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

Bons professores em um terreno perigoso: rumo a uma nova visão da qualidade e do profissionalismo

Ideas about what makes a good teacher are important in thinking about educational reform, and have come into focus recently. These ideas are contested and open to change. The first part of this paper traces models of the good teacher in Australia from the colonial-era good servant, through an ideal of the autonomous scholar-teacher, to contemporary lists of teacher competencies. The second part looks more closely at the incoherent but insistent way the good teacher is now defined under neoliberal governance by teacher registration authorities. The third part of the paper makes proposals for a new understanding of good teachers: based on understanding the labour process and occupational dynamics of teaching, the intellectual structure of Education studies, and the overall logic of education itself.Ideias sobre o que caracteriza um "bom professor" são importantes para se possa refletir a respeito da reforma educacional, e elas têm ganhado destaque recentemente. Essas ideias são controversas e estão abertas a mudanças. A primeira parte deste artigo examina modelos do que é considerado um "bom professor" na Austrália, desde os bons servidores da era colonial, passando pelo ideal do professor erudito autônomo, até as atuais listas de competências dos docentes. A segunda parte examina mais detalhadamente o modo pelo qual as autoridades responsáveis pelo registro e credenciamento de professores, em governos neoliberais, definem um "bom professor". A terceira parte oferece propostas para uma nova compreensão do conceito de "bom professor", baseadas no entendimento do processo de trabalho e da dinâmica ocupacional do ensino, na estrutura intelectual dos estudos sobre a Educação e na própria lógica da educação como um todo

A survey of the level of sulphur dioxide preservative in minced meat in Scotland 1988 - 1992

SIGLEAvailable from British Library Document Supply Centre-DSC:96/22430 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The evolution of instrument selection for inclusion in core outcome sets at OMERACT: Filter 2.2

Introduction OMERACT uses an evidence-based framework known as the ‘OMERACT Filter Instrument Selection Algorithm’ (OFISA) to guide decisions in the assessment of outcome measurement instruments for inclusion in a core outcome set for interventional and observational clinical trials. Methods A group of OMERACT imaging and patient-centered outcome methodologists worked with imaging outcome groups to facilitate the selection of imaging outcome measurement instruments using the OFISA approach. The lessons learned from this work influenced the evolution to Filter 2.2 and necessitated changes to OMERACT's documentation and processes. Results OMERACT has revised documentation and processes to incorporate the evolution of instrument selection to Filter 2.2. These revisions include creation of a template for detailed definitions of the target domain which is a necessary first step for instrument selection, modifications to the Summary of Measurement Properties (SOMP) table to account for sources of variability, and development of standardized reporting tables for each measurement property. Conclusions OMERACT Filter 2.2 represents additional modifications of the OMERACT guide for working groups in their rigorous assessment of measurement properties of instruments of various types, including imaging outcome measurement instruments. Enhanced reporting aims to increase the transparency of the evidence base leading to judgements for the endorsement of instruments in core outcome sets

Where to Seek Strategic Assets for Competitive Catch-up? A configurational study of emerging multinational enterprises expanding into foreign strategic factor markets

Emerging multinational enterprises (EMNEs) often engage in strategic-asset-seeking foreign direct investment (FDI) for competitive catch-up. This study explores the linkages between an EMNE’s competitive scenario consisting of a configuration of its awareness-motivation-capability (AMC) conditions and the comparative institutional advantages of its strategic-asset-seeking destination. Our configurational analyses of Chinese FDIs in the technology-intensive industries of OECD countries reveal a taxonomy of four distinct asset-seeking strategies of EMNEs. Our findings shed novel insights into the strategic variations within EMNEs based on a theoretically and methodologically extended AMC framework. This study also extends the varieties of capitalism literature by addressing the implications of comparative institutional advantages for foreign entrants, rather than domestic incumbent firms