Global Surgery – Redirecting Strategies for a Global Research Agenda Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”

Abstract More than three years have passed since the publication of the Lancet Commission on Global Surgery and its recommendations on scaling up surgery in sub-Saharan Africa (SSA). An important gap, the voice of the districts as well as lack of contextualized research, has been noted in its support of national surgical plans that run the risk of being at best, aspirational. Moreover, a ‘one-size-fits-all approach’ may not adequately address country-specific challenges on the ground. There is a need to redirect attention, effort, and funding in creating a global mechanism to gather baseline country information documenting every single district level government health facility’s ability and readiness to provide safe surgical, obstetric, trauma, and anesthesia care using the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to aid in directing country-specific efforts in surgical systems strengthening and ensuring that a basic package of essential surgical and anesthesia services is made available to each citizen with adequate financial protection by 2030. This global mechanism will enable benchmarking, accountability, and streamlining of the work of the global surgical community to achieve true progress in scaling up surgery not only in SSA, but for the rest of the developing world

A combined spectroscopic and photometric stellar activity study of Epsilon Eridani

We present simultaneous ground-based radial velocity (RV) measurements and space-based photometric measurements of the young and active K dwarf Epsilon Eridani. These measurements provide a data set for exploring methods of identifying and ultimately distinguishing stellar photospheric velocities from Keplerian motion. We compare three methods we have used in exploring this data set: Dalmatian, an MCMC spot modeling code that fits photometric and RV measurements simultaneously; the FF$'$ method, which uses photometric measurements to predict the stellar activity signal in simultaneous RV measurements; and H$\alpha$ analysis. We show that our H$\alpha$ measurements are strongly correlated with photometry from the Microvariability and Oscillations of STars (MOST) instrument, which led to a promising new method based solely on the spectroscopic observations. This new method, which we refer to as the HH$'$ method, uses H$\alpha$ measurements as input into the FF$'$ model. While the Dalmatian spot modeling analysis and the FF$'$ method with MOST space-based photometry are currently more robust, the HH$'$ method only makes use of one of the thousands of stellar lines in the visible spectrum. By leveraging additional spectral activity indicators, we believe the HH$'$ method may prove quite useful in disentangling stellar signals

Value innovation: an important aspect of global surgical care

Abstract Introduction Limited resources in low- and middle-income countries (LMICs) drive tremendous innovation in medicine, as well as in other fields. It is not often recognized that several important surgical tools and methods, widely used in high-income countries, have their origins in LMICs. Surgical care around the world stands much to gain from these innovations. In this paper, we provide a short review of some of these succesful innovations and their origins that have had an important impact in healthcare delivery worldwide. Review Examples of LMIC innovations that have been adapted in high-income countries include the Bogotá bag for temporary abdominal wound closure, the orthopaedic external fixator for complex fractures, a hydrocephalus fluid valve for normal pressure hydrocephalus, and intra-ocular lens and manual small incision cataract surgery. LMIC innovations that have had tremendous potential global impact include mosquito net mesh for inguinal hernia repair, and a flutter valve for intercostal drainage of pneumothorax. Conclusion Surgical innovations from LMICs have been shown to have comparable outcomes at a fraction of the cost of tools used in high-income countries. These innovations have the potential to revolutionize global surgical care. Advocates should actively seek out these innovations, campaign for the financial gains from these innovations to benefit their originators and their countries, and find ways to develop and distribute them locally as well as globally

Non-detection of previously reported transits of HD 97658b with MOST photometry

The radial velocity-discovered exoplanet HD 97658b was recently announced to transit, with a derived planetary radius of 2.93 \pm 0.28 R_{Earth}. As a transiting super-Earth orbiting a bright star, this planet would make an attractive candidate for additional observations, including studies of its atmospheric properties. We present and analyze follow-up photometric observations of the HD 97658 system acquired with the MOST space telescope. Our results show no transit with the depth and ephemeris reported in the announcement paper. For the same ephemeris, we rule out transits for a planet with radius larger than 2.09 R_{Earth}, corresponding to the reported 3\sigma lower limit. We also report new radial velocity measurements which continue to support the existence of an exoplanet with a period of 9.5 days, and obtain improved orbital parameters.Comment: 16 pages, 4 figures; 1 Table; accepted for publication in ApJL, includes changes made in response to the referee repor

Analysis of the MOST light curve of the heavily spotted K2IV component of the single-line spectroscopic binary II Pegasi

Continuous photometric observations of the visible component of the single-line, K2IV spectroscopic binary II Peg carried out by the MOST satellite during 31 consecutive days in 2008 have been analyzed. On top of spot-induced brightness modulation, eleven flares were detected of three distinct types characterized by different values of rise, decay and duration times. The flares showed a preference for occurrence at rotation phases when the most spotted hemisphere is directed to the observer, confirming previous similar reports. An attempt to detect a grazing primary minimum caused by the secondary component transiting in front of the visible star gave a negative result. The brightness variability caused by spots has been interpreted within a cold spot model. An assumption of differential rotation of the primary component gave a better fit to the light curve than a solid-body rotation model.Comment: Accepteed to MNRA

The HD 192263 system: planetary orbital period and stellar variability disentangled

As part of the Transit Ephemeris Refinement and Monitoring Survey (TERMS), we present new radial velocities and photometry of the HD 192263 system. Our analysis of the already available Keck-HIRES and CORALIE radial velocity measurements together with the five new Keck measurements we report in this paper results in improved orbital parameters for the system. We derive constraints on the size and phase location of the transit window for HD 192263b, a Jupiter-mass planet with a period of 24.3587 \pm 0.0022 days. We use 10 years of Automated Photoelectric Telescope (APT) photometry to analyze the stellar variability and search for planetary transits. We find continuing evidence of spot activity with periods near 23.4 days. The shape of the corresponding photometric variations changes over time, giving rise to not one but several Fourier peaks near this value. However, none of these frequencies coincides with the planet's orbital period and thus we find no evidence of star-planet interactions in the system. We attribute the ~23-day variability to stellar rotation. There are also indications of spot variations on longer (8 years) timescales. Finally, we use the photometric data to exclude transits for a planet with the predicted radius of 1.09 RJ, and as small as 0.79 RJ.Comment: 9 pages, 6 tables, 6 figures; accepted to Ap

Updated Parameters and a New Transmission Spectrum of HD 97658b

Recent years have seen increasing interest in the characterization of sub-Neptune-sized planets because of their prevalence in the Galaxy, contrasted with their absence in our solar system. HD 97658 is one of the brightest stars hosting a planet of this kind, and we present the transmission spectrum of this planet by combining four Hubble Space Telescope transits, 12 Spitzer/IRAC transits, and eight MOST transits of this system. Our transmission spectrum has a higher signal-to-noise ratio than those from previous works, and the result suggests that the slight increase in transit depth from wavelength 1.1–1.7 μm reported in previous works on the transmission spectrum of this planet is likely systematic. Nonetheless, our atmospheric modeling results are inconclusive, as no model provides an excellent match to our data. Nonetheless, we find that atmospheres with high C/O ratios (C/O ≳ 0.8) and metallicities of ≳100× solar metallicity are favored. We combine the mid-transit times from all of the new Spitzer and MOST observations and obtain an updated orbital period of P = 9.489295 ± 0.000005, with a best-fit transit time center at T₀ = 2456361.80690 ± 0.00038 (BJD). No transit timing variations are found in this system. We also present new measurements of the stellar rotation period (34 ± 2 days) and stellar activity cycle (9.6 yr) of the host star HD 97658. Finally, we calculate and rank the Transmission Spectroscopy Metric of all confirmed planets cooler than 1000 K and with sizes between 1 R⊕ and 4 R⊕. We find that at least a third of small planets cooler than 1000 K can be well characterized using James Webb Space Telescope, and of those, HD 97658b is ranked fifth, meaning that it remains a high-priority target for atmospheric characterization

Evidence for reflected light from the most eccentric exoplanet known

Planets in highly eccentric orbits form a class of objects not seen within our Solar System. The most extreme case known amongst these objects is the planet orbiting HD 20782, with an orbital period of 597 days and an eccentricity of 0.96. Here we present new data and analysis for this system as part of the Transit Ephemeris Refinement and Monitoring Survey (TERMS). We obtained CHIRON spectra to perform an independent estimation of the fundamental stellar parameters. New radial velocities from AAT and PARAS observations during periastron passage greatly improve the our knowledge of the eccentric nature of the orbit. The combined analysis of our Keplerian orbital and Hipparcos astrometry show that the inclination of the planetary orbit is > 1.25 degrees, ruling out stellar masses for the companion. Our long-term robotic photometry show that the star is extremely stable over long timescales. Photometric monitoring of the star during predicted transit and periastron times using MOST rule out a transit of the planet and reveal evidence of phase variations during periastron. These possible photometric phase variations are likely caused by reflected light from the planet's atmosphere and the dramatic change in star--planet separation surrounding the periastron passage

Extensive study of HD 25558, a long-period double-lined binary with two SPB components

We carried out an extensive observational study of the Slowly Pulsating B (SPB) star, HD 25558. The ≈2000 spectra obtained at different observatories, the ground-based and MOST satellite light curves revealed that this object is a double-lined spectroscopic binary with an orbital period of about nine years. The observations do not allow the inference of an orbital solution. We determined the physical parameters of the components, and found that both lie within the SPB instability strip. Accordingly, both show line-profile variations due to stellar pulsations. 11 independent frequencies were identified in the data. All the frequencies were attributed to one of the two components based on pixel-by-pixel variability analysis of the line profiles. Spectroscopic and photometric mode identification was also performed for the frequencies of both stars. These results suggest that the inclination and rotation of the two components are rather different. The primary is a slow rotator with ≈6 d period, seen at ≈60° inclination, while the secondary rotates fast with ≈1.2 d period, and is seen at ≈20° inclination. Spectropolarimetric measurements revealed that the secondary component has a magnetic field with at least a few hundred Gauss strength, while no magnetic field can be detected in the primary