Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

HCLIM38 : a flexible regional climate model applicable for different climate zones from coarse to convection-permitting scales

This paper presents a new version of HCLIM, a regional climate modelling system based on the ALADIN–HIRLAM numerical weather prediction (NWP) system. HCLIM uses atmospheric physics packages from three NWP model configurations, HARMONIE–AROME, ALARO and ALADIN, which are designed for use at different horizontal resolutions. The main focus of HCLIM is convection-permitting climate modelling, i.e. developing the climate version of HARMONIE–AROME. In HCLIM, the ALADIN and ALARO configurations are used for coarser resolutions at which convection needs to be parameterized. Here we describe the structure and development of the current recommended HCLIM version, cycle 38. We also present some aspects of the model performance. HCLIM38 is a new system for regional climate modelling, and it is being used in a number of national and international projects over different domains and climates ranging from equatorial to polar regions. Our initial evaluation indicates that HCLIM38 is applicable in different conditions and provides satisfactory results without additional region-specific tuning. HCLIM is developed by a consortium of national meteorological institutes in close collaboration with the ALADIN–HIRLAM NWP model development. While the current HCLIM cycle has considerable differences in model setup compared to the NWP version (primarily in the description of the surface), it is planned for the next cycle release that the two versions will use a very similar setup. This will ensure a feasible and timely climate model development as well as updates in the future and provide an evaluation of long-term model biases to both NWP and climate model developers.This research has been supported by Horizon 2020 (EUCP (grant no. 776613)) and the Maj and Tor Nessling foundation

Where Brain, Body and World Collide

The production cross section of electrons from semileptonic decays of beauty hadrons was measured at mid-rapidity (|y| < 0.8) in the transverse momentum range 1 < pt < 8 Gev/c with the ALICE experiment at the CERN LHC in pp collisions at a center of mass energy sqrt{s} = 7 TeV using an integrated luminosity of 2.2 nb^{-1}. Electrons from beauty hadron decays were selected based on the displacement of the decay vertex from the collision vertex. A perturbative QCD calculation agrees with the measurement within uncertainties. The data were extrapolated to the full phase space to determine the total cross section for the production of beauty quark-antiquark pairs

Pseudorapidity density of charged particles p-Pb collisions at sNN\sqrt{s_{NN}} = 5.02 TeV

The charged-particle pseudorapidity density measured over 4 units of pseudorapidity in non-single-diffractive (NSD) p-Pb collisions at a centre-of-mass energy per nucleon pair $\sqrt{s_{NN}}$ = 5.02 TeV is presented. The average value at midrapidity is measured to be 16.81 $\pm$ 0.71 (syst.), which corresponds to 2.14 $\pm$ 0.17 (syst.) per participating nucleon. This is 16% lower than in NSD pp collisions interpolated to the same collision energy, and 84% higher than in d-Au collisions at $\sqrt{s_{NN}}$ = 0.2 TeV. The measured pseudorapidity density in p-Pb collisions is compared to model predictions, and provides new constraints on the description of particle production in high-energy nuclear collisions.The charged-particle pseudorapidity density measured over four units of pseudorapidity in nonsingle-diffractive p+Pb collisions at a center-of-mass energy per nucleon pair sNN=5.02  TeV is presented. The average value at midrapidity is measured to be 16.81±0.71  (syst), which corresponds to 2.14±0.17  (syst) per participating nucleon, calculated with the Glauber model. This is 16% lower than in nonsingle-diffractive pp collisions interpolated to the same collision energy and 84% higher than in d+Au collisions at sNN=0.2  TeV. The measured pseudorapidity density in p+Pb collisions is compared to model predictions and provides new constraints on the description of particle production in high-energy nuclear collisions.The charged-particle pseudorapidity density measured over 4 units of pseudorapidity in non-single-diffractive (NSD) p-Pb collisions at a centre-of-mass energy per nucleon pair $\sqrt{s_{\rm NN}} = 5.02$ TeV is presented. The average value at midrapidity is measured to be $16.81 \pm 0.71$ (syst.), which corresponds to $2.14 \pm 0.17$ (syst.) per participating nucleon. This is 16% lower than in NSD pp collisions interpolated to the same collision energy, and 84% higher than in d-Au collisions at $\sqrt{s_{\rm NN}} = 0.2$ TeV. The measured pseudorapidity density in p-Pb collisions is compared to model predictions, and provides new constraints on the description of particle production in high-energy nuclear collisions

Energy Dependence of the Transverse Momentum Distributions of Charged Particles in pp Collisions Measured by ALICE

Differential cross sections of charged particles in inelastic pp collisions as a function of p_T have been measured at $\sqrt{s}$ = 0.9, 2.76 and 7 TeV at the LHC. The $p_T$ spectra are compared to NLO-pQCD calculations. Though the differential cross section for an individual $\sqrt{s}$ cannot be described by NLO-pQCD, the relative increase of cross section with sqrt(s) is in agreement with NLO-pQCD. Based on these measurements and observations, procedures are discussed to construct pp reference spectra at $\sqrt{s}$ = 2.76 and 5.02 TeV up to $p_T$ = 50 GeV/c as required for the calculation of the nuclear modification factor in nucleus-nucleus and proton-nucleus collisions

Charge correlations using the balance function in Pb?Pb collisions at ?sNN = 2.76 TeV

In high-energy heavy-ion collisions, the correlations between the emitted particles can be used as a probe to gain insight into the charge creation mechanisms. In this article, we report the first results of such studies using the electric charge balance function in the relative pseudorapidity \Delta\eta and azimuthal angle \Delta\phi in Pb-Pb collisions at sqrt{s_{NN}} = 2.76 TeV with the ALICE detector at the Large Hadron Collider. The width of the balance function decreases with growing centrality (i.e. for more central collisions) in both projections. This centrality dependence is not reproduced by HIJING, while AMPT, a model which incorporates strings and parton rescattering, exhibits qualitative agreement with the measured correlations in \Delta\phi but fails to describe the correlations in \Delta\eta. A thermal blast wave model incorporating local charge conservation and tuned to describe the p_T spectra and v_2 measurements reported by ALICE, is used to fit the centrality dependence of the width of the balance function and to extract the average separation of balancing charges at freeze-out. The comparison of our results with measurements at lower energies reveals an ordering with sqrt{s_{NN}}: the balance functions become narrower with increasing energy for all centralities. This is consistent with the effect of larger radial flow at the LHC energies but also with the late stage creation scenario of balancing charges. However, the relative decrease of the balance function widths in \Delta\eta and \Delta\phi with centrality from the highest SPS to the LHC energy exhibits only small differences. This observation cannot be interpreted solely within the framework where the majority of the charge is produced at a later stage in the evolution of the heavy-ion collision