Acute gastrointestinal haemorrhage on board a cruise ship in the Antarctic Peninsula

Antarctic tourism on board cruise ships has expanded since the 1990s, essentially in the Antarctic Peninsula. Due to remoteness, medical cases may evolve into life threatening conditions as emergency medical evacuations are challenging. We discuss the case of a young crew member who suddenly fainted with an epigastric pain and abundant rectal bleeding while on board a cruise ship heading to the Deception Island (62°57.6 South, 60°29.5 West), 44 h away from Ushuaia by sea. A medical evacuation was necessary to save the patient whose haemoglobin level rapidly decreased from 11 g/dL to 8.7 g/dL over an 8 h period due to uncontrolled gastrointestinal bleeding. Following discussions between the French, Chilean and Argentinean Medical Top Side Support and Maritime Rescue Authorities and despite poor weather conditions, an emergency medical evacuation by air to Chile was made possible. The evacuation, which was 2 days shorter compared to an evacuation by sea, allowed the patient to reach a hospital facility in time to save his life whereas he decompensated in haemorrhagic shock. As passengers on cruise ships are typically elderly and often following anticoagulant therapies, the risk of bleeding is most important. Facing a gastric haemorrhage, a transfusion is often required. In remote areas, transfusion of fresh whole blood to stabilize a critical patient until he reaches a hospital must be considered.

Cancer stem cells and macrophages: Implications in tumor biology and therapeutic strategies

This work was supported by a Ramón y Cajal Merit Award from the Ministerio de Economía y Competitividad, Spain (Bruno Sainz Jr.), a Clinic and Laboratory Integration Program (CLIP) grant from the Cancer Research Institute, NY (Bruno Sainz Jr.), and an NIH/NCI R00 (CA154605, Heather L. Machad

Pain-related Somato Sensory Evoked Potentials: A potential new tool to improve the prognostic prediction of coma after cardiac arrest

INTRODUCTION: Early prediction of a good outcome in comatose patients after cardiac arrest still remains an unsolved problem. The main aim of the present study was to examine the accuracy of middle-latency SSEP triggered by a painful electrical stimulation on median nerves to predict a favorable outcome. METHODS: No- and low-flow times, pupillary reflex, Glasgow motor score and biochemical data were evaluated at ICU admission. The following were considered within 72 h of cardiac arrest: highest creatinine value, hyperthermia occurrence, EEG, SSEP at low- (10 mA) and high-intensity (50 mA) stimulation, and blood pressure reactivity to 50 mA. Intensive care treatments were also considered. Data were compared to survival, consciousness recovery and 6-month CPC (Cerebral Performance Category). RESULTS: Pupillary reflex and EEG were statistically significant in predicting survival; the absence of blood pressure reactivity seems to predict brain death within 7 days of cardiac arrest. Middle- and short-latency SSEP were statistically significant in predicting consciousness recovery, and middle-latency SSEP was statistically significant in predicting 6-month CPC outcome. The prognostic capability of 50 mA middle-latency-SSEP was demonstrated to occur earlier than that of EEG reactivity. CONCLUSIONS: Neurophysiological evaluation constitutes the key to early information about the neurological prognostication of postanoxic coma. In particular, the presence of 50 mA middle-latency SSEP seems to be an early and reliable predictor of good neurological outcome, and its absence constitutes a marker of poor prognosis. Moreover, the absence 50 mA blood pressure reactivity seems to identify patients evolving towards the brain death

Bleeding management in remote environment: the use of fresh whole blood transfusion and lyophilised plasma

To mitigate medical risks in remote environments, the authors have implemented an innovative integrated medical support solution for bleeding management on board ships since 2013. Fresh whole blood transfusion (FWBT) and lyophilised plasma were put in place to address life threatening haemorrhages in maritime operations in the Arctic and Antarctica. The authors are illustrating the bleeding risks with an actual case occurring in Antarctica prior to the implementation of these procedures. They are presenting the different steps involved in the complex process of FWBT, from blood donors’ qualifications to actual transfusions. The pros and cons of blood transfusion in extreme remote environment are discussed, including the training of health care professionals, equipment requirements, legal and ethical issues, decision making in complex blood group matching, medical benefits and risks.

Preparation and medical follow-up for a single-handed transatlantic rowing race

Background: A single-handed transatlantic rowing race was organised between Senegal and French Guyana (2600 nautical miles). During the race, rowers adjust their lifestyle to maintain an optimal level of performance. Nutrition, circadian rhythm disturbance, psychological state, pain and other medical problems impact on physical abilities and increase the occurrence of accidents. We surveyed the prevalence of medical complications during this race and the preparation that we could suggest for this kind of activity. Materials and methods: This is a descriptive, retrospective case series study. Follow-up consisted of sending out a questionnaire and performing individual interviews. Results: A total of 23 participants including 1 woman and 22 men; mean age of 46.5 years (range: 35–59) entered the race. The race lasted for 39 to 52 days with participants rowing between 10 and 12 h/day. Nine participants dropped out. Energy intake was 4500 to 6000 kcal/day and fluid intake was 4 to 5.5 L/day. Mean weight loss was 13.3 kg. The resting period was 6 ± 1 h/24 h divided into 1.5 to 2 h periods essentially during darkness. A total of 92% of the racers required medical care for dermatological problems; other conditions requiring medical care were: tendinitis in 10 cases, diarrhoea in 4, moderate to severe seasickness in 4, hallucinations in 3, panic attacks in 2, burns in 2, and disembarkation syndrome (“land sickness”) lasting from 45 min to 6 h in 13. Conclusions: Physiological and psychological impact of this type of event is still unclear. The most common medical problems are dermatological, rheumatological complications and minor trauma. Medical and psychological preparation should be offered to candidates for these competitions.

Gestão- em momento de crise- do plano diretor participativo de São Luiz do Paraitinga-SP

Introdução: A UNESP foi única universidade presente antes, durante e depois da catástrofe ambiental que destruiu o patrimônio arquitetônico, urbanístico e paisagístico e que desabrigou mais mais de 100 famílias e desalojou mais de 5000 pessoas na cidade de São Luiz do Paraitinga SP.  Seus Docentes e cerca de 20 Bolsistas, mediaram de forma participativa dentro do Projeto PROEX (FAAC) - PEDESS e PDPB - Plano Estratégico de Desenvolvimento Saudável e Sustentável e PDPB - Plano Diretor Popular de Bairros, entre 2005 e 2009, o PEDESS regional e municipal e o Plano Diretor Participativo (PDP) do Município, que foi aprovado pela Câmara Municipal em dezembro de 2009. Com a enchente de janeiro de 2010, a UNESP foi chamada a participar da gestão no período de crise do PDP, através deste coordenador e seus bolsistas PROEX. Fato que permitiu que a Reitoria através do Prof. Dr. Herman Jacobus, implantasse e apoiasse o Programa Unesp para Desenvolvimento Sustentável de São Luiz do Paraitinga com a participação de onze frentes de trabalho e tendo este coordenador como um dos coordenadores do Programa. Objetivos: Assessorar a administração municipal em: Gestão do planejamento urbano e regional no período emergencial; Gestão do Plano Diretor Participativo (PDP) desenvolvido pela UNESP: Executar projetos urbanísticos, arquitetônicos e paisagísticos; Desenvolver projetos e ações em busca da sustentabilidade econômica, social, ambiental, cultural, turística, física e territorial voltadas para o desenvolvimento e melhoria da qualidade de vida da população. Cumprir de forma efetiva o papel social da UNESP junto à comunidade atingida pela catástrofe. Métodos: Todas as ações foram pautadas por métodos participativos, garantidos pela lei do Estatuto da Cidade e pela Lei de Assessoria Técnica Pública e Gratuita. Como princípio político e pedagógico buscou-se a indissociabilidade entre o ensino/pesquisa/extensão e teve como referenciais teóricos e didáticos a comunicação dialógica de Paulo Freire, as aulas passeio de Celestin Freinet, a criticidade de Levy Vygotsty e a busca da autogestão de Paul Singer. Resultados: Atualização do PDP; Planos de: Mobilidade Urbana, prevenção às enchentes, Gestão de Terras, Regularização Fundiária e Urbanização, Desenvolvimento Econômico - Projeto Canteiro Aberto, etc.; Projetos: Restauro do Asilo São Francisco de Paula, Praça de Eventos, Centro de Educação Sócio Ambiental, Rua da Música, Escola de Música, Anfiteatro/dique, Centro de Informação Turística, Cemitério, Concha Acústica, etc.; Assessorias Técnicas Públicas e Gratuitas a Bairros Populares: Novo CDHU, Santa Terezinha, Benfica e São Benedito; Assessorias diversas aos Gestores

Gestão- em momento de crise- do plano diretor participativo de São Luiz do Paraitinga-SP

Introdução: A UNESP foi única universidade presente antes, durante e depois da catástrofe ambiental que destruiu o patrimônio arquitetônico, urbanístico e paisagístico e que desabrigou mais mais de 100 famílias e desalojou mais de 5000 pessoas na cidade de São Luiz do Paraitinga SP.  Seus Docentes e cerca de 20 Bolsistas, mediaram de forma participativa dentro do Projeto PROEX (FAAC) - PEDESS e PDPB - Plano Estratégico de Desenvolvimento Saudável e Sustentável e PDPB - Plano Diretor Popular de Bairros, entre 2005 e 2009, o PEDESS regional e municipal e o Plano Diretor Participativo (PDP) do Município, que foi aprovado pela Câmara Municipal em dezembro de 2009. Com a enchente de janeiro de 2010, a UNESP foi chamada a participar da gestão no período de crise do PDP, através deste coordenador e seus bolsistas PROEX. Fato que permitiu que a Reitoria através do Prof. Dr. Herman Jacobus, implantasse e apoiasse o Programa Unesp para Desenvolvimento Sustentável de São Luiz do Paraitinga com a participação de onze frentes de trabalho e tendo este coordenador como um dos coordenadores do Programa. Objetivos: Assessorar a administração municipal em: Gestão do planejamento urbano e regional no período emergencial; Gestão do Plano Diretor Participativo (PDP) desenvolvido pela UNESP: Executar projetos urbanísticos, arquitetônicos e paisagísticos; Desenvolver projetos e ações em busca da sustentabilidade econômica, social, ambiental, cultural, turística, física e territorial voltadas para o desenvolvimento e melhoria da qualidade de vida da população. Cumprir de forma efetiva o papel social da UNESP junto à comunidade atingida pela catástrofe. Métodos: Todas as ações foram pautadas por métodos participativos, garantidos pela lei do Estatuto da Cidade e pela Lei de Assessoria Técnica Pública e Gratuita. Como princípio político e pedagógico buscou-se a indissociabilidade entre o ensino/pesquisa/extensão e teve como referenciais teóricos e didáticos a comunicação dialógica de Paulo Freire, as aulas passeio de Celestin Freinet, a criticidade de Levy Vygotsty e a busca da autogestão de Paul Singer. Resultados: Atualização do PDP; Planos de: Mobilidade Urbana, prevenção às enchentes, Gestão de Terras, Regularização Fundiária e Urbanização, Desenvolvimento Econômico - Projeto Canteiro Aberto, etc.; Projetos: Restauro do Asilo São Francisco de Paula, Praça de Eventos, Centro de Educação Sócio Ambiental, Rua da Música, Escola de Música, Anfiteatro/dique, Centro de Informação Turística, Cemitério, Concha Acústica, etc.; Assessorias Técnicas Públicas e Gratuitas a Bairros Populares: Novo CDHU, Santa Terezinha, Benfica e São Benedito; Assessorias diversas aos Gestores

The Simons Observatory: Science goals and forecasts

The Simons Observatory (SO) is a new cosmic microwave background experiment being built on Cerro Toco in Chile, due to begin observations in the early 2020s. We describe the scientific goals of the experiment, motivate the design, and forecast its performance. SO will measure the temperature and polarization anisotropy of the cosmic microwave background in six frequency bands: 27, 39, 93, 145, 225 and 280 GHz. The initial configuration of SO will have three small-aperture 0.5-m telescopes (SATs) and one large-aperture 6-m telescope (LAT), with a total of 60,000 cryogenic bolometers. Our key science goals are to characterize the primordial perturbations, measure the number of relativistic species and the mass of neutrinos, test for deviations from a cosmological constant, improve our understanding of galaxy evolution, and constrain the duration of reionization. The SATs will target the largest angular scales observable from Chile, mapping ~10% of the sky to a white noise level of 2 $\mu$K-arcmin in combined 93 and 145 GHz bands, to measure the primordial tensor-to-scalar ratio, $r$, at a target level of $\sigma(r)=0.003$. The LAT will map ~40% of the sky at arcminute angular resolution to an expected white noise level of 6 $\mu$K-arcmin in combined 93 and 145 GHz bands, overlapping with the majority of the LSST sky region and partially with DESI. With up to an order of magnitude lower polarization noise than maps from the Planck satellite, the high-resolution sky maps will constrain cosmological parameters derived from the damping tail, gravitational lensing of the microwave background, the primordial bispectrum, and the thermal and kinematic Sunyaev-Zel'dovich effects, and will aid in delensing the large-angle polarization signal to measure the tensor-to-scalar ratio. The survey will also provide a legacy catalog of 16,000 galaxy clusters and more than 20,000 extragalactic sources

The Athena X-ray Integral Field Unit: a consolidated design for the system requirement review of the preliminary definition phase

The Athena X-ray Integral Unit (X-IFU) is the high resolution X-ray spectrometer, studied since 2015 for flying in the mid-30s on the Athena space X-ray Observatory, a versatile observatory designed to address the Hot and Energetic Universe science theme, selected in November 2013 by the Survey Science Committee. Based on a large format array of Transition Edge Sensors (TES), it aims to provide spatially resolved X-ray spectroscopy, with a spectral resolution of 2.5 eV (up to 7 keV) over an hexagonal field of view of 5 arc minutes (equivalent diameter). The X-IFU entered its System Requirement Review (SRR) in June 2022, at about the same time when ESA called for an overall X-IFU redesign (including the X-IFU cryostat and the cooling chain), due to an unanticipated cost overrun of Athena. In this paper, after illustrating the breakthrough capabilities of the X-IFU, we describe the instrument as presented at its SRR, browsing through all the subsystems and associated requirements. We then show the instrument budgets, with a particular emphasis on the anticipated budgets of some of its key performance parameters. Finally we briefly discuss on the ongoing key technology demonstration activities, the calibration and the activities foreseen in the X-IFU Instrument Science Center, and touch on communication and outreach activities, the consortium organisation, and finally on the life cycle assessment of X-IFU aiming at minimising the environmental footprint, associated with the development of the instrument. Thanks to the studies conducted so far on X-IFU, it is expected that along the design-to-cost exercise requested by ESA, the X-IFU will maintain flagship capabilities in spatially resolved high resolution X-ray spectroscopy, enabling most of the original X-IFU related scientific objectives of the Athena mission to be retained. (abridged).Comment: 48 pages, 29 figures, Accepted for publication in Experimental Astronomy with minor editin

The Athena X-ray Integral Field Unit: a consolidated design for the system requirement review of the preliminary definition phase

The Athena X-ray Integral Unit (X-IFU) is the high resolution X-ray spectrometer studied since 2015 for flying in the mid-30s on the Athena space X-ray Observatory. Athena is a versatile observatory designed to address the Hot and Energetic Universe science theme, as selected in November 2013 by the Survey Science Committee. Based on a large format array of Transition Edge Sensors (TES), X-IFU aims to provide spatially resolved X-ray spectroscopy, with a spectral resolution of 2.5 eV (up to 7 keV) over a hexagonal field of view of 5 arc minutes (equivalent diameter). The X-IFU entered its System Requirement Review (SRR) in June 2022, at about the same time when ESA called for an overall X-IFU redesign (including the X-IFU cryostat and the cooling chain), due to an unanticipated cost overrun of Athena. In this paper, after illustrating the breakthrough capabilities of the X-IFU, we describe the instrument as presented at its SRR (i.e. in the course of its preliminary definition phase, so-called B1), browsing through all the subsystems and associated requirements. We then show the instrument budgets, with a particular emphasis on the anticipated budgets of some of its key performance parameters, such as the instrument efficiency, spectral resolution, energy scale knowledge, count rate capability, non X-ray background and target of opportunity efficiency. Finally, we briefly discuss the ongoing key technology demonstration activities, the calibration and the activities foreseen in the X-IFU Instrument Science Center, touch on communication and outreach activities, the consortium organisation and the life cycle assessment of X-IFU aiming at minimising the environmental footprint, associated with the development of the instrument. Thanks to the studies conducted so far on X-IFU, it is expected that along the design-to-cost exercise requested by ESA, the X-IFU will maintain flagship capabilities in spatially resolved high resolution X-ray spectroscopy, enabling most of the original X-IFU related scientific objectives of the Athena mission to be retained. The X-IFU will be provided by an international consortium led by France, The Netherlands and Italy, with ESA member state contributions from Belgium, Czech Republic, Finland, Germany, Poland, Spain, Switzerland, with additional contributions from the United States and Japan.The French contribution to X-IFU is funded by CNES, CNRS and CEA. This work has been also supported by ASI (Italian Space Agency) through the Contract 2019-27-HH.0, and by the ESA (European Space Agency) Core Technology Program (CTP) Contract No. 4000114932/15/NL/BW and the AREMBES - ESA CTP No.4000116655/16/NL/BW. This publication is part of grant RTI2018-096686-B-C21 funded by MCIN/AEI/10.13039/501100011033 and by “ERDF A way of making Europe”. This publication is part of grant RTI2018-096686-B-C21 and PID2020-115325GB-C31 funded by MCIN/AEI/10.13039/501100011033