Robert Lillywhite

The carbon footprints of home and in-center maintenance hemodialysis in the United Kingdom

Climate change presents a global health threat. However, the provision of healthcare, including dialysis, is associated with greenhouse gas emissions. The aim of this study was to determine the carbon footprints of the differing modalities and treatment regimes used to deliver maintenance hemodialysis (HD), in order to inform carbon reduction strategies at the level of both individual treatments and HD programs. This was a component analysis study adhering to PAS2050. Emissions factors were applied to data that were collected for building energy use, travel and procurement. Thrice weekly in‐center HD has a carbon footprint of 3.8 ton CO2 Eq per patient per year. The majority of emissions arise within the medical equipment (37%), energy use (21%), and patient travel (20%) sectors. The carbon footprint of providing home HD varies with the regime. For standard machines: 4 times weekly (4 days, 4.5 hours), 4.3 ton CO2 Eq; 5 times weekly (5 days, 4 hours), 5.1 ton CO2 Eq; short daily (6 days, 2 hours), 5.2 ton CO2 Eq; nocturnal (3 nightly, 7 hours), 3.9 ton CO2 Eq; and nocturnal (6 nightly, 7 hours), 7.2 ton CO2 Eq. For NxStage equipment: short daily (5.5 days, 3 hours), 1.8 t CO2 Eq; 6 nightly nocturnal (2.1 ton CO2 Eq). The carbon footprint of HD is influenced more by the frequency of treatments than by their duration. The anticipated rise in the prevalence of home HD patients, dialyzing more frequently and for longer than in‐center patients, will increase the emissions associated with HD programs (despite reductions in patient travel emissions). Emerging technologies, such as NxStage, might offer a solution to this problem.

The carbon footprint of a renal service in the United Kingdom

BACKGROUND Anthropogenic climate change presents a major global health threat. However, the very provision of healthcare itself is associated with a significant environmental impact. Carbon footprinting techniques are increasingly used outside of the healthcare sector to assess greenhouse gas emissions and inform strategies to reduce them. AIM This study represents the first assessment of the carbon footprint of an individual specialty service to include both direct and indirect emissions. METHODS This was a component analysis study. Activity data were collected for building energy use, travel and procurement. Established emissions factors were applied to reconcile this data to carbon dioxide equivalents (CO(2)eq) per year. RESULTS The Dorset Renal Service has a carbon footprint of 3006 tonnes CO(2)eq per annum, of which 381 tonnes CO(2)eq (13% of overall emissions) result from building energy use, 462 tonnes CO(2)eq from travel (15%) and 2163 tonnes CO(2)eq (72%) from procurement. The contributions of the major subsectors within procurement are: pharmaceuticals, 1043 tonnes CO(2)eq (35% of overall emissions); medical equipment, 753 tonnes CO(2)eq (25%). The emissions associated with healthcare episodes were estimated at 161 kg CO(2)eq per bed day for an inpatient admission and 22 kg CO(2)eq for an outpatient appointment. CONCLUSION These results suggest that carbon-reduction strategies focusing upon supply chain emissions are likely to yield the greatest benefits. Sustainable waste management and strategies to reduce emissions associated with building energy use and travel will also be important. A transformation in the way that clinical care is delivered is required, such that lower carbon clinical pathways, treatments and technologies are embraced. The estimations of greenhouse gas emissions associated with outpatient appointments and inpatient stays calculated here may facilitate modelling of the emissions of alternative pathways of care.

The Physical, Chemical and Microbial Characteristics of Biodegradable Municipal Waste Derived Composts

A comparative study of the physical, chemical and microbial properties of 12 composts sourced from United Kingdom commercial composting plants was carried out. The aim was to ascertain whether these composts could be used as growing media or for application to agricultural land. The composts were produced from either source segregated biodegradable municipal waste (BMW) or mixed municipal solid waste (MSW). Ten composts contained 100% source segregated BMW including green, fruit, vegetable, meat and kitchen waste, paper and cardboard. One compost was 72% mixed MSW plus 18% source segregated BMW, and one compost was 100% mixed MSW. Composts were analyzed for pH, electrical conductivity, carbohydrates, nutrients and contaminants. The composts sourced from mixed MSW contained higher levels of physical contaminants (glass, plastic and metal) than the source segregated BMW composts. Nitrogen concentrations (as % dry weight) were 1.7-2.2% where kitchen or meat waste was included and 1.0-1.6% otherwise. Phosphorus concentration ranged from 23 to 247 mg kg−1, and K from 1851 to 6615 mg kg−1. Total salts were higher in mixed waste composts (15-23 g kg−1), predominantly due to high concentrations of K, Ca, S and Na. Electrical conductivity varied from 670 μ cm−1 to 3320 μS cm−1. The levels of the heavy metals examined in the 10 source segregated BMW composts were much lower than the limits for composts in the United Kingdom (PAS 100). However, the 100% mixed MSW compost exceeded the PAS 100 levels in four of the seven heavy metals tested (Cu, Ni, Pb and Zn) which may have implications for repeated applications to agriculture. Salmonella was absent from all twelve composts, however, five composts contained levels of E. coli which exceeded the UK PAS 100 limits. Five composts produced from source segregated BMW could be applied to agricultural land, however, high levels of E. coli would exclude the other five. Moreover, high levels of heavy metals and physical contaminants would render the two mixed MSW composts unsuitable.

Chemical characterisation of vegetable and arable crop residue materials : a comparison of methods

Although it is widely recognised that chemical composition controls the patterns of decomposition and N mineralisation of crop residue materials, there has been little agreement as to the nature of the most important chemical fractions. We investigated whether this could be attributed to differences in methodologies employed for chemical characterisation of the lignin and cellulose fractions of plant materials. The cellulose and lignin contents of cauliflower, potato, red beet, Brussels sprouts and wheat crop residues were analysed by a number of contrasting methods. These were forage fibre and forest products analyses, which utilise KMnO4 and H2SO4 respectively to separate the two fractions, and a third method, which employs NaClO2. For all the materials, the forage fibre method gave substantially lower amounts of both lignin and cellulose than the other methods. There was correlation between lignin determined by the different methods. Low recovery of lignin by the forage fibre method was found to arise partly from incomplete delignification by KMnO4. The cellulose contents given by the different methods were highly correlated. However, it was apparent that the forage fibre method underestimated cellulose, since only alpha-cellulose was measured.

The performance of the EU-Rotate_N model in predicting the growth and nitrogen uptake of rotations of field vegetable crops in a Mediterranean environment.

The EU-Rotate_N model was developed as a tool to estimate the growth and nitrogen (N) uptake of vegetable crop rotations across a wide range of European climatic conditions and to assess the economic and environmental consequences of alternative management strategies. The model has been evaluated under field conditions in Germany and Norway and under greenhouse conditions in China. The present work evaluated the model using Italian data to evaluate its performance in a warm and dry environment. Data were collected from four 2-year field rotations, which included lettuce (Lactuca sativa L.), fennel (Foeniculum vulgare Mill.), spinach (Spinacia oleracea L.), broccoli (Brassica oleracea L. var. italica Plenck) and white cabbage (B. oleracea convar. capitata var. alba L.); each rotation used three different rates of N fertilizer (average recommended N1, assumed farmers practice N2=N1+0·3×N1 and a zero control N0). Although the model was not calibrated prior to running the simulations, results for above-ground dry matter biomass, crop residue biomass, crop N concentration and crop N uptake were promising. However, soil mineral N predictions to 0·6 m depth were poor. The main problem with the prediction of the test variables was the poor ability to capture N mineralization in some autumn periods and an inappropriate parameterization of fennel. In conclusion, the model performed well, giving results comparable with other bio-physical process simulation models, but for more complex crop rotations. The model has the potential for application in Mediterranean environments for field vegetable production.

Primary-care-based social prescribing for mental health: an analysis of financial and environmental sustainability

UNLABELLED Aim To assess the effects of a social prescribing service development on healthcare use and the subsequent economic and environmental costs. BACKGROUND Social prescribing services for mental healthcare create links with support in the community for people using primary care. Social prescribing services may reduce future healthcare use, and therefore reduce the financial and environmental costs of healthcare, by providing structured psychosocial support. The National Health Service (NHS) is required to reduce its carbon footprint by 80% by 2050 according to the Climate Change Act (2008). This study is the first of its kind to analyse both the financial and environmental impacts associated with healthcare use following social prescribing. The value of this observational study lies in its novel methodology of analysing the carbon footprint of a service at the primary-care level. METHOD An observational study was carried out to assess the impact of the service on the financial and environmental impacts of healthcare use. GP appointments, psychotropic medications and secondary-care referrals were measured. Findings Results demonstrate no statistical difference in the financial and carbon costs of healthcare use between groups. Social prescribing showed a trend towards reduced healthcare use, mainly due to a reduction in secondary-care referrals compared with controls. The associations found did not achieve significance due to the small sample size leading to a large degree of uncertainty regarding differences. This study demonstrates that these services are potentially able to pay for themselves through reducing future healthcare costs and are effective, low-carbon interventions, when compared with cognitive behavioral therapy or antidepressants. This is an important finding in light of Government targets for the NHS to reduce its carbon footprint by 80% by 2050. Larger studies are required to investigate the potentials of social prescribing services further.

Effect of Five Municipal Waste Derived Composts on a Cereal Crop

Agricultural soils were amended with five mixed feedstock (four source segregated and one mechanical biological treatment) municipal waste derived composts to investigate the effect on a cereal crop over two years. Composts were applied at two rates to contain either 250 or 500 kg nitrogen ha−1 and compared to a control which received no fertilizer. In year one, three of the composts increased barley yield (by up to 21%), compared to the control (no compost and no fertilizer) and two reduced it (by up to 33%). Application of the municipal waste derived compost resulted in greater nitrogen concentration in the grain and 1000 grain weight but reduced nitrogen uptake and yield. Application of composts had no significant effect on levels of lead, nickel and cadmium in the barley grains. Levels of soil potentially toxic elements were not significantly increased by application of the composts. In year two, all composts gave comparable or greater wheat yields in comparison to the control.

The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems

BACKGROUND Climate change is a major global public health priority. The delivery of health-care services generates considerable greenhouse gas emissions. Operating theatres are a resource-intensive subsector of health care, with high energy demands, consumable throughput, and waste volumes. The environmental impacts of these activities are generally accepted as necessary for the provision of quality care, but have not been examined in detail. In this study, we estimate the carbon footprint of operating theatres in hospitals in three health systems. METHODS Surgical suites at three academic quaternary-care hospitals were studied over a 1-year period in Canada (Vancouver General Hospital, VGH), the USA (University of Minnesota Medical Center, UMMC), and the UK (John Radcliffe Hospital, JRH). Greenhouse gas emissions were estimated using primary activity data and applicable emissions factors, and reported according to the Greenhouse Gas Protocol. FINDINGS Site greenhouse gas evaluations were done between Jan 1 and Dec 31, 2011. The surgical suites studied were found to have annual carbon footprints of 5 187 936 kg of CO2 equivalents (CO2e) at JRH, 4 181 864 kg of CO2e at UMMC, and 3 218 907 kg of CO2e at VGH. On a per unit area basis, JRH had the lowest carbon intensity at 1702 kg CO2e/m2, compared with 1951 kg CO2e/m2 at VGH and 2284 kg CO2e/m2 at UMMC. Based on case volumes at all three sites, VGH had the lowest carbon intensity per operation at 146 kg CO2e per case compared with 173 kg CO2e per case at JRH and 232 kg CO2e per case at UMMC. Anaesthetic gases and energy consumption were the largest sources of greenhouse gas emissions. Preferential use of desflurane resulted in a ten-fold difference in anaesthetic gas emissions between hospitals. Theatres were found to be three to six times more energy-intense than the hospital as a whole, primarily due to heating, ventilation, and air conditioning requirements. Overall, the carbon footprint of surgery in the three countries studied is estimated to be 9·7 million tonnes of CO2e per year. INTERPRETATION Operating theatres are an appreciable source of greenhouse gas emissions. Emissions reduction strategies including avoidance of desflurane and occupancy-based ventilation have the potential to lessen the climate impact of surgical services without compromising patient safety. FUNDING None.

Cost and carbon burden of long-acting injections: a sustainable evaluation

Aims and method This study explores the economic cost and carbon footprint associated with current patterns of prescribing long-term flupentixol decanoate long-acting injections. We conducted an analysis of prescription data from a mental health trust followed by economic and carbon cost projections using local and national data. Results A reduction of £300 000 could be achieved across England by improving prescribing behaviour, which equates to £250 per patient per year and 170 000 kg CO2e. These savings are unlikely to be released as cash from the service, but will lead to higher-value service provision at the same or lower cost. Most of these carbon emissions are attributable to the carbon footprint of the appointment – 88 000 kg CO2e (including energy use and materials used) and the overprescribing of medication – 66 000 kg CO2e. Clinical implications Psychiatrists need to review their prescribing practice of long-acting injections to reduce their impact on the National Health Service financial budget and the environment.

Horticulture and the environment

Horticulture interacts with the environment in many different ways. This chapter discusses three aspects: firstly the exploitation and degradation of natural resources (land, water); secondly, the use of, and generation of pollution from, synthetic resources (energy, fertilizer and pesticides); and thirdly, the visual and cultural impact of horticultural infrastructure. Horticultural production, in comparison to other agricultural sectors, occupies a small land area but due to its intensity of production, its environmental impact can be relatively greater. Access to, and management, of water resources is the aspect of greatest concern since loss of water resources, deterioration of water quality and pollution of surface water with pesticide residues, nitrates and phosphates are detrimental to both horticultural production and the wider environment. Land use and acidification are important locally but unlike the emission of greenhouse gases, are less important at the global scale. Intensive horticultural production can be responsible for both environmental and visual pollution but they are generally small-scale in global terms and any adverse impacts should be viewed in the context of the benefits that the industry provides in terms of economics, social employment and improved diets and health.