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

Stonefly (Plecoptera) fauna in a mountainous area of Central Brazil: composition and adult phenology

A survey of the stonefly (Plecoptera) fauna of streams of the Almas River basin, Pirenópolis, Goiás State, Central Brazil, is presented as well as data of some factors that could affeet the temporal distribution of the adults. For checking adult phenology, light sources were used in three stations from June 1993 to Jully 1994. The sampled individuais were identified to species or morphospecies, as possible. In this study, 301 individuais belonging to the perlid genera Anacroneuria Klapálek, 1909, Kempnyia Klapálek, 1916 and Macrogynoplax Enderlein, 1909 were collected. Adults of most species were collected along the studied period, except for those of Kempnyia that were restricted to the warm-rainy season, the same pattern for this genus in southeastern Brazil. Although adults of most species were collected along most of the studied period, the largest number of adults was collected in the months with larger mean temperatures, showing a clear seasonality in abundance

Effect of whey protein supplementation combined with resistance training on cellular health in pre-conditioned older women : a randomized, double-blind, placebo-controlled trial

The purpose of study was to analyze the effects of a combined whey protein (WP) and RT intervention on cellular health in pre-conditioned older women. The protocol is a randomized controlled clinical trial with a sample of seventy older women, divided into 3 groups: WP-placebo (WP-PLA, n = 24), placebo-WP (PLA-WP, n = 23), and placebo-placebo (PLA-PLA, n = 23). Each group drank 35 g of product (placebo or WP) pre- and post- training. The RT program was carried out over 12 weeks (3x/week; 3 × 8–12 repetitions maximum). Total body water (TBW), intra (ICW) and extracellular (ECW) water, resistance (R), reactance (Xc), and phase angle (PhA) assessed by bioimpedance spectroscopy. Lean soft tissue (LST) was measured using dual energy X-ray absorptiometry; and food consumption was assessed by means of the average of two 24-hour recalls. ANCOVA for repeated measures was applied for comparisons, with baseline scores used as covariates. A group by time interaction (P < 0.05) was observed for LST, ICW and the ECW/ICW ratio. There was a time effect (P <  0.05) for TBW, Xc, and PhA. A reduction (P <0.05) in R was found only in the WP-PLA and PLA-WP groups.Whey protein supplementation (pre- or post-) combined with RT promoted an increase in ICW and LST, and also a reduction in ECW/ICW ratio in pre-conditioned older women. Regardless of the supplementation intake, the RT regimen improved PhA in older adult women. This trial was registered at ClinicalTrials.gov: NCT0324719282232237CAPES - Coordenação de Aperfeiçoamento de Pessoal e Nível SuperiorCNPQ - Conselho Nacional de Desenvolvimento Científico e TecnológicoNão temNão temThe authors are grateful for: all the participants for their engagement in this investigation; Arla Foods Ingredients Group P/S for providing the samples of whey protein; and New Milen for providing the samples of maltodextrin. The investigation was funded by the Coordination for the Improvement of Higher Education Personnel (CAPES/Brazil), the National Council for Scientific and Technological Development (CNPq/Brazil), and the Ministry of Education (MEC/Brazil). Grant number: 309455/2013-8

Erratum: The Effects of Palmitic Acid on Nitric Oxide Production by Rat Skeletal Muscle: Mechanism via Superoxide and iNOS Activation

<b><i>Background: </i></b>Increased plasma concentrations of free fatty acids (FFA) can lead to insulin resistance in skeletal muscle, impaired effects on mitochondrial function, including uncoupling of oxidative phosphorylation and decrease of endogenous antioxidant defenses. Nitric oxide (NO) is a highly diffusible gas that presents a half-life of 5-10 seconds and is involved in several physiological and pathological conditions. The effects of palmitic acid on nitric oxide (NO) production by rat skeletal muscle cells and the possible mechanism involved were investigated. <b><i>Methods: </i></b>Primary cultured rat skeletal muscle cells were treated with palmitic acid and NO production was assessed by nitrite measurement (Griess method) and 4,5-diaminofluorescein diacetate (DAF-2-DA) assay. Nuclear factor-kappa B (NF-ĸB) activation was evaluated by electrophoretic mobility shift assay and iNOS protein content by western blotting. <b><i>Results: </i></b>Palmitic acid treatment increased nitric oxide production. This effect was abolished by treatment with NOS inhibitors, L-nitro-arginine (LNA) and L-nitro-arginine methyl esther (L-NAME). NF-ĸB activation and iNOS content were increased due to palmitic acid treatment. The participation of superoxide on nitric oxide production was investigated by incubating the cells with DAF-2-DA in the presence or absence of palmitic acid, a superoxide generator system (X-XO), a mixture of NOS inhibitors and SOD-PEG (superoxide dismutase linked to polyethylene glycol). Palmitic acid and X-XO system increased NO production and this effect was abolished when cells were treated with NOS inhibitors and also with SOD-PEG. <b><i>Conclusions: </i></b>In summary, palmitic acid stimulates NO production in cultured skeletal muscle cells through production of superoxide, nuclear factor-kappa B activation and increase of iNOS protein content