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

Estimating the energy cost of 5-m shuttle running through positive and negative work : a pilot study

Introduction The metabolic energy required to cover a shuttle distance is larger than that of linear running at constant speed [1]. However, an affordable method to estimate the energy cost of running when an athlete performs frequent Changes of Direction (CoD) is still unavailable. CoDs require a modification of the locomotor pattern to direct the momentum of straight running in a new direction and it is possible only applying an additional force to the ground. In this pilot study we assessed the accuracy of an algorithm to estimate the metabolic cost of shuttle running based on the computation of external positive and negative mechanical work. Materials and Methods The 3D position of 23 body landmarks applied on the body of four male participants (age: 26.3\ub14.8 y, weight: 65.5\ub15.7 kg, height: 173.5\ub16.6 cm) were recorded by means of a motion capture system (BTS Spa, Milano, Italy) while they were running over a 5-m shuttle course. After obtaining the instantaneous position of the body centre of mass [2], external mechanical positive and negative work were computed [3]. The oxygen uptake during the exercise (VO!) was measured using a K4b2 metabolimeter (Cosmed, Roma, Italy); the net metabolic cost was computed subtracting the standing metabolic rate. Two 5-min trials were arranged, with average speeds of 6.0 and 8.5 km/h. In the fifth minute, synchronized metabolic and kinematic data were recorded. Rate of perceived exertion (RPE) was assessed by Borg 6-20 scale. The proposed algorithm considers negative work only in the \u2018braking phases\u2019, i.e. when at least one foot is on the ground and the knee is flexing (flexion angular velocity < 0); in the remaining \u2018propulsive phases\u2019, only positive work was considered. Negative and positive work were supposed to have an efficiency of 6/5 and 1/4, respectively [4]. The estimated metabolic cost was compared with the classical positive-external-work-only (Wext-only) approach to mechanical work estimation. To compare results, a Wilcoxon signed rank test followed by Bonferroni-adjusted post-hoc comparisons was performed (alpha level: 0.05). Results Both the Wext-only and our approaches overestimated the normalized energy cost during shuttle running (Figure 1). However, post-hoc tests showed only a significant difference between measured and Wext-only estimation (p=0.001), while measured vs. estimated metabolic costs were not statistically different (p=0.445). Our method returned a mean error of 2.63\ub11.52 J/Kg 19s. Reported RPE was always between 10 and 13. Figure 1: comparison between measured (black), estimated (gray) and classically derived (white) metabolic cost during 5-m shuttle running. P1-4: participants; S (slow): 6.0 km/h; F (fast): 8.5 km/h. Discussion The better estimation we obtained considering negative work under certain conditions indicates the importance of elastic energy recovery in sharp CoD maneuvers. However, the contribution of anaerobic lactic and anaerobic alactic sources to the overall energy expenditure was not considered, even though the assumption of purely aerobic exercise couldn\u2019t have hold for every participant. In particular, it would be interesting to consider both one exercise load (running speed) below and one over the aerobic threshold (approximately 50% and 80% of !!"#). What is more, the cutting technique may have a considerable influence on running economy, and should somehow be considered. Nevertheless, the current results are promising and encourages further developments of this approach. References 1. Hatamoto et al, Open Acces J Sport Med, 4:117-122, 2013. 2. Mapelli et al, Gait Posture, 39:460-465, 2013. 3. Willems et al, J Exp Biol, 393:379-393, 1995. 4. Hill, Proc R Soc Biol Sci, 126:136-195, 1938

Erratum: Circulating Very-Low-Density Lipoprotein Characteristics Resulting from Fatty Liver in an Insulin Resistance Rat Model

The close association between nonalcoholic fatty liver and insulin resistance is now widely recognized. While the former is characterized by excessive intrahepatic triglyceride accumulation, the latter induces overproduction of very-low-density lipoprotein (VLDL) particles. It has not been well elucidated whether these apparently opposite mechanisms impact on VLDL characteristics or not. The aim of the present study was to evaluate the VLDL secretion and features resulting from insulin resistance and fatty liver in rats fed a sucrose-rich diet (SRD, i.e. addition of sucrose to drinking water during 12 weeks). No differences in calorie intake were observed in comparison to controls. Both groups showed similar weight gains throughout the treatment period. However, SRD rats showed an increased proportion of body fat as assessed by X-ray absorptiometry, increased visceral obesity, liver weight and fat accumulation in the liver (p < 0.04). Histological study revealed moderate micro- and macrovesicular steatosis. Fasting insulin, triglyceride and free fatty acid (FFA) levels increased while VLDLs decreased in SRD rats (p < 0.05). The chemical composition of VLDLs of SRD rats showed a higher percentage of triglycerides, and the VLDL triglyceride/protein ratio, an estimator of lipoprotein size, suggests that VLDL particles of SRD rats are larger than those of controls (p < 0.0005). FFA levels correlated with VLDL triglycerides (r = 0.49, p = 0.03) and liver fat content correlated with plasma triglycerides (r = 0.65), VLDL triglycerides (r = 0.55) and triglyceride/protein ratio (r = 0.52, p < 0.02). The VLDL secretion rate assay showed an increase in SRD rats (p < 0.02), confirming an overproduction despite liver fat accumulation. Our findings are consistent with an insulin resistance development model in which hepatic lipid content would constitute an important determinant of a triglyceride-rich, large-particle VLDL secretion; both features would increase its atherogenic potential

Significado da escolarização para um grupo de catadoras de um lixão The meaning of school education for a group of garbage collectors

O artigo analisa o significado da escolarização para um grupo de dez catadoras de um lixão do Grande Rio de Janeiro. Fornece informações sobre o trabalho delas no lixão e os arranjos familiares em que vivem. Descreve os breves contatos que tiveram com a escola em decorrência de condições precárias de vida na família de origem. Com base nesse contexto, explora suas expectativas em relação à escolarização de seus filhos.<br>The article analyses the role of formal education in the life of ten garbage collectors in the state of Rio de Janeiro. It provides information about their work at the landfill and about their family structure. Their expectations regarding their children's education are examined in the background of their precarious living conditions and limited experience and acquaintance with the educational system shown in the interviews

Estudos sobre a nutrição mineral do milho. II. Efeito de doses crescentes de N, P e K no crescimento, produção e composição mineral da variedade Piranão em condições controladas.

O milho, var. Piranao, foi cultivado em solucao nutritiva com niveis crescentes de N, P e K. Houve resposta linear a adicao de N e assintotica as doses de P e de K. A determinacao a atividade da reductase de nitrato se correlacionou melhor com a producao total nas folhas, por sua vez refletiu melhor o estado nutricional que a determinacao de putrescina nas folhas.197