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

Cold or warm? Constraining dark matter with primeval galaxies and cosmic reionization after Planck

Dark matter constitutes the great majority of the matter content in the Universe, but its microscopic nature remains an intriguing mystery, with profound implications for particle physics, astrophysics and cosmology. Here we shed light on the longstanding issue of whether the dark matter is warm or cold by combining the measurements of the galaxy luminosity functions out to high redshifts 0z~ 1 from the Hubble Space Telescope with the recent cosmological data on the reionization history of the Universe from the Planck mission. We derive robust and tight bounds on the mass of warm dark matter particle, finding that the current data require it to be in the narrow range between 2 and 3 keV . In addition, we show that a mass not exceeding 3 keV is also concurrently indicated by astrophysical constraints related to the local number of satellites in Milky Way-sized galaxies, though it is in marginal tension with analysis of the Lyman-alpha forest. For warm dark matter masses above 3 keV as well as for cold dark matter, to satisfy the Planck constraints on the optical depth and not to run into the satellite problem would require invoking astrophysical processes that inhibit galaxy formation in halos with mass MH lesssim few 7 10 8 Msolar, corresponding to a limiting UV magnitude MUV 48 -11. Anyway, we predict a downturn of the galaxy luminosity function at z~ 8 faintward of MUV 48 -12, and stress that its detailed shape is extremely informative both on particle physics and on the astrophysics of galaxy formation in small halos. These expectations will be tested via the Hubble Frontier Fields and with the advent of the James Webb Space Telescope, which will enable probing the very faint end of the galaxy luminosity function out to z ~ 8--10

Merneptah’s ‘Israel’ and the Absence of Origins in Biblical Scholarship

This article examines the Merneptah Stele and its role in recent efforts to reconstruct Israelite history and identity. Though necessarily concerned with the issues of translation and location as they relate to the entity named in the stele, this review is dominated by an assessment of the various ways in which biblical scholarship has related to this singular reference. To that end, issues of theory and method, both archaeological and anthropological, are prioritized as the review appraises the various attempts to isolate this entity as the Archimedean point of Israelite historical and ethnic development. Though certainly critical of what it perceives as the sterile reproduction of long-held beliefs, it is a review that, in its appeal to the work of Pierre Bourdieu, looks to identify prospects for further study of the stele, rather than foreclose the very questions that it raises