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

Small Landers and Separable Sub-Spacecraft for Near-term Solar Sails

Following the successful PHILAE landing with ESA's ROSETTA probe and the launch of the MINERVA rovers and the Mobile Asteroid Surface Scout, MASCOT, aboard the JAXA space probe, HAYABUSA2, to asteroid (162173) Ryugu, small landers have found increasing interest. Integrated at the instrument level in their mothership they support small solar system body studies. With efficient capabilities, resource-friendly design and inherent robustness they are an attractive exploration mission element. We discuss advantages and constraints of small sub-spacecraft, focusing on emerging areas of activity such as asteroid diversity studies, planetary defence, and asteroid mining, on the background of our projects PHILAE, MASCOT, MASCOT2, the JAXA-DLR Solar Power Sail Lander Design Study, and others. The GOSSAMER-1 solar sail deployment concept also involves independent separable sub-spacecraft operating synchronized to deploy the sail. Small spacecraft require big changes in the way we do things and occasionally a little more effort than would be anticipated based on a traditional large spacecraft approach. In a Constraints-Driven Engineering environment we apply Concurrent Design and Engineering (CD/CE), Concurrent Assembly, Integration and Verification (CAIV) and Model-Based Systems Engineering (MBSE). Near-term solar sails will likely be small spacecraft which we expect to harmonize well with nano-scale separable instrument payload packages

Platinum(II) Ring-Fused Chlorins as Near-Infrared Emitting Oxygen Sensors and Photodynamic Agents

Novel near-infrared luminescent compounds based on platinum(II) 4,5,6,7-tetrahydropyrazolo[1,5-a]pyridine-fused chlorins are described. These compounds have high photostability and display light emission, in particular simultaneous fluorescence and phosphorescence emission in solution at room temperature, in the biologically relevant 700-850 nm red and near-infrared (NIR) spectral region, making them excellent materials for biological imaging. The simultaneous presence of fluorescence and phosphorescence emission at room temperature, with the phosphorescence strongly quenched by oxygen whereas fluorescence remains unaffected, allows these compounds to be used as ratiometric oxygen sensors in chemical and biological media. Both steady-state (fluorescence vs phosphorescence intensities) and dynamic (dependence of phosphorescence lifetimes upon oxygen concentration) luminescence approaches can be used. Photocytotoxicity studies against human melanocytic melanoma cells (A375) indicate that these compounds display potential as photosensitizers in photodynamic therapy