Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Xylanase treatment of eucalyptus pulps in different chemical bleaching stages

Xylanase significantly reduces the kappa number but almost not modifies brightness and viscosity in studied pulps. On average, xylanase decreases the kappa number of chemical pulps 25 %. This intense effect on the kappa number can be explained by enzymatic hydrolysis of hemicellulose. We proved that xylanase treatment on P0 pulp (first chlorine dioxide step) yield a kappa number reduction higher than obtained by chemical PO and D1 steps together. On the other hand, thermogravimetric analysis shows that xylanase treatment has influence on the thermal degradation path of pulps. As general rule, control treatment (with TrisHCl buffer but without enzyme) leads broads cellulose degradation peak, shown that chlorhydrate of tris(hydroxymethyl) aminoethane adsorb on cellulose surface increasing paracrystalline cellulose content, that is, not-ordered surface crystalline cellulose. When TrisHCl and xylanase are used together, adsorption is less important. In any case, in xylanase-treated pulps cellulose thermally degrades in broader temperature interval than in initial pulp

Photobleaching of eucalyptus kraft pulps. Thermogravimetric monitoring

This study assesses the potential of UV light as method to bleach eucalyptus pulps in different steps of their chemical bleaching process in a pulp mill. Higher brightness increasing were obtained on dirtier pulps, that is, alkaline washed and oxygen delignified pulps. In any case, photobleaching shows first-order kinetics. Rate of chromophores removal is proportional to the chromophores content in fiber surface. Complementarily, thermogravimetric analysis proved that UV light (400 nm wavelength) do not damages fiber integrityPostprint (published version

Xylanase treatment of eucalyptus pulps in different chemical bleaching stages

Xylanase significantly reduces the kappa number but almost not modifies brightness and viscosity in studied pulps. On average, xylanase decreases the kappa number of chemical pulps 25 %. This intense effect on the kappa number can be explained by enzymatic hydrolysis of hemicellulose. We proved that xylanase treatment on P0 pulp (first chlorine dioxide step) yield a kappa number reduction higher than obtained by chemical PO and D1 steps together. On the other hand, thermogravimetric analysis shows that xylanase treatment has influence on the thermal degradation path of pulps. As general rule, control treatment (with TrisHCl buffer but without enzyme) leads broads cellulose degradation peak, shown that chlorhydrate of tris(hydroxymethyl) aminoethane adsorb on cellulose surface increasing paracrystalline cellulose content, that is, not-ordered surface crystalline cellulose. When TrisHCl and xylanase are used together, adsorption is less important. In any case, in xylanase-treated pulps cellulose thermally degrades in broader temperature interval than in initial pulpsPostprint (published version

Xylanase treatment of eucalyptus pulps in different chemical bleaching stages

Xylanase significantly reduces the kappa number but almost not modifies brightness and viscosity in studied pulps. On average, xylanase decreases the kappa number of chemical pulps 25 %. This intense effect on the kappa number can be explained by enzymatic hydrolysis of hemicellulose. We proved that xylanase treatment on P0 pulp (first chlorine dioxide step) yield a kappa number reduction higher than obtained by chemical PO and D1 steps together. On the other hand, thermogravimetric analysis shows that xylanase treatment has influence on the thermal degradation path of pulps. As general rule, control treatment (with TrisHCl buffer but without enzyme) leads broads cellulose degradation peak, shown that chlorhydrate of tris(hydroxymethyl) aminoethane adsorb on cellulose surface increasing paracrystalline cellulose content, that is, not-ordered surface crystalline cellulose. When TrisHCl and xylanase are used together, adsorption is less important. In any case, in xylanase-treated pulps cellulose thermally degrades in broader temperature interval than in initial pulp

Some problems in permutation groups

SIGLEAvailable from British Library Document Supply Centre- DSC:DX83842 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Photobleaching of eucalyptus kraft pulps. Thermogravimetric monitoring

This study assesses the potential of UV light as method to bleach eucalyptus pulps in different steps of their chemical bleaching process in a pulp mill. Higher brightness increasing were obtained on dirtier pulps, that is, alkaline washed and oxygen delignified pulps. In any case, photobleaching shows first-order kinetics. Rate of chromophores removal is proportional to the chromophores content in fiber surface. Complementarily, thermogravimetric analysis proved that UV light (400 nm wavelength) do not damages fiber integrit

Influence of enzyme and chemical adsorption on the thermal degradation path for eucalyptus pulp

Changes in thermal degradation path of eucalyptus pulp support enzymes (laccase from Trametes villosa) and chemicals (Tris–HCl or tartrate–tartaric buffer) adsorption on cellulose during biobleaching, thereby increasing cellulose amount that degrades at low temperature and decreasing the apparent crystallinity (ApC) of cellulose crystallites. Changes in ApC, which can be assessed by thermogravimetric analysis—but not X-ray diffraction spectroscopy—affect cellulose volatilization; thus, the higher ApC is, the lower is char production and the higher the volatilization temperature. A linear relationship between ApC and the volatilization/charring ratio (V/C) was observed in this wor

Synthesis gas production from various biomass feedstocks

The decomposition of five different biomass samples was studied in a horizontal laboratory reactor. The samples consisted of esparto grass, straw, Posidonea Oceanic seaweed, waste from urban and agricultural pruning and waste from forest pruning. Both pyrolysis in inert atmosphere and combustion in the presence of oxygen were studied. Different heating rates were used by varying the input speed. Major gas compounds were analyzed. The experimental results show that the amount of CO formed is lower in less dense species. It is also found that there is an increase of hydrocarbons formed at increasing feeding rates, in particular methane, while there is a decrease in the production of hydrogen.Financial support for this work provided by PROMETEO/2009/043/FEDER and ACOMP2010/075 of Generalitat Valenciana (Spain) and CTQ2008-05520 (Spanish MCI)

Pollutant formation and emissions from cement kiln stack using a solid recovered fuel from municipal solid waste

The thermal decomposition of a Solid Recovered Fuel (SRF) has been studied by two techniques. First, laboratory-scale experiments were performed in a horizontal furnace in which different atmospheres are studied to analyze the dioxins and furans (PCDD/Fs) evolved from the decomposition of the material. Sulfur presence is revealed to be important in PCDD/Fs formation. In the second technique, the emission of various pollutants (PAHs, PCDD/Fs, metals, acid gases …) were determined in a cement kiln fed on different proportions of SRF material, and where a maximum feed rate of 15000 kg SRF/h was achieved. In the laboratory furnace the dioxin toxicity revealed a maximum when the amount of oxygen in the atmosphere increased until approximately stoichiometric conditions. In the cement kiln, all emitted pollutants are under the legal limits. No correlation between SRF input and metal emission was observed.Support for this work was provided by CEMEX ESPANA, S.A., a company owned by the CEMEX group (http://www.cemex.com). Authors acknowledge the financial support for this work provided by PROMETEO/2009/043/FEDER and ACOMP2010/075 of Generalitat Valenciana (Spain) and CTQ2008-05520 (Spanish MCI)