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STUDY QUESTION Can artificial intelligence (AI) algorithms developed to assist embryologists in evaluating embryo morphokinetics be enriched with multi-centric clinical data to better predict clinical pregnancy outcome? SUMMARY ANSWER Training algorithms on multi-centric clinical data significantly increased AUC compared to algorithms that only analyzed the time-lapse system (TLS) videos. WHAT IS KNOWN ALREADY Several AI-based algorithms have been developed to predict pregnancy, most of them based only on analysis of the time-lapse recording of embryo development. It remains unclear, however, whether considering numerous clinical features can improve the predictive performances of time-lapse based embryo evaluation. STUDY DESIGN, SIZE, DURATION A dataset of 9986 embryos (95.60% known clinical pregnancy outcome, 32.47% frozen transfers) from 5226 patients from 14 European fertility centers (in two countries) recorded with three different TLS was used to train and validate the algorithms. A total of 31 clinical factors were collected. A separate test set (447 videos) was used to compare performances between embryologists and the algorithm. PARTICIPANTS/MATERIALS, SETTING, METHODS Clinical pregnancy (defined as a pregnancy leading to a fetal heartbeat) outcome was first predicted using a 3D convolutional neural network that analyzed videos of the embryonic development up to 2 or 3 days of development (33% of the database) or up to 5 or 6 days of development (67% of the database). The output video score was then fed as input alongside clinical features to a gradient boosting algorithm that generated a second score corresponding to the hybrid model. AUC was computed across 7-fold of the validation dataset for both models. These predictions were compared to those of 13 senior embryologists made on the test dataset. MAIN RESULTS AND THE ROLE OF CHANCE The average AUC of the hybrid model across all 7-fold was significantly higher than that of the video model (0.727 versus 0.684, respectively, P = 0.015; Wilcoxon test). A SHapley Additive exPlanations (SHAP) analysis of the hybrid model showed that the six first most important features to predict pregnancy were morphokinetics of the embryo (video score), oocyte age, total gonadotrophin dose intake, number of embryos generated, number of oocytes retrieved, and endometrium thickness. The hybrid model was shown to be superior to embryologists with respect to different metrics, including the balanced accuracy (P ≤ 0.003; Wilcoxon test). The likelihood of pregnancy was linearly linked to the hybrid score, with increasing odds ratio (maximum P-value = 0.001), demonstrating the ranking capacity of the model. Training individual hybrid models did not improve predictive performance. A clinic hold-out experiment was conducted and resulted in AUCs ranging between 0.63 and 0.73. Performance of the hybrid model did not vary between TLS or between subgroups of embryos transferred at different days of embryonic development. The hybrid model did fare better for patients older than 35 years (P LIMITATIONS, REASONS FOR CAUTION Participant centers were located in two countries, thus limiting the generalization of our conclusion to wider subpopulations of patients. Not all clinical features were available for all embryos, thus limiting the performances of the hybrid model in some instances. WIDER IMPLICATIONS OF THE FINDINGS Our study suggests that considering clinical data improves pregnancy predictive performances and that there is no need to retrain algorithms at the clinic level unless they follow strikingly different practices. This study characterizes a versatile AI algorithm with similar performance on different time-lapse microscopes and on embryos transferred at different development stages. It can also help with patients of different ages and protocols used but with varying performances, presumably because the task of predicting fetal heartbeat becomes more or less hard depending on the clinical context. This AI model can be made widely available and can help embryologists in a wide range of clinical scenarios to standardize their practices. STUDY FUNDING/COMPETING INTEREST(S) Funding for the study was provided by ImVitro with grant funding received in part from BPIFrance (Bourse French Tech Emergence (DOS0106572/00), Paris Innovation Amorçage (DOS0132841/00), and Aide au Développement DeepTech (DOS0152872/00)). A.B.-C. is a co-owner of, and holds stocks in, ImVitro SAS. A.B.-C. and F.D.M. hold a patent for ‘Devices and processes for machine learning prediction of in vitro fertilization’ (EP20305914.2). A.D., N.D., M.M.F., and F.D.M. are or have been employees of ImVitro and have been granted stock options. X.P.-V. has been paid as a consultant to ImVitro and has been granted stocks options of ImVitro. L.C.-D. and C.G.-S. have undertaken paid consultancy for ImVitro SAS. The remaining authors have no conflicts to declare. TRIAL REGISTRATION NUMBER N/A.

Despite the relatively high frequency of Achilles ruptures, there is no general consensus on the optimal treatment method. A general trend toward more patients being treated nonoperatively has emerged recently with the advent of functional rehabilitation. However, much of the recent data on this subject has been highly variable. This systematic review focused on Achilles tendon rupture (ATR) treatment outcomes, with a focus on rerupture and complication rates. This systematic review specifically focused on articles regarding ATR treatment that also included rerupture and complication rates. Treatments were divided into three categories: open minimally invasive, open standard, and nonoperative. Bivariate analyses were performed to compare complication and rerupture rates among pairs of treatment options, as well as between early weight bearing versus immobilization. There was significantly higher complications for minimally invasive compared to nonoperative treatment (risk ratio [RR] = 4.4154; p 0.05), lower complication rates for minimally invasive compared to open treatment (RR = 0.3231; p 0.05), and higher complications for open standard compared to nonoperative treatment (RR = 5.6350; p 0.001). There were significantly lower rerupture rates in minimally invasive compared to nonoperative treatment (RR = 0.4085; p 0.001), a significantly lower rerupture rate in nonoperative treatment compared to open treatment (RR = 0.2282; p 0.001), and no significant difference in rerupture rates when comparing minimally invasive to open standard treatment. We found that operative treatment is associated with fewer reruptures and more complications than a nonoperative approach. Minimally invasive surgery appears to be associated with a lower rate of complications than open operative treatment.

STUDY QUESTION What number of staff is sufficient to perform increasingly complicated processes in today’s modern ART laboratories? SUMMARY ANSWER The adequate number of personnel required for the efficient and safe operation of modern ART laboratories needs to be calculated. WHAT IS KNOWN ALREADY In today’s modern ART laboratories, the amount of time required to perform increasingly complicated processes has more than doubled, with a downward trend in the amount of work an embryologist can do. Different workload unit values have been used to evaluate each workload task and efficiency in a particular ART laboratory, as well as to occasionally compare one laboratory with another. STUDY DESIGN, SIZE, DURATION Seven senior embryologists working at different IVF centers, three public and four private centers, participated in this multicenter study conducted between 2019 and 2020. We prepared a survey to create a calculator for staff using the average (of three attempts) time spent in every laboratory by each embryologist of the center to perform any ART process. PARTICIPANTS/MATERIALS, SETTING, METHODS Different laboratory processes and activities related to quality control, time spent and conventional human double witnessing were included in the survey. To calculate the number of processes that each embryologist can perform per year, an embryologist was considered to be having a full-time contract and working 7 or 8 h/day. The times included in the calculation of each task were those corresponding to the 95th percentile. For the calculations, Microsoft® Office Excel® Professional Plus 2019 was used. MAIN RESULTS AND THE ROLE OF CHANCE The survey showed that the time needed per embryologist to perform the different processes necessary for a classic IVF cycle without time lapse (TL) was 8.11 h, and with TL, it was 10.27 h. The calculated time also considered the time spent in documentation handling, cycle preparation, database management and conventional human double witnessing verification. An ICSI without TL needed 8.55 h, and with TL, it needed 10.71 h. An ICSI-PGT without a TL cycle needed 11.75 h, and with TL, it needed 13.91 h. Furthermore, 1.81 h should be added for every vitrification support needed. The time needed to control more than 200 critical steps, including equipment control and culture parameters, was 30 min per day plus 3.9 min per device to control. The time spent in semen analysis (including documentation handling, cycle preparation and database management) or intrauterine insemination with a partner sperm was 2.7 h. For donor sperm, an additional hour was required for the management involved. The time required to perform a testicular biopsy and cryopreserve the sample was 4 h. Similarly, the time required to perform seminal cryopreservation was 3.7 h. LIMITATIONS, REASONS FOR CAUTION The study was conducted considering a full-time contract embryologist working 7 or 8 h/day, 5 days a week, with days off according to the Spanish regulations. However, our findings can be adapted to foreign regulations using the developed online calculation platform. WIDER IMPLICATIONS OF THE FINDINGS A new advanced staff calculator allows any IVF laboratory to estimate the minimum number of embryologists necessary without compromising the security or success of the results. Nevertheless, we recommend a minimum of two qualified embryologists in every laboratory, regardless of the workload. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Asociación para el Estudio de la Biología de la Reproducción (ASEBIR). None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.

International audience; Recent developments have shown that coupling a Micromegas gaseous detector on a glass substrate with a transparent anode and a CMOS camera enables the optical readout of Micromegas detectors with a good spatial resolution, demonstrating that the glass Micromegas detector is well-suited for imaging. This feasibility test has been effectuated with low-energy X-ray photons also permitting energy resolved imaging. This test opens the way to different applications. Here we will focus on two applications. Namely, neutron imaging for non-destructive examination of highly gamma-ray emitting objects, such as irradiated nuclear fuel or radioactive waste. And secondly, we are developing a beta imager for the cell tagging in the field of anticancerous drug studies.Both applications require to design the detectors in view of the specific constraints of reactor dismantling and medical applications: spatial resolution and strong gamma suppression for neutron imaging and precise rate and energy spectrum measurements for the beta.A dedicated system consisting of a glass Micromegas detector and an ultrasensitive camera has been designed and assembled. Here we present the first results from the characterization of the detectors, as well as the first acquired images.

Inflammatory breast cancer (IBC) is one of the most lethal subtypes of breast cancer (BC), accounting for approximately 1–5% of all cases of BC. Challenges in IBC include accurate and early diagnosis and the development of effective targeted therapies. Our previous studies identified the overexpression of metadherin (MTDH) in the plasma membrane of IBC cells, further confirmed in patient tissues. MTDH has been found to play a role in signaling pathways related to cancer. However, its mechanism of action in the progression of IBC remains unknown. To evaluate the function of MTDH, SUM-149 and SUM-190 IBC cells were edited with CRISPR/Cas9 vectors for in vitro characterization studies and used in mouse IBC xenografts. Our results demonstrate that the absence of MTDH significantly reduces IBC cell migration, proliferation, tumor spheroid formation, and the expression of NF-κB and STAT3 signaling molecules, which are crucial oncogenic pathways in IBC. Furthermore, IBC xenografts showed significant differences in tumor growth patterns, and lung tissue revealed epithelial-like cells in 43% of wild-type (WT) compared to 29% of CRISPR xenografts. Our study emphasizes the role of MTDH as a potential therapeutic target for the progression of IBC.

This work describes the implementation of the Immersed Boundary Method (IBM) in a high order discontinuous Galerkin framework for the CFD solver Horses3D [1]. High order schemes are very attractive due to their low numerical dissipation, their capability of providing high-accurate solutions and higher efficiency for a given level of accuracy with respect to low order schemes. However, the generation of high order meshes needed by these schemes is still a bottleneck since it requires a large amount of time. IBM tries to tackle the problem by preserving the high order beneficial properties while avoiding the generation of complex meshes.

This work implements and analyses an Immersed Boundary Method based on Volume Pezalization for the flow simulator Airbus-CODA (CFD for ONERA, DLR, and AIRBUS). The Immersed Boundary Volume Penalization has unique advantages, e.g. easy to implement, straightforward formulation for moving geometries, and numerical errors can be controlled apriori [1, 2], showing the potential for aeronautical applications. Numerical experiments will assess the accuracy of the Immersed Boundary Volume Penalization in CODA.

Purpose The purpose of this study was to evaluate the effect of intraoperative scrub nurse handoffs on surgical times for arthroscopically-assisted anterior cruciate ligament (ACL) reconstructions and hip arthroscopies. Methods A retrospective chart review was done at a major, urban academic medical center for all patients who underwent arthroscopically-assisted ACL reconstructions and hip arthroscopies for femoroacetabular impingement syndrome between May 2014 and May 2020. All ACL reconstructions were performed by 1 of 6 sports medicine fellowship–trained surgeons, and all hip arthroscopies were performed by a single surgeon. Operative times, number of scrub nurse handoffs, surgeon, patient demographics, and procedure-specific information were recorded. The association between patient characteristics and the number of handoffs, as well as the association between patient characteristics and operative times, stratified by scrub nurse handoffs, were calculated. A multivariable linear regression was performed to assess the association between intra-operative handoffs and operative times. Results Eight hundred twenty ACL reconstructions and 269 hip arthroscopies were identified. Multivariable linear regression demonstrated increasing intraoperative scrub nurse handoffs were associated with increased operative times for all patients. For ACL reconstructions, when including all possible covariates, 1 scrub nurse handoff increased operative times by 21.1 minutes (95% confidence interval [CI]: 15.36 to 26.89; P < .001), and 2+ handoffs increased operative times by 34.2 minutes (95% CI: 26.28 to 42.15; P < .001). For hip arthroscopies, 1 scrub nurse handoff increased operative times by 7.0 minutes (95% CI: 0.31 to 13.74; P = .04). Conclusion Although a causal link cannot be made, intraoperative scrub nurse handoffs were associated with statistically significant increase in operative times for both ACL reconstructions and hip arthroscopies. Level of Evidence Level III, retrospective cohort study.

Background Reference left and right ventricular (LV/RV) volumes normalized to age and gender have been published. However, the relative dilation of the LV compared to the RV in patients with heart failure (HF) symptoms and its prognostic association have not been evaluated. Purpose The present study investigated the relative dilation of the LV compared to the RV among patients with HF and preserved LV ejection fraction (HFpEF). We explored the association between LV/RV ratio (defined as the ratio between LV end-diastolic volume index [LVEDVi] and RV end-diastolic volume index [RVEDVi]) and outcomes. Methods Clinical and imaging data from consecutive ambulatory patients diagnosed with HFpEF between April 2011 and November 2021, and undergoing a cardiac magnetic resonance examination were retrieved. The endpoints were 1) all-cause death or first HF hospitalization, and 2) cardiovascular death or first HF hospitalization, 3) repeated HF hospitalizations. Results A total of 159 patients (median age 58 years [interquartile range 49–69], 64% men) were included. Median LVEF was 60% (54–70%), and the LV/RV ratio was 1.21 (1.07–1.40). Over a 3.5-year follow-up (1.5–5.0), all-cause death or first HF hospitalization occurred in 23 patients (15%) and cardiovascular death or first HF hospitalization in 22 (14%). Spline curve analysis showed a bimodal relationship between LV/RV and both outcomes, with a steep increase in risk Conclusions Among patients with HFpEF, an RVEDVi larger than the LVEDVi, or an LVEDVi ≥40% larger than the RVEDVi were significantly associated with worse outcomes. Funding Acknowledgement Type of funding sources: None.

Background Accurate diagnosis of the underlying cause of myocardial infarction (MI) without obstructive coronary artery disease (MINOCA) is crucial. Cardiovascular magnetic resonance (CMR) plays an important role in the work up of patients with MINOCA. However, the timing of performance of CMR may impact on the diagnosis yield. Purpose To establish the diagnostic yield of CMR in a large cohort of patients admitted with MINOCA based on the timing of referral to CMR. Methods All patients referred to CMR from January 2009 to February 2022 with MINOCA were included. Studies were performed on a 1.5 T or 3T scanners. SSFP cines, T2-weighted black-blood fat-sat images and DE-segmented GE IR images 10–15 minutes after iv gadolinium-DTPA administration (0.15mmol/kg) were performed in 3 long-axis and 11–15 parallel short-axis views. All images were reviewed and analyzed off-line with specialized post-processing software. Results A total of 203 patients (median age 49 years, 60% men) with MINOCA diagnosis were included. Main ECG alterations were ST-segment elevation (STE) (57%) and T wave inversion (19%). Mean peak high sensitivity (HS)-TnI levels were 3706pg/mL. Median time to CMR was 7 days (5–9 days). Mean LVEF was 58% (range 18–83%) and mean LVEDVi 77 mL/m2 (range 35–210 mL/m2). Regional wall abnormalities were present in 123 patients (62%). High signal in T2w images was detected in 153 cases (75%) and late gadolinium enhancement (LGE) in 143cases (71%). Final CMR diagnosis resulted in myocarditis in 46%, MI in 20%, Takotsubo in 18%, and other cardiomyopathies in 6.4%. CMR was normal in 15 patients and not conclusive in 1. When CMR was performed within 7 days of admission (median: 5 days (4–6 days); n: 116 patients), the distribution of diagnoses was myocarditis in 53%, MI in 20%, Takotsubo in 16%, other cardiomyopathies in 6% and normal CMR in 4%. Whereas, if CMR was performed after 7 days (median: 10 days (8–12 days); n: 87 patients), the diagnoses were as flows: myocarditis in 36%, MI in 22%, Takotsubo 20%, cardiomyopathies in 7%, not conclusive in 1% and normal CMR in 13% (Table 1). Conclusions CMR led to the underlying diagnosis of MINOCA in 92% of patients. Myocarditis was the most frequent diagnosis. The final diagnosis of myocarditis was more frequent when CMR was performed within 7 days with a lesser percentage of normal CMR. Funding Acknowledgement Type of funding sources: None.

Background Patients with heart failure (HF) and reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) display variable grades of left ventricular (LV) dilation. LV end-diastolic diameter (LVEDD) and volume (LVEDV) may not be concomitantly increased. The respective prognostic implications of LV dilation have not been explored. Purpose To assess the prognostic implications of LVEDD and LVEDV index (LVEDVi) in HFrEF/HFmrEF. Methods Data from consecutive HF outpatients undergoing cardiovascular magnetic resonance (CMR) and with LV ejection fraction Results A total of 564 patients (79% men, median age 65 years [56–73], ischaemic aetiology in 32%) were included. HFrEF was present in 85% of patients, and HFmrEF in 15%. Median values for LVEDD and LVEDVi were 63 mm (58–69) and 124 mL/m2 (104–149) respectively. LVEDD was significantly correlated with LVEDVi (r=0.804, p58 mm was not (p=0.278). There was a trend toward an independent association between LV dilation based on LVEDVi and outcome adjusting for HFrEF/HFmrEF status and ischaemic aetiology (hazard ratio 2.10, 95% confidence interval 1.00–4.41, p=0.050). An independent association was not found for LV dilation based on LVEDD. An LVEDD >66 mm was associated with increased risk of CV death or HF hospitalization on spline curve analysis (Figure 11). All patients with an LVEDD >66 mm had also LV dilation based on LVEDVi. Conclusions In patients with HFrEF and HFmrEF, LV dilation based on LVEDVi does not always coincide with a dilated LVEDD. The cut-off value of LVEDD associated with an excess of the combined endpoint is much larger than the value used in clinical practice. However, in patients with dilated LV based on LVEDVi, LVEDD does not add to the risk stratification. Funding Acknowledgement Type of funding sources: None.

The fate and presence of nanoplastics in wastewater treatment systems is a topic of increasing interest. Furthermore, challenges related to their quantification and identification have made it difficult to set up experimental conditions and compare results between studies. In this study, the effect of 100 nm polystyrene nanoplastics on activated sludge was evaluated. A concentration of 2 μg/L was used to continuously feed a sequencing batch reactor (SBR-NPs). Under the experimental conditions used in this study, no changes were observed in the process performance of the SBR-NPs compared to the reactor used as a control. Neither nitrification nor organic matter removal efficiency, which was 96% for both SBRs, were affected by the presence of 100 nm polystyrene nanoplastics, which suggests that the tested nanoplastics were not sufficiently toxic to the biomass. Although no significant differences in the relative abundances of predominant phyla between SBR-Control and SBR-NPs were observed, a slight shift in the relative abundance of Patescibacteria (1.5 ± 0.6% and 3.7 ± 0.8% in SBR-Control and SBR-NPs, respectively, at the end of the test) occurred. The higher abundance of this phylum in SBR-NPs compared to SBR-Control may suggest that these bacteria have some sensitivity to the presence of 100 nm polystyrene nanoplastics. Furthermore, even with the absence of nitrification inhibition, it was observed stagnation of the growth of Nitrotoga bacteria in SBR-NPs, which also suggests that the polystyrene nanoplastics could have an inhibitory effect on these cells and an impact on nitrification in the long term.

Background Cardiovascular disease presents an increasing health burden to low- and middle-income countries. Although ample therapeutic options and care improvement frameworks exist to address its prime risk factor, hypertension, blood pressure control rates remain poor. We describe the results of an effectiveness study of a multisector urban population health initiative that targets hypertension in a real-world implementation setting in cities across three continents. The initiative followed the “CARDIO4Cities” approach (quality of Care, early Access, policy Reform, Data and digital technology, Intersectoral collaboration, and local Ownership). Method The approach was applied in Ulaanbaatar in Mongolia, Dakar in Senegal, and São Paulo in Brazil. In each city, a portfolio of evidence-based practices was implemented, tailored to local priorities and available data. Outcomes were measured by extracting hypertension diagnosis, treatment and control rates from primary health records. Data from 18,997 patients with hypertension in primary health facilities were analyzed. Results Over one to two years of implementation, blood pressure control rates among enrolled patients receiving medication tripled in São Paulo (from 12·3% to 31·2%) and Dakar (from 6·7% to 19·4%) and increased six-fold in Ulaanbaatar (from 3·1% to 19·7%). Conclusions This study provides first evidence that a multisectoral population health approach to implement known best-practices, supported by data and digital technologies, and relying on local buy-in and ownership, can improve hypertension control in high-burden urban primary care settings in low-and middle-income countries.

International audience; Due to their simplicity and accuracy for reconstructing particle trajectories, Micromegas (Micro-MEsh-GAseous Structure) and Gas Electron Multiplier (GEM) detectors are commonly used as readout systems in Time Projection Chambers (TPCs). The main limitation of these two types of detectors is the ion backflow (IBF), which may result in space charge in a TPC. We present in this article a new Micro-Pattern Gaseous Detector (MPGD) structure, which combines a micro-mesh and a set made of a GEM surmounted by a micro-mesh at only a few hundreds μm above. We report the performance results of two prototypes using this new structure, and compare them to a single Micromegas and a hybrid detector composed of a Micromegas and a GEM with a few millimeters gap. Finally, we show that this new detector is capable of reducing the ion backflow to less than 0.2% for a total gain of around 2000.

International audience; BabyIAXO is a helioscope under construction to search for an emission of the axion particle from the Sun. At the same time it serves as an intermediate stage towards the International Axion Observatory (IAXO). An integral component of this experiment is a low background X-ray detector with a high efficiency in the 1–10 keV energy range. Micromegas detectors are considered as baseline technology for BabyIAXO thanks to the relatively high efficiency and very low background level. Other detector technologies developed to reach better energy resolution while maintaining high efficiency and low background level are also under study. In this paper, we review the BabyIAXO design and present the analysis of data taken with the prototype of an IAXO Micromegas detector. A background level of 8.8×10−7counts keV−1cm−2s−1 was reached.

[EN] According to previous research, it has been proved that wastewater treatment plants (WWTPs) can retain more than 90 % of the MPs contained in wastewater. However, a significant fraction of the MPs removed in WWTPs is retained in the sludge floc and this may lead to an environmental issue since biosolids can be used as fertilizers. The purpose of this research was to evaluate how the presence of polyethylene (PE) could interfere with the activated sludge performance. For this, a sequencing batch reactor (SBR) was continuously fed during 93 days with synthetic sewage and PE microbeads. It was observed that 98 +/- 2% of the total amount of MPs that entered SBR was accumulated in the activated sludge. Despite the high accumulation of MPs in the sludge, the depuration performance of the reactor was not compromised. However, the presence of MPs decreased the richness (Chao1) and abundance-based coverage estimators (ACE) and diversity (Shannon) of the bacterial community on day 93. Based on the analysis of the diversity indices and the relative abundances of microbial taxa, it was concluded that MPs had selective effects on activated sludge microbial community. However, MPs did not affect the abundance of nitrifying and denitrifying bacteria in the sludge., Authors thank the Spanish Ministry of Science, Innovation and Universities for the financial support (Reference of the project: RTI2018-096916-B-I00)

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with 80% of that mortality occurring in low- and middle-income countries. Hypertension, its primary risk factor, can be effectively addressed through multisectoral, multi-intervention initiatives. However, evidence for the population-level impact on cardiovascular (CV) event rates and mortality, and the cost-effectiveness of such initiatives is scarce as long-term longitudinal data is often lacking. Here, we model the long-term population health impact and cost-effectiveness of a multisectoral urban population health initiative designed to reduce hypertension, conducted in Ulaanbaatar (Mongolia), Dakar (Senegal), and in the district of Itaquera in São Paulo (Brazil) in collaboration with the local governments. We based our analysis on cohort-level data among hypertensive patients on treatment and control rates from a real-world effectiveness study of the CARDIO4Cities approach (built on quality of care, early access, policy reform, data and digital, Intersectoral collaboration, and local ownership). We built a decision tree model to estimate the CV event rates during implementation (1–2 years) and a Markov model to project health outcomes over 10 years. We estimated the number of CV events averted and quality-adjusted life-years gained (QALYs through the initiative and assessed its cost-effectiveness based on the costs reported by the funder using the incremental cost effectiveness ratio (ICER) and published thresholds. A one-way sensitivity analysis was performed to assess the robustness of the results. The modelled patient cohorts included 10,075 patients treated for hypertension in Ulaanbaatar, 5,236 in Dakar, and 5,844 in São Paulo. We estimated that 3.3–12.8% of strokes and 3.0–12.0% of coronary heart disease (CHD) events were averted during 1–2 years of implementation in the three cities. We estimated that over the subsequent 10 years, 3.6–9.9% of strokes, 2.8–7.8% of CHD events, and 2.7–7.9% of premature deaths would be averted. The estimated ICER was USD 748 QALY gained in Ulaanbaatar, USD 3091 in Dakar, and USD 784 in São Paulo. With that, the intervention was estimated to be cost-effective in Ulaanbaatar and São Paulo. For Dakar, cost-effectiveness was met under WHO-CHOICE standards, but not under more conservative standards adjusted for purchasing power parity (PPP) and opportunity costs. The findings were robust to the sensitivity analysis. Our results provide evidence that the favorable impact of multisector systemic interventions designed to reduce the hypertension burden extend to long-term population-level CV health outcomes and are likely cost-effective. The CARDIO4Cities approach is predicted to be a cost-effective solution to alleviate the growing CVD burden in cities across the world.

Gas turbine performance models typically rely on component maps to characterize engine component performance throughout the operational regime. For the sub-idle case, the lack of reliable rig test data or inability to run design codes far from design conditions entails that component maps have to be generated from the extrapolation of existing data at higher speeds. This undermines the accuracy of whole-engine sub-idle performance models, at times impacting engine development and certification of aviation engines and the accuracy of start-up performance prediction in industrial gas turbines. One of the main components driving this issue is the core compression system, which can present operability concerns during light-up and which also sets the combustor airflow required for ignition. This paper presents, discusses, and draws on previous approaches to describe a method enabling the creation of sub-idle compressor maps from analytical and physical grounds. The method relies on the calculation of zero-speed and torque-free lines to generate a map down to zero speed along with analytical interpolation. A method for the interpolation process is described. A sensitivity study is carried out to assess the effects that different elements of the map generation process may have on the accuracy of the resulting performance calculation. Overall, a method for the generation of accurate, consistent maps from limited geometry data is identified. European Union: Horizon 2020 Clean Sky 2 Joint Undertaking

This paper describes the application of low-order models to the prediction of the steady performance of axial compressors at sub-idle conditions. An Euler body-force method employing sub-idle performance correlations is developed and presented alongside a mean-line approach employing the same set of correlations. The low-order tools are used to generate the characteristic lines of the compressor in the locked-rotor and zero-torque windmilling conditions. The results are compared against steady-state operating points from three-dimensional (3D) Reynolds-averaged Navier–Stokes (RANS) computational fluid dynamics (CFD) simulations. The accuracy of the low-order tools in reproducing the results from high-fidelity CFD is analysed, and the trade-off with the computational cost of each method is discussed. The low-order tools presented are shown to offer a fast alternative to traditional CFD which can be used to predict the performance in sub-idle conditions of a new compressor design during early development stages.

Background and objective The SolSano (HealthySun) project is a primary school sun education program that has been running in Aragon, Spain, since 2000. In the short term, it has proven to be effective at promoting sun protection behaviors and heightening awareness in childhood. The aim of this study was to evaluate the long-term effectiveness of the SolSano program. Participants and methods Retrospective, observational, analytical, cohort study of students at the University of Zaragoza between 2015 and 2016. The students answered a previously validated, purpose-designed, online questionnaire. We calculated descriptive statistics for all variables and performed bivariate and multivariate analyses to test for differences between students who had attended a primary school that ran the SolSano program and those who had not. Results Data for 324 students were analyzed. Mean age was 22.9 years and 78% of the respondents were women. In total, 44% of the students had participated in the SolSano program at primary school. Half of the respondents (50.5%) had experienced 1 or 2 sunburn episodes the previous summer. Significant differences were only observed for some aspects addressed by the questionnaire between SolSano participants and nonparticipants. Conclusions This is the first study to evaluate the long-term effectiveness (15 years) of a primary school sun protection program. The absence of significant differences in our sample might be explained by non-continuation of the program into adolescence and the existence of sun protection campaigns outside the school.

El consumo de benzodiazepinas (BZD) ha crecido ininterrumpidamente en Espana desde los anos 90. La mitad de los pacientes mayores de 85 anos, y el 2 % de los adolescentes entre 15 y 19 anos han estado tratados con BZD (1). Ninguna indicacion clinica justifica la prescripcion prolongada de BZD; sin embargo, su uso prolongado es muy frecuente (2). La paciente estaba en tratamiento con alprazolam desde hace 14 anos. Durante un ano, redujo la dosis partiendo comprimidos de alprazolam 0,5 mg hasta llegar a una pauta de 0,25/0/0,25. Queria dejar la medicacion y acudio a su medico para que le prescribiera alguna alternativa. El tratamiento para la deshabituacion de benzodiazepinas (BZD) es la disminucion progresiva de la dosis, pero la no existencia de presentaciones comercializadas con las dosis necesarias complica la implementacion del tratamiento. El medico nos consulta si podiamos hacer algo al respecto.

Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented.