Swift XRT and VLT Observations of the Afterglow of GRB 041223

The Swift Gamma-Ray Burst Explorer, launched on 2004 November 20, is a multiwavelength, autonomous, rapid-slewing observatory for gamma-ray burst (GRB) astronomy. On 2004 December 23, during the activation phase of the mission, the Swift X-Ray Telescope (XRT) was pointed at a burst discovered earlier that day by the Swift Burst Alert Telescope. A fading, uncataloged X-ray source was discovered by the XRT and was observed over a period of about 3 hours, beginning 4.6 hours after the burst. The X-ray detection triggered a VLT observation of the optical/NIR counterpart, located about 1.1 arcseconds from the XRT position. The X-ray counterpart faded rapidly, with a power law index of -1.72 +/- 0.20. The average unabsorbed X-ray flux 4.6-7.9 hours after the burst was 6.5 x 10^{-12} erg cm^{-2} s^{-1} in the 0.5-10 keV band, for a power-law spectrum of photon index 2.02 +/- 0.13 with Galactic absorption. The NIR counterpart was observed at three epochs between 16 and 87 hours after the burst, and faded with a power-law index of -1.14 +/- 0.08 with a reddening-corrected SED power-law slope of -0.40 +/- 0.03. We find that the X-ray and NIR data are consistent with a two-component jet in a wind medium, with an early jet break in the narrow component and an underlying electron index of 1.8-2.0.Comment: 16 pages, including 4 figures. Accepted by Astrophysical Journal (Letters) on 15 February 200

GRB 050117: Simultaneous Gamma-ray and X-ray Observations with the Swift Satellite

The Swift Gamma-Ray Burst Explorer performed its first autonomous, X-ray follow-up to a newly detected GRB on 2005 January 17, within 193 seconds of the burst trigger by the Swift Burst Alert Telescope. While the burst was still in progress, the X-ray Telescope obtained a position and an image for an un-catalogued X-ray source; simultaneous with the gamma-ray observation. The XRT observed flux during the prompt emission was 1.1 x 10^{-8} ergs cm^{-2} s^{-1} in the 0.5-10 keV energy band. The emission in the X-ray band decreased by three orders of magnitude within 700 seconds, following the prompt emission. This is found to be consistent with the gamma-ray decay when extrapolated into the XRT energy band. During the following 6.3 hours, the XRT observed the afterglow in an automated sequence for an additional 947 seconds, until the burst became fully obscured by the Earth limb. A faint, extremely slowly decaying afterglow, alpha=-0.21$, was detected. Finally, a break in the lightcurve occurred and the flux decayed with alpha<-1.2$. The X-ray position triggered many follow-up observations: no optical afterglow could be confirmed, although a candidate was identified 3 arcsecs from the XRT position.Comment: 27 pages, 6 figures. Accepted for publication in Ap

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London