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Inhaled anesthetics account for a significant portion of the greenhouse gases generated by perioperative services within the healthcare systems. This cross-sectional study aimed to identify knowledge gaps and practice patterns related to carbon dioxide (CO2) absorbents and intraoperative delivery of fresh gas flows (FGF) for future sustainability endeavors. Secondary aims focused on differences in these knowledge gaps based on the level of training. Surveys were distributed at five large academic medical centers. In addition to site-specific CO2 absorbent use and practice volume and experience, respondents at each institution were queried about individual practice with FGF rates during anesthetic maintenance as well as the cost-effectiveness and environmental impact of different volatile anesthetics. Results were stratified and analyzed by the level of training. In total, 368 (44% physicians, 30% residents, and 26% nurse anesthetists) respondents completed surveys. Seventy-six percent of respondents were unaware or unsure about which type of CO2 absorbent was in use at their hospital. Fifty-nine percent and 48% of respondents used sevoflurane and desflurane with FGF ≥1 L/min, respectively. Most participants identified desflurane as the agent with the greatest environmental impact (89.9%) and a greater proportion of anesthesiologists correctly identified isoflurane as a cost-effective anesthetic (78.3%, p=0.02). Knowledge gaps about in-use CO2 absorbent and optimal FGF usage were identified within the anesthesia care team. Educational initiatives to increase awareness about the carbon emissions from anesthesia and newer CO2 absorbents will impact the environmental and economic cost per case and align anesthesia providers toward healthcare decarbonization.

BackgroundPerioperative services contribute up to 70% of the US hospitals' solid waste generation. While surgical textiles are more environmentally friendly than their disposable counterparts, many US institutions have converted to disposable surgical wear in the last few decades. End-users' perception surrounding reusable textiles is currently unknown.MethodsPerioperative staff at the University of California San Francisco (UCSF) were surveyed to assess perceptions of reusable surgical gowns to guide potential implementation. The instrument included eight close-ended questions drawn from prior studies and a free-response section. The survey was piloted before dissemination. Descriptive statistics and qualitative inductive theme analysis were applied.Results205 participants or 19.8% of the workforce responded. 77.6% perceived reusable surgical gowns as better for the environment, while 34.1% were unsure or believed that switching to reusable surgical gowns would increase surgical site infections. If given an option, 39.8% preferred reusable gowns, 30.7% preferred disposable gowns, and 25.4% had no preference. Qualitatively, four themes were identified concerning reusable gowns' 1) functionality and safety, 2) user comfort, 3) environmental concern, and 4) cost, which hindered end-user buy-in. Laundering water utilization in a drought-prone area was of particular concern.ConclusionsWhile most perioperative staff in a US tertiary hospital believed reusable surgical gowns were environmentally friendly, ambivalence towards transitioning to reusable gowns stemmed from uncertainty in reusable textiles' environmental benefits, safety profile, and cost savings. These perceptions may prevent successful implementation of reusable surgical gowns and suggest a need for staff education and context-specific environmental impact analyses.Key messageEnd-user perceptions on transitioning to reusable surgical gowns are mixed and revolve around uncertainty in their environmental benefits, cost, and functionality, which may hinder their successful implementation.

BackgroundInhaled anesthetics in the operating room are potent greenhouse gases and are a key contributor to carbon emissions from health care facilities. Real-time clinical decision support (CDS) systems lower anesthetic gas waste by prompting anesthesia professionals to reduce fresh gas flow (FGF) when a set threshold is exceeded. However, previous CDS systems have relied on proprietary or highly customized anesthesia information management systems, significantly reducing other institutions' accessibility to the technology and thus limiting overall environmental benefit.ObjectiveIn 2018, a CDS system that lowers anesthetic gas waste using methods that can be easily adopted by other institutions was developed at the University of California San Francisco (UCSF). This study aims to facilitate wider uptake of our CDS system and further reduce gas waste by describing the implementation of the FGF CDS toolkit at UCSF and the subsequent implementation at other medical campuses within the University of California Health network.MethodsWe developed a noninterruptive active CDS system to alert anesthesia professionals when FGF rates exceeded 0.7 L per minute for common volatile anesthetics. The implementation process at UCSF was documented and assembled into an informational toolkit to aid in the integration of the CDS system at other health care institutions. Before implementation, presentation-based education initiatives were used to disseminate information regarding the safety of low FGF use and its relationship to environmental sustainability. Our FGF CDS toolkit consisted of 4 main components for implementation: sustainability-focused education of anesthesia professionals, hardware integration of the CDS technology, software build of the CDS system, and data reporting of measured outcomes.ResultsThe FGF CDS system was successfully deployed at 5 University of California Health network campuses. Four of the institutions are independent from the institution that created the CDS system. The CDS system was deployed at each facility using the FGF CDS toolkit, which describes the main components of the technology and implementation. Each campus made modifications to the CDS tool to best suit their institution, emphasizing the versatility and adoptability of the technology and implementation framework.ConclusionsIt has previously been shown that the FGF CDS system reduces anesthetic gas waste, leading to environmental and fiscal benefits. Here, we demonstrate that the CDS system can be transferred to other medical facilities using our toolkit for implementation, making the technology and associated benefits globally accessible to advance mitigation of health care-related emissions.

ObjectiveTo establish a real-time quantitative polymerase chain reaction （PCR） method for rapid and accurate identification of Cronobacter spp. in food samples and artificially contaminated samples.MethodsPrimers and probes were designed based on the conserved region of gyrB of Cronobacter spp. DNA. The method was verified using a specificity test， absolute sensitivity test， relative sensitivity test， and anti-interference test. Detection sensitivity was determined using artificially contaminated samples.ResultsThe method established in this study could specifically amplify seven kinds of Cronobacter spp.， but not the other Enterobacter species closely related to it and other pathogens common in food， suggesting that this method has good anti-interference ability. The absolute sensitivity was 1-10 pg and the relative sensitivity was 103 CFU/mL using Cronobacter sakazakii. It had good anti-interference ability at the genome and culture level. The sensitivity of artificially contaminated samples could reach 100 CFU/mL after incubation at 36 ℃ for 24 h.ConclusionThe real-time PCR method developed in this study is rapid， specific， sensitive， and stable for the detection of Cronobacter spp. in infant formula food samples and can provide technical reference for the detection of Cronobacter spp. in infant formula food.

γ-GeSe has recently emerged as a promising material for electronics and optoelectronics due to its unique band structure and excellent electrical properties. However, controllable growth of γ-GeSe remains a significant challenge. In this work, the controllable growth of γ-GeSe microflakes (MFs) on a mica substrate was reported by vapor phase deposition via a rapid cooling strategy. The screw dislocation-driven growth behavior is confirmed based on systematic characterizations. Our experimental results demonstrate that the stress induced during the rapid cooling process is critical for the controllable synthesis of γ-GeSe MFs and corresponding growth mechanism was proposed. Our work provides a new experimental strategy for the controlled growth of γ-GeSe MFs, which is beneficial for constructing GeSe-based nanoelectronic and optoelectronic devices. [ABSTRACT FROM AUTHOR]

Two-dimensional (2D) transition metal dichalcogenides (TMDs) semiconductors are considered to be promising candidates for extending Moore's law. 2D TMDs with tunable wrinkled nanostructures can effectively modulate their optoelectronic properties. However, the controlled synthesis of large-area TMDs wrinkled nanostructures remains a major challenge. In this work, 2D WSe2 wrinkled nanostructures were prepared on soda-lime glass substrate by ambient pressure chemical vapor deposition based on the thermal mismatch-induced strategy. WSe2 wrinkled nanostructures can be further precisely controlled by adjusting the growth temperature and substrate thickness. In addition, the growth mechanism of WSe2 wrinkled nanostructures was revealed according to systematic experimental characterization. Corresponding results indicate that the photoluminescence and surface potential of WSe2 were associated with wrinkled nanostructures. The controllable synthesis strategy of 2D WSe2 wrinkled nanostructures has been developed, which can provide important experimental and theoretical support for exploring the applications of 2D wrinkled nanostructures in the field of strain sensing, optoelectronics, and nonlinear optical devices. [ABSTRACT FROM AUTHOR]