A global research priority agenda to advance public health responses to fatty liver disease

Background & aims An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of ‘agree’ responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement (‘agree’ + ‘somewhat agree’); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% ‘agree’), 13 priorities had 90% combined agreement. Conclusions Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community’s efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat

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

Reguladores vegetais e o desbaste químico de frutos de tangor murcote Plant growth regulators and 'Honey' orange fruit chemical thinning

O tangor 'Murcote' apresenta necessidade de desbaste de frutos devido a alternância de produção, caracterizado por anos de excessiva produção intercalado com anos de baixa produção, evitando assim, a diminuição da qualidade dos frutos. O presente trabalho teve por objetivo avaliar a eficiência de reguladores vegetais, a auxina ANA (ácido naftalenacético) e ethephon (etileno) no desbaste químico de frutos de tangor 'Murcote' aplicado 40 dias após o pleno florescimento. O experimento foi conduzido em Pratânia, SP, onde plantas de 5 anos de idade, enxertadas sobre o limoeiro 'Cravo', foram pulverizadas com ANA a 0, 100, 200, 300 e 400 mg L-1 e com ethephon a 200, 300 e 400 mg L-1, ambos em solução aquosa juntamente com adjuvante não iônico a 0,05%. A contagem dos frutos foi realizada previamente aos tratamentos em 2 ramos marcados por planta. O ANA não interferiu significativamente no desbaste de frutos, com porcentagens de queda variando entre 7 a 14%, enquanto que as pulverizações com ethephon mostraram maior eficiência no desbaste de frutos, principalmente na dose de 400 mg L-1, promovendo 66,6% de queda de frutos, sem contudo induzir a abscisão foliar. As doses inferiores de ethephon também promoveram desbaste de frutos da ordem de 40%. As porcentagens de queda de frutos foram pequenas, para plantas pulverizadas com ANA, enquanto que a aplicação de ethephon promoveu maior eficiência no desbaste de frutos.<br>Alternate bearing is an important caracteristic of some mandarins that reduces fruit quality and yield in tangor Murcott, and to reduce this effect is necessary to perform fruit thinning to avoid high and low production year by year. To evaluate the effects of plant growth regulators on fruit thinning of the 'honey' orange, an auxin (NAA-naphthalene acetic acid) and ethephon (ethylene), were applied 40 days after full bloom in an experiment carried out at Pratania, S.P., Brazil. Five-year-old plants grafted on Rangpur lime were used, sprayed with NAA (0, 100, 200, 300 e 400 mg L-1 and ethephon (200, 300, 400 mg L-1), both in water solution, containing 0.05% of non ionic wetting agent. Fruit number was determined before treatment applications in two shoots per plant. NAA did not promote significant differences on fruit thinning (between 7 to 14 %), however, the application of ethephon, at all rates, increased fruit thinning by 41.6 to 66.6%, with concentrations of 200 to 400 mg L-1 respectively, without leaf drop. Application of NAA did not promote chemical fruit thinning whereas ethephon showed high percentage of fruit thinning after full bloom with increased concentrations