Characterization of soot produced by the mini inverted soot generator with an atmospheric simulation chamber

The performance of a mini inverted soot generator (MISG) has been investigated at ChAMBRe (Chamber for Aerosol Modelling and Bio-aerosol Research) by studying the properties of soot particles generated by ethylene and propane combustion. This work deepens and expands the existing characterization of the MISG, which also exploits an atmospheric simulation chamber (ASC). Different from previous works, MISG performance has been also tested at different fuel flows and higher global equivalence ratios. MISG exhausts were investigated after their injection inside the atmospheric simulation chamber, which is another novelty of this work. Starting from an extensive classification of combustion conditions and resulting flame shapes, the MISG exhaust was characterized in terms of concentration of emitted particles and gases, particle size distribution, and optical properties. Soot particles were also collected on quartz fibre filters and then analysed by optical and thermal\u2013optical techniques to measure the spectral dependence of the absorption coefficient babs and their composition in terms of elemental carbon and organic carbon (EC and OC). Significant differences could be observed when the MISG was fuelled with ethylene and propane in terms of particle size. In particular, the production of super-micrometric aggregates was observed for ethylene combustion. With equal combustion conditions, ethylene produced a higher number concentration of particles and smaller mode diameters. Soot particles produced by propane combustion resulted in higher EC : TC (total carbon) ratios and they were more light absorbing than particles generated by ethylene combustion. Values of the mass absorption cross section (MAC) and of the \uc5ngstr\uf6m absorption exponent (AAE) turned out to be compatible with the literature, even if there were some specific differences. The comprehensive characterization of the MISG soot particles is an important piece of information to design and perform experiments in atmospheric simulation chambers. Particles with well-known properties can be used, for example, to investigate the possible interactions between soot and other atmospheric pollutants, the effects of meteorological variables on soot properties, and the oxidative and toxicological potential of soot particles

ChAMBRe: studi su bio-aerosol in camera di simulazione atmosferica

Nella Sezione di Genova dell\u2019Istituto Nazionale di Fisica Nucleare \ue8 stata recentemente installata, in collaborazione con il Laboratorio di Fisica Ambientale del Dipartimento di Fisica dell\u2019Universit\ue0 di Genova, ChAMBRe (Chamber for Aerosol Modelling and Bio-aerosol Research), la prima Camera di simulazione atmosferica specificatamente concepita per studiare la componente biologica dell\u2019aerosol atmosferico. Presso la camera di simulazione atmosferica CESAM (Cr\ue9teil, Francia) sono sati effettuati alcuni esperimenti pilota recentemente pubblicati [1], che sono stati lo spunto per la costruzione di una struttura dedicata allo studio del comportamento dei pi\uf9 comuni agenti patogeni presenti in atmosfera sotto forma di bioaerosol e in particolare dei meccanismi che controllano le interazioni tra questi e le altre componenti dell\u2019aerosol e pi\uf9 in generale dell\u2019atmosfera. L\u2019attivit\ue0 di ricerca a ChAMBRe si concentrer\ue0 sull\u2019indagine del comportamento del bio-aerosol in differenti condizioni atmosferiche e in presenza di tipici inquinanti antropici (come il monossido di carbonio, gli ossidi di azoto, etc.) che possono influenzare la vitalit\ue0, la morfologia e la dispersione dei batteri in atmosfera. Come primo passo \ue8 necessario innanzitutto mettere a punto un protocollo che garantisca la riproducibilit\ue0 degli esperimenti in una struttura complessa come ChAMBRe. Ci si \ue8 quindi concentrati su aspetti cruciali quali: crescita in vitro e successiva iniezione in camera di una data concentrazione di batteri, seguita da una fase di estrazione, campionamento e misura della vita media all\u2019interno della camera. Gli esperimenti sono volti anche ad identificare eventuali condizioni di stress ambientali e meccaniche per i microrganismi e la loro risposta come singoli individui e come colonie. Sono stati eseguiti esperimenti su due tipologie di ceppi batterici frequentemente utilizzati come organismi modello: il Bacillus subtilis e l\u2019Escherichia coli, appartenenti rispettivamente al gruppo dei Gram-positivi e dei Gram-negativi. I risultati e il protocollo sperimentale messo a punto verranno presentati a PM2018

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Comparative characterization of the performance of bio-aerosol nebulizers in connection with atmospheric simulation chambers

The interplay of bio-aerosol dispersion and impact, meteorology, and air quality is gaining increasing interest in the wide spectrum of atmospheric sciences. Experiments conducted inside confined artificial environments, such as atmospheric simulation chambers (ASCs), where atmospheric conditions and composition are controlled, can provide valuable information on bio-aerosol viability, dispersion, and impact. We focus here on the reproducible aerosolization and injection of viable microorganisms into an ASC, the first and crucial step of any experimental protocol to expose bio-aerosols to different atmospheric conditions. We compare the performance of three nebulizers specifically designed for bio-aerosol applications: the Collison nebulizer, the Blaustein Atomizing Modules (BLAM), and the Sparging Liquid Aerosol Generator (SLAG), all manufactured and commercialized by CH TECHNOLOGIES. The comparison refers to operating conditions and the concentration of viable bacteria at the nebulizer outlet, with the final goal being to measure the reproducibility of the nebulization procedures and assess their application in experiments inside ASCs. A typical bacterial test model, Escherichia coli (ATCC\uae 25922\u2122), was selected for such characterization. Bacteria suspensions with a concentration around 108 CFUmL1 were first aerosolized at different air pressures and collected by a liquid impinger to obtain a correlation curve between airflow and nebulized bacteria for each generator. Afterwards, bacteria were aerosolized inside the atmospheric simulation chamber ChAMBRe (Chamber for Aerosol Modelling and Bio-aerosol Research) to measure the reproducibility of the whole procedure. An overall reproducibility of 11% (i.e., standard deviation of the results obtained with the three nebulizers) was obtained with each nebulizer through a set of baseline experiments

Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

BACKGROUND: The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic.METHODS: The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020).RESULTS: Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (>200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (<20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices.CONCLUSION: This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

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

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