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Sustainability interventions were implemented at the Royal Brisbane and Women's Hospital (RBWH) following identification of inhaled anaesthetic gases as a target for reducing medical carbon emissions. This quality improvement study assessed and evaluated the impact of sustainability interventions on the environmental and financial cost of inhaled anaesthetic gas use in order to guide future initiatives and research in reducing carbon emissions from healthcare practice.Ethical exemption was granted from the RBWH Research Ethics Committee (EX/2021/QRBW/76078). Usage (bottles) and expenditure for desflurane and sevoflurane from January 2016 to December 2021 were obtained. Global warming potential and carbon dioxide equivalent (CO 2 e) were used to report environmental impact of volatile agents. Methods to estimate this were performed in Excel based on Campbell and Pierce methodology. An Environmental Protection Agency greenhouse gas equivalency calculator was used to convert CO 2 e to equivalent petrol carbon emissions and kilometres travelled by a typical passenger vehicle.The total number of bottles of sevoflurane and desflurane purchased between January 2016 and December 2021 decreased by 34.76% from 1991 to 1299. The number of desflurane bottles purchased decreased by 95.63% from 800 to 35 bottles. The number of sevoflurane bottles purchased increased by 6.13% from 1191 bottles to 1264 bottles. This was achieved by implementing quality improvement interventions such as staff education of desflurane-sparing practices, distribution of posters and progressive removal of desflurane from operating theatres. Total carbon emission from volatile anaesthetics equalled 2326 tonnes CO 2 e. Combined desflurane and sevoflurane emissions decreased by 87.88%. In 2016, desflurane made up 92.39% of the annual CO 2 e, which steadily decreased to 33.36% in 2021. Combined sevoflurane and desflurane usage costs decreased by 58.33%.Substantial reductions in carbon emissions from volatile anaesthetics demonstrate the significant degree to which environmentally sustainable practices have been implemented. Applying desflurane-sparing practice can heavily limit anaesthetic drug expenditure and contribution to environmental waste. This is important given the global health sector's challenge to optimise patient outcomes in the face of global climate change crisis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Research from the United States and Canada suggest that interracial relationships tend to have an elevated prevalence of intimate partner violence (IPV). Among seven extant studies, only one empirically examined speculations in the literature for this relationship. Based on analyses of data from Statistics Canada's 2009 General Social Survey (GSS), Brownridge was not able to fully account for the elevated odds of IPV in interracial relationships. The current study used data on 16,706 Canadians (731 in interracial relationships and 15,975 in noninterracial relationships) from the 2014 iteration of Statistics Canada's GSS to determine whether the risk of IPV in interracial relationships had changed since 2009 and to explore risk factors that may account for the elevated odds of IPV in interracial relationships. Results showed that individuals in interracial relationships faced elevated odds of IPV victimization relative to monoracial relationships in the 5-year reporting period prior to the study (odds ratio [OR] = 2.37; 95% confidence interval [CI] = [1.40, 4.02]; p < .001). This was similar to what Brownridge found in the 2009 GSS data, indicating that the elevated risk of IPV in interracial relationships had remained stable in Canada over a 10-year reporting period. Risk factors from three levels of an ecological model were explored, and logistic multiple regression analyses showed that characteristics of the partner (young age, drug use, and jealous behavior) fully accounted for the significantly elevated odds of IPV victimization in interracial unions. Although the leading speculation for this relationship implicates stressors that are unique to these relationships, the current study suggested that this phenomenon is mostly due to characteristics of individuals with whom those in interracial relationships are more likely to be coupled.

The aim of this work was to review and provide a summary of published literature on the clinical impact of thermal therapy (ie, warm water immersion, traditional sauna bathing, and dry infrared sauna) in patients with heart failure. Medline and Embase database literature searches were conducted, and studies that included measurement of heart failure-related clinical parameters were reviewed. Thermal therapy was found to have a positive impact on key heart failure-related parameters across multiple studies. Significant improvements were noted across a wide scope of heart failure-related parameters in the areas of (1) endothelial function, (2) hemodynamics, (3) cardiac geometry, (4) neurohormonal markers, and (5) quality of life. Of special note, thermal therapy also conveyed a strong antiarrhythmic effect in heart failure patients. The clinical evidence highlights repeatable and compelling data showing that thermal therapy may provide an important and viable adjunct in the treatment of heart failure.