A QR Code Based Zero-Watermarking Scheme for Authentication of Medical Images in Teleradiology Cloud

Healthcare institutions adapt cloud based archiving of medical images and patient records to share them efficiently. Controlled access to these records and authentication of images must be enforced to mitigate fraudulent activities and medical errors. This paper presents a zero-watermarking scheme implemented in the composite Contourlet Transform (CT)—Singular Value Decomposition (SVD) domain for unambiguous authentication of medical images. Further, a framework is proposed for accessing patient records based on the watermarking scheme. The patient identification details and a link to patient data encoded into a Quick Response (QR) code serves as the watermark. In the proposed scheme, the medical image is not subjected to degradations due to watermarking. Patient authentication and authorized access to patient data are realized on combining a Secret Share with the Master Share constructed from invariant features of the medical image. The Hu’s invariant image moments are exploited in creating the Master Share. The proposed system is evaluated with Checkmark software and is found to be robust to both geometric and non geometric attacks

Bactericidal Surfaces: An Emerging 21st Century Ultra-Precision Manufacturing and Materials Puzzle

Progress made by materials scientists in recent years has greatly helped the field of ultra-precision manufacturing. Ranging from healthcare to electronics components, phenomena such as twinning, dislocation nucleation, and high-pressure phase transformation have helped to exploit plasticity across a wide range of metallic and semiconductor materials. One current problem at the forefront of the healthcare sector that can benefit from these advances is that of bacterial infections in implanted prosthetic devices. The treatment of implant infections is often complicated by the growth of bacterial biofilms on implant surfaces, which form a barrier that effectively protects the infecting organisms from host immune defenses and exogenous antibiotics. Further surgery is usually required to disrupt the biofilm, or to remove the implant altogether to permit antibiotics to clear the infection, incurring considerable cost and healthcare burdens. In this review, we focus on elucidating aspects of bactericidal surfaces inspired by the biological world to inform the design of implant surface treatments that will suppress bacterial colonization. Alongside manufacturing and materials related challenges, the review identifies the most promising natural bactericidal surfaces and provides representative models of their structure, highlighting the importance of the critical slope presented by these surfaces. The scalable production of these complex hierarchical structures on freeform metallic implant surfaces has remained a scientific challenge to date and, as identified by this review, is one of the many 21st-century puzzles to be addressed by the field of applied physics

Discovery of two new phases of zirconium tetrakis(8-hydroxyquinolinolate): synthesis, crystal structure and their electron transporting characteristics in organic light emitting diodes (OLEDs)

Two new phases of zirconium tetrakis(8-hydroxyquinolinolate) (Zrq4) have been synthesised and characterised by single crystal X-ray diffraction. Their electrical, electronic, optical and thermal properties have been studied. Their electron transporting characteristics have been investigated in organic light emitting devices where the two phases show remarkable differences in performance. One of the forms (designated a-Zrq4) gives significantly lower operating voltage, higher efficiencies and longer lifetime than the other (designated b-Zrq4) in organic light emitting devices.EPSR

Novel lithium Schiff-base cluster complexes as electron injectors: synthesis, crystal structure, thin film characterisation and their performance in OLEDs

This journal is © The Royal Society of Chemistry 2012A set of novel lithium Schiff base cluster compounds has been synthesised and characterised for the first time and tested as electron injectors in OLED devices. Their electrical, electronic, thermal and optical properties have been investigated and compared with the industry standards LiF and lithium quinolinolate (LiQ). Amongst the compounds tested, lithium 2-((o tolylimino)methyl) phenolate was found to enhance the efficiency of OLEDs by 69% compared to LiF and 15% compared to LiQ. The same electron injector was found to extend the lifetimes of OLEDs by six-fold compared to LiF and 4.3- fold compared to LiQ respectively. The crystal structure of the parent compound, lithium 2- ((phenylamino)methyl)phenolate reveals that the compound is tetrameric in contrast to hexameric LiQ. Substituting the methyl group with fluorine causes a remarkable depression of the HOMO and LUMO levels by up to 1.2 eV. Analysis of current density vs. voltage characteristics of single-layer devices for Li–Al/electron injector/Li–Al and Al/electron injector/Al reveals that both sets of devices are operating as electron-only devices indicating that the formation of free lithium is the cause of enhanced electron injection, but either the energetic aluminium atoms (as proposed previously by other workers) or energetic lithium complexes on an aluminium surface (as we have demonstrated in this paper) are all that is required for efficient electron injection

Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study

Background The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. Objective This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. Study Design This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. Results We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P=.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. Conclusion One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

Background: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. Methods: We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. Results: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC. Conclusions: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors

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

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

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