A protocol for global multiphase estimation

Global estimation strategies allow to extract information on a phase or a set of phases without any prior knowledge, which is, instead, required for local estimation strategies. We devise a global multiphase protocol based on Holevo's estimation theory and apply it to the case of digital estimation, i.e. we estimate the phases in terms of the mutual information between them and the corresponding estimators. In the single-phase scenario, the protocol encompasses two specific known optimal strategies. We extend them to the simultaneous estimation of two phases and evaluate their performance. Then, we retrieve the ultimate digital bound on precision when a generic number of phases is simultaneously estimated. We show that in the multiphase strategy there is only a constant quantum advantage with respect to a sequence of independent single-phase estimations. This extends a recent similar result, which settled a controversy on the search for the multiphase enhancement

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract 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

Presentación de una nueva clasificación de plicaturas en abdominoplastia

Resumen Introducción y objetivo. El concepto de abdominoplastia se ha redefinido en los últimos años siendo el manejo del componente musculoaponeurótico un elemento fundamental para mejorar el contorno de la pared abdominal. Sin embargo, las indicaciones de plicatura no están claramente establecidas, encontrando descritas innumerables técnicas por diversos autores. El presente trabajo tiene por objetivo revisar la evidencia referente a las técnicas quirúrgicas de plicatura abdominal y proponer una clasificación de las mismas. Material y método. Búsqueda en la literatura de las técnicas quirúrgicas de plicatura en abdominoplastia y presentación de una clasificación original para las mismas. Resultados. Proponemos una clasificación de plicaturas basada en 3 elementos topográficos. El primero, la región anatómica predominante donde se realiza la plicatura (Tipo I o de línea alba, Tipo II o de rectos y Tipo III o de oblicuos). El segundo, la relación con el nivel del ombligo (supraumbilical, infraumbilical o supra-infraumbilical). Y el tercero, la orientación en el espacio de la plicatura (vertical, transversa u oblicua). Conclusiones. Consideramos que nuestra clasificación aporta una nomenclatura objetiva para la descripción de las plicaturas en abdominoplastia, ayudando así a definir sus indicaciones y a mejorar la comunicación de resultados

Evidence of a giant tyrannosaurid (Dinosauria: Theropoda) from the Upper Cretaceous (?Campanian) of Montana

We report an isolated right lacrimal of a tyrannosaurid theropod dinosaur, probably from the Upper Cretaceous (upper Campanian) Judith River Formation of Fergus County, Montana. The lacrimal was originally associated with the holotype of the giant crocodylian Deinosuchus rugosus, but was later identified as that of a tyrannosaurid. It is of comparable size to the corresponding element in the gigantic Maastrichtian tyrannosaurid Tyrannosaurus. Moreover, comparison of the lacrimal to those of other tyrannosaurids tentatively supports its referral to this genus. Consequently, provided that its stratigraphic provenance has been correctly identified, the specimen represents the oldest-known North American record of a Tyrannosaurus-sized tyrannosaurid, and possibly the most ancient occurrence of this genus yet documented

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care