Nitrous oxide splurge in a tertiary health care center and its environmental impact: No more laughing stock.

Background: Nitrous oxide has been an integral part of surgical anesthesia for many years in the developed world and is still used in developing countries such as India. The other main concerns in low-resource countries are the lack of an advanced anesthesia gas-scavenging system and modular surgical theatres. As a greenhouse gas that has been present in the atmosphere for more than 100 years and damages the ozone layer, nitrous oxide is three times worse than sevoflurane. Here, we conducted an observational study to quantify the annual nitrous oxide consumption and its environmental impact in terms of carbon dioxide equivalence in one of busiest tertiary health care and research centers in Northern India. Methods: Data related to nitrous oxide expenditure' from the operation theatre and manifold complex of our tertiary care hospital and research center from 2018 to 2021 were collected monthly and analyzed. The outcomes were extracted from our observational study, which was approved by our institutional ethics board (INT/IEC/2017/1372 Dated 25.11.2017) and registered prospectively under the Central Registry (CTRI/2018/07/014745 Dated 05.07.2018). Results: The annual nitrous oxide consumption in our tertiary care hospital was 22,081.00, 22,904.00, 17,456.00, and 18,392.00 m3 (cubic meters) in 2018, 2019, 2020, and 2021, respectively. This indicates that the environmental impact of nitrous oxide (in terms of CO2 equivalents) from our hospital in 2018, 2019, 2020, and 2021 was 13,016.64, 13,287.82, 10,289.94, and 10,841.24 tons, respectively. Conclusion: This huge amount of nitrous oxide splurge is no longer a matter of laughter, and serious efforts should be made at every central and peripheral health center level to reduce it.

Conflict of interest and disclosure policies in psychiatry and medicine: a comparative study of peer-reviewed journals.

OBJECTIVE: The authors reviewed and characterized conflict of interest (COI) and disclosure policies published in peer-reviewed psychiatric and nonpsychiatric journals. METHODS: The authors examined peer-reviewed publications in the psychiatric (N=20) and nonpsychiatric (N=20) literature. Using qualitative and quantitative approaches, they designed an instrument to compare COI and disclosure policies appearing in print or journal websites between January and May 2009. RESULTS: All journals published COI/disclosure policies that were accessible in print and online. There was substantial variability in policies, but little variability appeared to be field-specific. Psychiatric journals were more likely to request "complete" disclosure, and nonpsychiatric journals to request "relevant" disclosure, but medical journals tended to provide more detailed information about what could constitute a potential conflict and asked for broader, potentially relevant funding sources. Nonpsychiatric journals were more likely to give examples in their policies. Psychiatric journals were more likely to publish disclosures. CONCLUSION: This preliminary study suggests that there are discrepancies in the disclosure and COI information that journals request from authors. By and large, such discrepancies are not substantially different between psychiatric and nonpsychiatric journals. Challenges in codifying COI policies and creating standardized approaches across periodicals and across disciplines may reflect ongoing debates about what exactly constitutes a COI, what needs to be disclosed, and who is responsible for disclosing. Further study is warranted into how journals convey COI policies and how such policies can be optimized.

Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador observational study: time series analysis.

BACKGROUND: This study documented elevated rates of emergency room (ER) visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000. METHODS: We abstracted 5169 (43% females) ER records with primary respiratory conditions treated from January 1-December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), and asthma-related conditions in boys and girls for three age groups: 0-4, 5-9, and 10-15 years. RESULTS: At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER) visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively). The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]). Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460]) additional ER visits due to respiratory conditions. CONCLUSION: The study has demonstrated strong relationship between ash exposure and respiratory effects in children.