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

Caracterização de genótipos de trigo do bloco de cruzamento da Embrapa Trigo, RS, Brasil Characterization of wheat genotypes from the crossing block of the national wheat research center, RS, Brazil

No Centro Nacional de Pesquisa de Trigo (CNPT - Embrapa Trigo), em 1999, genótipos de trigo integrantes do bloco de cruzamento foram avaliados quanto à altura de planta, à duração do ciclo até o espigamento, ao comprimento do pedúnculo e ao número de grãos por espiga. Relacionando essas características, foram estudados 122 genótipos em duas épocas de semeadura, que consistiram os blocos. Foram medidos dez pedúnculos do afilho principal, de cada genótipo, e contou-se o número total de grãos de cada espiga. Para a apresentação dos resultados, foram considerados os valores médios dessas avaliações. Para a análise estatística, considerou-se o experimento como blocos casualizados. Dos resultados obtidos, concluiu-se que os genótipos de trigo BR 18, BR 42 e Sonora 64 destacam-se por porte baixo e ciclo precoce, enquanto Florida 301 e "Trigo de chapéu" destacam-se por porte alto e ciclo longo até o espigamento. A altura de planta mostra elevada correlação com comprimento do pedúnculo e duração do ciclo até o espigamento, e esta, com o comprimento de pedúnculo. Os genótipos de trigo CNT 10 e PF 92130 são indicados com finalidades artesanais por suas características de pedúnculo longo e número de grãos por espiga acima da média. O estudo mostra grande variabilidade genotípica em trigo quanto às características avaliadas, fornecendo informações sobre os genótipos que poderão ser utilizados por melhoristas, técnicos e agricultores.<br>Wheat genotypes from the crossing block were caracterized at the National Wheat Research Center (Embrapa Trigo) in 1999. Plant traits evaluated were height, cycle up to heading, peduncle length, and number of grains per spike. One hundred and twenty-two genotypes were evaluated at two seeding dates that consisted blocks. For each tretament, ten peduncles from the main tiller were measured and the total number of grain in each spike was counted. The mean values obtained in such evaluations were take into consideration for presenting the results. For statistical analysis, the experiment was considered complete block design. Based upon results the genotypes BR 18, BR 42 and Sonora 64 were outstanding for their low stature and early cycle. Florida 301 and "Trigo de chapéu" were outstanding for their high stature and long cycle up to heading. The plant height showed a high correlation with peduncle lenght and cycle up to heading, and the latter correlated with peduncle lenght. The genotypes CNT 10 and PF 92130 can be indicated for handicraft finalities due to the long peduncle and spike grain number above average. The study showed a considerable genotipic variability among wheat genotypes as to the traits assessed and provided information on wheat genotypes that may be used for breeding and commercial production

Interaction of 8^{8}He with 208^{208}Pb at near-barrier energies: 4^{4}He and 6^{6}He production

International audienceAngular distributions for the inclusive He4 and He6 production cross sections in the He8+Pb208 system at incident energies of 16 and 22 MeV measured at the SPIRAL facility of the GANIL laboratory are presented. Using a combination of kinematical arguments and distorted wave Born approximation (DWBA) calculations, neutron transfer reactions were inferred to be the dominant contributors to both inclusive cross sections. Model-dependent values for the ratios of two- to one-neutron stripping, σ2n/σ1n, were derived and compared with previous results for He8 and He6 projectiles incident on other heavy targets. Three- and four-neutron stripping were inferred to be the main processes leading to He4 production, although the exact mechanism remains to be elucidated

Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort : A prospective, observational study

BACKGROUND Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE The objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN A prospective observational study of a multicentre cohort. SETTING Sixty-three hospitals across Europe. PATIENTS Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO(2)) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation. RESULTS PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO(2); at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes. The study was registered at ClinicalTrials.gov (identifier NCT01346709)

Accelerated surgery versus standard care in hip fracture (HIP ATTACK) : an international, randomised, controlled trial

Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4\u20139) in the accelerated-surgery group and 24 h (10\u201342) in the standard-care group (p&lt;0\ub70001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0\ub791 (95% CI 0\ub772 to 1\ub714) and absolute risk reduction (ARR) of 1% ( 121 to 3; p=0\ub740). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0\ub797 (0\ub783 to 1\ub713) and an ARR of 1% ( 122 to 4; p=0\ub771). Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. Funding: Canadian Institutes of Health Research