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

Freeze/thaw protection of concrete with optimum rubber crumb content

This research looks at utilising an optimum quantity of rubber crumb as an air entraining ad-mixture in concrete, thus providing maximum freeze-thaw protection and maximum strength. Microscopic and chemical analysis was carried out on the rubber sample to investigate how rubber crumb entrains air and reacts with the surrounding concrete. The work contained two pilot studies that informed the main test methodology. The pilot studies examined the air content/compressive strength relationship (1) and freeze/thaw cycle durations (2). Pilot study 1 informed the main test program by identifying an optimum addition of rubber crumb to a concrete mix, which was found to be 0.6% by weight of concrete. The main test investigated the use of rubber crumb in providing freeze-thaw protection of a C40 concrete mix after 3 days of curing. A freeze-thaw test was carried out on three separate batches of concrete containing washed rubber crumb, unwashed rubber crumb and plain concrete respectively. It was found rubber crumb was effective in providing freeze/thaw protection in both cases. This work builds on recent work to identify the best practical solution for reducing waste and providing the maximum freeze/thaw protection for a cleaner production process

Conditions hydrologiques moyennes pour l'ocean pacifique sud-ouest: deuxieme partie

SIGLECNRS 9370 C / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Met gedichten onthaald: over poëzie in onthaalklassen voor anderstalige nieuwkomers (OKAN) /

Master of Arts in de vergelijkende moderne letterkund