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 investigations and mathematical modeling of the dynamics of thermal decomposition of carbon composites

The thermolysis of carbon compositions of leading enterprises of the electrode branch of industry is experimentally investigated by methods of differential thermal and gravimetric analysis in a temperature range of 200-900°C using a Setsys Evolution 1750 derivatograph. The samples of "green" billets differed in the granulometric composition of carbon of the filling agent and the type of the binding agent (pitch). They were heated at a rate of 15 K/min in the inert medium. The data on the isolation of volatiles were processed by mathematical modeling in the Mathcad-11 medium by one- and two-component diagrams of computation of the kinetics of the thermolysis process. Mathematical models adequately describing these experimental data were constructed. The constants or the reaction rate and activation energies of decomposition of the binder of carbon composites for both diagrams of the computations were established. An example of the computation of thermolysis for industrial conditions of roasting the graphitized electrode of the EG Ø200 mm grade is presented