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.

Linked Article: Earnshaw et al. Br J Dermatol 2020; 183:792–794.

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Summary Psoriasis is a chronic, hereditary disease with a complex immunopathogenesis, rendering it susceptible to misinformation. Misinformation related to psoriasis can have negative effects both on the public perception of psoriasis and on patients' knowledge of psoriasis. To characterize misinformation related to psoriasis available online, we performed a formal literature review via PubMed and a thematic review via Google. Key themes of misinformation included ‘victim‐blaming’ (hygiene), ‘vector’ (contagion), ‘vaccination’, ‘vilification’ of conventional therapy, ‘validation’ of natural treatment and diet, ‘veneration’ of cures and ‘vocalization’ from celebrities. Misinformation related to psoriasis is pervasive on social media and other websites. Dermatologists, as patient advocates, should be aware of the content of misinformation available online and combat misleading health information to optimize health outcomes for patients with psoriasis.

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Background: The burden of illness associated with atopic dermatitis (AD) is significant and multidimensional, especially in those with moderate to severe disease.Objective: Our objective was to evaluate the disease burden of patients with AD in relation to psychological distress, sleep disturbance, and alcohol misuse.Methods: Patients with AD, attending 2 tertiary referral centers in Dublin, Ireland, were recruited. A series of validated questionnaires were used including the Patient-

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A challenge for natural area managers is to ensure that public expenditure on land restoration is cost effective, efficient and transparent but this is difficult to achieve in practice, especially when there are many possible projects across multiple years. Here we develop a “roadmap” for investment in land restoration. It explicitly considers space, time and their interaction, in relation to ecological outcomes and restoration costs (and their variation in time and space). Using integer linear programming optimization in a benefit‐cost accounting framework, the roadmap incorporates: transitions between different stages of ecological recovery in a spatial mosaic of multiple ecosystem types; cost schedules associated with managing those transitions over time; time lags between beginning management and achieving outcomes; variations to constraints and goals associated with various factors including site accessibility, specific conservation priorities (such as threatened species or ecosystems); and background environmental trends. This approach enables land managers to: (1) forecast landscape‐scale outcomes of management strategies over long timeframes; (2) address the question of how long it will take and how much it will cost to achieve specific outcomes; and (3) explore potential trade‐offs in outcomes among alternative management strategies. We illustrate its application using a case study of forest restoration in Australia by a local government authority across a public conservation estate comprising 765 land units of varying size, totaling ˜13,000 ha, across five different floristic vegetation types, with an annual budget of ˜AU$5M, projected over a 50‐yr timeframe. These simulations revealed a trade‐off between management strategies that seek to increase either the total cover of native forest or the amount of high quality forest: quality‐based strategies were favored in scenarios in which shorter term (20–30 yr) timeframes were chosen at the outset, but cover‐based strategies were favored if longer time horizons were initially targeted. Projected outcomes were also strongly influenced by assumed background rates of vegetation decline or recovery. Many of the issues in this restoration roadmap are generalizable (even though specific outcomes and trade‐offs are likely to vary among case studies), and the approach is both scalable and transferable to other regions and ecosystems.