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

Efeitos da seleção para peso pós-desmame sobre características de carcaça e rendimento de cortes cárneos comerciais de bovinos Effects of selection for post weaning weight on carcass traits and meat cut yields of beef cattle

Foram avaliados os efeitos da seleção para peso pós-desmame sobre características de carcaça e rendimento de cortes cárneos comerciais de 44 bovinos machos não-castrados selecionados ou não para peso aos 378 dias, nascidos em 1999, Foram utilizados animais dos grupos genéticos Nelore Seleção (NeS), Nelore Controle (NeC) e Caracu Seleção (Ca). Os animais foram distribuídos aleatoriamente em duas categorias experimentais: grupo de alimentação restrita (AR) e grupo de alimentação ad libitum (AL). Em ambas as categorias, foram alocados oito animais dos grupos genéticos NeS e Ca e seis animais do grupo NeC. O período experimental foi determinado pelo tempo de acabamento dos animais, ou seja, quando atingiram, no mínimo, 4 mm de espessura de gordura subcutânea, avaliada por ultra-som, sobre o músculo Longissimus dorsi, na posição entre a 12ª e 13ª costelas. Em cada grupo genético, à medida que o acabamento preconizado para cada animal da categoria AL foi atingido, o animal da categoria AR mais semelhante quanto ao peso e à condição corporal no início do experimento foi também abatido. O efeito do grupo genético foi significativo para a maioria das características estudadas, porém, não houve interação significativa entre grupos genéticos e regimes alimentares. Os animais Ca e NeS tiveram maiores pesos de abate, sendo que animais Ca necessitaram de mais tempo de confinamento para atingirem o ponto de acabamento preconizado. O maior peso de abate desses animais também influenciou outras características correlacionadas, como pesos de carcaça, traseiro, dianteiro e ponta-de-agulha. A seleção para peso aumentou os pesos de abate, de carcaça e dos cortes primários. Os animais NeS apresentaram carne menos macia, mas ainda dentro dos padrões de maciez considerados satisfatórios (força de cisalhamento abaixo de 5 kgf).<br>Data from 44 bulls of the genetic groups Selection Nellore (NeS), Control Nellore (NeC) and Caracu (Ca) herds born in 1999 were used to evaluate the effects of selection for post weaning weight on carcass traits and meat cuts yields at 378 days of age (P 378). The animals were randomly distributed into two experimental classes: restricted feeding (AR) and ad libitum feeding (AL) including 8 animals from the NeS and Ca groups and 6 animals from the NeC group. Animals of each class were slaughtered in pairs when the animals AL group reached 4 mm of ultrasonic fat thickness on Longissimus dorsi muscle, between the 12th and 13th ribs. The interaction between genetic group and feeding class was not significant for most of the traits evaluated. The genetic group effect was significant. Animals of the Ca and NeS groups were heavier at slaughter and Ca animals required longer feedlot period to reach the desired fat thickness. Higher slaughter weights of these animals changed their carcass, hindquarter, forequarter and spare ribs weights. The selection for P 378 in the Nellore group resulted in heavier weights at slaughter, heavier carcasses and primary cuts, but lower meat tenderness, although within reasonable values of shear force (below 5.0 kgf)