Galaxies in the central regions of simulated galaxy clusters

In this paper, we assess the impact of numerical resolution and of the implementation of energy input from AGN feedback models on the inner structure of cluster sub-haloes in hydrodynamic simulations. We compare several zoom-in re-simulations of a sub-sample of the cluster-sized haloes studied in Meneghetti et al. (2020), obtained by varying mass resolution, softening length and AGN energy feedback scheme. We study the impact of these different setups on the subhalo abundances, their radial distribution, their density and mass profiles and the relation between the maximum circular velocity, which is a proxy for subhalo compactness. Regardless of the adopted numerical resolution and feedback model, subhaloes with masses Msub < 1e11Msun/h, the most relevant mass-range for galaxy-galaxy strong lensing, have maximum circular velocities ~30% smaller than those measured from strong lensing observations of Bergamini et al. (2019). We also find that simulations with less effective AGN energy feedback produce massive subhaloes (Msub> 1e11 Msun/h ) with higher maximum circular velocity and that their Vmax - Msub relation approaches the observed one. However the stellar-mass number count of these objects exceeds the one found in observations and we find that the compactness of these simulated subhaloes is the result of an extremely over-efficient star formation in their cores, also leading to larger-than-observed subhalo stellar mass. We conclude that simulations are unable to simultaneously reproduce the observed stellar masses and compactness (or maximum circular velocities) of cluster galaxies. Thus, the discrepancy between theory and observations that emerged from the analysis of Meneghetti et al. (2020) persists. It remains an open question as to whether such a discrepancy reflects limitations of the current implementation of galaxy formation models or the LCDM paradigm.Comment: 11 pages, 10 figures, abstract is redacted to fit arXiv character count limi

The probability of galaxy-galaxy strong lensing events in hydrodynamical simulations of galaxy clusters

Meneghetti et al. (2020) recently reported an excess of galaxy-galaxy strong lensing (GGSL) in galaxy clusters compared to expectations from the LCDM cosmological model. Theoretical estimates of the GGSL probability are based on the analysis of numerical hydrodynamical simulations in the LCDM cosmology. We quantify the impact of the numerical resolution and AGN feedback scheme adopted in cosmological simulations on the predicted GGSL probability and determine if varying these simulation properties can alleviate the gap with observations. We repeat the analysis of Meneghetti et al. (2020) on cluster-size halos simulated with different mass and force resolutions and implementing several independent AGN feedback schemes. We find that improving the mass resolution by a factor of ten and twenty-five, while using the same galaxy formation model that includes AGN feedback, does not affect the GGSL probability. We find similar results regarding the choice of gravitational softening. On the contrary, adopting an AGN feedback scheme that is less efficient at suppressing gas cooling and star formation leads to an increase in the GGSL probability by a factor between three and six. However, we notice that such simulations form overly massive subhalos whose contribution to the lensing cross-section would be significant while their Einstein radii are too large to be consistent with the observations. The primary contributors to the observed GGSL cross-sections are subhalos with smaller masses, that are compact enough to become critical for lensing. The population with these required characteristics appears to be absent in simulations.Comment: 13 pages, 11 figures. Submitted for publication on Astronomy and Astrophysic

&quot;Delirium Day&quot;: A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

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

Detection of diversity and stand parameters in Mediterranean forests using leaf-off discrete return LiDAR data

A methodological approach based on detailed land-use map, high-resolution LiDAR data and field surveys was developed to categorize productive and non-productive mixed forests, both in term of stand attributes and struc- tural diversity. In 2011, leaf-off dedicated airborne LiDAR data were collected in a 20,000 ha inland patchy area which was representative of soil land use in the Apennines mountains of southern Italy. By combining field and LiDAR data in 5574 ha of forests with coexisting evergreen and deciduous species, we modelled common forest stand variables (height, diameter, volume and biomass) with high accuracy (0.60 ≤ Adj.R2 ≤ 0.89). Moreover, a moderate correlation (0.425 ≤ τ ≤ 0.462) between field- and LiDAR-derived diversity indices was found. About 3393 ha of forests are enclosed in protected areas of the Natura 2000 network, which in turn possesses 77% (~576,286 Mg) of total aboveground dry biomass. Overall, eight forest types were identified, one of which, the Eu- ropean beech, is only found in the Natura 2000 sites, while other forest types are also found elsewhere. This is the first study to undertake a LiDAR analysis of Mediterranean forests in the Campania Region and might help better evaluate trade-off, especially in protected areas, in order to enhance multiple benefits and support sustainable management of forests