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

Effect of NPK fertilization on the chemical properties and bioactive compounds of the cabezona pineapple fruit: Pineapple quality

ABSTRAC Objective: To evaluate the effect of NPK fertilization on the chemical properties and bioactive compounds of the big-headed pineapple fruit. Design/methodology/approach: 15 NPK fertilization treatments were evaluated and established in the field in a Random Complete Block design with four repetitions per treatment. At the end of the crop cycle, the obtained fruits were determined pH, °Brix and % citric acid, following the methodology established by NMX-FF-028 and 011 respectively. The pH was measured directly to the juice with a potentiometer. Ascorbic acid with a kit to determine ascorbic acid from the SIGMA-ALDRICH® brand, the concentrations of total polyphenols were also determined following the methodology of De la Cruz et al. (2018) and those of total flavonoids following the methodology of Hossain et al. (2011) with modifications. Results: The average values for °Brix, % citric acid and pH were 7.3, 7.1 and 3.4 respectively, without significant differences between treatments. In the concentration of ascorbic acid, a highly significant difference was observed between treatments, with treatment three having the highest concentration (19.4 mg 100 g-1 FF). The concentrations of total polyphenols (41.34 mg 100 g-1 FF) and flavonoids (1.6 mg 100 g-1 FF) did not show significant differences between the fertilization treatments and the control. Study limitations/implications: The degree of maturity of the pineapple fruit directly influences the chemical properties and concentration of bioactive compounds. Findings/conclusions: NPK fertilization had no effect on °Brix and pH. The percentage of citric acid and the concentration of total polyphenols increase as the doses of P2O5 are increased. The concentration of ascorbic acid and total flavonoids is not affected by NPK fertilization dose. Keywords: Big-headed pineapple, NPK fertilization, Chemical properties, Bioactive compounds.Objective: To evaluate the effect of NPK fertilization on the chemical properties and bioactive compounds of the cabezona pineapple fruit. Design/methodology/approach: 15 NPK fertilization treatments were evaluated and carried out in the field in a random complete block design with four repetitions per treatment. At the end of the crop cycle, we determined the pH, °Brix and citric acid % of the fruits that were harvested, following the methodology established in NMX-FF-028 and 011. The pH of the juice was measured directly using a potentiometer. Ascorbic acid was measured with a SIGMA-ALDRICH® kit, the total polyphenol contents were determined following the methodology of De la Cruz-Ricardez et al. (2020), while total flavonoid contents were measured following a modified version of the methodology proposed by Hossain et al. (2011). Results: The mean values for °Brix, citric acid %, and pH were 7.3, 7.1 and 3.4 respectively, without significant differences between treatments. A highly significant difference in the concentration of ascorbic acid was observed between treatments; treatment three had the highest concentration (19.4 mg 100 g-1 FF). There were no significant differences between the fertilization treatments and the control, regarding total polyphenol content (41.34 mg 100 g-1 FF) and flavonoids (1.6 mg 100 g-1 FF) concentrations. Study limitations/implications: The ripening degree of the pineapple fruit directly influences the chemical properties and the concentration of bioactive compounds. Findings/conclusions: NPK fertilization had no effect on °Brix and pH. The citric acid percentage and the total polyphenol content increased as the doses of P2O5 increased. The ascorbic acid concentration and total flavonoid content are not affected by the NPK fertilization dose

Germination of Crotalaria and Lupinus (Fabaceae) seeds submitted to different pre-germination treatments and their effect on enzymatic activity during early germination

Abstract Most of the wild and native legume seeds has a hard and impermeable testa, which causes physical dormancy and prevents them from germinating even when environmental conditions are favorable. The study evaluated the effect of scarification treatments on germination and enzymatic activity of Crotalaria longirostrata (Cl) and Lupinus exaltatus (Le) seeds. After scarification treatments, germination percentage (GP) and rate (GR) were assessed during 30 days after seeding (DAS); and water absorption (WA) and specific enzymatic activity (SEA) during early germination (0, 6, 18, 36, 72, 120 h) in a growing chamber at 25 °C and photoperiod of 12 h. Scarification with 98% H2SO4 15 min increased GP and GR in both species. At 30 DAS, GP and GR of Le seeds were 34% and 0.97 seeds day-1, respectively. In Cl seeds, GP was 64% and GR 0.90 seeds day-1. Scarification with H2O at 80 °C 1 min also promoted germination in Cl (52%). At 120 h after seeding, Le and Cl seeds showed already a high GP with acid scarification (31% and 48%, respectively). In seeds of both species, scarification treatments affected WA and SEA during early germination. During this period, scarification treatments that increased GP also showed a higher α-D-galactosidase activity. The maximum enzyme activity was observed 72 h after hot water scarification in Cl (82.6 U/mg total protein), followed by acid scarification (54.5 U/mg total protein). In Le, the activity peak was 36 h after acid scarification (9.5 U/mg total protein). No relationship was observed between β-glucosidase activity and GP in both species. In conclusion, during early germination of both species, the increase in GP is accompanied by a rise in α-D-galactosidase activity between 36 and 72 h after seeding; and in Cl seeds, an alternative scarification treatment to increase GP may be the use of hot water