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

Challenges in microbial ecology: building predictive understanding of community function and dynamics.

The importance of microbial communities (MCs) cannot be overstated. MCs underpin the biogeochemical cycles of the earth's soil, oceans and the atmosphere, and perform ecosystem functions that impact plants, animals and humans. Yet our ability to predict and manage the function of these highly complex, dynamically changing communities is limited. Building predictive models that link MC composition to function is a key emerging challenge in microbial ecology. Here, we argue that addressing this challenge requires close coordination of experimental data collection and method development with mathematical model building. We discuss specific examples where model-experiment integration has already resulted in important insights into MC function and structure. We also highlight key research questions that still demand better integration of experiments and models. We argue that such integration is needed to achieve significant progress in our understanding of MC dynamics and function, and we make specific practical suggestions as to how this could be achieved

Polycyclic aromatic hydrocarbon (PAH) metabolites in marine fishes as a specific biomarker to indicate PAH pollution in the marine coastal environment

In this study, analysis methods for the PAH metabolites of naphthalene (Na), pyrene (Py) and benzo(a)pyrene (BaP) with different benzo-rings (2-4-5 rings respectively) were developed and the metabolism kinetics of Py and BaP in marine fishes were studied. Two PAH metabolites of Na and Py, namely 1-naphthol (1-OH Na) and 1-hydroxy pyrene (1-OH Py), were determined using the fixed wavelength fluorescence (FF) method, and the BaP metabolite, 3-hydroxy benzo(a)pyrene (3-OH BaP), was determined using reverse-phase HPLC with fluorescence detection. The dose- and time-response of Lateolabrax japonicus to Py metabolites and Sparus macrocephalus to BaP metabolites were studied in order to evaluate the use of PAH metabolites as a means of assessing exposure to PAHs. The results showed that both fishes could be induced to metabolize and eliminate their metabolites in vivo with increasing Py and BaP exposure concentrations in seawater. As Py and BaP concentrations increased, metabolite concentrations in the fish bile also increased. A significant dose-response of biliary PAH metabolites was observed after exposure for 1, 3 and 7 days for Py and 2, 4 and 7 days for BaP, respectively. These results provide the proof necessary for using PAH metabolites in marine fishes as a specific biomarker or early warning signal of PAH pollution in the marine coastal environment