Cassandra L. Thiel

Life Cycle Assessment Perspectives on Delivering an Infant in the US

This study introduces life cycle assessment as a tool to analyze one aspect of sustainability in healthcare: the birth of a baby. The process life cycle assessment case study presented evaluates two common procedures in a hospital, a cesarean section and a vaginal birth. This case study was conducted at Magee-Womens Hospital of the University of Pittsburgh Medical Center, which delivers over 10,000 infants per year. The results show that heating, ventilation, and air conditioning (HVAC), waste disposal, and the production of the disposable custom packs comprise a large percentage of the environmental impacts. Applying the life cycle assessment tool to medical procedures allows hospital decision makers to target and guide efforts to reduce the environmental impacts of healthcare procedures.

Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States

The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching

Carbon footprint and cost-effectiveness of cataract surgery.

2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system.

Infrastructures as socio-eco-technical systems: Five considerations for interdisciplinary dialogue

Purpose of review This article raises awareness about the cost–effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery. Recent findings As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical persons life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option. Summary Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.

Life Cycle Assessment as a tool for Improving Service Industry Sustainability

Infrastructure plays a key role in 21st century sustainability challenges related to burgeoning populations, increasing material and energy demand, environmental change, and shifts in social values. Social and political controversy over infrastructure decision making will continue to intensify without robust interdisciplinary and intersectoral dialogue over national-scale and local-scale infrastructure trajectories. Alongside large investments in physical and social systems, the infrastructure community—including planners, engineers, public works specialists, financiers, and sustainability scientists—needs to articulate a 21st century vision addressing the interrelated technological, social, and environmental dimensions of infrastructure systems. Such a vision needs to address existing systems in the industrialized world and new systems in countries seeking to improve human welfare through infrastructure development. Infrastructure systems—discussed here as primarily those integrating the built environment (Jones et al. 2001; Pulselli et al. 2007), transportation (Greene and Wegener 1997), power generation and distribution (Jacobson and Delucchi 2009), food production and processing (Food and Agriculture Organization of the United Nations 2011), manufacturing (Jovane et al. 2008), water delivery (Gleick 2003; Muller et al. 2015; Palmer et al. 2015), and waste treatment (Melosi 2008)—underpin the unprecedented material wealth of contemporary human society. These technological systems have developed alongside extensive social infrastructure including specialized knowledge and expertise housed in institutions, informal knowledge systems of operation and maintenance, and a broader system of governance and regulatory politics setting budgetary priorities, policy directions, and regulatory certainty. In combination with these policy processes, user behavior and demographic change influence the demand and maintenance costs for infrastructure services, both of which have an identified overall investment need of

Evaluating the Life Cycle Environmental Benefits and Trade-Offs of Water Reuse Systems for Net-Zero Buildings

3.6 trillion (ASCE 2013),

Minimal Custom Pack Design and Wide-Awake Hand Surgery: Reducing Waste and Spending in the Orthopedic Operating Room

2 trillion of which is needed by 2027 (ASCE 2017). Because infrastructure relies on environmental inputs to function, channels and protects society from environmental forces, and impacts environmental systems, attitudes about technology and appropriate human–nature relationships set the goals for long-term infrastructure sustainability. They do so through both a social willingness to pay for infrastructure systems and a social consciousness of and desire for specific types of systems. Shifting environmental conditions, including climatic changes and dispersed atmospheric pollutants, are exacerbated by the externalities of present infrastructure systems and the technologies they support. The extent of these shifts is rarely apparent until systems become overwhelmed (Gross 2010; Perrow 1999). For example, in the case of Hurricane Sandy, siloed system management created unforeseen vulnerabilities propagating through critical infrastructure systems (Klinenberg 2013, Comes and Van de Walle 2014), serving as an example of cascading failure (Rinaldi et al. 2001), as well as affecting system restoration (Sharkey et al. 2015). At the same time, infrastructure systems and the technologies and behaviors they enable serve as sources of risks and costs to public and environmental health; 8 of 10 people now live in urban areas with excessive air pollution primarily due to transport, manufacturing, and energy generation (WHO 2016). How has contemporary infrastructure practice come to this point? The modern infrastructure ideal of large, networked systems such as power generation, information technology, and transport (Dueñas-Osorio et al. 2007; Haimes and Jiang 2001;

Strategies to Reduce Greenhouse Gas Emissions from Laparoscopic Surgery

The ideas of corporate citizenship and sustainable development have demonstrated that corporations have a larger role than simply generating a profit. Some corporations have begun to evolve by including the principles of sustainable development and the triple bottom line into their growth and development plans. Promoting social well-being, minimizing environmental degradation, as well as maximizing economic profitability, is quickly becoming common practice.

Waste generated during glaucoma surgery: A comparison of two global facilities

Aging water infrastructure and increased water scarcity have resulted in higher interest in water reuse and decentralization. Rating systems for high-performance buildings implicitly promote the use of building-scale, decentralized water supply and treatment technologies. It is important to recognize the potential benefits and trade-offs of decentralized and centralized water systems in the context of high-performance buildings. For this reason and to fill a gap in the current literature, we completed a life cycle assessment (LCA) of the decentralized water system of a high-performance, net-zero energy, net-zero water building (NZB) that received multiple green building certifications and compared the results with two modeled buildings (conventional and water efficient) using centralized water systems. We investigated the NZBs impacts over varying lifetimes, conducted a break-even analysis, and included Monte Carlo uncertainty analysis. The results show that, although the NZB performs better in most categories than the conventional building, the water efficient building generally outperforms the NZB. The lifetime of the NZB, septic tank aeration, and use of solar energy have been found to be important factors in the NZBs impacts. While these findings are specific to the case study building, location, and treatment technologies, the framework for comparison of water and wastewater impacts of various buildings can be applied during building design to aid decision making. As we design and operate high-performance buildings, the potential trade-offs of advanced decentralized water treatment systems should be considered.

Attitude of US obstetricians and gynaecologists to global warming and medical waste

Background: The US health care sector has substantial financial and environmental footprints. As literature continues to study the differences between wide-awake hand surgery (WAHS) and the more traditional hand surgery with sedation & local anesthesia, we sought to explore the opportunities to enhance the sustainability of WAHS through analysis of the respective costs and waste generation of the 2 techniques. Methods: We created a “minimal” custom pack of disposable surgical supplies expressly for small hand surgery procedures and then measured the waste from 178 small hand surgeries performed using either the “minimal pack” or the “standard pack,” depending on physician pack choice. Patients were also asked to complete a postoperative survey on their experience. Data were analyzed using 1- and 2-way ANOVAs, 2-sample t tests, and Fisher exact tests. Results: As expected, WAHS with the minimal pack produced 0.3 kg (13%) less waste and cost