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

Geometrical features and metallurgical characteristics of Nd:YAG laser drilled holes in thick IN718 and Ti-6Al-4V sheets

Laser drilling is increasingly becoming the method of choice for precision drilling of a variety of components, particularly in the aircraft industry. Notwithstanding the current level of acceptance of laser drilling in the aerospace industry, a number of defects such as spatter, recast and taper are associated with laser drilled holes and elimination of these defects is the subject of intense research. The present paper deals with Nd:YAG laser drilling of 4 and 8 mm thick sections of IN718 and Ti-6Al-4V materials. The influence of type of material and its thickness, as well as parametric impact of key process variables like pulse frequency and pulse energy, have been determined. In the course of this study, relevant geometrical features of the drilled holes, like hole diameter and taper angle, have been comprehensively investigated. In addition, all metallurgical characteristics of interest, viz extent and nature of spatter, recast and heat-affected zone, have been evaluated. Effort has also been made to obtain some insights into the evolution of a through-thickness hole during laser percussion drilling of thick sections by careful experimentation involving monitoring the progression of the drilled hole with increasing number of laser pulses. Issues pertaining to variation of taper with depth of hole, change in crater depth with progressive drilling and specific energy consumption are also discussed

Influence of process parameters during pulsed Nd:YAG laser cutting of nickel-base superalloys

Although CO<SUB>2</SUB> lasers have been widely employed for commercial sheet metal cutting operations, increased recognition of the processing benefits afforded by pulsed Nd:YAG lasers has recently fuelled interest in the latter. Pulsed Nd:YAG laser cutting differs from conventional continuous wave laser cutting as it involves overlapping of a series of individual spots generated by each pulse. In this paper, a typical cutting regime for pulsed Nd:YAG laser cutting of 1 mm thick Hastelloy-X sheet has been constructed and explained in terms of extent of spot overlap. The characteristics of single holes drilled employing the same process parameters as those employed for cutting were investigated and correlated with the obtained processing regime. Additionally, the influence of key process parameters like pulse duration on the shift in the constructed processing regime was investigated. Cut quality attributes like kerf width, cut edge kerf profile and surface roughness were also studied and their dependence on process parameters has been discussed

A statistical approach to determine process parameter impact in Nd:YAG laser drilling of IN718 and Ti-6Al-4V sheets

The numerous unique advantages afforded by pulsed Nd:YAG laser systems have led to their increasing utility for producing high aspect ratio holes in a wide range of materials. Notwithstanding the growing industrial acceptance of the technique, the increasingly tighter geometrical tolerances and more stringent hole quality requirements of modern industrial components demand that "defects" such as taper, recast, spatter etc., in laser-drilled holes are minimized. Process parameters like pulse energy, pulse repetition rate, pulse duration, focal position, nozzle standoff, type of gas and gas pressure of the assist gas are known to significantly influence hole quality during laser drilling. The present study reports the use of Taguchi design of experiments technique to study the effects of the above process variables on the quality of the drilled holes and ascertain optimum processing conditions. Minimum taper in the drilled hole was considered as the desired target response. The entire study was conducted in three phases:(a) screening experiments, to identify process variables that critically influence taper in laser drilled holes, (b) Optimization experiments, to ascertain the set of parameters that would yield minimum taper and (c) validation trials, to assess the validity of the experimental procedures and results. Results indicate that laser drilling with focal position on the surface of the material being drilled and employing low level values of pulse duration and pulse energy represents the ideal conditions to achieve minimum taper in laser-drilled holes. Thorough assessment of results also reveals that the laser-drilling process, optimized considering taper in the drilled hole as the target response, leads to very significant improvements in respect of other hole quality attributes of interest such as spatter and recast as well

The effects of decentralization on the production and use of risk assessment: Insights from landslide management in India and Italy

Landslides represent a major threat to human life, property and the environment. Landslide hazard and risk assessments seek to inform the policy and practice of landslide hazard risk management, for example, by identifying high-risk areas so that appropriate policy and private actions could be taken in terms of preventive and mitigative measures. We examine whether a decentralized risk assessment system leads to better assessment outcomes compared to a centralized risk assessment system. The paper is based on a comparative study of two countries India and Italy and their responses to landslide risk. Our results indicate a causal relationship between decentralization and three outcomes. First, decentralization appears to be conducive to the more rapid and more complete assessment of risks in local places, through mapping at an appropriate scale. Second, decentralization appears to foster greater and more transparent communication of risk assessment products, such as maps. Third, decentralization appears to lead to a more open, and at times contentious, public discourse over how to interpret and respond to the information contained in the risk assessments and maps. However, in practice, decentralization faces serious institutional resistance. Our analysis does not preclude other risk assessment outcomes or competing explanations for differences in risk assessment and management outcomes. Rather, it provides an understanding of the direction in which the institutional change may be driven for bringing about more effective risk assessments and their use