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

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

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Seminario De Investigación Académica 2 - Música-MS109-201501

El curso tiene como finalidad que los alumnos lleven a cabo una investigación académica individual o grupal sobre un tema y problema de investigación planteado por ellos mismos principalmente que gire en torno a la mención propia de la carrera que están cursando. Para ello será necesario plantear una estrategia de investigación y proponer una hipótesis la misma que deberán justificar. Los resultados de la investigación son presentados en una monografía en la cual es indispensable aplicar las herramientas adquiridas en Seminario de Investigación Académica 1. El trabajo monográfico se realiza individualmente o en grupos de no más de cuatro integrantes. La honestidad intelectual y el respeto a la propiedad intelectual son requisitos fundamentales para el desarrollo de este curso

Seminario De Investigación Académica 2 - Música-MS191-201602

El curso tiene como finalidad que los alumnos desarrollen un proyecto de investigación que les sirva de sustento para la elaboración de la tesis sobre temas de música. Para ello será necesario plantear un tema de investigación con todas las aristas necesarias. El proyecto de investigación que el alumno desarrolla es real a partir de sus investigaciones el establecerá la dimensión de su problema los objetivos proponer una hipótesis la misma que deberán justificar. La honestidad intelectual y el respeto a la propiedad intelectual son requisitos fundamentales para el desarrollo de este curs

Seminario De Investigación Académica 2 - Música-MS191-201502

El curso tiene como finalidad que los alumnos lleven a cabo una investigación académica individual o grupal sobre un tema y problema de investigación planteado por ellos mismos principalmente que gire en torno a la mención propia de la carrera que están cursando. Para ello será necesario plantear una estrategia de investigación y proponer una hipótesis la misma que deberán justificar. Los resultados de la investigación son presentados en una monografía en la cual es indispensable aplicar las herramientas adquiridas en Seminario de Investigación Académica 1. El trabajo monográfico se realiza individualmente o en grupos de no más de cuatro integrantes. La honestidad intelectual y el respeto a la propiedad intelectual son requisitos fundamentales para el desarrollo de este curso.Las capacidades que se trabajan en este curso son Pensamiento Crítico y Manejo de la Información

Moral reasoning and support for punitive violence: A multi-methods analysis

When do residents in communities affected by violent crime support punitive violence? Are they less likely to support harsh punishments when they use moral principles to guide their decisions? Does the use of dehumanizing language to describe criminals predict support for harsh punishments? We document and analyze decisions about responding to crime from 62in-depth qualitative interviews with individuals affected by violence in the Mexican state of Michoacán to address these questions. We conduct a quantitative analysis of how different forms of moral reasoning are related to punishment preferences for specific crime events, and a qualitative content analysis to investigate mechanisms. We find that two types of moral reasoning are particularly associated with support for punitive punishments: “consequentialist” reasoning that involves weighing the costs and benefits of an action, and reasoning that dehumanizes accused criminals. “Deontological” reasoning about the right or just action, while extremely common, is used more equally across arguments for and against punitive violence. Analysis of social media posts of elites provides suggestive evidence that these patterns hold with elites who have more influence on the occurrence of violence events and criminal justice policy. Our results provide micro-foundations for theories that assume that consequentialist decision-making leads to support for punitive violence in high-violence, high-impunity settings, and show how psychological processes like dehumanization can feed into those processes

Seminario De Investigación Académica 2 - Música-MS191-201601

El curso tiene como finalidad que los alumnos desarrollen un proyecto de investigación que les sirva de sustento para la elaboración de la tesis sobre temas de música. Para ello será necesario plantear un tema de investigación con todas las aristas necesarias. El proyecto de investigación que el alumno desarrolla es real a partir de sus investigaciones el establecerá la dimensión de su problema los objetivos proponer una hipótesis la misma que deberán justificar. La honestidad intelectual y el respeto a la propiedad intelectual son requisitos fundamentales para el desarrollo de este curs