35 research outputs found

    Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

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    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

    Structural RFV: Recovery Form and Defaultable Debt Analysis

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    Receiving the same fractional recovery of par at default for bonds of the same issuer and seniority, regardless of remaining maturity, has been labelled in the academic literature as a Recovery of Face Value at Default (RFV). Such a recovery form results from language found in typical bond indentures and is supported by empirical evidence from defaulted bond values. We incorporate RFV into an exogenous boundary structural credit risk model and compare its effect to more typical recovery forms found in such models. We find that the chosen recovery form can significantly affect valuation and the sensitivities produced by these models, thus having important implications for empirical studies attempting to validate structural credit risk models. We show that some features of existing structural models are a result of the recovery form assumed in the model and do not necessarily hold under an RFV recovery form. Some of our results complement those found in the literature which examines the endogeneity of the default boundary. We find that some features that may have been solely attributed to modelling the boundary as an optimal decision by the fir

    Coordinator Rotation Via Domatic Partition In Self-Organizing Sensor Networks

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    We investigate the problem of energy conservation in ClusterHead rotation in wireless sensor networks. Nodes are battery powered without being replenished, thus maximizing lifetime of network by minimizing energy consumption poses challenge in design of protocols. We argue, though clustering addresses lifetime and scalability goals, it results to an expensive load-balancing scheme based on ClusterHead rotation(i.e. reclustering).The load balancing technique of existing clustering schemes uses global rotation of ClusterHead roles in order to prevent any single node from complete energy exhaustion. Theoretically, the problem of rotating the responsibility of being a ClusterHead has been abstracted as domatic partitioning problem for maximum cluster-lifetime problem. Instead, this work presents an analysis of its design and implementation aspects. We propose a domatic partitioning based scheme for ClusterHead rotation in clustering protocol. Our self-organizing protocol achieves energy-conservation in achieving local load balancing of nodes. The simulation results demonstrate that our approach outperforms re-clustering in terms of energy consumption, and lifetime parameters. © 2007 IEEE

    Voiding pressures in boys: Pdetmax versus pdetQmax – Does it make a difference?

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    Introduction: Invasive urodynamics (UDS) is a standard investigation in children. Studies measuring voiding pressures in children use varied nomenclatures and quote a wide range of voiding pressures. Thus, voiding pressures in children are not considered reliable and they do not find any place in the pediatric diagnostic armamentarium. On the contrary, adult studies have well-defined nomograms and standard values which make voiding studies indispensable in the diagnosis of voiding dysfunctions in adults. The difference primarily lies in the uniformity of parameters assessed in adults and the contrasting heterogeneity in the pediatric literature. Objective: The objective of this study was to study the voiding parameters observed during UDS in boys. Study Design: We retrospectively reviewed the pressure flow data obtained during conventional invasive UDS in 106 neurologically normal boys (6 months–16 years) who had different indications for urodynamics. The values of Pdetmax and PdetQmax were analyzed and compared with the existing data of pressure flow studies in children. Results: Pdetmax decreased with age whereas PdetQmax was independent of age. The difference between the values of Pdetmax and PdetQmax was more in the younger kids. The wide range of voiding detrusor pressure (Pdet) in the existing pediatric literature is similar to the values of Pdetmax observed in our study, whereas the value of PdetQmax is much lower. Discussion: The values of Pdetmax observed in this study are similar to the values of “maximum Pdet during voiding” documented in previous studies and are determined by detrusor contractility and functional/dynamic contraction of outflow during voiding. PdetQmax has been documented in very few pediatric studies and is significantly less than Pdetmax. Further prospective studies are needed to corroborate UDS findings with radiologic/cystoscopic findings to create nomograms of voiding parameters in children. Conclusion: Existing literature on pediatric voiding studies mentions voiding pressures during variable phases of void (usually Pdetmax) and the values have been very heterogeneous, making voiding pressure-flow studies unreliable in children. PdetQmax values are much lower than values quoted as “standard” pressures and are age independent. The use of PdetQmax instead of PdetMax may make voiding pressures in children more reproducible and informative
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