Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Evaluation of microbial qPCR workflows using engineered Saccharomyces cerevisiae

Aims: We describe the development and interlaboratory study of modified Saccharomyces cerevisiae as a candidate material to evaluate a full detection workflow including DNA extraction and quantitative polymerase chain reaction (qPCR). Methods and results: S. cerevisiae NE095 was prepared by stable insertion of DNA sequence External RNA Control Consortium-00095 into S. cerevisiae BY4739 to convey selectivity. For the interlaboratory study, a binomial regression model was used to select three cell concentrations, high (4 × 107 cells ml−1), intermediate (4 × 105 cells ml−1) and low (4 × 103 cells ml−1), and the number of samples per concentration. Seven participants, including potential end users, had combined rates of positive qPCR detection (quantification cycle <37) of 100%, 40%, and 0% for high, intermediate, and low concentrations, respectively. Conclusions: The NE095 strain was successfully detected by all participants, with the high concentration indicating a potential target concentration for a reference material. Significance and impact of the study: The engineered yeast has potential to support measurement assurance for the analytical process of qPCR, encompassing the method, equipment, and operator, to increase confidence in results and better inform decision-making in areas of applied microbiology. This material can also support process assessment for other DNA-based detection technologies

On the Parameterized Complexity Of Exact Satisfiability Problems

For many problems, the investigation of their parameterized complexity provides an interesting and useful point of view. The most obvious natural parameterization for the maximum satisfiability problem---the number of satisfiable clauses---makes little sense, because at least half of the clauses can be satisfied in any formula. We look at two optimization variants of the exact satisfiability problem, where a clause is only said to be fulfilled iff exactly one of its literals is set to true. Interestingly, these variants behave quite di#erently. In the case of ResMaxExactSAT, where over-satisfied clauses are entirely forbidden, we show fixed parameter tractability. On the other hand, if we choose to ignore over-satisfied clauses, the MaxExactSAT problem is obtained. Surprisingly

Guard Games on Graphs: Keep the Intruder Out!

A team of mobile agents, called guards, tries to keep an intruder out of an assigned area by blocking all possible attacks. In a graph model for this setting, the guards and the intruder are located on the vertices of a graph, and they move from node to node via connecting edges. The area protected by the guards is an induced subgraph of the given graph. We investigate the algorithmic aspects the guarding problem, which is to find the minimum number of guards sufficient to patrol the area. We show that the guarding problem is PSPACE-hard and provide a set of approximation algorithms. All approximation algorithms are based on the study of a variant of the game where the intruder must reach the guarded area in a single step in order to win. This variant of the game appears to be a 2-approximation for the guarding problem, and for graphs without cycles of length 5 the minimum number of required guards in both games coincides. We give a polynomial time algorithm for solving the one-step guarding problem in graphs of bounded treewidth, and complement this result by showing that the problem is W[1]-hard parameterized by the treewidth of the input graph. We also show that the problem is fixed parameter tractable (FPT) parameterized by the treewidth and maximum degree of the input graph. Finally, we turn our attention to a large class of sparse graphs, including plana

One-Year outcomes and health care utilization in survivors of severe acute respiratory syndrome

Background Severe Acute Respiratory Syndrome (SARS) became a global epidemic in 2003. Comprehensive information on 1-year outcomes and health care utilization is lacking. Research conducted during the SARS outbreak may help inform research planning for future public health emergencies. The objective of this study was to evaluate the 1-year outcomes in survivors of SARS and their family caregivers. Method The study was prospective and observational. We evaluated 117 SARS survivors from Toronto, Ontario. Patients were interviewed and underwent physical examination, pulmonary function testing, chest radiography, a 6-minute-walk test, quality-of-life measures, and self-report of health care utilization. At 1 year, informal caregivers were identified for a survey on caregiver burden. Results The enrolled survivors of SARS were young (median age, 42 years), and most were women (67%) and health care workers (65%). At 1 year after hospital discharge, pulmonary function measures were in the normal range, but 18% of patients had a significant reduction in distance walked in 6 minutes. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) domains were 0.3 to 1.0 SD below normal at 1 year. Of the patients, 17% had not returned to work by 1 year. Fifty-one patients required 668 visits to psychiatry or psychology practitioners. During the SARS epidemic, informal caregivers reported a decline of 1.6 SD below normal on the mental component score of the SF-36. Conclusions Most SARS survivors had good physical recovery from their illness, but some patients and their caregivers reported a significant reduction in mental health 1 year later. Strategies to ameliorate the psychological burden of an epidemic on the patient and family caregiver should be considered as part of future pandemic planning. Severe acute respiratory syndrome (SARS) became a global epidemic in 2003. Most cases were in Asia, and the largest concentration of North American cases occurred in Toronto, Ontario.1 Research efforts during and after the epidemic focused on the epidemiologic features of the illness,1- 2 the detailed characterization of the pathogen,3- 4 the clinical course,5- 10 and the short-term outcomes of the acute disease.11 The longer-term physical and psychological consequences of SARS were not reported until recently. Several investigations of these longer-term outcomes (>6 months) have focused on pulmonary function,12- 14 distance walked in 6 minutes,12 and health-related quality of life (QOL).12- 13 To date, in patients with SARS, there is little information on the pattern of return to work, exercise tolerance, or health care utilization after the SARS episode. Also, there have been no reports to our knowledge on the impact of this acute illness on the family caregiver. The goals of this study were to conduct a comprehensive and family-centered evaluation of the 1-year outcomes in survivors of SARS and their family caregivers