RESUMO
Recent major investments in infrastructure in the United States and globally present a crucial opportunity to embed equity within the heart of resilient infrastructure decision-making. Yet there is a notable absence of frameworks within the engineering and scientific fields for integrating equity into planning, design, and maintenance of infrastructure. Additionally, whole-of-government approaches to infrastructure, including the Justice40 Initiative, mimic elements of process management that support exploitative rather than exploratory innovation. These and other policies risk creating innovation traps that limit analytical and engineering advances necessary to prioritize equity in decision-making, identification and disruption of mechanisms that cause or contribute to inequities, and remediation of historic harms. Here, we propose a three-tiered framework toward equitable and resilient infrastructure through restorative justice, incremental policy innovation, and exploratory research innovation. This framework aims to ensure equitable access and benefits of infrastructure, minimize risk disparities, and embrace restorative justice to repair historical and systemic inequities. We outline incremental policy innovation and exploratory research action items to address and mitigate risk disparities, emphasizing the need for community-engaged research and the development of equity metrics. Among other action items, we recommend a certification system-referred to as Social, Environmental, and Economic Development (SEED)-to train infrastructure engineers and planners and ensure attentiveness to gaps that exist within and dynamically interact across each tier of the proposed framework. Through the framework and proposed actions, we advocate for a transformative vision for equitable infrastructure that emphasizes the interconnectedness of social, environmental, and technical dimensions in infrastructure planning, design, and maintenance.
RESUMO
The goal of this study was to systematically review the effects of biliary stenting on postoperative morbidity and mortality of patients with obstructive jaundice. PubMed, Embase, Cochrane Library, and other relevant databases were searched by computer and manually for published and unpublished studies on the impact of preoperative biliary drainage on patients with obstructive jaundice from 2000 to the present day. Two investigators independently selected the studies according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of the selected studies. Meta-analysis was performed to compare postoperative morbidity and mortality of patients between the drainage and nondrainage groups.Compared with the nondrainage group, the overall mortality, overall morbidity, infectious morbidity, incidence of wound infection, intra-abdominal abscess, pancreatic fistulas, bile leak, and delayed gastric emptying in the drainage group were not significantly different. Compared with the nondrainage group, the drainage group had a drainage time of <4 weeks with an increased overall morbidity by 7% to 23%; however, the overall morbidity of the drainage group with a drainage time >4 weeks was not significantly different. Compared with the nondrainage group, the overall mortality of the drainage group using metal stents and plastic stents as internal drainage devices was reduced by 0.5% to 6%, whereas that of the drainage group using plastic stent devices was not significantly different.In summary, preoperative drainage should be applied selectively. The drainage time should be >4 weeks, and metal stents should be used for internal drainage.