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

Paramagnetic defects in neutron-irradiated α-quartz: Novel Al-associated E’ centers

Two new paramagnetic defects ($E'_{14}$ and $E'_{16}$ ) have been revealed in neutron-irradiated natural ${\alpha}$ -quartz by using electron paramagnetic resonance (EPR) spectroscopy. The EPR spectra of the $E'_{16}$ center as well as a previously reported but incompletely characterized $E'_{11}$ center demonstrate that their super-hyperfine structures arise from interaction with 27Al, the first-ever examples of Al-associated $E'$ centers in crystalline quartz. The matrices g and $\textbf{A}(^{29}\text{Si})$ , $\textbf{A}(^{27}\text{Al})$ of $E'_{11,16}$ , g and $\textbf{A}(^{29}\text{Si})$ of the $E'_{14}$ center, have been determined

Assessing the zooplankton community and environmental factors in a Mediterranean wetland

Mediterranean wetlands represent unique repositories of biodiversity, but these ecosystems are increasingly threatened by human-induced habitat loss. Seventy percent of Greek wetlands (ponds, mires, marshes, etc.) have been lost in the past 80 years due to human intervention. In Greece habitat types of mires, listed in Directive 92/43/EEC, have been recorded in a few locations, one of the most important is Kalodiki wetland. Eutrophication key elements were determined at four sampling stations throughout 1 year in order to monitor the trophic conditions. Moreover, the zooplankton community was described as biological element relevant in the assessment of the ecological status of Kalodiki wetland. Kalodiki wetland exhibits nutrient concentrations corresponding to eutrophic conditions while according to chlorophyll-a values it is classified between mesotrophic and eutrophic status depending mostly on the sampling period. As concerning zooplankton community, it appears poor in species and dominated by small-sized organisms, which is generally typical of eutrophic, disturbed systems. Differences among zooplankton assemblages over seasons as well as among sampling sites highlight the role of both abiotic and biotic factors