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

DOE Joint Genome Institute Production Genomics Facility (PGF) Finishing Pipeline

The DOE Joint Genome Institute is an integrated high-throughput sequencing facility which provides high-quality genomic sequences to the scientific community. Currently there are approximately 300 microbial genomes in the JGI production genomics facility (PGF) pipeline in Walnut Creek and to date, 160 have been completely finished. The PGF microbial finishing group is involved in improving the microbial genomic sequences that come directly out of production. The finishing team is responsible for solving misassemblies, closing gaps, improving low-quality areas in the DNA assemblies and submitting high-quality data to the annotation group which in turn submit the sequence to the public domain. The finishing pipeline at PGF starts with resolving DNA repeats using an automated pipeline developed at JGI/PGF. Low quality and gap regions in the assemblies are resolved by directed reactions mainly using primers designed by applying Autofinishing functionality of Consed and other software developed in-house. Finally, manual checks are performed to ensure a minimum consensus phred quality of 30 or above, error rate is less than 1 base per 50,000bp and 2 times coverage throughout the DNA sequence assemblies. The strategies for solving repeats, misassemblies and difficult to finish regions will be further discussed in detail in this poster