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

The effect of a diverting ileostomy formation on nutritional status and energy intake of patients undergoing colorectal surgery

Background and aims: The effects of ileostomy construction and colonic bypass on the general nutritional status of the patients have not yet received much attention. The aim of the present study was to assess the effect of a diverting ileostomy formation, on the nutritional intake, body composition and nutritional status biochemical markers of patients with a newly formed ileostomy. Methods: This was an observational study. Patients scheduled for elective rectosigmoid resection at a surgical unit of a public university hospital, were considered for study inclusion. Patients in whom a diverting ileostomy was created were assigned to the ileostomy group (n = 41), and patients who underwent rectosigmoid resection without requiring a diverting ileostomy served as a control group (n = 37). Anthropometric characteristics, body composition, dietary intake and biochemical markers representative of nutritional status were assessed preoperatively and at 40 days postdischarge (NCT02036346). Results: Anthropometric and body composition characteristics (weight, BMI and body fat percentage) significantly declined from 75 to 71.6 kg, 26.9 to 25.6 kg/m2 and 28.6 to 25.6% respectively (p = 0.001 for all) in the ileostomy group, between the preoperative stage and 40 days postdischarge from the hospital. Furthermore, a significant reduction in mean daily energy intake from 1871 to 1713 kcal/day (p = 0.046) was observed in the ileostomy group 40 days after discharge compared to preoperative assessment. No significant changes in the above measured parameters were observed in the non-ileostomy group. Conclusion: Diverting ileostomy can have a negative effect on general nutritional status and dietary intake of patients, during the first postoperative period. Nutritional assessment might need to be included in the routine clinical management of this patient category to prevent weight loss and impaired energy intake. © 2020 European Society for Clinical Nutrition and Metabolis

The (n,2n)(n,2n) reaction for the lightest stable erbium isotope 162Er^{162}\mathrm{Er} from reaction threshold up to 19 MeV

International audienceThe Er162(n,2n)Er161 reaction cross section (Eth=9.26MeV) was measured at six incident neutron beam energies by means of the activation technique. Two energy regions were covered in the present work: the near-threshold energies between 10.7 and 11.3 MeV, as well as the higher energies from 17.1 up to 19.0 MeV. In this way, the energy range from the reaction threshold up to 19 MeV was experimentally mapped, considering also the existing experimental information around 14 MeV. The quasi-monoenergetic neutron beam at near-threshold energies was produced via the H2(d,n)He3 reaction, while the higher neutron beam energies were achieved by using the H3(d,n)He4 reaction. The primary deuteron beam was delivered in both cases by the 5.5 MV Tandem Van de Graaff accelerator of NSCR “Demokritos.” Statistical model calculations were performed and compared with all the available experimental data

ISOLDE PROGRAMME

The experiments aim at a broad exploration of the properties of atomic nuclei far away from the region of beta stability. Furthermore, the unique radioactive beams of over 60~elements produced at the on-line isotope separators ISOLDE-2 and ISOLDE-3 are used in a wide programme of atomic, solid state and surface physics. Around 300 scientists are involved in the project, coming from about 70 laboratories. \\ \\ The electromagnetic isotope separators are connected on-line with their production targets in the extracted 600 MeV proton or 910~MeV Helium-3 beam of the Synchro-Cyclotron. Secondary beams of radioactive isotopes are available at the facility in intensities of 10$^