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

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

Joint effect of obesity and TNFA variability on asthma: two international cohort studies

Obesity is a risk factor for asthma. Adipose tissue expresses pro-inflammatory molecules including tumour necrosis factor (TNF), and levels of TNF are also related to polymorphisms in the TNF-a (TNFA) gene. The current authors examined the joint effect of obesity and TNFA variability on asthma in adults by combining two population-based studies. The European Community Respiratory Health Survey and the Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults used comparable protocols, questionnaires and measures of lung function and atopy. DNA samples from 9,167 participants were genotyped for TNFA -308 and lymphotoxin-a (LTA) +252 gene variants. Obesity and TNFA were associated with asthma when mutually adjusting for their independent effects (odds ratio (OR) for obesity 2.4, 95% confidence interval (CI) 1.7–3.2; OR for TNFA -308 polymorphism 1.3, 95% CI 1.1–1.6). The association of obesity with asthma was stronger for subjects carrying the G/A and A/A TNFA -308 genotypes compared with the more common G/G genotype, particularly among nonatopics (OR for G/A and A/A genotypes 6.1, 95% CI 2.5–14.4; OR for G/G genotype 1.7, 95% CI 0.8–3.3). The present findings provide, for the first time, evidence for a complex pattern of interaction between obesity, a pro-inflammatory genetic factor and asthma

Atlas of Brazilian Snakes: Verified Point-Locality Maps to Mitigate the Wallacean Shortfall in a Megadiverse Snake Fauna

Accurate and detailed species distribution maps are fundamental for documenting and interpreting biological diversity. For snakes, an ecologically diverse group of reptiles, syntheses and detailed data on distribution patterns remain scarce. We present the first comprehensive collection of detailed, voucher-based, point-locality, range maps for all described and documented Brazilian snakes, withthe major aim of mitigating the Wallacean shortfall and as a contribution towards a better understanding of this rich, threatened, and poorly studied megadiverse fauna. We recorded a total of 412 snake species in Brazil on the basis of an extensive and verified point-locality database of 163,498 entries and 75,681 unique records (available here as Online Supporting Information). Our results reveal previously undocumented patterns of distribution, sampling effort, richness, and endemism levels, resulting in a more objective view of snake diversity in the Neotropics. Apart from these achievements, we understand that the most relevant and enduring contribution of the present atlas isto stimulate researchers to publish corrections, additions, and new discoveries.Fil: Nogueira, Cristiano C.. Universidade de Sao Paulo; BrasilFil: Argolo, Antonio. Universidade Estadual de Santa Cruz; BrasilFil: Arzamendia, Vanesa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto Nacional de Limnología. Universidad Nacional del Litoral. Instituto Nacional de Limnología; ArgentinaFil: Azevedo, Josué Anderson Rêgo. University of Gothenburg; SueciaFil: Barbo, Fausto Erritto. University of Gothenburg; SueciaFil: Bérnils, Renato S.. Universidade Federal do Espírito Santo; BrasilFil: Bolochio, Bruna E.. Universidad Federal Do Abc.; BrasilFil: Borges Martins, Marcio. Universidade Federal do Rio Grande do Sul; BrasilFil: Brasil Godinho, Marcela. Universidad Federal Do Abc.; BrasilFil: Braz, Henrique. Governo do Estado de Sao Paulo. Secretaria da Saude. Instituto Butantan; BrasilFil: Buononato, Marcus A.. No especifíca;Fil: Cisneros Heredia, Diego F.. Universidad San Francisco de Quito; EcuadorFil: Colli, Guarino Rinaldi. Universidade do Brasília; BrasilFil: Costa, Henrique C.. Universidade Federal de Juiz de Fora.; BrasilFil: Franco, Francisco. Governo do Estado de Sao Paulo. Secretaria da Saude. Instituto Butantan; BrasilFil: Giraudo, Alejandro Raul. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto Nacional de Limnología. Universidad Nacional del Litoral. Instituto Nacional de Limnología; ArgentinaFil: González, Rodrigo Cristián. Universidade Federal Do Estado Do Rio de Janeiro.; BrasilFil: Guedes, Thaís. University of Gothenburg; SueciaFil: Hoogmoed, Marinus S.. Museu Paraense Emi­lio Goeldi; BrasilFil: Marques, Otavio A.V.. Governo do Estado de Sao Paulo. Secretaria da Saude. Instituto Butantan; BrasilFil: Montingelli, Giovanna G.. Universidade de Sao Paulo; BrasilFil: Passos, Paulo. Universidade Federal Do Estado Do Rio de Janeiro.; BrasilFil: Prudente, Ana. Museu Paraense Emi­lio Goeldi; BrasilFil: Rivas, Gilson A.. Universidad del Zulia; VenezuelaFil: Sanchez, Paola M.. Universidade de Sao Paulo; BrasilFil: Serrano, Filipe C.. Universidade de Sao Paulo; BrasilFil: Silva, Nelson J.. Pontificia Universidade Catolica de Goias; BrasilFil: Strüssmann, Christine. Universidade Federal de Mato Grosso; BrasilFil: Vieira Alencar, João Paulo S.. Universidade de Sao Paulo; BrasilFil: Zaher, Hussam. Universidade de Sao Paulo; BrasilFil: Sawaya, Ricardo. Universidad Federal Do Abc.; BrasilFil: Martins Pimentel, Márcio. Universidade de Sao Paulo; Brasi

Technical Design Report for PANDA Electromagnetic Calorimeter (EMC)

This document presents the technical layout and the envisaged performance of the Electromagnetic Calorimeter (EMC) for the PANDA target spectrometer. The EMC has been designed to meet the physics goals of the PANDA experiment, which is being developed for the Facility for Antiproton and Ion Research (FAIR) at Darmstadt, Germany. The performance figures are based on extensive prototype tests and radiation hardness studies. The document shows that the EMC is ready for construction up to the front-end electronics interface

Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

Background: Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients. Methods: Since 2008, samples of elderly patients (age 65 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regression models were computed. Results: 3872 patients were included (mean age 79 \ub1 7.5 years, F:M ratio 1.1:1). GIB was reported in 120 patients (mean age 79.6 \ub1 7.3 years, F:M 0.9:1), with a crude prevalence of 3.1%. Upper GIB occurred in 72 patients (mean age 79.3 \ub1 7.6 years, F:M 0.8:1), lower GIB in 51 patients (mean age 79.4 \ub1 7.1 years, F:M 0.9:1), and both upper/lower GIB in 3 patients. Hemorrhagic gastritis/duodenitis and colonic diverticular disease were the most common causes. The LOS of patients with GIB was 11.7 \ub1 8.1 days, with a 3.3% in-hospital and a 9.4% 3-month mortality rates. Liver cirrhosis (OR 5.64; CI 2.51\u201312.65), non-ASA antiplatelet agents (OR 2.70; CI 1.23\u20135.90), and CIRS index of comorbidity >3 (OR 2.41; CI 1.16\u20134.98) were associated with GIB (p < 0.05). Conclusions: A high index of comorbidity is associated with high odds of GIB in elderly patients. The use of non-ASA antiplatelet agents should be discussed in patients with multimorbidity

Ultra high energy photons and neutrinos with JEM-EUSO

Ultra high energy photons and neutrinos are carriers of very important astrophysical information. They may be produced at the sites of cosmic ray acceleration or during the propagation of the cosmic rays in the intergalactic medium. In contrast to charged cosmic rays, photon and neutrino arrival directions point to the production site because they are not deflected by the magnetic fields of the Galaxy or the intergalactic medium. In this work we study the characteristics of the longitudinal development of showers initiated by photons and neutrinos at the highest energies. These studies are relevant for development of techniques for neutrino and photon identification by the JEM-EUSO telescope. In particular, we study the possibility of observing the multi-peak structure of very deep horizontal neutrino showers with JEM-EUSO. We also discuss the possibility to determine the flavor content of the incident neutrino flux by taking advantage of the different characteristics of the longitudinal profiles generated by different type of neutrinos. This is of grate importance for the study of the fundamental properties of neutrinos at the highest energies. Regarding photons, we discuss the detectability of the cosmogenic component by JEM-EUSO and also estimate the expected upper limits on the photon fraction which can be obtained from the future JEM-EUSO data for the case in which there are no photons in the samples

Performances of JEM-EUSO : angular reconstruction

Mounted on the International Space Station(ISS), the Extreme Universe Space Observatory, on-board the Japanese Experimental Module (JEM-EUSO), relies on the well established fluorescence technique to observe Extensive Air Showers (EAS) developing in the earth’s atmosphere. Focusing on the detection of Ultra High Energy Cosmic Rays (UHECR) in the decade of 10^{20} eV, JEM-EUSO will face new challenges by applying this technique from space. The EUSO Simulation and Analysis Framework (ESAF) has been developed in this context to provide a full end-to-end simulation frame, and assess the overall performance of the detector. Within ESAF, angular reconstruction can be separated into two conceptually different steps. The first step is pattern recognition, or filtering, of the signal to separate it from the background. The second step is to perform different types of fitting in order to search for the relevant geometrical parameters that best describe the previously selected signal. In this paper, we discuss some of the techniques we have implemented in ESAF to perform the geometrical reconstruction of EAS seen by JEM-EUSO. We also conduct thorough tests to assess the performances of these techniques in conditions which are relevant to the scope of the JEM-EUSO mission. We conclude by showing the expected angular resolution in the energy range that JEM-EUSO is expected to observe

EUSO-TA – First results from a ground-based EUSO telescope

International audienceEUSO-TA is a ground-based telescope, installed at the Telescope Array (TA) site in Black Rock Mesa, Utah, USA. This is the first detector to successfully use a Fresnel lens based optical system and multi-anode photomultipliers (64 channels per tube, 2304 channels encompassing a 10.6° × 10.6° field of view) for detection of Ultra High Energy Cosmic Rays (UHECR). The telescope is located in front of one of the fluorescence detectors of the TA experiment. Since its installation in 2013, the detector has observed several ultra-high energy cosmic ray events and, in addition, meteors. The limiting magnitude of 5.5 on summed frames ( ∼ 3 ms) has been established. Measurements of the UV night sky emission in different conditions and moon phases and positions have been completed. The performed observations serve as a proof of concept for the future application of this detector technology

First observations of speed of light tracks by a fluorescence detector looking down on the atmosphere

International audienceEUSO-Balloon is a pathfinder mission for the Extreme Universe Space Observatory onboard the Japanese Experiment Module (JEM-EUSO). It was launched on the moonless night of the 25th of August 2014 from Timmins, Canada. The flight ended successfully after maintaining the target altitude of 38 km for five hours. One part of the mission was a 2.5 hour underflight using a helicopter equipped with three UV light sources (LED, xenon flasher and laser) to perform an inflight calibration and examine the detectors capability to measure tracks moving at the speed of light. We describe the helicopter laser system and details of the underflight as well as how the laser tracks were recorded and found in the data. These are the first recorded laser tracks measured from a fluorescence detector looking down on the atmosphere. Finally, we present a first reconstruction of the direction of the laser tracks relative to the detector