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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Fidelity of molluscan assemblages from the touro passo formation (pleistocene-holocene), southern brazil: taphonomy as a tool for discovering natural baselines for freshwater communities

This study is the first assessment of mollusk fossil assemblages relative to the compositional fidelity of modern mollusk living and death assemblages. It also shows that the sedimentary record can provide information on the original, non-human-impacted, freshwater malacofauna biodiversity, based on Late Pleistocene shells. The fossil mollusk assemblage from the Touro Passo Formation (Pleistocene-Holocene) was compared to living and death assemblages of the Touro Passo River, southern Brazil, revealing little resemblance between fossil and live-dead species composition. Although the living and death assemblages agree closely in richness, species composition, and species relative abundances (both proportional and rank), the fossil assemblage differs significantly from both modern assemblages in most of these measures. The fossil assemblage is dominated by the native endemic corbiculid bivalve Cyanocyclas limosa and the gastropod Heleobia aff. bertoniana. These are absent in the living assemblages, and both living and death assemblages are dominated by the alien Asiatic corbiculid C. fluminea, which is absent in the fossil assemblage. The fossil assemblage also contains, overall, a higher proportional abundance of relatively thick-shelled species, suggesting a genuine bias against the thinner- and smaller-shelled species. Our results suggest that contemporary environmental changes, such as the introduction of some alien freshwater mollusk species, together with post-burial taphonomic processes, are the main factors leading to the poor fidelity of the fossil assemblage studied. Hence, the taxonomic composition of the Late Pleistocene mollusks from the Touro Passo Formation probably would show greater similarity to present-day assemblages wherever the mollusk biodiversity is not disturbed by human activities

Comparative analysis of drilling frequencies in recent brachiopod-mollusk associations from the Southern Brazilian Shelf

Over 14,000 specimens-5,204 brachiopods, 9,137 bivalves, and 178 gastropods-acquired from 30 collecting stations (0 to 45 m depth) in the Ubatuba and Picinguaba bays, southern Brazil, were compared for drilling frequencies. Beveled (countersunk) circular-to-subcircular borings (Oichnus-like drill holes) were found in diverse bivalves but also in the rhynchonelliform brachiopod Bouchardia rosea-a small, semi-infaunal to epifaunal, free-lying species that dominates the brachiopod fauna of the southern Brazilian shelf. Drill holes in bivalve mollusks and brachiopods are comparable in their morphology, average diameter, and diameter range, indicating attacks by a single type of drilling organism. Drill holes in brachiopods were rare (0.4%) and found only at five sampling sites. Drillings in bivalves were over 10 times as frequent as in brachiopods, but the average drilling frequency was still low (5.6%) compared to typical boring frequencies of Cenozoic mollusks. Some common bivalve species, however, were drilled at frequencies up to 50 times higher than those observed for shells of B. rosea from the same samples. Due to scarcity of drilled brachiopods, it is not possible to evaluate if the driller displayed a nonrandom (stereotyped) site, size, or valve preference. Drilled brachiopods may record (1) naticid or muricid predation, (2) predation by other drillers, (3) parasitic drillings, and (4) mistaken or opportunistic attacks. Low drilling frequency in brachiopods is consistent with recent reports on ancient and modern examples. The scarcity of drilling in brachiopods, coupled with much higher drilling frequencies observed in sympatric bivalves, suggests that drilling in brachiopods may have been due to facultative or erroneous attacks. The drilling frequencies observed here for the brachiopod-bivalve assemblages are remarkably similar to those reported for Permian brachiopod-bivalves associations. This report adds to the growing evidence for an intriguing macroecological stasis: multiple meta-analytical surveys of present-day and fossil rhynchonelliform brachiopods conducted in recent years also point to persistent scarcity and low intensity of biotic interactions between brachiopods and drilling organisms throughout their evolutionary history

Brachiopods of the Itararé Group from Mafra county, southern Brazil, and their geological significance

Two remarkable brachiopod-bearing occurrences are recorded in the Late Paleozoic deposits of the Paraná Basin, cropping-out in the Mafra county, State of Santa Catarina, southern Brazil. These deposits belong to the upper-mid part of Itararé Group, known as Mafra and Lontras assemblages. The first one belong to the mid portion of the Mafra Formation, recorded in the Potreiro Farm outcrop. The second brachiopod occurrence is recorded in a 1.5-m-thick deposit of dark siliceous shales (Lontras shale), in which fossil remains are extremely abundant. Shells come from the Campáleo outcrop, located close to the BR-280 highway, 2km far from Mafra county. These shales are referred to the upper part of the Campo Mourão Formation. Until now, only two species of brachiopods were formally described or identified for these assemblages (i.e., Lingula imbituvensis Oliveira, Orbiculoidea guaraunensis Oliveira). Hence, the brachiopods faunas above are here described and/or revised, based on the available material deposited in the CENPALEO scientific collection (Contestado University). Preliminary results of our systematic survey indicated that both faunas are much diverse than previously realized. The Lontras shale brachiopod assemblage includes: Biconvexiella roxoi (Oliveira), Quinquenella? sp., Beecheria? sp., Langella imbituvensis (Oliveira), and Orbiculoidea guaraunensis Oliveira. On the other hand, the Mafra assemblage is composed by B. roxoi, Q. rionegrensis?, L. imbituvensis, and O. guaraunensis. Therefore, both assemblages show various taxa in common. It is noteworthy that the species L. imbituvensis, B. roxoi and Q. rionegrensis are also recorded in the upper part of the Taciba Formation, in Teixeira Soares region, State of Paraná. This is significant since: a- suggests a close faunal affinity among those brachiopodassemblages from distinct units of the Itararé Group; b- indicates that the stratigraphic range of those three above mentioned species is very wide, in which the oldest occurrence is recorded in the mid portion of the Mafra Formation and the youngest one in the uppermost portion of the Taciba Formation. Finally, both faunas are remarkable since they precede the record of the Eurydesma fauna, which thrived in the Paraná Basin, during the deposition of the Taciba Formation.Fil: Neves, Jacqueline. P.. Universidade Federal do Paraná; BrasilFil: Taboada, Arturo Cesar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Centro de Investigación Esquel de Montaña y Estepa Patagónica. Universidad Nacional de la Patagonia "San Juan Bosco". Centro de Investigación Esquel de Montaña y Estepa Patagónica; ArgentinaFil: Weinschütz, Luis. C.. Universidade Federal do Paraná; BrasilFil: Simoes, Marcello G.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilXXV Congresso Brasileiro de PaleontologiaRiberao PretoBrasilSociedade Brasileira de Paleontologi

STOWING AWAY ON SHIPS THAT PASS IN THE NIGHT: SCLEROBIONT ASSEMBLAGES ON INDIVIDUALLY DATED BIVALVE AND BRACHIOPOD SHELLS FROM A SUBTROPICAL SHELF

This study evaluates encrustation and bioerosion of brachiopods (Bouchardia rosea) and bivalves (Semele casali) occurring on the inner shelf of the Southeast Brazilian Bight, accounting for differences in water depth, sediment type, host size, and time averaging. Frequencies of colonization covary across sites, but brachiopods are more frequently encrusted than bivalves at all sites, although this difference may disappear after standardization for shell size, depending on the chosen metric. Size selectivity during sclerobiont colonization appears to change as a function of their population density, rather than substrate differences between hosts. Sediment grain size and composition do not appear to exert environmental controls on encrustation or bioerosion, nor does either vary as a function of water depth alone. Radiocarbon-calibrated aspartic acid racemization dating of individual host valves shows similar age ranges and age structures for both hosts. Both epifaunal brachiopods and infaunal bivalves are colonized rapidly, within years to decades, with no further increase over millennial timescales. Rapid burial and sequestration from sclerobiont larvae is inconsistent with rapid postmortem exhumation and encrustation of infaunal bivalves, and indicates a brief temporal window for colonization. The relative abundance of sclerobionts is volatile over the time interval represented by dated valves, but temporal stability is seen in presence-absence data for epibiont and endobiont taxa. These results support the utility of taphonomic deployment experiments for investigating long-term patterns of hard-substrate colonization, but indicate careful consideration of host size is required for comparison of sclerobiont assemblages within or among taxa.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Permian bivalve molluscs from the Gai-As Formation, northern Namibia: systematics, taphonomy and biostratigraphy

Fossil bivalves from two horizons in the Gai-As Formation of NW Namibia are tentatively correlated with mid-Permian taxa of the Passa Dois Group of Brazil, supporting the concept that the Parana Basin extended into Africa. The Namibian fauna includes a new genus and species, Huabiella compressa, which was previously confused with Brazilian taxa. The taphonomy of the bivalve-rich strata indicates deposition under the influence of episodic events, such as storms. The Gai-As Formation directly overlies the mesosaurid-bearing deposits of the Huab Formation, indicating a significant unconformity when compared with the more complete succession of the Passa Dois Group, Parana Basin, Brazil. The studied bivalve assemblages are no younger than 265+/-2.5Ma (mid-Permian), based on U/Pb radiometric dating of zircons from tuffs.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Aspartic acid racemization dating of Holocene brachiopods and bivalves from the southern Brazilian shelf, South Atlantic

The extent of racemization of aspartic acid (Asp) has been used to estimate the ages of 9 shells of the epifaunal calcitic brachiopod Bouchardia rosea and 9 shells of the infaunal aragonitic bivalve Semele casali. Both taxa were collected concurrently from the same sites at depths of 10 m and 30 m off the coast of Brazil. Asp D/L values show an excellent correlation with radiocarbon age at both sites and for both taxa (r(Site)(2) (9) (B. rosea) = 0.97 r(Site)(2) (1) (B.) (rosea) = 0.997, r(Site)(2) (9) (S.) (casali) = 0.9998, r(2) (Site) (1) (S.casali) = 0.93). The Asp ratios plotted against reservoir-corrected AMS radiocarbon ages over the time span of multiple millennia can thus be used to develop reliable and precise geochronologies not only for aragonitic mollusks (widely used for dating previously), but also for calcitic brachiopods. At each collection site, Bouchardia specimens display consistently higher D/L values than specimens of Semele. Thermal differences between sites are also notable and in agreement with theoretical expectations, as extents of racemization for both taxa are greater at the warmer, shallower site than at the cooler, deeper one. In late Holocene marine settings, concurrent time series of aragonitic and calcitic shells can be assembled using Asp racemization dating, and parallel multi-centennial to multi-millennial records can be developed simultaneously for multiple biomineral systems. (c) 2006 University of Washington. All rights reserved

The Eurydesma-Lyonia fauna of the Capivarí marine beds, Late Paleozoic, Itararé Group, northeast of the Paraná Basin, Brazil

A 2-m-thick silty shale bed within the Taciba Formation, Itararé Group, Paraná Basin, State of São Paulo, southeastern Brazil, records marine sedimentation in a siliciclastic-dominated, low energy, shelfal setting during a short-lived deglacial event. Within this bed, which is located 100-150 m below the base of the early Permian, post-glacial, overlying Tatui Formation, remains of shelly marine benthos (Capivari assemblage) are disperse, and representing the highest phylum-level diversity so far identified within a given fossil-bearing horizon in the uppermost portion of the Itararé Group. The marine assemblage is dominated by rhynchonelliform brachiopods, with subordinated occurrences of bivalves, gastropods and crinoids. Shells of brachiopods (Lyonia rochacamposi, Rhynchopora grossopunctata, Biconve-xiella sp., Quinquenella rionegrensis), bivalves (Phestia tepuelensis, Streblopteria aff. lagunensis, Limipecten capivariensis, Praeundulomya cf. subelongata), and gastropods [Woolnoughia (Mourlonia)? sp., Peruvispira sp.] were identified. Crinoid columns were assigned to øPentaridica sp. Biconvexiella and Peruvispira are probably new species. The overwhelming majority of brachiopods belongs to B. sp. followed by R. grossopunctata. Particularly noteworthy is the record of L. rochacamposi that are also present in the uppermost part of the Taciba Formation in southern Brazil. Quinquenella, Phestia, Limipecten, and Praeundulomya are also recorded in fine to very fine sandstones/siltstones with hummocky cross-stratification and intercalated mudstones of the Taciba Formation, Teixeira Soares region, State of Paraná. Hence, the Capivari marine fauna correlates, but is not necessarily strict synchronous, with those of the upper part of the Taciba Formation from the southern Brazil, and Sauce Grande-Colorado(Argentina), Huab (Hardap shale of the Dwyka Group), Aranos area (Namibia), southwest Africa, and the Carnarvon (Western Australia) basins. This correlation suggests a latest Asselian-earliest Sakmarian age for the fauna. Data indicate that the Capivari fossil-bearing marine beds record a short-lived deglacial event and the first occurrence of members of the Eurydesma-Lyonia fauna in the northeastern part of the Paraná Basin, Brazil. [FAPESP 13/25317-7; CNPq 302903/12-3].Fil: Simoes, Marcello. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Neves, Jacqueline. Universidade Tecnologia Federal do Parana; BrasilFil: Taboada, Arturo Cesar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Centro de Investigación Esquel de Montaña y Estepa Patagónica. Universidad Nacional de la Patagonia "San Juan Bosco". Centro de Investigación Esquel de Montaña y Estepa Patagónica; ArgentinaFil: Pagani, María Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Museo Paleontológico Egidio Feruglio; ArgentinaFil: Varejao, Filipe, G.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Assine, Mario, L.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilXXV Congresso Brasileiro de PaleontologiaRiberao PretoBrasilSociedade Brasileira de Paleontologi

Quantitative comparisons and models of time-averaging in bivalve and brachiopod shell accumulations

The variation in time-averaging between different types of marine skeletal accumulations within a depositional system is not well understood. Here we provide quantitative data on the magnitude of time-averaging and the age structure of the sub-fossil record of two species with divergent physical and ecological characteristics, the brachiopod Bouchardia rosea and the bivalve Semele casali. Material was collected from two sites on a mixed carbonate-siliciclastic shelf off the coast of Brazil where both species are dominant components of the local fauna.Individual shells (n = 178) were dated using amino acid racemization (aspartic acid) calibrated with 24 AMS radiocarbon dates. Shell ages range from modern to 8118 years B.P. for brachiopods, and modern to 4437 years for bivalves. Significant differences in the shape and central tendency of age-frequency distributions are apparent between each sample. Such differences in time-averaging magnitude confirm the assumption that taphonomic processes are subject to stochastic variation at all spatial and temporal scales. Despite these differences, each sample is temporally incomplete at centennial resolution and three of the four samples have similar right-skewed age-frequency distributions. Simulations of temporal completeness indicate that samples of both species from the shallow site are consistent with a more strongly right-skewed and less-complete age-frequency distribution than those from the deep site.We conclude that intrinsic characteristics of each species exert less control on the time-averaging signature of these samples than do extrinsic factors such as variation in rates of sedimentation and taphonomic destruction. This suggests that brachiopod-dominated and bivalve-dominated shell accumulations may be more similar in temporal resolution than previously thought, and that the temporal resolution of multi-taxic shell accumulations may depend more on site-to-site differences than on the intrinsic properties of the constituent organisms.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq