Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...
Background The COVID‐19 pandemic has caused a global health emergency and affected the resources in both the public and private health sectors significantly. The present study aims to assess the impact of the pandemic on the services by the department in the first 3 months since the first COVID case in the region. Methods The study period was from 16 March to 15 June 2020. We queried the database for data on site of the tumor, diagnosis, stage, tumor board decisions and planning, surgical procedures, adjuvant treatment, and follow‐up details. The change in tumor board decision and actual treatment taken by the patient were all recorded, taking into consideration the COVID‐19 pandemic. Results Among the 1567 patient contacts, 1306 were out‐patient visits and 261 teleconsultations. Fifty‐four patients underwent surgery from the 87 admitted to the hospital. Ten preoperative patients and two postoperative patients were tested for COVID and reported to be negative. Conclusions The dilemma of providing cancer surgery services to the patients in this pandemic has been global. Strict measures and guidelines can help to overcome the COVID pandemic time, keeping in mind the locoregional logistics.
Deepwater oil and gas facilities typically encounter on an average up to 5% annual production losses due to unplanned downtime, conservatively estimated at billions of dollars impact for the industry. The existing toolkit and systems in place are not always adequate to identify and predict abnormal events that could lead towards unplanned facility shutdown. The interaction amongst process sub-systems and disturbances that propagate across these sub-systems with changing operating conditions are hard to predict without a fit-for-purpose model (or a digital twin). The focus of current work is on deepwater facility having several oil export pipeline pumps in parallel and several gas compressors in series. The alarm database showed records of several unplanned shutdown events around these critical equipements that resulted in undesirable outcomes such as production deferment, complete facility shutdown, loss of sales volumes and increased operational costs. In this work, an intelligent prognostic solution is proposed using machine learning (ML) framework for automatic prediction of impending facility downtime, and identification of key causative process variables. A systematic workflow was developed to identify, cleanse and process real time data for both model training and prediction. Several ML methods were evaluated; anomaly detection based on Principal Component Analysis (PCA) and Autoencoder (AE) algorithms were found performing better for the type of data available for the deepwater facility. The ML framework also supported analysis of underlying downtime causes to propose suitable mitigation steps. Knowledge based on physical understanding of the process was used to select each sub-system boundary and sensor list on which ML model was trained. These models were then cross-validated to test the accuracy of trained models. Finally, the alarm database was used to confirm the accuracy of the machine leaning models and identify root-causes for unplanned shutdowns. If the operating condition changes over time, the anomaly detection based ML models were setup to adapt to changing conditions by automatic model updates, resulting in significant reduction in false alarms. The adaptive ML models, when applied to one of the sub-system (with 30 different sensor data), predicted 24 unplanned events in 6 months of period, while when applied to another sub-system (with 40 sensor data), predicted only 6 unplanned downtime events. Several predictions were found as early as 30 mins to 2 hours, providing adequate early warning to take proactive actions. Case studies shown in the paper present diagnostic charts and identified early indicators were found in agreement with pre-alarms generated by existing alarm system, thus validating the ML solution. Current toolkit available to identify anomalous process behavior is limited to exception based surveillance with fixed min-max limits on each sensor data. Therefore, proposed adaptive ML solution has shown potential to revolutionize the topside process surveillance. This paper also describes how the ML framework can be scaled for a sustainable solution that provides prediction every minute, keeps the model evergreen utilizing cloud-based model deployment platform to train, predict and trigger automatic model updates and also span multiple process systems and facilities. Finally, we present directions for future work, where the current model can keep predicting various events and over time when sufficient events are collected, more advanced machine learning methods based on supervised ML can be developed and deployed.
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