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

A novel combinatorial strategy using Seliciclib (R) and Belinostat (R) for eradication of non-small cell lung cancer via apoptosis induction and BID activation

10.1016/j.canlet.2016.07.023CANCER LETTERS381149-57NETHERLAND

NASA's OCA Mirroring System: An Application of Multiagent Systems in Mission Control

Orbital Communications Adaptor (OCA) Flight Controllers, in NASA's International Space Station Mission Control Center, use different computer systems to uplink, downlink, mirror, archive, and deliver files to and from the International Space Station (ISS) in real time. The OCA Mirroring System (OCAMS) is a multiagent software system (MAS) that is operational in NASA's Mission Control Center. This paper presents OCAMS and its workings in an operational setting where flight controllers rely on the system 24x7. We also discuss the return on investment, based on a simulation baseline, six months of 24x7 operations at NASA Johnson Space Center in Houston, Texas, and a projection of future capabilities. This paper ends with a discussion of the value of MAS and future planned functionality and capabilities