Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Characterization of the Radiation Resistance of Glass Fiber Reinforced Plastics for Superconducting Magnets

The overall performance of accelerator magnets strongly relies on electrical and mechanical robustness of their components. With an increase of the energy, future particle accelerators will have to withstand integral doses of ionizing radiation of up to several tens of MGy. Initially developed for the components of the D1 separation dipole magnet, designed and manufactured by KEK and part of the HL-LHC Project, this study was enlarged to characterise a spectrum of Glass Fiber Reinforced Polymers and resins potentially interesting for superconducting magnets. As a collaboration between CERN, KEK and QST Takasaki, an irradiation campaign was held with gamma-ray doses going from 10 MGy to 100 MGy. This paper describes the different methodologies applied to perform mechanical and chemical tests, both at room and cryogenic temperatures on a wide range of materials and resins. The results and the analysis of these tests are presented with the goal to provide some guidance on the choice of specific material or resin in HEP applications

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

Charm production and fragmentation fractions at midrapidity in pp collisions at √s = 13 TeV

Measurements of the production cross sections of prompt D0, D+, D∗+, D+s, Λ+c, and Ξ+c charm hadrons at midrapidity in proton−proton collisions at s√=13 TeV with the ALICE detector are presented. The D-meson cross sections as a function of transverse momentum (pT) are provided with improved precision and granularity. The ratios of pT-differential meson production cross sections based on this publication and on measurements at different rapidity and collision energy provide a constraint on gluon parton distribution functions at low values of Bjorken-x (10−5−10−4). The measurements of Λ+c (Ξ+c) baryon production extend the measured pT intervals down to pT=0(3)~GeV/c. These measurements are used to determine the charm-quark fragmentation fractions and the cc¯¯ production cross section at midrapidity (|y|<0.5) based on the sum of the cross sections of the weakly-decaying ground-state charm hadrons D0, D+, D+s, Λ+c, Ξ0c and, for the first time, Ξ+c, and of the strongly-decaying J/psi mesons. The first measurements of Ξ+c and Σ0,++c fragmentation fractions at midrapidity are also reported. A significantly larger fraction of charm quarks hadronising to baryons is found compared to e+e− and ep collisions. The cc¯¯ production cross section at midrapidity is found to be at the upper bound of state-of-the-art perturbative QCD calculations

Two-particle transverse momentum correlations in pp and p–Pb collisions at energies available at the CERN Large Hadron Collider

Two-particle transverse momentum differential correlators, recently measured in Pb--Pb collisions at energies available at the CERN Large Hadron Collider (LHC), provide an additional tool to gain insights into particle production mechanisms and infer transport properties, such as the ratio of shear viscosity to entropy density, of the medium created in Pb-Pb collisions. The longitudinal long-range correlations and the large azimuthal anisotropy measured at low transverse momenta in small collision systems, namely pp and p-Pb, at LHC energies resemble manifestations of collective behaviour. This suggests that locally equilibrated matter may be produced in these small collision systems, similar to what is observed in Pb-Pb collisions. In this work, the same two-particle transverse momentum differential correlators are exploited in pp and p-Pb collisions at s√=7 TeV and sNN−−−√=5.02 TeV, respectively, to seek evidence for viscous effects. Specifically, the strength and shape of the correlators are studied as a function of the produced particle multiplicity to identify evidence for longitudinal broadening that might reveal the presence of viscous effects in these smaller systems. The measured correlators and their evolution from pp and p--Pb to Pb--Pb collisions are additionally compared to predictions from Monte Carlo event generators, and the potential presence of viscous effects is discussed

Measurements of the groomed jet radius and momentum splitting fraction with the soft drop and dynamical grooming algorithms in pp collisions at √s = 5.02 TeV

This article presents measurements of the groomed jet radius and momentum splitting fraction in pp collisions at s√=5.02 TeV with the ALICE detector at the Large Hadron Collider. Inclusive charged-particle jets are reconstructed at midrapidity using the anti-kT algorithm for transverse momentum 60<pchjetT<80 GeV/c. We report results using two different grooming algorithms: soft drop and, for the first time, dynamical grooming. For each grooming algorithm, a variety of grooming settings are used in order to explore the impact of collinear radiation on these jet substructure observables. These results are compared to perturbative calculations that include resummation of large logarithms at all orders in the strong coupling constant. We find good agreement of the theoretical predictions with the data for all grooming settings considered

Enhanced deuteron coalescence probability in jets

The transverse-momentum (pT) spectra and coalescence parameters B2 of (anti)deuterons are measured in pp collisions at s√=13 TeV for the first time in and out of jets. In this measurement, the direction of the leading particle with the highest pT in the event (pleadT>5 GeV/c) is used as an approximation for the jet axis. The event is consequently divided into three azimuthal regions and the jet signal is obtained as the difference between the Toward region, that contains jet fragmentation products in addition to the underlying event (UE), and the Transverse region, which is dominated by the UE. The coalescence parameter in the jet is found to be approximately a factor of 10 larger than that in the underlying event. This experimental observation is consistent with the coalescence picture and can be attributed to the smaller average phase-space distance between nucleons inside the jet cone as compared to the underlying event. The results presented in this Letter are compared to predictions from a simple nucleon coalescence model, where the phase space distributions of nucleons are generated using PYTHIA 8 with the Monash 2013 tuning, and to predictions from a deuteron production model based on ordinary nuclear reactions with parametrized energy-dependent cross sections tuned on data. The latter model is implemented in PYTHIA 8.3. Both models reproduce the observed large difference between in-jet and out-of-jet coalescence parameters, although the almost flat trend of the BJet2 is not reproduced by the models, which instead give a decreasing trend

Forward rapidity J/ψ production as a function of charged-particle multiplicity in pp collisions at s \sqrt{s} = 5.02 and 13 TeV

International audienceThe production of J/ψ is measured as a function of charged-particle multiplicity at forward rapidity in proton-proton (pp) collisions at center-of-mass energies $\sqrt{s}$ = 5.02 and 13 TeV. The J/ψ mesons are reconstructed via their decay into dimuons in the rapidity interval (2.5 < y < 4.0), whereas the charged-particle multiplicity density (dN$_{ch}$/dη) is measured at midrapidity (|η| < 1). The production rate as a function of multiplicity is reported as the ratio of the yield in a given multiplicity interval to the multiplicity-integrated one. This observable shows a linear increase with charged-particle multiplicity normalized to the corresponding average value for inelastic events (dN$_{ch}$/dη/〈dN$_{ch}$/dη〉), at both the colliding energies. Measurements are compared with available ALICE results at midrapidity and theoretical model calculations. First measurement of the mean transverse momentum (〈p$_{T}$〉) of J/ψ in pp collisions exhibits an increasing trend as a function of dN$_{ch}$/dη/〈dN$_{ch}$/dη〉 showing a saturation towards high charged-particle multiplicities.[graphic not available: see fulltext

Energy dependence of coherent photonuclear production of J/ψ mesons in ultra-peripheral Pb-Pb collisions at sNN \sqrt{{\textrm{s}}_{\textrm{NN}}} = 5.02 TeV

International audienceThe cross section for coherent photonuclear production of J/ψ is presented as a function of the electromagnetic dissociation (EMD) of Pb. The measurement is performed with the ALICE detector in ultra-peripheral Pb-Pb collisions at a centre-of-mass energy per nucleon pair of $\sqrt{{\textrm{s}}_{\textrm{NN}}}$ = 5.02 TeV. Cross sections are presented in five different J/ψ rapidity ranges within |y| < 4, with the J/ψ reconstructed via its dilepton decay channels. In some events the J/ψ is not accompanied by EMD, while other events do produce neutrons from EMD at beam rapidities either in one or the other beam direction, or in both. The cross sections in a given rapidity range and for different configurations of neutrons from EMD allow for the extraction of the energy dependence of this process in the range 17 < W$_{γ Pb,n}$ < 920 GeV, where W$_{γ Pb,n}$ is the centre-of-mass energy per nucleon of the γPb system. This range corresponds to a Bjorken-x interval spanning about three orders of magnitude: 1.1 × 10$^{−5}$ < x < 3.3 × 10$^{−2}$. In addition to the ultra-peripheral and photonuclear cross sections, the nuclear suppression factor is obtained. These measurements point to a strong depletion of the gluon distribution in Pb nuclei over a broad, previously unexplored, energy range. These results, together with previous ALICE measurements, provide unprecedented information to probe quantum chromodynamics at high energies.[graphic not available: see fulltext

Measurement of the production of charm jets tagged with D0 mesons in pp collisions at √s = 5.02 and 13 TeV

The measurement of the production of charm jets, identified by the presence of a D0 meson in the jet constituents, is presented in proton-proton collisions at centre-of-mass energies of s√ = 5.02 and 13 TeV with the ALICE detector at the CERN LHC. The D0 mesons were reconstructed from their hadronic decay D0→K−π+ and the respective charge conjugate. Jets were reconstructed from D0-meson candidates and charged particles using the anti-kT algorithm, in the jet transverse momentum range 5<pT;chjet<50 GeV/c, pseudorapidity |ηjet|<0.9−R, and with the jet resolution parameters R = 0.2, 0.4, 0.6. The distribution of the jet momentum fraction carried by a D0 meson along the jet axis (zch||) was measured in the range 0.4<zch||<1.0 in four ranges of the jet transverse momentum. Comparisons of results for different collision energies and jet resolution parameters are also presented. The measurements are compared to predictions from Monte Carlo event generators based on leading-order and next-to-leading-order perturbative quantum chromodynamics calculations. A generally good description of the main features of the data is obtained in spite of a few discrepancies at low pT;chjet. Measurements were also done for R=0.3 at s√ = 5.02 TeV and are shown along with their comparisons to theoretical predictions in an appendix to this paper