Charming and bewitching : considering the Harry Potter series

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Addictive and wonderful : the experience of reading the Harry Potter series

Aquest document està relacionat amb: Charming and bewitching : considering the Harry Potter serie

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Asperger: mi reto es aprender- Caso de convivencia escolar

El objetivo del presente estudio de caso es identificar el impacto de la convivencia escolar en la vida emocional y social de un adolescente, diagnosticado con Síndrome de Asperger y describir cómo era la vida emocional y social cuando el niño se encontraba en un ambiente escolar y cómo se encuentra actualmente con escolarización en casa.The objective of this case study is to identify the impact of school coexistence on the emotional and social life of an adolescent, diagnosed with Asperger syndrome and describe what emotional and social life was like when the child was in a school environment and how they are currently doing with home [email protected]@campusucc.edu.c

Early-stage sustainability assessment of enzyme production in the framework of lignocellulosic biorefinery

15 p.-6 fig.-4 tab.The use and integration of enzymatic processes for the biotransformation of biomass within the biorefinery framework creates the need to confirm whether these novel production systems are in the route to environmental sustainability. In this study, the environmental profiles of the production of two oxidative enzymes, hydroxymethylfurfural oxidase (HMFO) from Methylovorus and unspecific peroxygenase (UPO) from Chaetomium globosum (CglUPO) for the enzymatic production of FDCA as precursor of bioplastics were analyzed. Laboratory-scale experiments allowed the identification of the consumption of energy, with over 80% share in every impact category for HMFO and chemicals and energy in CglUPO as primary hotspots of the systems. The results are transposed for HMFO when laboratory inventories were extrapolated to full scale processing, showing that impacts are attributed not only to energy demand but also to the use of chemicals required for the formulation of the culture medium. In terms of process units, the fermenter, where enzyme production takes place, corresponds to the stage that contributes the most to the environmental impacts, with a 57% share, followed by the downstream separation scheme (37%). Extrapolation of laboratory data to full-scale also represented a change in the relative difference of the impact per functional unit of 45% for CgIUPO. The endpoint damage categories showed a significant reduction in their full-scale impacts to about half the burden. The analysis of the outcomes of the uncertainty analysis showed that the resource depletion category had the least dispersion of data, while the level of uncertainty is more relevant for human health, as it takes into account the combined effect of a larger number of impact categories and the processes involved. This study shows that, although being bio-based catalysts, the production of enzymes involves several steps which may incur in environmental impact. Thus, it is recommended that enzymes are carefully included within the system boundaries for their evaluation, since they could be the major hotspot in the biorefinery value chain. De-fossilization of the plastic industry will be possible with thoroughly optimized bio-transformations, with carbon-based media from residual resources, minimized use of chemicals and the implementation of energy integration measures.This research was supported by the European EnzOx2 BBI JU-Project (H2020-BBI-PPP-2015-2-1-720297). S. Bello, G. Feijoo and M.T. Moreira belong to the Galician Competitive Research Group GRC ED431C 2017/29 and to the CRETUS Strategic Partnership (ED431E 2018/01). All these programmes are co-funded by FEDER (EU).Peer reviewe

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

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