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

Effect of Dietary Protein Level on Growth Performance, Protein Utilization and Body Composition of Nile Tilapia Cultured in Low Salinity Water

Abstract The juveniles of Nile tilapia, Oreochromis niloticus (body weight 1.0±0.03 g) were reared in seawater tanks (35 liters each) in order to examine their optimum dietary protein requirements. They were fed four isoenergetic (20.3 kJg -1 ) diets containing 25%, 30%, 35% and 40% protein at a daily ration of 5% body weight for 42 days. Fish fed diets of 35% and 40% protein produced higher weight gain and growth rate than those of the other diets. Broken line regression analysis yielded an optimal protein level of 35%. Feed conversion and protein efficiency were significantly higher at 35% and 40% protein diets than remaining diets. Fish whole body composition showed that moisture, protein and ash content of the fish fed diets of 35% and 40% protein was significantly higher than that of fish fed diets containing protein levels of 25% and 30%, although the lipid contents were lower. Fish fed 35% and 40% protein diets showed higher nitrogen gain and nitrogen retention efficiency than those fed on other diets. Based on the biological data, it was estimated that the optimal level of protein for O. niloticus weighing between 1.0 g and 5.7 g was 35%