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

Nitrous oxide emissions from soil due to urine deposition by grazing cattle in Brazil

Urine deposition to the soil can result in nitrous oxide emissions through the microbial processes of nitrification and denitrification. The objective of this experiment was to estimate N2O emissions from urine depositions to grassland during summer in Southeast Brazil. A field experiment was conducted in which N2O emissions were measured from known volumes of urine applied to the soil, using the static chamber method. Measurements continued for one month after application. Application of urine to soil increased N2O fluxes compared to those from the control site. There were two significant N2O emission peaks for the urine treatment at around the 3rd and 13th days after application, the first in response to the urine application and the second most likely in response to a rainfall event. The N2O emissions accounted for 0.2% of the applied urine N. These represent the first data relating to emissions from urine depositions by grazing cattle in Brazil. Further measurements across a range of soil and weather conditions in Brazil are required to develop national and regional specific emission factors for inventory development

Successful use of autogenous bone graft for the treatment of a radius-ulna nonunion in an amputee dog

Fracture nonunions represent important complications in orthopedic surgeries. Nonunion repairs or bone defects are surgically challenging. Our aim was to describe a nonunion case, which was repaired with rapid bone recovery. An 8-month-old male mixed breed dog that has been previously operated was presented to the Veterinary Medical Teaching Hospital of São Paulo State University, with a right radius-ulna nonunion and an amputated contralateral forelimb. A cancellous bone graft was collected from a partially amputated limb, in order to correct the nonunion, and used in association with a locking plate. After four weeks, the bone graft had been incorporated into the original bone. Clinical union with good weight bearing was achieved after eight weeks

Partial lateral corpectomy associated with pediculectomy to treat extradural chondroma in a dog: technique description

This study aimed to describe in detail the surgical technique of partial lateral corpectomy (PLC) associated with pediculectomy to treat an in vitro extradural chondroma. A 12-year old female Cocker Spaniel was seen in the hospital with proprioceptive ataxia of hind limbs associated with extradural compression between the 1st and 2nd lumbar vertebrae. The owner opted for euthanasia since the patient's condition changed due to simultaneous illnesses that culminated in a poor prognosis. The patient's body was formally ceded to perform experimental spinal decompression. The technique was effective to completely remove the epidural mass with minimal manipulation of the spinal cord

Vinasse application and cessation of burning in sugarcane management can have positive impact on soil carbon stocks

Bioenergy crops, such as sugarcane, have the potential to mitigate greenhouse gas emissions through fossil fuel substitution. However, increased sugarcane propagation and recent management changes have raised concerns that these practices may deplete soil carbon (C) stocks, thereby limiting the net greenhouse gas benefit. In this study, we use both a measured and modelled approach to evaluate the impacts of two common sugarcane management practices on soil C sequestration potential in Brazil. We explore how transitions from conventional (mineral fertiliser/burning) to improved (vinasse application/unburned) practices influence soil C stocks in total and in physically fractionated soil down to one metre. Results suggest that vinasse application leads to an accumulation of soil C of 0.55 Mg ha-1 yr-1 at 0-30 cm depth and applying unburned management led to gains of~0.7 Mg ha-1 yr-1 at 30-60 cm depth. Soil C concentration in the Silt+Clay fraction of topsoil (0-20 cm) showed higher C content in unburned management but it did not differ under vinasse application. The CENTURY model was used to simulate the consequences of management changes beyond the temporal extent of the measurements. Simulations indicated that vinasse was not the key factor driving increases in soil C stocks but its application may be the most readily available practice to prevent the soil C losses under burned management. Furthermore, cessation of burning may increase topsoil C by 40% after ~50 years. These are the first data comparing different sugarcane management transitions within a single area. Our findings indicate that both vinasse application and the cessation of burning can play an important role in reducing the time required for sugarcane ethanol production to reach a net C benefit (payback time). © 2018 Zani et al

Role of tidal volume and positive end-expiratory pressure in the development of Ventilator-Induced Lung Injury

Puede afirmarse que cuando en el Mercurio Peruano y en marzo de 1829 (es decir apenas ocho años después de la declaración de la independencia nacional), Felipe Pardo y Aliaga publica la sátira en verso "El carnaval de Lima", se inicia la historia del Costumbrismo en sentido estricto en el Perú O si se prefiere tomar como referencia una obra de mayor entidad, puede sostenerse mejor que el hito inicial está dado por el estreno de Frutos de la Educación, la primera comedia del mismo Pardo (6 de ..