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

An astronomically-tuned climate framework for hominins in the Turkana Basin.

Understanding the influence of orbital climate cycles on hominin evolution remains a key challenge in paleoanthropology. The two major unresolved issues are: the absence of a climate proxy yielding high-resolution (< 20 kyr) terrestrial climate records, and the lack of age control on hominin fossil occurrences at sufficiently high resolution. Here we present a novel climate proxy, strontium isotope ratios (⁸⁷Sr/⁸⁶Sr) of lacustrine fish fossils from the Turkana Basin, that solves these issues by recording orbitally forced variation in summer monsoon intensity over the Ethiopian Highlands. We successfully applied the climate proxy to a ~ 150 kyr time interval of ~ 2 million year old paleolake deposits containing hominin fossils. Existing age control of the studied interval was improved by a new magnetostratigraphic record precisely locating the base of the Olduvai chron (C2n) near the bottom of the sequence. Spectral analysis demonstrates that ⁸⁷Sr/⁸⁶Sr variability is primarily determined by precession, which enables us to place hominin fossils in an astronomically-tuned climate framework. The Sr climate proxy is potentially applicable to all hominin-bearing lake deposits in the Turkana Basin, ranging in age from ~ 4.2 to 0.8 million years ago (Ma). Our results demonstrate that between ~ 2 and 1.85 Ma the Turkana Basin remained well-watered and inhabited by hominins even during periods of precession maxima when summer monsoon intensity was lowest. This is in contrast to other basins in the East African Rift System (EARS) that were impacted heavily by precession-forced droughts. We hypothesize that during lake phases, the Turkana Basin was an aridity refugium for permanent-water dependent fauna – including hominins – over the precessional climate cycles

Editorials

The measles epidemicThe recruitment of blood donors from the black population of South AfricaReporting occupational diseaseTechnological advances in regional anaesthesiaQuality in health car

Gradual or abrupt? Changes in water source of Lake Turkana (Kenya) during the African Humid Period inferred from Sr isotope ratios

Human Origin

Improved age control on early Homo fossils from the upper Burgi Member at Koobi Fora, Kenya

To address questions regarding the evolutionary origin, radiation and dispersal of the genus Homo, it is crucial to be able to place the occurrence of hominin fossils in a high-resolution chronological framework. The period around 2 Ma (millions of years ago) in eastern Africa is of particular interest as it is at this time that a more substantial fossil record of the genus Homo is first found. Here we combine magnetostratigraphy and strontium (Sr) isotope stratigraphy to improve age control on hominin-bearing upper Burgi (UBU) deposits in Areas 105 and 131 on the Karari Ridge in the eastern Turkana Basin (Kenya).We identify the base of the Olduvai subchron (bC2n) plus a short isolated interval of consistently normal polarity that we interpret to be the Pre-Olduvai event. Combined with precession-forced (w20 kyr [thousands of years]) wetedry climate cycles resolved by Sr isotope ratios, the magnetostratigraphic data allow us to construct an age model for the UBU deposits. We provide detailed age constraints for 15 hominin fossils from Area 131, showing that key specimens such as cranium KNM-ER 1470, partial face KNM-ER 62000 and mandibles KNM-ER 1482, KNM-ER 1801, and KNM-ER 1802 can be constrained between 1.945 0.004 and 2.058 0.034 Ma, and thus older than previously estimated. The new ages are consistent with a temporal overlap of two species of early Homo that can be distinguished by their facial morphology. Further, our results show that in this time interval, hominins occurred throughout the wetedry climate cycles, supporting the hypothesis that the lacustrine Turkana Basin was a refugium during regionally dry periods. By establishing the observed first appearance datum of a marine-derived stingray in UBU deposits at 2.058 0.034 Ma, we show that at this time the Turkana Basin was hydrographically connected to the Indian Ocean, facilitating dispersal of fauna between these areas. From a biogeographical perspective, we propose that the Indian Ocean coastal strip should be considered as a possible source area for one or more of the multiple Homo species in the Turkana Basin from over 2 Ma onwards

Perspectivas e desafios no debate sobre financiamento e gestão da educação: da CONAE a um novo PNE Prospects and challenges in the debate on funding and administrating education: from CONAE to a new PNE

O artigo analisa as proposições mais importantes no documento final da CONAE 2010 quanto às questões do financiamento e da gestão da educação e, de forma complementar, cotejar tal texto com as indicações do Plano Nacional de Educação (PNE, Lei n. 172/2001). A leitura e o confronto de tais proposições buscarão contribuir com um dos desdobramentos objetivados pela própria CONAE, que é o de indicar elementos para um novo PNE. O pano de fundo desta construção colocará em tela uma disputa pelas concepções de educação pública e papel do Estado. Os desafios dessa luta se materializarão na disputa pela consolidação das metas aprovadas na conferência nos espaços da democracia representativa formal brasileira.<br>This paper explores the most important propositions from the final resolution of the 2010 CONAE with regard to education funding and administration. Complementarily, it collates the conference documents with the details of the National Plan for Education (Law n. 172/2001). These propositions were read and compared to contribute to one of the very developments intended by the CONAE: indicating elements for a new National Plan for Education. The background of this construction is a dispute around the conceptions of public education and the role of the State. The challenges of this struggle will be materialized in the quarrel to consolidate the goals indicated by the conference in the spaces of formal representative democracy in Brazil