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

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

Extracting interpersonal stance from vocal signals

Item does not contain fulltextThe role of emotions and other affective states within Human-Computer Interaction (HCI) is gaining importance. Introducing affect into computer applications typically makes these systems more efficient, effective and enjoyable. This paper presents a model that is able to extract interpersonal stance from vocal signals. To achieve this, a dataset of 3840 sentences spoken by 20 semi-professional actors was built and was used to train and test a model based on Support Vector Machines (SVM). An analysis of the results indicates that there is much variation in the way people express interpersonal stance, which makes it difficult to build a generic model. Instead, the model shows good performance on the individual level (with accuracy above 80%). The implications of these findings for HCI systems are discussed.MA3HMI 2018: Fourth International Workshop on Multimodal Analysis enabling Artificial Agents in Human-Agent Interaction, Boulder, CO, USA, October 16 - 20, 201

Development of a Natural Convection Benchmark - Experimental and Numerical Analysis of Natural Convection Heat Transfer of a Cuboid in an Enclosure

This research focuses on the development of a benchmark on the basis of which Computational Fluid Dynamics codes can be validated. The geometry consists of a heated copper element, which is placed inside a perspex box. A numerical model of this geometry should ideally show a one-to-one correspondence with reality. By natural convection an axisymmetric, buoyant plume develops above the heated element. The numerical model is used to predict the behaviour of this plume. The vertical velocity of the rising air is measured by means of a laser Doppler anemometer and the temperature in the plume is determined by a temperature probe. The behaviour of the plume is compared to literature

Oordeelsvorming bij initiële cijferanalyse in de accountantscontrole

Oordeelsvorming bij initiële cijferanalyse in de accountantscontrol

The impact of organ-at-risk contour variations on automatically generated treatment plans for NSCLC

Background and purpose: Quality of automatic contouring is generally assessed by comparison with manual delineations, but the effect of contour differences on the resulting dose distribution remains unknown. This study evaluated dosimetric differences between treatment plans optimized using various organ-at-risk (OAR) contouring methods.Materials and methods: OARs of twenty lung cancer patients were manually and automatically contoured, after which user-adjustments were made. For each contour set, an automated treatment plan was generated. The dosimetric effect of intra-observer contour variation and the influence of contour variations on treatment plan evaluation and generation were studied using dose-volume histogram (DVH)parameters for thoracic OARs.Results: Dosimetric effect of intra-observer contour variability was highest for Heart D-max (3.4 +/- 6.8 Gy) and lowest for Lungs-GTV D-mean (0.3 +/- 0.4 Gy). The effect of contour variation on treatment plan evaluation was highest for Heart D-max (6.0 +/- 13.4 Gy) and Esophagus D-max (8.7 +/- 17.2 Gy). Dose differences for the various treatment plans, evaluated on the reference (manual) contour, were on average below 1 Gy/1%. For Heart D-mean, higher dose differences were found for overlap with PTV (median 0.2 Gy, 95% 1.7 Gy) vs. no PTV overlap (median 0 Gy, 95% 0.5 Gy). For D-max-parameters, largest dose difference was found between 0-1 cm distance to PTV (median 1.5 Gy, 95% 4.7 Gy).Conclusion: Dose differences arising from automatic contour variations were of the same magnitude or lower than intra-observer contour variability. For Heart D-mean, we recommend delineation errors to be corrected when the heart overlaps with the PTV. For D-max-parameters, we recommend checking contours if the distance is close to PTV (<5 cm). For the lungs, only obvious large errors need to be adjusted. (C) 2021 The Authors. Published by Elsevier B.V

Evaluation of measures for assessing time-saving of automatic organ-at-risk segmentation in radiotherapy

BACKGROUND AND PURPOSE: In radiotherapy, automatic organ-at-risk segmentation algorithms allow faster delineation times, but clinically relevant contour evaluation remains challenging. Commonly used measures to assess automatic contours, such as volumetric Dice Similarity Coefficient (DSC) or Hausdorff distance, have shown to be good measures for geometric similarity, but do not always correlate with clinical applicability of the contours, or time needed to adjust them. This study aimed to evaluate the correlation of new and commonly used evaluation measures with time-saving during contouring. MATERIALS AND METHODS: Twenty lung cancer patients were used to compare user-adjustments after atlas-based and deep-learning contouring with manual contouring. The absolute time needed (s) of adjusting the auto-contour compared to manual contouring was recorded, from this relative time-saving (%) was calculated. New evaluation measures (surface DSC and added path length, APL) and conventional evaluation measures (volumetric DSC and Hausdorff distance) were correlated with time-recordings and time-savings, quantified with the Pearson correlation coefficient, R. RESULTS: The highest correlation (R = 0.87) was found between APL and absolute adaption time. Lower correlations were found for APL with relative time-saving (R = -0.38), for surface DSC with absolute adaption time (R = -0.69) and relative time-saving (R = 0.57). Volumetric DSC and Hausdorff distance also showed lower correlation coefficients for absolute adaptation time (R = -0.32 and 0.64, respectively) and relative time-saving (R = 0.44 and -0.64, respectively). CONCLUSION: Surface DSC and APL are better indicators for contour adaptation time and time-saving when using auto-segmentation and provide more clinically relevant and better quantitative measures for automatically-generated contour quality, compared to commonly-used geometry-based measures