet of employees of the University of Porto and the relationship with the carbon footprint of their food consumption. METHODS: An observational, analytical study was carried out, through the analysis of food consumption data collected in the form of a survey in the previous 24 h inserted in the eAT24 software, as well as the analysis of sociodemographic, lifestyle, and health data collected in the questionnaire. The carbon footprint was calculated from the previous 24 h surveys using data available on a website, obtained in carbon dioxide equivalent per kilogram of food. Sociodemographic, eating habit, and lifestyle questions were selected to understand the relationship between these and adherence to the Mediterranean diet and the carbon footprint of food consumption. RESULTS: In total, 13.2% of the participants had a Mediterranean diet score equal to or greater than six, and the sample had an average food intake carbon footprint of 8146 ± 3081 CO2eq/Kg of food. A weak, statistically significant positive correlation (r = 0.142, p = 0.006) was observed between Mediterranean diet adherence and the carbon footprint of food intake. CONCLUSIONS: Most of the participants had a low adherence to the Mediterranean diet, as well as a high carbon footprint of food intake when compared to other countries. People with higher scores for Mediterranean diet adherence have, on average, a higher carbon footprint from food consumption intake.

Life cycle assessment of carbon footprint in dual-phase automotive strip steel production.

As the demand for automotive materials grows more stringent in environmental considerations, it becomes imperative to conduct thorough environmental impact assessments of dual-phase automotive strip steel (DP steel). However, the absence of detailed and comparable studies has left the carbon footprint of DP steel and its sources largely unknown. This study addresses this gap by establishing a cradle-to-gate life cycle model for DP steel, encompassing on-site production, energy systems, and upstream processes. The analysis identifies and scrutinizes key factors influencing the carbon footprint, with a focus on upstream mining, transportation, and on-site production processes. The results indicate that the carbon footprint of DP steel is 2.721 kgCO2-eq/kgDP, with on-site processes contributing significantly at 88.1%. Sensitivity analysis is employed to assess the impact of changes in resource structure, on-site energy, CO2 emission factors, and byproduct recovery on the carbon footprint. Proposals for mitigating carbon emissions in DP steel production include enhancing process gas recovery, transitioning to cleaner energy sources, and reducing the hot metal-to-steel ratio. These findings offer valuable insights for steering steel production towards environmentally sustainable practices.

A bibliometric analysis of the role of nanotechnology in dark fermentative biohydrogen production.

Recently, nanoparticles have drawn a lot of interest as catalysts to enhance the effectiveness and output of biohydrogen generation processes. This review article provides a comprehensive bibliometric analysis of the significance of nanotechnology in dark fermentative biohydrogen production. The study examines the scientific literature from the database of The Web of Science© while the bibliometric investigation utilized VOSviewer© and Bibliometrix software tools to conduct the analysis. The findings revealed that a total of 232 articles focused on studying dark fermentation for hydrogen production throughout the entire duration. The extracted data was used to analyze publication trends, authorship patterns, and geographic distribution along with types and effects of nanoparticles on the microbial community responsible for dark fermentative biohydrogen production. The findings of this bibliometric analysis provide valuable insights into the advancements and achievements in the utilization of nanoparticles in the dark fermentation process used to produce biohydrogen.

The role of the health sector in tackling climate change: A narrative review.

Climate change is one of the largest threats to population health and has already affected the ecosystem, food production, and health and wellbeing of populations all over the world. The healthcare sector is responsible for around 5 % of greenhouse gas emissions worldwide and can play a key role in reducing global warming. This narrative review summarized the information on the role of healthcare systems in addressing climate change and strategies for reducing its negative impact to illustrate different types of actions that can support the ecological transformation of healthcare systems to help reaching sustainable development goals. A wide range of green interventions are shown to be effective to reduce the carbon footprint of healthcare and can have a meaningful impact if implemented systematically. However, these would not suffice unless accompanied by systemic mitigation strategies altering how healthcare is provided and consumed. Sustainable healthcare strategies such as reducing waste and low-value care will have direct benefits for the environment while improving economic and health outcomes. The healthcare sector has a unique opportunity to leverage its position and resources to provide a comprehensive strategy for fighting climate change and improving population health and the environment on which it depends.

A techno-economic analysis of diesel exhaust injection into mine tailings for carbon sequestration.

The environmental impact of off-grid mines in remote, cold climates is significantly intensified by their dependence on fossil fuels for power and heating. A promising solution lies in the potential to capture and permanently store carbon within mine tailings, thus allowing the mining industry to take a leading role in carbon removal initiatives and provide sustainable solutions. This study explores energy-optimal design scenarios for flue gas injection into mine waste to capture carbon. The approach involves installing perforated pipes within dry stack tailings. The established reduced-order model in this research serves as a novel tool for decision-making, aiding in the selection of an appropriate perforation scheme for the injection pipes embedded in the tailings. A cost analysis is also performed to assess the financial viability of the proposed concept under different operating parameters. Operational expenses, particularly energy costs, are found to be influenced by the permeability of the tailings. In instances of lower permeabilities, larger injection pipes are required. The findings indicate that achieving viable operating costs for sequestering one tonne of carbon dioxide hinges on amenable pipe sizing and engineering. Additionally, the study estimates that maintaining a reasonable level (around 1%) between the power being decarbonized and the power required for the carbon sequestration operation is crucial.

Chronotype is associated with Mediterranean dietary adherence and environmental footprints.

This cross-sectional study was carried out to determine the relationship between nutrition according to chronotype and the Mediterranean diet and environmental footprints. "Morningness Eveningness Questionnaire" was used to determine the chronotype classification, and "Mediterranean Diet Adherence Screener" was used to evaluate adherence to the Mediterranean diet. In addition, the food consumption record of the participants was taken and the carbon and water footprints were calculated. A total of 472 adults with a mean age of 22.7 ± 5.0 years participated in the study. Accordingly, 61.0% of the participants were morning type, 15.7% were intermediate type, and 23.3% were evening type. Individuals with higher chronotype values (morning) tended to be more adherent to the Mediterranean diet and had lower environmental (carbon and water) footprints (p < 0.05). The results of this study; showed that diet according to chronotype affects adherence to the Mediterranean diet and environmental footprints.

Experimental Global Warming Potential-Weighted Specific Stiffness Comparison among Different Natural and Synthetic Fibers in a Composite Component Manufactured by Tailored Fiber Placement.

This work aims to evaluate experimentally different fibers and resins in a topologically optimized composite component. The selected ones are made of carbon, glass, basalt, flax, hemp, and jute fibers. Tailored Fiber Placement (TFP) was used to manufacture the textile preforms, which were infused with two different epoxy resins: a partly biogenic and a fully petro-based one. The main objective is to evaluate and compare the absolute and specific mechanical performance of synthetic and natural fibers within a component framework as a base for improving assessments of sustainable endless-fiber reinforced composite material. Furthermore, manufacturing aspects regarding the different fibers are also considered in this work. In assessing the efficiency of the fiber-matrix systems, both the specific stiffness and the specific stiffness relative to carbon dioxide equivalents (CO2eq.) as measures for the global warming potential (GWP) are taken into account for comparison. The primary findings indicate that basalt and flax fibers outperform carbon fibers notably in terms of specific stiffness weighted by CO2eq.. Additionally, the selection of epoxy resin significantly influences the assessment of sustainable fiber-plastic composites.

The effect of aeration mode (intermittent vs. continuous) on nutrient removal and greenhouse gas emissions in the wastewater treatment plant of Corleone (Italy).

The paper reports the results of an experimental study aimed at comparing two configurations of a full-scale wastewater treatment plant (WWTP): conventional activated sludge (CAS) and oxic-settling-anaerobic process (OSA) with intermittent aeration (IA). A comprehensive monitoring campaign was carried out to assess multiple parameters for comparing the two configurations: carbon and nutrient removal, greenhouse gas emissions, respirometric analysis, and sludge production. A holistic approach has been adopted in the study with the novelty of including the carbon footprint (CF) contribution (as direct, indirect and derivative emissions) in comparing the two configurations. Results showed that the OSA-IA configuration performed better in total chemical oxygen demand (TCOD) and ortho-phosphate (PO4-P) removal. CAS performed better for Total Suspended Solids (TSS) removal showing a worsening of settling properties for OSA-IA. The heterotrophic yield coefficient and maximum growth rate decreased, suggesting a shift to sludge reduction metabolism in the OSA-IA configuration. Autotrophic biomass showed a reduced yield coefficient and maximum growth yield due to the negative effects of the sludge holding tank in the OSA-IA configuration on nitrification. The OSA-IA configuration had higher indirect emissions (30.5 % vs 21.3 % in CAS) from additional energy consumption due to additional mixers and sludge recirculation pumps. The CF value was lower for OSA-IA than for CAS configuration (0.36 kgCO2/m3 vs 0.39 kgCO2/m3 in CAS).