30 research outputs found

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

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    This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

    Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

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    : The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

    Determinación de la viscosidad de fluidos newtonianos y no newtonianos (una revisión del viscosímetro de Couette)

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    Newtonian viscosity is studied in the theoretical and laboratory courses of physics of fluids in natural sciences and engineering. Because of the increasing use of Non-Newtonian fluids is necessary to include them in these courses. To driving experiences that enable to the students to distinguish between Newtonian and non-Newtonian fluids will allow to improve their knowledge about fluids. The purpose of this work is to give a didactic tool to differentiate between Newtonian and Non-Newtonian fluids by using their flow curves. In addition, the details of a concentric cylinders viscometer (Couette Viscometer) construction of low cost are shown, the which one can be manufactured by the students. Finally, the characterization of two commercial fluids is included.En los cursos elementales de física de fluidos, teóricos y de laboratorio, a nivel licenciatura e ingeniería, se estudia el tema de viscosidad haciendo referencia únicamente a los fluidos newtonianos. Sin embargo, el creciente empleo de fluidos no newtonianos, obliga a incluir el estudio de este tipo de fluidos. Por lo que conducir experiencias que permitan al estudiante distinguir entre los fluidos newtonianos y no newtonianos ampliará su conocimiento general en este tema. El objetivo de este trabajo es dar una herramienta didáctica para diferenciar entre fluidos newtonianos y no newtonianos a partir de las curvas de flujo. Además, se presentan detalles para la construcción de un viscosímetro de cilindros concéntricos (de Couette) de bajo costo, el cual puede ser fabricado por los mismos estudiantes. Finalmente, se muestran los resultados de la caracterización viscosa de dos fluidos comerciales usando el viscosímetro construido

    CVN impact energy and fracture characteristics correlations with different oxide nanoparticles improving submerged arc welds

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    The main aim of this research is to correlate the toughness improvement with fracture features of tested Charpy V-Notch impact specimens obtained from submerged arc welds enriched by different oxide nanoparticles (TiO _2 , SiO _2 , Al _2 O _3 and Mn _2 O _3 ). Through Scanning Electron Microscopy (SEM) fractography, fracture features were determined, which are the shear fracture percent, the loading angle, as well as the diameter of dimples and the width of cleavage sheets at ductile and brittle fracture regions, respectively. It was observed an increase of the Charpy V-Notch impact energy with the decrease of loading angle and the average diameter of dimples, as well as with the increase of its shear fractures percents. Moreover, it was correlated the increase of Acicular Ferrite surface density with the decrease of width of cleavage sheets. Thus, the toughness of the submerged arc welds can be improved by adding TiO _2 , SiO _2 , Al _2 O _3 or Mn _2 O _3 nanoparticles

    Structural Roles of TiO2 in CaF2-SiO2-CaO-TiO2 Submerged Arc Welding Fluxes

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    A series of fused CaF2-SiO2-CaO-based fluxes geared towards submerged arc welding has been prepared with incremental TiO2 additions. Through systematic investigation on physical properties, quantitative relationship between TiO2 content and corresponding structural information has been established, and the roles played by TiO2 have been profiled. It is found that TiO2 has been introduced into the silicate network by acting as network-former, increasing the degree of polymerization while lowering the strength of the flux.The National Natural Science Foundation of China, Newton Advanced Fellowship by the Royal Society , Special Fund for Key Program of Science and Technology of Liaoning Province, Research Fund for Central Universities, Xingliao Talents Program and State Key Laboratory of Metal Material for Marine Equipment and Application.http://link.springer.com/journal/116632021-08-20am2021Materials Science and Metallurgical Engineerin

    When Health Systems Are Barriers to Health Care: Challenges Faced by Uninsured Mexican Kidney Patients

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    BACKGROUND: Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. METHODS: The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. RESULTS: In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. CONCLUSIONS: Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort

    Correction: Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study (World Journal of Surgery, (2022), 46, 9, (2021-2035), 10.1007/s00268-022-06649-z)

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    In the original online version of this article Oreste Claudio Buonomo’s family name was misspelled. The original article was corrected
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