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Strategies to Reduce Greenhouse Gas Emissions from Laparoscopic Surgery
Objectives. To determine the carbon footprint of various sustainability interventions used for laparoscopic hysterectomy.
Methods. We designed interventions for laparoscopic hysterectomy from approaches that sustainable health care organizations advocate. We used a hybrid environmental life cycle assessment framework to estimate greenhouse gas emissions from the proposed interventions. We conducted the study from September 2015 to December 2016 at the University of Pittsburgh (Pittsburgh, Pennsylvania).
Results. The largest carbon footprint savings came from selecting specific anesthetic gases and minimizing the materials used in surgery. Energy-related interventions resulted in a 10% reduction in carbon footprint per case but would result in larger savings for the whole facility. Commonly implemented approaches, such as recycling surgical waste, resulted in less than a 5% reduction in greenhouse gases.
Conclusions. To reduce the environmental emissions of surgeries, health care providers need to implement a combination of approaches, including minimizing materials, moving away from certain heat-trapping anesthetic gases, maximizing instrument reuse or single-use device reprocessing, and reducing off-hour energy use in the operating room. These strategies can reduce the carbon footprint of an average laparoscopic hysterectomy by up to 80%. Recycling alone does very little to reduce environmental footprint.
Public Health Implications. Health care services are a major source of environmental emissions and reducing their carbon footprint would improve environmental and human health. Facilities seeking to reduce environmental footprint should take a comprehensive systems approach to find safe and effective interventions and should identify and address policy barriers to implementing more sustainable practices.
Journal Article
SPRING CLEANING: RURAL WATER IMPACTS, VALUATION, AND PROPERTY RIGHTS INSTITUTIONS
Using a randomized evaluation in Kenya, we measure health impacts of spring protection, an investment that improves source water quality. We also estimate households' valuation of spring protection and simulate the welfare impacts of alternatives to the current system of common property rights in water, which limits incentives for private investment. Spring infrastructure investments reduce fecal contamination by 66%, but household water quality improves less, due to recontamination. Child diarrhea falls by one quarter. Travel-cost based revealed preference estimates of households' valuations are much smaller than both stated preference valuations and health planners' valuations, and are consistent with models in which the demand for health is highly income elastic. We estimate that private property norms would generate little additional investment while imposing large static costs due to above-marginal-cost pricing, private property would function better at higher income levels or under water scarcity, and alternative institutions could yield Pareto improvements.
Journal Article
Numbers of wildlife fatalities at renewable energy facilities in a targeted development region
Increased interest in renewable energy has fostered development of wind and solar energy facilities globally. However, energy development sometimes has negative environmental impacts, such as wildlife fatalities. Efforts by regional land managers to balance energy potential while minimizing fatality risk currently rely on datasets that are aggregated at continental, but not regional scales, that focus on single species, or that implement meta-analyses that inappropriately use inferential statistics. We compiled and summarized fatality data from 87 reports for solar and wind facilities in the Mojave and Sonoran Deserts region of southern California within the Desert Renewable Energy Conservation Plan area. Our goal was to evaluate potential temporal and guild-specific patterns in fatalities, especially for priority species of conservation concern. We also aimed to provide a perspective on approaches interpreting these types of data, given inherent limitations in how they were collected. Mourning doves (
Zenaida macroura
), Chukar (
Alectoris chukar
) and California Quail (
Callipepla californica
), and passerines (
Passeriformes
), accounted for the most commonly reported fatalities. However, our aggregated count data were derived from raw, uncorrected totals, and thus reflect an absolute minimum number of fatalities for the monitored period. Additionally, patterns in the raw data suggested that many species commonly documented as fatalities (e.g., waterbirds and other nocturnal migrants, bats) are rarely counted during typical pre-construction use surveys. This may explain the more commonly observed mismatch between pre-construction risk assessment and actual fatalities. Our work may serve to guide design of future scientific research to address temporal and spatial patterns in fatalities and to apply rigorous guild-specific survey methodologies to estimate populations at risk from renewable energy development.
Journal Article
Effect of the spatial form of outpatient buildings on energy consumption in different climate zones in China
Under the influence of global epidemics and the need for urban expansion, many outpatient buildings have been rapidly constructed, but the problem of high energy consumption has been neglected. There is a lack of research on the impact of outpatient building forms on energy consumption in different climate zones. Many studies have demonstrated that the energy consumption of a given building can be greatly reduced by adopting a reasonable spatial form design at the early stages of design. Therefore, if architects choose a reasonable spatial form, this could effectively reduce energy consumption. In this study, outpatient building cases in China were summarized, and three typical spatial forms were proposed: the centralized, corridor, and courtyard forms. The DesignBuilder tool was used to simulate and analyse the typical building energy consumption in different climate zones. The results showed that the corridor form (southwards) should be chosen in the severe cold zone, the centralized form (southwards) should be chosen in the cold zone and the hot summer and cold winter zone, the centralized form (northwards) should be chosen in the hot summer and warm winter zone, and the centralized or corridor form can be chosen in the warm zone. The results of this study could provide a reference for energy-efficient design of outpatient buildings in China and other regions with similar conditions and could help architects quickly select reasonable spatial forms at the early stages of design.
Journal Article
Livelihood vulnerability and climate change: a comparative analysis of smallholders in the Indo-Gangetic plains
In the Indo-Gangetic Plains, one of India's most productive agricultural regions, smallholder livelihood vulnerability can inhibit sustainable development. As there are significant differences in economic development, natural resources and agricultural productivity within the region, we estimate the Livelihood Vulnerability Index in two districts (Vaishali, Bihar and Karnal, Haryana) to determine suitable adaptation strategies under diverse conditions. To reflect different aspects of climate exposure, we include both self-reported climate shocks and spatially interpolated weather data. The assessment of 1127 households shows that while both districts have similar exposure and adaptive capacity levels, the sensitivity dimension makes Vaishali more vulnerable to climate change. To reduce sensitivity, decision-makers should focus on improving infrastructure (e.g., permanent housing, latrines, health centers, alternative energy sources). To improve adaptive capacity and reduce climate risk in both regions, policymakers should promote the expansion of extension training for livelihood diversification, information and communication technologies as well as conservation agriculture.
Journal Article
Green Buildings and Health
Green building design is becoming broadly adopted, with one green building standard reporting over 3.5 billion square feet certified to date. By definition, green buildings focus on minimizing impacts to the environment through reductions in energy usage, water usage, and minimizing environmental disturbances from the building site. Also by definition, but perhaps less widely recognized, green buildings aim to improve human health through design of healthy indoor environments. The benefits related to reduced energy and water consumption are well-documented, but the potential human health benefits of green buildings are only recently being investigated. The objective of our review was to examine the state of evidence on green building design as it specifically relates to indoor environmental quality and human health. Overall, the initial scientific evidence indicates better indoor environmental quality in green buildings versus non-green buildings, with direct benefits to human health for occupants of those buildings. A limitation of much of the research to date is the reliance on indirect, lagging and subjective measures of health. To address this, we propose a framework for identifying direct, objective and leading “Health Performance Indicators” for use in future studies of buildings and health.
Journal Article
Bat mortality in wind farms of southern Europe: temporal patterns and implications in the current context of climate change
The expansion of renewable energy production, especially wind power, is one of the cornerstones of our strategy for mitigating climate change. However, there is growing concern about the impacts of this energy source on biodiversity. In particular, very little is known about the impact on groups of fauna such as bats, which are especially sensitive to environmental changes. We investigated the temporal patterns of bat fatalities in wind farms in the province of Cádiz, in the south of the Iberian Peninsula. An eleven-year data set (2009–2019) from a surveillance program of bird and bat mortality in wind farms was analysed. A total of 2,858 fatalities concerning 10 bat genera were reported, although more than 90% of the affected animals were individuals of the genera Pipistrellus, Eptesicus and Nyctalus. Bat mortality occurred mainly during the summer and autumn, especially in August. However, species such as the genus Pipistrellus, present collisions throughout the year, including all winter months in the case of the genus Pipistrellus. The probability of mortality was positively correlated with the maximum daily temperature. According to the model prediction, the probability of fatality begins to increase slightly from 20 °C and then rises sharply when the temperature exceeds 30 °C, that can be interpreted as a consequence of increasing bat activity at local scale. According to the regional projections of global climate models, an increase in maximum temperatures and the arrival of milder winters may lead to an increase in the annual mortality of bats in wind farms in the coming decades.
Journal Article
Energy Consumption Trends and Determinants in Polish Hospitals: Implications for Energy Efficiency Strategies
In the construction sector, hospitals are the buildings with the highest energy consumption. Due to the high demand for energy, hospitals’ energy efficiency is becoming very important. This study aims to examine the trends and factors that determine energy consumption in Polish hospitals from 2010 to 2019, highlighting the impact of hospital size and medical activities on energy efficiency. The analysis was carried out using data from 3061 hospital reports obtained from the e-Health Center, a state budgetary unit established by the Minister of Health. To measure and compare the efficiency of energy usage in hospitals, we developed eight energy usage efficiency indexes based on hospital size and medical activity. The size of the hospitals was described by the number of beds, operation rooms, doctors, nurses, and fixed assets value. Hospital activity was measured by the number of person-days, patients, and operations. Statistical analysis was carried out using StatSoft Statistica software version 13.3. The results show that larger hospitals are more energy efficient across various measures of energy use than smaller hospitals. The findings revealed also several important relationships between energy usage and factors connected with size and hospital activity, such as the number of beds, patients and person-days, medical staff, operations, and fixed asset values, underscoring the necessity for customizing energy efficiency strategies. This research contributes empirical insights that can guide policymakers and hospital administrators in their endeavors to improve energy efficiency and promote sustainability within healthcare facilities.
Journal Article
Ways To Build a Greener Healthcare System; Comment on \A Review of the Applicability of Current Green Practices in Healthcare Facilities\
Green practices have become the responsibility of healthcare system in the current warming planet. The article by Soares and colleagues reviews the literature on circular economy implementation in the European Union and its application in healthcare system. In this commentary, we complement the findings by discussing ways to build a greener healthcare system and introducing life cycle assessment (LCA), a method to quantify the environmental impacts of products and services in healthcare. LCA is useful to compare the environmental impacts of different clinical products and pathways. Within the healthcare system, avoiding overdiagnosis and overprescribing, improving building energy efficiency, and fleet electrification are important green practices. In addition, we cannot ignore the differences in regional energy system when comparing the carbon footprint of different healthcare systems.
Journal Article