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meantime, I'm going to introduce another speaker who's been brought to us through gusts to whom we are really, really grateful. Alex found over. And who is coming from a little bit of a different perspective today, as he spent the last six years is a vendor in the space of orthopedic was sharing. It's, um, product related ticks. The greening up the operating theater on were really very grateful to Alex for joining us all the way from the US. Thank you ever so much for that were really grateful. Yeah. Let me just share my screen really quick. Here one second. Sorry about that. Cool. Um, can you see the screen? Yes, become. Thank you. Great. Um well, thank you, Juliet. And, um, And again, thank you to the gas organization as well, too, for, um invited me to come speak to you. All is well today to it is a huge honor for me and, um, And as you said, I'm coming from just a slightly different perspective today, but I hope that some of the things that I've seen from the other side of the fence can help impact your practices as surgeons and conditions in the field. Um, before we get going, though, uh, just a quick outline of what I would like to talk about today is just give me a brief break down of my background, um, kind of industry trends on where where things have been going, Um, some opportunity for you to get involved with some Maybe just more tangible, um, things to do. And then also some future things that I've seen that that I think you're promising for the future of surgery. Um, so starting with my background, you'll see, uh, I'll start. I'll start with the end and work my way back. Why does it say vegetarian on there? And what does this have to do with anything? Eso Quick story. Four years ago, as a carnivore traveling around the country and driving 25,000 miles per year for work, I decided to make one small change to reduce my personal carbon footprint. The change was actually easier than I thought, but the impact was much greater than I imagined it would be. Um, what I noticed as I moved away from meat was people would engage me first with ridicule, then with curiosity and in many cases finally action on their part to make it. Let's change themselves. Um, why don't I start telling you about vegetarianism? Know it's not to convert you all. It's It's to say that sometimes even the little list of actions, despite how small they may feel to you, have a lasting impact on those around you and can actually shake more change than drastic measures. Um, now to my clinical background, a little different than those on this call, I am not a trained clinician. But I have spent the past six years working for orthopedic company called Arthrex. My job entail supporting surgeries on a daily basis and constantly working with operating theaters in the U. S. In my six years with arthritis, I saw growing trend by many industry leaders, including my own towards single use plastic products, um, with MAWR and more moving away from reusable goods. Whether these were in common T notices, screws used almost daily or a new Nana scope cameras all we're moving away from re use and into one time use. This growing trend drove me mad and let me to dig into this a bit further to see if there could be any solutions available. Um, so over the past, over the last 30 years, the medical industry and largely the surgical feeder has moved some of it's most commonly used goods to plastic for form for related safety and cost savings. Um, from the safety side, research does support this trend as it is reduced the risk of transitions of things like HIV, hep, A, B and C and most importantly, CJD. Our crude felt Jacobs disease, while the use of plastics for certain items can have active, justify for one time use you to risk of infection. Other common good such a zombie wraps for trays, caps and gowns, one time use anchor systems and even kidney bulls, which are used almost every surgery. I have no real basis for their transition of plastic form. Most of this development in one time use can be attributed to mystery influence, as capitalization has led the drive for less reusable and move through continual replacement are you? So when when you look at it from the cost perspective, you could argue as well that money has been saved in one time. Use items that do cost sometimes 1/10 or 1/20 overall cost of reusable goods. But one must look at the full cycle and not just the initial transaction costs. Yes, one time plastics can be cheaper initially, but fourth cycle, they can produce more than a save, both economically and environmentally. Currently, when you look at the NHS, then it's just produces or 600,000 tons of medical waste each year. And of that, 130,000 tons of that is plastic waste. But yet only 5% is said to be recycled. Right now, the cost of disposal for this waist is upwards of 73 million lbs each year, which then goes on to landfills that are now becoming more full and forcing many in the industry to start burning. These items, which nearly brings more health risks, risks back to society in the form of poor air quality. So you see, the cost is not not a good metric for moving to more plastic. It is a metric for movie more product when the benefits few in the form of industry in harm's way more in the form of economics and lasting environmental impact. So what we actually do about it we have heard this Our whole lives reduce, reuse, recycle. But today I'm gonna argue some of the ways to, um more so reduce and reuse. And when necessary, I would say recycle. And I know we've heard some great talks on recycling, which is fantastic A well, but I think on the, um, next point, So I'll show you that, um maybe reducing reuse is also ah, great way to to, um, reduce. This is well and And you do this, I think, most importantly through the voice that you have a surgeon's and as clinicians in this room to really speak and use that voice that's powerful in the operating theater. So I mentioned earlier blue wraps this year, a study came out from I'm gonna miss pronounce her name. But Frida see and eggman produce that they use the study of the US where they found that each year 115 million kg up the wrap is wasted in the US alone. The blue wrap is a multi layer nonwoven packaging material made a polyp or plain ah plastic that is actually quite stable to be recycled into other forms. Such a Z dishware, containers and clothing Viber. Um, the issue with the wrap is twofold. One. The recycling of this material is really being done, or it's being done improperly, leading to be wrapped, making up nearly 11.5% of all medical waste in surgical care. More importantly, the eagle cost associated with the wrap comes mostly from its production, contributing 88% of its total. Ekoko just before it ever reaches the facility it serves, meaning even when recycled after the major cost, the environment have already been established, making recycling less impactful than one might think. There There is a solution, though. In the same study, the authors brought to light the use of reusable, rigid sterilization containers, or RSC's, which are a fancy way of saying metal containers. Um, these RSC's have a net 85% less equal cost than that of blue wrap. They congenitally be used up to 10,000 cycles as opposed to a single cycle with the wrap and have a net ICO benefit. After just 68 of the 5th 5000 cycles use by surgeons and, um, conditions like yourselves. Raising your voice is to your surgical coordinator and procurement specialists could lead to major transitions in the front of blue wrap with huge upsides both economically and environmentally. The 2nd 2nd practical area of focus comes in a commonly used items for O. R. Set up the surgeon preference cards, and we've heard a couple talks on this is well, too. But in 2016, a group of researchers at UCSF in California followed their neurology surgical department and found that on average, eat surgery had a wasted product costs of $960. This limited scope study estimated that the recurring cost accounted for $2.9 million a year in wasted products, and this was just one department. Now, um, this study, of course, has some gaps in its scope. But in reality, there many estimations as high as 30% that have been made about the amount of products opened but never used in surgery. This is something I know. I have personally witnessed multiple times as a rep supporting these cases. The solution may be simpler, though then, then thought. While not all products will go on to be used in surgery, paying close attention to the common procedure cards can make a huge impact on the overall wasted goods and surgery. Staff, as you know, uses these as the recipe card to make sure all items are ready and available for surgery when the first incision is made. If the card says it often the opening first thing to avoid any delays, I know time is limited and the solution I am suggesting next will require some more time invested. But setting up a common cadence to review procedure cards on a quarterly or bi annually basis can lead to significant savings in products not used a good ah, good for step. For this could be simply, Just inform your daily staff of your own desire to track and manage these cards with the preference. That preference is that correct? You can ask them to mark items with a highlighter that are not used that are not used but opens and then give that back to back to you at the end of the case. Likely your office manager can collate these items for a better visual, and really, tracking of your items can be made with the combo of both oversight and review. These unused products can be drastically reduced. So, uh, finally, I just want to touch on a couple of cool things. I, in my research, also found kind of exciting for the future ahead. I mentioned it before, but digital preference cards are on the horizon and could bring significant impact. I mentioned that also that time is often the killer of many. Preference is not being updated, but the advance of options are becoming available where all parties, including vendors, have access to change and update these cards so the right things are available and open every time for surgery. Another really cool trend that I found was in medical remanufacturing and, um, working with different systems to to bring down the total amount of goods that have to be produced at one time. Some companies, like Vanguard and Intra Test UK, are rethinking the way we manufacture, read and reprocess are goods. While they have not bridged yet to orthopedics, future is bright for when they do make you sleep and then lastly, um, and more probably most importantly, more surgeon input will ultimately be the driver of many changes induced industries. Missing mission is to gain more surgeon access and more surgeon attention if the voices collectively changed to demand more sustainable products. Industry will respond even if it takes some time, as most Waist is produced before the product is even in the hands of the surgeon surgeons becoming more active, forming discussion groups, leading and leading the charge toward industry players to find more creative ways to reduce overall ICO Impact will ultimately play the largest role in the market as a whole. Um, again, I just want think the gasp organization, um, and yourselves for allowing me to the short opportunity speak a bit more from the vendor perspective and lend some, hopefully practical tips of where to start. I hope you found this helpful, and I've left this last screen with Q r. Take to my information. If you have any desires to continue a conversation about driving down waist from a product perspective. Thank you. Thank you all in. Um, yeah, we'll take any questions you have. That was brilliant. Thank you so much.