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

Endogenous (In)Formal Institutions.

Despite the huge evidence documenting the relevance of inclusive political institutions and a culture of cooperation, we still lack a framework that identifies their origins and interaction. In a model in which an elite and a citizenry try to cooperate in consumption risk-sharing and investment, we show that a rise in the investment value encourages the elite to introduce more inclusive political institutions to convince the citizenry that a sufficient part of the returns on joint investments will be shared. In addition, accumulation of culture rises with the severity of consumption risk if this is not too large and thus cheating is not too appealing. Finally, the citizenry may over-accumulate culture to credibly commit to cooperate in investment when its value falls and so inclusive political institutions are at risk. These predictions are consistent with the evolution of activity-specific geographic factors, monasticism, and political institutions in a panel of 90 European regions spanning the 1000-1600 period. Evidence from several identification strategies suggests that the relationships we uncover are causal

Pauline : opera, in four acts /

Includes publisher's advertisements at beginning and end.First edition statements from cover, second from title page.Place and date of publication inferred from place and date of first performance."The passages in the libretto, which are distinguished by inverted commas, have been taken literally, or almost literally, from The lady of Lyons"--Title page verso."Personages"--Title page verso; includes performers.First performed in London at the Lyceum Theatre, 22 November 1876. See Loewenberg.Loewenberg, Alfred. Annals of opera,Mode of access: Internet

Danses polovtziennes du Prince Igor / Borodine, comp. ; The London Philharmonic Choir ; Frédéric Jackson, chef de choeur ; The London Philharmonic Orchestra ; Eduard Van Beinum, dir.. L'amour sorcier / Manuel de Falla, comp. ; The London Philharmonic Orchestra ; Anthony Collins, dir.

Titre uniforme : Borodin, Aleksandr Porfirʹevič (1833-1887). Compositeur. [Knâz' Igor'. Poloveckie plâski]Titre uniforme : Falla, Manuel de (1876-1946). Compositeur. [El amor brujo. G 68]Comprend : Danses polovtziennes du Prince Igor / Borodine, comp. ; The London Philharmonic Choir ; Frédéric Jackson, chef de choeur ; Eduard Van Beinum, dir. ; L'amour sorcier / Manuel de Falla, comp. ; Anthony Collins, dir.BnF-Partenariats, Collection sonore - BelieveContient une table des matière

Agglomeration and growth with and without capital mobility

'This paper presents a simple framework in which the location and the growth rate of economic activities are endogenous and interact. We show that the nature of the equilibrium and of the relation between growth and location depends fundamentally on whether capital is assumed to be mobile (in which case we interpret it as physical capital) or immobile (human capital). In the first case, with constant returns to scale, growth and location are independent and no divergence or convergence process takes place. We show that newly created firms can relocate to the poor region, even though there is always a higher share of firms in the rich region, if the industry is competitive and if the return to capital is low. With immobile capital, a process of convergence between regions takes place when transaction costs on goods are sufficiently high but a process of 'catastrophic' agglomeration occurs when these costs are sufficiently high and regional inequality is not affected between regions. With localized technological spillovers, higher spatial concentration of economic activities spurs growth, whether capital is mobile or not. This implies that lowering transaction costs on goods can spur growth but increase regional inequality. Lowering transaction costs on 'trade in technologies' between regions may increase both regional equality and growth.' (author's abstract)Das Arbeitspapier stellt einen einfachen Rahmen vor, in welchem der Standort und die Wachstumsrate von wirtschaftlichen Aktivitaeten endogen sind und interagieren. Die Autoren zeigen, dass das Wesen des Gleichgewichts und der Beziehung zwischen Wachstum und Standort entscheidend davon abhaengt, ob das Kapital als beweglich (physisches Kapital) oder als unbeweglich (Humankapital) angenommen wird. Im ersten Fall sind Wachstum und Standort unabhaengig und es findet kein Divergenz- oder Konvergenzprozess statt. Es wird gezeigt, dass neu gegruendete Unternehmen in eine arme Region umgesiedelt werden koennen, obwohl es immer einen hoeheren Anteil von Unternehmen in einer reichen Region gibt, wenn die Industrie wettbewerbsfaehig und der Rueckfluss an Kapital gering ist. Im Falle des unbeweglichen Kapitals findet ein Konvergenzprozess zwischen Regionen statt, wenn die Transaktionskosten von Guetern ausreichend hoch sind, aber es erscheint ein Prozess von 'katastrophaler' Agglomeration, wenn diese Kosten ausreichend hoch sind und eine regionale Ungleichheit zwischen Regionen nicht gegeben ist. Durch standortgebundene technologische Ueberlaeufe kann eine hoehere raeumliche Konzentration von wirtschaftlichen Aktivitaeten das Wachstum anregen, egal ob das Kapital beweglich oder nicht beweglich ist. Dies bedeutet, dass niedrigere Transaktionskosten von Guetern zu Wachstum anregen, aber das regionale Ungleichgewicht verstaerken koennen. Niedrigere Transaktionskosten beim 'Handel von Technologien' zwischen Regionen koennten zugleich die regionale Gleichheit und das Wachstum vergroessern. (ICIUebers)German title: Agglomeration und Wachstum mit und ohne KapitalmobilitaetAvailable from http://www.hwwa.de/Publikationen/Discussion Paper/2001/130.pdf / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman