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  1. Article ; Online: Sustainable Purchasing Practices

    Juliana Duffy / Jonathan E. Slutzman / Cassandra L. Thiel / Meghan Landes

    Western Journal of Emergency Medicine, Vol 24, Iss 6, Pp 1034-

    A Comparison of Single-use and Reusable Pulse Oximeters in the Emergency Department

    2023  Volume 1042

    Abstract: Background: Delivering healthcare requires significant resources and creates waste that pollutes the environment, contributes to the climate crisis, and harms human health. Prior studies have generally shown durable, reusable medical devices to be ... ...

    Abstract Background: Delivering healthcare requires significant resources and creates waste that pollutes the environment, contributes to the climate crisis, and harms human health. Prior studies have generally shown durable, reusable medical devices to be environmentally superior to disposables, but this has not been investigated for pulse oximetry probes. Objective: Our goal was to compare the daily carbon footprint of single-use and reusable pulse oximeters in the emergency department (ED). Methods: Using a Life Cycle Assessment (LCA), we analyzed greenhouse gas (GHG) emissions from pulse oximeter use in an urban, tertiary care ED, that sees approximately 150 patients per day. Low (387 uses), moderate (474 uses), and high use (561 uses), as well as cleaning scenarios, were modelled for the reusable oximeters and compared to the daily use of single-use oximeters (150 uses). We calculated GHG emissions, measured in kilograms of carbon dioxide equivalents (kgCO2e), across all life cycle stages using life-cycle assessment software and the ecoinvent database. We also carried out an uncertainty analysis using Monte Carlo methodology and calculated the break-even point for reusable oximeters. Results: Per day of use, reusable oximeters produced fewer greenhouse gases in low-, moderate-, and high-use scenarios compared to disposable oximeters: 3.9 kgCO2e, 4.9 kgCO2e, 5.7 kgCO2e vs 23.4 kgCO2e, respectively). An uncertainty analysis showed there was no overlap in emissions, and a sensitivity analysis found reusable oximeters only need to be used 2.3 times before they match the emissions created by a single disposable oximeter. Use phases associated with the greatest emissions varied between oximeters, with the cleaning phase of reusables responsible for the majority of its GHG emissions (99%) compared to the production phases of the single-use oximeter (74%). Conclusion: Reusable pulse oximeters generated fewer greenhouse gas emissions per day of use than their disposable counterparts. Given that the pulse oximeter is an ...
    Keywords Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Subject code 621
    Language English
    Publishing date 2023-09-01T00:00:00Z
    Publisher eScholarship Publishing, University of California
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Telemedicine and the environment

    Cassandra L. Thiel / Natasha Mehta / Cory Sean Sejo / Lubna Qureshi / Meagan Moyer / Vincent Valentino / Jason Saleh

    npj Digital Medicine, Vol 6, Iss 1, Pp 1-

    life cycle environmental emissions from in-person and virtual clinic visits

    2023  Volume 8

    Abstract: Abstract Concern over climate change is growing in the healthcare space, and telemedicine has been rapidly expanding since the start of the COVID19 pandemic. Understanding the various sources of environmental emissions from clinic visits—both virtual and ...

    Abstract Abstract Concern over climate change is growing in the healthcare space, and telemedicine has been rapidly expanding since the start of the COVID19 pandemic. Understanding the various sources of environmental emissions from clinic visits—both virtual and in-person—will help create a more sustainable healthcare system. This study uses a Life Cycle Assessment with retrospective clinical data from Stanford Health Care (SHC) in 2019–2021 to determine the environmental emissions associated with in-person and virtual clinic visits. SHC saw 13% increase in clinic visits, but due to the rise in telemedicine services, the Greenhouse Gas emissions (GHGs) from these visits decreased 36% between 2019 and 2021. Telemedicine (phone and video appointments) helped SHC avoid approximately 17,000 metric tons of GHGs in 2021. Some departments, such as psychiatry and cancer achieved greater GHG reductions, as they were able to perform more virtual visits. Telemedicine is an important component for the reduction of GHGs in healthcare systems; however, telemedicine cannot replace every clinic visit and proper triaging and tracking systems should be in place to avoid duplicative care.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 700
    Language English
    Publishing date 2023-05-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Dumpster Diving in the Emergency Department

    Sarah Hsu / Cassandra L. Thiel / Michael J. Mello / Jonathan E. Slutzman

    Western Journal of Emergency Medicine, Vol 21, Iss

    2020  Volume 5

    Abstract: Introduction: Healthcare contributes 10% of greenhouse gases in the United States and generates two milion tons of waste each year. Reducing healthcare waste can reduce the environmental impact of healthcare and lower hospitals’ waste disposal costs. ... ...

    Abstract Introduction: Healthcare contributes 10% of greenhouse gases in the United States and generates two milion tons of waste each year. Reducing healthcare waste can reduce the environmental impact of healthcare and lower hospitals’ waste disposal costs. However, no literature to date has examined US emergency department (ED) waste management. The purpose of this study was to quantify and describe the amount of waste generated by an ED, identify deviations from waste policy, and explore areas for waste reduction. Methods: We conducted a 24-hour (weekday) ED waste audit in an urban, tertiary-care academic medical center. All waste generated in the ED during the study period was collected, manually sorted into separate categories based on its predominant material, and weighed. We tracked deviations from hospital waste policy using the hospital’s Infection Control Manual, state regulations, and Health Insurance Portability and Accountability Act standards. Lastly, we calculated direct pollutant emissions from ED waste disposal activities using the M+WasteCare Calculator. Results: The ED generated 671.8 kilograms (kg) total waste during a 24-hour collection period. On a per-patient basis, the ED generated 1.99 kg of total waste per encounter. The majority was plastic (64.6%), with paper-derived products (18.4%) the next largest category. Only 14.9% of waste disposed of in red bags met the criteria for regulated medical waste. We identified several deviations from waste policy, including loose sharps not placed in sharps containers, as well as re-processable items and protected health information thrown in medical and solid waste. We also identified over 200 unused items. Pollutant emissions resulting per day from ED waste disposal include 3110 kg carbon dioxide equivalent and 576 grams of other criteria pollutants, heavy metals, and toxins. Conclusion: The ED generates significant amounts of waste. Current ED waste disposal practices reveal several opportunities to reduce total waste generated, increase adherence to ...
    Keywords Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Subject code 710
    Language English
    Publishing date 2020-08-01T00:00:00Z
    Publisher eScholarship Publishing, University of California
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Conservation Practices for Personal Protective Equipment

    Cassandra L. Thiel / Pallavi Sreedhar / Genevieve S. Silva / Hannah C. Greene / Meenakshi Seetharaman / Meghan Durr / Timothy Roberts / Rajesh Vedanthan / Paul H. Lee / Gizely Andrade / Omar El-Shahawy / Sarah E. Hochman

    International Journal of Environmental Research and Public Health, Vol 20, Iss 2575, p

    A Systematic Review with Focus on Lower-Income Countries

    2023  Volume 2575

    Abstract: During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable ... ...

    Abstract During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic approaches for conserving single-use PPE, expecting that lower-income countries or developing contexts may already be uniquely conserving PPE. However, of the 50 included studies, only 3 originated from middle-income countries and none originated from low-income countries. Data from the included studies suggest PPE remained effective with extended use and with multiple or repeated use in clinical settings, as long as donning and doffing were performed in a standard manner. Multiple decontamination techniques were effective in disinfecting single use PPE for repeated use. These findings can inform healthcare facilities and providers in establishing protocols for safe conservation of PPE supplies and updating existing protocols to improve sustainability and overall resilience. Future studies should evaluate conservation practices in low-resource settings during non-pandemic times to develop strategies for more sustainable and resilient healthcare worldwide.
    Keywords PPE ; sustainability ; waste ; resilience ; conservation ; efficiency ; Medicine ; R
    Subject code 333
    Language English
    Publishing date 2023-01-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Waste generation and carbon emissions of a hospital kitchen in the US

    Cassandra L Thiel / SiWoon Park / Aviva A Musicus / Jenna Agins / Jocelyn Gan / Jeffrey Held / Amy Horrocks / Marie A Bragg

    PLoS ONE, Vol 16, Iss 3, p e

    Potential for waste diversion and carbon reductions.

    2021  Volume 0247616

    Abstract: This study measured the total quantity and composition of waste generated in a large, New York City (NYC) hospital kitchen over a one-day period to assess the impact of potential waste diversion strategies in potential weight of waste diverted from ... ...

    Abstract This study measured the total quantity and composition of waste generated in a large, New York City (NYC) hospital kitchen over a one-day period to assess the impact of potential waste diversion strategies in potential weight of waste diverted from landfill and reduction in greenhouse gas (GHG) emissions. During the one-day audit, the hospital kitchen generated 1515.15 kg (1.7 US tons) of solid waste daily or 0.23 kg of total waste per meal served. Extrapolating to all meals served in 2019, the hospital kitchen generates over 442,067 kg (487 US tons) of waste and emits approximately 294,466 kg of CO2e annually from waste disposal. Most of this waste (85%, 376,247 kg or 415 US tons annually) is currently sent to landfill. With feasible changes, including increased recycling and moderate composting, this hospital could reduce landfilled waste by 205,245 kg (226 US tons, or 55% reduction) and reduce GHG emissions by 189,025 kg CO2e (64% reduction). Given NYC's ambitious waste and GHG emission reduction targets outlined in its OneNYC strategic plan, studies analyzing composition, emissions, and waste diversion potential of large institutions can be valuable in achieving city sustainability goals.
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Identifying high-value care for Medicare beneficiaries

    Jeph Herrin / Leora I Horwitz / Susannah M Bernheim / Zhenqiu Lin / Arjun K Venkatesh / Cassandra L Thiel / Huihui Yu / Sunita M Desai

    BMJ Open, Vol 12, Iss

    a cross-sectional study of acute care hospitals in the USA

    2022  Volume 3

    Keywords Medicine ; R
    Language English
    Publishing date 2022-03-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article: Dynamic Life Cycle Assessments of a Conventional Green Building and a Net Zero Energy Building: Exploration of Static, Dynamic, Attributional, and Consequential Electricity Grid Models

    Collinge, William O / Amy E. Landis / Cassandra L. Thiel / Harold J. Rickenbacker / Melissa M. Bilec

    Environmental science & technology. 2018 Sept. 07, v. 52, no. 19

    2018  

    Abstract: Our study assesses the differences between regional average- and marginal-electricity generation mixes as well as the variability between predicted and observed energy consumption of a “conventional green” Leadership in Energy and Environmental Design ( ... ...

    Abstract Our study assesses the differences between regional average- and marginal-electricity generation mixes as well as the variability between predicted and observed energy consumption of a “conventional green” Leadership in Energy and Environmental Design (LEED) building and a Net-Zero Energy Living Building (NZEB). The aim of our study was to evaluate the importance of using temporally resolved building-level data while capturing the dynamic effects a changing electrical grid has on the life cycle impacts of buildings. Two static and four dynamic life cycle assessment (LCA) models were evaluated for both buildings. Both buildings’ results show that the most appropriate models (hybrid consequential for the LEED Gold building, hourly consequential for the NZEB) significantly modified the use-phase global warming potential (GWP) impacts relative to the design static LCA (49% greater impact for the LEED Gold building; 45% greater reduction for the NZEB). In other words, a “standard” LCA would underestimate the use phase impacts of the LEED Gold building and the benefits of the NZEB in the GWP category. Although the results in this paper are specific to two case study buildings, the methods developed are scalable and can be implemented more widely to improve building life cycle impact estimates.
    Keywords buildings ; case studies ; design for environment ; electricity ; energy ; global warming potential ; life cycle assessment ; models
    Language English
    Dates of publication 2018-0907
    Size p. 11429-11438.
    Publishing place American Chemical Society
    Document type Article
    ISSN 1520-5851
    DOI 10.1021/acs.est.7b06535
    Database NAL-Catalogue (AGRICOLA)

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  8. Article ; Online: Grand Challenges in global eye health

    Jacqueline Ramke, PhD / Jennifer R Evans, PhD / Esmael Habtamu, PhD / Nyawira Mwangi, PhD / Juan Carlos Silva, MD / Bonnielin K Swenor, PhD / Nathan Congdon, ProfMD / Hannah B Faal, ProfFRCOphth / Allen Foster, ProfFRCOphth / David S Friedman, ProfPhD / Stephen Gichuhi, PhD / Jost B Jonas, ProfPhD / Peng T Khaw, ProfPhD / Fatima Kyari, PhD / Gudlavalleti V S Murthy, ProfMD / Ningli Wang, ProfPhD / Tien Y Wong, ProfMD / Richard Wormald, MSc / Mayinuer Yusufu, MTI /
    Hugh Taylor, FRANZCO / Serge Resnikoff, ProfPhD / Sheila K West, ProfPhD / Matthew J Burton, ProfPhD / Ada Aghaji / Adeyemi T Adewole / Adrienne Csutak / Ahmad Shah Salam / Ala Paduca / Alain M Bron / Alastair K Denniston / Alberto Lazo Legua / Aldiana Halim / Alemayehu Woldeyes Tefera / Alice Mwangi / Alicia J Jenkins / Amanda Davis / Amel Meddeb-Ouertani / Amina H Wali / Ana G Palis / Ana Bastos de Carvalho / Anagha Joshi / Andreas J Kreis / Andreas Mueller / Andrew Bastawrous / Andrew Cooper / Andrew F Smith / Andrzej Grzybowski / Anitha Arvind / Anne M Karanu / Anne O Orlina / Anthea Burnett / Aryati Yashadhana / Asela P Abeydeera / Aselia Abdurakhmanova / Ashik Mohamed / Ashish Bacchav / Ashlie Bernhisel / Aubrey Walton Webson / Augusto Azuara-Blanco / Ava Hossain / Bayazit Ilhan / Bella Assumpta Lucienne / Benoit Tousignant / Bindiganavale R Shamanna / Boateng Wiafe / Brigitte Mueller / Cagatay Caglar / Caleb Mpyet / Carl H Abraham / Carol Y Cheung / Cassandra L Thiel / Catherine L Jan / Chike Emedike / Chimgee Chuluunkhuu / Chinomso Chinyere / Christin Henein / Clare E Gilbert / Covadonga Bascaran / Cristina Elena Nitulescu / Daksha Patel / Damodar Bachani / Daniel Kiage / Daniel Etya'ale / David Dahdal / Dawn Woo Lawson / Denise Godin / Dennis G Nkanga / Dennis M Ondeyo / Donna O'Brien / Dorothy M Mutie / Ebtisam S K Alalawi / Eduardo Mayorga / Effendy Bin Hashim / Elham Ashrafi / Elizabeth Andrew Kishiki / Elizabeth Kurian / Fabrizio D'Esposito / Faith Masila / Fernando Yaacov Pena / Fortunat Büsch / Fotis Topouzis / Francesco Bandello / Funmilayo J Oyediji / Gabriele Thumann / Gamal Ezz Elarab / Gatera Fiston Kitema / Gerhard Schlenther / Gertrude Oforiwa Fefoame / Gillian M Cochrane / Guna Laganovska / Haroon R Awan / Harris M Ansari / Heiko Philippin / Helen Burn / Helen Dimaras / Helena P Filipe / Henrietta I Monye / Himal Kandel / Hoby Lalaina Randrianarisoa / Iain Jones / Ian E Murdoch / Ido Didi Fabian / Imran A Khan / Indra P Sharma / Islam Elbeih / Islay Mactaggart / J Carlos Pastor / Jan E E Keunen / Jane A Ohuma / Jason Pithuwa Nirwoth / Jaouad Hammou / Jayme R Vianna / Jean-eudes Biao / Jennifer M Burr / Jeremy D Keenan / Jess Blijkers / Joanna M Black / Joao Barbosa Breda / Joao M Furtado / John C Buchan / John G Lawrenson / John H Kempen / Joshua R Ehrlich / Judith Stern / Justine H Zhang / Kadircan H Keskinbora / Karin M Knoll / Karl Blanchet / Katrina L Schmid / Koichi Ono / Kolawole Ogundimu / Komi Balo / Kussome Paulin Somda / Kwame Yeboah / Kwesi N Amissah-Arthur / Leone Nasehi / Lene Øverland / Lingam Vijaya / Lisa Keay / Lisa M Hamm / Lizette Mowatt / Lloyd C M Harrison-Williams / Lucia Silva / Luigi Bilotto / Manfred Mörchen / Mansur Rabiu / Marcia Zondervan / Margarida Chagunda / Maria Teresa Sandinha / Mariano Yee Melgar / Marisela Salas Vargas / Mark D Daniell / Marzieh Katibeh / Matt Broom / Megan E Collins / Mehmet Numan Alp / Michael A Kwarteng / Michael Belkin / Michael Gichangi / Michelle Sylvanowicz / Min Wu / Miriam R Cano / Mohammad Shalaby / Mona Duggal / Moncef Khairallah / Muhammed Batur / Mukharram M Bikbov / Muralidhar Ramappa / Nagaraju Pamarathi / Naira Khachatryan / Nasiru Muhammad / Neil Kennedy / Neil Murray / Nicholas A V Beare / Nick Astbury / Nicole A Carnt / Nigel A St Rose / Nigel H Barker / Niranjan K Pehere / Nkechinyere J Uche / Noemi Lois / Oluwaseun O Awe / Oscar J Mujica / Oteri E Okolo / Padmaja Kumari Rani / Paisan Ruamviboonsuk / Papa Amadou Ndiaye / Parami Dhakhwa / Pavel Rozsival / Pearl K Mbulawa / Pearse A Keane / Pete R Jones / Peter Holland / Phanindra Babu Nukella / Philip I Burgess / Pinar Aydin O'Dwyer / Prabhath Piyasena / Pradeep Bastola / Priya Morjaria / Qais Nasimee / Raizza A T Rambacal / Rajdeep Das / Rajiv B Khandekar / Rajvardhan Azad / Ramona Bashshur / Raúl A R C Sousa / Rebecca Oenga / Reeta Gurung / Robert Geneau / Robert J Jacobs / Robert P Finger / Robyn H Guymer / Rodica Sevciuc / Rohit C Khanna / Ronnie George / Ronnie Graham / Ryo Kawasaki / S May Ho / Sailesh Kumar Mishra / Sandeep Buttan / Sandra S Block / Sandra Talero / Sangchul Yoon / Sanil Joseph / Sare Safi / Sarity Dodson / Sergio R Munoz / Seydou Bakayoko / Seyed Farzad Mohammadi / Shabir Ahmad Muez / Shahina Pardhan / Shelley Hopkins / Shwu-Jiuan Sheu / Sidi Mohamed Coulibaly / Silvana A Schellini / Simon Arunga / Simon R Bush / Sobha Sivaprasad / Solange R Salomao / Srinivas Marmamula / Stella N Onwubiko / Stuti L Misra / Subeesh Kuyyadiyil / Sucheta Kulkarni / Sudarshan khanal / Sumrana Yasmin / Suzana Nikolic Pavljasevic / Suzanne S Gilbert / Tasanee Braithwaite / Tatiana Ghidirimschi / Thulasiraj Ravilla / Timothy R Fricke / Tiziana Cogliati / Tsehaynesh Kassa / Tunde Peto / Ute Dibb / Van C Lansingh / Victor H Hu / Victoria M Sheffield / Wanjiku Mathenge / William H Dean / Winifred Nolan / Yoshimune Hiratsuka / Yousaf Jamal Mahsood / Yuddha Sapkota

    The Lancet. Healthy Longevity, Vol 3, Iss 1, Pp e31-e

    a global prioritisation process using Delphi method

    2022  Volume 41

    Abstract: Summary: Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health- ...

    Abstract Summary: Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
    Keywords Geriatrics ; RC952-954.6 ; Medicine ; R
    Subject code 360
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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