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 relation between objective and subjective exposure to traffic noise around two suburban highway viaducts in Ghent : lessons for urban environmental policy

A growing empirical evidence base identifies environmental noise exposure as an important health problem. While the health effects depend for a great part on personal noise sensitivity and contextual factors, in environmental policy, generic noise standards and procedures based on objective sound levels are used. In this article, the relation between objective and subjective noise exposure variables is further explored by carrying out a residents’ survey in a highly noise polluted area along two highways south of the city centre of Ghent, Belgium. The survey results show only a weak correlation between objective and subjective exposure variables, with both variables demonstrating different associations with the respondents’ background characteristics. While lower-educated and lower-income people are generally higher exposed according to the models, they do not report a higher subjective exposure. People who have been living longer in the area are not necessarily higher exposed according to the models but do report a higher subjective exposure. Most strikingly, owners of a comfortable detached house report a higher subjective exposure than renters of an apartment or small house, while the latter group is significantly higher exposed according to the models. The results support a plea for the joint evaluation of both objective and subjective noise exposure variables in environmental policy and environmental assessments. In addition, the results argue for specific attention for noise exposure of socio-economically vulnerable people and the establishment of a shared knowledge base on noise exposure with both objective and subjective information

Many Labs 5: Registered Replication of Albarracín et al. (2008), Experiment 5

In Experiment 5 of Albarracín et al. (2008), participants primed with words associated with action performed better on a subsequent cognitive task than did participants primed with words associated with inaction. A direct replication attempt by Frank, Kim, and Lee (2016) as part of the Reproducibility Project: Psychology (RP:P) failed to find evidence for this effect. In this article, we discuss several potential explanations for these discrepant findings: the source of participants (Amazon’s Mechanical Turk vs. traditional undergraduate-student pool), the setting of participation (online vs. in lab), and the possible moderating role of affect. We tested Albarracín et al.’s original hypothesis in two new samples: For the first sample, we followed the protocol developed by Frank et al. and recruited participants via Amazon’s Mechanical Turk (n = 580). For the second sample, we used a revised protocol incorporating feedback from the original authors and recruited participants from eight universities (n = 884). We did not detect moderation by protocol; patterns in the revised protocol resembled those in our implementation of the RP:P protocol, but the estimate of the focal effect size was smaller than that found originally by Albarracín et al. and larger than that found in Frank et al.’s replication attempt. We discuss these findings and possible explanations

Many Labs 5: Registered Replication of Albarracín et al. (2008), Experiment 5

In Experiment 5 of Albarracín et al. (2008), participants primed with words associated with action performed better on a subsequent cognitive task than did participants primed with words associated with inaction. A direct replication attempt by Frank, Kim, and Lee (2016) as part of the Reproducibility Project: Psychology (RP:P) failed to find evidence for this effect. In this article, we discuss several potential explanations for these discrepant findings: the source of participants (Amazon’s Mechanical Turk vs. traditional undergraduate-student pool), the setting of participation (online vs. in lab), and the possible moderating role of affect. We tested Albarracín et al.’s original hypothesis in two new samples: For the first sample, we followed the protocol developed by Frank et al. and recruited participants via Amazon’s Mechanical Turk (n = 580). For the second sample, we used a revised protocol incorporating feedback from the original authors and recruited participants from eight universities (n = 884). We did not detect moderation by protocol; patterns in the revised protocol resembled those in our implementation of the RP:P protocol, but the estimate of the focal effect size was smaller than that found originally by Albarracín et al. and larger than that found in Frank et al.’s replication attempt. We discuss these findings and possible explanations

Male breast cancer in BRCA1 and BRCA2 mutation carriers: pathology data from the Consortium of Investigators of Modifiers of BRCA1/2

Abstract Background BRCA1 and, more commonly, BRCA2 mutations are associated with increased risk of male breast cancer (MBC). However, only a paucity of data exists on the pathology of breast cancers (BCs) in men with BRCA1/2 mutations. Using the largest available dataset, we determined whether MBCs arising in BRCA1/2 mutation carriers display specific pathologic features and whether these features differ from those of BRCA1/2 female BCs (FBCs). Methods We characterised the pathologic features of 419 BRCA1/2 MBCs and, using logistic regression analysis, contrasted those with data from 9675 BRCA1/2 FBCs and with population-based data from 6351 MBCs in the Surveillance, Epidemiology, and End Results (SEER) database. Results Among BRCA2 MBCs, grade significantly decreased with increasing age at diagnosis (P = 0.005). Compared with BRCA2 FBCs, BRCA2 MBCs were of significantly higher stage (P for trend = 2 × 10−5) and higher grade (P for trend = 0.005) and were more likely to be oestrogen receptor–positive [odds ratio (OR) 10.59; 95 % confidence interval (CI) 5.15–21.80] and progesterone receptor–positive (OR 5.04; 95 % CI 3.17–8.04). With the exception of grade, similar patterns of associations emerged when we compared BRCA1 MBCs and FBCs. BRCA2 MBCs also presented with higher grade than MBCs from the SEER database (P for trend = 4 × 10−12). Conclusions On the basis of the largest series analysed to date, our results show that BRCA1/2 MBCs display distinct pathologic characteristics compared with BRCA1/2 FBCs, and we identified a specific BRCA2-associated MBC phenotype characterised by a variable suggesting greater biological aggressiveness (i.e., high histologic grade). These findings could lead to the development of gender-specific risk prediction models and guide clinical strategies appropriate for MBC management

Many Labs 5: Testing Pre-Data-Collection Peer Review as an Intervention to Increase Replicability

Replication studies in psychological science sometimes fail to reproduce prior findings. If these studies use methods that are unfaithful to the original study or ineffective in eliciting the phenomenon of interest, then a failure to replicate may be a failure of the protocol rather than a challenge to the original finding. Formal pre-data-collection peer review by experts may address shortcomings and increase replicability rates. We selected 10 replication studies from the Reproducibility Project: Psychology (RP:P; Open Science Collaboration, 2015) for which the original authors had expressed concerns about the replication designs before data collection; only one of these studies had yielded a statistically significant effect (p < .05). Commenters suggested that lack of adherence to expert review and low-powered tests were the reasons that most of these RP:P studies failed to replicate the original effects. We revised the replication protocols and received formal peer review prior to conducting new replication studies. We administered the RP:P and revised protocols in multiple laboratories (median number of laboratories per original study = 6.5, range = 3–9; median total sample = 1,279.5, range = 276–3,512) for high-powered tests of each original finding with both protocols. Overall, following the preregistered analysis plan, we found that the revised protocols produced effect sizes similar to those of the RP:P protocols (Δr = .002 or .014, depending on analytic approach). The median effect size for the revised protocols (r = .05) was similar to that of the RP:P protocols (r = .04) and the original RP:P replications (r = .11), and smaller than that of the original studies (r = .37). Analysis of the cumulative evidence across the original studies and the corresponding three replication attempts provided very precise estimates of the 10 tested effects and indicated that their effect sizes (median r = .07, range = .00–.15) were 78% smaller, on average, than the original effect sizes (median r = .37, range = .19–.50)