Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Isothermal read-out for thermoluminescence dosimetry with CaSO4:Dy (TLD-900)

Experiments on the isothermal decay of the therraoluminescence associated with the main dosimetry peak of CaS04:Dy (TLD-900) dosemeters are described in this paper. The results on the kinetics parameters s (the frequency factor) and b (the order of the kinetics) and a new time dependence study on accidental high dose occurrence are also reported

Effect of particle size in the TL response of natural quartz sensitized by high dose of gamma radiation and heat-treatments

This work investigates the effect of particle size in the thermoluminescence (TL) response of a quartz crystal that was initially crushed and classified into ten size fractions between 38 &#956;m and 5 mm. Aliquots of each size fraction were sensitized with a dose of 25 kGy of &#947; rays and heat-treatments at 400 °C. TL glow curves of sensitized and non-sensitized samples were recorded as a function of different test-doses of &#947; rays. For the non-sensitized samples, the TL peak near 325 °C increases with the decrease in particle size. In the case of sensitized samples, a strong TL peak near 300 °C increases with the increase in particle size up to mean grain size equal to 304 &#956;m. Above 304 &#956;m, an abrupt reduction in the TL intensity is noticed for the sensitized peak. These effects are discussed in relation to the specific surface area of quartz particles and the intensity of the electron paramagnetic resonance signal of the E'1 center induced by the sensitization process

The environment and the eye.

The use of the 'environment' has become extended to include population changes, the 'domestic' environment, and cultural factors, in addition to physical influences such as global warming and ultraviolet radiation (UVR). The likely effects of each of these classes of agents on the eye and rates of blindness are illustrated by reference mainly to cataract and trachoma--two of the commonest causes of the world blindness.Trachoma infection and its blinding consequences could be eventually eliminated by environmental measures and changes in behaviour. While the threat of increased incidence of blindness from cataract due to ozone depletion and greater solar UVR has receded, global warming may become a factor in the early onset and rapid progression of cataract. Although we continue to need research into the physical and biological causes of cataract, elimination of world blindness will only be achieved when we understand the conceptual and cultural environments which are inhibiting the acceptance of cataract surgery