Association of the superior semicircular canal and tegmen tympani dehiscences and its relationship with the pneumatisation of the temporal bone

To analyse the degree of pneumatisation of the temporal bone when there is an association between dehiscence of the superior semicircular canal and dehiscence of the tegmen tympani. Materials and methods We analysed a retrospective CT study of 124 selected cases. A single inclusion criterion was applied: the presence of a dehiscence of the tegmen tympani. On the other hand, the degree of temporal pneumatisation was assessed by axial and coronal planes, and has been divided into the following grades O, I, II and III, according to the status and relationship of the mastoid, the bony labyrinth, the petrous segment of the carotid canal and sigmoid sinus. Results Of the 124 cases studied, 35 (28.2%) presented both dehiscences. In 26 of the 35 (47.3%), grade II pneumatisation, 4 (14,8%), grade I, and 5 (11,9%) grade III was observed, with a statistically significant relationship (p < 0.001). On the other hand, we did not find a significant relationship when relating both dehiscences in any age or sex group. However, when relating the degree of pneumatisation to sex, among those with grade III pneumatisation, the proportion of men (52.4%) was significantly higher than that of women (47.6%) (p = 0.017). Conclusion We have detected a statistically significant relationship between the coexistence of grade II pneumatisation and the presence of both dehiscences in the temporal bone

Are congenital malformations more frequent in fetuses with intrahepatic persistent right umbilical vein? A comparative study

Objective Persistent right umbilical vein (PRUV) is a vascular anomaly where the right umbilical vein remains as the only conduit that returns oxygenated blood to the fetus. It has classically been described as associated with numerous defects. We distinguish the intrahepatic variant (better prognosis) and the extrahepatic variant (associated with worse prognosis). The objective of this study was to compare rates of congenital malformations in fetuses with intrahepatic PRUV (I-PRUV) versus singleton pregnancies without risk factors. Materials and Methods A multicenter, crossover design, comparative study was performed between 2003 and 2013 on fetuses diagnosed with I-PRUV (n = 56), and singleton pregnancies without congenital malformation risk factors (n = 4050). Results Fifty-six cases of I-PRUV were diagnosed (incidence 1:770). A statistically significant association between I-PRUV and the presence of congenital malformations (odds ratio 4.321; 95% confidence interval 2.15–8.69) was found. This positive association was only observed with genitourinary malformations (odds ratio 3.038; 95% confidence interval 1.08–8.56). Conclusion Our rate of malformations associated with I-PRUV (17.9%) is similar to previously published rates. I-PRUV has shown a significant increase in the rate of associated malformations, although this association has only been found to be statistically significant in the genitourinary system. Noteworthy is the fact that this comparative study has not pointed to a significant increase in the congenital heart malformation rate. Diagnosis of isolated I-PRUV does not carry a worse prognosis

Global transpiration data from sap flow measurements: The SAPFLUXNET database

Plant transpiration links physiological responses of vegetation to water supply and demand with hydrological, energy, and carbon budgets at the land-atmosphere interface. However, despite being the main land evaporative flux at the global scale, transpiration and its response to environmental drivers are currently not well constrained by observations. Here we introduce the first global compilation of whole-plant transpiration data from sap flow measurements (SAPFLUXNET, https://sapfluxnet.creaf.cat/, last access: 8 June 2021). We harmonized and quality-controlled individual datasets supplied by contributors worldwide in a semi-automatic data workflow implemented in the R programming language. Datasets include sub-daily time series of sap flow and hydrometeorological drivers for one or more growing seasons, as well as metadata on the stand characteristics, plant attributes, and technical details of the measurements. SAPFLUXNET contains 202 globally distributed datasets with sap flow time series for 2714 plants, mostly trees, of 174 species. SAPFLUXNET has a broad bioclimatic coverage, with woodland/shrubland and temperate forest biomes especially well represented (80% of the datasets). The measurements cover a wide variety of stand structural characteristics and plant sizes. The datasets encompass the period between 1995 and 2018, with 50% of the datasets being at least 3 years long. Accompanying radiation and vapour pressure deficit data are available for most of the datasets, while on-site soil water content is available for 56% of the datasets. Many datasets contain data for species that make up 90% or more of the total stand basal area, allowing the estimation of stand transpiration in diverse ecological settings. SAPFLUXNET adds to existing plant trait datasets, ecosystem flux networks, and remote sensing products to help increase our understanding of plant water use, plant responses to drought, and ecohydrological processes. SAPFLUXNET version 0.1.5 is freely available from the Zenodo repository (10.5281/zenodo.3971689; Poyatos et al., 2020a). The "sapfluxnetr"R package-designed to access, visualize, and process SAPFLUXNET data-is available from CRAN. © 2021 Rafael Poyatos et al.This research was supported by the Minis-terio de Economía y Competitividad (grant no. CGL2014-55883-JIN), the Ministerio de Ciencia e Innovación (grant no. RTI2018-095297-J-I00), the Ministerio de Ciencia e Innovación (grant no. CAS16/00207), the Agència de Gestió d’Ajuts Universitaris i de Recerca (grant no. SGR1001), the Alexander von Humboldt-Stiftung (Humboldt Research Fellowship for Experienced Researchers (RP)), and the Institució Catalana de Recerca i Estudis Avançats (Academia Award (JMV)). Víctor Flo was supported by the doctoral fellowship FPU15/03939 (MECD, Spain)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract 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

Neurophobia among resident physicians in the emergency service

Introducción La neurofobia se define como el miedo hacia la neurología que surge de la incapacidad para aplicar los conocimientos teóricos a situaciones clínicas prácticas. Este fenómeno parece no limitarse únicamente a estudiantes de medicina, pero no se dispone de estudios previos en el ámbito de urgencias. Este trabajo valora la percepción de conocimientos en las distintas patologías neurológicas urgentes por parte de médicos en formación y posibles motivos de neurofobia. Material y métodos. Se trata de un estudio transversal multicéntrico mediante encuestas autoadministradas a médicos en formación de todo el Servicio Aragonés de Salud. Se interrogó sobre su miedo a la neurología y otras especialidades médicas, posibles causas y percepción de conocimientos en patologías neurológicas en el servicio de urgencias. Resultados Se obtuvieron 134 respuestas. El 27,6% (37) sufría neurofobia. La neurología fue la tercera disciplina que mayor interés despertó, pero se considera la de mayor dificultad. Las áreas en las que mayor seguridad mostraron fueron las cefaleas y la patología vascular. Donde mayor inseguridad existía fue en la neuromuscular, la neurooftalmología y la lesión medular aguda. En ninguna de las áreas hubo un porcentaje mayor del 50% que se sintiera seguro o muy seguro. Conclusiones La neurofobia está presente entre los médicos en formación que desempeñan su labor en los servicios de urgencias. Su distribución depende del grado de exposición a los pacientes. Los neurólogos debemos desempeñar un papel activo en la formación de nuevos especialistas y promover la colaboración con los servicios de urgencias

Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: An ESGICH survey

Background: Scant information is available about how transplant centers are managing their use of quantitative molecular testing (QNAT) assays for active cytomegalovirus (CMV) infection monitoring in solid organ transplant (SOT) recipients. The current study was aimed at gathering information on current practices in the management of CMV infection across European centers in the era of molecular testing assays. Methods: A questionnaire-based cross-sectional survey study was conducted by the European Study Group of Infections in Immunocompromised Hosts (ESGICH) of the Society of Clinical Microbiology and Infectious Diseases (ESCMID). The invitation and a weekly reminder with a personal link to an Internet service provider (https://es.surveymonkey.com/) was sent to transplant physicians, transplant infectious diseases specialists, and clinical virologists working at 340 European transplant centers. Results: Of the 1181 specialists surveyed, a total of 173 responded (14.8%): 73 transplant physicians, 57 transplant infectious diseases specialists, and 43 virologists from 173 institutions located at 23 different countries. The majority of centers used QNAT assays for active CMV infection monitoring. Most centers preferred commercially available real-time polymerase chain reaction (RT-PCR) assays over laboratory-developed procedures for quantifying CMV DNA load in whole blood or plasma. Use of a wide variety of DNA extraction platforms and RT-PCR assays was reported. All programs used antiviral prophylaxis, preemptive therapy, or both, according to current guidelines. However, the centers used different criteria for starting preemptive antiviral treatment, for monitoring systemic CMV DNA load, and for requesting genotypic assays to detect emerging CMV-resistant variants. Conclusions: Significant variation in CMV infection management in SOT recipients still remains across European centers in the era of molecular testing. International multicenter studies are required to achieve commutability of CMV testing and antiviral management procedures

Impact of beam far side-lobe knowledge in the presence of foregrounds for LiteBIRD

We present a study of the impact of an uncertainty in the beam far side-lobe knowledge on the measurement of the Cosmic Microwave Background $B$-mode signal at large scale. It is expected to be one of the main source of systematic effects in future CMB observations. Because it is crucial for all-sky survey missions to take into account the interplays between beam systematic effects and all the data analysis steps, the primary goal of this paper is to provide the methodology to carry out the end-to-end study of their effect for a space-borne CMB polarization experiment, up to the cosmological results in the form of a bias $\delta r$ on the tensor-to-scalar ratio $r$. LiteBIRD is dedicated to target the measurement of CMB primordial $B$ modes by reaching a sensitivity of $\sigma \left( r \right) \leq 10^{-3}$ assuming $r=0$. As a demonstration of our framework, we derive the relationship between the knowledge of the beam far side-lobes and the tentatively allocated error budget under given assumptions on design, simulation and component separation method. We assume no mitigation of the far side-lobes effect at any stage of the analysis pipeline. We show that $\delta r$ is mostly due to the integrated fractional power difference between the estimated beams and the true beams in the far side-lobes region, with little dependence on the actual shape of the beams, for low enough $\delta r$. Under our set of assumptions, in particular considering the specific foreground cleaning method we used, we find that the integrated fractional power in the far side-lobes should be known at a level as tight as $\sim 10^{-4}$, to achieve the required limit on the bias \delta r < 1.9 \times 10^{-5}. The framework and tools developed for this study can be easily adapted to provide requirements under different design, data analysis frameworks and for other future space-borne experiments beyond LiteBIRD

Impact of beam far side-lobe knowledge in the presence of foregrounds for LiteBIRD

We present a study of the impact of an uncertainty in the beam far side-lobe knowledge on the measurement of the Cosmic Microwave Background $B$-mode signal at large scale. It is expected to be one of the main source of systematic effects in future CMB observations. Because it is crucial for all-sky survey missions to take into account the interplays between beam systematic effects and all the data analysis steps, the primary goal of this paper is to provide the methodology to carry out the end-to-end study of their effect for a space-borne CMB polarization experiment, up to the cosmological results in the form of a bias $δr$ on the tensor-to-scalar ratio $r$. LiteBIRD is dedicated to target the measurement of CMB primordial $B$ modes by reaching a sensitivity of $σ\left( r \right) \leq 10^{-3}$ assuming $r=0$. As a demonstration of our framework, we derive the relationship between the knowledge of the beam far side-lobes and the tentatively allocated error budget under given assumptions on design, simulation and component separation method. We assume no mitigation of the far side-lobes effect at any stage of the analysis pipeline. We show that $δr$ is mostly due to the integrated fractional power difference between the estimated beams and the true beams in the far side-lobes region, with little dependence on the actual shape of the beams, for low enough $δr$. Under our set of assumptions, in particular considering the specific foreground cleaning method we used, we find that the integrated fractional power in the far side-lobes should be known at a level as tight as $\sim 10^{-4}$, to achieve the required limit on the bias $δr < 1.9 \times 10^{-5}$. The framework and tools developed for this study can be easily adapted to provide requirements under different design, data analysis frameworks and for other future space-borne experiments beyond LiteBIRD

LiteBIRD Science Goals and Forecasts: Improving Sensitivity to Inflationary Gravitational Waves with Multitracer Delensing

We estimate the efficiency of mitigating the lensing $B$-mode polarization, the so-called delensing, for the $LiteBIRD$ experiment with multiple external data sets of lensing-mass tracers. The current best bound on the tensor-to-scalar ratio, $r$, is limited by lensing rather than Galactic foregrounds. Delensing will be a critical step to improve sensitivity to $r$ as measurements of $r$ become more and more limited by lensing. In this paper, we extend the analysis of the recent $LiteBIRD$ forecast paper to include multiple mass tracers, i.e., the CMB lensing maps from $LiteBIRD$ and CMB-S4-like experiment, cosmic infrared background, and galaxy number density from $Euclid$- and LSST-like survey. We find that multi-tracer delensing will further improve the constraint on $r$ by about $20\%$. In $LiteBIRD$, the residual Galactic foregrounds also significantly contribute to uncertainties of the $B$-modes, and delensing becomes more important if the residual foregrounds are further reduced by an improved component separation method

LiteBIRD Science Goals and Forecasts: A full-sky measurement of gravitational lensing of the CMB

We explore the capability of measuring lensing signals in LiteBIRD full-sky polarization maps. With a 30 arcmin beam width and an impressively low polarization noise of 2.16μK-arcmin, LiteBIRD will be able to measure the full-sky polarization of the cosmic microwave background (CMB) very precisely. This unique sensitivity also enables the reconstruction of a nearly full-sky lensing map using only polarization data, even considering its limited capability to capture small-scale CMB anisotropies. In this paper, we investigate the ability to construct a full-sky lensing measurement in the presence of Galactic foregrounds, finding that several possible biases from Galactic foregrounds should be negligible after component separation by harmonic-space internal linear combination. We find that the signal-to-noise ratio of the lensing is approximately 40 using only polarization data measured over 90% of the sky. This achievement is comparable to Planck's recent lensing measurement with both temperature and polarization and represents a four-fold improvement over Planck's polarization-only lensing measurement. The LiteBIRD lensing map will complement the Planck lensing map and provide several opportunities for cross-correlation science, especially in the northern hemisphere