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

Human walking in the real world: Interactions between terrain type, gait parameters, and energy expenditure.

Humans often traverse real-world environments with a variety of surface irregularities and inconsistencies, which can disrupt steady gait and require additional effort. Such effects have, however, scarcely been demonstrated quantitatively, because few laboratory biomechanical measures apply outdoors. Walking can nevertheless be quantified by other means. In particular, the foot's trajectory in space can be reconstructed from foot-mounted inertial measurement units (IMUs), to yield measures of stride and associated variabilities. But it remains unknown whether such measures are related to metabolic energy expenditure. We therefore quantified the effect of five different outdoor terrains on foot motion (from IMUs) and net metabolic rate (from oxygen consumption) in healthy adults (N = 10; walking at 1.25 m/s). Energy expenditure increased significantly (P < 0.05) in the order Sidewalk, Dirt, Gravel, Grass, and Woodchips, with Woodchips about 27% costlier than Sidewalk. Terrain type also affected measures, particularly stride variability and virtual foot clearance (swing foot's lowest height above consecutive footfalls). In combination, such measures can also roughly predict metabolic cost (adjusted R2 = 0.52, partial least squares regression), and even discriminate between terrain types (10% reclassification error). Body-worn sensors can characterize how uneven terrain affects gait, gait variability, and metabolic cost in the real world

Evaluation of Error-State Kalman Filter Method for Estimating Human Lower-Limb Kinematics during Various Walking Gaits

Inertial measurement units (IMUs) offer an attractive way to study human lower-limb kinematics without traditional laboratory constraints. We present an error-state Kalman filter method to estimate 3D joint angles, joint angle ranges of motion, stride length, and step width using data from an array of seven body-worn IMUs. Importantly, this paper contributes a novel joint axis measurement correction that reduces joint angle drift errors without assumptions of strict hinge-like joint behaviors of the hip and knee. We evaluate the method compared to two optical motion capture methods on twenty human subjects performing six different types of walking gait consisting of forward walking (at three speeds), backward walking, and lateral walking (left and right). For all gaits, RMS differences in joint angle estimates generally remain below 5 degrees for all three ankle joint angles and for flexion/extension and abduction/adduction of the hips and knees when compared to estimates from reflective markers on the IMUs. Additionally, mean RMS differences in estimated stride length and step width remain below 0.13 m for all gait types, except stride length during slow walking. This study confirms the method&rsquo;s potential for non-laboratory based gait analysis, motivating further evaluation with IMU-only measurements and pathological gaits

Estimating Stair Running Performance Using Inertial Sensors

Stair running, both ascending and descending, is a challenging aerobic exercise that many athletes, recreational runners, and soldiers perform during training. Studying biomechanics of stair running over multiple steps has been limited by the practical challenges presented while using optical-based motion tracking systems. We propose using foot-mounted inertial measurement units (IMUs) as a solution as they enable unrestricted motion capture in any environment and without need for external references. In particular, this paper presents methods for estimating foot velocity and trajectory during stair running using foot-mounted IMUs. Computational methods leverage the stationary periods occurring during the stance phase and known stair geometry to estimate foot orientation and trajectory, ultimately used to calculate stride metrics. These calculations, applied to human participant stair running data, reveal performance trends through timing, trajectory, energy, and force stride metrics. We present the results of our analysis of experimental data collected on eleven subjects. Overall, we determine that for either ascending or descending, the stance time is the strongest predictor of speed as shown by its high correlation with stride time

Method for Estimating Three-Dimensional Knee Rotations Using Two Inertial Measurement Units: Validation with a Coordinate Measurement Machine

Three-dimensional rotations across the human knee serve as important markers of knee health and performance in multiple contexts including human mobility, worker safety and health, athletic performance, and warfighter performance. While knee rotations can be estimated using optical motion capture, that method is largely limited to the laboratory and small capture volumes. These limitations may be overcome by deploying wearable inertial measurement units (IMUs). The objective of this study is to present a new IMU-based method for estimating 3D knee rotations and to benchmark the accuracy of the results using an instrumented mechanical linkage. The method employs data from shank- and thigh-mounted IMUs and a vector constraint for the medial-lateral axis of the knee during periods when the knee joint functions predominantly as a hinge. The method is carefully validated using data from high precision optical encoders in a mechanism that replicates 3D knee rotations spanning (1) pure flexion/extension, (2) pure internal/external rotation, (3) pure abduction/adduction, and (4) combinations of all three rotations. Regardless of the movement type, the IMU-derived estimates of 3D knee rotations replicate the truth data with high confidence (RMS error &lt; 4 ° and correlation coefficient r ≥ 0.94 )

L'Auto-vélo : automobilisme, cyclisme, athlétisme, yachting, aérostation, escrime, hippisme / dir. Henri Desgranges

03 juillet 19181918/07/03 (A19,N6372)