A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

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

Development and external validation of the 'Global Surgical-Site Infection' (GloSSI) predictive model in adult patients undergoing gastrointestinal surgery

Background: Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models. Methods: This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July-November 2014) and GlobalSurg-2 (January-July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator ('LASSO')) and machine learning (extreme gradient boosting ('XGBoost')). Final model selection was based on prognostic accuracy and clinical utility. Results: There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept -0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models. Conclusion: The 'Global Surgical-Site Infection' score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm

SS18 Together with Animal-Specific Factors Defines Human BAF-Type SWI/SNF Complexes

Contains fulltext : 94049.pdf (publisher's version ) (Open Access

Study of the process e+e-→π+π-η using initial state radiation

© 2018 authors. We study the process e+e-→π+π-ηγ, where the photon is radiated from the initial state. About 8000 fully reconstructed events of this process are selected from the BABAR data sample with an integrated luminosity of 469 fb-1. Using the π+π-η invariant mass spectrum, we measure the e+e-→π+π-η cross section in the e+e- center-of-mass energy range from 1.15 to 3.5 GeV. The cross section is well described by the Vector-Meson dominance model with four ρ-like states. We observe 49±9 events of the J/ψ decay to π+π-η and measure the product ΓJ/Ψ→e+e-BJ/Ψ→π+π-η=2.34±0.43stat±0.16syst eV

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 &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 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

Supernova neutrino burst detection with the Deep Underground Neutrino Experiment

The Deep Underground Neutrino Experiment (DUNE), a 40-kton underground liquid argon time projection chamber experiment, will be sensitive to the electron-neutrino flavor component of the burst of neutrinos expected from the next Galactic core-collapse supernova. Such an observation will bring unique insight into the astrophysics of core collapse as well as into the properties of neutrinos. The general capabilities of DUNE for neutrino detection in the relevant few- to few-tens-of-MeV neutrino energy range will be described. As an example, DUNE's ability to constrain the νe spectral parameters of the neutrino burst will be considered

Search for heavy neutral leptons using tau lepton decays at <i>BaBaR</i>

This article presents a model-independent search for an additional, mostly sterile, heavy neutral lepton (HNL), that is capable of mixing with the Standard Model τ neutrino with a mixing strength of |Uτ4|2, corresponding to the absolute square of the extended Pontecorvo-Maki-Nakagawa-Sakata matrix element. Data from the BABAR experiment, with a total integrated luminosity of 424 fb-1, are analyzed using a kinematic approach that makes no assumptions on the model behind the origins of the HNL, its lifetime or decay modes. No significant signal is found. Upper limits on |Uτ4|2 at the 95% confidence level, depend on the HNL mass hypothesis and vary from 2.31×10-2 to 5.04×10-6 (with all uncertainties considered), across the mass range 100<m4<1300 MeV/c2; the more stringent limits being placed at higher masses

Search for B mesogenesis at BaBar

A new mechanism has been proposed to simultaneously explain the presence of dark matter and the matter-antimatter asymmetry in the Universe. This scenario predicts exotic B -meson decays into a baryon and a dark-sector antibaryon (ψ D ) with branching fractions accessible at B factories. We present a search for B→ΛψD decays using data collected by the BABAR experiment at SLAC. This reaction is identified by fully reconstructing the accompanying B meson and requiring the presence of a single Λ baryon in the remaining particles. No significant signal is observed, and bounds on the B → Λ ψ D branching fraction are derived in the range 0.13 – 5.2 × 10 − 5 for 1.0 < m ψ D < 4.2 GeV / c 2. These results set strong constraints on the parameter space allowed by the theory

Study of the reactions e plus e- ? K+K-,r0,r0,r0, e+ e-?K0SK?,r?,r0,r0, and e plus e-? K0SK?,r?,r+,r- at center-of-mass energies from threshold to 4.5 GeV using initial-state radiation

We study the processes e+e-→K+K-π0π0π0γ, KS0K±π?π0π0γ, and KS0K±π?π+π-γ in which an energetic photon is radiated from the initial state. The data were collected with the BABAR detector at the SLAC National Accelerator Laboratory. About 1200, 2600, and 6000 events, respectively, are selected from a data sample corresponding to an integrated luminosity of 469 fb-1. The invariant mass of the hadronic final state defines the effective e+e- center-of-mass energy. The center-of-mass energies range from threshold to 4.5 GeV. From the mass spectra, the first ever measurements of the e+e-→K+K-π0π0π0, e+e-→KS0K±π?π0π0, and e+e-→KS0K±π?π+π- cross sections are performed. The contributions from the intermediate states that include η, φ, ρ, K∗(892), and other resonances are presented. We observe the J/ψ and ψ(2S) in most of these final states and measure the corresponding branching fractions, many of them for the first time