Some Implications of the Cosmological Constant to Fundamental Physics

In the presence of a cosmological constant, ordinary Poincare' special relativity is no longer valid and must be replaced by a de Sitter special relativity, in which Minkowski space is replaced by a de Sitter spacetime. In consequence, the ordinary notions of energy and momentum change, and will satisfy a different kinematic relation. Such a theory is a different kind of a doubly special relativity. Since the only difference between the Poincare' and the de Sitter groups is the replacement of translations by certain linear combinations of translations and proper conformal transformations, the net result of this change is ultimately the breakdown of ordinary translational invariance. From the experimental point of view, therefore, a de Sitter special relativity might be probed by looking for possible violations of translational invariance. If we assume the existence of a connection between the energy scale of an experiment and the local value of the cosmological constant, there would be changes in the kinematics of massive particles which could hopefully be detected in high-energy experiments. Furthermore, due to the presence of a horizon, the usual causal structure of spacetime would be significantly modified at the Planck scale.Comment: 15 pages, lecture presented at the "XIIth Brazilian School of Cosmology and Gravitation", Mangaratiba, Rio de Janeiro, September 10-23, 200

Cosmological Term and Fundamental Physics

A nonvanishing cosmological term in Einstein's equations implies a nonvanishing spacetime curvature even in absence of any kind of matter. It would, in consequence, affect many of the underlying kinematic tenets of physical theory. The usual commutative spacetime translations of the Poincare' group would be replaced by the mixed conformal translations of the de Sitter group, leading to obvious alterations in elementary concepts such as time, energy and momentum. Although negligible at small scales, such modifications may come to have important consequences both in the large and for the inflationary picture of the early Universe. A qualitative discussion is presented which suggests deep changes in Hamiltonian, Quantum and Statistical Mechanics. In the primeval universe as described by the standard cosmological model, in particular, the equations of state of the matter sources could be quite different from those usually introduced.Comment: RevTeX, 4 pages. Selected for Honorable Mention in the Annual Essay Competition of the Gravity Research Foundation for the year 200

Statistical Anisotropy from Anisotropic Inflation

We review an inflationary scenario with the anisotropic expansion rate. An anisotropic inflationary universe can be realized by a vector field coupled with an inflaton, which can be regarded as a counter example to the cosmic no-hair conjecture. We show generality of anisotropic inflation and derive a universal property. We formulate cosmological perturbation theory in anisotropic inflation. Using the formalism, we show anisotropic inflation gives rise to the statistical anisotropy in primordial fluctuations. We also explain a method to test anisotropic inflation using the cosmic microwave background radiation (CMB).Comment: 32 pages, 5 figures, invited review for CQG, published versio

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

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

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700