Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78 center dot 6%] female patients and 4922 [21 center dot 4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1 center dot 4 [IQR 0 center dot 6-3 center dot 4]) compared with the prepandemic phase (2 center dot 0 [0 center dot 9-3 center dot 7]; p<0 center dot 0001) and pandemic decrease phase (2 center dot 3 [1 center dot 0-5 center dot 0]; p<0 center dot 0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69 center dot 0%] of 3704 vs 1515 [71 center dot 5%] of 2119; OR 1 center dot 1 [95% CI 1 center dot 0-1 center dot 3]; p=0 center dot 042), lymph node metastases (343 [9 center dot 3%] vs 264 [12 center dot 5%]; OR 1 center dot 4 [1 center dot 2-1 center dot 7]; p=0 center dot 0001), and tumours at high risk of structural disease recurrence (203 [5 center dot 7%] of 3584 vs 155 [7 center dot 7%] of 2006; OR 1 center dot 4 [1 center dot 1-1 center dot 7]; p=0 center dot 0039).Interpretation Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.Funding None.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved

Searching for VHE gamma-ray emission associated with IceCube neutrino alerts using FACT, H.E.S.S., MAGIC, and VERITAS

The realtime follow-up of neutrino events is a promising approach to searchfor astrophysical neutrino sources. It has so far provided compelling evidencefor a neutrino point source: the flaring gamma-ray blazar TXS 0506+056 observedin coincidence with the high-energy neutrino IceCube-170922A detected byIceCube. The detection of very-high-energy gamma rays (VHE, $\mathrm{E} >100\,\mathrm{GeV}$) from this source helped establish the coincidence andconstrained the modeling of the blazar emission at the time of the IceCubeevent. The four major imaging atmospheric Cherenkov telescope arrays (IACTs) -FACT, H.E.S.S., MAGIC, and VERITAS - operate an active follow-up program oftarget-of-opportunity observations of neutrino alerts sent by IceCube. Thisprogram has two main components. One are the observations of known gamma-raysources around which a cluster of candidate neutrino events has been identifiedby IceCube (Gamma-ray Follow-Up, GFU). Second one is the follow-up of singlehigh-energy neutrino candidate events of potential astrophysical origin such asIceCube-170922A. GFU has been recently upgraded by IceCube in collaborationwith the IACT groups. We present here recent results from the IACT follow-upprograms of IceCube neutrino alerts and a description of the upgraded IceCubeGFU system.<br

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

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

Perfil da produção científica em saúde do trabalhador Profile of the scientific production in workers' health

O objetivo deste estudo foi traçar o perfil da produção científica referente à saúde do trabalhador, no período compreendido entre 2001 e março de 2008. A pesquisa foi operacionalizada por meio da busca eletrônica de artigos indexados na base de dados Scientific Electronic Library Online (SciELO), a partir dos descritores "saúde do(s) trabalhador(es)" e "saúde ocupacional". Foram analisados 170 artigos completos. O periódico Cadernos de Saúde Pública concentra a maior parte dos trabalhos (35.29%), seguido pela Revista Ciência & Saúde Coletiva (16,47%). Constatou-se, ainda, que o método de abordagem mais utilizado foi o quantitativo (53,52%), os objetos de estudo mais frequente foram as discussões conceituais das relações saúde-ambiente-trabalho (40,59%), e a população mais estudada foi a dos profissionais da área de saúde (20,59%). Verificou-se, ainda, que a produção científica nacional sobre o tema concentra-se na região sudeste (69,66%). O aumento da produção científica no campo da saúde do trabalhador acompanha a tendência de aumento da produção científica nacional nos últimos 8 anos. O estudo mostra o potencial de crescimento da área compatível com a demanda de conhecimento dos gestores de políticas públicas que envolvem as relações saúde-ambiente-trabalho.<br>This study aimed to outline the profile of the scientific literature on workers' health in the period between 2001 and March 2008. The research was conducted through the electronic search of papers indexed in the database Scientific Electronic Library Online (SciELO) with the descriptors "workers' health" and "occupational health". Overall, 170 complete papers were analyzed. The journal Cadernos de Saúde Pública was the source that published most papers (35,29%), followed by Ciência & Saúde Coletiva (16,47%). The quantitative method was used by 53.52% of the papers, conceptual discussions about Health-Environment-Work relations were the most frequent object of study (40.59%), and health professionals were the most studied population (20,59%). It was also verified that Brazil's scientific production on the theme is concentrated in the Southeast (69,66%). The increase in scientific production in the field of workers' health has followed the growth tendency of the national scientific production in the last 8 years. The study shows that the potential growth of this field is compatible with the demand for knowledge of public policies managers who work with Health-Environment-Work relations

Erosividade da chuva e erodibilidade de Cambissolo e Latossolo na região de Lavras, sul de Minas Gerais Rainfall erosivity and erodibility of Cambisol (Inceptisol) and Latosol (Oxisol) in the region of Lavras, Southern Minas Gerais State, Brazil

No Brasil, ainda são relativamente poucos os estudos envolvendo erodibilidade do solo, principalmente Cambissolos, dada a morosidade na obtenção dos resultados de experimentos com chuva natural. O conhecimento dos índices de erosividade e de erodibilidade é importante para o planejamento conservacionista, contribuindo para a sustentabilidade dos solos. Este estudo teve como objetivos determinar a erosividade da chuva e a erodibilidade de Cambissolo Háplico Tb distrófico típico e Latossolo Vermelho distroférrico típico, sob chuva natural, em Lavras (MG), no período de 1998 a 2002. Os dados de precipitação pluviométrica foram obtidos na Estação Climatológica Principal de Lavras, localizada no campus da Universidade Federal de Lavras, próxima das unidades experimentais de perdas de solo. A erosividade (EI30) foi determinada a partir do produto da energia cinética da chuva pela sua intensidade máxima em 30 min. Estes dados, correlacionados com as perdas de solo, permitiram obter o índice de erodibilidade dos solos. A precipitação total média anual foi 1.287 mm e a erosividade média foi de 4.865 MJ mm ha-1 h-1 ano-1. A erodibilidade foi 0,0355 Mg h MJ-1 mm-1 para o Cambissolo e 0,0032 Mg h MJ-1 mm-1 para o Latossolo, em consonância com seus atributos mineralógicos, químicos, físicos e morfológicos diferenciais.<br>Relatively few studies in Brazil have investigated soil erodibility, mainly for Cambisols (Inceptisols), due to the tediousness of data collection in natural rainfall experiments. Knowledge about erodibility and erosivity is important for conservation planning, which contributes to soil sustainability. This study aimed at evaluating the rainfall erosivity and erodibility of a typic dystrophic Tb Haplic Cambisol (Inceptisol) and a typic dystroferric Red Latosol (Oxisol) under natural rainfall, in Lavras, state of Minas Gerais, Brazil, between 1998 and 2002. Pluvial precipitation data were obtained from the main weather station of Lavras, of the Universidade Federal de Lavras, close to the soil loss experimental plots. Erosivity (EI30) was calculated as the product of the rain kinetic energy by the maximum intensity in 30 min. Based on these data, correlated with the soil losses, the soil erodibility could be computed. The mean annual total precipitation was 1,287 mm and the mean calculated erosivity 4,865 MJ mm ha-1 h-1 year-1. The erodibility of the Cambisol was 0.026 Mg h MJ-1 mm-1 and of the Latosol 0.004 Mg h MJ-1 mm-1, in agreement with their differential mineralogical, chemical, physical and morphological properties