Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.
Product-Service Systems (PSS) are seen as key enablers of circularity. However, better sustainability performance of PSS when compared to transactional business models is not given and it must be carefully considered in the design process. The early-stage PSS design is considered crucial because it determines most of the future offerings' impact. Nevertheless, manufacturing companies struggle with PSS design and often rely on ad hoc intuitive approaches with low success rates. Current PSS design approaches have been dispersed in literature until a recent systematic literature review by the authors proposed a comprehensive generic process model to enable the inclusion of sustainability considerations in the early stages. This paper takes the generic process model as a starting point and instantiates it to the context of two manufacturing companies, seeking to (i) explore the instantiation process from a generic to company-specific process models to support manufacturing companies; and (ii) reflect upon and prepare an evaluation of the generic process model concerning eight predefined criteria. The study reveals a number of potential areas for improving both generic and instantiated process models.
El pensamiento crítico y la deliberación conjunta son aspectos fundamentales en la educación de la ciudadanía en una sociedad democrática. Este trabajo estudia el papel de la emoción como elemento relevante en este tipo de procesos.
Las fíbulas “de caballito”, con o sin jinete, suelen vincularse con una élite ecuestre que asume el protagonismo en la nueva organización social de la segunda Edad del Hierro de la Hispania céltica, estructurada en torno a los oppida y sus territorios. Almagro-Gorbea y Torres (1999) realizaron una clasificación tipo-cronológica de los ejemplares conocidos, identificando una serie de talleres. Frente a un catálogo de 136 piezas, las que incorporaban un jinete representaban solo un 10 %. Una serie de nuevos hallazgos, así como las revisiones realizadas en las colecciones de diversos museos, permiten identificar dentro de este grupo un tipo concreto, con una distribución que abarca los territorios celtibérico, vacceo y vetón. Denominado como “tipo Castellares”, las características formales de todos los ejemplares son idénticas. Su estudio formal, técnico y analítico permite plantear su interpretación como símbolos compartidos de alianzas entre jefes en momentos de conflicto.
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