Međudjelovanje četiri-razinskog atoma u impulsnom svojstvenom stanju s jednomodnim poljem

We study the interaction between a four-level atom (ladder type) in a momentum eigenstate with a single mode cavity field in the presence of non-linearities of both the field and the intensity-dependent coupling. The constants of motion and the wave function for the atomic system have been obtained. Special attention is given to discuss some statistical aspects of the considered atomic system such as momentum increment, momentum diffusion and high-order squeezing. The influence of the Kerr-like medium and the intensity dependent coupling on the momentum increment and the high-order squeezing are investigated numerically. It is found that addition of these parameters has an important effect on both the momentum increment and the squeezing phenomenon.Proučavamo međudjelovanje četiri-razinskog atoma (poput ljestvi) u impulsnom svojstvenom stanju s jednomodnim poljem u rezonatoru, uz nelinearnosti polja i vezanja ovisnog o intenzitetu. Izveli smo stalnice gibanja valne funkcije atomskog sustava. Posebnu smo pažnju posvetili raspravi o statističkim odlikama razmatranog atomskog sustava, kao što su povećanje i difuzija impulsa i zbijanje višeg reda. Numerički smo istražili utjecaj Kerrovog sredstva i vezanja ovisnog o intenzitetu na povećanje impulsa i zbijanje višeg reda. Našli smo da dodavanje tih parametara ima snažan učinak na povećanje impulsa i pojavu zbijanja

Assessing surface solar irradiance in Northern Africa desert climate and its long-term variations from Meteosat images

International audienceTwo databases of solar surface irradiance (SSI) derived from satellites are compared to ground measurements for Algeria, Egypt, Libya and Tunisia. It is found that it is possible to accurately derive the SSI from geostationary meteorological satellites, even with a coarse spatial resolution. The two databases HelioClim-1 and SSE exhibit similar and good performances. The bias is lower for SSE than for HelioClim-1, as a whole; inversely, HelioClim-1exhibits a smaller scattering of data compared to ground measurements (smaller standard-deviation) than the SSE, allowing better performances when mapping the long-term variations in the SSI. These long-term variations from 1985 to 2005 show that these four nations experience dimming as a whole. Detailed analyses of the range of dimming at sites with long-term records and of its spatial distribution have been performed. It has been found that the analysis of SSI from HelioClim-1 supports the findings for the individual sites. Several phenomena may explain the dimming. One is the transportation of sand dust northwards from the Sahel; another one is the increase in urbanization and a third one is the increase in cloud cover and aerosol loading

Validation of the surface downwelling solar irradiance estimates of the HelioClim-3 database in Egypt

International audienceHelioClim-3 (HC3) is a database providing time series of the surface downwelling solar irradiance that are computed from images of the Meteosat satellites. This paper presents the validation results of the hourly global horizontal irradiance (GHI) and direct normal irradiance (DNI), i.e., beam irradiance at normal incidence, of versions four and five of HC3 at seven Egyptian sites. The validation is performed for all-sky conditions, as well as cloud-free conditions. Both versions of HC3 provide similar OPEN ACCESS Remote Sens. 2015, 7 9270 performances whatever the conditions. Another comparison is made with the estimates provided by the McClear database that is restricted to cloud-free conditions. All databases capture well the temporal variability of the GHI in all conditions, McClear being superior for cloud-free cases. In cloud-free conditions for the GHI, the relative root mean square error (RMSE) are fairly similar, ranging from 6% to 15%; both HC3 databases exhibit a smaller bias than McClear. McClear offers an overall better performance for the cloud-free DNI estimates. For all-sky conditions, the relative RMSE for GHI ranges from 10% to 22%, except one station, while, for the DNI, the results are not so good for the two stations with DNI measurements

Eranet-Med Optimed- Water Project: Results on soil Moisture Maps of Semi-Arid Environment by using Optical/Microwave Satellite Data

This project deals with the implementation of an innovative water management system in Mediterranean countries (i.e. Tunisia and Egypt), which suffer from chronic water scarcity, together with two European countries (Germany and Italy). The consortium is developing and applying synergic methods and algorithms for investigating the water cycle, using remote sensing techniques. The focus is on the use of satellite data (optical and microwave) for monitoring vegetation cover and water status along with soil moisture temporal evolutions in order to improve the knowledge of the water cycle in arid areas. Both local and regional monitoring are carried out in order to investigate different spatial scales. The scope of the project is to propose practical and costeffective solutions for driving and updating a method for the sustainable use of water in agriculture. First results on soil moisture mapping retrieved in Tunisia using an Artificial Neural Network (ANN) based algorithm is presented in this pap

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone