Revisiting the SN1987A gamma-ray limit on ultralight axion-like particles

We revise the bound from the supernova SN1987A on the coupling of ultralight axion-like particles (ALPs) to photons. In a core-collapse supernova, ALPs would be emitted via the Primakoff process, and eventually convert into gamma rays in the magnetic field of the Milky Way. The lack of a gamma-ray signal in the GRS instrument of the SMM satellite in coincidence with the observation of the neutrinos emitted from SN1987A therefore provides a strong bound on their coupling to photons. Due to the large uncertainty associated with the current bound, we revise this argument, based on state-of-the-art physical inputs both for the supernova models and for the Milky-Way magnetic field. Furthermore, we provide major amendments, such as the consistent treatment of nucleon-degeneracy effects and of the reduction of the nuclear masses in the hot and dense nuclear medium of the supernova. With these improvements, we obtain a new upper limit on the photon-ALP coupling: g_{a\gamma} < 5.3 x 10^{-12} GeV^{-1}, for m_a < 4.4 x 10^{-10} eV, and we also give its dependence at larger ALP masses. Moreover, we discuss how much the Fermi-LAT satellite experiment could improve this bound, should a close-enough supernova explode in the near future.Comment: Accepted for publication in JCAP (December 22nd, 2014

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

On determination of electronic-vibro-rotational term values of diatomic molecules from measured wavenumbers

A method is proposed for determining rovibronic term values of diatomics from experimental data on the wavenumbers of electronic-vibro-rotational spectral lines. In contrast to existing techniques, the new one is based on the Rydberg-Ritz principle only. It is shown that a link between a set of rovibronic term values and a set of wavenumbers of observed rovibronic spectral lines appears when three and more different electronic-vibrational states are pairwise-connected by radiative transitions. The method differs from known techniques in several aspects, namely, it: 1) doesn't need any assumptions concerning an internal structure of a molecule; 2) doesn't involve any intermediate parameters (as molecular constants in traditional techniques); 3) gives an opportunity to use in one-stage optimization procedure all available experimental data obtained for various band systems, by various authors, and in various works; 4) provides in an interactive mode the opportunity to select the experimental values, eliminating rough errors, to revise wrong identifications of spectral lines and to compare various sets of experimental data for mutual consistency; 5) allows to obtain not only an optimal set of rovibronic term values, but also the error bars depending on quantity and quality of existing experimental data. Necessary precondition for use of this method is a preliminary identification of electronic-vibro-rotational lines to certain electronic-vibro-rotational radiative transitions. For this purpose one has to use traditional methods of the analysis of molecular spectra.Comment: 10 pages, 2 figures, in Russia

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe