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

Aprendizajes y prácticas educativas en las actuales condiciones de época: COVID-19

“Esta obra colectiva es el resultado de una convocatoria a docentes, investigadores y profesionales del campo pedagógico a visibilizar procesos investigativos y prácticas educativas situadas en el marco de COVI-19. La misma se inscribe en el trabajo llevado a cabo por el equipo de Investigación responsable del Proyecto “Sentidos y significados acerca de aprender en las actuales condiciones de época: un estudio con docentes y estudiantes de la educación secundarias en la ciudad de Córdoba” de la Facultad de Filosofía y Humanidades. Universidad Nacional de Córdoba. El momento excepcional que estamos atravesando, pero que también nos atraviesa, ha modificado la percepción temporal a punto tal que habitamos un tiempo acelerado y angustiante que nos exige la producción de conocimiento provisorio. La presente publicación surge como un espacio para detenernos a documentar lo que nos acontece y, a su vez, como oportunidad para atesorar y resguardar las experiencias educativas que hemos construido, inventado y reinventando en este contexto. En ella encontrarán pluralidad de voces acerca de enseñar y aprender durante la pandemia. Este texto es una pausa para reflexionar sobre el hacer y las prácticas educativas por venir”.Fil: Beltramino, Lucia (comp.). Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Escuela de Archivología; Argentina

Mathematical models for food safety in public health

This project of applied science was undertaken to provide evidence to face complex and multifaceted issues posed by the control of zoonotic foodborne pathogens and the related challenges for public health, veterinary medicine, food and environmental safety. The thesis is divided in two different parts, each addressing a specific zoonotic pathogens: Hepatitis E virus (HEV) and Shiga toxin-producing E.coli (STEC). The main goal was to produce estimations to help targeting intervention strategies in livestock and in food production chain. In Part I, a bottom-up risk assessment approach has been followed using original and existing data, to analyse the risk of consumers exposure to HEV through the consumption of contaminated food, following the from farm to fork approach, i.e. considering the two main compartments of the food production chain: the primary production level and the consumer level. In the pre-harvest block the HEV transmission dynamic was modeled to identify risk factors influencing the prevalence of HEV positive pigs entering the foodproduction chain at slaughtering. In the post-harvest block we compared several foodstuff to evaluate the risk of transmission of HEV to humans and to underline possible risk factors in the primary production that can lead to higher contamination of food products. In Part II, the objective of our quantitative assessment were Shiga toxin-producing E.coli (STEC). In this case the availability of subtyping characterisation data of STEC isolated from different non-human sources and the complexity of transmission cycle of the STEC led us to choose a top-down approach, from the reported cases of infection in humans, through the food chain up to the primary source of STEC infection. This project was carried out within an ongoing European project (DISCOVER) were a original dataset were put together. We were able to adapt classical source attribution model to STEC using a novel approach for pathogenicity definition that allowed us to weigh the importance of the different sources in causation of human infection

Do bank-affiliated P&C insurers perform better? An empirical investigation

This article analyses the impact of bank affiliation on the performance of P&C insurance companies by examining a sample of Italian P&C insurers operating during the 2005–2015 time frame. After completing a descriptive analysis to single out bankaffiliated insurers’ specific features, we perform a multivariate regression in order to ascertain whether affiliation affects operating profitability. Our findings show that bank affiliation at best does not entail any cost advantage while altering the influence of underwriting results on firm performance. The way this happens deviates from what has been found for life insurance operations, where bank affiliation also has an impact. Our results suggest that the competitive levers that bank-affiliated insurers exploit in the P&C business are different from those adopted by other firms and that these levers are specific to non-life insurance activity

Bank affiliation influence on life insurers’ performance before and after the financial crisis

The article analyses the link between life insurers’ profitability and bank affiliation. It also examines the influence that the differences in product mix and distribution costs displayed by bank affiliated versus traditional insurers has on results. On top of that, it investigates the changes that the big financial crisis caused in the previously established correlations, helping us to explore the influence of macroeconomic settings on performance’s drivers. To achieve the above goals, we consider a sample of Italian life insurers and we perform a panel regression analysis using variables based on information coming from insurers’ financial statements and ownership data from 2003 to 2013. Our results highlights that, until 2007, possibly due to different products’ offerings depending on their affiliation, neither distribution efficiency nor being bank affiliated significantly affected life insurers’ performance. Product mix composition did not influence results as well. During the bull financial market lasting from 2000 to 2007, financial policies marketed by bank affiliated insurers fetched good returns to their issuers thanks to exceptionally high management fees compensating from their lower profitability compared to traditional with profit policies. However, the big financial crisis challenged the previous drivers of profitability. In the new macroeconomic conditions, both distribution efficiency and bank affiliation prove to be crucial in fostering performance. Moreover, adverse economic conditions make product mix revision crucial in order to adapt to changes in demand and sustain profitability

Interaction between DNA and benzo- and tetrahydrofurocoumarins: thermodynamic and molecular modeling studies

The non-covalent interaction of a series of new water-soluble benzo- and tetrahydrobenzofurocoumarins with salmon testes DNA has been studied using flow linear dichroism, circular dichroism, contact fluorescence energy transfer and ethidium bromide displacement assay. The new derivatives are characterised by having an alkyl amino side chain protonated at physiological pH; this fact strongly enhances the solubility in aqueous media and the affinity for the macromolecule. The results show significant difference in the affinity and the mode of binding among the examined compounds depending on the nature of the fourth condensed ring and the position of the alkylamino side chain. Benzofurocoumarins derivatives bind DNA by undergoing intercalation inside the duplex macromolecule, whereas tetrahydrobenzofurocoumarins derivatives show a substantial tilt relative to the base planes. Molecular modeling studies have been performed to characterise in detail the intercalation mechanism of these benzofurocoumarins to DNA

Quantitative Methods for the Prioritization of Foods Implicated in the Transmission of Hepatititis E to Humans in Italy

Hepatitis E is considered an emerging foodborne disease in Europe. Several types of foods are implicated in the transmission of the hepatitis E virus (HEV) to humans, in particular, pork and wild boar products. We developed a parametric stochastic model to estimate the risk of foodborne exposure to HEV in the Italian population and to rank the relevance of pork products with and without liver (PL and PNL, respectively), leafy vegetables, shellfish and raw milk in HEV transmission. Original data on HEV prevalence in different foods were obtained from a recent sampling study conducted in Italy at the retail level. Other data were obtained by publicly available sources and published literature. The model output indicated that the consumption of PNL was associated with the highest number of HEV infections in the population. However, the sensitivity analysis showed that slight variations in the consumption of PL led to an increase in the number of HEV infections much higher than PNL, suggesting that PL at an individual level are the top risky food. Uncertainty analysis underlined that further characterization of the pork products preparation and better assessment of consumption data at a regional level is critical information for fine-tuning the most risky implicated food items in Italy

Anti-Müllerian hormone concentrations and antral follicle counts for the prediction of pregnancy outcomes after intrauterine insemination

Objective To evaluate anti-Müllerian hormone (AMH) concentrations and antral follicle counts (AFCs) in the prediction of pregnancy outcomes after controlled ovarian stimulation among women undergoing intrauterine insemination. Methods A retrospective study included women with unexplained infertility aged 41 years or younger who attended a fertility clinic in Italy between December 2009 and May 2014. Ovarian stimulation was achieved with recombinant follicle-stimulating hormone or highly purified human menopausal gonadotropin. Receiver operating characteristic curves were generated to predict ongoing pregnancy. The primary outcome was the association between AMH/AFC and ongoing pregnancy, and was assessed by logistic regression. Results Overall, 276 women were included, of whom 43 (15.6%) achieved ongoing pregnancy. Multivariate analysis showed that women with a serum day-3 concentration of AMH higher than 2.3 ng/mL were more likely to have ongoing pregnancy than were those with a concentration lower than 2.3 ng/mL (odds ratio 5.84, 95% confidence interval 2.38-14.31; P < 0.001). No associations were recorded for AFCs. Conclusion AMH should be used to predict the pregnancy outcome of intrauterine insemination