Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
The return of Hong Kong by Britain in 1997 1 and of Macau by Portugal in 1999 2 formally marked the end of one era of Sino-European relations and the beginning of another. Both events had been preceded by protracted negotiations, detailed bilateral treaties and, in the history of imperial withdrawal, extended transition periods. 3 Consequently, since the signing of the Joint Declarations (JD), 4 the local, national and international implications of the two events have been the foci of historical assessment, strategic analysis, contingency planning and policy reformulation. As the concept of "one country-two systems" is put to the test, this predictable and, indeed, inevitable process continues. An important question emerging from the process is whether, in the rapidly changing conditions of the 21st century, the two territories, as treaty-based Special Administrative Regions (SAR), will be assets or liabilities in Sino-European relations. An alternative, perhaps more focused and, therefore satisfactory form of the question is under what circumstances would the territories be assets and under what other circumstances could they become liabilities in the relations between Europe and China? Historical Factors The historical events heralding the end of European extra-territoriality in China had occurred much earlier. The peaking of Chinese nationalism in the 1920s had exposed the vulnerability of the port of Hong Kong to strikes. 5 Had that high-tide permanently extinguished the commercial life
Assembly procedures are a common task in several domains of application. Augmented Reality (AR) has been considered as having great potential in assisting users while performing such tasks. However, poor interaction design and lack of studies, often results in complex and hard to use AR systems. This paper considers three different interaction methods for assembly procedures (Touch gestures in a mobile device; Mobile Device movements; 3D Controllers and See-through HMD). It also describes a controlled experiment aimed at comparing acceptance and usability between these methods in an assembly task using Lego blocks. The main conclusions are that participants were faster using the 3D controllers and Video see-through HMD. Participants also preferred the HMD condition, even though some reported light symptoms of nausea, sickness and/or disorientation, probably due to limited resolution of the HMD cameras used in the video see-through setting and some latency issues. In addition, although some research claims that manipulation of virtual objects with movements of the mobile device can be considered as natural, this condition was the least preferred by the participants. CCS Concepts: • Human-centered computing → Mixed / augmented reality; User studies; Usability testing; • Applied computing → Computer-aided manufacturing;
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