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

Intraventricular hemorrhage following removal of external ventricular drains: Report of 2 pediatric cases

Risk of intraventricular bleeding following External Ventricular Drains (EVDs) placement is well recognized. On the contrary, hemorrhage following removal of EVD is considered highly unlikely. We report two cases of massive, symptomatic intraventricular hemorrhage that occurred soon after removal of EVD, in two pediatric patients, one affected by posterior fossa tumor, and the other by acute post-traumatic hydrocephalus. This complication significantly affected outcome: in both cases EVD should be replaced, hospitalization was prolonged and further surgery was required for persisting hydrocephalus. The first patient also presented neurological deficits and delay in starting oncological therapies. There are currently no articles that specifically address hemorrhagic risk in EVDs removal. Only one paper that evaluates EVD associated hemorrhage also discuss about hemorrhages caused by removal of the catheter in children. Such risk appears to be not negligible, with hemorrhagic rate of 21.9%. More often, these hemorrhages have few clinical significance, but severe sequelae, may also occur. This should be considered in decision making, and in discussing the risks with a patient's family. Keywords: Hydrocephalus, Pediatric, Complication, Shuntin

New high statistics measurement of K-e4 decay form factors and pi pi scattering phase shifts

We report results from a new measurement of the K-e4 decay K-+/- -> pi(+)pi(-)e(+/-)nu by the NA48/2 collaboration at the CERN SPS, based on a partial sample of more than 670 000 K-e4 decays in both charged modes collected in 2003. The form factors of the hadronic current (F,G,H) and pi pi phase difference (delta=delta(s)-delta(p)) have been measured in ten independent bins of the pi pi mass spectrum to investigate their variation. A sizeable acceptance at large pi pi mass, a low background and a very good resolution contribute to an improved experimental accuracy, a factor two better than in the previous measurement, when extracting the pi pi scattering lengths a(0) (0) and a(0) (2). Under the assumption of isospin symmetry and using numerical solutions of the Roy equations, the following values are obtained in the plane (a(0) (0),a(0) (2)): a(0) (0)=0.233 +/- 0.016(stat)+/- 0.007(syst),a(0) (2)=-0.0471 +/- 0.011(stat)+/- 0.004syst. The presence of potentially large isospin effects is also considered and will allow comparison with precise predictions from Chiral Perturbation Theory

A new measurement of the K-+/- -> pi(+/-)gamma gamma decay at the NA48/2 experiment

The NA48/2 experiment at CERN collected two data samples with minimum bias trigger conditions in 2003 and 2004. A measurement of the rate and dynamic properties of the rare decay K-+/- -> pi(+/-)gamma gamma from these data sets based on 149 decay candidates with an estimated background of 15.5 +/- 0.7 events is reported. The model-independent branching ratio in the kinematic range z = (m(gamma gamma)/m(K))(2) > 0.2 is measured to be B-MI(z > 0.2) = (0.877 +/- 0.089) x 10(-6), and the branching ratio in the full kinematic range assuming a particular Chiral Perturbation Theory description to be B(K-pi gamma gamma) = (0.910 +/- 0.075) x 10(-6). (C) 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/)

Search for the dark photon in pi(0) decays

A sample of 1.69 x 10(7) fully reconstructed pi(0) -> gamma e(+)e(-) decay candidates collected by the NA48/2 experiment at CERN in 2003-2004 is analyzed to search for the dark photon (A') production in the pi(0) -> gamma A' decay followed by the prompt A' -> e(+)e(-) decay. No signal is observed, and an exclusion region in the plane of the dark photon mass m(A') and mixing parameter epsilon(2) is established. The obtained upper limits on epsilon(2) are more stringent than the previous limits in the mass range 9 MeV/c(2) pi(+/-)A' decay is also evaluated. (C) 2015 The Authors. Published by Elsevier B.V

Platelet count does not predict bleeding in cirrhotic patients: Results from the PRO-LIVER Study

OBJECTIVES: Thrombocytopenia is a hallmark for patients with cirrhosis and it is perceived as a risk factor for bleeding events. However, the relationship between platelet count and bleeding is still unclear. METHODS: We investigated the relationship between platelet count and major or clinical relevant nonmajor bleedings during a follow-up of \ue2\u88\ubc4 years. RESULTS: A total of 280 cirrhotic patients with different degrees of liver disease (67% males; age 64\uc2\ub137 years; 47% Child\ue2\u80\u93Pugh B and C) were followed up for a median of 1,129 (interquartile range: 800\ue2\u80\u931,498) days yielding 953.12 patient-year of observation. The annual rate of any significant bleeding was 5.45%/year (3.57%/year and 1.89%/year for major and minor bleeding, respectively). Fifty-two (18.6%) patients experienced a major (n=34) or minor (n=18) bleeding event, predominantly from gastrointestinal origin. Platelet counts progressively decreased with the worsening of liver disease and were similar in patients with or without major or minor bleeding: a platelet count \ue2\u89\ua450\uc3\u97103/\uce\ubcl was detected in 3 (6%) patients with and in 20 (9%) patients without any bleeding event. Conversely, prothrombin time-international normalized ratio was slightly higher in patients with overall or major bleeding. On Cox proportional hazard analysis, only a previous gastrointestinal bleeding (hazard ratio (HR): 1.96; 95% confidence interval: 1.11\ue2\u80\u933.47; P=0.020) and encephalopathy (HR: 2.05; 95% confidence interval: 1.16\ue2\u80\u933.62; P=0.013) independently predicted overall bleeding events. CONCLUSIONS: Platelet count does not predict unprovoked major or minor bleeding in cirrhotic patients

Hard color-singlet exchange in dijet events in proton-proton collisions at s=\sqrt{s} = 13 TeV

International audienceEvents where the two leading jets are separated by a pseudorapidity interval devoid of particle activity, known as jet-gap-jet events, are studied in proton-proton collisions at $\sqrt{s} =$ 13 TeV. The signature is expected from hard color-singlet exchange. Each of the highest transverse momentum ($p_\mathrm{T}$) jets must have $p_\mathrm{T}^\text{jet}$$\gt$ 40 GeV and pseudorapidity 1.4 $\lt$$|\eta^\text{jet}|$$\lt$ 4.7, with $\eta^\text{jet1} \eta^\text{jet2}$$\lt$ 0, where $\text{jet1}$ and $\text{jet2}$ are the leading and subleading jets in $p_\mathrm{T}$, respectively. The analysis is based on data collected by the CMS and TOTEM experiments during a low luminosity, high-$\beta^*$ run at the CERN LHC in 2015, with an integrated luminosity of 0.66 pb$^{-1}$. Events with a low number of charged particles with $p_\mathrm{T}$$\gt$ 0.2 GeV in the interval $|\eta|$$\lt$ 1 between the jets are observed in excess of calculations that assume only color-exchange. The fraction of events produced via color-singlet exchange, $f_\text{CSE}$, is measured as a function of $p_\mathrm{T}^\text{jet2}$, the pseudorapidity difference between the two leading jets, and the azimuthal angular separation between the two leading jets. The fraction $f_\text{CSE}$ has values of 0.4-1.0%. The results are compared with previous measurements and with predictions from perturbative quantum chromodynamics. In addition, the first study of jet-gap-jet events detected in association with an intact proton using a subsample of events with an integrated luminosity of 0.40 pb$^{-1}$ is presented. The intact protons are detected with the Roman pot detectors of the TOTEM experiment. The $f_\text{CSE}$ in this sample is 2.91 $\pm$ 0.70 (stat) $^{+1.08}_{-1.01}$ (syst) times larger than that for inclusive dijet production in dijets with similar kinematics

Measurement of single-diffractive dijet production in proton-proton collisions at s=\sqrt{s} =s​= 8 TeV with the CMS and TOTEM experiments

Measurements are presented of the single-diffractive dijet cross section and the diffractive cross section as a function of the proton fractional momentum loss $\xi$ and the four-momentum transfer squared t. Both processes ${\text{ p }{}{}} {\text{ p }{}{}} \rightarrow {\text{ p }{}{}} {\text{ X }}$ and ${\text{ p }{}{}} {\text{ p }{}{}} \rightarrow {\text{ X }} {\text{ p }{}{}}$, i.e. with the proton scattering to either side of the interaction point, are measured, where ${\text{ X }}$ includes at least two jets; the results of the two processes are averaged. The analyses are based on data collected simultaneously with the CMS and TOTEM detectors at the LHC in proton–proton collisions at $\sqrt{s} = 8\,\text {Te}\text {V}$ during a dedicated run with $\beta ^{*} = 90\,\text {m}$ at low instantaneous luminosity and correspond to an integrated luminosity of $37.5{\,\text {nb}^{-1}}$. The single-diffractive dijet cross section $\sigma ^{{\text{ p }{}{}} {\text{ X }}}_{\mathrm {jj}}$, in the kinematic region $\xi 40\,\text {Ge}\text {V}$, and pseudorapidity $|\eta | < 4.4$, is 21.7 \pm 0.9\,\text {(stat)} \,^{+3.0}_{-3.3}\,\text {(syst)} \pm 0.9\,\text {(lumi)} \,\text {nb} . The ratio of the single-diffractive to inclusive dijet yields, normalised per unit of $\xi$, is presented as a function of x, the longitudinal momentum fraction of the proton carried by the struck parton. The ratio in the kinematic region defined above, for x values in the range $-2.9 \le \log _{10} x \le -1.6$, is $R = (\sigma ^{{\text{ p }{}{}} {\text{ X }}}_{\mathrm {jj}}/\Delta \xi )/\sigma _{\mathrm {jj}} = 0.025 \pm 0.001\,\text {(stat)} \pm 0.003\,\text {(syst)}$, where $\sigma ^{{\text{ p }{}{}} {\text{ X }}}_{\mathrm {jj}}$ and $\sigma _{\mathrm {jj}}$ are the single-diffractive and inclusive dijet cross sections, respectively. The results are compared with predictions from models of diffractive and nondiffractive interactions. Monte Carlo predictions based on the HERA diffractive parton distribution functions agree well with the data when corrected for the effect of soft rescattering between the spectator partons