Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.
The River Rhône in the south of France is susceptible to periodic flooding, leaving communities and vast areas of agricultural land inundated for significant periods of time. Efforts to control flooding in the lower Rhône valley have been undertaken since the middle of the nineteenth century, notably through the construction of levees and other flood defence and river management structures. These have subsequently been raised and widened following each major flood event, making their capacity to resist floods difficult to evaluate. Recent flood events have resulted in numerous breaches in the existing system of protection. The recent introduction of a global strategy for flood management in the lower Rhône catchment (Plan Rhône) includes for major infrastructure improvements to enhance the resilience of existing flood defences. This paper examines the application of the Plan Rhône since its release, presenting case studies and, where appropriate, the collaborative work undertaken by the main actors involved. This paper examines the application of the Plan Rhône since its release, presenting case studies and, where appropriate, the collaborative work undertaken by the main actors involved. Details of the different approaches undertaken to evaluate the risks associated with the levees are provided, together with proposed solutions to enhance the resilience of the global system of protection against a flood with a probability of exceedance of 10−3 (1 in 1000 year return period).
Abstract. Flooding can have significant direct and indirect negative effects on a railway network affecting both infrastructure and rail operations. Such impacts include the delaying or cancelling of train services, damage to railway structures or the implementation of costly maintenance and monitoring programs to ensure the safety and performance of the railway system. Identifying sections of railway line at risk from flooding allows appropriate actions to be targeted at specific areas and contributes to an effective asset management plan. Flooding of railway infrastructure can have numerous sources including surface water run-off, insufficient capacity of hydraulic structures or the inundation of embankments located in floodplains. Consequences of flooding include the destabilisation of structures (surface erosion of embankments or the undermining of bridge foundations), differential settlement of structures and damage to the track structure. This paper details an innovative approach developed at the SNCF using a Geographic Information System (GIS) model to identify zones of the railway network at risk of different types of flooding. The GIS model RiskVIP has been constructed through the assessment of three distinct components of risk: µVulnerability ¶ Dssessment of the susceptibility of the railway infrastructure to flood conditions), Intensity ¶ FDSDFLW\ of a catchment to generate a flood flow), Probability ¶ SUREDELOLW\ RI D UDLQIDOO HYHQW7KURXJK WKH DSSOLFDWLRQ RI GHFLVLRQ WUHHV WKH FRPSRQHQW µInteQVLW\ ¶ has been characterised in the model by the physical properties of the catchment intercepted by the railway line (surface area of the catchment, slope and land cover characteristics) and µVulnerability ¶ by the infrastructure itself (type, geometry and the presence of hydraulic structures). In order to evaluate its efficiency at identifying sites at risk of flooding, the model has been tested in the region of LanguedocRoussillon in France on a reach of over 380km of railway line. In order to charactHULVH WKH FRPSRQHQW µprobability ¶ data relating to important historic rainfall events have been used in the model against which known incidents on the railway line have been subsequently analysed. Initial results are very positive with a high level of capture of known incidents by the model in relation to the type of flooding recorded. The model RiskVIP allows the evaluation of flood risk to be undertaken at different scales and will aid in targeting precise reaches of railway line to be studied in more detail. It is a tool which can aid in the management of flood risk on the railway network, optimising for example the maintenance program of drainage structures, ensuring monitoring and inspections are targeted at problem reaches, identifying areas where civil works are necessary and improving the overall resilience of the railway system.
This article speculates about the theory and practice of visual culture by examining the potent linkages between the figure of the cave and the making of images. Because the cave functions as a signifier for the artistic imperative, an endorsement of art history’s place in cultural representation and also as a mythic beginning point in the Western hegemony of the visual, its figuration carries within it a set of suppositions on which the visual depends but which are rendered subservient or effaced in the genealogy of visualization. We focus in particular on the creation of Alexander Pope’s grotto and on a comparison between Robert Smithson’s and Ana Mendieta’s evocations of the cave.
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