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

Anticipating the course of an action: evidence from corticospinal excitability

Using transcranial magnetic stimulation (TMS) we investigated how changes in corticospinal excitability (CSE) depend on anticipated task variables of future intended actions. Specifically, we examined the time course of single- and paired-pulse modulation in movement selection decisions influenced by predicted demands of a forthcoming object manipulation

Trauma and Distress on a Cruise during the COVID-19 Pandemic: A Qualitative Study with Italian and French Tourists

The COVID-19 pandemic has drastically changed our daily lives. One of the sectors most affected was tourism and travel – and, more specifically, cruises, given the prolonged time passengers spend with others within the small spaces of the cruise ship. While finding well- organised entertainment opportunities on cruises is possible, emergency conditions may cause panic. On such occasions, reactions can be highly stressful or even traumatic. This research explores the events and emotions experienced by passengers during a cruise ship quarantined for COVID-19. The empirical materials consist of interviews with 15 passengers. The analyses show four thematic areas: fear of contagion, feelings of discrimination, cooperation between passengers and relationship with the crew. The problems during a cruise ship quarantine presented by the passengers in this study reveal the need for psychological preparation for the crew and security personnel. Finally, we suggest that telemedicine andtelepsychology are key elements to improve the efficiency of behavioral control on cruise ships and to mitigate the COVID-19 effects on tourists' well-being during a quarantine