Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

CIRCUMSTANCES OF THE UNIFICATION OF LITHUANIAN ANTI-SOVIET PARTISANS DURING 1946-1949

In 2019 comes the 70th anniversary of the founding of LLKS – the Union of Lithuanian Freedom Fighters (Lietuvos Laisvės Kovos Sąjūdi). This underground organization had been founded in February of 1949. It united the people, who had been fighting against the Soviet power in Lithuania. Heads of the LLKS were active partisans and they called themselves freedom fighters. In the same time, other people called partisans ‘forest men’, ‘greens’ etc. The main purpose of this article – to consider the process of unification of the forces of Lithuanian partisans under unified command and to highlight the main circumstances of this process. The article is based on the archival materials and modern research writings. So far, very few research papers about Lithuanian anti-Soviet struggle have been published outside Lithuania. That’s why one of the goals of the author – to provide the information about this episode of the modern history of Lithuania to Ukrainian readers. Perhaps, the similarity with Ukrainian national insurgent movement during the 2nd World War will be found. The final ambition of the armed struggle of Lithuanian partisans was the creation of free democratic Lithuania. Partisans considered the mistakes of Lithuanian state-building during the interwar period, such as authoritarian regime and weak social politics. Freedom fighters hoped to get help from the West countries – Great Britain of the USA – through the mediation of Lithuanian emigrants. The unification of partisans was difficult because of the activity of infiltrated Soviet security agents. The chronological framework of the article covers the period of 1946-1949, when where held the main events of the unification of partisans. Active partisan struggle against the Soviet in Lithuania power lasted to 1953.</jats:p

Heat Saving Reserve in Residential Buildings

The paper concerns thermal energy consumption in residential buildings. Heat consumption data of more than two thousands buildings are compared. Special attention is given to compare heat consumption in identical buildings as former Soviet practice of housing construction has been based on repetitive multiflat buildings. Heat consumption in sister-buildings differs up to two times. The conclusion may be drawn up that this phenomenon is caused mainly by inappropriate behaviour of tenants, lack of qualified service and construction faults. Identical multiflat residential buildings heat consumption data gives the possibility to evaluate influence of local factors as maintenance, uncertainty of structure dimensions or construction materials thermal properties. Huge heat saving reserves lie not only in renovation but also in less visible but not less effective building maintenance scrutinization and control

Ežerinių nuosėdų džiūvimas sėsdintuvuose

Vytauto Didžiojo universitetasŽemės ūkio akademij

EVALUATION OF REFURBISHMENT IN MULTI-FLAT BUILDINGS CONSIDERING TERNARY BENEFIT

Inefficient heat use in old multi-flat residential buildings causes problems to the residents spending a large part of their incomes on heat bills as well as for the State working towards achieving goals of energy efficiency increase, climate change mitigation and energy security. However, the Lithuanian program of multi-flat building renovation keeps stalling, and therefore danger that much of this energy saving potential will go unrealised appears. The paper is concerned with the problems that arise when renovating multi-flat buildings according to the existing legislation. In this case, the emphasis is placed on the factors that have influence on decisions made by building owners to either participate or not in the renovation program. The paper demonstrates that the currently employed method of evaluating building renovation projects does not correctly reflect the benefits of refurbishment and gives financially unattractive financial indicators. Thus, the new method of investment distribution is introduced considering three aspects of benefits for building renovation. The case analysed demonstrates how the suggested “ternary benefit” method could be used for differentiating between financing sources and presenting relevant information to the building owners. Another related problem is heat saving assessment in the building refurbishment process. The paper argues that energy audits are far more suitable for the evaluation of modernisation projects than for energy performance certification. Santrauka Neefektyvus šilumos vartojimas senuose daugiabučiuose pastatuose yra opi problema tiek didelę dalį savo pajamų šildymo išlaidoms skiriantiems gyventojams, tiek valstybei siekiant didinti energijos efektyvumą, mažinti klimato kaitą ir energinės nepriklausomybės tikslų. Tačiau daugiabučių namų modernizavimo programa vis stringa ir kyla grėsmė, kad energijos taupymo potencialas artimiausiu metu nebus realizuotas. Analizuojant modernizavimo procese kylančias problemas ir ieškant jų sprendimo, šiame straipsnyje analizuojama dabartiniu metu taikoma daugiabučių namų modernizavimo projektų vertinimo metodika. Dėmesys sutelkiamas ties veiksniais, lemiančiais pastato savininkų apsisprendimą dalyvauti modernizacijos projekte, tokiais kaip modernizavimo projekto finansinis patrauklumas. Viena iš svarbių daugiabučių namų modernizavimo procesą stabdančių problemų yra dabartinis modernizavimo projektų vertinimo metodas. Pirma, šis metodas neatspindi trejopos renovacijos naudos pastato savininkams. Antra, taikomas šilumos taupymo prognozavimo metodas yra nepakankamai patikimas. Straipsnyje siūloma vietoje įprasto renovacijos projektų vertinimo metodo taikyti „trejopos naudos“ metodą. Šis metodas atskleidžia renovacijai reikalingų investicijų pasiskirstymą pagal sukuriamą naudą. Tokiu būdu galima diferencijuoti renovacijos finansavimo šaltinius, suteikti išsamios informacijos pastato savininkams. Straipsnyje aprašomas atliktas konkretaus tipinio daugiabučio namo modernizavimo projekto vertinimas įprastiniu ir „trejopos naudos“ metodu. Palyginimo rezultatai rodo, kad, visas investicijas nepagrįstai priskiriant energijos efektyvumo priemonėms, renovacijos projektai tampa nepatrauklūs daugiabučių pastatų savininkams. Raktiniai žodžiai: pastatų renovacija; daugiabučių modernizavimas; energijos efektyvumas; „dvejopos naudos“ metodas; „trejopos naudos“ metodas; šilumos taupymas; energinis auditas; pastatų energinio naudingumo sertifikavima

CONVERSION OF INDUSTRIAL BUILDINGS AND AREAS IN TERMS OF SUSTAINABLE DEVELOPMENT BY USING BIM TECHNOLOGY: ANALYSIS AND FURTHER DEVELOPMENTS / INDUSTRINIŲ PASTATŲ IR TERITORIJŲ KONVERSIJA DARNAUS VYSTYMOSI POŽIŪRIU TAIKANT BIM TECHNOLOGIJAS: SITUACIJOS ANALIZĖ IR PERSPEKTYVOS

The article deals with abandoned industrial buildings and lands conversion concept, objectives, problems, beneficial results of a successful conversion for urban expansion, as a complex process of sustainable development. The tools for making effective management and usage of abandoned buildings decisions are considered. The article analyzes the 5D BIM model throughout the life cycle of the building. The foreign good practice is analyzed, where the modern digital technology is used for reconstruction of old buildings. The building information model application possibilities are examined throughout the lifespan of a building. The measures for CO2 emission reduction in the construction sector are proposed. Finaly, the model for conversion of abanoded buildings is proposed, based on MCDM and BIM technologies. Santrauka  Straipsnyje nagrinėjama apleistų industrinių pastatų ir teritorijų konversijos samprata, tikslai, problemos, sėkmingos konversijos rezultatų nauda miesto plėtrai kaip kompleksinis procesas darnaus vystymosi požiūriu. Aptariamos priemonės, kurios padėtų priimti efektyvius apleistų pastatų tvarkymo ir naudojimo sprendimus. Straipsnyje yra analizuojamas BIM 5D modelis per visą pastato gyvavimo ciklą. Analizuojama užsienio geroji praktika, kur taikomos šiuolaikinės skaitmeninės technologijos rekonstruojant senus pastatus. Tiriamos statinio informacinio modelio taikymo galimybės per visą pastato gyvavimo laikotarpį. Siūlomos priemonės mažinti išmetamo CO2 kiekį statybos sektoriuje. Pasiūlytas apleistų objektų konversijos modelis,pagrįstas MCDM ir BIM technologijomis. Raktiniai žodžiai: BIM, statinio informacinis modeliavimas, pastato gyvavimo ciklas, konversija, industrinės teritorijos, darnus vystymasis, CO2 emisija