Foreseeing the future of mutualistic communities beyond collapse

International audienc

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

Systemic risk in ecosystems

It is common knowledge that the millions of species that inhabit the Earth have adaptations that enable them to survive in different environments. Fish have gills which allow them to breath under water, while the wings of birds allow them to fly. These adaptations are, as different as they may be, a different solution to the same problem: the problem of staying alive and reproduce in a world where species are under the constant pressure of natural selection. Perhaps less well known, but maybe not surprising when thought about carefully, is that the often complex networks of interactions between species, e.g. between plants and pollinators or between predators and prey, have certain non-random properties as well. These ‘network structural properties’, i.e. specific ways in which the interactions within networks are arranged most likely allow the often large numbers of species in ecosystems to coexist. Just like similar adaptations may be found in a wide variety of species, e.g. gills or gill-like organs in aquatic animals and wings on birds, insects, and bats, similar network structural properties may be found in a wide variety of ecosystems. Similarities that may occur simply because they are, like adaptations, a solution to the same problem: the problem of coexistence in systems where species heavily influence each other’s probability of survival. While we are beginning to understand more about the structural properties of ecological networks, i.e. the networks of interactions between species, and how they might allow large numbers of species to coexist in complex ecosystems, the Earth and its ecosystems are changing at increasingly rapid rates due to human activities. In some cases, these changes are relatively simple in the sense that they affect a large group of species similarly, e.g. the effect of pesticides on a large group of insect pollinators, while in other cases these changes may be complex, e.g. the effects of climate change on the phenology and distribution of species which in turn leads to alterations in strengths of interspecific interactions in a way that is unique for each interaction. Ecosystems may respond in various ways to such changes (regardless of whether their effects are simple or complex). When conditions change gradually, the state of some ecosystems (e.g. the size of populations) may change likewise, in a smooth, gradual manner. Other systems may respond strongly to change within a narrow range of environmental conditions, but are relatively insensitive to change outside of this range. Particularly sudden shifts may occur when ecosystems have multiple alternative states. Such systems cannot change smoothly from one state (e.g. large population sizes) to an alternative state (e.g. a state in which some or all species are extinct). Instead, a sudden shift or ‘critical transition’ occurs when environmental conditions pass a critical point. To return back to the original state after such a transition, a return to conditions prior to the transition is often not sufficient; instead, a larger change in conditions is needed until another critical point is reached at which the system shifts back to the original state, a phenomenon called ‘hysteresis’. While the outcome of critical transitions is relatively predictable when a few leading species or species groups determine the state of an ecosystem, this may not be the case when ecosystem dynamics are determined by many interacting species. The consequences of critical transitions in such complex ecosystems might be severe, for example, when leading to the extinction of a large number of species. Not all critical transitions, however, will have dramatic consequences. Complex ecosystems may potentially shift to many different, alternative states. Some of those may imply minor, harmless changes in the state of a system, or invoke positive change, whereas others may have catastrophic con- sequences. The amount and type of change needed to cause a transition and a system’s future state after an impending critical transition depends in complex and often unknown ways on how ecosystems are organized, i.e. on the feedback mechanisms within it, and thus on the structure of ecological networks and/or how this structure might be changed by changing environmental conditions. Assessing or mitigating the risks associated with critical transitions in complex ecosystems thus requires a fundamental insight in the interrelationships between the structural properties of ecological networks, the dynamics of ecosystems, and the way in which these properties and dynamics might be affected by changing environmental conditions. Despite a longstanding interest in ecological networks and more recent advances in detecting commonalities in the structure of ecological networks, the common ground between studying the structure of ecological networks and the potential causes and consequences of critical transitions in complex ecosystems remains largely unexplored. In this thesis, I hope to have provided novel ideas and insights that might help to address the question of whether changing environmental conditions are likely to lead to large-scale systemic regime shifts in complex ecosystems. An emerging property of complex ecosystems that may be referred to as ‘systemic risk’