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

Mineralogical and geochemical studies on soils and Nile bottom sediments of Luxor–Aswan area, South Egypt

Abstract Background The geochemical studies on the rare earth elements to demonstrate sources of the toxic metals for soils and Nile sediments for Aswan area are seldom. Results Minerallogically, the studied soil agriculture samples consist mainly of quartz (42%), clay minerals (33%), plagioclase (20%) and magnesin-calcite (5%). Clay minerals are composed of montmorillonite as bentonite. The studied Nile sediments consist mainly of quartz (75%), clay minerals (15%), plagioclase (5%) and calcite (5%). Clay minerals are composed of calcian-montmorillonite (10%) and Kaolinite (5%). Geochemically, the chemical analytical techniques of the environment-sensitive elements, including Pb, Cd, As, Ni, Co, Cu, Cr, Zn, U and Th, have been performed for agricultural soils and sediments of Aswan–Luxor District to assess the geochemical characteristics of these elements and their impact on soil environmental and plant, as well as their provenance. Conclusions Average content of Cd was about 1.5-fold for the studied Nile sediments and slightly higher soil agriculture than (MPL). Pb and Cr average contents twofold of (MPL) for Nile sediments and Cr average of soil is represented 2.5-fold of (MPL). The average content of As, Cu, Co, Ni and U in both Nile sediments and cultivated soil in the studied area is lower than the maximum permissible limit (MPL). Average content of Pb, Zn and Cr was about 2, 2- and 2.5-fold, respectively, according to USPHS for the Nile sediments and threefold of Cr for the agriculture soils. The agricultural soil of Luxor–Aswan district is characteristic highly enrichment of As, Co, Zn, Cu, Ni, Mn, U and Th than those of the Nile sediments. In addition, the Nile sediments have high concentration average of Cr, Zn, Mn and Pb and low contamination of the other elements. The sources of the toxic metals in the studied area may probably be natural or anthropogenic. The anthropogenic source is resulting from paper, Ferrosilicon factories and Phosphate mines at Edfu, as well as Sand quarry, Shale mine and the Nitrogen Fertilizer factory at Aswan. In addition, natural sources such as waste of the drains floods

Mineralogical, petrographical, geochemical, diageneses and provenance of the Cretaceous Black Shales, Duwi Formation at Quseir-Safaga, Red Sea, Egypt

The Duwi Formation in the Quseir-Safaga area is conformably overlain by the Quseir variegated shales and underlain by the Dakhla shales. Detailed mineralogical and geochemical studies were carried out on the middle member of the black shales of the Duwi Formation in Quseir-Safaga province to infer their source rocks, paleo-weathering and provenance of the sources. The studied black shales are highly fossiliferous and fissile. They are texturally classified as phosphatic marly mudstone microfacies. Mineralogically, they are composed mainly of calcite, apatite, quartz, pyrite and clay minerals. The studied clay fraction reveals that the well-crystalline Na-montmorillonite is the dominating clay mineral with mixed layer montmorillonite-illite and minor kaolinite. These shales could be used as a source for the sodium bentonite. The studied black shales are highly mature, detrital and authigenic in origin. They are most probably derived from basic volcanic rocks by intensive chemical weathering. The provenance constituted a part of passive and active continental margins similar to those the Devonian/Mississippian shales in USA. The Cretaceous black shales of the Duwi Formation in Quseir-Safaga area are part of Mes-Neoarchean Shales, and are typically comparable to the Archean Shale Average. The average values of Cu, Ni, Zn, Cr, V, As and Se and, with the ratios Rb/Sr and Cr/Ni, are enriched with respect to those of the PAAS values. This could be attributed to the abundance of mafic components. The felsic source rocks were considered as an added source similar to Cretaceous and Cambrian black shales in India and China; respectively. The ratios V/Cr, V/(V + Ni) and Mo/Al and the high concentrations of the redox sensitive elements revealed that the studied black shales were deposited under relatively euxinic to anoxic reducing marine environments coupled with hydrothermal solutions. They were found comparable to the Cretaceous Gulf of California, Posidonia, Cretaceous/Tertiary black shales, and those in the Black Sea. The studied black shales can be classified as good to excellent source of oil and trace elements. The chemical composition of the studied black shales of the Duwi Formation (Cretaceous) was correlated to published data at different localities and ages

Electrical, mineralogical, geochemical and provenance of

Detailed mineralogical and geochemical studies were carried out on the middle members of the black shales of the Duwi Formation (Quseir–Safaga province) to define their source rock, paleo-weathering, pollution impact and provenance of the sources. The studied black shales are highly fossiliferous and fissile. They are texturally classified as phosphatic marly mudstone microfacies. The black shale mineral composition is mainly composed of calcite, apatite, quartz, pyrite and clay minerals. The average values of Cu, Ni, Zn, Cr, V, As and Se and the ratios Rb/Sr and Cr/Ni in black shale are enriched compared to those of the Post-Archean Australian Shale (PAAS) values. Electrical properties of samples were measured using a non-polarizing electrode, at room temperature (∼18 °C), and relative atmospheric humidity of (∼35%), in the frequency range from 42 Hz to 5 MHz. The changes in electrical properties were argued to be due to the change in mineral composition. Generally, the electrical properties of rocks are changed due to many factors such as grain size, mineral composition, grain shape and inter-granular relations between grains. The dielectric constant decreases with frequency, and increases with conductor concentration. Also, the conductivity increases with the increase of conductor continuous paths between electrodes

Mineralogy, geochemistry, petrography, and depositional environment of Gebel El-Qurn, Early Eocene, West Luxor, South Egypt

Abstract Background Luxor represented the modern Egyptian city that occupies the site of ancient Thebes. Thebes Mountain on the West Bank of the Nile, opposite the town of Luxor, is among the most famous historical sites of the world. Carbonate rocks exposed at Gebel El-Qurn, west Luxor, south Egypt has been investigated for mineralogical, petrographical, and geochemical studies to illustrate its depositional environments. Results We revealed that the carbonate rocks in the Gebel El-Qurn, west Luxor, are mainly of Lower Eocene age. The carbonate rocks that belong to the Thebes Formation were deposited under shallow, warm, oxidizing, open marine environment. Petrographically, they are differentiated into five microfacies: (1) nummulitic bioclastic wackestone/mudstone, (2) nummulitic biosparite grainstone, (3) nummulitic rudstone microfacies, (4) pelecypod biomicrite wacke/packstone, and (5) biomicrite dolomitic lime-mudstone. Diagenetically, carbonate rocks were subjected to cementation, compaction, neomorphism, dissolution, and dolomitization processes. Mineralogically, XRD revealed that the studied carbonate samples consist mainly of calcite as well as dolomite, quartz, halite, pyrite, and clay minerals. EDX data indicated that the dolomite of the Gebel El-Qurn is non-stoichiometric in composition, and the size of crystals is up to 80 μm. Geochemically, the carbonate rocks of the Gebel El-Qurn are impoverished in Sr and Na content. This may be attributed to the diagenetic processes, which took place under less saline environment than seawater. Dolomite crystals were formed by re-crystallization under mixed marine-meteoric environment. The positive correlation between Sr and Fe2O3 indicates that the studied carbonates were deposited under control of bacterial activity. The studied carbonate rocks are characterized by light REE (LREE) enrichment with respect to heavy REE (HREE). The total radioactivity measurements are ranging from 4 to 5.9 ppm for U and from 5.5 to 6.6 ppm for Th. The radioactivity measurements are less than the background level of carbonates, and they are in the permissible limits for carbonates used in cement industries and as building stones. Conclusions The petrographical and geochemical observations, as well as mineralogical investigation, indicate that the carbonate rocks in the Gebel El-Qurn were deposited in a shallow, warm open marine environment

Mineralogical, geochemical characteristics and origin of Late Cretaceous phosphorite in Duwi Formation (Geble Duwi Mine), Red Sea region, Egypt

The Late Cretaceous Duwi Formation in Egypt overlies non-marine, varicolored shale of the middle Campanian Quseir Formation. It is conformably overlain by gray, laminated, foraminiferal-rich marine shale of the middle Maastrichtian Dakhla Formation. Detailed mineralogical and geochemical studies were carried out on the phosphate rocks of the Duwi Formation in Quseir-Safaga province (Geble Duwi Mine) to infer their source rocks, paleo-weathering and provenance of the sources. The importance of the effect of phosphate rock depends on the chemical form of phosphorus in which this element is combined. This information is important in the assessment of possible radiological hazards to human health; due to the presence of uranium in the apatite structure. The phosphatic rock materials may be used as building stones or as phosphatic fertilizers and animal feed ingredients. Mineralogically, they are composed mainly of apatite (fluor-apatite), calcite and quartz with minor amounts of pyrite. The studied Duwi phosphates are authigenic in origin, comparable to those of phosphatic nodules of Peru and Chile margins. They are most probably derived from pre-existing authigenic phosphorites. Provenance, they originate from reworked older sedimentary phosphorites and biogenic sources. The geochemical data, CIA values suggested that the Duwi Formation phosphates were subjected to low chemical weathering. Generally, the enrichment of the trace elements, REEs and uranium may have occurred during diagenesis. The studied phosphate samples were compared to the average of the Average World Phosphorite (AWP) and the Average Shale Composition (ASC). The major, trace and rare earth elements contents are compared with those in Egypt, North African, Asian and other localities. The ratios V/Cr, V/(V + Ni) and Mo/Al and the high concentrations of the redox sensitive elements revealed that the studied phosphates were deposited under anoxic reducing marine environments coupled with hydrothermal solutions, which is comparable to the environmental condition of the associated black shales. The concentration of the trace and toxic elements in the studied samples are considered to be below the limits for most field-grown crops