An acoustic investigation of the near-surface turbulence on Mars.

The Perseverance rover is carrying out an original acoustic experiment on Mars: the SuperCam microphone records the spherical acoustic waves generated by laser sparks at distances from 2 m to more than 8 m. These N-shaped acoustic waves scatter from the multiple local heterogeneities of the turbulent atmosphere. Therefore, large and random fluctuations of sound travel time and intensity develop as the waves cross the medium. The variances of the travel times and the scintillation index (normalized variance of the sound intensity) are studied within the mathematical formalism of the propagation of spherical acoustic waves through thermal turbulence to infer statistical properties of the Mars atmospheric temperature fluctuation field. The comparison with the theory is made by simplifying assumptions that do not include wind fluctuations and diffraction effects. Two Earth years (about one Martian year) of observations acquired during the maximum convective period (10:00-14:00 Mars local time) show a good agreement between the dataset and the formalism: the travel time variance diverges from the linear Chernov solution exactly where the density of occurrence of the first caustic reaches its maximum. Moreover, on average, waves travel faster than the mean speed of sound due to a fast path effect, which is also observed on Earth. To account for the distribution of turbulent eddies, several power spectra are tested and the best match to observation is obtained with a generalized von Karman spectrum with a shallower slope than the Kolmogorov cascade, ϕ(k)∝(1+k2L2)-4/3. It is associated with an outer scale of turbulence, L, of 11 cm at 2 m above the surface and a standard deviation of 6 K over 9 s for the temperature. These near-surface atmospheric properties are consistent with a weak to moderate wave scattering regime around noon with little saturation. Overall, this study presents an innovative and promising methodology to probe the near-surface atmospheric turbulence on Mars.

Update of the international HerniaSurge guidelines for groin hernia management.

BACKGROUND: Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. METHOD: A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. RESULTS: Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. CONCLUSION: The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.

[Sustainability in private surgical practice-A narrative review]. / Nachhaltigkeit in der chirurgischen Niederlassung ­ ein narratives Review.

Background: Surgery is contributing to the climate crisis, not least in the outpatient sector. The present publication aims to identify the challenges this poses, and to provide clear, preferably evidence-based recommendations on environmental protection while simultaneously reducing costs. Method: Narrative review with a non-systematic search and selection in PubMed/MEDLINE and grey area literature as well as expert interviews. Results: Numerous primary articles, evidence syntheses, practical recommendations for action and checklists were identified and two experts were interviewed. Environmental issues were identified in the production and procurement, transport of people and goods, usage of materials, pharmaceuticals including anesthetic gases and energy consumption in the outpatient practice and also in disposal, recycling, and sterilization. High-quality publications do not describe a lack of knowledge on alternatives but on a lack of implementation in clinical practice. Therefore, the identified issues were classified in the 5­R scheme (reduce, reuse, recycle, rethink, research) to present recommendations for action, which are synergetic in terms of cost reduction, patient and staff satisfaction. Furthermore, changes in regulatory frameworks are discussed. Conclusion: Outpatient surgery comes with relevant consumption of resources and carbon emissions. There are numerous opportunities for action that combine environmental protection with cost reduction as well as patient and staff satisfaction. Incentives, guidelines, and legal framework conditions are needed for comprehensive environmental protection in the private sector.

Quality of Life after Desarda Technique for Inguinal Hernia Repair-A Comparative Retrospective Multicenter Study of 120 Patients.

Inguinal hernia repair, according to Desarda, is a pure tissue surgical technique using external oblique fascia to reinforce the posterior wall of the inguinal canal. This has provided an impetus for the rethinking of guideline adherence toward minimally invasive and mesh-based surgery of inguinal hernia. In this study, a retrospective analysis of this technique was conducted in two German hospitals. Between 6/2013 and 12/2020, 120 operations were performed. Analysis included patient characteristics, duration of operation, length of hospital stay, and perioperative complications. Data were used to achieve a matched-pair analysis comparing Desarda to laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Propensity scores were calculated based on five preoperative variables, including sex, age, American Society of Anesthesiology classification, localization, and width of the inguinal hernia in order to achieve comparability. Additionally, we assessed pain level and quality of life (QoL) 12 months postoperatively. The focus of our study was a comparison of QoL to a reference population and TAPP cohort. The study population consisted of 106 male and 14 female patients, and the median age was 37.5 years. The median operation time was 50 min, and the median length of hospital stay was 2 days. At a follow-up of 17 months, the median recurrence rate was 0.8%, and two cases of chronic postoperative pain were recorded. Postoperative QoL does not significantly differ between Desarda and TAPP. In contrast, Desarda patients had a significantly higher QoL compared with the reference population. In summary, Desarda's procedure is a good option as a pure tissue method for inguinal hernia repair.

[Sustainability in private surgical practice-A narrative review]. / Nachhaltigkeit in der chirurgischen Niederlassung ­ ein narratives Review.

BACKGROUND: Surgery is contributing to the climate crisis, not least in the outpatient sector. The present publication aims to identify the challenges this poses, and to provide clear, preferably evidence-based recommendations on environmental protection while simultaneously reducing costs. METHOD: Narrative review with a non-systematic search and selection in PubMed/MEDLINE and grey area literature as well as expert interviews. RESULTS: Numerous primary articles, evidence syntheses, practical recommendations for action and checklists were identified and two experts were interviewed. Environmental issues were identified in the production and procurement, transport of people and goods, usage of materials, pharmaceuticals including anesthetic gases and energy consumption in the outpatient practice and also in disposal, recycling, and sterilization. High-quality publications do not describe a lack of knowledge on alternatives but on a lack of implementation in clinical practice. Therefore, the identified issues were classified in the 5­R scheme (reduce, reuse, recycle, rethink, research) to present recommendations for action, which are synergetic in terms of cost reduction, patient and staff satisfaction. Furthermore, changes in regulatory frameworks are discussed. CONCLUSION: Outpatient surgery comes with relevant consumption of resources and carbon emissions. There are numerous opportunities for action that combine environmental protection with cost reduction as well as patient and staff satisfaction. Incentives, guidelines, and legal framework conditions are needed for comprehensive environmental protection in the private sector.

Planetary Protection Assessment of Radioisotope Thermoelectric Generator (RTG)-Powered Landed Missions to Ocean Worlds: Application to Enceladus.

Landed missions to icy worlds with a subsurface liquid water ocean must meet planetary protection requirements and ensure a sufficiently small likelihood of any microorganism-bearing part of the landed element reaching the ocean. A higher bound on this likelihood is set by the potential for radioisotope thermoelectric generator (RTG) power sources, the hottest possible landed element, to melt through the ice shell and reach the ocean. In this study, we quantify this potential as a function of three key parameters: surface temperature, ice shell thickness (i.e., heat flux through the shell), and thickness of a porous (insulating) snow or regolith cover. Although the model we describe can be applied to any ocean world, we present results in the context of a landed mission concept to the south polar terrain of Saturn's moon Enceladus. In this particular context, we discuss planetary protection considerations for landing site selection. The likelihood of forward microbial contamination of Enceladus' ocean by an RTG-powered landed mission can be made sufficiently low to not undermine compliance with the planetary protection policy.

The dynamic atmospheric and aeolian environment of Jezero crater, Mars.

Despite the importance of sand and dust to Mars geomorphology, weather, and exploration, the processes that move sand and that raise dust to maintain Mars' ubiquitous dust haze and to produce dust storms have not been well quantified in situ, with missions lacking either the necessary sensors or a sufficiently active aeolian environment. Perseverance rover's novel environmental sensors and Jezero crater's dusty environment remedy this. In Perseverance's first 216 sols, four convective vortices raised dust locally, while, on average, four passed the rover daily, over 25% of which were significantly dusty ("dust devils"). More rarely, dust lifting by nonvortex wind gusts was produced by daytime convection cells advected over the crater by strong regional daytime upslope winds, which also control aeolian surface features. One such event covered 10 times more area than the largest dust devil, suggesting that dust devils and wind gusts could raise equal amounts of dust under nonstorm conditions.

Influence of the Multi-Mission Radioisotope Thermoelectric Generator (MMRTG) on the local atmospheric environment.

A survey around a recently-fueled MMRTG in the terrestrial atmosphere finds a warm air plume with a characteristic updraft velocity of ~1 m/s and a temperature rise of ~4 â€‹K. Additionally, a roughly hundredfold enhancement in ion density to ~70,000/cm3 in the vicinity (<~1 â€‹m) of the generator was observed: air electrical conductivity was measured to be ~10-13 â€‹S/m. No evidence of ozone production was detected. These observations inform the electrical charging environment and possible local perturbation to meteorological measurements on Mars or Titan on MMRTG-powered landers or rovers. On Mars, the effects of any electrical conductivity enhancement are likely small, but on Titan they may be significant.

Scientific Observations With the InSight Solar Arrays: Dust, Clouds, and Eclipses on Mars.

Records of solar array currents recorded by the InSight lander during its first 200 sols on Mars are presented. In addition to the geometric variation in illumination on seasonal and diurnal timescales, the data are influenced by dust suspended in the atmosphere and deposited on the solar panels. Although no dust devils have been detected by InSight's cameras, brief excursions in solar array currents suggest that at least some of the vortices detected by transient pressure drops are accompanied by dust. A step increase in array output (i.e., a "cleaning event") was observed to be directly associated with the passage of a strong vortex. Some quasiperiodic variations in solar array current are suggestive of dust variations in the planetary boundary layer. Nonzero array outputs before sunrise and after sunset are indicative of scattering in the atmosphere: A notable increase in evening twilight currents is observed associated with noctilucent clouds, likely of water or carbon dioxide ice. Finally, although the observations are intermittent (typically a few hours per sol) and at a modest sample rate (one to two samples per minute), three single-sample light dips are seen associated with Phobos eclipses. These results demonstrate that engineering data from solar arrays provide valuable scientific situational awareness of the Martian environment.

The root of anomalously specular reflections from solid surfaces on Saturn's moon Titan.

Saturn's moon Titan has a methane cycle with clouds, rain, rivers, lakes, and seas; it is the only world known to presently have a volatile cycle akin to Earth's tropospheric water cycle. Anomalously specular radar reflections (ASRR) from Titan's tropical region were observed with the Arecibo Observatory (AO) and Green Bank Telescope (GBT) and interpreted as evidence for liquid surfaces. The Cassini spacecraft discovered lakes/seas on Titan, however, it did not observe lakes/seas at the AO/GBT anomalously specular locations. A satisfactory explanation for the ASRR has been elusive for more than a decade. Here we show that the ASRR originate from one terrain unit, likely paleolakes/paleoseas. Titan observations provide ground-truth in the search for oceans on exoearths and an important lesson is that identifying liquid surfaces by specular reflections requires a stringent definition of specular; we propose a definition for this purpose.

[Diagnostic algorithm "FAI and sports hernia" : Results of the consensus meeting for groin pain in athletes]. / Diagnostik-Algorithmus Grenzbereich "FAI und Sportlerleiste" : Ergebnisse des Konsensustreffens Leistenschmerz beim Sportler.

As a result of the complexity and diversity of diseases in the region of the groin, differentiation of the various soft-tissue and bone pathologies remains a challenge for differential diagnosis in routine clinical practice. In the case of athletes with pain localized in the area of the groin, femoroacetabular impingement (FAI) and athlete's groin must be considered as important causes of the groin pain, whereby the common occurrence of double pathologies further complicates diagnosis. Despite the importance of groin pain and its differential diagnoses in everyday clinical practice, there has been a lack of recognized recommendations for diagnostic procedure to date. To this end, a consensus meeting was held in February 2017, in which a group composed equally of groin and hip surgeons took part. With the formulation of recommendations and the establishment of a practicable diagnostic path, colleagues that are involved in treating such patients should be sensitized to this issue and the quality of the diagnosis of groin pain improved in routine clinical practice.

Influencing Factors on the Outcome in Female Groin Hernia Repair: A Registry-based Multivariable Analysis of 15,601 Patients.

OBJECTIVE: Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair. BACKGROUND: In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair. METHODS: In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified. RESULTS: In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates. CONCLUSIONS: Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.

Groin Hernias in Women-A Review of the Literature.

Background: To date, there are few studies and no systematic reviews focusing specifically on groin hernia in women. Most of the existing knowledge comes from registry data. Objective: This present review now reports on such findings as are available on groin hernia in women. Materials and Methods: A systematic search of the available literature was performed in September 2018 using Medline, PubMed, Google Scholar, and the Cochrane Library. For the present analysis 80 publications were identified. Results: The lifetime risk of developing a groin hernia in women is 3-5.8%. The proportion of women in the overall collective of operated groin hernias is 8.0-11.5%. In women, the proportion of femoral hernias is 16.7-37%. Risk factors for development of a groin hernia in women of high age and with a positive family history. A groin hernia during pregnancy should not be operated on. The rate of emergency procedures in women, at 14.5-17.0%, is 3 to 4-fold higher than in men and at 40.6% is even higher for femoral hernia. Therefore, watchful waiting is not indicated in women. During surgical repair of groin hernia in females the presence of a femoral hernia should always be excluded and if detected should be repaired using a laparo-endoscopic or open preperitoneal mesh technique. A higher rate of chronic postoperative inguinal pain must be expected in females. Conclusion: Special characteristics must be taken into account for repair of groin hernia in women.

Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS).

Introduction: Recently, the promising results of new procedures for the treatment of rectus diastasis with concomitant hernias using extraperitoneal mesh placement and anatomical restoration of the linea alba were published. To date, there is no recognized classification of rectus diastasis (RD) with concomitant hernias. This is urgently needed for comparative assessment of new surgical techniques. A working group of the German Hernia Society (DHG) and the International Endohernia Society (IEHS) set itself the task of devising such a classification. Materials and Methods: A systematic search of the available literature was performed up to October 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. A meeting of the working group was held in May 2018 in Hamburg. For the present analysis 30 publications were identified as relevant. Results: In addition to the usual patient- and technique-related influencing factors on the outcome of hernia surgery, a typical means of rectus diastasis classification and diagnosis should be devised. Here the length of the rectus diastasis should be classified in terms of the respective subxiphoidal, epigastric, umbilical, infraumbilical, and suprapubic sectors affected as well as by the width in centimeters, whereby W1 < 3 cm, W2 = 3- ≤ 5 cm, and W3 > 5 cm. Furthermore, gender, the concomitant hernias, previous abdominal surgery, number of pregnancies and multiple births, spontaneous birth or caesarian section, skin condition, diagnostic procedures and preoperative pain rate and localization of pain should be recorded. Conclusion: Such a unique classification is needed for assessment of the treatment results in patients with RD.

Enceladus Plume Density from Cassini Spacecraft Attitude Control Data.

The plumes of Enceladus are of interest both as a geophysical phemonenon, and as an astrobiological opportunity for sampling internal material. Here we report measurements of the total mass density (gas plus dust, a combination not reported before except in the engineering literature) deduced from telemetry of Cassini's Attitude and Articulation Control System (AACS), as the spacecraft's thrusters or reaction wheels worked to maintain the desired attitude in the presence of gas drag torques during close flybys. The drag torque shows good agreement with the water vapor density measured by other instruments during the E5 encounter, but indicates a rather higher mass density on other passes (E3,E14), possibly indicating variations in gas composition and/or gas:dust ratio. The spacecraft appears to have intercepted about 0.2 grams of material, on flyby E21 in October 2015 indicating a peak mass density of ~5.5×10-11 kgm-3, the highest of all the flybys measured (E3,E5,E7,E9,E14,E21).

Strategies for Detecting Biological Molecules on Titan.

Saturn's moon Titan has all the ingredients needed to produce "life as we know it." When exposed to liquid water, organic molecules analogous to those found on Titan produce a range of biomolecules such as amino acids. Titan thus provides a natural laboratory for studying the products of prebiotic chemistry. In this work, we examine the ideal locales to search for evidence of, or progression toward, life on Titan. We determine that the best sites to identify biological molecules are deposits of impact melt on the floors of large, fresh impact craters, specifically Sinlap, Selk, and Menrva craters. We find that it is not possible to identify biomolecules on Titan through remote sensing, but rather through in situ measurements capable of identifying a wide range of biological molecules. Given the nonuniformity of impact melt exposures on the floor of a weathered impact crater, the ideal lander would be capable of precision targeting. This would allow it to identify the locations of fresh impact melt deposits, and/or sites where the melt deposits have been exposed through erosion or mass wasting. Determining the extent of prebiotic chemistry within these melt deposits would help us to understand how life could originate on a world very different from Earth. Key Words: Titan-Prebiotic chemistry-Solar system exploration-Impact processes-Volcanism. Astrobiology 18, 571-585.

Vital Signs: Seismology of Icy Ocean Worlds.

Ice-covered ocean worlds possess diverse energy sources and associated mechanisms that are capable of driving significant seismic activity, but to date no measurements of their seismic activity have been obtained. Such investigations could reveal the transport properties and radial structures, with possibilities for locating and characterizing trapped liquids that may host life and yielding critical constraints on redox fluxes and thus on habitability. Modeling efforts have examined seismic sources from tectonic fracturing and impacts. Here, we describe other possible seismic sources, their associations with science questions constraining habitability, and the feasibility of implementing such investigations. We argue, by analogy with the Moon, that detectable seismic activity should occur frequently on tidally flexed ocean worlds. Their ices fracture more easily than rocks and dissipate more tidal energy than the <1 GW of the Moon and Mars. Icy ocean worlds also should create less thermal noise due to their greater distance and consequently smaller diurnal temperature variations. They also lack substantial atmospheres (except in the case of Titan) that would create additional noise. Thus, seismic experiments could be less complex and less susceptible to noise than prior or planned planetary seismology investigations of the Moon or Mars. Key Words: Seismology-Redox-Ocean worlds-Europa-Ice-Hydrothermal. Astrobiology 18, 37-53.

Onboard Science Insights and Vehicle Dynamics from Scale-Model Trials of the Titan Mare Explorer (TiME) Capsule at Laguna Negra, Chile.

A scale model of the proposed Titan Mare Explorer capsule was deployed at the Planetary Lake Lander field site at Laguna Negra, Chile. The tests served to calibrate models of wind-driven drift of the capsule and to understand its attitude motion in the wave field, as well as to identify dynamic and acoustic signatures of shoreline approach. This information enables formulation of onboard trigger criteria for near-shore science data acquisition. Key Words: Titan-Vehicle dynamics-Science autonomy-Lake. Astrobiology 18, 607-618.

Initiation of a lightning search using the lightning and airglow camera onboard the Venus orbiter Akatsuki.

The existence of lightning discharges in the Venus atmosphere has been controversial for more than 30 years, with many positive and negative reports published. The lightning and airglow camera (LAC) onboard the Venus orbiter, Akatsuki, was designed to observe the light curve of possible flashes at a sufficiently high sampling rate to discriminate lightning from other sources and can thereby perform a more definitive search for optical emissions. Akatsuki arrived at Venus during December 2016, 5 years following its launch. The initial operations of LAC through November 2016 have included a progressive increase in the high voltage applied to the avalanche photodiode detector. LAC began lightning survey observations in December 2016. It was confirmed that the operational high voltage was achieved and that the triggering system functions correctly. LAC lightning search observations are planned to continue for several years.