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

Analyse of growth traits in Simmental breed in Brazil

Registros de pesos ao nascimento, aos 100, 205, 365 e 550 dias de idade, de 7587 animais controlados pela Associação Brasileira de Criadores da Raça Simental, criados em 150 fazendas e em diversos estados do Brasil, foram usados para estimar os componentes de variância e os parâmetros genéticos dessas características. O peso padronizado aos 205 dias (desmama) foi usado como característica âncora. O aplicativo MTDFREML, sob modelo animal completo, foi utilizado para análise dos dados. As estimativas de herdabilidades total, direta e materna e as correlações genéticas entre os efeitos materno e direto e os maternos permanentes foram obtidas mediante análises bicaracterísticas. Os seguintes valores foram encontrados: 0,23, 0,22, 0,05, -0,10, 0,07 para peso ao nascer; 0,09, 0,08, 0,00, 0,85, 0,17 para peso aos 100 dias de idade; 0,13, 0,13, 0,05, -0,17, 0,02 para peso aos 205 dias de idade; 0,15, 0,19, 0,06, -0,41, 0,03 para peso aos 365 dias de idade. A herdabilidade direta estimada para o peso aos 550 dias de idade, na análise bicaracterística com o peso à desmama, foi de 0,24. Exceto para peso ao nascimento (moderado), as correlações genética, fenotípica e ambiente entre peso à desmama e as outras características foram altas e positivas. Os efeitos maternos foram importantes e devem ser incluídos nos programas de melhoramento da raça Simental.Records of birth, 100-day, weaning, yearling and 550-day weights of 7,587 calves born from 1977 to 1997, and 25,812 pedigree data were used to estimate variance components and genetic parameters of Simmental cattle raised on farms in Brazil, with MTDFREML procedure under animal model. The estimates of total, direct and maternal heritabilities, genetic correlations between maternal and genetic effects, and maternal permanent effects obtained by bivariate analyses, were estimated combining the weaning weight (205 days) with the other weights, being respectively .23, .22, .05, -.10, .07 for birth weight; .09,.08, .00, .85, .17 for 100-day weight; .13, .13, .05, -.17, .02 for 205-day weight; and .15, .19, .06, -.41, .03 for 365-day weight. Direct heritability, estimated for 550-day weight, in two traits analysis with weaning weight, was .24. Except for birth weight (moderate), the genetic, phenotypic and environmental correlations between weaning weight and other traits were high and positive. The maternal effects were important for Simmental cattle and should be included in beef cattle breeding programs

Comparação entre análises para permanência no rebanho de vacas Nelore utilizando modelo linear e modelo de limiar

Foram obtidas estimativas de herdabilidade e preditas diferenças esperadas na progênie para probabilidade de permanência no rebanho (stayability) de 4180 touros com filhas na base de dados do Programa de Melhoramento Genético da Raça Nelore. Modelo de limiar e modelo linear foram utilizados sob análise Bayesiana via software multiple-trait Gibbs sampler for animal models. A implementação adotada considerou tamanho de cadeia de Gibbs de 225 mil, período de descarte amostral de 25 mil e tomada de amostra a cada mil rodadas. As estimativas de herdabilidade foram de menor magnitude para o modelo linear, 0,065, contra 0,158 sob modelo de limiar. Quando transformadas para escala normal subjacente, o valor obtido ficou em 0,13±0,05, bem próximo àquele encontrado sob modelo de limiar. A correlação entre classificações foi de 97%. O modelo de análise considerado para stayability, sob enfoque bayesiano, parece não influenciar a classificação dos animais quanto aos valores genéticos preditos. Análises sob modelo linear, com reduzido tempo de processamento, poderiam ser preferidas bastando transformar a escala da característica para obter a estimativa de herdabilidade.Heritability and expected progeny difference (EPD) for stayability based on progeny records of 4,180 sires from the Programa de Melhoramento Genético da Raça Nelore were estimated. Bayesian analyses for threshold and linear models were performed using the software multiple trait Gibbs sampler for animal model. Gibbs size chain of 225,000, burn-in of 25,000 and thinning interval of 1,000 cycles were considered for implementation purpose. The heritability estimated by linear model (.065) was lower than for threshold model (0.158). The heritability estimate for transformed continuous threshold scale was .13±.05 which is close to the heritability estimate for threshold model. The high rank correlation between the solutions from both models (97%) suggests the stayability analysis under Bayesian perspective does not influence the rank of the animal EPD. Therefore linear model analysis for transformed threshold stayability data, which has a reduced processing time, should be used.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq