33 research outputs found

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    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

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    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

    Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

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    This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

    Resource Management with X.509 Inter-domain Authorization Certi\ufb01cates (InterAC)

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    Collaboration among independent administrative domains would require: i) confidentiality, integrity, non-repudiation of communication between the domains; ii) minimum and reversible modifications to the intra-domain precollaboration setup; iii) maintain functional autonomy while collaborating; and, iv) ability to quickly transform frompost-collaboration to pre-collaboration stage. In this paper, we put forward our mechanism that satisfies above requirements while staying within industry standards so that the mechanism becomes practical and deployable. Our approach is based on X.509 certificate extension. We have designed a non-critical extension capturing users' rights in such a unique way that the need for collaboration or the post-collaboration stage does not require update of the certificate. Thus, greatly reducing the revocation costs and size of CRLs. Furthermore, rights amplification and degradation of users from collaborating domains into host domain can be easily performed. Thus, providing functional autonomy to collaborators. Initiation of collaboration among two domains require issuance of one certificate from each domain and revocation of these certificates ends the collaboration - ease of manageability

    Resource management with X.509 inter-domain authorization certificates (InterAC)

    No full text
    Collaboration among independent administrative domains would require: i) confidentiality, integrity, non-repudiation of communication between the domains; ii) minimum and reversible modifications to the intra-domain pre-collaboration setup; iii) maintain functional autonomy while collaborating; and, iv) ability to quickly transform from post-collaboration to pre-collaboration stage. In this paper, we put forward our mechanism that satisfies above requirements while staying within industry standards so that the mechanism becomes practical and deployable. Our approach is based on X.509 certificate extension. We have designed a non-critical extension capturing users' rights in such a unique way that the need for collaboration or the post-collaboration stage does not require update of the certificate. Thus, greatly reducing the revocation costs and size of CRLs. Furthermore, rights amplification and degradation of users from collaborating domains into host domain can be easily performed. Thus, providing functional autonomy to collaborators. Initiation of collaboration among two domains require issuance of one certificate from each domain and revocation of these certificates ends the collaboration - ease of manageability. © 2010 Springer-Verlag

    Addressing the Shortcomings of One-Way Chains

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    One-way hash chains have been the preferred choice, over the symmetric and asymmetric key cryptography, in security setups where e#ciency mattered; despite the ephemeral confidentiality and authentication they assure. Known constructions of one-way chains (for example, SHA-1 based), only ensure the forward secrecy and have limitations over their length i.e., a priori knowledge of chain's length is necessary before constructing it. In this paper, we will see how our approach, based on chameleon functions, leads to the generation of practically unbounded one-way chains with constant storage and computational requirements. We provide the construction and advantages of our proposal with the help of a secure group communication setup. We also provide the implementation details of our construction and argue its suitability for security setups, where one cannot a priori determine the longevity of the setup
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