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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Memory Aware Synapses: Learning What (not) to Forget

© 2018, Springer Nature Switzerland AG. Humans can learn in a continuous manner. Old rarely utilized knowledge can be overwritten by new incoming information while important, frequently used knowledge is prevented from being erased. In artificial learning systems, lifelong learning so far has focused mainly on accumulating knowledge over tasks and overcoming catastrophic forgetting. In this paper, we argue that, given the limited model capacity and the unlimited new information to be learned, knowledge has to be preserved or erased selectively. Inspired by neuroplasticity, we propose a novel approach for lifelong learning, coined Memory Aware Synapses (MAS). It computes the importance of the parameters of a neural network in an unsupervised and online manner. Given a new sample which is fed to the network, MAS accumulates an importance measure for each parameter of the network, based on how sensitive the predicted output function is to a change in this parameter. When learning a new task, changes to important parameters can then be penalized, effectively preventing important knowledge related to previous tasks from being overwritten. Further, we show an interesting connection between a local version of our method and Hebb’s rule, which is a model for the learning process in the brain. We test our method on a sequence of object recognition tasks and on the challenging problem of learning an embedding for predicting triplets. We show state-of-the-art performance and, for the first time, the ability to adapt the importance of the parameters based on unlabeled data towards what the network needs (not) to forget, which may vary depending on test conditions.status: publishe

Continual learning with tiny episodic memories

In continual learning (CL), an agent learns from a stream of tasks leveraging prior experience to transfer knowledge to future tasks. It is an ideal framework to decrease the amount of supervision in the existing learning algorithms. But for a successful knowledge transfer, the learner needs to remember how to perform previous tasks. One way to endow the learner the ability to perform tasks seen in the past is to store a small memory, dubbed episodic memory, that stores few examples from previous tasks and then to replay these examples when training for future tasks. In this work, we empirically analyze the effectiveness of a very small episodic memory in a CL setup where each training example is only seen once. Surprisingly, across four rather different supervised learning benchmarks adapted to CL, a very simple baseline, that jointly trains on both examples from the current task as well as examples stored in the episodic memory, significantly outperforms specifically designed CL approaches with and without episodic memory. Interestingly, we find that repetitive training on even tiny memories of past tasks does not harm generalization, on the contrary, it improves it, with gains between 7\% and 17\% when the memory is populated with a single example per class

Continual learning with tiny episodic memories

In continual learning (CL), an agent learns from a stream of tasks leveraging prior experience to transfer knowledge to future tasks. It is an ideal framework to decrease the amount of supervision in the existing learning algorithms. But for a successful knowledge transfer, the learner needs to remember how to perform previous tasks. One way to endow the learner the ability to perform tasks seen in the past is to store a small memory, dubbed episodic memory, that stores few examples from previous tasks and then to replay these examples when training for future tasks. In this work, we empirically analyze the effectiveness of a very small episodic memory in a CL setup where each training example is only seen once. Surprisingly, across four rather different supervised learning benchmarks adapted to CL, a very simple baseline, that jointly trains on both examples from the current task as well as examples stored in the episodic memory, significantly outperforms specifically designed CL approaches with and without episodic memory. Interestingly, we find that repetitive training on even tiny memories of past tasks does not harm generalization, on the contrary, it improves it, with gains between 7\% and 17\% when the memory is populated with a single example per class