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

Effects of electrical field on hatchability performance of eggs from a layer-type breeder

Eggs from a layer-type breeder flock (Baladi, King Saud University) between 50 and 63 weeks of age were used in three trials to study the effects of electrical field (EF) during incubation on albumen and yolk heights, incubation temperature, egg weight loss and hatchability traits. The effects of egg size and eggshell characteristics on hatchability traits of eggs incubated under EF were investigated. 2. Eggs were weighed and graded into three weight classes (small, medium, and large). The physical dimensions, eggshell characteristics, and conductance of eggs were examined. The incubator was divided into two compartments for the control and EF treatments. Two aluminium plates were fitted on the inside walls of the EF compartment, face to face, and connected to a step up electric transformer. Eggs were exposed constantly to the EF during the first 18 d of incubation at the level of 30 kV/m, 60 Hz. 3. Egg size influenced the physical dimensions and eggshell characteristics of eggs. Large eggs had higher egg weight, egg surface area, egg volume, eggshell conductance, and eggshell weight and lower yolk weight percentage than medium or small size eggs. Small eggs had lower egg length and higher egg density than large or medium size eggs. Large eggs had higher eggshell thickness than small size eggs. 4. EF incubation of eggs raised incubation temperature by 0.06 C, and increased the percentage of egg weight loss, hatchability, and weight of hatching chicks and reduced the early embryo deaths, and length of incubation by approximately 9.8, 19.6, 1.7, 62.1 and 2.1%, respectively. 5. There was no significant difference between the two incubation treatments in the heights of albumen and yolk of incubated eggs, percentages of late embryo deaths, and pips with live and dead embryos. Hatchability traits were not significantly influenced by egg size. 6. It was concluded that EF incubation of eggs increased hatchability, chick-hatching weight, and reduced the length of incubation of Baladi eggs. Differences in the physical dimensions and eggshell characteristics of eggs did not influence hatchability traits of eggs under EF incubation

Effect of Pigment Intensity and Region of Eggshell on the Spectral Transmission of Light That Passes the Eggshell of Chickens

La investigación doctoral busca analizar el circuito de rock platense partiendo de la premisa que sostiene que el mismo se estructura y organiza a partir de disputas y luchas que se dan entre los actores participantes -o posibles participantes- por las características, sentidos y límites del mismo. Así, nos interesa rastrear procesos de distinción, de tradicionalización, de alterización y otros que se tornen relevantes en la búsqueda por identificar los principios que operan en estas disputas entre los distintos actores. No pretendemos brindar una definición a priori de la expresión "rock platense" sino que en cambio ocupará el lugar de una categoría de clasificación relevante y en disputa para los actores que forman parte del circuito.Universidad Nacional de La Plat

It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

BACKGROUND: The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. METHODS: A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. RESULTS: Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. CONCLUSION: Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened