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.

Modern society is increasingly dependent on the stability of a complex system of interdependent infrastructure sectors. It is imperative to build resilience of large-scale infrastructures like metro systems for addressing the threat of natural disasters and man-made attacks in urban areas. Analysis is needed to ensure that these systems are capable of withstanding and containing unexpected perturbations, and develop heuristic strategies for guiding the design of more resilient networks in the future. We present a comprehensive, multi-pronged framework that analyses information on network topology, spatial organization and passenger flow to understand the resilience of the London metro system. Topology of the London metro system is not fault tolerant in terms of maintaining connectivity at the periphery of the network since it does not exhibit small-world properties. The passenger strength distribution follows a power law, suggesting that while the London metro system is robust to random failures, it is vulnerable to disruptions on a few critical stations. The analysis further identifies particular sources of structural and functional vulnerabilities that need to be mitigated for improving the resilience of the London metro network. The insights from our framework provide useful strategies to build resilience for both existing and upcoming metro systems.

This research examined the environmental impacts due to the construction phase of commercial buildings. Previous building research has often overlooked the construction phase and focused on the material and use phases, discounting the significant environmental impacts of construction. The research was conducted using life-cycle assessment (LCA) methodology, which is a systematic environmental management tool that holistically analyzes and assesses the environmental impacts of a product or process. Life-cycle inventory results focused on particulate matter, global warming potential, SOx , NOx , CO, Pb, nonmethane volatile organic compounds, energy usage, and solid and liquid wastes. Results over the entire building life cycle indicate that construction, while not as significant as the use phase, is as important as other life-cycle stages. This research used augmented process-based hybrid LCA to model the construction phase; this modeling approach effectively combined process and input-output (IO) LCA. One ...