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

Symbolic Decision Procedures for QBF

Much recent work has gone into adapting techniques that were originally developed for SAT solving to QBF solving. In particular, QBF solvers are often based on SAT solvers. Most competitive QBF solvers are search-based. In this work we explore an alternative approach to QBF solving, based on symbolic quantifier elimination. We extend some recent symbolic approaches for SAT solving to symbolic QBF solving, using various decision-diagram formalisms such as OBDDs and ZDDs. In both approaches, QBF formulas are solved by eliminating all their quantifiers. Our first solver, QMRES, maintains a set of clauses represented by a ZDD and eliminates quantifiers via multi-resolution. Our second solver, QBDD, maintains a set of OBDDs, and eliminate quantifier by applying them to the underlying OBDDs. We compare our symbolic solvers to several competitive search-based solvers. We show that QBDD is not competitive, but QMRES compares favorably with search-based solvers on various benchmarks consisting of non-random formulas