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

Betrayal as Market Barrier: Identity-Based Limits to Diversification among High-Status Corporate Law Firms 1

Why are some diversified market identities problematic but others are not? We examine this question in the context of high-status corporate law firms, which often diversify into one low-status area of work—family law ðFLÞ—but face a barrier ðstrong disapproval from existing clientsÞ that prevents diversification into another such area—plaintiffs’ personal injury law ðPILÞ. Drawing on a qualitative study of the Boston legal market, we argue that this barrier reflects a situation where loyalty norms have been violated, and it surfaces because service to individual plaintiffs is tantamount to betraying the interests of corporate clients. Our analysis clarifies identity-based limits to diversification, indicating that they are rooted in concerns about the firm’s commitments as well as its capabilities, and suggests a more general refinement of theory on status and conformity. Interviewer: Respondent: How would you react if you learned your outside law firm was doing personal injury law? That’s bad...They’d lose credibility instantly....It’s just the feeling, like they’re taking the other side, like they’re disloyal

Betrayal as Market Barrier: Identity-Based Limits to Diversification among High-Status Corporate Law Firms

Why are some diversified market identities problematic but others are not? We examine this question in the context of high-status corporate law firms, which often diversify into one low-status area of work—family law (FL)—but face a barrier (strong disapproval from existing clients) that prevents diversification into another such area—plaintiffs’ personal injury law (PIL). Drawing on a qualitative study of the Boston legal market, we argue that this barrier reflects a situation where loyalty norms have been violated, and it surfaces because service to individual plaintiffs is tantamount to betraying the interests of corporate clients. Our analysis clarifies identity-based limits to diversification, indicating that they are rooted in concerns about the firm’s commitments as well as its capabilities, and suggests a more general refinement of theory on status and conformity

In and out of the well: flux and reflux of scepticism and nature

The article tries to capture the style of Hume's scepticism and to offer hints on its nature as a process. Hume wrote that "If truth be at all within the reach of human capacity, 'tis certain it must lie very deep and abstruse", and that "Philosophy would render us entirely Pyrrhonian, were not nature too strong for it". The article considers these expressions of scepticism, their sources and their double-edged structure throughout Hume's works, and shows that philosophical scepticism, insofar as it is an abstruse philosophy, can only be intermittent

Guidelines on the standards for the training of specialised health professionals dealing with breast cancer

According to EUSOMA position paper 'The requirements of a specialist breast unit', each breast unit should have a core team made up of health professionals who have undergone specialist training in breast cancer. In this paper, on behalf of EUSOMA, authors have identified the standards of training in breast cancer, to harmonise and foster breast care training in Europe. The aim of this paper is to contribute to the increase in the level of care in a breast unit, as the input of qualified health professionals increases the quality of breast cancer patient care.Journal ArticlePractice Guidelineinfo:eu-repo/semantics/publishe

Considerations of Environmentally Relevant Test Conditions for Improved Evaluation of Ecological Hazards of Engineered Nanomaterials.

Engineered nanomaterials (ENMs) are increasingly entering the environment with uncertain consequences including potential ecological effects. Various research communities view differently whether ecotoxicological testing of ENMs should be conducted using environmentally relevant concentrations-where observing outcomes is difficult-versus higher ENM doses, where responses are observable. What exposure conditions are typically used in assessing ENM hazards to populations? What conditions are used to test ecosystem-scale hazards? What is known regarding actual ENMs in the environment, via measurements or modeling simulations? How should exposure conditions, ENM transformation, dose, and body burden be used in interpreting biological and computational findings for assessing risks? These questions were addressed in the context of this critical review. As a result, three main recommendations emerged. First, researchers should improve ecotoxicology of ENMs by choosing test end points, duration, and study conditions-including ENM test concentrations-that align with realistic exposure scenarios. Second, testing should proceed via tiers with iterative feedback that informs experiments at other levels of biological organization. Finally, environmental realism in ENM hazard assessments should involve greater coordination among ENM quantitative analysts, exposure modelers, and ecotoxicologists, across government, industry, and academia