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

Biomass Inventory of Federal Forest Lands at Petawawa: A Case Study

An inventory was completed of federal forest lands located near Petawawa, Ontario. Using established procedures, the inventory was designed to provide estimates of standard forest data as well as of forest biomass.The average ovendry biomass on the 18 337 ha or natural forests was 130 t/ha. For individual forest strata, averages ranged from 69 t/ha to 159 t/ha. By stand component, trees equal to or greater than 8.1 cm dbh contained 96% of total biomass. saplings contained 3%, and seedlings 1%. By tree component, stem wood accounted for 66% of total biomass. Estimates were made of biomass quantities removed; this ranges from 69% to 95% of total stand biomass, depending on harvesting method.An assessment of changes required in conventional inventory procedures for estimating aboveground biomass indicated that they would be minor, with no serious effects on cost, time, or precision. </jats:p

Optimization of strength, ductility and electrical conductivity of Cu-Cr-Zr alloy by combining multi-route ECAP and aging

Properties of Cu-Cr-Zr alloy with ultrafine-grained (UFG) structure produced by equal-channel angular pressing (ECAP) via different routes have been investigated. Special attention was paid to the optimization of multi-functional structural, thermal, electrical and mechanical properties of the alloy by aging of UFG one. Multi-pass ECAP via different routes gives rise to the formation of a deformation-induced submicrocrystalline structure with the grain (subgrain) sizes in the range of 200-300. nm depending on applied routes which leads to high hardness and strength in the Cu-Cr-Zr alloy with reduced ductility. Amongst the applied routes, route-Bc was found to be the best processing path for achieving the lowest grain size, the highest hardness and strength. Aging of 8Bc-processed UFG samples increases the hardness and strength of Cu-Cr-Zr alloy while retaining an electrical conductivity comparable to that of aged coarse-grained (CG) one. A satisfactory electrical conductivity of 71%IACS without considerable loss of peak hardness was achieved after aging of 8Bc-processed UFG alloy at 425. °C for 240. min. The precipitation strengthened UFG alloy remains its stable behavior at elevated temperatures up to 450. °C. © 2015 Elsevier B.V

Growth responses and delayed winter hardening in Sitka Spruce following summer exposure to ozone.

Two-year-old seedlings of Sitka spruce [Picea sitchensis (Bong) Cart.] were exposed to < 5, 70, 120 and 170 nl l−1 O3 for 7 h day−1 in large ventilated glasshouses during the summer of 1986. Relative growth rates (RGR) were calculated at intervals throughout the summer and autumn using a non-destructive technique in which measurements of stem height and diameter were used to estimate above-ground biomass. No statistically significant effects of the ozone on growth were apparent during or after the period of fumigation, and growth of the seedlings had largely been completed by the end of August. The winter hardiness of these plants was subsequently tested on 10 November and 8 December by subjecting detached shoots to a range of carefully regulated freezing temperatures in controlled environment chambers. The results for the samples taken on the earlier date suggested that plants exposed to ozone were more sensitive to frost than the controls, and that this effect was dependent on the concentration of the pollutant. In the samples taken later, all the shoots appeared to have hardened equally to freezing temperatures in excess of about –20 °C. The results suggest that early autumn frosts might be damaging to Sitka spruce after exposure to high ozone concentrations in summer

A large and rapid planar failure: causes, mechanism, and consequences (Mordut, Gumushane, Turkey)

Gumushane is a small city located on highway connecting the harbour city Trabzon in the Black Sea Region of Turkey to the Eastern Anatolia. Following an excavation to create an area for housing on the northeast side of this highway, a large and rapid planar failure inclined to the southwest occurred. A large amount of fractured and weathered granitic material moved downward over this planar failure. After the failure, the highway was closed to traffic for 1 week, and more than ten houses on top of this failure were collapsed completely. The present study aims to investigate the mechanism of this failure. The study was performed using kinematical, limit equilibrium and numerical analyses for both post- and pre-failure conditions. Based on the detailed field observations, the failure mode was determined to be planar, and the slide mechanism was determined to be controlled by three fault planes. As a result of these analyses, it can be concluded that the slope before failure had critical conditions and that the excavation and uncontrolled blasting triggered and accelerated the slope failure.WOS:0003324878000302-s2.0-8489670076