Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

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 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). 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

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

An Approach for Effort Estimation of Service Oriented Architecture (SOA) Projects

In the last few decades SOA (Service Oriented Architecture) has become the new trend in the IT industry. Many organizations tend to migrate to SOA in order to cope with the rapidly changing business. Effort estimation of SOA projects has become a real challenge to project managers due to the limited literatures addressing this issue. The traditional effort estimation techniques do not fit SOA projects entirely, as SOA has unique characteristics were not addressed by the traditional cost estimation approaches. These unique SOA characteristics include: loose coupling, reusability, composability and discoverability. On the other hand, cost estimation approaches that were proposed to estimate SOA projects, are still immature and most of them are impractical. They cannot be used in real life projects, as they are more guidelines than actual practical cost estimation approaches. This paper proposes an effort estimation approach for SOA projects that has been applied to different variety of services. It considers SOA characteristics and the various cost factors for different types of services including available, migrated, new and composed services. This proposed approach provides effort estimation technique for each type of service. The proposed approach also gives effort distribution among project phases for easily resources allocation. This framework has been applied to real life projects in the IT industry as the SOA project is divided into its component services and each service is estimated solely based on its type. The services' efforts are then aggregated to calculate the project’s overall effort. The estimated effort relative error in the case studies ranges from 3.66 % and 19.14%

Agent-based web search personalization approach using dynamic user profile

The World Wide Web has become the largest library through the history of the humanity. Having such a huge library made the search process more complex as the syntactic search engines offer an overwhelming amount of search results. Vocabulary problems like polysemy and synonymy can make the search results of traditional search engines irrelevant to users. Such problems trigger a strong need for personalizing the web search results based on user preferences. In this paper, we propose a new multi-agent system based approach for personalizing the web search results. The proposed approach introduces a model to build a user profile from initial and basic information, and maintain it through implicit user feedback to establish a complete, dynamic and up-to-date user profile. In the web search process, the model semantically optimizes the user query in two steps: query optimization using user profile preferences and query optimization using the WordNet ontology. The model builds on the advantages of the current search engines by utilizing them for retrieving the web search results. We present a detailed case study and simulation results evaluation to illustrate how the proposed model works and its expected value in increasing the precision of the traditional search engines and solving the vocabulary problems

Efficient email classification approach based on semantic methods

Emails have become one of the major applications in daily life. The continuous growth in the number of email users has led to a massive increase of unsolicited emails, which are also known as spam emails. Managing and classifying this huge number of emails is an important challenge. Most of the approaches introduced to solve this problem handled the high dimensionality of emails by using syntactic feature selection. In this paper, an efficient email filtering approach based on semantic methods is addressed. The proposed approach employs the WordNet ontology and applies different semantic based methods and similarity measures for reducing the huge number of extracted textual features, and hence the space and time complexities are reduced. Moreover, to get the minimal optimal features’ set, feature dimensionality reduction has been integrated using feature selection techniques such as the Principal Component Analysis (PCA) and the Correlation Feature Selection (CFS). Experimental results on the standard benchmark Enron Dataset showed that the proposed semantic filtering approach combined with the feature selection achieves high computational performance at high space and time reduction rates. A comparative study for several classification algorithms indicated that the Logistic Regression achieves the highest accuracy compared to Naïve Bayes, Support Vector Machine, J48, Random Forest, and radial basis function networks. By integrating the CFS feature selection technique, the average recorded accuracy for the all used algorithms is above 90%, with more than 90% feature reduction. Besides, the conducted experiments showed that the proposed work has a highly significant performance with higher accuracy and less time compared to other related works. Keywords: Email classification, Spam, WordNet ontology, Semantic similarity, Features reductio

Influence of Nitrogen Source and Growth Phase on Extracellular Biosynthesis of Silver Nanoparticles Using Cultural Filtrates of <i>Scenedesmus obliquus</i>

In this study, silver nanoparticles (AgNPs) were green-synthesized extracellularly by the action of bioactive compounds in cultural filtrates of green microalga Scenedesmus obliquus (KY621475). The influences of six different nitrogen sources (i.e., NaNO3, CO(NH4)2, (NH4)2CO3, KNO3, NH4NO3, and (NH4)2SO4) on extracellular biosynthesis of AgNPs were observed by UV&#8211;Visible spectroscopy (380&#8211;425 nm) and confirmed using high-resolution transmission electron microscopy (HRTEM). The highest biomass production was observed in the case of urea and ammonium carbonate treatments, which, surprisingly, showed negative activity for AgNPs biosynthesis. Considering their coupling and compatible presence in cultural filtrates, reductases (especially nitrate reductase) as reduction agents are assumed to play a key role in the extracellular biosynthesis of AgNPs. The cultural filtrates of the potassium and sodium nitrate treatments produce AgNPs of relatively small size (5&#8211;10 and 4&#8211;10 nm, respectively), smaller than those produced by filtrate of ammonium nitrate treatment. The antimicrobial activity of produced AgNPs was a function mainly of particle size, which was influenced by the nitrogen source of the microalgal culture. The AgNPs produced from the KNO3 and NaNO3 cultural filtrates performed the best as antimicrobial agents