Overview of recent TJ-II stellarator results

The main results obtained in the TJ-II stellarator in the last two years are reported. The most important topics investigated have been modelling and validation of impurity transport, validation of gyrokinetic simulations, turbulence characterisation, effect of magnetic configuration on transport, fuelling with pellet injection, fast particles and liquid metal plasma facing components. As regards impurity transport research, a number of working lines exploring several recently discovered effects have been developed: the effect of tangential drifts on stellarator neoclassical transport, the impurity flux driven by electric fields tangent to magnetic surfaces and attempts of experimental validation with Doppler reflectometry of the variation of the radial electric field on the flux surface. Concerning gyrokinetic simulations, two validation activities have been performed, the comparison with measurements of zonal flow relaxation in pellet-induced fast transients and the comparison with experimental poloidal variation of fluctuations amplitude. The impact of radial electric fields on turbulence spreading in the edge and scrape-off layer has been also experimentally characterized using a 2D Langmuir probe array. Another remarkable piece of work has been the investigation of the radial propagation of small temperature perturbations using transfer entropy. Research on the physics and modelling of plasma core fuelling with pellet and tracer-encapsulated solid-pellet injection has produced also relevant results. Neutral beam injection driven Alfvénic activity and its possible control by electron cyclotron current drive has been examined as well in TJ-II. Finally, recent results on alternative plasma facing components based on liquid metals are also presentedThis work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014–2018 under Grant Agreement No. 633053. It has been partially funded by the Ministerio de Ciencia, Inovación y Universidades of Spain under projects ENE2013-48109-P, ENE2015-70142-P and FIS2017-88892-P. It has also received funds from the Spanish Government via mobility grant PRX17/00425. The authors thankfully acknowledge the computer resources at MareNostrum and the technical support provided by the Barcelona S.C. It has been supported as well by The Science and Technology Center in Ukraine (STCU), Project P-507F

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

Degradation of Benzotriazole UV-stabilizers in the presence of organic photosensitizers and visible light: A time-resolved mechanistic study

[EN] Benzotriazole UV-stabilizers (BUVSs) are commonly used in industry as solar filters, due to their strong UV light absorption. Because of their extended usage, environmental contamination of waters due to BUVSs constitutes a growing concern. Direct photodegradation of BUVSs is not efficient due to their intrinsic thermal pathways to release the absorbed light. Nevertheless, their abatement in natural environments could be assisted by chromophoric dissolved organic matter. Among the BUVSs, three representative candidates were selected, UV-326, UV-327 and UV-328, to demonstrate the potential of Riboflavin (RF) as a natural visible-light absorbing photocatalyst for the abatement of these recalcitrant pollutants under reductive conditions. The use of visible light and DABCO, as a model sacrificial electron donor, generates the radical anion RFTA.-. This key species reacts with the solar filters, achieving their reductive abatement from the medium. Moreover, the participation of every potential reactive species has been investigated by photophysical techniques, together with determination of the quenching rate constant for every reaction pathway. Consequently, evidence supported the main role of the reductive photodegradation pathway, being RFTA.- the key species in the abatement of BUVSs.This research was funded by H2020/Marie Sklodowska-Curie Actions under the AQUAlity project (Reference: 765860) and European Union's Horizon 2020 Research and Innovation Program under European Research Council (ERC) through the HyMAP project (grant agreement No. 648319). Project PID2019-110441RB-C33 financed by MCIN/AEI/10.13039/501100011033 and AEI-MICINN/FEDER, UE through the Nympha Project (PID2019-106315RB-I00), the regional government of "Comunidad de Madrid" and the European Structural Funds through their financial support to FotoArt-CM project (S2018/NMT-4367) are also acknowledged.Pavanello, A.; Gomez-Mendoza, M.; De La Peña O'shea, V.; Miranda Alonso, MÁ.; Marín García, ML. (2022). Degradation of Benzotriazole UV-stabilizers in the presence of organic photosensitizers and visible light: A time-resolved mechanistic study. Journal of Photochemistry and Photobiology B Biology. 230:1-11. https://doi.org/10.1016/j.jphotobiol.2022.11244411123

Replacing soybean meal with Narbon vetch (Vicia narbonensis L.) in pig diets: composition of subcutaneous fat and fresh loin, and sensory attributes of dry-cured product

Aim of the study: To evaluate the consequences for pork quality traits of replacing soybean meal with Narbon vetch in pig diets.Area of study: Castilla-Leon, Spain.Material and methods: 48 Duroc × Iberian barrows were fed diets with 0% (V0), 5% (V5), 10% (V10) and 20% (V20) inclusion of Narbon vetch. Pork quality traits investigated were 1) intramuscular fat, protein and moisture content of fresh loin, 2) fatty acid composition of subcutaneous fat, and 3) sensory attributes (Triangle test and a Simple Difference Test with a non-trained taste panel) of cured loin.Main results: Inclusion of Narbon vetch in the diet showed no significant effect on intramuscular fat, protein and moisture in fresh loin samples. Stearic acid was higher in subcutaneous fat of V5 than in V0 and V10 (p < 0.05), and oleic acid was higher in V10 than in V0, V5 and V20 (p < 0.05); no other differences in fatty acid composition were observed. Taste panelists tended to be able to distinguish V10 from V0 cured loins (p < 0.10), and were able to distinguish V20 from V0 loins (p < 0.05), in particular due to a perceived difference in taste, texture and marbling. No differences in intensity of the texture, marbling, aroma and color of cured loins were found between V0 and V5.Research highlights: Inclusion of Narbon vetch in pig diets did not significantly affect fresh loin composition or fatty acid composition of subcutaneous fat. Consumers perceived a difference in sensory characteristics of cured loin with replacement of soybean meal with Narbon Vetch, but they did not characterize this as more favorable

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era

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 &lt; 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)