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

The representation of getting ill in adolescents with systemic lupus erythematosus

ABSTRACT Introduction: This study, developed in a federal hospital in the city of Rio de Janeiro, has aimed to analyze the social representation of chronic disease and its treatment, in the perspective of adolescents and their caregivers. Methods: The sample consisted of 31 adolescents (11–21 years) with systemic lupus erythematosus and 19 caregivers (32–66 years), followed in the pediatrics and in the internal medicine outpatient clinics for a period of six months. Data was collected from the free association of words test, using chronic disease and treatment of chronic disease impulses, and later submitted to the Multiple Correspondence Analysis using the R software. Results: The group of adolescents associated the impulse chronic disease with the words medication, bad, illness, difficulty, no cure, faith and joy; and in the group of caregivers, to care, treatment, no cure and the word ‘no’. The impulse treatment of chronic disease was associated, in the group of adolescents, with the words patience, improvement, help, affection, care and bad; and in the group of caregivers, to caring, hope, schedule, knowledge, obedience, medication, professional and improvement. Caregivers also associated impulses and words according to age: chronic disease was associated with the word care (over 61 years), pain and impotence (42–61 years), treatment (22–41 years); and treatment of chronic disease, with the words strength (over 61 years), professional, knowledge and improvement (42–61 years), affection and schedule (22–41 years). Conclusions: Considering as subjective and dynamic the experience of getting ill, knowing the representations can contribute to the orientation of conduct and type of psychotherapeutic intervention needed

Effect of the kappa-casein gene polymorphism, breed and seasonality on physicochemical characteristics, composition and stability of bovine milk Efeito do polimorfismo do gene da kappa-caseína, da raça e da sazonalidade sobre as características físico-químicas, de composição e de estabilidade do leite bovino

The objective of this study was to evaluate the effect of genetic polymorphism of kappa-casein, breed and seasonality on the physicochemical characteristics, composition and stability of milk in commercial dairy herds. A total of 879 milk and blood samples were collected from 603 Holstein and 276 Girolando cows, obtained during rainy and dry seasons. Milk samples were analyzed to determine the physicochemical characteristics, composition and ethanol stability, while blood samples were subjected to polymerase chain reaction to identify the kappa-casein genotype. The frequencies of genotypes AA, AB and BB of k-casein were respectively, 66.83, 31.84 and 1.33% for Holstein, and 71.38, 27.90 and 0.72% for the Girolando cows, respectively. The A allele was more frequent than the B allele, both for Holstein (0.827 and 0.173) and Girolando cows (0.853 and 0.147), respectively. Cows of AB and BB genotypes showed a higher milk fat content compared to the AA genotype. There was an interaction between breed and seasonality on the concentration of milk urea with higher values for Holstein and Girolando cows in the rainy and dry season, respectively. The levels of lactose, total solids, crude protein, true protein, casein and the casein:true protein ratio were higher during the dry season, while during the rainy season, the somatic cell count and milk urea concentration were higher. There was no association between milk stability and k-casein genotypes, but Holstein cows showed higher milk stability than Girolando cows, and milk was more stable during the rainy season than during the dry season.<br>Objetivou-se avaliar o efeito do polimorfismo genético da kappa-caseína, da raça e da sazonalidade sobre as características físico-químicas, a composição e a estabilidade do leite bovino de rebanhos comerciais. Foram coletadas 879 amostras de leite e de sangue de 603 vacas da raça Holandesa e 276 da raça Girolando, obtidas durante as estações seca e chuvosa. As amostras de leite foram analisadas para determinação de características físico-químicas, de composição e de estabilidade ao etanol, e as amostras de sangue foram submetidas à reação em cadeia da polimerase para identificação do genótipo da kappa-caseína. As frequências dos genótipos AA, AB e BB da kappa-caseína foram, respectivamente, de 66,83; 31,84; e 1,33% para a raça Holandesa e 71,38; 27,90; e 0,72% para a Girolando. O alelo A foi mais frequente que o B, tanto para a raça Holandesa (0,827 e 0,173) quanto para a Girolando (0,853 e 0,147). Vacas dos genótipos AB e BB apresentaram maior teor de gordura no leite que as do genótipo AA. Houve interação entre raça e sazonalidade para a concentração de ureia do leite, com maiores concentrações para as raças Holandesa e Girolando, respectivamente, nas estações chuvosa e seca. Os teores de lactose, sólidos totais, proteína bruta, proteína verdadeira e caseína e a relação caseína/proteína verdadeira foram maiores durante o período seco, enquanto, durante a estação chuvosa, a contagem de células somáticas e os teores de nitrogênio ureico no leite foram maiores. Não houve associação entre a estabilidade do leite e os genótipos da kappacaseína, no entanto, o leite de vacas Holandesas é mais estável que o de vacas Girolando e, durante a estação chuvosa, apresenta maior estabilidade que na estação seca

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved