95 research outputs found

    Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

    No full text
    Background: This study assessed the potential cost-effectiveness of high (80‚Äď100%) vs low (21‚Äď35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ().Results:HighFiO2maybecost‚ąíeffective(cheaperandeffective).InNigeria,theaveragecostforhighFiO2was). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was 216 compared with 222forlowFiO2leadingtoa¬†‚ąí222 for low FiO2 leading to a¬†‚ąí6 (95% confidence interval [CI]:¬†‚ąí13to¬†‚ąí13 to¬†‚ąí1) difference in costs. In India, the average cost for high FiO2 was 184comparedwith184 compared with 195 for low FiO2 leading to a¬†‚ąí11(9511 (95% CI:¬†‚ąí15 to¬†‚ąí6)differenceincosts.InSouthAfrica,theaveragecostforhighFiO2was6) difference in costs. In South Africa, the average cost for high FiO2 was 1164 compared with 1257forlowFiO2leadingtoa¬†‚ąí1257 for low FiO2 leading to a¬†‚ąí93 (95% CI:¬†‚ąí132to¬†‚ąí132 to¬†‚ąí65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a¬†‚ąí1.05 (95% CI:¬†‚ąí1.14 to¬†‚ąí0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

    Neutron-induced fission cross sections of Th 232 and U 233 up to 1 GeV using parallel plate avalanche counters at the CERN n_TOF facility

    Get PDF
    The neutron-induced fission cross sections of 232 Th and 233 U were measured relative to 235 U in a wide neutron energy range up to 1 GeV (and from fission threshold in the case of 232 Th , and from 0.7 eV in case of 233 U ), using the white-spectrum neutron source at the CERN Neutron Time-of-Flight (n_TOF) facility. Parallel plate avalanche counters (PPACs) were used, installed at the Experimental Area 1 (EAR1), which is located at 185 m from the neutron spallation target. The anisotropic emission of fission fragments were taken into account in the detection efficiency by using, in the case of 233 U , previous results available in EXFOR, whereas in the case of 232 Th these data were obtained from our measurement, using PPACs and targets tilted 45 ¬į with respect to the neutron beam direction. Finally, the obtained results are compared with past measurements and major evaluated nuclear data libraries. Calculations using the high-energy reaction models INCL + + and ABLA07 were performed and some of their parameters were modified to reproduce the experimental results. At high energies, where no other neutron data exist, our results are compared with experimental data on proton-induced fission. Moreover, the dependence of the fission cross section at 1 GeV with the fissility parameter of the target nucleus is studied by combining those ( p , f ) data with our ( n , f ) data on 232 Th and 233 U and on other isotopes studied earlier at n_TOF using the same experimental setup.Peer ReviewedArticle escrit per 81 autors/autores: D. Tarr√≠o , L. Tassan-Got, I. Duran, L. S. Leong, C. Paradela, L. Audouin, E. Leal-Cidoncha, C. Le Naour, M. Caama√Īo, A. Ventura, S. Altstadt, J. Andrzejewski, M. Barbagallo, V. B√©cares, F. Becv√° ňá ňár,F. Belloni, E. Berthoumieux, J. Billowes, V. Boccone, D. Bosnar, M. Brugger, M. Calviani, F. Calvi√Īo, D. Cano-Ott, C. Carrapi√ßo, F. Cerutti, E. Chiaveri,M. Chin, N. Colonna, G. Cort√©s, M. A. Cort√©s-Giraldo, M. Diakaki, C. Domingo-Pardo, N. Dzysiuk, C. Eleftheriadis, A. Ferrari, K. Fraval, S. Ganesan, A. R. Garc√≠a, G. Giubrone, M. B. G√≥mez-Hornillos, I. F. Gon√ßalves, E. Gonz√°lez-Romero,E. Griesmayer, C. Guerrero, F. Gunsing, P. Gurusamy, D. G. Jenkins, E. Jericha, Y. Kadi, F. K√§ppeler,‚Ć D. Karadimos, P. Koehler, M. Kokkoris, M. Krticka, J. Kroll, C. Langer, C. Lederer, H. Leeb, R. Losito, A. Manousos, J. Marganiec, T. Mart√≠nez, C. Massimi, P. F. Mastinu,M. Mastromarco, M. Meaze, E. Mendoza, A. Mengoni, P. M. Milazzo, F. Mingrone, M. Mirea,,‚Ć W. Mondalaers, A. Pavlik, J. Perkowski, A. Plompen, J. Praena, J. M. Quesada, T. Rauscher, R. Reifarth, A. Riego, M. S. Robles, F. Roman, C. Rubbia, R. Sarmento, P. Schillebeeckx,S. Schmidt, G. Tagliente, J. L. Tain, A. Tsinganis, S. Valenta, G. Vannini, V. Variale, P. Vaz, R. Versaci, M. J. Vermeulen, V. Vlachoudis, R. Vlastou,A. Wallner, T. Ware, M. Weigand, C. Wei√ü, T. J. Wright, P. ŇĹugecPostprint (published version

    Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

    No full text
    Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. None

    Neutron-induced fission cross sections of <math><mmultiscripts><mi>Th</mi><mprescripts/><none/><mn>232</mn></mmultiscripts></math> and <math><mmultiscripts><mi mathvariant="normal">U</mi><mprescripts/><none/><mn>233</mn></mmultiscripts></math> up to 1 GeV using parallel plate avalanche counters at the CERN n_TOF facility

    No full text
    International audienceThe neutron-induced fission cross sections¬†of Th232 and U233 were measured relative to U235 in a wide neutron energy range up to 1 GeV (and from fission threshold in the case of Th232, and from 0.7¬†eV in case of U233), using the white-spectrum neutron source at the CERN Neutron Time-of-Flight (n_TOF) facility. Parallel plate avalanche counters (PPACs) were used, installed at the Experimental Area 1 (EAR1), which is located at 185¬†m from the neutron spallation target. The anisotropic emission of fission fragments were taken into account in the detection efficiency by using, in the case of U233, previous results available in EXFOR, whereas in the case of Th232 these data were obtained from our measurement, using PPACs and targets tilted 45‚ąė with respect to the neutron beam direction. Finally, the obtained results are compared with past measurements and major evaluated nuclear data libraries. Calculations using the high-energy reaction models INCL++ and ABLA07 were performed and some of their parameters were modified to reproduce the experimental results. At high energies, where no other neutron data exist, our results are compared with experimental data on proton-induced fission. Moreover, the dependence of the fission cross section¬†at 1 GeV with the fissility parameter of the target nucleus is studied by combining those (p,f) data with our (n,f) data on Th232 and U233 and on other isotopes studied earlier at n_TOF using the same experimental setup

    Multi-ancestry genetic study of type 2 diabetes highlights the power of diverse populations for discovery and translation.

    No full text
    We assembled an ancestrally diverse collection of genome-wide association studies (GWAS) of type 2 diabetes (T2D) in 180,834 affected individuals and 1,159,055 controls (48.9% non-European descent) through the Diabetes Meta-Analysis of Trans-Ethnic association studies (DIAMANTE) Consortium. Multi-ancestry GWAS meta-analysis identified 237 loci attaining stringent genome-wide significance (P‚ÄČ&lt;‚ÄČ5‚ÄČ√ó‚ÄČ10-9), which were delineated to 338 distinct association signals. Fine-mapping of these signals was enhanced by the increased sample size and expanded population diversity of the multi-ancestry meta-analysis, which localized 54.4% of T2D associations to a single variant with &gt;50% posterior probability. This improved fine-mapping enabled systematic assessment of candidate causal genes and molecular mechanisms through which T2D associations are mediated, laying the foundations for functional investigations. Multi-ancestry genetic risk scores enhanced transferability of T2D prediction across diverse populations. Our study provides a step toward more effective clinical translation of T2D GWAS to improve global health for all, irrespective of genetic background

    92^{92}Zr(n,ő≥n,\gamma) and (nn,tot) measurements at the GELINA and n_TOF facilities

    Get PDF
    International audienceBackground: Stellar nucleosynthesis of elements heavier than iron is driven by neutron capture processes. 92Zris positioned at a strategic point along the slow nucleosynthesis path, given its proximity to the neutron magicnumber N = 50 and its position at the matching region between the weak and main slow processes.Purpose: In parallel with recent improved astronomical data, the extraction of accurate Maxwellian averagedcross sections (MACSs) derived from a more complete and accurate set of resonance parameters should allowfor a better understanding of the stellar conditions at which nucleosynthesis takes place.Methods: Transmission and capture cross section measurements using enriched 92Zr metallic samples wereperformed at the time-of flight facilities GELINA of JRC-Geel (BE) and n_TOF of CERN (CH). The neutronbeam passing through the samples was investigated in transmission measurements at GELINA using a Li-glassscintillator. The ő≥ rays emitted during the neutron capture reactions were detected by C6D6 detectors at bothGELINA and n_TOF.Results: Resonance parameters of individual resonances up to 81 keV were extracted from a combined resonanceshape analysis of experimental transmissions and capture yields. For the majority of the resonances the paritywas determined from an analysis of the transmission data obtained with different sample thicknesses. Averageresonance parameters were calculated.Conclusions: Maxwellian averaged cross sections were extracted from resonances observed up to 81 keV. TheMACS for kT = 30 keV is fully consistent with experimental data reported in the literature. The MACSs forkT¬† 15 keV are in good agreement with those derived from the ENDF/B-VIII.0 library and recommendedin the KADONIS database. For kT higher than 30 keV differences are observed. A comparison with MACSsobtained with the cross sections recommended in the JEFF-3.3 and JENDL-4.0 libraries shows discrepancieseven for kT¬† 15 keV

    Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation: The GLORIA-AF registry

    No full text
    Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores &gt;2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores &gt;2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and 651 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score &gt;2 and 64 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores &gt;2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores &gt;2 and 27.5% in those with scores 642. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007

    Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation: The GLORIA-AF registry

    No full text
    Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores &gt;2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores &gt;2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ‚Č•1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score &gt;2 and ‚ȧ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores &gt;2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores &gt;2 and 27.5% in those with scores ‚ȧ2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007. ¬© 2020 Hellenic Society of Cardiolog

    Measurement of the őĪ ratio and (n,ő≥) cross section of U 235 from 0.2 to 200 eV at n_TOF MEASUREMENT of the őĪ RATIO and ... J. BALIBREA-CORREA et al.

    Get PDF
    ¬© 2020 the Author(s). Published by the American Physical Society under the terms of the Creative Commons Attribution 4.0 International license (https://creativecommons.org/licenses/by/4.0/). Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.We measured the neutron capture-to-fission cross-section ratio (őĪ ratio) and the capture cross section of U235 between 0.2 and 200 eV at the n_TOF facility at CERN. The simultaneous measurement of neutron-induced capture and fission rates was performed by means of the n_TOF BaF2 Total Absorption Calorimeter (TAC), used for detection of ő≥ rays, in combination with a set of micromegas detectors used as fission tagging detectors. The energy dependence of the capture cross section was obtained with help of the Li6(n,t) standard reaction determining the n_TOF neutron fluence; the well-known integral of the U235(n,f) cross section between 7.8 and 11 eV was then used for its absolute normalization. The őĪ ratio, obtained with slightly higher statistical fluctuations, was determined directly, without need for any reference cross section. To perform the analysis of this measurement we developed a new methodology to correct the experimentally observed effect that the probabilities of detecting a fission reaction in the TAC and the micromegas detectors are not independent. The results of this work have been used in a new evaluation of U235 performed within the scope of the Collaborative International Evaluated Library Organisation (CIELO) Project, and are consistent with the ENDF/B-VIII.0 and JEFF-3.3 capture cross sections below 4 eV and above 100 eV. However, the measured capture cross section is on average 10% larger between 4 and 100 eV.Peer reviewe