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

Layout-Aware Scan Chain Reorder for Launch-Off-Shift Transition Test Coverage

Launch-off-shift (LOS) is a popular delay test technique for scan-based designs. However, it is usually not possible to achieve good delay fault coverage in LOS test due to conflicts in test vectors. In this article, we propose a layout-based scan chain ordering method to improve fault coverage for LOS test with limited routing overhead. A fast and effective algorithm is used to eliminate conflicts in test vectors while at the same time restrict the extra scan chain routing. This approach provides many advantages. (1) The proposed method can improve delay fault coverage for LOS test. (2) With layout information taken into account, the routing penalty is limited, and thus the impact on circuit performance will not be significant. Experimental results show that the proposed LOS test method achieves about the same level of delay fault coverage as enhanced scan does, while the average scan chain wire length is about 2.2 times of the shortest scan chain

Scan-Chain Partition for High Test-Data Compressibility and Low Shift Power Under Routing Constraint

The degree of achievable test-data compression depends on not only the compression scheme but also the structure of the applied test data. Therefore, it is possible to improve the compression rate of a given test set by carefully organizing the way that test data are present in the scan structure. The relationship between signal probability and test-data entropy is explored in this paper, and the results show that the theoretical maximum compression can be increased through a partition of scan flip-flops such that the test data present in each partition have a skewed signal distribution. In essence, this approach simply puts similar scan flip-flops in an adjacent part of a scan chain, which also helps to reduce shift power in the scan test process. Furthermore, it is shown that the intrapartition scan-chain order has little impact on the compressibility of a test set; thus, it is easy to achieve higher test compression with low routing overhead. Experimental results show that the proposed partition method can raise the compression rates of various compression schemes by more than 17%, and the average reduction in shift power is about 50%. In contrast, the increase in routing length is limited