Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The HERMES-technologic and scientific pathfinder

HERMES-TP/SP (High Energy Rapid Modular Ensemble of Satellites Technologic and Scientific Pathfinder) is a constellation of six 3U nano-satellites hosting simple but innovative X-ray detectors, characterized by a large energy band and excellent temporal resolution, and thus optimized for the monitoring of Cosmic High Energy transients such as Gamma Ray Bursts and the electromagnetic counterparts of Gravitational Wave Events, and for the determination of their positions. The projects are funded by the Italian Ministry of University and Research and by the Italian Space Agency, and by the European Union's Horizon 2020 Research and Innovation Program under Grant Agreement No. 821896. HERMES-TP/SP is an in-orbit demonstration, that should be tested starting from 2022. It is intrinsically a modular experiment that can be naturally expanded to provide a global, sensitive all sky monitor for high-energy transients

The scientific payload on-board the HERMES-TP and HERMES-SP CubeSat missions

none103siHERMES (High Energy Rapid Modular Ensemble of Satellites) Technological and Scientific pathfinder is a space borne mission based on a LEO constellation of nano-satellites. The 3U CubeSat buses host new miniaturized detectors to probe the temporal emission of bright high-energy transients such as Gamma-Ray Bursts (GRBs). Fast transient localization, in a field of view of several steradians and with arcmin-level accuracy, is gained by comparing time delays among the same event detection epochs occurred on at least 3 nano-satellites. With a launch date in 2022, HERMES transient monitoring represents a keystone capability to complement the next generation of gravitational wave experiments. In this paper we will illustrate the HERMES payload design, highlighting the technical solutions adopted to allow a wide-energy-band and sensitive X-ray and gamma-ray detector to be accommodated in a CubeSat 1U volume together with its complete control electronics and data handling system.noneEvangelista, Yuri; Fiore, Fabrizio; Fuschino, Fabio; Campana, Riccardo; Ceraudo, Francesco; Demenev, Evgeny; Guzman, Alejandro; Labanti, Claudio; La Rosa, Giovanni; Fiorini, Mauro; Gandola, Massimo; Grassi, Marco; Mele, Filippo; Morgante, Gianluca; Nogara, Paolo; Piazzolla, Raffaele; Pliego Caballero, Samuel; Rashevskaya, Irina; Russo, Francesco; Sciarrone, Giulia; Sottile, Giuseppe; Milankovich, Dorottya; Pál, András; Ambrosino, Filippo; Auricchio, Natalia; Barbera, Marco; Bellutti, Pierluigi; Bertuccio, Giuseppe; Borghi, Giacomo; Cao, Jiewei; Chen, Tianxiang; Dilillo, Giuseppe; Feroci, Marco; Ficorella, Francesco; Lo Cicero, Ugo; Malcovati, Piero; Morbidini, Alfredo; Pauletta, Giovanni; Picciotto, Antonino; Rachevski, Alexandre; Santangelo, Andrea; Tenzer, Chistoph; Vacchi, Andrea; Wang, Lingjun; Xu, Yupeng; Zampa, Gianluigi; Zampa, Nicola; Zorzi, Nicola; Burderi, Luciano; Lavagna, Michèle; Bertacin, Roberto; Lunghi, Paolo; Monge, Angel; Negri, Barbara; Pirrotta, Simone; Puccetti, Simonetta; Sanna, Andrea; Amarilli, Fabrizio; Amelino-Camelia, Giovanni; Bechini, Michele; Citossi, Marco; Colagrossi, Andrea; Curzel, Serena; Della Casa, Giovanni; Cinelli, Marco; Del Santo, Melania; Di Salvo, Tiziana; Feruglio, Chiara; Ferrandi, Fabrizio; Fiorito, Michele; Gacnik, Dejan; Galgóczi, Gabor; Gambino, Angelo Francesco; Ghirlanda, Giancarlo; Gomboc, Andreja; Karlica, Mile; Efremov, Pavel; Kostic, Uros; Clerici, Aurora; Lopez Fernandez, Borja; Maselli, Alessandro; Nava, Lara; Ohno, Masanori; Ottolina, Daniele; Pasquale, Andrea; Perri, Matteo; Piccinin, Margherita; Prinetto, Jacopo; Riggio, Alessandro; Ripa, Jakub; Papitto, Alessandro; Piranomonte, Silvia; Scala, Francesca; Selcan, David; Silvestrini, Stefano; Rotovnik, Tomaz; Virgilli, Enrico; Troisi, Ivan; Werner, Norbert; Zanotti, Giovanni; Anitra, Alessio; Manca, Arianna; Clerici, AuroraEvangelista, Yuri; Fiore, Fabrizio; Fuschino, Fabio; Campana, Riccardo; Ceraudo, Francesco; Demenev, Evgeny; Guzman, Alejandro; Labanti, Claudio; La Rosa, Giovanni; Fiorini, Mauro; Gandola, Massimo; Grassi, Marco; Mele, Filippo; Morgante, Gianluca; Nogara, Paolo; Piazzolla, Raffaele; Pliego Caballero, Samuel; Rashevskaya, Irina; Russo, Francesco; Sciarrone, Giulia; Sottile, Giuseppe; Milankovich, Dorottya; Pál, András; Ambrosino, Filippo; Auricchio, Natalia; Barbera, Marco; Bellutti, Pierluigi; Bertuccio, Giuseppe; Borghi, Giacomo; Cao, Jiewei; Chen, Tianxiang; Dilillo, Giuseppe; Feroci, Marco; Ficorella, Francesco; Lo Cicero, Ugo; Malcovati, Piero; Morbidini, Alfredo; Pauletta, Giovanni; Picciotto, Antonino; Rachevski, Alexandre; Santangelo, Andrea; Tenzer, Chistoph; Vacchi, Andrea; Wang, Lingjun; Xu, Yupeng; Zampa, Gianluigi; Zampa, Nicola; Zorzi, Nicola; Burderi, Luciano; Lavagna, Michèle; Bertacin, Roberto; Lunghi, Paolo; Monge, Angel; Negri, Barbara; Pirrotta, Simone; Puccetti, Simonetta; Sanna, Andrea; Amarilli, Fabrizio; Amelino-Camelia, Giovanni; Bechini, Michele; Citossi, Marco; Colagrossi, Andrea; Curzel, Serena; Della Casa, Giovanni; Cinelli, Marco; Del Santo, Melania; Di Salvo, Tiziana; Feruglio, Chiara; Ferrandi, Fabrizio; Fiorito, Michele; Gacnik, Dejan; Galgóczi, Gabor; Gambino, Angelo Francesco; Ghirlanda, Giancarlo; Gomboc, Andreja; Karlica, Mile; Efremov, Pavel; Kostic, Uros; Clerici, Aurora; Lopez Fernandez, Borja; Maselli, Alessandro; Nava, Lara; Ohno, Masanori; Ottolina, Daniele; Pasquale, Andrea; Perri, Matteo; Piccinin, Margherita; Prinetto, Jacopo; Riggio, Alessandro; Ripa, Jakub; Papitto, Alessandro; Piranomonte, Silvia; Scala, Francesca; Selcan, David; Silvestrini, Stefano; Rotovnik, Tomaz; Virgilli, Enrico; Troisi, Ivan; Werner, Norbert; Zanotti, Giovanni; Anitra, Alessio; Manca, Arianna; Clerici, Auror

Timing techniques applied to distributed modular high-energy astronomy: the H.E.R.M.E.S. project

The association of GW170817 with GRB170817A proved that electromagnetic counterparts of gravitational wave events are the key to deeply understand the physics of NS-NS merges. Upgrades of the existing GW antennas and the construction of new ones will allow to increase sensitivity down to several hundred Mpc vastly increasing the number of possible electromagnetic counterparts. Monitoring of the hard X-ray/soft gamma-ray sky with good localisation capabilities will help to effectively tackle this problem allowing to fully exploit multi-messenger astronomy. However, building a high energy all-sky monitor with large collective area might be particularly challenging due to the need to place the detectors onboard satellites of limited size. Distributed astronomy is a simple and cheap solution to overcome this difficulty. Here we discuss in detail dedicated timing techniques that allow to precisely locate an astronomical event in the sky taking advantage of the spatial distribution of a swarm of detectors orbiting Earth

GrailQuest and HERMES: hunting for gravitational wave electromagnetic counterparts and probing space-time quantum foam

106nonenoneBurderi, Luciano; Di Salvo, Tiziana; Riggio, Alessandro; Gambino, Angelo Francesco; Sanna, Andrea; Fiore, Fabrizio; Amarilli, Fabrizio; Amati, Lorenzo; Ambrosino, Filippo; Amelino-Camelia, Giovanni; Anitra, Alessio; Barbera, Marco; Bechini, Michele; Bellutti, Paolo; Bertaccin, Roberto; Bertuccio, Giuseppe; Campana, Riccardo; Cao, Jiewei; Capozziello, Salvatore; Ceraudo, Francesco; Chen, Tianxiang; Cinelli, Marco; Citossi, Marco; Clerici, Aurora; Colagrossi, Andrea; Costa, Enrico; Curzel, Serena; De Laurentis, Mariafelicia; Della Casa, Giovanni; Della Valle, Massimo; Demenev, Evgeny; Del Santo, Melania; Dilillo, Giuseppe; Efremov, Pavel; Evangelista, Yuri; Feroci, Marco; Ferruglio, Chiara; Ferrandi, Fabrizio; Fiorini, Mauro; Fiorito, Michele; Frontera, Filippo; Fuschino, Fabio; Gacnik, Dejan; Galgoczi, Gabor; Gao, Na; Gandola, Massimo; Ghirlanda, Giancarlo; Gamboc, Andreja; Grassi, Marco; Guidorzi, Cristiano; Guzman, Alejandro; Iaria, Rosario; Karlica, Mile; Kostic, Uros; Labanti, Claudio; La Rosa, Giovanni; Lo Cicero, Ugo; Lopez Fernandez, Borja; Lunghi, Paolo; Malcovati, Piero; Maselli, Alessandro; Manca, Arianna; Mele, Filippo; Milankovich, Dorottya; Monge, Angel; Morgante, Gianluca; Nava, Lara; Negri, Barbara; Nogara, Paolo; Ohno, Masanori; Ottolina, Daniele; Pasquale, Andrea; Pal, Andras; Perri, Matteo; Piccinin, Margherita; Piazzolla, Raffaele; Pirrotta, Simone; Pliego-Caballero, Samuel; Prinetto, Jacopo; Pucacco, Giuseppe; Puccetti, Simonetta; Rapisarda, Massimo; Rashevskaya, Irina; Rashevsky, Alexander; Ripa, Jakub; Russo, Francesco; Papitto, Alessandro; Piranomonte, Silvia; Santangelo, Andrea; Scala, Francesca; Sciarrone, Giulia; Selcan, David; Silvestrini, Stefano; Sottile, Giuseppe; Rotovnik, Tomaz; Tenzer, Christoph; Troisi, Ivan; Vacchi, Andrea; Virgilli, Enrico; Werner, Norbert; Wang, Lingjun; Xu, Yupeng; Zampa, Gianluigi; Zampa, Nicola; Zane, Silvia; Zanotti, GiovanniBurderi, Luciano; Di Salvo, Tiziana; Riggio, Alessandro; Gambino, Angelo Francesco; Sanna, Andrea; Fiore, Fabrizio; Amarilli, Fabrizio; Amati, Lorenzo; Ambrosino, Filippo; Amelino-Camelia, Giovanni; Anitra, Alessio; Barbera, Marco; Bechini, Michele; Bellutti, Paolo; Bertaccin, Roberto; Bertuccio, Giuseppe; Campana, Riccardo; Cao, Jiewei; Capozziello, Salvatore; Ceraudo, Francesco; Chen, Tianxiang; Cinelli, Marco; Citossi, Marco; Clerici, Aurora; Colagrossi, Andrea; Costa, Enrico; Curzel, Serena; De Laurentis, Mariafelicia; Della Casa, Giovanni; Della Valle, Massimo; Demenev, Evgeny; Del Santo, Melania; Dilillo, Giuseppe; Efremov, Pavel; Evangelista, Yuri; Feroci, Marco; Ferruglio, Chiara; Ferrandi, Fabrizio; Fiorini, Mauro; Fiorito, Michele; Frontera, Filippo; Fuschino, Fabio; Gacnik, Dejan; Galgoczi, Gabor; Gao, Na; Gandola, Massimo; Ghirlanda, Giancarlo; Gamboc, Andreja; Grassi, Marco; Guidorzi, Cristiano; Guzman, Alejandro; Iaria, Rosario; Karlica, Mile; Kostic, Uros; Labanti, Claudio; La Rosa, Giovanni; Lo Cicero, Ugo; Lopez Fernandez, Borja; Lunghi, Paolo; Malcovati, Piero; Maselli, Alessandro; Manca, Arianna; Mele, Filippo; Milankovich, Dorottya; Monge, Angel; Morgante, Gianluca; Nava, Lara; Negri, Barbara; Nogara, Paolo; Ohno, Masanori; Ottolina, Daniele; Pasquale, Andrea; Pal, Andras; Perri, Matteo; Piccinin, Margherita; Piazzolla, Raffaele; Pirrotta, Simone; Pliego-Caballero, Samuel; Prinetto, Jacopo; Pucacco, Giuseppe; Puccetti, Simonetta; Rapisarda, Massimo; Rashevskaya, Irina; Rashevsky, Alexander; Ripa, Jakub; Russo, Francesco; Papitto, Alessandro; Piranomonte, Silvia; Santangelo, Andrea; Scala, Francesca; Sciarrone, Giulia; Selcan, David; Silvestrini, Stefano; Sottile, Giuseppe; Rotovnik, Tomaz; Tenzer, Christoph; Troisi, Ivan; Vacchi, Andrea; Virgilli, Enrico; Werner, Norbert; Wang, Lingjun; Xu, Yupeng; Zampa, Gianluigi; Zampa, Nicola; Zane, Silvia; Zanotti, Giovann

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia