Evidence of the Practice of Self-Medication with Antibiotics among the Lay Public in Low- and Middle-Income Countries: A Scoping Review

The current scoping review is an attempt to explore the key reasons, determinants, patterns and prevalence related to self-medication with antibiotics (SMA) among the lay public. An online search was conducted using Google Scholar, Science Direct, ProQuest and PubMed. A two-phase mapping approach was used. In the first phase, studies were screened. In the second phase, the data were extracted from selected studies followed by the assessment of data quality. A total of 24 studies were included; 20 were cross-sectional, 3 were qualitative and one was observational. The most common indications were flu, cough, common colds, sore throat, diarrhea, toothache and fever. The most common determinants reported were past good experience and suggestions from friends or relatives. The use of SMA was observed to be more frequent in younger aged individuals belonging to low- or middle-income groups. The prevalence rate was reported to be high among the South Asian lay public and may be a major contributor to antibiotic resistance. In conclusion, this scoping review identifies a need for education campaigns and mass media campaigns to strengthen lay public awareness about the side effects and risks associated with SMA. In addition to this, there is a need to implement strict policies by government agencies to restrict over the counter availability of antibiotics

Protective effect of Arque-Ajeeb on acute experimental diarrhoea in rats

BACKGROUND: Diarrhoea is a major health problem for children worldwide, accounting for 5–8 million deaths each year. Arque-Ajeeb (AA) is a compound formulation of Unani medicine. It is reputed for its beneficial effects in the treatment of diarrhoea and cholera, but the claim of its efficacy is yet to be tested. Therefore the present study has been planned to investigate the real efficacy of this drug in rats. METHODS: The effect of Arque-Ajeeb was investigated for antidiarrhoeal activity against charcoal-induced gut transit, serotonin-induced diarrhoea and PGE(2)-induced small intestine enteropooling in rats. The control, standard and test groups of experimental animals were administered with normal saline (p.o.), diphenoxylate hydrochloride (5 mg/kg, p.o.) and Arque-Ajeeb (0.07 ml and 0.14 ml/kg, p.o.) respectively except the control group of PGE(2)-induced small intestine enteropooling which received only 5% ethanol in normal saline (i.p.). Charcoal (10 ml/kg, p.o.) and serotonin (600 μg/kg, i.p.) were administered after 30 min, while PGE(2 )(100 μg/kg, p.o.) was administered immediately afterwards. The distance traveled by charcoal in small intestine was measured after 15 and 30 min of charcoal administration, diarrhoea was observed every 30-min for six hour after serotonin administration and the volume of intestinal fluid was measured after 30 min of PGE(2 )administration. RESULTS: Arque-Ajeeb (0.07 ml and 0.14 ml/kg) significantly inhibited the frequency of defaecation and decreased the propulsion of charcoal meal through the gastrointestinal tract, reduced the wetness of faecal droppings in serotonin-induced diarrhoea and also reduced the PGE(2)-induced small intestine enteropooling. CONCLUSION: Arque-Ajeeb may have potential to reduce the diarrhoea in rats. Thus the drug may prove to be an alternate remedy in diarrhoea

Reflectance response of tapered optical fiber coated with graphene oxide nanostructured thin film for aqueous ethanol sensing

In this work, optical sensing performance of tapered multimode fiber tip coated with graphene oxide (GO) nanostructured thin film towards aqueous ethanol with different concentrations is investigated. The tapering process of the optical fiber is done by a glass processing machine. The multimode optical fiber tip is dip-coated with GO and annealed at 70 °C to enhance the binding of the nanomaterials to the silica fiber. FESEM, Raman microscopy and XRD analyses are performed to micro-characterize the GO thin films. The morphology of the GO is observed to be in sheets forms. The reflectance response of the GO coated fiber tip is compared with the uncoated tip. The measurements are taken using a spectrophotometer in the optical wavelength range of 550–720 nm. The reflectance response of the GO coated fiber tip reduced proportionally, upon exposure to ethanol with concentration range of 5–80%. The dynamic response of the developed sensor showed strong reversibility and repeatability when it is exposed to ethanol with concentrations of 5%, 20% and 40% in distilled water. At room temperature, the sensor shows fast response and recovery as low as 19 and 25 s, respectively

Simple and efficient expression of Agaricus meleagris pyranose dehydrogenase in Pichia pastoris

Pyranose dehydrogenase (PDH) is a fungal flavin-dependent sugar oxidoreductase that is highly interesting for applications in organic synthesis or electrochemistry. The low expression levels of the filamentous fungus Agaricus meleagris as well as the demand for engineered PDH make heterologous expression necessary. Recently, Aspergillus species were described to efficiently secrete recombinant PDH. Here, we evaluate recombinant protein production with expression hosts more suitable for genetic engineering. Expression in Escherichia coli resulted in no soluble or active PDH. Heterologous expression in the methylotrophic yeast Pichia pastoris was investigated using two different signal sequences as well as a codon-optimized sequence. A 96-well plate activity screening for transformants of all constructs was established and the best expressing clone was used for large-scale production in 50-L scale, which gave a volumetric yield of 223 mg L−1 PDH or 1,330 U L−1 d−1 in space–time yield. Purification yielded 13.4 g of pure enzyme representing 95.8% of the initial activity. The hyperglycosylated recombinant enzyme had a 20% lower specific activity than the native enzyme; however, the kinetic properties were essentially identical. This study demonstrates the successful expression of PDH in the eukaryotic host organism P. pastoris paving the way for protein engineering. Additionally, the feasibility of large-scale production of the enzyme with this expression system together with a simplified purification scheme for easy high-yield purification is shown

A hybrid MBE-based growth method for large-area synthesis of stacked hexagonal boron nitride/graphene heterostructures

Van der Waals heterostructures combining hexagonal boron nitride (h-BN) and graphene offer many potential advantages, but remain difficult to produce as continuous films over large areas. In particular, the growth of h-BN on graphene has proven to be challenging due to the inertness of the graphene surface. Here we exploit a scalable molecular beam epitaxy based method to allow both the h-BN and graphene to form in a stacked heterostructure in the favorable growth environment provided by a Ni(111) substrate. This involves first saturating a Ni film on MgO(111) with C, growing h-BN on the exposed metal surface, and precipitating the C back to the h-BN/Ni interface to form graphene. The resulting laterally continuous heterostructure is composed of a top layer of few-layer thick h-BN on an intermediate few-layer thick graphene, lying on top of Ni/MgO(111). Examinations by synchrotron-based grazing incidence diffraction, X-ray photoemission spectroscopy, and UV-Raman spectroscopy reveal that while the h-BN is relaxed, the lattice constant of graphene is significantly reduced, likely due to nitrogen doping. These results illustrate a different pathway for the production of h-BN/graphene heterostructures, and open a new perspective for the large-area preparation of heterosystems combining graphene and other 2D or 3D materials

Patient-reported outcome measures of the impact of cancer on patient’s everyday lives: a systematic review

Purpose: Patients with advanced disease are living longer and commonly used patient-reported outcome measures (PROMs) may miss relevant elements of the quality of extended survival. This systematic review examines the measures used to capture aspects of the quality of survival including impact on patients’ everyday lives such as finances, work and family roles. Methods: Searches were conducted in MEDLINE, EMBASE, CINAHL and PsycINFO restricted to English language articles. Information on study characteristics, instruments and outcomes was systematically extracted and synthesised. A predefined set of criteria was used to rate the quality of studies. Results: From 2761 potentially relevant articles, 22 met all inclusion criteria, including 10 concerning financial distress, 3 on roles and responsibilities and 9 on multiple aspects of social well-being. Generally, studies were not of high quality; many lacked bias free participant selection, had confounding factors and had not accounted for all participants. High levels of financial distress were reported and were associated with multiple demographic factors such as age and income. There were few reports concerned with impacts on patients’ roles/responsibilities in everyday life although practical and emotional struggles with parenting were identified. Social difficulties were common and associated with multiple factors including being a caregiver. Many studies were single time-point surveys and used non-validated measures. Exceptions were employment of the COST and Social Difficulties Inventory (SDI), validated measures of financial and social distress respectively. Conclusions: Impact on some important parts of patients’ everyday lives is insufficiently and inconsistently captured. Further PROM development focussing on roles and responsibilities, including work and caring for dependents, is warranted. Implications for Cancer Survivors: Factors such as finances, employment and responsibility for caring for dependents (e.g. children and elderly relatives) can affect the well-being of cancer survivors. There is a need to ensure that any instruments used to assess patients’ social well-being are broad enough to include these areas so that any difficulties arising can be better understood and appropriately supported

The Regulation of MS-KIF18A Expression and Cross Talk with Estrogen Receptor

This study provides a novel view on the interactions between the MS-KIF18A, a kinesin protein, and estrogen receptor alpha (ERα) which were studied in vivo and in vitro. Additionally, the regulation of MS-KIF18A expression by estrogen was investigated at the gene and protein levels. An association between recombinant proteins; ERα and MS-KIF18A was demonstrated in vitro in a pull down assay. Such interactions were proven also for endogenous proteins in MBA-15 cells were detected prominently in the cytoplasm and are up-regulated by estrogen. Additionally, an association between these proteins and the transcription factor NF-κB was identified. MS-KIF18A mRNA expression was measured in vivo in relation to age and estrogen level in mice and rats models. A decrease in MS-KIF18A mRNA level was measured in old and in OVX-estrogen depleted rats as compared to young animals. The low MS-KIF18A mRNA expression in OVX rats was restored by estrogen treatment. We studied the regulation of MS-KIF18A transcription by estrogen using the luciferase reporter gene and chromatin immuno-percipitation (ChIP) assays. The luciferase reporter gene assay demonstrated an increase in MS-KIF18A promoter activity in response to 10−8 M estrogen and 10−7M ICI-182,780. Complimentary, the ChIP assay quantified the binding of ERα and pcJun to the MS-KIF18A promoter that was enhanced in cells treated by estrogen and ICI-182,780. In addition, cells treated by estrogen expressed higher levels of MS-KIF18A mRNA and protein and the protein turnover in MBA-15 cells was accelerated. Presented data demonstrated that ERα is a defined cargo of MS-KIF18A and added novel insight on the role of estrogen in regulation of MS-KIF18A expression both in vivo and in vitro

METIS research advances towards the 5G mobile and wireless system definition

[EN] The Mobile and wireless communications Enablers for the Twenty-twenty Information Society (METIS) project is laying the foundations of Fifth Generation (5G) mobile and wireless communication system putting together the point of view of vendors, operators, vertical players, and academia. METIS envisions a 5G system concept that efficiently integrates new applications developed in the METIS horizontal topics and evolved versions of existing services and systems. This article provides a first view on the METIS system concept, highlights the main features including architecture, and addresses the challenges while discussing perspectives for the further research work.Part of this work has been performed in the framework of the FP7 project ICT-317669 METIS, which is partly funded by the European Commission. The authors would like to acknowledge the contributions of their colleagues in METIS with special thanks to Petar Popovski, Peter Fertl, David Gozalvez-Serrano, Andreas Hoglund, Zexian Li, and Krystian Pawlak. Also thanks to Josef Eichinger and Malte Schellmann for the fruitful discussions during the revision of this article.Monserrat Del Río, JF.; Mange, G.; Braun, V.; Tullberg, H.; Zimmermann, G.; Bulakci, O. (2015). METIS research advances towards the 5G mobile and wireless system definition. EURASIP Journal on Wireless Communications and Networking. 2015(53):1-16. https://doi.org/10.1186/s13638-015-0302-9S116201553Cisco, in Global Mobile Data Traffic Forecast Update, 2014–2019 White Paper, February 2015. http://www.cisco.com/c/en/us/solutions/collateral/service-provider/visual-networking-index-vni/white_paper_c11-520862.pdfMETIS, in Mobile and wireless communications Enablers for the Twenty-twenty Information Society, EU 7th Framework Programme project, http://www.metis2020.com .ICT-317669 METIS project, in Scenarios, requirements and KPIs for 5G mobile and wireless system, Deliverable D1.1, May 2013, https://www.metis2020.com/documents/deliverables/B Ahlgren, C Dannewitz, C Imbrenda, D Kutscher, B Ohlman, A survey of information-centric networking. IEEE Commun Mag 50(7), 26–36 (2012)A Osseiran, F Boccardi, V Braun, K Kusume, P Marsch, M Maternia, O Queseth, M Schellmann, H Schotten, H Taoka, H Tullberg, MA Uusitalo, B Timus, M Fallgren, Scenarios for the 5G mobile and wireless communications: the vision of the METIS project. IEEE Commun Mag 52(5), 26–35 (2014)D Gomez-Barquero, D Calabuig, JF Monserrat, N Garcia and J Perez-Romero, Hopfield neural network - based approach for joint dynamic resource allocation in heterogeneous wireless networks, in Proceedings 64th IEEE Vehicular Technology Conference (VTC), Montreal. 2006JF Monserrat, P Sroka, G Auer, J Cabrejas, D Martin-Sacristan, A Mihovska, R Rossi, A. Saul, R. Schoenen, Advanced Radio Resource Management for IMT-Advanced in WINNER+ (II), in Proc. Future Network and Mobile Summit, pp.1-9, June 2010.F Boccardi, RW Heath, A Lozano, TL Marzetta, P Popovski, Five disruptive technology directions for 5G. IEEE Commun Mag 52(2), 74–80 (2014)JG Andrews, S Buzzi, C Wan, SV Hanly, A Lozano, ACK Soong, JC Zhang, What will 5G be? IEEE J Sel Area Comm 32(6), 1065–1082 (2014)MN Tehrani, M Uysal, H Yanikomeroglu, Device-to-device communication in 5G cellular networks: challenges, solutions, and future directions. IEEE Commun Mag 52(5), 86–92 (2014)N Bhushan, L Junyi, D Malladi, R Gilmore, D Brenner, A Damnjanovic, R Sukhavasi, C Patel, S Geirhofer, Network densification: the dominant theme for wireless evolution into 5G. IEEE Commun Mag 52(2), 82–89 (2014)K Okino, T Nakayama, C Yamazaki, H Sato, Y Kusano, Pico Cell Range Expansion with Interference Mitigation toward LTE-Advanced Heterogeneous Networks, in Proc. of IEEE International Conference on Communications (ICC), 2011.P Mugen, L Dong, W Yao, L Jian Li, C Hsiao-Hwa, Self-configuration and self-optimization in LTE-advanced heterogeneous networks. IEEE Commun Mag 51(5), 36–45 (2013)I Siomina, D Yuan, Load Balancing in Heterogeneous LTE: Range Optimization via Offset and Load-coupling Characterization, in Proc. of IEEE Int. Conference on Communications (ICC). June 2012.KI Pedersen, Y Wang, B Soret, F Frederiksen, eICIC Functionality and Performance for LTE HetNet Co-Channel Deployments, in Proc. of IEEE Vehicular Technology Conf, Sep 2012X Gu, X Deng, Q Li, L Zhang, W Li, Capacity Analysis and Optimization in Heterogeneous Network with Adaptive Cell Range Control, Int. J. Antennas. Propag. 2014(215803), 10 (2014)K Smiljkovikj, P Popovski, L Gavrilovska, Analysis of the Decoupled Access for DL and UL in Wireless Heterogeneous Networks, in IEEE Wireless Communications Letters, in press, doi:10.1109/LWC.2015.2388676.P Agyapong, M. Iwamura, D. Staehle, W. Kiess, A. Benjebbour, Design considerations for a 5G network architecture. IEEE Commun Mag 52(11), 65–75 (2014)L Yan, X Fang, Reliability Evaluation of 5G C/U-plane Decoupled Architecture for High-speed Railway. EURASIP J Wirel Commun Netw 2014, 127 (2014)B Zafar, S Gherekhloo, M Haardt, Analysis of multihop relaying networks: communication between range-limited and cooperative nodes. IEEE Veh Technol Mag 7(3), 40–47 (2012)Study on Mobile Relay for Evolved Universal Terrestrial Radio Access (E-UTRA), 3GPP TR 36.836, V2.0.2, July 2013.A Krendzel, LTE-A Mobile Relay Handling: Architecture Aspects, in Proc. of the 19th European Wireless Conference (EW), Guildford, UK, pp. 1–6, 2013.M Khanfouci, Y Sui, A Papadogiannis, and M Färber, Moving Relays and Mobility aspects, ARTIST4G project deliverable D3.5c-v2.0, 2012.F Haider, M Dianati, and R Tafazolli, A Simulation Based Study of Mobile Femtocell Assisted LTE Networks, in Proc. Of the 7th International Wireless Communications and Mobile Computing Conference (IWCMC), Istanbul, Turkey, pp. 2198–2203, 2011F Haider, W Haiming, H Haas, Y Dongfeng, W Haiming, G Xiqi, Y Xiao-Hu, E Hepsaydir, Spectral efficiency enalysis of mobile Femtocell based cellular systems, in Proc. of the 13th International Conference on Communication Technology (ICCT), Jinan, pp. 347–351, September 2011.ICT-317669 METIS project, Initial report on horizontal topics, first results and 5G system concept, Deliverable D6.2, April 2014, https://www.metis2020.com/documents/deliverables/Study on LTE Device to Device Proximity Services, 3GPP TR 36.843, 2014.V Yazıcı, UC Kozat, M Oguz, Sunay, A new control plane for 5G network architecture with a case study on unified handoff, mobility, and routing management. IEEE Commun Mag 52(11), 76–85 (2014)F Malandrino, C Casetti, C-F Chiasserini, Toward D2D-enhanced heterogeneous networks. IEEE Commun Mag 52(11), 94–100 (2014)A Asadi, Q Wang, V Mancuso, A survey on device-to-Device communication in cellular networks. IEEE Commun Surv Tutor 16(4), 1801–1819 (2014)D Feng, L Lu, YY Wu, GY Li, G Feng, S Li, Device-to-device communications underlaying cellular networks. IEEE Trans Commun 61(8), 3541–3551 (2013)C Xu, L Song, Z Han, Q Zhao, X Wang, X Cheng, B Jiao, Efficiency resource allocation for device-to-device underlay communication systems: a reverse iterative combinatorial auction based approach. IEEE J Sel Area Comm 31(9), 348–358 (2013)S Lingyang, D Niyato, H Zhu, E Hossain, Game-theoretic resource allocation methods for device-to-device communication. IEEE Wireless Commun 21(3), 136–144 (2014)G Aloi, M Di Felice, V Loscrì, P Pace, G Ruggeri, Spontaneous smartphone networks as a user-centric solution for the future internet. IEEE Commun Mag 52(12), 26–33 (2014)PA Frangoudis, GC Polyzos, Security and performance challenges for user-centric wireless networking. IEEE Commun Mag 52(12), 48–55 (2014)ITU-R M.2079, in Technical and operational information for identifying Spectrum for the terrestrial component of future development of IMT-2000 and IMT-Advanced, 2006AB MacKenzie, LA DaSilva, Application of signal processing to addressing wireless data demand [in the spotlight]. IEEE Signal Process Mag 29(6), 168–166 (2012)X Cheng, Y Koucheryavy, Y Li, F Zhao, T Znati (ed.), Dynamic Spectrum Access for Throughput, Delay, and Fairness Enhancement In Cognitive Radio Networks, EURASIP J Wirel Commun Netw, November 2014MR Akdeniz, Y Liu, MK Samimi, S Sun, S Rangan, TS Rappaport, E Erkip, Millimeter wave channel modeling and cellular capacity evaluation. IEEE J Sel Area Comm 32(6), 1164–1179 (2014)A Adhikary, E Al Safadi, M Samimi, R Wang, G Caire, TS Rappaport, AF Molisch, Joint spatial division and multiplexing for mm-wave channels. IEEE J Sel Area Comm 32(6), 1239–1255 (2014)K Pentikousis, Y Wang, W Hu, Mobileflow: toward software-defined mobile networks. IEEE Commun Mag 51(7), 44–53 (2013)E3 D2.4. Cognitive Function mapping to Networks Architectures, Standard Engineering and Software Technologies for Cognitive Radios, E3 Project Deliverable 2.4, December 2009.R Wang, H Hu, X Yang, Potentials and challenges of C-RAN supporting Multi-RATs toward 5G mobile networks. IEEE. Access. 2(1187), 1195 (2014)V Jungnickel, K Manolakis, W Zirwas, B Panzner, V Braun, M Lossow, M Sternad, R Apelfrojd, T Svensson, The role of small cells, coordinated multipoint, and massive MIMO in 5G. IEEE Commun Mag 52(5), 44–51 (2014)E Larsson, O Edfors, F Tufvesson, T Marzetta, Massive MIMO for next generation wireless systems. IEEE Commun Mag 52(2), 186–195 (2014)W Roh, S Ji-Yun, P Jeongho, L Byunghwan, L Jaekon, K Yungsoo, C Jaeweon, C Kyungwhoon, F Aryanfar, Millimeter-wave Beamforming as an Enabling Technology for 5G Cellular Communications: Theoretical Feasibility and Prototype Results. IEEE Commun Mag 2(2), 106–113 (2014)AL Swindlehust, E Ayanoglu, P Heydari, F Capolino, Millimeter-wave massive MIMO: the next wireless revolution? IEEE Commun Mag 52(9), 56–62 (2014)L Lu, GY Li, AL Swindlehurst, A Ashikhmin, Z Rui, An overview of massive MIMO: benefits and challenges. IEEE J Sel Top Signal Process 8(5), 742–758 (2014)S Roger, D Calabuig, J Cabrejas, JF Monserrat, Multi-user non-coherent detection for downlink MIMO communication. IEEE Signal Process Lett 21(10), 1225–1229 (2014)X Wang, M Chen, T Taleb, A Ksentini, V Leung, Cache in the air: exploiting content caching and delivery techniques for 5G systems. IEEE Commun Mag 52(2), 131–139 (2014)ETSI ISG NFV (Operator Group), Network Functions Virtualisation – Network Operator Perspectives on Industry Progress, Updated White Paper, October 2013NGMN Alliance, in Suggestions on potential solutions for C-RAN, White Paper, January 2013ETSI ISG NFV, Network Functions Virtualisation (NFV); Virtual Network Functions Architecture, v1.1.1, Dec 2014.A Tzanakaki, MP Anastasopoulos, GS Zervas, BR Rofoee, R Nejabati, D Simeonidou, Virtualization of heterogeneous wireless-optical network and IT infrastructures in support of cloud and mobile cloud services. IEEE Commun Mag 51(8), 155–161 (2013)A Manzalini, R Saracco, C Buyukkoc, P Chemuouil, S Kukliński, A Gladisch, M Fukui, W Shen, M Fujiwara, K Shimano, E Dekel, D Soldani, M Ulema, W Cerroni, F Callegati, G Schembra, V Riccobene, C Mas Machuca, A Galis, J Mueller, Software-Defined Networks for Future Networks and Services: Main Technical Challenges and Business Implications, IEEE Workshop SDN4FNS, 1–16, 2013CEPT ECC, in Licensed Shared Access (LSA), ECC Report 205, February 2014IEEE 802.11, in IEEE 802.11-2012 Part11: Wireless LAN Medium Access Control (MAC) and Physical Layer (PHY) Specifications, IEEE Standard, March 2012D Martín-Sacristán, JF Monserrat, J Cabrejas-Peñuelas, D Calabuig, S Garrigas, N Cardona, On the way towards fourth-generation mobile: 3GPP LTE and LTE-Advanced. EURASIP J Wirel Commun Netw 2009, 10 (2009)ICT-317669 METIS, Final report on architecture, Deliverable D6.4, January 2015, https://www.metis2020.com/documents/deliverables/ICT-317669 METIS, Report on simulation results and evaluations, Deliverable D6.5, February 2015, https://www.metis2020.com/documents/deliverables/Ö Bulakci, Z Ren, C Zhou, J Eichinger, P Fertl, S Stanczak, Dynamic Nomadic Node Selection for Performance Enhancement in Composite Fading/Shadowing Environments, (IEEE VTC 2014-Spring, Seoul, South Korea)ICT-317669 METIS, Final report on network-level solutions, Deliverable D4.3 Version 1, February 201

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised