Critical factors to be considered when planning the implementation of environmental improvements and energy saving

To identify the critical success factors in the adoption of energy efficiency actions in Brazilian hospitals and describe their behaviour are the objectives of this paper. In order to achieve these goals, a literature review was performed on green management and energy efficiency. This was the basis to define the questions of the interview script applied to two hospitals located in the state of Sao Paulo, Brazil. The interview script application was complemented by secondary data and direct observation. The results showed that: a) the studied hospitals are embracing environmental management actions more often and, whenever possible, energy efficiency actions are taken as well; and b) in the cases analysed top management support, commitment with the environment, green process design and employee empowerment were some of the most relevant critical success factors to the accomplishment of energy efficiency actions. These findings may be of interest to emerging countries, including BRICS (Brazil, Russia, India, China and South Africa).

Effects of residential energy-saving lamps on the attraction of nocturnal insects

Many species of insects display a disposition to move towards light. As a consequence, nocturnal artificial lighting often contributes to an increase in insect population among humans. We tested the hypothesis that residential white lamps can evoke significantly different attraction to insects even when their light outputs are nearly indistinguishable to humans. In a two-choice experiment using insect traps equipped with either a compact fluorescent or a LED light source with similar photometric specifications, about three times more insects were captured in the trap with a compact fluorescent lamp than in the LED trap. The results suggest that LED lamps are preferable to compact fluorescent lamps when the objective is to avoid attracting nocturnal insects to households.

Saving the Vaquita: Immediate Action, Not More Data

The recent likely extinction of the baiji (Chinese river dolphin [Lipotes vexillifer]) (Turvey et al. 2007) makes the vaquita (Gulf of California porpoise [Phocoena sinus]) the most endangered cetacean. The vaquita has the smallest range of any porpoise, dolphin, or whale and, like the baiji, has long been threatened primarily by accidental deaths in fishing gear (bycatch) (Rojas-Bracho et al. 2006). Despite repeated recommendations from scientific bodies and conservation organizations, no effective actions have been taken to remove nets from the vaquita’s environment. Here, we address three questions that are important to vaquita conservation: (1) How many vaquitas remain? (2) How much time is left to find a solution to the bycatch problem? and (3) Are further abundance surveys or bycatch estimates needed to justify the immediate removal of all entangling nets from the range of the vaquita? Our answers are, in short: (1) there are about 150 vaquitas left, (2) there are at most 2 years within which to find a solution, and (3) further abundance surveys or bycatch estimates are not needed. The answers to the first two questions make clear that action is needed now, whereas the answer to the last question removes the excuse of uncertainty as a delay tactic. Herein we explain our reasoning.

Studio dell'energy saving negli impianti farmaceutici: soluzioni ottimali per il ricircolo dei fluidi di processo

Questa tesi si pone il problema di studiare lo stato dell’arte degli impianti di produzione farmaceutici e di formulare, in base ai risultati ottenuti, uno o più possibili ipotesi di recupero d’energia, con particolare attenzione ai fluidi termo-vettori: in altri termini, questa tesi si prefissa l’obiettivo di realizzare un sistema utile e concreto per recuperare parte dell’energia termica, che nell'attuale concezione dell’impianto e dei suoi macchinari andrebbe smaltita e persa nei fluidi in uscita dal processo, e convertirla in energia riutilizzabile. Come modello per lo studio del problema, si fa riferimento a un tipico layout di produzione del farmaco, progettato e dimensionato dalla ditta IMA S.p.A. , settore Active, il quale entra come “materiale grezzo” ed esce come prodotto finito. L’azienda concepisce e progetta tipicamente le sue macchine e, di conseguenza, i suoi impianti in base alla quantità di prodotto che mediamente ogni ciclo produttivo lavorerà: in parole povere, gli impianti della divisione Active di IMA S.p.A. sono dimensionati e suddivisi per “taglie”.

Saving morality: Why we cannot, and why we must

Philosophers and laymen alike have often used morality to invite misconceptions of human life into ethics, and also of ethics into human life. The Kant/Williams discourse provides a rich backdrop on which to consider these misconceptions. But the misconceptionsof morality involved are just as numerous and just as serious. One thing that the Kant/Williams discourse shows is this: that ethics can be neither contained by nor cultivated without morality. Though much of Williams’ critique of Kantian morality is quite astute, thephilosophical and ethical wisdoms of morality abound in spite of these. Morality understands the fundamental condition of moral loss, and the sometimes irreducible quandaries that this condition places human beings in. It understands the nature of the moral law, and theintricacies that the levels of letter and spirit invite into human life. Perhaps more importantly, it understands the uncompromising relationship between moral loss and moral law, and how the human navigation of this relationship leads into the ethical realm via giving rise to ethical conviction. Finally, for all of its pressures, morality abounds in valuable wisdoms for the one discovering that the human soul occupies a place of ethical significance in the world. It is responsible for pointing out, grounding and providing a framework for some of the most fundamental truths about the world and human beings; and these are essential to any viable ethical theory and sensible conception of human life.

Daily organ tracking in intensity-modulated radiotherapy of prostate cancer using an electronic portal imaging device with a dose saving acquisition mode

BACKGROUND AND PURPOSE: Daily use of conventional electronic portal imaging devices (EPID) for organ tracking is limited due to the relatively high dose required for high quality image acquisition. We studied the use of a novel dose saving acquisition mode (RadMode) allowing to take images with one monitor unit per image in prostate cancer patients undergoing intensity-modulated radiotherapy (IMRT) and tracking of implanted fiducial gold markers. PATIENTS AND METHODS: Twenty five patients underwent implantation of three fiducial gold markers prior to the planning CT. Before each treatment of a course of 37 fractions, orthogonal localization images from the antero-posterior and from the lateral direction were acquired. Portal images of both the setup procedure and the five IMRT treatment beams were analyzed. RESULTS: On average, four localization images were needed for a correct patient setup, resulting in four monitor units extra dose per fraction. The mean extra dose delivered to the patient was thereby increased by 1.2%. The procedure was precise enough to reduce the mean displacements prior to treatment to < o =0.3 mm. CONCLUSIONS: The use of a new dose saving acquisition mode enables to perform daily EPID-based prostate tracking with a cumulative extra dose of below 1 Gy. This concept is efficiently used in IMRT-treated patients, where separation of setup beams from treatment beams is mandatory.

Introduction of a novel dose saving acquisition mode for the PortalVision aS500 EPID to facilitate on-line patient setup verification

In external beam radiotherapy, electronic portal imaging becomes more and more an indispensable tool for the verification of the patient setup. For the safe clinical introduction of high dose conformal radiotherapy like intensity modulated radiation therapy, on-line patient setup verification is a prerequisite to ensure that the planned dosimetric coverage of the tumor volume is actually realized in the patient. Since the direction of setup fields often deviates from the direction of the treatment beams, extra dose is delivered to the patient during the acquisition of these portal images which may reach clinical relevance. The aim of this work was to develop a new acquisition mode for the PortalVision aS500 electronic portal imaging device from Varian Medical Systems that allows one to take portal images with reduced dose while keeping good image quality. The new acquisition mode, called RadMode, selectively enables and disables beam pulses during image acquisition allowing one to stop wasting valuable dose during the initial acquisition of "reset frames." Images of excellent quality can be taken with 1 MU only. This low dose per image facilitates daily setup verification with considerably reduced extra dose.

Structured training in intraosseous infusion to improve potentially life saving skills in pediatric emergencies - Results of an open prospective national quality development project over 3 years

BACKGROUND: Children in emergencies need peripheral intravenous (IV) access in order to receive drugs or fluids. The success of IV access is associated with the age of patients and fails in up to 50% of children younger than 6 years. In such situations, it is essential that physicians and paramedics have a tool and easily learnable skills with a high chance of success. According to international guidelines intraosseous (IO) access would be the next step after failed IV access. Our hypothesis was that the success rate in IO puncturing can be improved by standardizing the training; so we developed an IO workshop. METHODS: Twenty-eight hospitals and ambulance services participated in an evaluation process over 3 years. IO workshops and the distribution of standardized IO sets were coordinated by the study group of the University Hospital of Berne. Any attempted or successful IO punctures were evaluated with a standardized interview. RESULTS: We investigated 35 applications in 30 patients (a total of 49 punctures) between November 2001 and December 2004. IO puncture was not successful in 5 patients. The success rate depended neither on the occupation nor the experience of users. Attendance at a standardized IO workshop increased the overall success rate from 77% to 100%, which was statistically not significant (P = 0.074). CONCLUSIONS: Standardized training in IO puncturing seems to improve success more than previous experience and occupation of providers. However, we could not show a significant increase in success rate after this training. Larger supranational studies are needed to show a significant impact of teaching on rarely used emergency skills.