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Main Authors:	Daniel A. Carson, Ali Hooshyari, Jesse Gale, Greg Evans, Flavio V. Ordones, Lodewikus P. Vermeulen
Format:	Artículo Open Access
Published:	Wiley 2025
Subjects:	BJUI Compass
Online Access:	https://bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.70063
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The carbon footprint of transperineal prostate biopsy Daniel A. Carson Ali Hooshyari Jesse Gale Greg Evans Flavio V. Ordones Lodewikus P. Vermeulen BJUI Compass AbstractObjectiveTo evaluate the carbon footprint of transperineal prostate biopsy (TPPB). Climate change is the biggest global public health threat of the 21st century. Healthcare contributes 5% to global greenhouse gas emissions. Despite growing enthusiasm for sustainable urology, there is little data on the environmental impact of urological practice.Patients and methodsEmissions associated with TPPB (under local anaesthesia) at a hospital in Aotearoa New Zealand were estimated from electricity consumption, procurement of equipment/supplies, travel of staff and patients, waste disposal and sterilisation of linen. Emissions coefficients were used to determine CO2 equivalents (kgCO2e) emitted.ResultsTPPB was associated with 70 kgCO2e of emissions per case. This equates to 280 km of travel by car, or an economy seat on a 70‐minute flight. The largest contributors were procurement (76%) and travel (23%). Electricity, waste disposal and sterilisation of linen did not contribute significantly to emissions (cumulatively <1.5%).ConclusionsThis is the first study to evaluate the carbon footprint of a TPPB. Emissions were derived mostly from procurement and travel. These may be mitigated by review of standardised equipment packs, transitioning to reusables and introducing outreach biopsy clinics. Adherence to pragmatic evidence‐based guidelines for prostate cancer may reduce emissions associated with overdiagnosis and unnecessary biopsies. Further research is required to characterise the broader environmental impact of urology services. 10.1002/bco2.70063 http://creativecommons.org/licenses/by/4.0/

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// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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