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

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

Mineralogical and geotechnical properties of a latosol from Minas Gerais, Brazil

The mineralogical, chemical, and geotechnical properties of a latosol from the uplands of Minas Gerais, Brazil were studied to identify its collapsibility characteristics, which are little known. Near surface subsidence is a serious problem in the area and civil engineers consider soils with similar characteristics to cover 65% of the Brazilian land surface. This soil is classified as a lateritic or residual soil from a civil engineering standpoint, and as an Oxisol in the U.S. Soil Taxonomy. The parent material is believed to be Upper Pre-Cambrian limestone deposited about 500 million years B.P. Three hand-cut blocks from the horizons, the AB (20-70 cm), the B (70-120 cm) and the C (120-170 cm), were sampled at a well-drained upland site. All three are similar chemically and mineralogically. All are clays, averaging 11% sand, 28% silt, 61% clay. The silt fraction consists of aggregates cemented by iron oxides because clay increases and silt decreases after reductive dissolution of the iron oxide minerals. Kaolinite is the dominant clay mineral, with gibbsite, mica, hydroxy-interlayered vermiculite, rutile, anatase, goethite, and hematite also present. The pH (in 0.004 M CaCl\sb2) ranges from 5.2 in the AB to 4.30 in the B and C horizons. The point of zero charge ranges from 5.2 to 3.9 and is within 0.4 pH units of the soil pH. The soil is very porous (60% porosity) and has a very low dry density of 1000 kg m\sp{-3}. At normal overburden pressures the soil is moderately collapsible. The collapse potential index (CPI) is a function of the soil pH, the load at which water inundation is applied, and the initial degree of saturation. At moisture contents $\u3c$25%, CPI decreased from 4.05% to 2.34% when the pH of undisturbed specimens was increased from 4.7 to 6.8 using CaCO\sb3. At moisture contents $\u3e$25%, soil pH does not affect the CPI. At a constant soil pH of 5.61, when the initial moisture content increased from 9.4% to 25%, CPI decreased from 3% to 0.7%. When the soil pH increased the CPI decreased, in the range of moisture content below 25%, afterwards the soil pH seems not to affect the CPI. When the load under which the specimen is inundated with water increased, the CPI increased

Geomechanics of landfills - Innovative technology for liners

Cracks in clayey landfill liner, which cannot be closed up upon re-wetting, affect the long-term performance of a landfill. In this paper, the mixture bentonite-zeolite (BEZ) is presented as a potential liner material due to its plastic properties. Also, it may fulfill an existing demand, in developing countries, for liners that are cost-effective, natural and in compliance with environmental regulations. Traditional liners have shortcomings: (i) clayey soil is suitable for liners if the temperature and moisture fluctuations are not high; otherwise, they may form cracks; (ii) geomembranes, considered as the best alternatives for liners, are out of reach of most underdeveloped countries for their high price, and do not last more than 4 years; (iii) the interface of a CGL (clay geosynthetic liner) is susceptible to sliding. In the studies performed, the low volumetric shrinkage of the BEZ indicates that it is not affected by moisture content fluctuations, and its hydraulic conductivity in the order of 10(-10) cm/s meets regulatory agency requirements. Also, its inherent chemical properties (specially clinoptilolite zeolite) and its natural selectivity indicates that it will adsorb heavy metals such as Pb2+, Zn2+, Cd2+, Ni2+,Fe2+, and Mn2+ that may be present in leachate. Therefore, BEZ is a potential innovative material for liners in landfills