Car Travel Research Articles

Improving inpatient and daycare admission estimates with gravity models

AbstractGrowing healthcare costs have been accompanied by increased policymakers’ interest in the efficiency of healthcare systems. Network formation by hospitals as a vehicle for consolidation and achieving economies of scale has emerged as an important topic of conversation among academics and practitioners. Within networks, consolidation of particular specialties or entire campuses is expected and encouraged to take place. This paper describes the main findings of an effort to build gravity-type models to describe patient choices in inpatient and daycare hospital facilities. It analyzes the distance decay effects as a function of car travel times and great-circle distance, and it offers a method for inclusion of university hospitals. Additionally, it reviews the impact of driving and transit accessibility on hospital attraction and reviews the differences in distance decay for patient age groups and hospitalization types. In the described application, the best models achieve a Mean Absolute Percentage Error of around 10% in non-metropolitan areas, and 14.5% across different region types. Results in metropolitan areas suggest that latent factors unrelated to proximity and size have a significant role in determining hospital choices. Furthermore, the effects of relative driving and transit accessibility are found to be small or non-existent.

Which Mode Will Be Effective in a Massive Evacuation?

The earthquake which struck Eastern Japan in 2011 caused many casualties. The ratio of the mode of evacuation in areas damaged by the earthquake varied depending on geographical conditions, but cars were the primary mode in many areas. Although the Japanese government has provided guidelines to assist evacuation during a natural disaster, the disaster in 2011 demonstrated that the behavior of refugees did not adhere to these guidelines. This study analyzes refugees’ behavior during evacuations using a dataset gathered through surveys of refugees in 2011. By analyzing their evacuation speed and distance based on their geographical conditions, the necessary distance and available distance for their evacuation are calculated in this study, following which an optimized distance for evacuation is derived. Analyzing various modes of evacuation, such as walking, bicycling, and car travel, this study identifies thresholds for an efficient mode of evacuation based on evacuation distance. In conclusion, this study finds that a walking-based evacuation plan is necessary in most areas, whereas vehicles are required in areas where it is impossible to evacuate by walking.

Making urban travel sustainable: Travel reductions are needed

Many cities around the world are aiming to be zero emission or environmentally sustainable, particularly cities in the Economic Cooperation and Development (OECD) countries. This paper contributes to the literature by using a systems approach to argue for a wider view, not only for the full range of deleterious effects of urban transport in a given city itself, but also for its impact on possibly distant locations that supply transport inputs and receive its waste products. The paper uses the published literature to first examine the various adverse effects of urban travel, and then to critically evaluate the proposed technology-based solutions. The main finding is that all these solutions are found wanting to some extent, especially given the limited time frame available; hence, for urban sustainability, large travel reductions are thus needed. It then looks at a very different approach: reductions in urban vehicular travel, particularly by car. Four approaches considered (changing urban land-use, reducing private vehicle travel convenience, introducing carbon taxes, using information technology as a travel substitute), This paper concludes that various measures for decreasing the convenience of car travel, such as by cutting speed limits and parking spaces, as being the most equitable in OECD cities, and potentially capable of rapid implementation.

Flying Cars and Hyperloops?

Despite the traditional science fiction scenario, few really expect a proliferation of flying cars in 2050. But it's hard to find a prediction of transportation for the middle of this century that does not hinge on a combination of electric vehicles driving themselves around. Yet is this less ambitious picture also likely to be inaccurate? Despite the promises made by governments to transform the world of car travel, 2050 probably will not look that different from today at the global level and that goes for many other aspects of travel beyond just cars. One clear obstacle to change is that vehicles have a long useful life. Though commercial fleet owners tend to replace vehicles after five years to avoid rising repair costs, private owners will still buy them and keep them running for far longer.

How do pandemics affect intercity air travel? Implications for traffic and environment

This paper investigates how a pandemic affects the distribution of traffic between public and private transport and the emissions from the transport sector. By assuming that there exists higher health risk of traveling in public transport than in private transport and using air transport and private cars as examples, we find the following results. First, the effects of a pandemic on the traffic volumes of airline services and private cars depend crucially on, for instance, the willingness-to-pay of travelers, the degree of substitution between transport modes, the demand-side network effect (via schedule delays), and the supply-side network effect (via the economies of traffic density). In particular, heterogeneous effects of the pandemic on the traffic volumes and flight frequencies of different airline services are found. Second, the total transport-related CO2 emissions decrease after the pandemic if the CO2 emissions per air traveler (or per flight) are sufficiently high, or the degree of substitution between airline services and private cars is sufficiently low. Third, numerical examples on the change in price of car travel and the introduction of high-speed rail show consistent insights. Finally, several policy implications are discussed.

Estimate of the reduced travel and CO2 emissions through utilisation of video software in a remote pharmacist-led outpatient lipid clinic

Abstract Introduction Since the 2008 Climate Change Act, the NHS has a net zero national target.1 Using Pathway Transformation Funding supported by Academic Health Scienced Network North East North Cumbria, a pathway for a pharmacist-led lipid clinic was developed, utilising video software for consultations and a homecare medicines delivery service. The two manufacturers of PCSK9i also have Net Zero carbon policies. Aim The objective of this sub-analysis was to estimate number of miles of travel associated with initiation and ongoing treatment with PCSK9i medication for the remote outpatient clinic model compared with traditional face-to-face model. The study did not require ethics approval. Methods 50 patients from the PCSK9i caseload were reviewed in March 2022. Distance from home to Trust site was determined and travel estimated for the first and subsequent years. An assumption was made that patients travelled from and returned to home address by car. Delivery of medication to the patient’s home was made by a Homecare company and they estimated 4 miles travelled per delivery vs. 12.2miles from patient home to hospital. Patient experience scores for the traditional outpatient model for PCSK9i therapy and the novel pathway utilising remote consultations and homecare delivery of medication were compared. Ethical approval was not required for this service evaluation. Results The traditional face-to-face lipid clinic model involved 7 visits to hospital, comprising initial assessment (1 visit) and collection of medication (6 visits) for the first 12 months of therapy. The second and subsequent years of PCSK9i therapy were assumed for 4 visits to hospital for collection of medicines only. For the 50 patients sampled, the mean distance from home to hospital site was 12.2miles (range 0.4-56 miles). Emissions were calculated using an average CO2 emissions per car in the UK as 221.4 grams per mile.2 For each patient, switching to remote consultations and homecare medicines delivery reduced the total year 1 travel from 171 miles of patient car journeys to 24 miles of homecare medicines delivery. Year 2 and subsequent years would similarly reduce from 98 miles to 16 miles for deliveries. Patient experience scores for previous years of the traditional face-to-face model were compared. Based on the limited responses available there was no negative impact on how patients rated the service following changes. Additional questions on the process of booking and joining the virtual consultation were rated as excellent. Discussion/Conclusion Over a 5-year period, PCSK9i therapy using a remote clinic with homecare delivery of medicines reduces car journeys by 473 miles per patient and CO2 emissions by 105 kg.2 This is more than the equivalent distance travelling from Newcastle to Cornwall. Although estimates of travel factor in the associated miles of homecare delivery travel, they do not account for patients who would use public transport, thereby overestimating the miles driven by car. This may be balanced in assumptions underestimating the number of variations to the minimum appointment schedule, such as following intolerance for medication. No negative impact was seen on patient experience scores when compared to the traditional face-to-face model.

Mode substitution and carbon emission impacts of electric bike sharing systems

This paper presents a quantitative analysis of the mode substitution and usage-phase carbon emission impacts of the electric bike-sharing system (EBSS) on urban transportation using self-administrated survey data and EBSS operating data. The substitution probabilities of a given EBSS trip for different transport modes is determined using the Bayesian inference method. Emission impact is measured by comparing the current emissions to those generated by other transport modes without the EBSS. Remarkably, the partial-trip substitution impact of the EBSS on car travel is investigated, where the EBSS serves as a connection to public transit. The results show that the EBSS barely generates new trips; most short-distance EBSS trips were transferred from walking and conventional bike-sharing, and most long-distance trips were shifted from cars, buses, and the subway. Around 5% of EBSS trips less than 2 km were transferred from the car by integrating with public transit while accounting for over half of the emission reduction. Based on our method, the CO2 emissions per km of EBSS are 19.47 g, with 6.91 g generated by e-bikes due to electricity consumption and 12.56 g by trucks for battery swapping and bike relocation. The studied EBSS has saved 75.52% of CO2 emissions that other transport modes could have generated.

Abstract A050: Analysis of methods to improve engagement of under-represented and socioeconomically deprived patients in clinical research

Abstract The current under-representation of racial and ethnic minorities and socio-economically disadvantaged participants in clinical trials represents an important problem, because it reduces generalizability of trial results and should urgently be addressed in all diseases. Decentralized trials may improve engagement of under-represented populations with long-standing health disparities and may be relevant to patients with pancreatic cancer who would benefit from at home trial participation. We completed a fully decentralized randomized double-blind phase II clinical trial in New York State for participants with mild-to-moderate COVID-19. Electronic data were collected for 28 days (5 vital readings and 1 survey with 20 questions per day) from 55 non-hospitalized participants. Home monitoring devices, HIPAA compliant data submission technology, and internet access were provided free-of-charge. We enrolled 40% White, 33% Black or African American and 27% Other/Mixed/Unknown participants. Of these, 25% self-identified as Hispanic or Latino. This exceeded national and New York state averages of minority populations, in contrast with the current clinical trial landscape. We found that the local area within a 30-minute return car journey from our main research hospital disproportionately over-represented socio-economically advantaged white inhabitants. We found that decentralization enabled the inclusion of participants living up to a 2-hour journey from this hospital in socio-economically deprived geographies with higher minority race representation. We excluded selection bias, by demonstrating that our trial population represented the differences of social deprivation observed between races at the national and state level (p = 0.003). In addition to trial enrollment, completeness of trial data has an important impact on the veracity of trial results. Half our participants were assigned a dedicated team member to make telephone call reminders if participants had not submitted data by mid-day despite of a pre-ceding automated notification to the supplied electronic device. Daily telephone follow-up significantly reduced missing electronic data in participants living above the median deprivation index (submitted data per day 4 out of 6 vs 6 out of 6: p = 0.03), thereby aiding equitable data collection from traditionally under-represented participant groups. Our findings require further validation and refinement from multiple centers and expansion to patients with reduced mobility and cachexia due to progressing pancreatic cancer. Also, other factors such as language assistance and recruitment methods, need to be addressed in clinical trials to mitigate against their negative impact on equitable recruitment. Nevertheless, for now we identify decentralization combined with engagement telephone calls as readily actionable methods to improve inclusion of under-represented participants in clinical trials. Citation Format: Hassal Lee, Alexander Shakeel Bates, Richard Dima, Sandeep Nadella, Nicole Jordan-Martin, Christina Brennan, Tobias Janowitz. Analysis of methods to improve engagement of under-represented and socioeconomically deprived patients in clinical research [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A050.

Making and breaking links: the transformative potential of shared mobility from a practice theories perspective

Shared mobility has the potential to contribute to the transition to a more sustainable mobility system. However, the environmental impacts and the extent of proliferation of the various shared mobility practices differ considerably. It is problematic that the most widespread practice—free-floating carsharing—shows the least environmental potential. Thus, the question arises as to why some shared mobility practices proliferate more readily than others. This paper studies this question from a practice theoretical perspective, focusing on how practices link or do not link with one another. It analyses how various shared mobility practices, as well as the practice of private car travel, connect to other practices via spatial-material and temporal links. The analysis explains why private car travel and, to a lesser degree, free-floating carsharing integrate relatively easily into everyday life, while other forms of shared mobility struggle to do so. This observation leads to the need for far-reaching interventions, both in the making of links of sustainable practices but also in the breaking of links of unsustainable practices. This paper scrutinizes this issue in an anticipatory and theory-based manner and offers suggestions on how to refine practice theoretical concepts regarding inter-practice connections.

Proposal for an Institutional Carpooling System among Workers from the Public-Education Sector

Car journeys to work represent a high percentage of daily mobility. Carpooling can be an efficient alternative for managing this transport demand. Carpooling benefits are not limited to reducing emissions and energy consumption: users can also benefit in the reduction in travel costs and travel time using high-occupancy vehicle lanes, as well as reducing commuting stress. The organization of such a system is not easy to carry out individually. Institutions and companies with a high number of employees are suitable for carpooling initiatives, and the education sector holds a high number of workers. Considering the large number of teachers and the fact that many of them are regular drivers, the sector presents an opportunity to design a formal carpooling transport system. This paper presents the design of a proposal for a carpooling system among workers from the education sector in the region of Andalusia, Spain. The system yielded relevant benefits such as cost savings, emissions reductions, and a high number of potential users. The designed system can potentially improve transport conditions for workers in commuting displacements and reduce occupational traffic accidents.

Will leisure trips be more affected than work trips by autonomous technology? Modelling self-driving public transport and cars in Stockholm, Sweden

• Enhancing the public transport service had only a marginal effect on ridership, except for rural areas where the impact was greater. • Leisure and service trips were more impacted by self-driving technology than commuting trips. • Walking and bicycling declined across all modelled scenarios. Self-driving technology may lead to a paradigm shift for the transport industry with shared cars available to every-one. However, this vision has increasingly been challenged as too optimistic and unsubstantiated. In this study we explore societal impacts of using this technology for both cars and public transport and investigate differences depending on geography and trip purpose. Four scenarios were designed through workshops with 130 transport experts, modelled using a conventional four-step model for Stockholm, Sweden and evaluated in terms of changes to mode choice, number of trips and person kilometres. We find larger increases for non-commuting trips, i.e. service and leisure trips, than for commuting trips, questioning the view of the ‘productive work trip’ as self-driving technology’s main impact on society. As these trips are primarily made outside of rush hours, this may lead to a changed transport system. Geographic differences are substantial and heavily dependent on the cost model for car alternatives, even indicating a reduction in car travel in rural areas if private ownership would be replaced by shared cars. Furthermore, walking and cycling levels decreased in all scenarios while enhancing public transport using self-driving technology had a limited impact on ridership. These results show that the impacts of self-driving technology may have varied societal impacts even within a region and may lead to increased car travel, especially off-peak. These conclusions stress the need for policies that are sensitive to both geography and time.

Changes in diet and physical activity after a pilot intervention to tackle childhood obesity in a deprived inner-London community: an observational cohort study

BackgroundLocal authorities in England are uniquely positioned to modify obesogenic local environments contributing to childhood obesity. Evaluating the effects of local authority-led, community-wide approaches is challenging. This study examines changes in diet and physical activity in children aged 6–11 years after a 4-year, complex, community-based, pilot intervention in Golborne, one of the most deprived areas in London. MethodsThe Go-Golborne intervention aimed to shape the local environment by building on local assets, connecting stakeholders in local government and the community, and synchronising existing activities. Activities focused on six themes to make changes to local environments and reduce the consumption of sugary snacks and beverages, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually in 2016–19, from children from six local schools. Results were compared with the data collected at baseline. We used multilevel, linear (for dietary outcomes), and logistic (for physical activity) random-slope regression models to examine changes in diet and physical activity by time on study, adjusting for baseline age, sex, ethnicity, deprivation quintile, school, and baseline weight status. Dietary outcomes were calculated by summing the total occasions a participant indicated they ate or drank a certain food or drink (reported as portions per day, expressed as a β coefficient). The physical activity outcomes were developed by creating six binary variables to distinguish those who were most active from those who were least active. Findings1650 children (mean age 7·9 years [SD:1·6]; 808 [49%] girls and 842 [51%] boys) were included. After 3 years of follow-up, we noted reductions in sugary beverage consumption (adjusted β –0·43 portions [95% CI –0·55 to –0·32]; p<0·0001) and car travel to and from school (adjusted odds ratio [OR] 0·19 [95% CI 0·06 to 0·66]; p<0·0001), whereas screen time increased (high vs moderate or low; 2·30 [1·36 to 3·90]; p=0·0021). For other dietary and physical activity outcomes, no evidence of changes and no variation by subgroups were noted. InterpretationLocal authorities can make changes to the obesogenic environment, and mixed results from the Go-Golborne intervention show that collaboration is possible between academics, local authorities, and the community, highlighting the need for robust intervention design in real-world settings, where the need for practical community interventions are met alongside academic rigour. FundingRoyal Borough of Kensington and Chelsea. CB is funded by the School for Public Health Research of the National Institute for Health and Care Research (grant reference PD-SPH-2015). CJ is partly funded by Public Health at the Royal Borough of Kensington and Chelsea and by the National Institute for Health and Care Research Applied Research Collaborative. The views expressed are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.

Exploring the Relationship between Built Environment and Commuting Mode Choice: Longitudinal Evidence from China.

The literature has offered much evidence regarding associations between the built environment (BE) and commuting behavior. However, most prior studies are conducted based on cross-sectional samples from developed countries, and little is known about the longitudinal link between BE and commuting behavior. Based on two rounds of survey data from China, this study examines relationships of BE with commuting mode choice from both cross-sectional and longitudinal perspectives. The effects of life-cycle events are considered within a unified framework. Results of the longitudinal examination of BE and commuting mode shift largely support the cross-sectional analysis. Specifically, promoting more balanced land use and improving residential density are important for car use reductions and active travel initiatives. Meanwhile, more balanced land use improves the probability of commuting by motorcycle and electric bike, but reduces the probability of commuting by public transit. This study also highlights the remarkable role played by life-cycle events in affecting commuting mode shifts.

IMPLEMENTATION OF FREE STUDENT TRANSPORT POLICY IN THE CITY OF BANJARBARU

School or student transportation services is one form of special service management in the City of Banjarbaru. Since the launch of the Free Student Transport Program (APG) by the Mayor of Banjarbaru, the people of the City of Banjarbaru have been warmly welcomed, especially parents of students. However, this did not last long because their child was forced to return to using a motorbike. After all, the students were not transported by the free transportation provided by the Banjarbaru City Government. As a result, APG in Banjarbaru City has not run optimally until now. So it is necessary to know the needs, support, and constraints that affect the implementation of the Free Student Transport Policy. This study aims to analyze the community's needs, government and community support, and the obstacles that affect the implementation of the APG policy in the City of Banjarbaru. This research method uses qualitative methods through collecting data with the stages of observation, data reduction, data presentation, concluding, and interviews. The implementation of APG in Banjarbaru City does not provide safety insurance. There are two doors in the APG, a car type with student entry and exit; the door is still manual or cannot close automatically. The APG seat has a safety belt but is not used by students because the passengers exceed the capacity. The car (Travel A), the passenger seat facing left and right, does not have a safety belt (Track B); in the APG, there is no handle grip (hanging handle). In the operation of the APG, it is operated by one driver, and there is no other security/assistant officer. Unlike the bus type APG, all facilities are complete, the level of comfort and safety is guaranteed. The operation of APG is exclusively for the students.

A New Transit Safety Narrative

Public transportation is, overall, a relatively safe (low crash risk) and secure (low crime risk) transport mode. Transit travel has about one-tenth the traffic casualty (injury or death) rate as automobile travel, and residents of transit-oriented communities have about one-fifth the per capita crash casualty rate as in automobile-oriented communities. Transit also tends to have lower overall crime rates than automobile travel, and transit improvements can help reduce overall crime risk by improving surveillance and economic opportunities for at-risk populations. Despite its relative safety and security, many people consider transit travel dangerous and are reluctant to use it or support service expansions in their communities. Various factors contribute to this excessive fear, including the nature of transit travel, heavy media coverage of transit-related crashes and crimes, and conventional traffic safety messages that emphasize danger rather than safety. Transit agencies can help create a new transit safety narrative by better communicating transit’s overall safety and security impacts and providing better guidance concerning how users and communities can enhance transit safety and security.

An Evaluation of Comprehensive Transit Improvements—TriMet’s Streamline Program

Transit performance is influenced by a variety of factors in an urban environment. Making transit more convenient and competitive with automobile travel is a key objective for the Tri-County Metropolitan Transportation District of Oregon (TriMet). TriMet’s goal is to have a “Total Transit System” that makes transit an attractive choice for riders. Portland’s Streamline program has been a significant effort toward meeting these goals. The program has resulted in operating and capital cost savings for TriMet by delaying the need to add more buses to the fleet as well as operating savings due to reductions in running time variability. Further, the way the program was implemented resulted in a greater increase in ridership than would have been achieved had the service increases been spread more evenly around the system, confirming that the BRT approach serves transit agencies effectively by concentrating improvements on corridors.

Terrorism, Transit and Public Safety: Evaluating the Risks

This paper evaluates the overall safety of public transit, taking into account all risks, including recent terrorist attacks. It indicates that transit is an extremely safe mode, with total per-passenger-mile fatality rates approximately one-tenth that of automobile travel. It is important for individuals and public officials to avoid overreacting to terrorist threats in ways that increase overall danger. Transit terrorism would cause more total casualties and harm to society if individuals respond to attacks by shifting from public transit to less safe modes, or if decision makers respond by reducing support for public transit.

Using explainable machine learning to understand how urban form shapes sustainable mobility

Municipalities are increasingly acknowledging the importance of urban form interventions that can reduce intra-city car travel in achieving more sustainable cities. Current academic knowledge for supporting such policies falls short in providing the spatial details required to plan specific interventions. Here, we develop an explainable machine learning framework to identify location-specific relevance of built environment for urban motorised travel, using a sample of 3.5 million car commutes over one year in Berlin and high-resolution urban form data. Results demonstrate that subcenters play a vital role in reducing commuting-related travel distance, giving support to the 15-minute city hypothesis. Observed threshold effects of induced CO 2 emissions require low-carbon-policies targeted towards densifying the inner city while releasing peripheral low income communities from car dependence. This research provides a starting point for increasingly rich big data analyses of urban form for creating low-carbon and inclusive urban planning strategies. • Subcenters in Berlin are vital to reduce commuting distances. • CO 2 inducing threshold effects require densification of the inner city. • Peripheral low-income communities necessitate release from car dependence. • Identification of location-specific urban form effects on car travel using SHAP values.

CATHETER-DIRECTED THROMBECTOMY OF A SADDLE PULMONARY EMBOLUS

CATHETER-DIRECTED THROMBECTOMY OF A SADDLE PULMONARY EMBOLUS

One step closer towards a greener NHS: decommissioning of piped nitrous oxide manifolds

Background: Nitrous oxide (N2O) is a widely used anaesthetic gas that is both a powerful greenhouse agent with 298 times the global warming potential of carbon dioxide (CO2)1 and detrimental to the ozone layer. According to NHS Lothian recent investigations, massive N2O leakage from piped manifold systems has been highlighted.2 One simple solution is to decommission N2O manifolds, with small N2O cylinders on the anaesthetic machines reserved for occasional usage. Hence, this project is initiated at Perth Royal Infirmary (PRI) with the goal of decommissioning the piped N2O manifold facility to meet the NHS Scotland Zero N2O emission by year 2027. Methods: A survey was conducted among all anaesthetists in PRI Anaesthetic department to evaluate their N2O usage preference and feasibility of decommissioning the piped N2O manifold. The N2O supply data provided by the pharmacy team was over a period of 10 months for the year 2021–22. To quantify the clinical usage at PRI, we captured the cumulative N2O usage over a 20-day period, using the data obtained from the service mode on each anaesthetic machine. From there, we extrapolated and calculated the annual estimated supply, usage, and wastage amount. Results: From the survey, all anaesthetists reported that their N2O usage is very low. Seventy-one percent of anaesthetists have decreased N2O usage over the past 5 yr, and there are no objections to the decommissioning of the piped N2O manifold. Based on our calculations, only 5475 L N2O are estimated to be consumed as opposed to 126 890 L supplied per annum. This demonstrates that as much as 96% or 121 415 L N2O are wasted. Financially, this is equivalent to 13.5 size G N2O cylinders worth £3145 per annum. To put into perspective, this corresponds to 64 964 kg CO2 equivalent emission or a staggering 541 366 km of car travel. Conclusions: We found significant wastage of N2O, unnecessary long-term financial expenditure, and adverse consequences to planetary health that could all be prevented. Our next step is to execute the plan of decommissioning piped N2O manifolds in accordance with the interim protocol for decommissioning set by the Scottish Government. Although this is a small step towards a greener sustainable future, multidisciplinary efforts from all related departments are essential in making this vision a reality. Eventually, re-audit will be carried out to evaluate the outcome of this action before rolling this improvement plan out to all sites within NHS Tayside. 1.Myhre G, Shindell D, Breon FM, et al. Anthropogenic and natural radiative forcing. In: IPCC Fifth Assessment Report. 2013.2.Chakera A, Fennell-Wells A, Allen A. Nitrous oxide project: piped nitrous oxide waste reduction strategy. Association of Anaesthetists, 2021 Jan 15. Available from: https://anaesthetists.org/Home/Resources-publications/Environment/Nitrous-oxide-project.