Electrocautery, diathermy, and surgical energy devices: are surgical teams at risk during the COVID-19 pandemic?

OBJECTIVE: The aim of the study was to provide a rapid synthesis of available data to identify the risk posed by utilizing surgical energy devices intraoperatively due to the generation of surgical smoke, an aerosol. Secondarily it aims to summarize methods to minimize potential risk to operating room staff. SUMMARY BACKGROUND DATA: Continuing operative practice during the coronavirus disease-19 (COVID-19) pandemic places the health of operating theatre staff at potential risk. SARS-CoV2 is transmitted through inhaled droplets and aerosol particles, thus posing an inhalation threat even at considerable distance. Surgical energy devices generate an aerosol of biological particular matter during use. The risk to healthcare staff through use of surgical energy devices is unknown. METHODS: This review was conducted utilizing a rapid review methodology to enable efficient generation and dissemination of information useful for concurrent clinical practice. RESULTS: There are conflicting stances on the use of energy devices and laparoscopy by different surgical governing bodies and societies. There is no definitive evidence that aerosol generated by energy devices may carry active SARS-CoV2 virus. However, investigations of other viruses have demonstrated aerosolization through energy devise use. Measures to reduce potential transmission include appropriate personal protective equipment, evacuation and filtration of surgical plume, limiting energy device use if appropriate, and adjusting endoscopic and laparoscopic practice (low CO2 pressures, evacuation through ultrafiltration systems). CONCLUSIONS: The risk of transmission of SARS-CoV2 through aerosolized surgical smoke associated with energy device use is not fully understood, however transmission is biologically plausible. Caution and appropriate measures to reduce risk to healthcare staff should be implemented when considering intraoperative use of energy devices

The first spectroscopic IR reverberation programme on Mrk 509

Near IR spectroscopic reverberation of Active Galactic Nuclei (AGN) potentially allows the infrared (IR) broad line region (BLR) to be reverberated alongside the disc and dust continua, while the spectra can also reveal details of dust astro-chemistry. Here, we describe results of a short pilot study (17 near-IR spectra over a 183 d period) for Mrk 509. The spectra give a luminosity-weighted dust radius of 〈Rd,lum〉 = 186 ± 4 light-days for blackbody (large grain dust), consistent with previous (photometric) reverberation campaigns, whereas carbon and silicate dust give much larger radii. We develop a method of calibrating spectral data in objects where the narrow lines are extended beyond the slit width. We demonstrate this by showing our resultant photometric band light curves are consistent with previous results, with a hot dust lag at >40 d in the K band, clearly different from the accretion disc response at <20 d in the z band. We place this limit of 40 d by demonstrating clearly that the modest variability that we do detect in the H and K band does not reverberate on time-scales of less than 40 d. We also extract the Pa β line light curve, and find a lag which is consistent with the optical BLR H β line of ∼70–90 d. This is important as direct imaging of the near-IR BLR is now possible in a few objects, so we need to understand its relation to the better studied optical BLR

The Bantustan State and the South African Transition: Militarisation, Patrimonialism and the Collapse of the Ciskei Regime, 1986-1994

This article examines the Ciskei bantustan and processes of state formation during the transition to democracy. In the Ciskei, the rule of Brigadier Gqozo rested on the continued support of the South African state: identified as the weakest link in the National Party’s conservative alliance, the Ciskei became the first target for the African National Congress’ mass action campaign of 1992. The struggle in the Ciskei thus had some significance for the shape of the transition. While at a constitutional level the National Party eventually conceded to the re-incorporation of the bantustans in late 1992, it continued to stall change and to bolster the bantustans through covert military operations and land transfers to bantustan elites. These dynamics of state formation are critical aspects of the history of the transition and were at the heart of the emerging political conflict in the Ciskei, which by mid-1992 was escalating into civil war. This article examines mass mobilisation, political repression and the consequences of the patrimonial militarisation of the Ciskei state in the Ciskei/ Border region. By focusing on processes of state formation and struggles over the fabric of the state, this article provides a corrective to the prevailing academic focus on the elite negotiations and argues for the value of social histories of the bantustan states for understanding the enduring legacies of these regimes

A survey of pain practices in the surgical neonate : an Australasian perspective

Objectives: The aim of this study was to describe the current pain assessment and management practices in neonatal units providing surgical care across both Australia and New Zealand. Methods: An electronic survey was administered to one nursing and one medical representative at each of the 15 Australian and New Zealand neonatal surgical units. Results: All 15 eligible units responded to the survey with a response rate of 97% (29/30 possible respondents). Dosing and titration of analgesics was a collaborative decision between nursing and medical staff (64%), with pain assessment being undertaken using a validated tool and occurring in 13 of the 15 units (87%). Morphine was the first choice of opioid employed and non-pharmacological measures for comfort were utilized in 11 units (79%). A weaning protocol was utilized in nine units (60%), with 14 units (93%) using a tool to guide management of Iatrogenic Withdrawal Syndrome. Discussion: Though the survey highlighted some variation in practice, there was considerable consistency in pain assessment and management practices across Australian and New Zealand neonatal units

JBI series paper 4: the role of collaborative evidence networks in promoting and supporting evidence-based healthcare globally: reflections from 25 years across 38 countries.

Evidence-based healthcare is a worldwide movement with hundreds of organisations and thousands of individuals working to ensure that healthcare practice, policy, and decision-making is informed by rigorous research evidence, to improve health outcomes. The success of this global agenda however depends on individuals and organisations working together within a functioning evidence ecosystem. Collaborative evidence networks are a key mechanism to facilitate the synthesis, transfer and implementation of evidence into healthcare policy and practice. Using the Network Functions Approach as a framework for review, this paper explores the strategic functions and form of the JBI Collaboration to illustrate the role of a collaborative evidence network in promoting and supporting evidence-based healthcare globally. It illustrates how the functions of a collaborative evidence network enable the development, exchange and dissemination of knowledge, the building of social capital, mobilization of resources and amplification and advocacy of members work and ideas, which increase the capacity and effectiveness of members in achieving their unified purpose. Effective and sustainable collaborative evidence networks have innovative ways of relating and mobilising energy for action; and combine formal and informal structures and relationships to successfully work together to address complex global health issues and drive the evidence-based healthcare agenda forward

The relativistic jet of the γ-ray emitting narrow-line Seyfert 1 galaxy 1H 0323+342

The detection of several radio-loud narrow-line Seyfert 1 (NLS1) galaxies by the Fermi Gamma-Ray Space Telescope hints at the existence of a rare, new class of γ -ray emitting active galactic nuclei with low black hole masses. Like flat spectrum radio quasars (FSRQs), their γ -ray emission is thought to be produced via the external Compton mechanism whereby relativistic jet electrons upscatter a photon field external to the jet, e.g. from the accretion disc, broad line region (BLR), and dusty torus, to higher energies. Here we study the origin of the γ -ray emission in the lowest-redshift candidate among the currently known γ -ray emitting NLS1s, 1H 0323+342, and take a new approach. We observationally constrain the external photon field using quasi-simultaneous near-infrared, optical, and X-ray spectroscopy. Applying a one-zone leptonic jet model, we simulate the range of jet parameters for which this photon field, when Compton scattered to higher energies, can explain the γ -ray emission. We find that the site of the γ -ray emission lies well within the BLR and that the seed photons mainly originate from the accretion disc. The jet power that we determine, 1.0 × 1045 erg s−1, is approximately half the accretion disc luminosity. We show that this object is not simply a low-mass FSRQ, its jet is intrinsically less powerful than predicted by scaling a typical FSRQ jet by black hole mass and accretion rate. That γ -ray-emitting NLS1s appear to host underpowered jets may go some way to explaining why so few have been detected to date