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

Micropollutant removal in an algal treatment system fed with source separated wastewater streams

Micropollutant removal in an algal treatment system fed with source separated wastewater streams was studied. Batch experiments with the microalgae Chlorella sorokiniana grown on urine, anaerobically treated black water and synthetic urine were performed to assess the removal of six spiked pharmaceuticals (diclofenac, ibuprofen, paracetamol, metoprolol, carbamazepine and trimethoprim). Additionally, incorporation of these pharmaceuticals and three estrogens (estrone, 17ß-estradiol and ethinylestradiol) into algal biomass was studied. Biodegradation and photolysis led to 60–100% removal of diclofenac, ibuprofen, paracetamol and metoprolol. Removal of carbamazepine and trimethoprim was incomplete and did not exceed 30% and 60%, respectively. Sorption to algal biomass accounted for less than 20% of the micropollutant removal. Furthermore, the presence of micropollutants did not inhibit C. sorokiniana growth at applied concentrations. Algal treatment systems allow simultaneous removal of micropollutants and recovery of nutrients from source separated wastewater. Nutrient rich algal biomass can be harvested and applied as fertilizer in agriculture, as lower input of micropollutants to soil is achieved when algal biomass is applied as fertilizer instead of urine

Avaliação econômica e desempenho de machos e fêmeas Canchim em confinamento alimentados com dietas à base de silagem de milho e concentrado ou cana-de-açúcar e concentrado contendo grãos de girassol Economic evaluation and performance of feedlot male and female Canchim fed corn silage and concentrate or sugar cane plus concentrate with sunflower seed based diets

Objetivou-se avaliar os efeitos do fornecimento de dietas com silagem de milho ou com cana-de-açúcar + grãos de girassol e a influência da condição sexual do animal sobre o desempenho de bovinos jovens em confinamento e os resultados econômicos desse sistema de produção. Foram utilizados 30 animais Canchim (dez machos não-castrados, dez machos castrados e dez novilhas), com 15 meses de idade e 289 kg de peso corporal (PC), mantidos em baias individuais durante 105 dias. Todos os animais foram pesados no início do experimento e a cada 35 dias e, ao final do confinamento, foram abatidos em frigorífico comercial para realização das medidas de características de carcaça. Os machos não-castrados apresentaram maior ingestão de nutrientes em comparação às fêmeas, tanto em valores absolutos quanto em valores relativos ao PC. Os machos castrados apresentaram valores intermediários e não diferiram dos não-castrados e das fêmeas. Os machos não-castrados apresentaram maior ganho de peso diário e desenvolvimento muscular, representado pela maior área de olho-de-lombo. Também foram mais eficientes quanto à conversão alimentar e ao rendimento de carcaça. Não houve efeito das dietas sobre a ingestão de nutrientes, à exceção do EE, que foi maior para a dieta com cana-de-açúcar + semente de girassol, com mais teor desse nutriente. As dietas também não influenciaram o desempenho dos animais. A dieta com silagem de milho mostrou-se economicamente mais viável para terminação de bovinos jovens em confinamento. Os machos não-castrados são os mais adequados para exploração de bovinos jovens em confinamento, independentemente da dieta.<br>The objective of this experiment was to evaluate the effects of diets with corn silage or with sugar cane + sunflower seed and influence of sexual categories of fedlot young cattle on the performance and economic results of this production system. Thirty animals of Canchim breed (10 young bulls, 10 castrated males and 10 females) averagfing 15 months old and 289 kg BW were housed in individual stalls, for 105 days and weighted in the beginning of the experiment and every 35 days. At the end of the feedlot, all the animals were slaughtered in commercial frigorific and measures of carcass characteristics were made. Young bulls showed higher nutrient intakes as compared to females, in absolute values and in relation LW values. The castrated males presented intermediary values, not differing from young bulls and females. Young bulls presented higher daily weight gain and muscular development, represented by the largest rib eye area. They were also more efficient as for feed conversion and carcass yield. No effect was observed for diets on the ingestion of nutrients, except for EE, that was higher for the diet with sugarcane + sunflower seed, with more of this nutrient. Diets also did not influence performance of the animals. Diet with corn silage showed more economically viable to raised young cattle in fed lot finishing. Young bulls were the animals more adequate for the exploration of young cattle in feedlot, independently of diet