Abstract
Background
Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of ...this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions.
Methods
A systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations.
Results
Of a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review.
Conclusion
Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE.
Graphical Abstract
This systematic review provides a comprehensive overview of all the issues surrounding personal protective equipment for surgeons during the COVID-19 pandemic. To overcome this global challenge needs an evidence-based, collaborative, innovative multidisciplinary approach.
Graphical Abstract
Better to be safe than sorry
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Despite evidence of high activity, the number of surgical procedures performed in UK hospitals, their cost and subsequent mortality remain unclear.
Time-trend ecological study using hospital episode ...data from England, Scotland, Wales and Northern Ireland. The primary outcome was the number of in-hospital procedures, grouped using three increasingly specific categories of surgery. Secondary outcomes were all-cause mortality, length of hospital stay and healthcare costs according to standard National Health Service tariffs.
Between April 1, 2009 and March 31, 2014, 39 631 801 surgical patient episodes were recorded. There was an annual average of 7 926 360 procedures (inclusive category), 5 104 165 procedures (intermediate category) and 1 526 421 procedures (restrictive category). This equates to 12 537, 8073 and 2414 procedures per 100 000 population per year, respectively. On average there were 85 181 deaths (1.1%) within 30 days of a procedure each year, rising to 178 040 deaths (2.3%) after 90 days. Approximately 62.8% of all procedures were day cases. Median length of stay for in-patient procedures was 1.7 (1.3–2.0) days. The total cost of surgery over the 5 yr period was £54.6 billion ($104.4 billion), representing an average annual cost of £10.9 billion (inclusive), £9.5 billion (intermediate) and £5.6 billion (restrictive). For each category, the number of procedures increased each year, while mortality decreased. One-third of all mortalities in national death registers occurred within 90 days of a procedure (inclusive category).
The number of surgical procedures in the UK varies widely according to definition. The number of procedures is slowly increasing whilst the number of deaths is decreasing.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Summary
Background
There is increased proportional mortality from Parkinson's disease amongst livestock farmers. The hypokinesia of Parkinson's disease has been linked to Helicobacter pylori. H. suis ...is the most common zoonotic helicobacter in man.
Aim
To compare the frequency of H. suis, relative to H. pylori, in gastric biopsies of patients with idiopathic parkinsonism (IP) and controls from gastroenterology services.
Methods
DNA extracts, archived at a Helicobacter Reference Laboratory, from IP patient and gastroenterology service biopsies were examined anonymously for H. suis, using species‐specific RT‐PCR.
Results
Relative risk of having H. suis in 60 IP patients compared with 256 controls was 10 times greater than that of having H. pylori. In patients with IP and controls, respectively, frequencies of H. suis were 27 (exact binomial 95% C.I. 15, 38) and 2 (0, 3)%, and of H. pylori, 28 (17, 40) and 16 (12, 21)%. Excess of H. suis in IP held when only the antral or corporal biopsy was considered. Of 16 IP patients with H. suis, 11 were from 19 with proven H. pylori eradication, 3 from 17 pre‐H. pylori eradication, 2 from 24 H. pylori culture/PCR‐negative. Frequency was different between groups (P = 0.001), greatest where H. pylori had been eradicated. Even without known exposure to anti‐H. pylori therapy, H. suis was more frequent in IP patients (5/41) than in controls (1/155) (P = 0.002). Partial multilocus sequence typing confirmed that strains from IP patients (6) and control (1) differed from RT‐PCR standard strain.
Conclusions
Greater frequency of H. suis in idiopathic parkinsonism appears exaggerated following H. pylori eradication. Multilocus sequence testing comparison with porcine strains may clarify whether transmission is from pigs/porcine products or of human‐adapted, H. suis‐like, bacteria.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
We present measurements of the E-mode polarization angular auto-power spectrum (EE) and temperature-E-mode cross-power spectrum (TE) of the cosmic microwave background (CMB) using 150 GHz data from ...three seasons of SPTpol observations. We report the power spectra over the spherical harmonic multipole range and detect nine acoustic peaks in the EE spectrum with high signal-to-noise ratio. These measurements are the most sensitive to date of the EE and TE power spectra at and , respectively. The observations cover 500 , a fivefold increase in area compared to previous SPTpol analyses, which increases our sensitivity to the photon diffusion damping tail of the CMB power spectra enabling tighter constraints on ΛCDM model extensions. After masking all sources with unpolarized flux mJy, we place a 95% confidence upper limit on residual polarized point-source power of at , suggesting that the EE damping tail dominates foregrounds to at least with modest source masking. We find that the SPTpol data set is in mild tension with the ΛCDM model ( ), and different data splits prefer parameter values that differ at the level. When fitting SPTpol data at , we find cosmological parameter constraints consistent with those for Planck temperature. Including SPTpol data at results in a preference for a higher value of the expansion rate ( ) and a lower value for present-day density fluctuations ( ).
Summary
Background and aim
Current treatment for irritable bowel syndrome (IBS) is suboptimal. Fermentable oligo‐, di‐, mono‐saccharides and polyols (FODMAPs) may trigger gastrointestinal symptoms in ...IBS patients. Our aim was to determine whether a low FODMAP diet improves symptoms in IBS patients.
Methods
Irritable bowel syndrome patients, who had performed hydrogen/methane breath testing for fructose and lactose malabsorption and had received dietary advice regarding the low FODMAP diet, were included. The effect of low FODMAP diet was prospectively evaluated using a symptom questionnaire. Furthermore, questions about adherence and satisfaction with symptom improvement, dietary advice and diet were assessed.
Results
Ninety patients with a mean follow up of 15.7 months were studied. Most symptoms including abdominal pain, bloating, flatulence and diarrhoea significantly improved (p < 0.001 for all). 75.6%, 37.8% and 13.3% of patients had fructose, lactose malabsorption or small intestinal bacterial overgrowth respectively. Fructose malabsorption was significantly associated with symptom improvement (abdominal pain odds ratio (OR) 7.09 95% confidence interval (CI) 2.01–25.0, bloating OR 8.71 (95% CI 2.76–27.5), flatulence OR 7.64 (95% CI 2.53–23.0) and diarrhoea OR 3.39 (95% CI 1.17–9.78), p < 0.029 for all). Most patients (75.6%) were adherent to the diet, which was associated with symptom improvement (abdominal pain, bloating, flatulence and diarrhoea all significantly associated with adherence, r > 0.27, p < 0.011). Most patients (72.1%) were satisfied with their symptoms.
Conclusions
The low FODMAP diet shows efficacy for IBS patients. The current strategy of breath testing and dietary advice provides a good basis to understand and adhere to the diet.
Linked Comment: www.youtube.com/IJCPeditorial
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Fast radio bursts (FRBs) are highly dispersed millisecond-duration radio flashes probably arriving from far outside the Milky Way
. This phenomenon was discovered at radio frequencies near 1.4 GHz ...and so far has been observed in one case
at as high as 8 GHz, but not below 700 MHz in spite of significant searches at low frequencies
. Here we report detections of 13 FRBs at radio frequencies as low as 400 MHz, on the Canadian Hydrogen Intensity Mapping Experiment (CHIME) using the CHIME/FRB instrument
. They were detected during a telescope pre-commissioning phase, when our sensitivity and field-of-view were not yet at design specifications. Emission in multiple events is seen down to 400 MHz, the lowest radio frequency to which we are sensitive. The FRBs show various temporal scattering behaviours, with the majority significantly scattered, and some apparently unscattered to within measurement uncertainty even at our lowest frequencies. Of the 13 reported here, one event has the lowest dispersion measure yet reported, implying that it is among the closest yet known, and another has shown multiple repeat bursts, as described in a companion paper
. The overall scattering properties of our sample suggest that FRBs as a class are preferentially located in environments that scatter radio waves more strongly than the diffuse interstellar medium in the Milky Way.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The COVID-19 pandemic has heavily impacted elective and emergency surgery around the world. We aimed to confirm the incidence of perioperative severe acute respiratory syndrome coronavirus 2 ...(SARS-CoV-2) infection and associated mortality after surgery.
Analysis of routine electronic health record data from NHS hospitals in England. We extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between January 1, 2020 and February 28, 2021. The exposure was SARS-CoV-2 infection defined by International Classification of Diseases (ICD)-10 codes. The primary outcome measure was 90 day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, Index of Multiple Deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals (CI).
We identified 2 666 978 patients undergoing surgery of whom 28 777 (1.1%) had SARS-CoV-2 infection. In total, 26 364 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 6153/28 777 21.4% vs no SARS-CoV-2: 20 211/2 638 201 0.8%; OR=5.7 95% CI, 5.5–5.9; P<0.001). Amongst patients undergoing elective surgery, 2412/1 857 586 (0.1%) had SARS-CoV-2, of whom 172/2412 (7.1%) died, compared with 1414/1 857 586 (0.1%) patients without SARS-CoV-2 (OR=25.8 95% CI, 21.7–30.9; P<0.001). Amongst patients undergoing emergency surgery, 22 918/582 292 (3.9%) patients had SARS-CoV-2, of whom 5752/22 918 (25.1%) died, compared with 18 060/559 374 (3.4%) patients without SARS-CoV-2 (OR=5.5 95% CI, 5.3–5.7; P<0.001).
The low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We present a search for anisotropic cosmic birefringence in 500 deg2 of southern sky observed at 150 GHz with the SPTpol camera on the South Pole Telescope. We reconstruct a map of cosmic ...polarization rotation anisotropies using higher-order correlations between the observed cosmic microwave background (CMB) E and B fields. We then measure the angular power spectrum of this map, which is found to be consistent with zero. The nondetection is translated into an upper limit on the amplitude of the scale-invariant cosmic rotation power spectrum, L(L + 1) CααL/2π < 0.10 × 10−4 rad2 (0.033 deg2, 95% C.L.). This upper limit can be used to place constraints on the strength of primordial magnetic fields, B1 Mpc < 17 nG (95% C.L.), and on the coupling constant of the Chern-Simons electromagnetic term gaγ < 4.0 × 10−2/HI (95% C.L.), where HI is the inflationary Hubble scale. For the first time, we also cross-correlate the CMB temperature fluctuations with the reconstructed rotation angle map, a signal expected to be nonvanishing in certain theoretical scenarios, and find no detectable signal. We perform a suite of systematics and consistency checks and find no evidence for contamination.
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CMK, CTK, FMFMET, IJS, NUK, PNG, UM
We present cosmological constraints based on the cosmic microwave background (CMB) lensing potential power spectrum measurement from the recent 500 deg2 SPTpol survey, the most precise CMB lensing ...measurement from the ground to date. We fit a flat ΛCDM model to the reconstructed lensing power spectrum alone and in addition with other data sets: baryon acoustic oscillations (BAO), as well as primary CMB spectra from Planck and SPTpol. The cosmological constraints based on SPTpol and Planck lensing band powers are in good agreement when analyzed alone and in combination with Planck full-sky primary CMB data. With weak priors on the baryon density and other parameters, the SPTpol CMB lensing data alone provide a 4% constraint on . Jointly fitting with BAO data, we find , , and , up to away from the central values preferred by Planck lensing + BAO. However, we recover good agreement between SPTpol and Planck when restricting the analysis to similar scales. We also consider single-parameter extensions to the flat ΛCDM model. The SPTpol lensing spectrum constrains the spatial curvature to be and the sum of the neutrino masses to be eV at 95% C.L. (with Planck primary CMB and BAO data), in good agreement with the Planck lensing results. With the differences in the signal-to-noise ratio of the lensing modes and the angular scales covered in the lensing spectra, this analysis represents an important independent check on the full-sky Planck lensing measurement.
ABSTRACT We present a measurement of the cosmic microwave background (CMB) gravitational lensing potential using data from the first two seasons of observations with SPTpol, the ...polarization-sensitive receiver currently installed on the South Pole Telescope. The observations used in this work cover 100 deg2 of sky with arcminute resolution at 150 GHz. Using a quadratic estimator, we make maps of the CMB lensing potential from combinations of CMB temperature and polarization maps. We combine these lensing potential maps to form a minimum-variance (MV) map. The lensing potential is measured with a signal-to-noise ratio of greater than one for angular multipoles between . This is the highest signal-to-noise mass map made from the CMB to date and will be powerful in cross-correlation with other tracers of large-scale structure. We calculate the power spectrum of the lensing potential for each estimator, and we report the value of the MV power spectrum between as our primary result. We constrain the ratio of the spectrum to a fiducial ΛCDM model to be AMV = 0.92 0.14 (Stat.) 0.08 (Sys.). Restricting ourselves to polarized data only, we find APOL = 0.92 0.24 (Stat.) 0.11 (Sys.). This measurement rejects the hypothesis of no lensing at using polarization data alone, and at using both temperature and polarization data.
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