Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract 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

Optimal Ranges of Training Load and Recovery Status Prior to the Game to Maximize Game-day Performance in Soccer

Identifying ideal ranges of training load (TL) and recovery status before soccer games is essential to maximize game-day performance. PURPOSE: To determine how accumulative TL and subjective fatigue affect performance during the game. METHODS: Twenty-one male semi-professional soccer players (mean ± standard deviation; age: 22 ± 2 years; mass: 77.3 ± 6.9 kg) wore a player tracking device to monitor TL during each practice and game. A 7-day accumulation of high speed running and sprinting (HSR+Sprint, ³12.30 mph), total distance (TD), low acceleration (LowACC: 0.50-1.99 m×s-2), and high acceleration (HighACC: 2.00-50.00 m×s-2) was calculated. Also, 7-day average fatigue and pre-game fatigue was monitored using a 0 to 10 Likert scale. Game-day performance was defined as the percent changes in average HR and velocity between 1st and 2nd halves. Standard least square regression analysis was performed to determine if TL metrics and fatigue predicted game-day performance. Then, a predictive modeling decision tree was used to establish optimal ranges for each variable and corresponding probability of positive game-day performance. RESULTS: TD, LowACC,HighACC,HSR+Sprint, and game-day fatigue predicted game-day performance in HR (pnd half compared to 1st half. Similarly, achieving LowACC between 0.8 ≤ 1.6 miles and HighACC between 0.1 ≤ 0.2 miles had a 74% and 82% probability maintaining performance in the 2nd half. Additionally, HSR+Sprint between 0.1 ≤ 0.9 miles in practice had a 77% probability and game-day fatigue within 2-4 (small-somewhat fatigued) had an 80% probability. For velocity, TD, LowACC, HighACC, and 7-day average fatigue predicted game-day performance (pnd half. CONCLUSION: In order to achieve better game-day performance, players need to follow the designated ranges of TL, specifically for TD, LowACC,HighACC,and HSR+Sprint. Also, maintaining low levels of fatigue can lead to better game-day performance. Based on these findings, coaches can create individualized training and recovery plans for their players during practice to optimize performance in the game

Determining the Geographic Origin of Animal Samples

While the identification of the species from an unknown sample is a first step, and often a crucial one, it may also be important to identify the region of origin of the sample. This becomes an important issue when a species is protected in one region but not in another, or if wild animals are caught and sold as captive bred. The movement of an animal can also be important in cases such as those of stolen animals or even for conservation purposes. One way to determine the origin of a sample is by comparing the ratios of different isotopes using methods such as inductively coupled plasma mass spectrometry (ICP-MS) and isotope ratio mass spectrometry (IRMS). This chapter will give a very basic understanding of the principles of isotopes, ICP-MS and IRMS and their uses in tracing the movements of species. It has been written for the reader with little to no understanding of isotopes or their use in forensic wildlife crime and who comes from a mainly biological background. In addition, case examples using the techniques will be presented