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

Fabrication Errors Influence on the Sperical Array Radiation Pattern

The paper studies fabrication errors influence on the radiation pattern of a spherical antennas array. The developed Moment Method (MoM) program analyzes a particular influence of an azimuth and elevation position and local angle errors of antenna elements as well as model dimension errors on the radiation pattern. The spectral domain approach to the analysis of the spherical antenna arrays is applied here. Finally, results obtained from the theoretical investigation are verified by comparison with measured results

Reduction of Sidelobes by Nonuniform Elements Spacing of a Spherical Antenna Array

This paper presents a significant sidelobe reduction if nonuniform elevational spacing of antenna elements on the sphere is used. Antenna elements are progressively phased with a uniform amplitude excitation. The calculation of the required element position is presented. The achieved sidelobe level reduction with unequally spaced arrays could reach even more than 20dB difference with regard to the first significant sidelobe level of equally spaced arrays. By this method, arrays have the ability to produce the desired radiation pattern and could satisfy requirements for many applications