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

Search behavior in goat (Capra hircus) kids from mothers kept at different animal densities throughout pregnancy

Individual differences in cognitive performance are often reported but factors related to variation within species are rarely addressed. Goats (Capra hircus) have been subjects of many cognitive studies recently but without focus on individual variation. Among others, factors such as prenatal stress and sex of the individual have been proposed as possible explanations for individual variation in cognitive skills. We aimed to study whether prenatal environment, prenatal stress, litter size, sex, and birth weight influences search behavior skills of goat kids. Pregnant Norwegian dairy goats were exposed to different spatial allowance (namely 1.0, 2.0, or 3.0 m2 per animal) within the commercially applied range during pregnancy and their serum cortisol levels were measured six times within this period. Twenty-six of the kids born entered a three-stage searching task with increasing difficulty when they were 6 weeks old. The tasks included finding a bucket of milk: while moving (stage 1), after moving and disappearing behind a curtain (stage 2), and moving behind a displacement device and the device moving behind a curtain while hiding the bucket (stage 3). We found that prenatal animal density had no effect on the search skills of the offspring, while kids with higher prenatal maternal cortisol levels performed better at the highest stage tested: finding an object after single invisible displacement. At this stage, singleton kids and males performed better than twins and females. Birth weight had no effect at this stage. The findings suggest that maternal cortisol in the observed range had a facilitating effect on cognitive development of goat kids