Non-Cardiac Surgery in Developing Countries: Epidemiological Aspects and Economical Opportunities – The Case of Brazil

Background: Worldwide distribution of surgical interventions is unequal. Developed countries account for the majority of surgeries and information about non-cardiac operations in developing countries is scarce. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. Methods and Findings: This is a retrospective cohort study that investigated the time window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The following variables were studied: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. The results were presented as sum, average and percentage. The trend analysis was performed by linear regression model. There were 32,659,513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period and nowadays nearly 3 million operations are performed annually. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200%. The total expenses related to surgical hospitalizations were more than $10 billion in all these years. The yearly cost of surgical procedures to public health system was more than$1.27 billion for all surgical hospitalizations, and in average, U$445.24 per surgical procedure. The total cost of blood transfusion was near$98 million in all years and annually approximately $10 million were spent in perioperative transfusion. The surgical mortality had an increment of 31.11% in the period. Actually, in 2007, the surgical mortality in Brazil was 1.77%. All the variables had a significant increment along the studied period: r square (r(2)) = 0.447 for the number of surgeries (P = 0.012), r(2) = 0.439 for in-hospital expenses (P = 0.014) and r(2) = 0.907 for surgical mortality (P = 0.0055). Conclusion: The volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil.Scholarship Program of Cardiology Society of Sao Paulo (SOCESP)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP

Joint Observation of the Galactic Center with MAGIC and CTA-LST-1

MAGIC is a system of two Imaging Atmospheric Cherenkov Telescopes (IACTs), designed to detect very-high-energy gamma rays, and is operating in stereoscopic mode since 2009 at the Observatorio del Roque de Los Muchachos in La Palma, Spain. In 2018, the prototype IACT of the Large-Sized Telescope (LST-1) for the Cherenkov Telescope Array, a next-generation ground-based gamma-ray observatory, was inaugurated at the same site, at a distance of approximately 100 meters from the MAGIC telescopes. Using joint observations between MAGIC and LST-1, we developed a dedicated analysis pipeline and established the threefold telescope system via software, achieving the highest sensitivity in the northern hemisphere. Based on this enhanced performance, MAGIC and LST-1 have been jointly and regularly observing the Galactic Center, a region of paramount importance and complexity for IACTs. In particular, the gamma-ray emission from the dynamical center of the Milky Way is under debate. Although previous measurements suggested that a supermassive black hole Sagittarius A* plays a primary role, its radiation mechanism remains unclear, mainly due to limited angular resolution and sensitivity. The enhanced sensitivity in our novel approach is thus expected to provide new insights into the question. We here present the current status of the data analysis for the Galactic Center joint MAGIC and LST-1 observations

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Trend analysis of economical data adjusted for monetary depreciation.

<p>A – Mean in-hospital expense per surgery. B- Mean transfusion cost per surgery.</p

Trends analysis results.

<p>A- Number of surgery per 1,000 inhabitants. B – Mortality. C- Length of Stay.</p

Economical data of surgical procedures performed from 1995 to 2007 adjusted for monetary depreciation.

<p>The values were corrected to monetary depreciation in the period. The year 1995 was used as reference.</p

Performance of the Large-Sized Telescope prototype of the Cherenkov Telescope Array

The next-generation ground-based gamma-ray Cherenkov Telescope Array Observatory (CTAO) will consist of imaging atmospheric Cherenkov telescopes (IACTs) of three different sizes distributed in two sites. The Large-Sized Telescopes will cover the low-energy end of the CTA energy range, starting at about 20 GeV. After its first years of operation at the CTA northern site, the Large-Sized Telescope prototype (LST-1) is in the final stage of its commissioning phase, having collected a significant amount of scientific data to date.In this contribution, we present the physics performance of the telescope using low-zenith Crab Nebula observations and Monte Carlo simulations fine-tuned accordingly. We show performance figures of merit such as the energy threshold, effective area, energy and angular resolution, and sensitivity based on the standard Hillas-parameters approach and following the source-independent and dependent analysis methods. The analysis threshold is estimated at 30 GeV. The energy resolution is around 30%, and the angular resolution is 0.3 degrees at 100 GeV.The best integral sensitivity of LST-1 is about 1.1% of the Crab Nebula flux above 250 GeV for 50 hours of observations. We also show the spectral energy distribution and light curve from Crab Nebula observations, which agree with results from other IACTs and link smoothly with Fermi-LAT when considering statistical and systematic uncertainties near the energy threshold