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

The 2014 SIM IT Key Issues and Trends Study

This article presents the major findings from the Society for Information Management\u27s (SIM) 2014 IT Trends Study. Organizations continue to invest in IT to improve operations, reduce costs, and enable business strategies. IT budgets, hiring, and salaries are modestly increasing, and IT executives are cautiously optimistic that this trend will continue into next year. Overall, the Study finds that IT is becoming more strategic and business focused. As organizations become more digitized, their focus is shifting away from tactical and operational IT issues like efficiency, service delivery, and cost reduction to more strategic and organizational priorities like business agility, innovation, the velocity of change in the organization, IT time-to-market, and the value of IT to the business. These trends are confirmed by a corresponding shift in how CIOs are spending their time, how their performance is measured, and the skills that are most important to their success.Click here for the online-only appendix (pdf)

Cross-Tissue Transcriptomic Analysis of Human Secondary Lymphoid Organ-Residing ILC3s Reveals a Quiescent State in the Absence of Inflammation

A substantial number of human and mouse group 3 innate lymphoid cells (ILC3s) reside in secondary lymphoid organs, yet the phenotype and function of these ILC3s is incompletely understood. Here, we employed an unbiased cross-tissue transcriptomic approach to compare human ILC3s from non-inflamed lymph nodes and spleen to their phenotypic counterparts in inflamed tonsils and from circulation. These analyses revealed that, in the absence of inflammation, lymphoid organ-residing ILC3s lack transcription of cytokines associated with classical ILC3 functions. This was independent of expression of the natural cytotoxicity receptor NKp44. However, and in contrast to ILC3s from peripheral blood, lymphoid organ-residing ILC3s express activating cytokine receptors and have acquired the ability to be recruited into immune responses by inflammatory cytokines. This comprehensive cross-tissue dataset will allow for identification of functional changes in human lymphoid organ ILC3s associated with human disease. Bar-Ephraim et al. describe a cross-tissue transcriptional comparison of human ILC3s and show that ILC3s in lymph nodes and spleen share a transcriptional profile that is distinct from that of tonsil ILC3s. Lymphoid organ ILC3s are a substantial pool of resting cells that can be recruited into immune responses upon local activation

Regulatory Science Transparency: Assessment Of Environmental Protection Agency’s Proposed Rule on Strengthening Transparency in Regulatory Science

In its proposed rule, Strengthening Transparency in Regulatory Science, the Environmental Protection Agency (EPA) requires transparency in certain areas of regulatory science. The proposed rule mandates public access to the details of studies that address dose response and models. This paper is the result of a study conducted by graduate students at Georgetown University. The study relied upon a specific process for selecting a small number from an exceptionally large number of responses to study the subject. The evaluation of the responses was largely based on Best Available Regulatory Science (BARS) and Metrics for Evaluation of Regulatory Science Claims derived from BARS. The results of the study indicate that opposition to the EPA's proposed rule is largely based on the claim that its implementation would eliminate key studies that contain confidential data from consideration during the regulatory process. Although the proposed rule would allow exemptions from the public access requirements, there is opposition to making exemptions available at the discretion of the EPA Administrator. The study concluded that a regulatory science process called "controlled transparency" would be a reasonable solution to compliance with transparency requirements while protecting confidential information.https://doi.org/10.21423/jrs-v07moghiss

Single-cell analysis of human non-small cell lung cancer lesions refines tumor classification and patient stratification

International audienceImmunotherapy is a mainstay of non-small cell lung cancer (NSCLC) management. While tumor mutational burden (TMB) correlates with response to immunotherapy, little is known about the relationship between the baseline immune response and tumor genotype. Using single-cell RNA sequencing, we profiled 361,929 cells from 35 early-stage NSCLC lesions. We identified a cellular module consisting of PDCD1+CXCL13+ activated T cells, IgG+ plasma cells, and SPP1+ macrophages, referred to as the lung cancer activation module (LCAMhi). We confirmed LCAMhi enrichment in multiple NSCLC cohorts, and paired CITE-seq established an antibody panel to identify LCAMhi lesions. LCAM presence was found to be independent of overall immune cell content and correlated with TMB, cancer testis antigens, and TP53 mutations. High baseline LCAM scores correlated with enhanced NSCLC response to immunotherapy even in patients with above median TMB, suggesting that immune cell composition, while correlated with TMB, may be a nonredundant biomarker of response to immunotherapy