The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.

promise was doubtful and its validity unlikely to have been vetted. Predatory journals are a global threat. They accept articles for publication-along with authors' fees-without performing promised quality checks for issues such as plagiarism or ethical approval. Naive readers are not the only victims. Many researchers have been duped into submitting to predatory journals, in which their work can be overlooked. One study that focused on 46,000 researchers based in Italy found that about 5% of them published in such outlets 1. A separate analysis suggests predatory publishers collect millions of dollars in publication fees that are ultimately paid out by funders such as the US National Institutes of Health (NIH) 2. One barrier to combating predatory publishing is, in our view, the lack of an agreed definition. By analogy, consider the historical criteria for deciding whether an abnormal bulge in the aorta, the largest artery in the body, could be deemed an aneurysm-a dangerous W hen 'Jane' turned to alternative medicine, she had already exhausted radiotherapy, chemotherapy and other standard treatments for breast cancer. Her alternative-medicine practitioner shared an article about a therapy involving vitamin infusions. To her and her practitioner, it seemed to be authentic grounds for hope. But when Jane showed the article to her son-in-law (one of the authors of this Comment), he realized it came from a predatory journal-meaning its Leading scholars and publishers from ten countries have agreed a definition of predatory publishing that can protect scholarship. It took 12 hours of discussion, 18 questions and 3 rounds to reach.

Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring selfisolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14

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