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

Utilização de óleo de soja em rações para vacas leiteiras no período de transição: consumo, produção e composição do leite Use of soybean oil for dairy cows during transition period: Intake, milk yield and composition

O objetivo neste estudo foi avaliar o desempenho produtivo de vacas leiteiras sob suplementação com óleo de soja durante o período de transição. Foram utilizadas 20 vacas da raça Holandesa, multíparas e gestantes, distribuídas aleatoriamente em duas rações: controle, com 2,5% de extrato etéreo (EE) na matéria seca (MS); e gordura, com adição de 3,0% de óleo de soja e 5,5% de EE na MS. Os valores médios de consumo de MS e nutrientes não diferiram no período pré e pós-parto nas vacas das dietas controle e com óleo de soja, exceto no maior consumo de EE, em decorrência da maior concentração desse nutriente na dieta com óleo. Em virtude da maior densidade energética da ração com óleo de soja, as vacas apresentaram maior consumo de nutrientes digestíveis totais e energia líquida no pós-parto. Não foi observada alteração nas produções de leite e gordura, no entanto, observou-se redução do teor de gordura do leite nas vacas da ração com óleo de soja em relação àquelas da ração controle. As rações utilizadas não influenciaram o consumo, mas a dieta com óleo de soja aumentou a ingestão de energia líquida e melhorou o balanço de nutrientes no início da lactação. Foi observado aumento não-significativo (+ 2,53 kg/dia) na produção de leite das vacas da dieta com óleo de soja.<br>The objective of this study was to evaluate the productivity of dairy cows supplemented with soybean oil during the transition period. Twenty multiparous and pregnant Holstein cows were randomly allocated to two diets: control (C), 2.5% ether extract (EE) in the dry matter (DM); and fat (G), with the addition of 3% soybean oil, and 5.5% EE in the dry matter. The average values for intake were not different in the pre- and post-partum for cows on the control and fat diets except for an increase in EE intake due to great concentration of this nutrient in the soybean oil diet. Due to the higher energy density of the fat diet, cows had higher intake of total digestible nutrients and net lactation energy during the post-partum. There was no alteration in milk and fat yield, but a reduction in the milk fat content was observed for cows fed fat diet compared with the control diet. The diets used had no influence on the intake, and the fat diet resulted in an increased net energy intake and improvement in the nutrient balance during the initial phase of lactation. A non-significant increase in milk yield (+ 2.53 kg/d) was observed when using the fat diet

Human immunodeficiency virus continuum of care in 11 european union countries at the end of 2016 overall and by key population: Have we made progress?

Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control

Multi-messenger Observations of a Binary Neutron Star Merger

International audienceOn 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of $\sim 1.7\,{\rm{s}}$ with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg(2) at a luminosity distance of ${40}_{-8}^{+8}$ Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 $\,{M}_{\odot }$. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at $\sim 40\,{\rm{Mpc}}$) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ∼10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position $\sim 9$ and $\sim 16$ days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC 4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta