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

Clinical and pathological aspects of multicentric hemangiosarcoma in a Pinscher dog

A 3-year-old female Pinscher dog was presented with a history of lameness and pain in hind limbs for one week which acutely progressed to non-ambulatory paraparesis. The dog had been apathetic and anorexic during the six days prior to presentation. The neurological findings were compatible with upper motor neuron signs to the left hind limb due to a spinal cord compressive mass on the twelfth thoracic vertebral body. On the other hand, signs of lower motor neurons to the right hind limb were due to a mass with a pathological fracture in the right proximal femur, compressing the sciatic nerve. A histopathological analysis of all organs revealedthe proliferation of endothelial cells showingin filtrative growth and organization into vascular structures with a solid pattern. In addition, immunohistochemycal analysis revealed low proliferation index and citoplasmatic positivity for CD-31, confirming the vascular nature of the neoplasm. Clinical, histopathological and immunophenotipical findings were consistent with hemangiosarcoma

Clinical and pathological aspects of multicentric hemangiosarcoma in a Pinscher dog Sinais neurológicos multifocais devido ao hemangiossarcoma multicêntrico em um cão Pinscher: aspectos clínicos e patológicos

A 3-year-old female Pinscher dog was presented with a history of lameness and pain in hind limbs for one week which acutely progressed to non-ambulatory paraparesis. The dog had been apathetic and anorexic during the six days prior to presentation. The neurological findings were compatible with upper motor neuron signs to the left hind limb due to a spinal cord compressive mass on the twelfth thoracic vertebral body. On the other hand, signs of lower motor neurons to the right hind limb were due to a mass with a pathological fracture in the right proximal femur, compressing the sciatic nerve. A histopathological analysis of all organs revealedthe proliferation of endothelial cells showingin filtrative growth and organization into vascular structures with a solid pattern. In addition, immunohistochemycal analysis revealed low proliferation index and citoplasmatic positivity for CD-31, confirming the vascular nature of the neoplasm. Clinical, histopathological and immunophenotipical findings were consistent with hemangiosarcoma.Uma cadela Pinscher de três anos de idade foi atendida em Hospital Veterinário Escola com histórico de dor nos membros pélvicos com progressão aguda para paraparesia não ambulatória. O animal estava apático e anoréxico há seis dias. Os achados neurológicos foram compatíveis com sinais de lesão de neurônios motores superiores para o membro pélvico esquerdo devido a uma massa no 12º corpo vertebral comprimindo a medula espinhal. Por outro lado, foram observados sinais de lesão de neurônios motores inferiores para o membro pélvico direito devido a uma fratura patológica no colo proximal do fêmur direito que comprimiu o nervo isquiático. Análises histopatológicas de todos os órgãos revelaram proliferação de células endoteliais com crescimento infiltrativo e organização sólida em estruturas vasculares. Adicionalmente, a análise imuno-histoquímica revelou baixa proliferação e marcação citoplasmática positiva para CD-31, confirmando a natureza vascular da neoplasia. Os achados clínicos, histopatológicos e imuno-histoquímicos foram consistentes com hemangiossarcoma

Parâmetros de degradabilidade potencial da matéria seca e da proteína bruta das silagens de seis genótipos de sorgo (Sorghum bicolor (L.) Moench), com e sem tanino no grão, avaliados pela técnica in situ Potential degradability parameters of the dry matter and crude protein of six sorghum silage genotypes (Sorghum bicolor (L.) Moench), with or without tannin on grain, evaluated by in situ technique

Para testar o efeito da presença de tanino no grão sobre os parâmetros de degradabilidade potencial da matéria seca e da proteína bruta de seis genótipos de sorgo para silagem, foi conduzido um experimento utilizando a técnica da degradabilidade in situ. Quatro novilhos canulados no rúmen, alimentados individualmente, duas vezes ao dia ad libitum com feno de Tifton 85, foram utilizados para a incubação de silagens de sorgo no estádio de grão leitoso, pertencentes a seis genótipos: BR 303, BR 304, BR 601e AG 2006 (sem tanino no grão); BR 700 e BR 701 (com tanino). Foram incubadas 5 g de amostra nos tempos de incubação: 6, 12, 24, 48, 72 e 96 horas. O tempo zero (t0) foi utilizado para cálculo da fração solúvel. A presença do tanino reduziu a extensão de degradação da matéria seca e da proteína bruta nas silagens de sorgo BR 700 e BR 701. As degradabilidades potenciais destes nutrientes foram influenciada pelo tanino. Não foi observado efeito depressivo do tanino sobre as taxas de degradação para nenhum nutriente, em nenhuma silagem testada.<br>The aim of this experiment was to evaluate the effect of tannin on grain over potential degradability parameters of the dry matter and crude protein of six sorghum silage genotypes by in situ technique. It was used four crossbred steers, canulated in rumen, fed ad libitum twice at day with a diet comprised by Cynodon dactylon hay. Six sorghum silage genotypes, harvested at milk stage, were incubated in the rumen: BR 303, BR 304, BR 601, and AG 2006 (without tannin on grain); BR 700, and BR 701 (with tannin on grain). Five grams of samples were incubated at times: 6, 12, 24, 48, 72, and 96 hours. The time zero (t0) was used to calculate the soluble fraction. Tannin decrease the extent of degradation of dry matter and crude protein of BR 700 and BR 701 sorghum silages. The potential degradabilities of these nutrients were reduced by tannin presence on grain. There was not effect of tannin on degradation rate of the nutrient compounds in anyone tested sorghum silage

The relationship between leaf growth and ABA accumulation in the grass leaf elongation zone.

Detached barley (Hordeum vulgare L.) shoots, maintained at different air temperatures and VPDs, were fed ABA via the sub-crown internode in a leaf elongation assay. Analysis of variance of leaf elongation rate (LER) showed significant effects of temperature (T), fed [ABA] and the interaction T × [ABA]. However, the interaction became non-significant when LER was modelled against the [ABA] of the elongation zone, [EZ-ABA] When detached barley shoots were fed sap from droughted maize (Zea mays L.) plants, sap [ABA] could not explain the growth inhibitory activity. Measurement of [EZ-ABA] accounted for this 'unexplained' growth inhibition. The detached shoot experiments indicated that [EZ-ABA], and not xylem sap [ABA], was an appropriate explanatory variable to measure in droughted plants. However, ABA accumulation in the elongation zone could not explain a 35% growth reduction in intact droughted plants; thus we considered an interaction of water status and ABA. Using a coleoptile growth assay, we applied mild osmotic stresses (ψ=0 to −0.06 MPa) and 10−4 mol m−3 ABA. Individually, these treatments did not inhibit growth. However, osmotic stress and ABA applied together significantly reduced growth. This interaction may be an important mechanism in explaining leaf growth inhibition of droughted plants

Fitting a taper function to minimize the sum of absolute deviations Ajuste de uma função de afilamento via minimização da soma dos desvios absolutos

Multiple product inventories of forests require accurate estimates of the diameter, length and volume of each product. Taper functions have been used to precisely describe tree form, once they provide estimates for the diameter at any height or the height at any diameter. This study applied a goal programming technique to estimate the parameters of two taper functions to describe individual tree forms. The goal programming formulation generates parameters that minimize total absolute deviations (MOTAD). These parameters generated by the MOTAD method were compared to those of ordinary least squares (OLS) method. The analysis used a set of 178 trees cut from cloned eucalyptus plantations in the Southern part of the state of Bahia, Brazil. The values of the estimated parameters for the two taper functions resulted very similar when the two methods were compared. There was no significant difference between the two fitting methods according to the statistics used to evaluate the quality of the generated estimates. OLS and MOTAD resulted equally precise in the estimation of diameters and volumes outside and inside bark.<br>Os inventários florestais para múltiplos produtos requerem estimativas exatas do diâmetro, comprimento e volume de cada produto. As equações de afilamento têm sido usadas para descrever precisamente a forma da árvore uma vez que estas funções fornecem estimativas de diâmetro a qualquer altura ou de altura em qualquer diâmetro. Este trabalho aplica um modelo de programação por metas para estimar os parâmetros de duas equações de afilamento para descrever a forma do tronco de árvores individuais. O modelo de programação por metas gera parâmetros que minimizam a soma dos desvios absolutos (MOTAD). Esses parâmetros gerados pelo método MOTAD foram comparados aos parâmetros gerados pelo método dos mínimos quadrados ordinários (OLS). A análise se baseou em dados de cubagem de 178 árvores obtidas em plantios clonais de eucaliptos conduzidos na região sul da Bahia. Os valores dos parâmetros estimados por ambos os métodos de ajuste para as duas funções de afilamento mostraram-se muito semelhantes. Não houve diferença significativa entre os indicadores usados para avaliar a qualidade dos parâmetros estimados pelos dois métodos de ajuste. Os métodos OLS e MOTAD mostraram-se igualmente precisos na estimação de diâmetros e volumes com casca e sem casca