Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

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

The Euclidean matching problem

Résumé. 2014 Nous étudions le problème du couplage (« matching ») en dimension finie. Les corrélations euclidiennes entre les distances peuvent être prises en compte de manière systématique. Par rapport au cas des distances aléatoires indépendantes que nous avions étudiées précédemment, les corrélations triangulaires euclidiennes engendrent des corrections qui s'annulent dans la limite où la dimension de l'espace tend vers l'infini, et restent relativement petites à toute dimension. Abstract. 2014 We study the matching problem in finite dimensions. The Euclidean correlations of the distances can be taken into account in a systematic way. With respect to the case of independent random distances which we have studied before, the adjonction of Euclidean triangular correlations gives rise to corrections which vanish when the dimension of space goes to infinity, and remain relatively small in any dimensions

Muscle Regeneration in mdx Mice: Resistance to Repeated Necrosis is Compatible with Myofiber Maturity

The regenerated muscle fibers of mdx dystrophic mice remain permanently centronucleated and show resistance to repeated necrosis. Searching for mechanisms that could induce such resistance, we studied whether mdx regenerated fibers differ from the original ones by having a smaller calibre or by showing a different histochemical typing. Moreover, since in several genetic diseases of skeletal muscle the deleterious effects of abnormal gene expression are suppressed in immature fibers, we studied the expression of developmental myosin heavy chain (d-MHC) as a marker of persistent immaturity in mdx regenerated fibers. Our results show that in mdx gastrocnemius: 1) the course of the disease is accompanied by a prevalent loss of large-calibre original fibers with relative preservation of small-calibre fibers. On the contrary, regenerated fibers tend to grow larger than the original ones, without showing repeated necrosis. 2) Type II fibers show a mild decrease in number but are still largely preponderant over type I fibers at 6 months. 3) Expression of d-MHC is absent in fully regenerated myofibers. In conclusion, while large calibre and type II fibers are more vulnerable among the original myofiber population, these factors do not interfere with viability o

APE-100 Computer: (i) The Architecture

We describe APE-100, a SIMD, modular parallel processor architecture for large scale scientific computations. The largest configuration that will be implemented in the present design will deliver a peak speed of 100 Gflops. This performance is, for instance, required for high precision computations in Quantum Chromo Dynamics, for which APE-100 is very well suited. Keywords: Parallelism, architectures, floating point, VLSI. 1. Overview. In the years 1985\Gamma1987, the APE collaboration has been involved in a major effort to design and build a parallel computer in the 1 Gflops range. APE [1] has been one among several projects [2] that have built floating point engines mainly tailored to the requirements of numerical simulations of Lattice Gauge Theories (LGT) and especially of Lattice Quantum Chromo Dynamics [3] (QCD), the gauge theory which, in the continuum limit, is supposed to describe the strong interactions between elementary particles. Three APE units, featuring floating poi..