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

Experimental Heat Transfer Study On The Shock Absorber Operation

This paper focused on the experimental heat transfer study on the shock absorber operation. The objective of this study is to analysis the heat transfer rate at surface absorber body. The shock absorber test rig was developed to collect experimental data. This test rig also useful to test and indicates the condition of shock absorber. A new and modify shock absorber twin tube type 1600cc will be used for this experiment. Ethanol and water are using as alternative substance for damping fluid to improve the air gap between the internal and outside body. Ten cycles of bounce and jounce shock absorber operation before heat transfer were measured. The problem of overheating will be effect of damping fluid characteristics and decrease shock absorber performance. However, using additive on damping fluid with water or ethanol will be good substance to improve heat transfer inside the absorber. Ethanol as a substance can be increased heat transfer inside absorber up to 38%. Furthermore, water has a higher thermal conductivity and increasing heat transfer rate better than ethanol; the result shows that using the water can increased the rate of heat transfer up to 45%. Finally, additive with higher thermal conductivity as the substance should give better heat transfer rate from inside absorber to surroundings

Smart Methodology of Stiffness Nonlinearity Identification Vibration System

Nonlinear identification is a very popular topic in the area of structural dynamics. Detection, localisation and quantification of nonlinearities are very important steps for assessing faults or damages in engineering structures. There have been many studies of identifying structural nonlinearities based on vibration data but most methods are only suitable for a small number of degrees of freedom and few nonlinear terms. In this paper, a procedure that utilises the restoring force surface method is developed in order to identify the parameters of nonlinear properties such as cubic stiffness, bilinear stiffness or free play. This method employs measured vibration data, and can be applied to structures of many degrees-of-freedom. In this paper, NASTRAN is used to compute the frequencies and modes of the structure under study. The simulated nonlinear model is formulated in modal space with additional terms representing nonlinear behaviour. Nonlinear curve fitting then enables interpretation of the nonlinear stiffness via the restoring force surface. The method is shown by MATLAB simulations to yield quite accurate identification of stiffness nonlinearity

Simulation of lamb wave interactions with defects in a thin plate

The understanding of Lamb wave propagation and its interaction with defects are crucial part of SHM technology. Being of high relevance due to the costs of experimental equipment, the dynamic finite element analysis is performed in this study. FEA analysis was implemented to simulate propagation of Lamb waves in healthy and defective aluminium plate. The wavefield visualisation shows a high degree of difference between these two plates, which shows the interaction with defects. This study is useful for a good understanding of the Lamb wave interaction with defect before applying this method for a real application

Implementing sustainability in existing building through retrofitting measures

Energy is part of everyday lives and often taken for granted. Daily energy usage in existing building has produced vast amount of greenhouse gas emissions (GHG) and this contributes to major cause of climate change. Society today has become much too dependent on electrical devices and appliances without any regard that excessive energy consumption is threat to climate change. Malaysia has been progressively contributing efforts in tackling climate change and growth rate of GHG emission through promoting sustainable living and improving energy consumption in built-environment sector. The main driver in reducing energy consumption is by retrofitting existing building stocks in Malaysia. Excessive energy consumption in existing building is related to unethical behaviour of owner/tenants as the main consumer. Retrofitting the existing building is one of possible way in improving the energy efficiency. Thus, this report aims to reflect existing building stocks in Malaysia, factors that contribute to excessive energy consumption in existing building and understanding of retrofit concept. By the end of this report, retrofitting measures to improve energy efficiency in existing building are highlighted, including case study of successful retrofitting implementation at Perdana Putra, the Prime Minister's Office in Putrajaya. Implementation of effective and affordable retrofit measures help the existing building to depend less on energy usage, which lead to reduce national energy consumption

Fatigue Features Extraction of Road Load Time Data Using the S-Transform

This paper presents the algorithm development of a new fatigue data editing technique using S-T approach. In general, the S-transform (S-T) is a time-frequency spectral localization method which performs a multi-resolution analysis on signal. This method represents a better time-frequency resolution especially for non-stationary signal analysis. This technique was developed to produce shortened fatigue data for fatigue durability testing. The S-T method was applied to detect the damaging events contained in the fatigue signals due to high S-T spectrum location. The damaging events were extracted from an original fatigue signal to produce the shortened edited signal which has equivalent fatigue damage. Three types of road load fatigue data were used for simulation purpose, pave track, highway and country road. In this study, an algorithm was developed, to detect the damaging events in the original fatigue signal. The algorithm can be used to extract the fatigue damaging events and these events were combined in order to produce a new edited signal which neglect the low amplitude cycles. The edited signal consists of the majority of the original fatigue damage in the shortened signal with 15–25% time reduction. Thus, it has been suggested that this shortened signal can then be used in the laboratory fatigue testing for the purpose of accelerated fatigue testin

Establishment procedure of child restraint systems reference list for ASEAN NCAP

Babies and children below the age of 12 are the most vulnerable road users compared to older children (i.e., 12 years and above) and adults. To reduce the risk of severe injuries in the case of crashes or emergency braking, it is important that these groups of children are transported properly using age- or size-appropriate Child Restraint Systems (CRS) for as long as possible. As part of the ASEAN NCAP protocol, a so-called "CRS Reference List" that contains a sample of widely available, well-performing child seats in the ASEAN market was established to assess the vehicle’s ability to safely and correctly accommodate child seats. The reference list should be reviewed every two years following a systematic revision process and published in ASEAN NCAP’s website. In this paper, some shortlisted CRS identified in previous work would be assessed following ASEAN NCAP Child Occupant Protection (COP) protocol where the CRS performance is evaluated. The technical assessment is explained in detail in this paper, where several measurements taken during vehicle impact tests using several shortlisted CRS are shown. The final "CRS Reference List" would then be established by ASEAN NCAP following the systematic assessment process based on the findings and recommendations from this work for the future ASEAN NCAP COP assessment

Development of anthropometric database for ASEAN NCAP: A case study of Malaysian children aged 6 years old

With the rapid growth of human populations throughout the globe, physical characteristics of human body composition may have significant variation, particularly in height and weight. Access to this information is vital for any product development programs, especially when it comes to safety aspects; hence it is particularly important to the New Car Assessment Program for Southeast Asian Countries (ASEAN NCAP) as the champion of vehicle safety in ASEAN region. This paper aims to describe the development of anthropometric database for ASEAN NCAP. Tasks such as identification of important anthropometric parameters, methodology of measurement and data analysis are explained. A total of 42 anthropometric parameters were measured using direct measuring methods; however only 8 parameters are discussed in this paper. As a case study, a total of 143 Malaysian children aged 6 years old have participated in the anthropometric measurement activity. Statistical information including the mean, standard deviation, 5th percentile, 50th percentile and 95th percentile for each parameter for various body dimensions were tabulated. The collected data and mean of 42 parameters are utilised further for the development of digital 3D-models (using SolidWorks) of the Malaysian children aged 6 years old

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit