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ObjectiveProcedure-intense specialties, such as surgery or endoscopy, are a major contributor to the impact of the healthcare sector on the environment. We aimed to measure the amount of waste generated during endoscopic procedures and to understand the impact on waste of changing from reusable to single use endoscopes in the USA.DesignWe conducted a 5-day audit (cross-sectional study) of all endoscopies performed at two US academic medical centres with low and a high endoscopy volume (2000 and 13 000 procedures annually, respectively). We calculated the average disposable waste (excluding waste from reprocessing) generated during one endoscopic procedure to estimate waste of all endoscopic procedures generated in the USA annually (18 million). We further estimated the impact of changing from reusable to single-use endoscopes taking reprocessing waste into account.Results278 endoscopies were performed for 243 patients. Each endoscopy generated 2.1 kg of disposable waste (46 L volume). 64% of waste was going to the landfill, 28% represented biohazard waste and 9% was recycled. The estimated total waste generated during all endoscopic procedures performed in the USA annually would weigh 38 000 metric tons (equivalent of 25 000 passenger cars) and cover 117 soccer fields to 1 m depth. If all endoscopic procedures were performed with single-use endoscopes and accounting for reprocessing, the net waste mass would increase by 40%. Excluding waste from ancillary supplies, net waste generated from reprocessing and endoscope disposal would quadruple with only using single-use endoscopes.ConclusionThis quantitative assessment of the environmental impact of endoscopic procedures highlights that a large amount of waste is generated from disposable instruments. Transitioning to single-use endoscopes may reduce reprocessing waste but would increase net waste.

During winters, the northern Adriatic Sea experiences frequent, intense cold‐air outbreaks that drive oceanic heat loss and imprint complex but predictable patterns in the underlying waters. This strong, reliable forcing makes this region an excellent laboratory for observational and numerical investigations of air‐sea interaction, sediment and biological transport, and mesoscale wind‐driven flow. Narrow sea surface wind jets, commonly known as “bora,” occur when cold, dry air spills through gaps in the Dinaric Alps (the mountain range situated along the Adriatic's eastern shore). Horizontal variations in these winds drive a mosaic of oceanic cyclonic and anticyclonic cells that draw coastal waters far into the middle basin. The winds also drive intense cooling and overturning, producing a sharp front between dense, vertically homogenous waters (North Adriatic Dense Water, or NAdDW) in the north and the lighter (colder, fresher), stratified waters of the Po River plume. Once subducted at the front, the NAdDW flows southward in a narrow vein following the isobaths (contours of constant depth) of the Italian coast. In addition to governing the basin's general circulation, these processes also influence sediment transport and modulate biological and optical variability

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Exact analytical solutions are found to describe f plane time-dependent, elliptical warm-core rings where the interface intersects the surface along the periphery. The space variables can be eliminated to reduce the problem to a system of differential equations in time. The motion of the center of mass is resolved and subtracted. Small departures from circular shape have three intrinsic frequencies' two are inertial and superinertial, while the third is a low-frequency mode that corresponds to a slow rotation of the elliptical eddy without change in shape. An exact solution for steadily rotating elliptical eddies of finite eccentricity (named Rodons) is also found and discussed. Comparison with elliptical warm-core Gulf Stream rings shows that this low-frequency mode may explain their clockwise rotation. The solution also shows the existence of a periodically reversing deformation field that, combined with a reasonable amount of mixing, would result in an efficient homogenization of the water contained in the ring. An exact solution that corresponds to the pulsation of a circular eddy has also been found.