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

Aim: 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. // Method: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. // Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). // Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks

Nonlinear observers for predicting state-of-charge and state-of-health of lead-acid batteries for hybrid-electric vehicles

Abstract—This paper describes the application of state-estimation techniques for the real-time prediction of the state-of-charge (SoC) and state-of-health (SoH) of lead-acid cells. Specifically, approaches based on the well-known Kalman Filter (KF) and Extended Kalman Filter (EKF), are presented, using a generic cell model, to provide correction for offset, drift, and long-term state divergence—an unfortunate feature of more traditional coulomb-counting techniques. The underlying dynamic behavior of each cell is modeled using two capacitors (bulk and surface) and three resistors (terminal, surface, and end), from which the SoC is determined from the voltage present on the bulk capacitor. Although the structure of the model has been previously reported for describing the characteristics of lithium-ion cells, here it is shown to also provide an alternative to commonly employed models of lead-acid cells when used in conjunction with a KF to estimate SoC and an EKF to predict state-of-health (SoH). Measurements using real-time road data are used to compare the performance of conventional integration-based methods for estimating SoC with those predicted from the presented state estimation schemes. Results show that the proposed methodologies are superior to more traditional techniques, with accuracy in determining the SoC within 2% being demonstrated. Moreover, by accounting for the nonlinearities present within the dynamic cell model, the application of an EKF is shown to provide verifiable indications of SoH of the cell pack

Observer techniques for estimating the state-of-charge and state-of-health of VRLABs for hybrid electric vehicles

The paper describes the application of observer-based state-estimation techniques for the real-time prediction of state-of-charge (SoC) and state-of-health (SoH) of lead-acid cells. Specifically, an approach based on the well-known Kalman filter, is employed, to estimate SoC, and the subsequent use of the EKF to accommodate model non-linearities to predict battery SoH. The underlying dynamic behaviour of each cell is based on a generic Randles' equivalent circuit comprising of two-capacitors (bulk and surface) and three resistors, (terminal, transfer and self-discharging). The presented techniques are shown to correct for offset, drift and long-term state divergence-an unfortunate feature of employing stand-alone models and more traditional coulomb-counting techniques. Measurements using real-time road data are used to compare the performance of conventional integration-based methods for estimating SoC, with those predicted from the presented state estimation schemes. Results show that the proposed methodologies are superior with SoC being estimated to be within 1% of measured. Moreover, by accounting for the nonlinearities present within the dynamic cell model, the application of an EKF is shown to provide verifiable indications of SoH of the cell pack

State-of-charge and state-of-health prediction of lead-acid batteries for hybrid electric vehicles using non-linear observers

The paper describes the application of state-estimation techniques for the real-time prediction of state-of-charge (SoC) and state-of-health (SoH) of lead-acid cells. Approaches based on the extended Kalman filter (EKF) are presented to provide correction for offset, drift and state divergence - an unfortunate feature of more traditional coulomb-counting techniques. Experimental results are employed to demonstrate the relative attributes of the proposed methodolog

Sensorless control of deep-sea ROVs PMSMs excited by matrix converters

The paper reports the development of model-based sensorless control methodologies for driving PMSMs using matrix converters. In particular, experimental results show that observer-based state-estimation techniques normally employed for sensorless control of PMSMs using voltage source inverters (VSIs), can be readily exported to matrix converter counterparts with minimal additional computational overhead. Furthermore, zero speed start-up and speed reversal are experimentally demonstrated. Finally, the observer is designed to be fault tolerant such that upon detection of a broken terminal (phase fault), the PMSM remains operational and could be utilized to provide a limp-home capabilit

Multicentre observational cohort study of NSAIDs as risk factors for postoperative adverse events in gastrointestinal surgery

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as postoperative analgesia by the Enhanced Recovery After Surgery Society. Recent studies have raised concerns that NSAID administration following colorectal anastomosis may be associated with increased risk of anastomotic leak. This multicentre study aims to determine NSAIDs' safety profile following gastrointestinal resection. Methods and analysis: This prospective, multicentre cohort study will be performed over a 2-week period utilising a collaborative methodology. Consecutive adults undergoing open or laparoscopic, elective or emergency gastrointestinal resection will be included. The primary end point will be the 30-day morbidity, assessed using the Clavien-Dindo classification. This study will be disseminated through medical student networks, with an anticipated recruitment of at least 900 patients. The study will be powered to detect a 10% increase in complication rates with NSAID use. Ethics and dissemination: Following the Research Ethics Committee Chairperson's review, a formal waiver was received. This study will be registered as a clinical audit or service evaluation at each participating hospital. Dissemination will take place through previously described novel research collaborative networks

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

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

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population. Trial registration: ClinicalTrials.gov NCT04509986

Should Soft Tissue Sarcomas be Treated at a Specialist Centre?

Objective. We have investigated whether there is evidence that patients with soft tissue sarcomas do better if treated in a specialist centre compared with district general hospitals