Lockdown during the COVID-19 pandemic: impact on infants with pyloric stenosis

The COVID-19 pandemic has posed challenges for the delivery of healthcare for infants with disruption to 6-week health checks and health visitor services.1 An area of particular concern is late presentation to the hospital.2 However, current data do not offer an objective picture of how significant a problem this may be, with other reports showing low rates of delays in presentation.3 Infantile hypertrophic pyloric stenosis (IHPS) is a common, non-infective infantile condition with a predictable clinical course and therefore a good indicator condition to assess for delays in presentation. We aimed to assess whether infants with IHPS presented later during ‘lockdown’ compared with the same period the preceding year

Assessing the role of large herbivores in the structuring and functioning of freshwater and marine angiosperm ecosystems

2 figuras, 3 tablasWhile large herbivores can have strong impacts on terrestrial ecosystems, much less is known of their role in aquatic systems. We reviewed the literature to determine: (1) which large herbivores (>10 kg) have a (semi-)aquatic lifestyle and are important consumers of submerged vascular plants, (2) their impact on submerged plant abundance and species composition and (3) their ecosystem functions. We grouped herbivores according to diet, habitat selection and movement ecology: (1) Fully aquatic species, either resident or migratory (manatees, dugongs, turtles), (2) Semi-aquatic species that live both in water and on land, either resident or migratory (swans), (3) Resident semi-aquatic species that live in water and forage mainly on land (hippopotamuses, beavers, capybara), (4) Resident terrestrial species with relatively large home ranges that frequent aquatic habitats (cervids, water buffalo, lowland tapir). Fully aquatic species and swans have the strongest impact on submerged plant abundance and species composition. They may maintain grazing lawns. Because they sometimes target belowground parts, their activity can result in local collapse of plant beds. Semi-aquatic species and turtles serve as important aquatic-terrestrial linkages, by transporting nutrients across ecosystem boundaries. Hippopotamuses and beavers are important geomorphological engineers, capable of altering the land and hydrology at landscape scales. Migratory species and terrestrial species with large home ranges are potentially important dispersal vectors of plant propagules and nutrients. Clearly, large aquatic herbivores have strong impacts on associated species and can be critical ecosystem engineers of aquatic systems, with the ability to modify direct and indirect functional pathways in ecosystems. While global populations of large aquatic herbivores are declining, some show remarkable local recoveries with dramatic consequences for the systems they inhabit. A better understanding of these functional roles will help set priorities for the effective management of large aquatic herbivores along with the plant habitats they rely on.This research was funded by the Spanish Ministry of Science and Innovation (CTM2013-48027-C3-3-R), an Intramural Project from the Spanish National Research Council (CSIC, 201330E062) and the Pew Marine Fellowship.Peer reviewe

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

Towards Interactive AI-assisted Material Selection for Sustainable Building Design

We present an AI-assisted workflow that supports architects in designing wall assemblies using sustainable materials. Material selection in architecture is a complex process involving multiple data points and trade-offs across environmental performance, cost, and constructability. Making this process more efficient is essential for encouraging sustainable design practices. Our approach uses artificial intelligence and large language models to streamline aspects of material analysis and information management. The workflow integrates into standard architectural practice by translating wall assembly sketches into graph representations that reflect components and their relationships. Through an interactive interface with graph visualisation, architects can explore material options, review properties and substitute components in line with their design intent. We contribute a prototype workflow and report findings from a preliminary study on the integration of AI tools in early design stages. The study highlights benefits such as reduced decision effort, increased confidence, and improved access to material information

Co-ordinated observations of transient luminous events during the EuroSprite 2003 campaign

During the Northern Hemisphere summer of 2003 a sprite observation campaign was conducted from Southern Europe and the magnetically conjugate region in South Africa. The campaign brought together a wide variety of instrumentation to investigate the effects of sprites on the mesosphere, and to search for signatures of the relativistic electron acceleration process in the magnetically conjugate hemisphere. Measurements in Europe included optical video imaging from a remote-controlled, semi-automatic camera system located at the Observatoire du Pic du Midi in the Pyrénées mountains in Southern France, infrasound observations from France, and ULF-HF electromagnetic observations from a number of locations. The measurements in South Africa included observations of optical emissions and VLF electromagnetic waves. The campaign was successful, with more than 100 sprites observed during 10 storms. The paper will give an overview of the campaign and some results. They include: (1) the first clear identification of infrasound from sprites, allowing independent (of optical observations) estimates of the energy input to the mesosphere, (2) the first detection of sprites triggered by intra-cloud lightning, a result that underscores the need for considering the complete thunderstorm source field resulting from both cloud-to-ground discharges and the intra-cloud discharges feeding them, and (3) a clear one-to-one relationship with sprites and early VLF events, suggesting that VLF ground transmitter signals can be an important tool for estimating ionisation and relaxation of ionised structures in sprites. No signatures of relativistic electrons were identified during the campaign