Neutrino Imaging of the Galactic Centre and Millisecond Pulsar Population

In this work, we consider the possible presence of a large population of millisecond pulsars in the Galactic Centre. Their direct detection would be challenging due to severe pulse broadening caused by scattering of radiation. We propose a new method to constrain their population with neutrino imaging of the Galactic Centre. Millisecond pulsars are proposed cosmic-ray accelerators. The high-energy protons they produce will collide with the baryonic matter in the central molecular zone to create charged and neutral pions that decay into neutrinos and $\gamma$-rays, respectively. The specific neutrino and $\gamma$-ray fluxes must be below their corresponding observed values, allowing us to put a conservative upper limit on the millisecond pulsar population of N_MSP < 10,000 within a galacto-centric radius of 20 pc. This upper limit is sensitive to the proton acceleration efficiency of the pulsars, but is less dependent on the particle injection spectral index and the choice of mass tracers. The population will be better constrained when high resolution neutrino observations of the Galactic Centre become available. The presence of these millisecond pulsars can account for the $\gamma$-ray excess in the Galactic Centre.Comment: 8 pages, 2 figures, Presented at the 38th International Cosmic Ray Conference (ICRC2023); PoS (ICRC2023), 106

Neutrino imaging of the Galactic Centre and Millisecond Pulsar Population

Despite the potentially large population of millisecond pulsars in the Galactic Centre, direct detection of them is almost impossible using the current radio telescopes, due to severe pulse broadening caused by radiation scattering. We propose that imaging the Galactic Centre using neutrinos provides us a way to constrain the millisecond pulsar population. Millisecond pulsars are proposed cosmic-ray accelerators. The high-energy protons they produce will collide with the baryonic matter in the central molecular zone, which creates charged and neutral pions that decay into neutrinos and γ rays, respectively. The specific fluxes of neutrino and γ -ray emission for the case with CS emission as the baryon tracer in the Central Molecular Zone that we computed, subjected to γ -ray observation by H.E.S.S., set a conservative upper limit of NMSP<10,000 for the Galactic Centre millisecond pulsar population, with an injecting proton energy spectral index Γ=−1 and an efficiency of fp=1% converting the pulsar's rotational power to cosmic-ray power. This population of millisecond pulsars could explain the GeV γ -ray excess in the Galactic Centre

Sobrevida de pessoas idosas hospitalizadas com uso prévio de medicamentos potencialmente inapropriados

Resumo Objetivos Neste estudo prospectivo, avaliamos o impacto do uso de medicamentos potencialmente inapropriados prescritos antes da internação (PIM-ph) na mortalidade de idosos. Métodos Foram incluídos 318 pacientes com idade ≥ 65 anos que procuraram atendimento de emergência e foram internados por qualquer motivo clínico. As informações sobre os indicadores clínicos e sociais foram obtidas por meio de entrevistas estruturadas, 24 a 48 horas após a internação. Os medicamentos usados por esses pacientes foram registrados e o uso de PIM-ph foi identificado pela análise brasileira baseada em consenso de uso de PIM. A análise considerou a influência de todo conjunto de PIM-ph, bem como de alguns PIM-ph específicos. O impacto do uso de PIM-ph na sobrevida de idosos hospitalizados foi determinado por meio da análise multivariada de regressão de Cox. Resultados A prevalência de PIM-ph foi 49,7% (n = 158). Um total de 85 (26,7%) pacientes faleceram durante a internação ou até 30 dias após a alta. Dezoito classes farmacológicas de uso de PIM-ph foram identificadas. O uso de PIM-ph, benzodiazepínico (IC: 1.055-3.365, p= 0.032), digoxina (IC: 1.623-7.048, p=0.001) e diuréticos de alça (IC: 1.000-3.455, p=0.05) aumentou o risco relativo de mortalidade independente de sexo, idade, causas clínicas de hospitalização, risco de fragilidade, suporte social, presença de sintomas de confusão, polifarmácia e evolução intra-hospitalar de complicações geriátricas. Conclusão O uso de PIM-ph (Benzodiazepínicos, digoxina e diuréticos de alça) pode contribuir para o risco de mortalidade em idosos hospitalizados. Esses resultados podem ser relevantes no manejo e cuidado terapêutico de pacientes hospitalizados

Prescrição de antimicrobianos para idosos hospitalizados: análise do benefício e associação com implementação de limitação de esforço terapêutico e cuidados paliativos

Background and Objectives: Many advances have occurred in the prevention, diagnosis and treatment of infectious diseases, but they are still the main causes of hospitalization and death in older adults. The objective of this study was to verify the benefit of antimicrobial use and its association with the implementation of other therapeutic measures and with the indication of palliative care in the last two weeks of life of hospitalized older adults, in order to subsidize the development of rational models for this group. Methods: A retrospective study was carried out by analyzing the medical records of the older adult participants of the cohort epidemiological study ―Development of a Care Line for Older Adults at the University Hospital of Santa Maria‖, which presented death as an outcome. Results: Of the 97 individuals evaluated, 89.7% (n = 87) used antibiotics in the last two weeks of life. Among those who used antibacterial agents, 38.9% presented clinical signs of improvement after treatment initiation (n=28). Thus, it was possible to affirm that there was no association between symptom relief and antibacterial use (p = 0.377). Among those who benefited from antibiotic therapy, 46.4% were indicated for respiratory infection and 14.3% for urinary tract infection. We found no dependence between the use of antibacterial drugs and the other therapeutic measures adopted (p = 0.057), nor with the indication of palliative care (p = 0.065). Conclusion: There was little evidence of benefit in the use of antibiotics in the studied group, which indicates the need for a different care plan adequacy for this patient profile.Justificación y Objetivos: Ocurrieron muchos avances en la prevención, diagnóstico y tratamiento de las enfermedades infecciosas, pero todavía son las principales causas de hospitalización y muerte en ancianos. El presente trabajo tuvo como objetivo verificar el beneficio del uso de antimicrobianos y su asociación con la implementación de otras medidas terapéuticas y con la indicación de cuidados paliativos en las dos últimas semanas de vida de ancianos en internación hospitalaria con el fin de fomentar el desarrollo de modelos racionales de prescripción para este grupo. Métodos: Se desarrolló un estudio retrospectivo realizado por el análisis de historiales de los ancianos participantes del estudio epidemiológico del tipo cohorte ―Desarrollo de una línea de cuidados para el anciano en el Hospital Universitario de Santa María‖, que presentaron muerte como desenlace. Resultados: De los 97 individuos evaluados, el 89,7% (n = 87) hicieron uso de antibiótico en las dos últimas semanas de vida. Entre los que utilizaron el antibacteriano, el 38,9% presentó signos clínicos de mejora después del inicio del tratamiento (n = 28). Así fue posible afirmar que no hubo asociación entre el alivio de los síntomas y el uso de antibacteriano (p = 0,377). Entre los que se beneficiaron de la antibioticoterapia, el 46,4% fue indicado para infección respiratoria y el 14,3% para infección del tracto urinario. No se encontró dependencia entre el uso de antibacteriano y las otras medidas terapéuticas adoptadas (p = 0,057), ni con la indicación de cuidado paliativo (p = 0,065). Conclusión: Se observó poca evidencia de beneficio en el uso de antibacteriano en el grupo estudiado, lo que señala la necesidad de una adecuación del plan de cuidado diferenciada para ese perfil de pacientes.Justificativa e Objetivos: Muitos avanços ocorreram em prevenção, diagnóstico e tratamento das doenças infecciosas, porém elas ainda são as principais causas de hospitalização e morte em idosos. O objetivo deste trabalho foi verificar o benefício do uso de antimicrobianos e sua associação com a implementação de outras medidas terapêuticas e com a indicação de cuidados paliativos nas duas últimas semanas de vida de idosos em internação hospitalar, a fim de subsidiar o desenvolvimento de modelos racionais de prescrição para este grupo. Métodos: Foi desenvolvido um estudo retrospectivo realizado pela análise de prontuários dos idosos participantes do estudo epidemiológico do tipo coorte ―Desenvolvimento de uma linha de cuidados para o idoso no Hospital Universitário de Santa Maria‖ que apresentaram óbito como desfecho. Resultados: Dos 97 indivíduos avaliados, 89,7% (n = 87) fizeram uso de antibiótico nas duas últimas semanas de vida. Entre aqueles que utilizaram antibacteriano, 38,9% apresentaram sinais clínicos de melhora após o início do tratamento (n = 28). Assim, foi possível afirmar que não houve associação entre o alívio dos sintomas e o uso de antibacteriano (p = 0,377). Entre aqueles que se beneficiaram da antibioticoterapia, 46,4% foram indicados para infecção respiratória e 14,3% para infecção do trato urinário. Não foi encontrada dependência entre o uso de antibacteriano e as outras medidas terapêuticas adotadas (p = 0,057), nem com a indicação de cuidado paliativo (p = 0,065). Conclusão: Observou-se pouca evidência de benefício no uso de antibacteriano no grupo estudado, o que sinaliza a necessidade de uma adequação de plano de cuidado diferenciada para esse perfil de pacientes

Levantamento epidemiológico do benefício de inibidores de neuraminidase na síndrome respiratória aguda grave por COVID-19

Background and objectives: The COVID-19 pandemic and its consequent severe acute respiratory syndrome (SARS) have taken the lives of millions since 2020. The use of neuraminidase inhibitors is a promising alternative in treating this disease, with several studies on off-label use being conducted since the beginning of the pandemic, but none of them have a large sample size and analyze multiple risk factors. The purpose of this article is to identify possible associations between various factors and risk of hospitalization, need for ventilation and death, as well as the influence of the prescription of Zanamivir and Oseltamivir on these same indicators. Methods: In this transversal study, approximately 900,000 medical records from all regions of Brazil were collected from the Ministry of Health database, and after that, proper statistical analysis of the variables was performed. Results: Hospitalization was associated with gender, ethnicity, education, local urbanization, State, and its percentage of elderly, as well as the climate. The prescription of Zanamivir and Oseltamivir was associated with higher incidence of symptoms, lower hospitalization and death rate, and lower need for invasive and non-invasive ventilation. Medical records from146,160 patients were excluded due to SARS not caused by COVID-19. Conclusion: From this data, it is possible to draw a risk profile for hospitalization by SARS and consider the use of Zanamivir and Oseltamivir as a treatment for these patients.Justificación y objetivos: la pandemia Covid-19 y su consiguiente síndrome respiratorio agudo severo (SRAS) han muerto millones de personas desde 2020. El uso de inhibidores de la neuraminidasa es una alternativa prometedora en el tratamiento de esta enfermedad, con varios estudios sobre el uso off-label que se realiza desde el principio de la pandemia, pero ninguno que tenga un tamaño de muestra grande y analice múltiples factores de riesgo. El propósito de este artículo es identificar posibles asociaciones entre varios factores y el riesgo de hospitalización, necesidad de ventilación y muerte, así como la influencia de la prescripción de Zanamivir y Oseltamivir en los mismos indicadores. Métodos: En este estudio transversal, se encuestaron a los datos del Ministerio de Salud de aproximadamente 900,000 registros de todas las regiones de Brasil, después de que se realizó un tratamiento estadístico adecuado de las variables. Resultados: La hospitalización se asoció con género, etnia, educación, urbanización del sitio, Estado y porcentaje de ancianos, así como el clima. La prescripción de zanamivir y oseltamivir se asoció con la mayor incidencia de síntomas, menor hospitalización y tasa de mortalidad y menor necesidad de ventilación invasiva y no invasiva. Se excluyeron 146,160 registros médicos debido a SRAS no causado por Covid-19. Conclusión: con estos datos, es posible dibujar un perfil de riesgo para la hospitalización por SRAS y considerar el uso de zanamivir y oseltamivir como tratamiento para estos pacientes.Justificativa e objetivos: A pandemia de COVID-19 e sua consequente síndrome respiratória aguda grave (SRAG) levaram milhões de pessoas a óbito desde 2020. O uso de inibidores da neuraminidase é uma alternativa promissora no tratamento dessa doença, com vários estudos sobre o uso off-label sendo conduzidos desde o início da pandemia, mas nenhum que tenha um grande tamanho amostral e que analise vários fatores de risco. O objetivo deste artigo é identificar possíveis associações entre diversos fatores e risco de hospitalização, necessidade de ventilação e óbito, assim como a influência da prescrição de Zanamivir e Oseltamivir nos mesmos indicadores. Métodos: Neste estudo transversal, foi feito o levantamento de aproximadamente 900 mil prontuários de todas as regiões do Brasil, provenientes de dados do Ministério da Saúde, e em seguida foi realizado o tratamento estatístico adequado das variáveis. Resultados: A hospitalização foi associada a sexo, etnia, escolaridade, urbanização do local, Estado e porcentagem de idosos do mesmo, assim como o clima. Já a prescrição de Zanamivir e Oseltamivir foi associada a maior incidência de sintomas, menor taxa de hospitalização e óbito e menor necessidade de ventilação invasiva e não-invasiva. Foram excluídos 146.160 prontuários devido a SRAG não ocasionada pela COVID-19. Conclusão: Com esses dados, é possível traçar um perfil de risco para hospitalização por SRAG e considerar o uso de Zanamivir e Oseltamivir como tratamento para esses pacientes

Structured reporting for fibrosing lung disease: a model shared by radiologist and pulmonologist

Objectives: To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD). Methods: The writing committee selected the HRCT criteria\ue2\u80\u94the Delphi items\ue2\u80\u94for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as \ue2\u80\u9cessential\ue2\u80\u9d, \ue2\u80\u9coptional\ue2\u80\u9d, or \ue2\u80\u9cnot relevant\ue2\u80\u9d. The items rated \ue2\u80\u9cessential\ue2\u80\u9d by &lt; 80% of the RP were selected for the PP rating. The format of reporting was rated by both RP and PP. Results: A total of 42 RPs and 12 PPs participated to the survey. In both Delphi round 1 and 2, 10/27 (37.7%) items were rated \ue2\u80\u9cessential\ue2\u80\u9d by more than 80% of RP. The remaining 17/27 (63.3%) items were rated by the PP in round 3, with 2/17 items (11.7%) rated \ue2\u80\u9cessential\ue2\u80\u9d by the PP. PP proposed additional items for conclusion domain, which were rated by RPs in the fourth round. Poor consensus was observed for the format of reporting. Conclusions: This study provides a template for structured report of FLD that features essential items as agreed by expert thoracic radiologists and pulmonologists

Where symbols meet meanings: The organization of gestures and words in the middle temporal gyrus

Every day we use actions, gestures and words to interact with other people and with the environment. Being able to understand people’s movements and communicative intentions is critical to our ability to act successfully in the world. Here we present three studies aiming at investigating the relationship between actions, gestures and words in the brain. In the first study we described and offer a standardized data set of 230 well-controlled stimuli of meaningful (pantomimes and emblems) and meaningless gestures together with norms, with the aim of promoting replicability between studies. One hundred and thirty raters (Italian and non-Italian speakers) rated the meaningfulness of the gestures, and provided a name and a description for each of them. To our knowledge, this is the first data set of meaningful and meaningless gestures presented in the literature. In the second study, we aimed 1) at characterizing the neural network associated with the processing of different categories of gestures (pantomimes, emblems and meaningless gestures) using fMRI, and 2) at contrasting the role of precentral and temporal areas in action understanding, using rTMS. In particular, we applied rTMS to the posterior middle temporal gyrus (pMTG) and to the ventral premotor cortex (PMv) in different sessions, while participants were performing either a semantic or a perceptual judgment task. According to motor theories of action understanding, rTMS applied to the PMv, but not to the pMTG, should impair performance during the semantic judgment task. By contrast, according to cognitive theories of action understanding, rTMS applied to pMTG, but not to PMv, should impair performance in this task. Results from the fMRI experiment revealed a sensitivity of the MTG to meaningful in comparison to meaningless gestures. Additionally, three different brain areas seemed to contribute to the processing of pantomimes and emblems: superior parietal lobe (SPL) and precentral gyrus (PCG) in the case of pantomimes and IFG in the case of emblems. Unfortunately, we did not observe any significant effect of rTMS in any condition. The third study aimed at investigating how pantomimes, emblems and words are organized in the middle temporal gyrus, using fMRI. We observed a posterior-to-anterior structure, both in the left and in the right hemisphere, that might reflect the input modality and also the arbitrariness of the relationship between form and meaning

The Large-Scale Organization of Gestures and Words in the Middle Temporal Gyrus

The middle temporal gyrus (MTG) has been shown to be recruited during the processing of words, but also during the observation of actions. Here we investigated how information related to words and gestures is organized along the MTG. To this aim, we measured the BOLD response in the MTG to video clips of gestures and spoken words in 17 healthy human adults (male and female). Gestures consisted of videos of an actress performing object-use pantomimes (iconic representations of object-directed actions; e.g., playing guitar), emblems (conventional gestures, e.g., thumb up), and meaningless gestures. Word stimuli (verbs, nouns) consisted of video clips of the same actress pronouncing words. We found a stronger response to meaningful compared with meaningless gestures along the whole left and large portions of the right MTG. Importantly, we observed a gradient, with posterior regions responding more strongly to gestures (pantomimes and emblems) than words and anterior regions showing a stronger response to words than gestures. In an intermediate region in the left hemisphere, the response was significantly higher to words and emblems (i.e., items with a greater arbitrariness of the sign-to-meaning mapping) than to pantomimes. These results show that the large-scale organization of information in the MTG is driven by the input modality and may also reflect the arbitrariness of the relationship between sign and meaning