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

Differential cross-section measurements of the production of four charged leptons in association with two jets using the ATLAS detector

Differential cross-sections are measured for the production of four charged leptons in association with two jets. These measurements are sensitive to final states in which the jets are produced via the strong interaction as well as to the purely-electroweak vector boson scattering process. The analysis is performed using proton-proton collision data collected by ATLAS at √s = 13 TeV and with an integrated luminosity of 140 fb−1. The data are corrected for the effects of detector inefficiency and resolution and are compared to state-of-the-art Monte Carlo event generator predictions. The differential cross-sections are used to search for anomalous weak-boson self-interactions that are induced by dimension-six and dimension-eight operators in Standard Model effective field theory

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Search for Higgs boson decays into a pair of pseudoscalar particles in the final state with the ATLAS detector in collisions at

This paper presents a search for decays of the Higgs boson with a mass of 125 GeV into a pair of new pseudoscalar particles, H -> aa, where one a-boson decays into a b-quark pair and the other into a muon pair. The search uses 139 fb(-1) of proton-proton collision data at a center-of-mass energy root s = 13 TeV recorded between 2015 and 2018 by the ATLAS experiment at the LHC. A narrow dimuon resonance is searched for in the invariant mass spectrum between 16 GeV and 62 GeV. The largest excess of events above the Standard Model backgrounds is observed at a dimuon invariant mass of 52 GeV and corresponds to a local (global) significance of 3.3 sigma (1.7 sigma). Upper limits at 95% confidence level are placed on the branching ratio of the Higgs boson to the bb mu mu final state, beta(H -> aa -> bb mu mu), and are in the range 0.2-4.0 x 10(-4), depending on the signal mass hypothesis

Search for events with a pair of displaced vertices from long-lived neutral particles decaying into hadronic jets in the ATLAS muon spectrometer in collisions at

A search for events with two displaced vertices from long-lived particle (LLP) pairs using data collected by the ATLAS detector at the LHC is presented. This analysis uses 139 fb(-1) of proton-proton collision data at root s=13 TeV recorded in 2015-2018. The search employs techniques for reconstructing vertices of LLPs decaying to jets in the muon spectrometer displaced between 3 and 14 m with respect to the primary interaction vertex. The observed numbers of events are consistent with the expected background and limits for several benchmark signals are determined. For the Higgs boson with a mass of 125 GeV, the paper reports the first exclusion limits for branching fractions into neutral long-lived particles below 0.1%, while branching fractions above 10% are excluded at 95% confidence level for LLP proper lifetimes ranging from 4 cm to 72.4 m. In addition, the paper present the first results for the decay of LLPs into (tt) over bar in the ATLAS muon spectrometer

Constraints on Higgs boson production with large transverse momentum using decays in the ATLAS detector

This paper reports constraints on Higgs boson production with transverse momentum above 1 TeV. The analyzed data from proton-proton collisions at a center-of-mass energy of 13 TeV were recorded with the ATLAS detector at the Large Hadron Collider from 2015 to 2018 and correspond to an integrated luminosity of 136 fb(-1.) Higgs bosons decaying into b (b) over bar are reconstructed as single large-radius jets recoiling against a hadronic system and are identified by the experimental signature of two b-hadron decays. The experimental techniques are validated in the same kinematic regime using the Z -> b (b) over bar process. The 95% confidence-level upper limit on the cross section for Higgs boson production with transverse momentum above 450 GeV is 115 fb, and above 1 TeV it is 9.6 fb. The Standard Model cross section predictions for a Higgs boson with a mass of 125 GeV in the same kinematic regions are 18.4 fb and 0.13 fb, respectively

Search for heavy particles in the -tagged dijet mass distribution with additional -tagged jets in proton-proton collisions at with the ATLAS experiment

A search optimized for new heavy particles decaying to two b-quarks and produced in association with additional b-quarks is reported. The sensitivity is improved by b-tagging at least one lower-pT jet in addition to the two highest-pT jets. The data used in this search correspond to an integrated luminosity of 103 fb-1 collected with a dedicated trijet trigger during the 2017 and 2018 pffisffi = 13 TeV proton-proton collision runs with the ATLAS detector at the LHC. The search looks for resonant peaks in the b-tagged dijet invariant mass spectrum over a smoothly falling background. The background is estimated with an innovative data-driven method based on orthonormal functions. The observed b-tagged dijet invariant mass spectrum is compatible with the background-only hypothesis. Upper limits at 95% confidence level on a heavy vector-boson production cross section times branching ratio to a pair of b-quarks are derived

Search for neutral long-lived particles in pp collisions at s \sqrt{s} = 13 TeV that decay into displaced hadronic jets in the ATLAS calorimeter

A search for decays of pair-produced neutral long-lived particles (LLPs) is presented using 139 fb(-1) of proton-proton collision data collected by the ATLAS detector at the LHC in 2015-2018 at a centre-of-mass energy of 13 TeV. Dedicated techniques were developed for the reconstruction of displaced jets produced by LLPs decaying hadronically in the ATLAS hadronic calorimeter. Two search regions are defined for different LLP kinematic regimes. The observed numbers of events are consistent with the expected background, and limits for several benchmark signals are determined. For a SM Higgs boson with a mass of 125 GeV, branching ratios above 10% are excluded at 95% confidence level for values of c times LLP mean proper lifetime in the range between 20 mm and 10 m depending on the model. Upper limits are also set on the cross-section times branching ratio for scalars with a mass of 60 GeV and for masses between 200 GeV and 1 Tev

Search for single production of a vectorlike quark decaying into a Higgs boson and top quark with fully hadronic final states using the ATLAS detector

A search is made for a vectorlike T quark decaying into a Higgs boson and a top quark in 13 TeV protonproton collisions using the ATLAS detector at the Large Hadron Collider with a data sample corresponding to an integrated luminosity of 139 fb???1. The Higgs-boson and top-quark candidates are identified in the all-hadronic decay mode, where H - bb ?? and t - bW - bqq??0 are reconstructed as large-radius jets. The candidate Higgs boson, top quark, and associated B hadrons are identified using tagging algorithms. No significant excess is observed above the background, so limits are set on the production cross section of a singlet T quark at 95% confidence level, depending on the mass mT and coupling ??T of the vectorlike T quark to Standard Model particles. In the considered mass range between 1.0 and 2.3 TeV, the upper limit on the allowed coupling values increases with mT from a minimum value of 0.35 for 1.07 < mT < 1.4 TeV to 1.6 for mT 1/4 2.3 TeV

Search for Higgs boson pair production in the two bottom quarks plus two photons final state in collisions at with the ATLAS detector

Searches are performed for nonresonant and resonant di-Higgs boson production in the b (b) over bar gamma gamma final state. The dataset used corresponds to an integrated luminosity of 139 fb(-1) of proton-proton collisions at a center-of- mass energy of 13 TeV recorded by the ATLAS detector at the CERN Large Hadron Collider. No excess above the expected background is found and upper limits on the di-Higgs boson production cross sections are set. A 95% confidence-level upper limit of 4.2 times the cross section predicted by the Standard Model is set on pp -> HH nonresonant production, where the expected limit is 5.7 times the Standard Model predicted value. The expected constraints are obtained for a background hypothesis excluding pp -> HH production. The observed (expected) constraints on the Higgs boson trilinear coupling modifier kappa(lambda) are determined to be [-1.5, 6.7] ([-2.4, 7.7]) at 95% confidence level, where the expected constraints on kappa(lambda) are obtained excluding pp -> HH production from the background hypothesis. For resonant production of a new hypothetical scalar particle X (X -> HH -> b (b) over bar gamma gamma), limits on the cross section for pp -> X -> HH are presented in the narrow-width approximation as a function of m x in the range 251 GeV <= m(X) <= 1000 GeV. The observed (expected) limits on the cross section for pp ->> X -> HH range from 640 fb to 44 fb (391 fb to 46 fb) over the considered mass range