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

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Getting rid of rain and stars: mitigating inhibition effects in ddPCR assays, the case of the invasive crayfish Pacifastacus leniusculus in the streams of Luxembourg

ddPCR is getting more and more popular in the field of eDNA-based aquatic monitoring. Even if emulsion PCR used in ddPCR confers a partial resistance to inhibition due to the high number of reactions for the same sample (between 10K and 20K), it is not impervious to it. Inhibition impacts the fluorescence amplitude of positive droplets, affecting both their dispersion and their position relatively to the negative droplets cloud. This fluctuation could jeopardize the use of a shared threshold among several samples and thus the objective assignation of the positive droplets.This is even more critical for low concentration samples such as eDNA samples: the positive droplets are scarce and it is thus crucial to objectively discriminate if they can be counted as positive by establishing an appropriate threshold. Another issue is the artifactual generation of high fluorescence droplets that could be counted as positive with a single threshold solution.Here we propose a double threshold method to take both high fluorescence droplets and PCR inhibition impact into account allowing for an objective sorting of the positive and negative droplets in ddPCR assays

Genetic status of the endangered plant species Gladiolus palustris in the western part of its distribution area

International audienceMany endangered plant species suffer from the effects of ongoing fragmentation of their populations leading to a loss of genetic diversity through genetic drift. In addition, populations of rare plants may also be affected by hybridization with other plant species. We studied the genetic population structure of populations of the endangered Gladiolus palustris in the western limit of its distribution area using AFLP markers. In addition, we clarified the taxonomic status of populations where hybridization with the closely related G. imbricatus was suspected based on morphology by sequencing the ITS region of the nuclear ribosomal DNA as well as two regions of the chloroplast DNA. Our analysis of the genetic population structure of G. palustris revealed a strong differentiation among geographical regions, which was much higher than the differentiation among populations within regions. Most populations retained a considerable amount of genetic variation. To counteract the future loss of genetic diversity through drift, we recommend using the largest populations per region as seed source to increase genetic diversity in genetic depauperate populations of the same region. Our genetic analyses indicated that some French populations of G. palustris are of hybrid origin. These hybridization events are likely to be ancient as these populations are very isolated and some parent taxa went regionally extinct. As these hybrid populations may elucidate post-glacial distribution patterns of related Gladiolus taxa, we advocate that they deserve the same conservation efforts as purebred ones

Upper and a Lower Threshold Correction Factor for the different target rivers.

(XLSX)</p

Map of the ddPCR results.

(a) Number of successful amplification out of 10 replicates; (b) Mean concentrations per site in cp/μl.</p

Localization of the 34 sampling sites.

The colors of the dots represent the different rivers sampled (Red = Alzette, Blue = Sure, Green = Eisch, Brown = Clerve, Pink = Wiltz, Orange = Attert, Purple = Mamer).</p

Concentration measured and volume filtered for each replicate.

0* = replicates in which 3 or less positive amplification events were observed; NLOQ = Concentration measured under LOQ, replicates only retained for absence/presence information. (XLSX)</p