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

Modeling a cylindrical rubber block of tyre tread compound for predicting the temperature profile under heating condition

In the rubber industry, curing is very important parameter. There are many methodologies are used industrially in order to predict the optimum curing time of rubber product. The methodologies are mainly two types as practical and numerical approaches. In the practical approach, it is used a lot of manual activities to collect the temperature distribution within the rubber product. It is time consuming and non-economical method. Therefore, most of the industries are attempting to develop numerical models for the rubber curing. Nowadays the trend is to develop software-based numerical modellings to predict not only the temperature distribution but also state of cure of the rubber product. In this research it was attempted to predict the temperature profile of cylindrical tread rubber block using a well-known software called Solidwork. The accuracy of the model was verified by practically measured data. In order to match practical temperature profile, with the modelled figures, the thermal properties were changed. Even though there are several thermal properties such as thermal conductivity and specific heat capacity, the critical thermal property is the thermal diffusivity. Based on the results, the prediction of temperature profile with the default settings of the software and fixed thermal properties would not be possible

Wave attenuation experiments over living shorelines over time: a wave tank study to assess recreational boating pressures

With sea level rise, erosion, and human disturbances affecting coastal areas, strategies to protect and stabilize existing shorelines are needed. One popular solution to stabilize while conserving intertidal habitat is the use of “living shoreline” techniques which are designed to mimic natural shoreline communities by using native plants and animals. However, little information is available on the success of living shoreline stabilization. This project evaluated the wave energy attenuation associated with living shorelines that contained Crassostrea virginica (eastern oyster) and/or Spartina alterniflora (smooth cordgrass) in a wave tank. Four living shoreline techniques were assessed, including a control (sediment only), oysters alone, cordgrass alone, and a combination of oysters plus cordgrass. Time since deployment (newly deployed, one-year after deployment) was also assessed to see how wave energy attenuation changed with natural oyster recruitment and plant growth. Wave energy was calculated for each newly deployed and one-year old shoreline stabilization treatment using capacitance wave gauges and generated waves that were representative of boat wakes in Mosquito Lagoon, a shallow-water estuary in Florida. All one-year old treatments attenuated significantly more energy than newly-deployed treatments. The combination of one-year old S. alterniflora plus live C. virginica was the most effective as this treatment reduced 67 % of the wave energy created by a single recreational boat wake, compared to bare sediment. Natural resource managers and landowners facing shoreline erosion issues can use this information to create effective stabilization protocols that preserve shorelines while conserving native intertidal habitats

Prevention of stroke : A strategic global imperative

The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs

Kuluttajabarometri maakunnittain 2000, 2. neljännes

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