Effectiveness of Nurse-Led Preoperative Assessment for Anesthesia: A Prospective Cohort Study.

PURPOSE: This study aimed to evaluate, in low-complexity surgical patients, the effectiveness of preoperative assessment carried out by nurses with formal postgraduate anesthetic training compared to that carried out by anesthesiologists in terms of cancellations and inadequate surgical preparation. DESIGN: This experimental research was conducted using a prospective cohort study. METHODS: One hundred and eighty-three patients were recruited who had undergone low-complexity surgery between May and September 2020. Sixty-nine patients were preoperatively assessed by a nurse with specific 1-year postgraduate university training in anesthesia and 114 by an anesthesiologist. Data collection included a questionnaire to assess patient satisfaction and knowledge acquired from the preoperative assessment. FINDINGS: Cancellations of surgery were the same in both cohorts (3.8%, 2.6%). The incidence of poor preparation attributable to the patient was also similar in both cohorts (17.0% vs 18.4%). Patients seen by nurses valued the satisfaction with the preoperative assessment more highly than patients seen by anesthesiologists (median 91.67 vs 84.62). In terms of Knowledge obtained from the preoperative assessment, both professionals did not show statistically significant differences in knowledge levels. CONCLUSIONS: Preoperative patient assessment performed by a nurse, with formal anesthesia training, in low-complexity surgical patients can be as effective as that performed by an anesthesiologist, without having an impact on surgical cancellations or patient preparation. On the day of surgery, patients who had been assessed by a nurse were more satisfied with their care during the visit and acquired similar knowledge about preoperative preparation as patients assessed by anesthesiologists.

Protective Effects of Halite to Vacuum and Vacuum-Ultraviolet Radiation: A Potential Scenario During a Young Sun Superflare.

Halite (NaCl mineral) has exhibited the potential to preserve microorganisms for millions of years on Earth. This mineral was also identified on Mars and in meteorites. In this study, we investigated the potential of halite crystals to protect microbial life-forms on the surface of an airless body (e.g., meteorite), for instance, during a lithopanspermia process (interplanetary travel step) in the early Solar System. To investigate the effect of the radiation of the young Sun on microorganisms, we performed extensive simulation experiments by employing a synchrotron facility. We focused on two exposure conditions: vacuum (low Earth orbit, 10-4 Pa) and vacuum-ultraviolet (VUV) radiation (range 57.6-124 nm, flux 7.14 W/m2), with the latter representing an extreme scenario with high VUV fluxes comparable to the amount of radiation of a stellar superflare from the young Sun. The stellar VUV parameters were estimated by using the very well-studied solar analog of the young Sun, κ1 Cet. To evaluate the protective effects of halite, we entrapped a halophilic archaeon (Haloferax volcanii) and a non-halophilic bacterium (Deinococcus radiodurans) in laboratory-grown halite. Control groups were cells entrapped in salt crystals (mixtures of different salts and NaCl) and non-trapped (naked) cells, respectively. All groups were exposed either to vacuum alone or to vacuum plus VUV. Our results demonstrate that halite can serve as protection against vacuum and VUV radiation, regardless of the type of microorganism. In addition, we found that the protection is higher than provided by crystals obtained from mixtures of salts. This extends the protective effects of halite documented in previous studies and reinforces the possibility to consider the crystals of this mineral as potential preservation structures in airless bodies or as vehicles for the interplanetary transfer of microorganisms.

Appropriateness of the dialysis modality selection process: A cross-sectional study.

Studies that specifically quantify the appropriateness of the process of dialysis modality selection are lacking. Peritoneal dialysis (PD) offers clinical and social advantages over hemodialysis (HD), but may be underused. We aimed to determine the appropriateness of the process of dialysis modality selection and quantify the percentage of patients who could potentially have been PD candidates. We performed a cross-sectional study that included adult patients from a hospital Nephrology Department in Barcelona who started dialysis between 2014 and 2015. We assessed the appropriateness of dialysis modalities selection by defining 3 sequential domains based on 3 critical steps in choosing a dialysis modality: eligibility for either treatment, information about modalities, and shared decision-making. We obtained data using medical records and a patient questionnaire. The dialysis modality selection process was considered appropriate when patients had no contraindications for the selected option, received complete information about both modalities, and voluntarily chose the selected option. A total of 141 patients were included in this study. The median age was 72 years (interquartile range 63-82 years), and 65% of the patients were men. The dialysis modality selection process was potentially inappropriate in 22% of the participants because of problems related to information about dialysis modalities (15%) or shared decision-making (7%). Appropriate PD use can potentially increase from 17% to 38%. Patient age and lack of information regarding dialysis options were independently associated with the potential degree of inappropriate dialysis modality selection. Our findings indicate areas for improvement in the selection of dialysis modalities. With better education and shared decision-making, the number of patients with PD could potentially double. The analysis of appropriateness is a helpful approach for studying renal replacement treatment patterns and identifying strategies to optimize their use.

Atmospheric characterization of terrestrial exoplanets in the mid-infrared: biosignatures, habitability, and diversity.

Exoplanet science is one of the most thriving fields of modern astrophysics. A major goal is the atmospheric characterization of dozens of small, terrestrial exoplanets in order to search for signatures in their atmospheres that indicate biological activity, assess their ability to provide conditions for life as we know it, and investigate their expected atmospheric diversity. None of the currently adopted projects or missions, from ground or in space, can address these goals. In this White Paper, submitted to ESA in response to the Voyage 2050 Call, we argue that a large space-based mission designed to detect and investigate thermal emission spectra of terrestrial exoplanets in the mid-infrared wavelength range provides unique scientific potential to address these goals and surpasses the capabilities of other approaches. While NASA might be focusing on large missions that aim to detect terrestrial planets in reflected light, ESA has the opportunity to take leadership and spearhead the development of a large mid-infrared exoplanet mission within the scope of the "Voyage 2050" long-term plan establishing Europe at the forefront of exoplanet science for decades to come. Given the ambitious science goals of such a mission, additional international partners might be interested in participating and contributing to a roadmap that, in the long run, leads to a successful implementation. A new, dedicated development program funded by ESA to help reduce development and implementation cost and further push some of the required key technologies would be a first important step in this direction. Ultimately, a large mid-infrared exoplanet imaging mission will be needed to help answer one of humankind's most fundamental questions: "How unique is our Earth?"

Timing of Pulmonary Rehabilitation in Readmitted Patients with Severe Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial.

Early pulmonary rehabilitation (PR), started during hospitalization or within the first month after discharge, has been shown to reduce exacerbations and improve health-related-quality of life (HRQoL) and exercise capacity. However, no randomized clinical trials (RCT) have compared the efficacy of PR started during hospitalization (DHPR) to PR initiated one month post-hospitalization (PHPR). We conducted an RCT to compare DHPR to PHPR in severe patients with COPD readmitted for exacerbations in a tertiary hospital setting. Patients were randomized to receive three months of DHPR or PHPR. Outcomes were assessed at completion of the PR programme and at months 3 and 9. A total of 53 patients (26 DHPR and 27 PHPR) were included. There were no between-group differences in the number of exacerbations (mean, 3.62 vs. 3.04 in the DHPR and PHPR groups, respectively; p = 0.403). Dyspnea in activities of daily living, exercise capacity, and all HRQoL parameters improved in the PHPR group. In the DHPR group, improvement was observed only for some HRQoL parameters. All gains in both groups were lost during follow-up. More adverse events were observed in the DHPR group (20 vs 5, p = 0.023), although none of these were clinically significant. In this sample of patients with severe COPD readmitted to the hospital for exacerbations, both approaches to PR were safe, but PHPR yielded better outcomes overall. These findings suggest that, PR should be initiated in patients with severe COPD only after hospital discharge when the patients' clinical condition has stabilized.

Syphilis and other sexually transmitted infections among waste pickers in Brasilia, Brazil.

There are millions of waste pickers worldwide that are predominantly located in low- and middle-income countries. They survive on sorting and selling reusable orrecyclable materials discarded by society.While sorting, they are exposed to occupational risks and hazards, including cuts from sharp objects and medical wastes, that could be contaminated by infectious diseases. Because of these exposures, a study was conducted to determine the prevalence of syphilis and other sexually transmitted infections (STI's) among waste pickers. A cross-sectional study using a semi-structured questionnaire and blood samples for serological tests were collected. A total of 1,025 waste pickers were interviewed. Most participants were women (67.54%), without a partner (70.11%), were an average of 40 years old, and had between 3 and 4 children. There were 755 samples collected for syphilis, 791 for HIV, 866 for hepatitis B, and 859 for hepatitis C. Of these samples, 28 (3.70%) waste pickers had reagent serology for syphilis, 6 (0.75%) for HIV; 6 (0.69%) for acute hepatitis B and 1 (0.11%) for hepatitis C. Overall, this study identified the serological status of waste pickers; this information can be used to encourage waste pickers to seek health treatment for STIs and receive education to understand the risks associated with being exposed to medical waste or syringes.

Ground-based detection of an extended helium atmosphere in the Saturn-mass exoplanet WASP-69b.

Hot gas giant exoplanets can lose part of their atmosphere due to strong stellar irradiation, and these losses can affect their physical and chemical evolution. Studies of atmospheric escape from exoplanets have mostly relied on space-based observations of the hydrogen Lyman-α line in the far ultraviolet region, which is strongly affected by interstellar absorption. Using ground-based high-resolution spectroscopy, we detected excess absorption in the helium triplet at 1083 nanometers during the transit of the Saturn-mass exoplanet WASP-69b, at a signal-to-noise ratio of 18. We measured line blueshifts of several kilometers per second and posttransit absorption, which we interpret as the escape of part of the atmosphere trailing behind the planet in comet-like form.

Stellar aspects of habitability--characterizing target stars for terrestrial planet-finding missions.

We present and discuss the criteria for selecting potential target stars suitable for the search for Earth-like planets, with a special emphasis on the stellar aspects of habitability. Missions that search for terrestrial exoplanets will explore the presence and habitability of Earth-like exoplanets around several hundred nearby stars, mainly F, G, K, and M stars. The evaluation of the list of potential target systems is essential in order to develop mission concepts for a search for terrestrial exoplanets. Using the Darwin All Sky Star Catalogue (DASSC), we discuss the selection criteria, configuration-dependent subcatalogues, and the implication of stellar activity for habitability.

CoRoT measures solar-like oscillations and granulation in stars hotter than the Sun.

Oscillations of the Sun have been used to understand its interior structure. The extension of similar studies to more distant stars has raised many difficulties despite the strong efforts of the international community over the past decades. The CoRoT (Convection Rotation and Planetary Transits) satellite, launched in December 2006, has now measured oscillations and the stellar granulation signature in three main sequence stars that are noticeably hotter than the sun. The oscillation amplitudes are about 1.5 times as large as those in the Sun; the stellar granulation is up to three times as high. The stellar amplitudes are about 25% below the theoretic values, providing a measurement of the nonadiabaticity of the process ruling the oscillations in the outer layers of the stars.

Water vapour in the atmosphere of a transiting extrasolar planet.

Water is predicted to be among the most abundant (if not the most abundant) molecular species after hydrogen in the atmospheres of close-in extrasolar giant planets ('hot Jupiters'). Several attempts have been made to detect water on such planets, but have either failed to find compelling evidence for it or led to claims that should be taken with caution. Here we report an analysis of recent observations of the hot Jupiter HD 189733b (ref. 6) taken during the transit, when the planet passed in front of its parent star. We find that absorption by water vapour is the most likely cause of the wavelength-dependent variations in the effective radius of the planet at the infrared wavelengths 3.6 mum, 5.8 mum (both ref. 7) and 8 mum (ref. 8). The larger effective radius observed at visible wavelengths may arise from either stellar variability or the presence of clouds/hazes. We explain the report of a non-detection of water on HD 189733b (ref. 4) as being a consequence of the nearly isothermal vertical profile of the planet's atmosphere.

M stars as targets for terrestrial exoplanet searches and biosignature detection.

The changing view of planets orbiting low mass stars, M stars, as potentially hospitable worlds for life and its remote detection was motivated by several factors, including the demonstration of viable atmospheres and oceans on tidally locked planets, normal incidence of dust disks, including debris disks, detection of planets with masses in the 5-20 M() range, and predictions of unusually strong spectral biosignatures. We present a critical discussion of M star properties that are relevant for the long- and short-term thermal, dynamical, geological, and environmental stability of conventional liquid water habitable zone (HZ) M star planets, and the advantages and disadvantages of M stars as targets in searches for terrestrial HZ planets using various detection techniques. Biological viability seems supported by unmatched very long-term stability conferred by tidal locking, small HZ size, an apparent short-fall of gas giant planet perturbers, immunity to large astrosphere compressions, and several other factors, assuming incidence and evolutionary rate of life benefit from lack of variability. Tectonic regulation of climate and dynamo generation of a protective magnetic field, especially for a planet in synchronous rotation, are important unresolved questions that must await improved geodynamic models, though they both probably impose constraints on the planet mass. M star HZ terrestrial planets must survive a number of early trials in order to enjoy their many Gyr of stability. Their formation may be jeopardized by an insufficient initial disk supply of solids, resulting in the formation of objects too small and/or dry for habitability. The small empirical gas giant fraction for M stars reduces the risk of formation suppression or orbit disruption from either migrating or nonmigrating giant planets, but effects of perturbations from lower mass planets in these systems are uncertain. During the first approximately 1 Gyr, atmospheric retention is at peril because of intense and frequent stellar flares and sporadic energetic particle events, and impact erosion, both enhanced, the former dramatically, for M star HZ semimajor axes. Loss of atmosphere by interactions with energetic particles is likely unless the planetary magnetic moment is sufficiently large. For the smallest stellar masses a period of high planetary surface temperature, while the parent star approaches the main sequence, must be endured. The formation and retention of a thick atmosphere and a strong magnetic field as buffers for a sufficiently massive planet emerge as prerequisites for an M star planet to enter a long period of stability with its habitability intact. However, the star will then be subjected to short-term fluctuations with consequences including frequent unpredictable variation in atmospheric chemistry and surficial radiation field. After a review of evidence concerning disks and planets associated with M stars, we evaluate M stars as targets for future HZ planet search programs. Strong advantages of M stars for most approaches to HZ detection are offset by their faintness, leading to severe constraints due to accessible sample size, stellar crowding (transits), or angular size of the HZ (direct imaging). Gravitational lensing is unlikely to detect HZ M star planets because the HZ size decreases with mass faster than the Einstein ring size to which the method is sensitive. M star Earth-twin planets are predicted to exhibit surprisingly strong bands of nitrous oxide, methyl chloride, and methane, and work on signatures for other climate categories is summarized. The rest of the paper is devoted to an examination of evidence and implications of the unusual radiation and particle environments for atmospheric chemistry and surface radiation doses, and is summarized in the Synopsis. We conclude that attempts at remote sensing of biosignatures and nonbiological markers from M star planets are important, not as tests of any quantitative theories or rational arguments, but instead because they offer an inspection of the residues from a Gyr-long biochemistry experiment in the presence of extreme environmental fluctuations. A detection or repeated nondetections could provide a unique opportunity to partially answer a fundamental and recurrent question about the relation between stability and complexity, one that is not addressed by remote detection from a planet orbiting a solar-like star, and can only be studied on Earth using restricted microbial systems in serial evolution experiments or in artificial life simulations. This proposal requires a planet that has retained its atmosphere and a water supply. The discussion given here suggests that observations of M star exoplanets can decide this latter question with only slight modifications to plans already in place for direct imaging terrestrial exoplanet missions.

Coronal mass ejection (CME) activity of low mass M stars as an important factor for the habitability of terrestrial exoplanets. I. CME impact on expected magnetospheres of Earth-like exoplanets in close-in habitable zones.

Low mass M- and K-type stars are much more numerous in the solar neighborhood than solar-like G-type stars. Therefore, some of them may appear as interesting candidates for the target star lists of terrestrial exoplanet (i.e., planets with mass, radius, and internal parameters identical to Earth) search programs like Darwin (ESA) or the Terrestrial Planet Finder Coronagraph/Inferometer (NASA). The higher level of stellar activity of low mass M stars, as compared to solar-like G stars, as well as the closer orbital distances of their habitable zones (HZs), means that terrestrial-type exoplanets within HZs of these stars are more influenced by stellar activity than one would expect for a planet in an HZ of a solar-like star. Here we examine the influences of stellar coronal mass ejection (CME) activity on planetary environments and the role CMEs may play in the definition of habitability criterion for the terrestrial type exoplanets near M stars. We pay attention to the fact that exoplanets within HZs that are in close proximity to low mass M stars may become tidally locked, which, in turn, can result in relatively weak intrinsic planetary magnetic moments. Taking into account existing observational data and models that involve the Sun and related hypothetical parameters of extrasolar CMEs (density, velocity, size, and occurrence rate), we show that Earth-like exoplanets within close-in HZs should experience a continuous CME exposure over long periods of time. This fact, together with small magnetic moments of tidally locked exoplanets, may result in little or no magnetospheric protection of planetary atmospheres from a dense flow of CME plasma. Magnetospheric standoff distances of weakly magnetized Earth-like exoplanets at orbital distances

Coronal mass ejection (CME) activity of low mass M stars as an important factor for the habitability of terrestrial exoplanets. II. CME-induced ion pick up of Earth-like exoplanets in close-in habitable zones.

Atmospheric erosion of CO2-rich Earth-size exoplanets due to coronal mass ejection (CME)-induced ion pick up within close-in habitable zones of active M-type dwarf stars is investigated. Since M stars are active at the X-ray and extreme ultraviolet radiation (XUV) wave-lengths over long periods of time, we have applied a thermal balance model at various XUV flux input values for simulating the thermospheric heating by photodissociation and ionization processes due to exothermic chemical reactions and cooling by the CO2 infrared radiation in the 15 microm band. Our study shows that intense XUV radiation of active M stars results in atmospheric expansion and extended exospheres. Using thermospheric neutral and ion densities calculated for various XUV fluxes, we applied a numerical test particle model for simulation of atmospheric ion pick up loss from an extended exosphere arising from its interaction with expected minimum and maximum CME plasma flows. Our results indicate that the Earth-like exoplanets that have no, or weak, magnetic moments may lose tens to hundreds of bars of atmospheric pressure, or even their whole atmospheres due to the CME-induced O ion pick up at orbital distances