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

Pourquoi se tourner vers le religieux ? Des besoins affectifs et cognitifs au désir d'expansion de soi

How explain, from a psychological perspective, why some people turn to religion today ? What are the motives ? This question is particularly important in the current context of secularized societies and religious market. There is substantial evidence in previous literature on psychology of religion to support the idea that attraction to religion occurs in the presence of pre-existing psychological vulnerabilities (socio-affective and cognitive). In addition to these compensation needs, we theorized that modem religious people can also be characterized by motivations that dénoté self-realization and optimal development (self-growth motives). In the present paper, seven studies are presented. Among specific populations (New Religious Move-ments members and ex-members, converts to traditional religions, free-lance spiritual seekers, and atheists), a variety of measures were examined in the frame of these two paradigms (compensation needs vs. self-growth motives). Comparisons to scores from the général population on the saine measures suggested a co-existence of these two kinds of motives. Moreover, interesting quantitative différences observed between populations studied could be interpreted in terms of correspondence between supply (people's motives) and offer (group's characteristics).Comment expliquer, dans une perspective psychologique, pourquoi certaines personnes se tournent vers le religieux aujourd'hui ? Quels sont les motifs d'attraction pour le religieux ? Cette question est particulièrement importante dans le contexte actuel de la sécularisation et du marché du religieux. Des résultats solides soutiennent la présence de vulnérabilités psychologiques (socio-affectives et cognitives) préalables à l'attraction pour le religieux. Outre ces besoins compensatoires, nous émettons l'hypothèse que la religiosité moderne est caractérisée par des motivations qui reflètent la réalisation de soi et le développement optimal de la personne (désir de réalisation de soi). Dans le présent article, sept études sont rapportées. Parmi des populations spécifiques (membres et ex-membres de Nouveaux Mouvements Religieux, convertis à des religions traditionnelles, personnes en recherche sur le plan spirituel et athées), plusieurs mesures ont été examinées dans le cadre de ces deux paradigmes (besoins de compensation et désir de réalisation de soi). Les comparaisons aux scores obtenus par la population tout-venant sur les mêmes mesures suggèrent la coexistence de ces deux types de motifs. En outre, les différences quantitatives observées entre les populations étudiées semblent pouvoir être interprétées en termes de correspondance entre la demande (motifs d'attraction) et l'offre (caractéristiques du groupe religieux/spirituel).Buxant C. Pourquoi se tourner vers le religieux ? Des besoins affectifs et cognitifs au désir d'expansion de soi. In: Revue théologique de Louvain, 40ᵉ année, fasc. 1, 2009. pp. 41-65

Targeting the maize T-urf13 product into tobacco mitochondria confers methomyl sensitivity to mitochondrial respiration.

The URF13 protein, which is encoded by the maize mitochondrial T-urf13 gene, is thought to be responsible for pathotoxin and methomyl sensitivity and male sterility. We have investigated whether T-urf13 confers toxin sensitivity and male sterility when expressed in another plant species. The coding sequence of T-urf13 was fused to a mitochondrial targeting presequence, placed under the control of the cauliflower mosaic virus 35S promoter, and introduced into tobacco by Agrobacterium tumefaciens-mediated transformation. Plants expressing high levels of URF13 were methomyl sensitive. Subcellular analysis indicated that URF13 is mainly associated with the mitochondria. Adding methomyl to isolated mitochondria stimulated NADH-linked respiration and uncoupled oxidative phosphorylation, indicating that URF13 was imported into the mitochondria, and conferred toxin sensitivity. Most control plants, which expressed the T-urf13c construct lacking the mitochondrial presequence, were methomyl sensitive and contained URF13 in a membrane fraction. Subcellular fractionation by sucrose gradient centrifugation showed that URF13 sedimented at several positions, suggesting the protein is associated with various organelles, including mitochondria. No methomyl effect was observed in isolated mitochondria, however, indicating that URF13 was not imported and did not confer toxin sensitivity to the mitochondria. Thus, URF13 confers toxin sensitivity to transgenic tobacco with or without import into the mitochondria. There was no correlation between the expression of URF13 and male sterility, suggesting either that URF13 does not cause male sterility in transgenic tobacco or that URF13 is not expressed in sufficient amounts in the appropriate anther cells

Sentinel lymph node procedure : Unanswered questions

SCOPUS: re.jinfo:eu-repo/semantics/publishe