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

Intake and digestion by wethers fed a tropical grass-based diet supplemented with increasing levels of canola meal

AbstractEight Polwarth×Texel wethers (31±3.8kg body weight (BW)), housed in metabolic cages and offered sudangrass (Sorghum sudanense) ad libitum, were used in a replicated 4×4 Latin Square experiment to evaluate the effects of increasing levels of canola meal supplementation on intake, digestibility, duodenal flow of N compounds and on N excretion. Four of the eight wethers were fitted with duodenal cannula. Treatments included no supplement (0) or daily supplementation with 5, 10 or 15g/kg BW of a canola meal mixture (nine parts canola meal one part cracked corn grain). Forage dry matter (DM) intake decreased linearly and total DM, organic matter (OM), digestible OM and N intake increased linearly with increasing levels of supplementation. Supplementation did not affect neutral (NDF) or acid detergent fiber (ADF) digestibility whereas it tended to improve DM and OM digestibility. Fecal and urinary N excretion, as well as duodenal flow of α-amino N and non-ammonia non-microbial N increased linearly with increasing levels of supplementation. Rumen microbial protein flowing to duodenum and the efficiency of rumen microbial protein synthesis were not affected by treatments. The proportion of rumen degradable protein which was used for microbial protein synthesis decreased linearly with increasing levels of supplementation, but at a higher rate than was the reduction of the proportion of N intake which reached the small intestine as α-amino N. In conclusion, despite increasing N excretion and exerting a depressive effect on forage intake, supplementation with a high-degradable true protein source improves α-amino N and energy supply in ruminants fed tropical grass based-diets

Desempenho e características de carcaças de cordeiros suplementados com diferentes níveis de resíduo de biodiesel

Estudou-se a suplementação de dietas de cordeiros confinados com resíduo de biodiesel, utilizando-se 25 ovinos, SRD, machos, castrados, com média de peso de 20kg. O delineamento experimental foi de blocos ao acaso, com cinco repetições por tratamento e esquema de parcelas subdivididas para os dados de biometria. O experimento teve a duração de 70 dias. As dietas eram compostas de 34% de volumoso e 61% de concentrado, à base de milho, soja, minerais e 5% de óleo de dendê ou resíduo de biodiesel, em percentagens crescentes - zero, 25, 50, 75 e 100%. Os animais foram abatidos ao final do experimento para avaliação da carcaça. Foram observados efeitos significativos (P<0,05) de percentagem de inclusão do resíduo, para as variáveis de desempenho e biometria demonstrados nos efeitos lineares crescentes das equações de regressão, assim como para peso da carcaça quente (PCQ) -, com médias de 14; 15,92; 16,14; 16,42 e 18,02% - e peso da carcaça fria (PCF) -, com médias de 13,12; 14,78; 15,06; 15,70 e 17,25% -, para dietas com, respectivamente, 0, 25, 50, 100% de resíduo de biodiesel de dendê. A utilização de resíduo de biodiesel de dendê na alimentação de cordeiros em crescimento é alternativa para aumentar a densidade energética de suas dietas