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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Characterization and nutritional value of precooked products of kiwicha grains (Amaranthus caudatus)

AbstractKiwicha has significant nutritional characteristics. It is commonly used as a puffed product, but there is little research on the lamination process. In this paper, the physical, functional properties, chemical composition and acceptability of the precooked kiwicha grains were studied. Puffed (PK) and laminated kiwicha (LK) were made. Puffed amaranth (CPA) was used as a commercial reference standard. The raw grain (RG) showed a higher bulk density (0.85 g/ml) than in PK (0.18 g/ml) and LK (0.38 g/ml). Both products had a good expansion. The yellow index decreased in PK (50.92) and LK (45.87) respect to RG (65.64). The largest was CPA (58.54). In all the products, the precooking increased the index of absorption, solubility and swelling power. Also, they showed major pasting temperature, low peak viscosity and breakdown viscosity. In both formulated products, the content of total, soluble and insoluble dietary fibre decreased during the precooking process. The content of protein was optimal (between 14.57-14.59 g/100g). PK had high acceptability (5.84), preference (84.48%), purchase (38.79%) and consumption (43.96%) intention. The lowest was CPA. This work demonstrates that it&#8217;s feasible to make precooked products with good quality characteristics, chemical composition and acceptability for the development of new products

Implications of processing on the levels of antinutritional factors in cereal grains

The phytic acid, phenolic compounds, tannins, oxalate and trypsin inhibitors are known as antinutritional factors (ANFs) that commonly are present in cereal grains. They contribute to a lower nutritional value of cereals because they indirectly decrease the bioavailability of nutrients. Fortunately, these ANFs can be modified or reduced through different processing methods such as mechanical (decortication and milling), physical (soaking), heat (boiling, pressure cooking, autoclaving, roasting, extrusion and microwave cooking) and chemical (germination and fermentation). The purpose of this review is to discuss different ANFs of cereals and the influence of their processing on the levels of ANFs.Fil: Burgos, Verónica Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones para la Industria Química. Universidad Nacional de Salta. Facultad de Ingeniería. Instituto de Investigaciones para la Industria Química; ArgentinaFil: Armada de Romano, Margarita. Universidad Nacional de Salta. Facultad de Ingeniería; Argentin

Physicochemical characterization and consumer response to new Andean ingredients-based fresh pasta: Gnocchi

Gnocchi is a typical Italian, potato-based, fresh pasta. Nowadays, there is not sufficient research about this pasta with non-traditional ingredients. The aims of this research were to characterize the physicochemical, texture and sensory quality of new Andean ingredients-based fresh pasta (Gnocchi) and to relate these characteristics to consumer response. There was no difference in moisture among raw gnocchi (p < 0.05). Commercial gnocchi (C) had the highest values of WAI (Water Absorption Index), cooking loss and luminosity. The values of WSI (Water Solubility Index) and water absorption were the highest for quinoa gnocchi (Q). Textural parameters and microstructure in cooked gnocchis showed that A and Q were the gummiest, showing little loss of granular structure. The average acceptability of Q, A and C was 3.79, 3.96 and 4.49, respectively. In addition, it was reflected in the purchase intention, which may be due to the lack of variety in the local market. This study demonstrates that fresh pasta gnocchis with Andean ingredients are high-quality and contribute to the revaluation of these exceptional Andean crops, which are very important to community of food and gastronomy sciences.Fil: Burgos, Verónica Elizabeth. Universidad Nacional de Salta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones para la Industria Química. Universidad Nacional de Salta. Facultad de Ingeniería. Instituto de Investigaciones para la Industria Química; ArgentinaFil: López, Estela Patricia. Universidad Nacional de Salta. Facultad de Ciencias de la Salud; ArgentinaFil: Goldner, Maria Cristina. Universidad Nacional de Salta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones para la Industria Química. Universidad Nacional de Salta. Facultad de Ingeniería. Instituto de Investigaciones para la Industria Química; ArgentinaFil: Del Castillo, Valeria Cristina. Universidad Nacional de Salta. Consejo de Investigacion; Argentina. Universidad Nacional de Salta. Facultad de Ingeniería; Argentin

Effect of precooking on antinutritional factors and mineral bioaccessibility in kiwicha grains

Kiwicha is the most important genus of Amaranthus and has a high mineral content. However, it contains antinutritional factors that may influence their bioaccessibility. Thus, the aim of our study was to evaluate the effect of precooking on antinutritional factors and mineral bioaccessibility of iron, calcium and zinc in kiwicha grains. Puffed kiwicha (PK) had the highest bioaccessibility and potential contribution (PC) of iron. The bioaccessibility of zinc was reduced in PK and laminated kiwicha (LK). The heat treatment decreased the content of: total dietary fiber (11–14%), bound fraction (15–36%) and total polyphenols (15–16%) and inositol hexaphosphate (19–27%). Phytic acid free fraction and total polyphenols, values exhibited a high negative correlation with iron, calcium and zinc bioaccessibility. On the other hand, iron bioaccessibility improved with puffing and therefore PK had the highest PC to requirements for children (4–8 years old), pregnant women and aging adults. Puffing and lamination processes increased the calcium bioaccessibility but decreased that of zinc. We concluded that the precooking of kiwicha grain influenced on antinutritional factors and, consequently, the minerals bioaccessibility. It would be important to study the effect of other processes and the use of enhancers to improve mineral bioaccessibility and potential contribution.Fil: Burgos, Verónica Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones para la Industria Química. Universidad Nacional de Salta. Facultad de Ingeniería. Instituto de Investigaciones para la Industria Química; ArgentinaFil: Binaghi, Maria Julieta. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Sanidad Nutrición Bromatología y Toxicología; ArgentinaFil: Ronayne de Ferrer, Patricia Ana. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Sanidad Nutrición Bromatología y Toxicología; ArgentinaFil: Armada de Romano, Margarita. Universidad Nacional de Salta. Facultad de Ingeniería; Argentin