Connect with us

Spread & Containment

Operating rooms are the climate change contributor no one’s talking about

In April 2021, during the Leaders Summit on Climate, President Biden announced his goal to drastically reduce the United States’ greenhouse gas emissions…

Published

on

In April 2021, during the Leaders Summit on Climate, President Biden announced his goal to drastically reduce the United States’ greenhouse gas emissions by 2030.

Credit: Jacob Dwyer/Michigan Medicine

In April 2021, during the Leaders Summit on Climate, President Biden announced his goal to drastically reduce the United States’ greenhouse gas emissions by 2030.

Victor Agbafe was watching the address on TV. The University of Michigan Medical School student, who is also studying law at Yale, immediately texted a few mentors, including Michigan Medicine integrated plastic surgery resident Nicholas Berlin, M.D., M.P.H., M.S.

The question that emerged from their messages was a crucial one: What role can the medical community, which accounts for about 8.5% of America’s greenhouse gas emissions, play in these climate change reduction efforts?

A year later, research that Agbafe and Berlin led outlines some answers. Their paper describes how surgery, particularly cancer surgery, contributes to climate change and suggests some solutions to combat the problem, from reducing waste to rethinking how surgical care is delivered.

“In general, these ideas are good for our planet,” Agbafe said. “But also, surgery unfortunately plays a disproportionate role in the carbon output and the waste we produce in medicine.”

Operating rooms are a massive source of greenhouse gas production for hospitals, representing 70% of their waste and generating three to six times as much carbon as the rest of health systems.

Cancer care is an obvious target for greener efforts within surgery, Berlin notes, because it often involves intense levels of care over a short period of time.

Plus, minimally invasive surgeries that require a lot of energy, including robotic-assisted operations, have become common treatments for cancers ranging from colorectal and uterine cancer to head and neck cancer. A robotic-assisted hysterectomy, for example, produces as much carbon as driving more than 2,200 miles in a car — the equivalent of a road trip from Ann Arbor, Mich., to Los Angeles.

“If we can lower our greenhouse gas output, we have a chance to extend the lifespan of our patients and expand access to timely care,” Agbafe said. “And we think it’s really important that the surgical community is proactive at being at that table.”

What to do differently

One of the most feasible changes to make in this space would be around waste reduction, Agbafe said.

This might be as simple as making sure that anything thrown away before or during surgery is properly categorized and labeled since it’s estimated that over 90% of OR waste does not meet the necessary standards for the type of trash it ends up in. (The red waste bags in ORs are intended only for items that have been exposed to bodily fluids and are much more expensive to dispose of than clear disposal bags.)

Hospitals could also consider switching to some reusable or reprocessed devices and surgical gowns since there is no link between reused tools and hospital-acquired infections.

Some of the pair’s other suggestions involve optimizing ORs’ energy use. Agbafe and Berlin point to the American Society of Healthcare Engineering’s recommendations to install energy-efficient lighting, schedule preventive maintenance and minimize air flow into rooms that aren’t being used as easy ways to green the systems.

The surgical supply chain could be more efficient, too, they write. Estimates suggest that 87% of the surgical instruments laid out for an operation are rarely used, so coming up with standardized lists of the necessary tools for surgeries that occur regularly could cut down on cost, waste and the energy needed to sterilize and repackage those instruments.

Moving more manufacturing of surgical supplies closer to hospitals — or choosing to source from suppliers that are locally based — could also reduce the OR’s carbon footprint.

“Given some of the geopolitical events that have been going on right now in Ukraine and with China and the competition there along with the effects of pandemic is creating an increasing emphasis on resiliency within supply chains,” Agbafe said. “So this idea of localizing our operating room supply chains is something that there’s a lot of political energy and momentum within the public to move towards.”

Reimagining care delivery

But perhaps the broadest way the oncology space could cut down on its greenhouse gas emissions is to change how surgical care is delivered, starting with permanently offering telemedicine.

“We think telemedicine is a great opportunity for us to lower the climate impact and improve the quality of care by doing so,” Agbafe said. “During the pandemic, we’ve been using virtual care and if we could make that a routine aspect of cancer care for pre-op and post-op, that’s a way we can reduce the climate impact of delivering care and make it more convenient for patients.”

Reducing low-value care is another way to eliminate carbon-producing activities associated with unnecessary scans, testing and procedures.

This has been a priority for U-M, thanks to the Michigan Program on Value Enhancement — a collaboration of Michigan Medicine and the University of Michigan Institute for Healthcare Policy that aims to improve the quality of care at the institution — and a partnership with the similarly oriented Michigan Value Collaborative, also referred to as MVC, a collaborative quality initiative that serves the entire state.

Last year, the two organizations collaborated on a study that highlighted how much routine testing was still done before surgeries despite its low value. Berlin was the first author.

“U-M is considered one of the leading institutions studying low-value care and efforts to limit that type of care,” Berlin said. “But like a lot of other centers, we are really just at the precipice of these initiatives. I would anticipate big changes in the next 10 years.”

From gas to (more sustainable) gas

Some sustainability shifts may come even sooner at Michigan Medicine.

For instance, the Department of Anesthesiology recently launched the Green Anesthesia Initiative, or GAIA for short. Its mission: become more environmentally conscious about the types and rates of anesthesia its providers use, another area Agbafe and Berlin say is ripe for improvement.

“This is a topic of fairly intense discussion right now in the field, and I’ve been thinking about it for a while,” said George Mashour, M.D., Ph.D., the chair of the Department of Anesthesiology and the Robert B. Sweet Professor of Anesthesiology at the University of Michigan Medical School. “Unlike other industries, I don’t think that we require massive disruption in order to make progress because, fortunately, we have options.”

Several inhaled gases regularly used for anesthesia are A-list offenders when it comes to greenhouse gas production. Nitrous oxide, commonly known as laughing gas, is a greenhouse gas, a direct ozone depleter and does not dissipate from the atmosphere for more than a century after it’s produced.

However, the inhaled anesthetic sevoflurane has much less of an environmental impact than nitrous oxide and other common inhaled agents, so Mashour says it would be a good alternative.

“The overall goal is to shift away from some of these egregious culprits and start making better choices about which drug we use and then also how we use it,” Mashour said.

“The contributions in terms of greenhouse gas effect or ozone-depleting action partly relate to how much is getting pumped out into the atmosphere and that relates directly to how high we have our fresh gas flow,” he added. “If we have, for example, 10 liters going, we’re blowing a lot of anesthetic into the scavenging and waste and atmospheric systems that doesn’t need to be there.”

To that end, Mashour’s colleagues in the Department of Anesthesiology are already leading a national initiative to try to reduce anesthetic gas flow rates through the Multicenter Perioperative Outcomes Group, another quality initiative that includes health centers from across the country.

Mashour plans to roll out other elements of GAIA over a three- to- five-year period.

“We could be doing better,” he said. “Right now, we’re starting the conversations, getting people on board and making structural choices in the department to help make it easy for people to do the right thing.”


Read More

Continue Reading

Spread & Containment

ThreatX raises a fresh round of capital to protect APIs and web apps

ThreatX, a vendor selling API protection services to mainly enterprise clients, today announced that it raised $30 million in a Series B funding round…

Published

on

ThreatX, a vendor selling API protection services to mainly enterprise clients, today announced that it raised $30 million in a Series B funding round led by Harbert Growth Partners with participation from Vistara Growth, .406 Ventures, Grotech Ventures and Access Venture Partners. With the new cash, which brings ThreatX’s total raised to $52 million, CEO Gene Fay tells TechCrunch that ThreatX will “accelerate” investments in platform development while scaling sales and marketing initiatives.

The raise highlights investors’ continued confidence in cybersecurity businesses to net returns, despite the current macroeconomic woes. While there’s some evidence that fundraising has begun to slow down, cybersecurity startups raised $2.4 billion between January and June, according to PitchBook. Companies that defend APIs from outside attack have been particularly fruitful, lately, with startups such as Ghost Security and Corsha raising tens of millions of dollars in capital.

ThreatX was co-founded in 2014 by Bret Settle and Andrius Useckas. Prior to starting ThreatX, Settle was VP of enterprise architecture at BMC; Useckas had worked with Bret at BMC, where he was an enterprise security architect. The two were also colleagues at Corporate Express, which was acquired by Staples in 2008, where Useckas came in as an external pen tester.

“Over the course of working together for several years, Settle and Andrius saw a massive gap in the market in terms of solutions to protect BMC’s application portfolio,” said Fay, who was appointed CEO of ThreatX in 2020. “The products available required endless tuning and rule-writing and returned piles of false positives. Through all of this, the notion of innovating in the space — and ThreatX — was born.”

ThreatX offers API protection, bot and DDoS mitigation and traditional web application firewalls (WAF) for first- and third-party web apps. The platform builds a profile of threat actors, leveraging a detection and correlation engine to show which actors are actively attacking and which might pose the greatest threat.

Image Credits: ThreatX

Fay sees ThreatX competing primarily with two categories of cybersecurity vendors. The first are newer API observability tools such as Salt Security and Noname. The second are bot management platforms like Cequence and WAF players such as Akamai, F5 and Imperva, which generally rely on applying rules-based protection to web apps and APIs.

Fay argues that the former group — the bot management and WAF vendors —  tend to offer capabilities that came together through acquisition, so they’re less integrated. As for the latter — the API observability tools — Fay asserts that they often don’t offer web app or bot protection and require offline analysis, which precludes the ability to block attacks in real time.

“The bottom line is that to protect APIs, you must be able to block attacks in real time,” Fay said. “Grabbing data through observation and analyzing it after the fact may be interesting, but it does little from an immediate security standpoint. For our customers, the number one priority is protection — in real time, all the time. That is the value proposition we offer to our customers.”

Real-time protection or no, it’s true that API attacks are a growing cyber threat. Gartner predicts that by 2022, API attacks will become the most frequent attack vector, causing data breaches for enterprise web software.

“The COVID-19 pandemic accelerated use of APIs as companies looked at how they might provide new services to deliver value — and derive revenue — from customers,” Fay added. “As people — both as consumers and professionals — turned to technology to get more done, reliance on both APIs and web applications grew substantially. That, in turn, has increased the need for security in this context — which presents a ton of opportunity for ThreatX.

While Fay demurred when asked about financials, he said that ThreatX currently has “more than” 100 customers. He declined to name any names.

When reached for comment, Harbert Growth Partners general partner Tom Roberts said in a statement:

APIs are a strategic priority for businesses of all sizes and have become a primary target for threat actors. Organizations are now contending with constant threats and require API and web application protection capabilities that can identify and respond to attacks in real time. This need for “real-time attack protection” is driving the API security market toward an aggressive pivot. Based on ThreatX’s strong customer traction and unique product capabilities, we believe the company is well positioned to meet this shift head-on as a valuable partner to businesses looking to secure their attack surface.

Read More

Continue Reading

Government

CDC Announces Overhaul After Botching Pandemic

CDC Announces Overhaul After Botching Pandemic

After more than two years of missteps and backpedaling over Covid-19 guidance that had a profound…

Published

on

CDC Announces Overhaul After Botching Pandemic

After more than two years of missteps and backpedaling over Covid-19 guidance that had a profound effect on Americans' lives, the Centers for Disease Control (CDC) announced on Wednesday that the agency would undergo a complete overhaul - and will revamp everything from its operations to its culture after failing to meet expectations during the pandemic, Bloomberg reports.

Director Rochelle Walensky began telling CDC’s staff Wednesday that the changes are aimed at replacing the agency’s insular, academic culture with one that’s quicker to respond to emergencies. That will mean more rapidly turning research into health recommendations, working better with other parts of government and improving how the CDC communicates with the public. -Bloomberg

"For 75 years, CDC and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations," said Director Rochelle Walensky. "I want us all to do better and it starts with CDC leading the way.  My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication and timeliness."

As Bloomberg further notes, The agency has been faulted for an inadequate testing and surveillance program, for not collecting important data on how the virus was spreading and how vaccines were performing, for being too under the influence of the White House during the Trump administration and for repeated challenges communicating to a politically divided and sometimes skeptical public."

A few examples:

Walensky made the announcement in a Wednesday morning video message to CDC staff, where she said that the US has 'significant work to do' in order to improve the country's public health defenses.

"Prior to this pandemic, our infrastructure within the agency and around the country was too frail to tackle what we confronted with Covid-19," she said. "To be frank, we are responsible for some pretty dramatic, pretty public mistakes — from testing, to data, to communications."

The CDC overhaul comes on the heels of the agency admitting that "unvaccinated people now have the same guidance as vaccinated people" - and that those exposed to COVID-19 are no longer required to quarantine.

Tyler Durden Wed, 08/17/2022 - 12:22

Read More

Continue Reading

Spread & Containment

#EmptyOldTrafford: why Manchester United’s attempt to recruit global fans may be backfiring

Social media calls for a boycott of the club’s upcoming match against Liverpool seem to mostly becoming from outside the UK.

Published

on

United fans are calling for a stadium boycott – but the majority live thousands of miles from Old Trafford. warasit phothisuk/Shutterstock

After years of underachievement on the field, Manchester United was supposed to bounce back this Premier League season.

But an opening game home defeat to Brighton and Hove Albion, followed by an embarrassing capitulation away at Brentford, has left United bottom of the Premier League, with zero points. This has prompted former club captain Gary Neville to assert that the club has now reached rock bottom.

In protest, fans have taken to social media to call for a boycott of United’s next game, Monday’s home clash against historic rivals Liverpool. Organised around the hashtag #EmptyOldTrafford, many posts take aim at the club’s owners, the Glazer family, who critics accuse of prioritising the club’s commercial activity and global reach over performance on the pitch.

As part of a longitudinal research project monitoring football clubs and social media, we sampled 21,610 tweets featuring the #EmptyOldTrafford hashtag between Saturday 13 August to Monday 15 August 2022. What we found was striking. It appears that a majority of Twitter users encouraging fans not to attend the Liverpool game are based outside the UK and may never even have attended a game at Old Trafford.

This would suggest that the club’s strategy of recruiting fans worldwide for commercial reasons may be backfiring. In building a huge following across the world, United may also have inadvertently cultivated a community of global social media activists intent on influencing how the club is run.

United’s commercial success

Fans, followers and pundits frequently target the blame for United’s descent from greatness at its owners, the Glazers, a family of US sports entrepreneurs who took control of the club in 2005.

The Glazers’ focus on the commercial development of United has seen the club constantly feature towards the top of financial performance and brand valuation league tables. In 2012, it generated US$478 million (£396 million) in revenues, which reached a pre-pandemic peak of US$796 million in 2019.

Such revenues are also a result of the club’s pursuit of overseas fan engagement. This appears to have been very successful. In one study, it was estimated that United has 1.1 billion worldwide fans and followers. In another study, it was identified that the Manchester club has upwards of 170 million followers across all social media platforms. That’s enough to fill Old Trafford 2,292 times.

Thai Manchester United fans
Manchester United is regarded as the world’s most-supported sports team. mooinblack/Shutterstock

Fan frustration

In May 2020, United fans’ frustration about poor results manifested itself in a pitch protest against the Glazers, leading to a home game against Liverpool being postponed. Just last season, fans had also planned mass walkouts during games to express their discontent, but few fans actually left the stadium on these occasions.

This time around, calls for a walkout have been amplified by social media. Our map of accounts using the #EmptyOldTrafford hashtag shows that United fans and followers from a multitude of countries have been calling for people to stay away from the game against Liverpool, including significant clusters in the US, west Africa and India.

A map showing global clusters of twitter activity
The protest hashtag has been used across the world. Wasim Ahmed, Author provided

We themed the tweets according to their content, colour coding them on our map. Some explicitly criticised the owners, while others focused on encouraging loyal fans to join the protest.

A table of the themes grouped by the researchers
We grouped tweets into four main themes. Simon Chadwick, Author provided

Curiously, we noted that of the inflammatory aggressive clusters, the biggest is centred in Nigeria. One reason for this could be that the club has a significant fan base in the west African country, perhaps following its signing-on loan in 2020 of Nigerian international Odion Ighalo. Another reason could be that Nigerian celebrities including Adekunle Gold, Uche Jombo and Mayorkun have ridiculed Manchester United online.

There is a third explanation. It’s possible that Nigerian troll farms are being specifically engaged to spread the #EmptyOldTrafford hashtag, though by whom and for what purpose is unclear. What is clear from our work is that the largest number of Twitter accounts involved in the hashtag were only established this year. That’s often a sign that accounts have been created for a specific purpose.

It could be that fans are joining Twitter with the intention of supporting the protest. Alternatively, one might argue that new users are more vehement in expressing their views about United and the Glazers. But if troll farms have helped the #EmptyOldTrafford hashtag trend on Twitter, it suggests there are some worrying new developments on social media that top football clubs must address.

Pressure on the Glazers

Manchester United fans will be aware that ticket revenue accounts for a tiny proportion of the club’s total income. If the #EmptyOldTrafford protest is successful and the stadium is conspicuously empty for the Liverpool game, it may only serve as a passing embarrassment for the club’s owners.

But a football club with global ambitions is subject to global scrutiny and criticism, especially in the age of social media. A one-off stadium protest may not rattle sponsors and commercial partners, but the ongoing discontent of the global audience they’re trying to reach may well do.

Even if the atmosphere at Monday’s fixture is muted, our findings suggest that United’s global fan base has found its voice. It’s that development, rather than events in Manchester, that may ultimately encourage the club’s owners to address United’s decade-long slide to Premier League mediocrity.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

Read More

Continue Reading

Trending