BACKGROUND: Delays in surgery start times can lead to poor patient outcomes and considerable increases in healthcare expenditures. This is especially true in developing countries that often face systemic inefficiencies, such as a shortage of operating rooms and trained surgical personnel. With substantial effects on patient outcomes, healthcare efficiency, and resource allocation, identifying delays in first-case elective surgery is a crucial area of research.
METHODS: A multicenter observational study was conducted at three comprehensive and specialized hospitals in the Amhara region of Ethiopia from May 1 to October 30, 2023. The primary aim of the study was to determine the occurrence of late first-case start times, defined as a patient being in the operating room at or after the hospital\'s incision time of 2:30 a.m. The secondary aim was to discover potential root causes of delayed first-case start times. All patients scheduled for elective surgery as the first case on the operating list throughout the study period were included in the study. Every emergency, day case, after-hours case, and canceled case was excluded.
RESULTS: A total of 530 surgical patients were included during the study window from May 1 to October 1, 2023. Of these, 41.5% were general surgeries, 20.4% were gynecology and obstetrics surgeries, and 13.2% were orthopedic surgery procedures. Before the procedure started, nine (1.7%) of the participants had prolonged discussion with a member of the surgical team. Patients who arrived in the operating room waiting area at or after 2:30 a.m. were 2.5 times more likely to experience a first-case start time delay than those who arrived before or at 2:00 a.m. (AOR = 2.50; 95% CI: 1.13-5.14). Furthermore, participants with abnormal investigation results were 2.4 times more likely to have a late first-case start time (AOR = 2.41; 95% CI: 1.06, 5.50). Moreover, the odds of a late first-case start time were increased by 10.53 times with the surgeon being in the operating room at or after 2:30 a.m. (AOR = 10.53; 95% CI: 5.51, 20.11).
CONCLUSIONS: The research highlights a significant occurrence of delayed start times for the first elective surgical procedures. Therefore, directing attention to aspects such as ensuring patients and surgical teams arrive promptly (by or before 2:00 a.m.) and timely evaluation and communication of investigative findings before the scheduled surgery day could facilitate efforts to maximize operating room efficiency and enhance patient health outcomes.

UNASSIGNED: Diabetes technology is a fundamental part of modern diabetes therapy. Its widespread usage is associated with an increasing amount of \"diabetes technology waste.\" The aim of this study was to quantify this waste in a real-world situation in a specialized diabetes practice in Germany.
UNASSIGNED: Eighty patients with diabetes and insulin treatment participated and collected all of their therapy-associated waste for three months. Their attitude toward sustainability of antidiabetic therapy, waste generation, and their own waste reduction/separation behavior was surveyed.
UNASSIGNED: In total, 23 707 pieces of therapy-associated waste were collected. They comprised 5362 test strips, 630 glucose sensors, 14 619 needles, 519 insulin cartridges, 599 pens, and 1463 pieces of aids for insulin pump therapy. Type and quantity of the collected waste depended on the type of diabetes and the respective therapy, ie, multiple daily injections, usage of glucose sensors, or pump therapy. Most participants (92%) were surprised by the amounts of waste and reported an increased awareness toward the resource consumption of their therapy (87%). The survey indicated an enhanced interest in waste separation (94%) and a demand for the reduction and recycling of devices/aids (93%).
UNASSIGNED: Our data revealed the amount and complexity of the waste generated by modern diabetes therapy. Extrapolating these data, it can be estimated that around 1.2 billion pieces of diabetes technology waste are generated in Germany per year. The major concern of the study participants was the limited number of recycling options. A clear demand for improved sustainability of the medical products was expressed.

Corruption is known to be one of the real life situations which may jeopardize the effectiveness of fines in deterring crime. We present a model of \'crime with corruption\' by which both the dilution of crime deterrence due to corruption, as well as the possibility of crime encouraging fines, are formally highlighted. More importantly, by running an experiment on a subject pool of students for the case of illegal waste disposal, we provide experimental evidence on the validity of our theoretical predictions. We find that increasing fine rate may become crime encouraging, or at least ineffective, beyond a context-specific fine threshold. From a policy perspective, we suggest that the optimal design of a crime-deterring sanctioning system must simultaneously account for both corruption practices and anti-corruption policies.

The winemaking process generates an annual global production of about 10 million tons of waste consisting of stalks, skin, and seeds. The possible reutilization of wine pomace is strictly linked to its chemical composition. In this preliminary study, three different Sardinian white grapes (Malvasia, Vermentino and Nasco) grown in the same area were evaluated through a whole wine production chain. To reduce environmental impact, all the grapes were treated following the integrated production practice (IPP) strategies. The adopted agronomic methods and the main physico-chemical parameters of the fresh fruits and musts were evaluated. A fully qualitative and quantitative characterization of the phenolic fraction of the pomace extracts was performed by HPLC-DAD after a post-winemaking process. Water and ethanol were utilized as green solvents in the extraction process. Additionally, the entire pomace post-winemaking process was carried out within the winery facilities to reduce energy loss and road transportation. The findings demonstrated that large amounts of beneficial polyphenols are present in pomace extracts, and that the type of grape used, agronomic practices, and winemaking method all influence the quantity and quality of the extracts. The polyphenol concentrations in the Vermentino (28,391.5 ± 7.0 mg/kg) and Malvasia pomace (11,316.3 ± 6.5 mg/kg) were found to be the highest and lowest, respectively.

Landfill site selection is an essential aspect of sustainable solid waste management as it ensures that the waste generated by a community or region is disposed of in an environmentally friendly and safe manner. The approach for selecting landfill sites seeks to choose locations that provide the least risk to the environment and public health while still satisfying the demands of the local community. This research aims to use a multi-criteria assessment to determine a landfill location in Al-Balqa Governorate in Jordan to ensure that the chosen site meets the needs of all stakeholders while minimizing the negative impact on the environment and the community. This research developed a hierarchy structure to make landfill site selection decisions, which involves identifying parameters such as distance to surface water, land cover, distance from urban and rural areas, distance to roads, slope, and soil permeability. A rating system was used to evaluate each criterion, and weights were assigned to reflect their relative importance. An overlay weighting technique was then used to assess site suitability based on expert opinions from related fields. In this studied area, about 204,283 m2 is required to address 25 years of municipal solid waste volume, whereas this technique identified around 79,210,000 m2 of potential landfill sites. Overall, the research highlights the importance of using a multi-criteria assessment approach for landfill site selection to ensure that the chosen site meets the needs of all stakeholders while minimizing negative impacts on the environment and public health. The study provides insights that can be useful for decision-makers involved in sustainable solid waste management in Jordan and other similar regions. -How to Find the suitable landfills to achieve sustainable development.-What aspects and criteria were comsidered in choosing the landfill site.

BACKGROUND: Perioperative opioid use has been associated with adverse clinical outcomes. Additionally, opioid disposal carries significant costs, due to the waste of pharmaceutical products and the time needed by skilled labor to report the waste. In this study, we aimed to estimate costs and predict factors of opioid-associated intraoperative product waste, as well as to evaluate whether higher intraoperative opioid doses are associated with increased risk of adverse postoperative outcomes.
METHODS: We included 170,607 patients undergoing general anesthesia and receiving intraoperative fentanyl, hydromorphone, or morphine at Beth Israel Deaconess Medical Center, Boston, MA, USA, between January 2010 and June 2020. We estimated product waste-associated costs based on various opioid syringe sizes and determined predictors of opioid waste. Further, we evaluated whether higher opioid doses were associated with postoperative adverse events according to the severity-indexed, incident report-based medication error-reporting program classification. The primary outcome included post-extubation desaturation, postoperative nausea or vomiting, or postoperative somnolence or sedation.
RESULTS: The use of the smallest syringe sizes (50 mcg for fentanyl, 0.2 mg for hydromorphone, and 2 mg for morphine) resulted in the lowest product waste-associated costs. The main predictor of opioid waste was the administration of more than one intraoperative opioid (adjusted odds ratio [aOR] = 7.64, 95% CI 7.40-7.89, P < 0.001). Intraoperative doses of fentanyl > 50-100 mcg (aOR = 1.17 [1.10-1.25], P < 0.001, adjusted risk difference [ARD] 2%) and > 100 mcg (aOR = 1.24 [1.16-1.33], P < 0.001, ARD 3%), hydromorphone > 1 mg (aOR = 1.13 [1.06-1.20], P < 0.001, ARD 2%), and morphine > 2-4 mg (aOR = 1.26 [1.02-1.56], P = 0.04, ARD 3%) and > 4 mg (aOR = 1.45 [1.18-1.77], P < 0.001, ARD 5%) were associated with higher risk of the primary outcome.
CONCLUSIONS: Smaller syringe sizes of intraoperative opioids may help to reduce product waste and associated costs, as well postoperative adverse events through utilization of lower intraoperative opioid doses.

Today, Ukraine is far from European standards, and the country\'s waste management system remains confronted with environmental and technogenic problems, with 7 % of the territory occupied by landfills. Most settlements in Ukraine do not have solid waste management programs or sanitation schemes. Landfills, and especially municipal solid waste dumps, are significant contributors to air, water, and soil pollution. The objective of this research is to develop a comprehensive understanding of the environmental impact of landfills, to translate them from a descriptive and abstract plane to a mathematical plane, and to identify the sanitary protection zones currently utilized for landfills. The subject of this study is the municipal waste landfill of the Zhytomyr territorial community (Ukraine), a typical Ukrainian landfill operated with minimal environmental protection measures. The authors used an original approach to assess the environmental hazard of a municipal waste landfill, taking into consideration the values of absolute indicators of water pollution for specific physicochemical characteristics; maximum permissible concentrations of the studied indicators; distance from the landfill boundary; the amount of excess of the absolute indicator of pollution compared to the MPC; and the intensity of odor in the landfill. The calculated pollution indicators served as the basis for an integrated assessment of the environmental hazards posed by the municipal waste landfill. The study revealed that the Ot indicator (evaluation of the environmental hazards of municipal waste landfills) depends exponentially on the landfill boundary. Based on the value of Ot, environmental zoning was carried out: according to the calculations and taking into account the monitoring of the environmental condition in the landfill\'s impact zone, the authors recommended the parameters of environmental zoning on the basis of the Ot value. The purpose of this study is to clarify the sanitary protection zones that are currently used for landfills and solid household waste disposals. The research materials can also be used to create databases on landfills, enabling the development of a plan to manage them as sources of heightened environmental risk.

OBJECTIVE: To evaluate patient satisfaction on gynaecological examination with metal, plastic and biobased plastic vaginal specula, and to investigate whether patients are willing to compromise on comfort for a more sustainable healthcare system.
METHODS: Cross-sectional study: population-based survey.
METHODS: Gynaecological outpatient clinics in five Dutch hospitals.
METHODS: Patients during general gynaecology consultation hours.
METHODS: A survey containing two questions about patient demographics, four about comfort and five about sustainability and healthcare was distributed.
METHODS: Comfort score (scale 1-10).
RESULTS: (1) temperature, size and ease of insertion, (2) willingness to compromise for a more sustainable healthcare system.
RESULTS: In all, 196 patients completed the survey. Biobased plastic vaginal specula scored significantly higher on comfort than the metal ones (mean 8.03 ± 1.65 versus 7.26 ± 1.51 respectively; P < 0.001). The biobased plastic vaginal speculum is significantly the most comfortable on temperature, whereas the metal speculum is the least comfortable (P < 0.007). Most patients are willing to compromise on comfort or are open to the reuse of disposables to contribute to a more sustainable healthcare. The majority of patients (77%) urge healthcare organisations to combat climate change.
CONCLUSIONS: There is a small but statistically significant difference in favour of a biobased plastic speculum regarding comfort score, although it might be questioned whether this is clinically relevant. Furthermore, patients are willing to compromise on comfort for a more sustainable healthcare, which should be a contributing factor in speculum selection.

In this study, cow dung biomass was converted into biochar (BC). BC900 was obtained through one-step pyrolysis at 900 °C, while BC700-900 and BC900-700 were obtained via two-step pyrolysis at temperature ranges of 700-900 °C and 900-700 °C, respectively. The primary objective was to investigate the adsorption performance and application value of BCs for tetracycline (TC) in water. The samples underwent characterization using scanning electron microscopy and mapping analysis, Fourier transform infrared spectroscopy, X-ray diffraction, and thermogravimetric analysis. Subsequently, the effects of reaction time, adsorbent dosage, temperature, pH, and ionic strength were analyzed. Based on the fitting results of adsorption kinetics, the pyrolytic BCs exhibited a better fit with the pseudo-secondary kinetic model. The adsorption isotherm indicated monolayer adsorption on the surface of the adsorbents, with maximum adsorption capacities of 158.93 mg/g for BC900-700, 150.15 mg/g for BC700-900, and 142.56 mg/g for BC900, respectively. Furthermore, results from simulated wastewater and regeneration experiments demonstrated that BC900-700 exhibited not only excellent adsorption performance in wastewater but also remarkable regeneration capabilities. The two-step pyrolysis BCs in this study displayed a higher adsorption capacity compared to the one-step pyrolysis BCs in practical applications. These findings provide insights for further exploring the adsorption mechanism and optimizing the process.

UNASSIGNED: The objective of study was to assess the knowledge and awareness of the management of biological waste (BMW) among undergraduate students of Dental College, Tamilnadu state.
UNASSIGNED: Among the students of Dental College in Tamilnadu state, India, a cross-sectional observational research was conducted. A pre-designed questionnaire was distributed to the students. Their expertise and awareness of managing biomedical waste were the variables that were investigated.
UNASSIGNED: One hundred and eighty students were participated. The male to female ratio was 1:2, and the average age of responders was 19.76 ± 1.03 years. When it comes to information concerning the management of biomedical waste, an average of 60.33% were correct and 39.57% were incorrect. For their knowledge of the same, 81.35% were correct and 18.65% were incorrect.
UNASSIGNED: The findings indicated that students had a high degree of knowledge and understanding regarding the management of biomedical waste.