SS25. Cryopreserved Venous Allograft: An Alternative Conduit for Reconstruction of Infected Prosthetic Aortic Grafts

Olivé Milián, ArmandPla general picat del mosaic format per tres cercles: el central, amb un sol de color ocre sobre un cel blau. El sol, somrient, està encarat cap al sud. Aquest està envoltat d'un primer anell dentat i un segon on s'hi representen les fases d

ARTop: an open-source tool for measuring active region topology at the solar photosphere

The importance of measuring topological quantities, such as magnetic helicity, in solar observations has long been recognized. In particular, topological quantities play an important role in both understanding and predicting solar eruptions. In this paper, we present ARTop (Active Region Topology), an open-source and end-to-end software tool that allows researchers to calculate the fluxes of topological quantities based on solar magnetograms. In addition to this, ARTop also allows for the efficient analysis of these quantities in both 2D maps and time series. ARTop calculates the fluxes of magnetic helicity and magnetic winding, together with particular decompositions of these quantities. To perform these calculations, SHARP magnetograms are downloaded and velocity maps are created using the DAVE4VM method. Visualization tools, written in Python, are provided to aid in the selection of appropriate output variables and for the straightforward creation of maps and time series. Additionally, other analysis functions are included to facilitate and aid solar flare investigations. This software offers researchers a powerful tool for investigating the behaviour of active regions and the origins of space weather

Direct evidence that twisted flux tube emergence creates solar active regions

The magnetic nature of the formation of solar active regions lies at the heart of understanding solar activity and, in particular, solar eruptions. A widespread model, used in many theoretical studies, simulations and the interpretation of observations, is that the basic structure of an active region is created by the emergence of a large tube of pre-twisted magnetic field. Despite plausible reasons and the availability of various proxies suggesting the accuracy of this model, there has not yet been a methodology that can clearly and directly identify the emergence of large pre-twisted magnetic flux tubes. Here, we present a clear signature of the emergence of pre-twisted magnetic flux tubes by investigating a robust topological quantity, called magnetic winding, in solar observations. This quantity detects the emerging magnetic topology despite the significant deformation experienced by the emerging magnetic field. Magnetic winding complements existing measures, such as magnetic helicity, by providing distinct information about field line topology, thus allowing for the direct identification of emerging twisted magnetic flux tubes

Homologous Flares and Magnetic Field Topology in Active Region NOAA 10501 on 20 November 2003

We present and interpret observations of two morphologically homologous flares that occurred in active region (AR) NOAA 10501 on 20 November 2003. Both flares displayed four homologous H-alpha ribbons and were both accompanied by coronal mass ejections (CMEs). The central flare ribbons were located at the site of an emerging bipole in the center of the active region. The negative polarity of this bipole fragmented in two main pieces, one rotating around the positive polarity by ~ 110 deg within 32 hours. We model the coronal magnetic field and compute its topology, using as boundary condition the magnetogram closest in time to each flare. In particular, we calculate the location of quasiseparatrix layers (QSLs) in order to understand the connectivity between the flare ribbons. Though several polarities were present in AR 10501, the global magnetic field topology corresponds to a quadrupolar magnetic field distribution without magnetic null points. For both flares, the photospheric traces of QSLs are similar and match well the locations of the four H-alpha ribbons. This globally unchanged topology and the continuous shearing by the rotating bipole are two key factors responsible for the flare homology. However, our analyses also indicate that different magnetic connectivity domains of the quadrupolar configuration become unstable during each flare, so that magnetic reconnection proceeds differently in both events.Comment: 24 pages, 10 figures, Solar Physics (accepted

Deciphering the Pre–solar-storm Features of the 2017 September Storm From Global and Local Dynamics

We investigate whether global toroid patterns and the local magnetic field topology of solar active region (AR) 12673 together can hindcast the occurrence of the biggest X-flares of solar cycle (SC)-24. Magnetic toroid patterns (narrow latitude belts warped in longitude, in which ARs are tightly bound) derived from the surface distributions of ARs, prior and during AR 12673 emergence, reveal that the portions of the south toroid containing AR 12673 was not tipped away from its north-toroid counterpart at that longitude, unlike the 2003 Halloween storms scenario. During the minimum phase there were too few emergences to determine multimode longitudinal toroid patterns. A new emergence within AR 12673 produced a complex nonpotential structure, which led to the rapid buildup of helicity and winding that triggered the biggest X-flare of SC-24, suggesting that this minimum-phase storm can be anticipated several hours before its occurrence. However, global patterns and local dynamics for a peak-phase storm, such as that from AR 11263, behaved like the 2003 Halloween storms, producing the third biggest X-flare of SC-24. AR 11263 was present at the longitude where the north and south toroids tipped away from each other. While global toroid patterns indicate that prestorm features can be forecast with a lead time of a few months, their application to observational data can be complicated by complex interactions with turbulent flows. Complex nonpotential field structure development hours before the storm are necessary for short-term prediction. We infer that minimum-phase storms cannot be forecast accurately more than a few hours ahead, while flare-prone ARs in the peak phase may be anticipated much earlier, possibly months ahead from global toroid patterns

Outcomes of Aortic Surgery for Abdominal Aortic Graft Infections

Background: Literature on postoperative outcomes following aortic surgery for aortic graft infection (AGI) is limited by relatively small sample sizes, resulting in lack of national benchmarks for quality of care. We report in-hospital outcomes following abdominal aortic surgery for AGI and identify factors associated with postoperative complications using the Nationwide Inpatient Sample (NIS) database. Methods: Patients who underwent aortic graft resection for AGI were identified from the 2002 to 2008 NIS database, a multicenter database capturing 20% of all US admissions. Multivariable logistic regression analyses were performed. Results: Among 394 patients (men: 73.4%) who underwent abdominal aortic surgery for AGI, 53% of the admissions were emergent/urgent. A significant trend for decreasing number of abdominal aortic surgery for AGIs per year was observed (Pearson r correlation: -.96; P = .0006). Over the same time span, a significant correlation was also seen with decrease in open and increase in endovascular aortic aneurysm repairs in the NIS database. In-hospital rates of overall postoperative morbidity and mortality were 68.3% and 19.8%, respectively. In-hospital rates of postoperative respiratory failure, renal failure, and cardiac arrest were 35.5%, 14.2%, and 8.9%, respectively. Median length of stay was 26 days, with median hospital charges being US$184 162. On multivariable analysis, increase in age per year (odds ratio [OR] 1.07; 95% confidence interval [CI]: 1.03-1.12) was independently associated with postoperative morbidity, while higher hospital volume for this procedure was protective (OR: 0.71; 95% CI: 0.56-0.89). No preoperative factors were independently associated with postoperative mortality. Conclusion: Incidence of abdominal aortic surgery for AGI has progressively declined over the span of our study in association with decreased open and increased endovascular aortic aneurysm repairs. Aortic surgery for AGI is associated with very high morbidity and mortality rates along with prolonged lengths of stay and elevated hospital charges. The outcomes of operations for AGI are better in younger patients and higher volume hospitals

Assessing the prevalence of sensory and motor impairments in childhood in Bangladesh using key informants

Objectives The study was conducted to determine whether trained key informants (KI) could identify children with impairments. Design Trained KI identified children with defined impairments/epilepsy who were then examined by a medical team at a nearby assessment centre (Key Informant Methodology: KIM). A population-based household randomised sample survey was also conducted for comparing the prevalence estimates. Setting Three districts in North Bangladesh. Participants Study population of approximately 258 000 children aged 0-<18 years, within which 3910 children were identified by KI, 94.8% of whom attended assessment camps. In the household survey, 8120 children were examined, of whom 119 were identified with an impairment/epilepsy. Main outcome measures Prevalence estimates of severe visual impairment (SVI), moderate/severe hearing impairment (HI), substantial physical impairment (PI) and epilepsy. Results Overall prevalence estimates of impairments, including presumed HI, showed significant differences comparing KIM (9.0/1000 (95% CI 8.7 to 9.4)) with the household survey (14.7/1000 (95% CI 12.0 to 17.3)). Good agreement was observed for SVI (KIM 0.7/1000 children: survey 0.5/1000), PI (KIM 6.2/1000 children: survey 8.0/1000) and epilepsy (KIM 1.5/1000 children: survey 2.2/1000). Prevalence estimates for HI were much lower using KIM (2/1000) compared to the survey (6.4/1000). Excluding HI, overall prevalence estimates were similar (KIM: 7.5/1000 children (95% CI 7.2 to 7.8) survey: 8.4/1000 (95% CI 6.4 to 10.4)). Conclusions KIM offers a low cost and relatively rapid way to identify children with SVI, PI and epilepsy in Bangladesh. HI is underestimated using KIM, requiring further research. © 2014 BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health

The impact of the Lesotho Child Grant Programme in the lives of children and adults with disabilities: Disaggregated analysis of a community randomized controlled trial

Globally, people with disabilities are disproportionally affected by poverty. Social protection policies, including cash transfers, are key strategies to address poverty “in all its forms”, but it is currently unclear how such programmes affect people with disabilities. This study examines differences in the impact of the Lesotho Child Grant Programme (CGP) on food security, health, education and livelihoods between people with and without disabilities using data from a community randomized control trial. Overall, this study finds the CGP had significant and differential impacts for people with disabilities across multiple health indicators (e.g. increased health expenditures, self-rated health, likelihood of seeking healthcare). The CGP also had an impact on food security, decreasing the number of months households with and without members with disabilities faced extreme food shortages. There was also a modest but significant and differential impact of the CGP on the engagement of people with disabilities in paid work. The CGP only had an impact on school enrolment for children without disabilities, however the difference in impact was non-significant and likely due to underpowered sample sizes. Overall, people with disabilities receiving the CGP still experienced high levels of absolute deprivation, and were generally still worse off compared to people without disabilities, indicating a need for adapted or complementary social protection and other poverty alleviation programmes

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

Eye health and vision have widespread and profound implications for many aspects of life, health, sustainable development, and the economy. Yet nowadays, many people, families, and populations continue to suffer the consequences of poor access to high-quality, affordable eye care, leading to vision impairment and blindness. In 2020, an estimated 596 million people had distance vision impairment worldwide, of whom 43 million were blind. Another 510 million people had uncorrected near vision impairment, simply because of not having reading spectacles. A large proportion of those affected (90%), live in low-income and middle-income countries (LMICs). However, encouragingly, more than 90% of people with vision impairment have a preventable or treatable cause with existing highly cost-effective interventions. Eye conditions affect all stages of life, with young children and older people being particularly affected. Crucially, women, rural populations, and ethnic minority groups are more likely to have vision impairment, and this pervasive inequality needs to be addressed. By 2050, population ageing, growth, and urbanisation might lead to an estimated 895 million people with distance vision impairment, of whom 61 million will be blind. Action to prioritise eye health is needed now. This Commission defines eye health as maximised vision, ocular health, and functional ability, thereby contributing to overall health and wellbeing, social inclusion, and quality of life. Eye health is essential to achieve many of the Sustainable Development Goals (SDGs). Poor eye health and impaired vision have a negative effect on quality of life and restrict equitable access to and achievement in education and the workplace. Vision loss has substantial financial implications for affected individuals, families, and communities. Although high-quality data for global economic estimates are scarce, particularly for LMICs, conservative assessments based on the latest prevalence figures for 2020 suggest that annual global productivity loss from vision impairment is approximately US$410·7 billion purchasing power parity. Vision impairment reduces mobility, affects mental wellbeing, exacerbates risk of dementia, increases likelihood of falls and road traffic crashes, increases the need for social care, and ultimately leads to higher mortality rates. By contrast, vision facilitates many daily life activities, enables better educational outcomes, and increases work productivity, reducing inequality. An increasing amount of evidence shows the potential for vision to advance the SDGs, by contributing towards poverty reduction, zero hunger, good health and wellbeing, quality education, gender equality, and decent work. Eye health is a global public priority, transforming lives in both poor and wealthy communities. Therefore, eye health needs to be reframed as a development as well as a health issue and given greater prominence within the global development and health agendas. Vision loss has many causes that require promotional, preventive, treatment, and rehabilitative interventions. Cataract, uncorrected refractive error, glaucoma, age-related macular degeneration, and diabetic retinopathy are responsible for most global vision impairment. Research has identified treatments to reduce or eliminate blindness from all these conditions; the priority is to deliver treatments where they are most needed. Proven eye care interventions, such as cataract surgery and spectacle provision, are among the most cost-effective in all of health care. Greater financial investment is needed so that millions of people living with unnecessary vision impairment and blindness can benefit from these interventions. Lessons from the past three decades give hope that this challenge can be met. Between 1990 and 2020, the age-standardised global prevalence of blindness fell by 28·5%. Since the 1990s, prevalence of major infectious causes of blindness—onchocerciasis and trachoma—have declined substantially. Hope remains that by 2030, the transmission of onchocerciasis will be interrupted, and trachoma will be eliminated as a public health problem in every country worldwide. However, the ageing population has led to a higher crude prevalence of age-related causes of blindness, and thus an increased total number of people with blindness in some regions. Despite this progress, business as usual will not keep pace with the demographic trends of an ageing global population or address the inequities that persist in each country. New threats to eye health are emerging, including the worldwide increase in diabetic retinopathy, high myopia, retinopathy of prematurity, and chronic eye diseases of ageing such as glaucoma and age-related macular degeneration. With the projected increase in such conditions and their associated vision loss over the coming decades, urgent action is needed to develop innovative treatments and deliver services at a greater scale than previously achieved. Good eye health at the community and national level has been marginalised as a luxury available to only wealthy or urban areas. Eye health needs to be urgently brought into the mainstream of national health and development policy, planning, financing, and action. The challenge is to develop and deliver comprehensive eye health services (promotion, prevention, treatment, rehabilitation) that address the full range of eye conditions within the context of universal health coverage. Accessing services should not bring the risk of falling into poverty and services should be of high quality, as envisaged by the WHO framework for health-care quality: effective, safe, people-centred, timely, equitable, integrated, and efficient. To this framework we add the need for services to be environmentally sustainable. Universal health coverage is not universal without eye care. Multiple obstacles need to be overcome to achieve universal coverage for eye health. Important issues include complex barriers to availability and access to quality services, cost, major shortages and maldistribution of well-trained personnel, and lack of suitable, well maintained equipment and consumables. These issues are particularly widespread in LMICs, but also occur in underserved communities in high-income countries. Strong partnerships need to be formed with natural allies working in areas affected by eye health, such as non-communicable diseases, neglected tropical diseases, healthy ageing, children's services, education, disability, and rehabilitation. The eye health sector has traditionally focused on treatment and rehabilitation, and underused health promotion and prevention strategies to lessen the impact of eye disease and reduce inequality. Solving these problems will depend on solutions established from high quality evidence that can guide more effective implementation at scale. Evidence-based approaches will need to address existing deficiencies in the supply and demand. Strategic investments in discovery research, harnessing new findings from diverse fields, and implementation research to guide effective scale up are needed globally. Encouragingly, developments in telemedicine, mobile health, artificial intelligence, and distance learning could potentially enable eye care professionals to deliver higher quality care that is more plentiful, equitable, and cost-effective. This Commission did a Grand Challenges in Global Eye Health prioritisation exercise to highlight key areas for concerted research and action. This exercise has identified a broad set of challenges spanning the fields of epidemiology, health systems, diagnostics, therapeutics, and implementation. The most compelling of these issues, picked from among 3400 suggestions proposed by 336 people from 118 countries, can help to frame the future research agenda for global eye health. In this Commission, we harness lessons learned from over two decades, present the growing evidence for the life-transforming impact of eye care, and provide a thorough understanding of rapid developments in the field. This report was created through a broad consultation involving experts within and outside the eye care sector to help inform governments and other stakeholders about the path forward for eye health beyond 2020, to further the SDGs (including universal health coverage), and work towards a world without avoidable vision loss. The next few years are a crucial time for the global eye health community and its partners in health care, government, and other sectors to consider the successes and challenges encountered in the past two decades, and at the same time to chart a way forward for the upcoming decades. Moving forward requires building on the strong foundation laid by WHO and partners in VISION 2020 with renewed impetus to ultimately deliver high quality universal eye health care for all