Quantum gravity phenomenology at the dawn of the multi-messenger era—A review

The exploration of the universe has recently entered a new era thanks to the multi-messenger paradigm, characterized by a continuous increase in the quantity and quality of experimental data that is obtained by the detection of the various cosmic messengers (photons, neutrinos, cosmic rays and gravitational waves) from numerous origins. They give us information about their sources in the universe and the properties of the intergalactic medium. Moreover, multi-messenger astronomy opens up the possibility to search for phenomenological signatures of quantum gravity. On the one hand, the most energetic events allow us to test our physical theories at energy regimes which are not directly accessible in accelerators; on the other hand, tiny effects in the propagation of very high energy particles could be amplified by cosmological distances. After decades of merely theoretical investigations, the possibility of obtaining phenomenological indications of Planck-scale effects is a revolutionary step in the quest for a quantum theory of gravity, but it requires cooperation between different communities of physicists (both theoretical and experimental). This review, prepared within the COST Action CA18108 “Quantum gravity phenomenology in the multi-messenger approach”, is aimed at promoting this cooperation by giving a state-of-the art account of the interdisciplinary expertise that is needed in the effective search of quantum gravity footprints in the production, propagation and detection of cosmic messengers.publishedVersio

Aspectos clínico-patológicos do envenenamento botrópico experimental em equinos

Estudou-se as alterações clínico-patológicas e laboratoriais em equinos, inoculados experimentalmente com a peçonha de Bothropoides jararaca, Bothrops jararacussu, Bothrops moojeni e Bothropoides neuwiedi, com a finalidade de fornecer subsídios para o diagnóstico do envenenamento pela picada dessas. Os venenos liofilizados foram diluídos em 1ml de solução fisiológica e administrados a seis equinos, por via subcutânea, nas doses de 0,5 e 1mg/kg (B. jararaca), 0,8 e 1,6mg/kg (B. jararacussu), 0,205mg/kg (B. moojeni) e 1mg/kg (B. neuwiedi). Todos os equinos, menos os que receberam o veneno de B. jararacussu, morreram Os sinais clínicos iniciaram-se entre 8min e 2h10min após a inoculação. O período de evolução variou, nos quatro casos de êxito letal, de 24h41min a 70h41min, e nos dois equinos que se recuperaram foi de 16 dias. O quadro clínico, independente do tipo de veneno e das doses, caracterizou-se por aumento de volume no local da inoculação, arrastar da pinça do membro inoculado no solo, inquietação, apatia, diminuição da resposta aos estímulos externos, mucosas pálidas e hemorragias. Os exames laboratoriais revelaram anemia normocítica normocrômica com progressiva diminuição no número de hemácias, da hemoglobina e do hematócrito, e leucocitose por neutrofilia. Houve aumento de alamina aminotransferase, creatinaquinase, dehidrogenase láctica, ureia e glicose, bem como aumento do tempo de ativação da protrombina e do tempo de tromboplastina parcial ativada. Os achados de necropsia foram extensas hemorragias no tecido subcutâneo, com presença de sangue não coagulado e em boa parte associadas a edema (edema hemorrágico), que se estendia desde o local da inoculação até as regiões cervical, torácica, escapular e membro. Na periferia das áreas hemorrágicas havia predominantemente edema gelatinoso. Havia ainda presença de grande quantidade de líquido sanguinolento nas cavidades torácica, pericárdica e abdominal. Não foram encontradas alterações histológicas significativas

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Envenenamento experimental por Bothropoides jararaca e Bothrops jararacussu em ovinos: aspectos clínico-patológicos e laboratoriais Experimental poisoning by Bothropoides jararaca and Bothrops jararacussu in sheep: clinic-pathological and laboratory aspects

Esse estudo teve como objetivo determinar as alterações clínico-patológicas e laboratoriais em ovinos inoculados com a peçonha de Bothropoides jararaca e Bothrops jararacussu, no intuito de fornecer subsídios que possam facilitar o estabelecimento do diagnóstico e do diagnóstico diferencial dessa condição. Os venenos liofilizados foram diluídos em 1 ml de solução fisiológica e administrados a quatro ovinos por via subcutânea. Três ovinos foram a óbito e um que recebeu a dose de 0,5mg/kg (B. jararaca), recuperou-se. Os sinais clínicos tiveram início entre 7 minutos e 1 hora. O período de evolução variou de 7 horas 9 minutos a 21 horas 59 minutos. O quadro clínico, independentemente das doses, caracterizou-se por aumento de volume no local da inoculação, tempo de sangramento e de preenchimento capilar aumentados, taquicardia, dispnéia, mucosas hipocoradas e apatia. Os exames laboratoriais revelaram acentuada anemia normocítica normocrômica, trombocitopenia, acentuada redução de fibrinogênio e proteínas plasmáticas totais, hematócrito diminuído em dois animais, além de acentuado aumento de creatinaquinase e desidrogenase lática em todos os animais. À necropsia, os principais achados no local da inoculação e tecidos adjacentes eram extensas hemorragias no animal que recebeu o veneno de B. jararaca e edema e acentuado edema pulmonar agudo para os dois animais envenenados por B. jararacussu. Além de hemorragia e edema a principal alteração histopatológica verificada foi necrose das fibras musculares e de vasos, no local de inoculação e adjacências. A necrose tubular renal foi atribuída ao quadro de choque. Nos ovinos deste estudo, o aumento de volume observado no local de inoculação e adjacências era constituído predominantemente por sangue (B. jararaca) e por edema (B. jararacussu).<br>The purpose of this study was to establish the clinic-pathological and laboratory changes in sheep inoculated with Bothropoides jararaca and Bothrops jararacussu venom to provide subsidies for the differential diagnosis of snake bites. The liofilized venoms were diluted in 1 ml saline and administrated subcutaneously to four sheep. Three of the animals died, and the one that received 0.5mg/kg (B. jararaca venom) recovered. First symptoms were observed from 7 minutes to 1 hour after inoculation, and the clinical course varied from 7 hours and 9 minutes to 21 hours and 59 minutes. The symptoms, independent of the dosage, were swelling of the inoculation site, increased bleeding time and capillary filling, tachycardia, dyspnea, pale mucous membranes and diminished reaction to external stimuli. Laboratory tests revealed pronounced normocytic and normochromic anemia, trombocytopenia, slight reduction of fibrogen and total plasmatic protein, in two animals diminished hematocrit, besides pronounced increase of creatinaquinase and lactic dehydrogenase. At necropsy, the main findings at the inoculation site and adjacent tissues were extensive hemorrhages in the sheep inoculated with jararaca venom, and predominantly edema in the two animals inoculated with jararacussu venom. In two sheep which received jararacussu venom, acute pulmonary edema was observed. Hemorrhage and edema as the main histopathological changes, besides necrosis of muscle fibers and vessels at the inoculation site and adjacent tissue was observed. The renal tubular necrosis was attributed to shock. The volume increase at the inoculation site and surroundings was mainly due to hemorrhage (B. jararaca) or edema (B. jararacussu)

Quantum gravity phenomenology at the dawn of the multi-messenger era—A review

The exploration of the universe has recently entered a new era thanks to the multi-messenger paradigm, characterized by a continuous increase in the quantity and quality of experimental data that is obtained by the detection of the various cosmic messengers (photons, neutrinos, cosmic rays and gravitational waves) from numerous origins. They give us information about their sources in the universe and the properties of the intergalactic medium. Moreover, multi-messenger astronomy opens up the possibility to search for phenomenological signatures of quantum gravity. On the one hand, the most energetic events allow us to test our physical theories at energy regimes which are not directly accessible in accelerators; on the other hand, tiny effects in the propagation of very high energy particles could be amplified by cosmological distances. After decades of merely theoretical investigations, the possibility of obtaining phenomenological indications of Planck-scale effects is a revolutionary step in the quest for a quantum theory of gravity, but it requires cooperation between different communities of physicists (both theoretical and experimental). This review, prepared within the COST Action CA18108 “Quantum gravity phenomenology in the multi-messenger approach”, is aimed at promoting this cooperation by giving a state-of-the art account of the interdisciplinary expertise that is needed in the effective search of quantum gravity footprints in the production, propagation and detection of cosmic messengers

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)