Inflation with Ω≠1\Omega \not = 1

We discuss various models of inflationary universe with $\Omega \not = 1$. A homogeneous universe with $\Omega > 1$ may appear due to creation of the universe "from nothing" in the theories where the effective potential becomes very steep at large $\phi$, or in the theories where the inflaton field $\phi$ nonminimally couples to gravity. Inflation with $\Omega < 1$ generally requires intermediate first order phase transition with the bubble formation, and with a second stage of inflation inside the bubble. It is possible to realize this scenario in the context of a theory of one scalar field, but typically it requires artificially bent effective potentials and/or nonminimal kinetic terms. It is much easier to obtain an open universe in the models involving two scalar fields. However, these models have their own specific problems. We propose three different models of this type which can describe an open homogeneous inflationary universe.Comment: 29 pages, LaTeX, parameters of one of the models are slightly modifie

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