Numerical study of bio-fluids and mass transfer processes through membranes

La reologia de la sang (hemoreología) exerceix un ppel important en la perforació de teixits i l'alteració de les seves condicions fisiològiques és gairebé sempre la principal causa de patologies cardiovasculars. Per tant, l'estudi dels perfils de velocitat i l'esforç de tall de la sang al llarg de micro-venes és important en la investigació de malalties cardiovasculars. Recents avenços en organs-on-a-chip remarquen la possibilitat d'usar lung-on-a-xips el qual ha estat desenvolupat per reemplaçar les funcions respiratòries de l'home en assajos farmaceuticos. S'ha avançat en l'estudi de processos de micro-separació a través de membranes micro-poroses desenvolupant una eina numèrica per modelar el comportaments dels micro-dispositius usant la geometria dels lung-on-a-chip en dues i tres dimensions, on una membrana artificial separa dos canals amb dos diferents fluids i així dos diferents règims de flux. A causa de que és un problema de múltiples escales, el nou codi consisteix d'un model híbrid LBM-FD (Lattice Boltzmann - diferències finites) sobre una malla no uniforme que modela processos de transferència de massa en fluxos no newtonians. El model híbrid LBM-FD va ser usat per estudiar el transport de massa a través d'una membrana hidrofòbica i microporosa ocalizada entre un flux co-corrent passant a través de canals rectangulars, similar als microdispositius usats en el projecte lung-on-a- xip. Estecódigo ha estat usat per fer un estudi paramètric en la recerca de la correlació entre el nombre de Peclet al canal permeat i els processos de transferència de massa a través de la membrana (Sherwood number mitjana ). Les correlacions al microdispositiu bidimensional reprodueix correctament la relació lineal de amb el nombre de porus. Les correlacions mostren un valor de l'exponencial en la llei de potències de 1/3 (el que caracteritza el problema de Graetz-Leveque) de pel que fa a Pe. S'han trobat les correlacions en dues i tres dimensions. En el cas tridimensional es comparen els resultats obtinguts usant el flux del model de la llei de pontencias truncat amb un grau de pseudo-plasticitat de n = 0.7 pel que fa als resultats obtinguts per flux newtonià n = 1. El cas no-newtonià mostra un increment del 5% en la transferència de massa () respecte al cas newtonià.La reología de la sangre (hemoreología) desempeña un papel importante en la perforación de tejidos y la alteración de sus condiciones fisiológicas es casi siempre la principal causa de patologías cardiovasculares. Por lo tanto, el estudio de los perfiles de velocidad y el esfuerzo de corte de la sangre a lo largo de micro-venas es importante en la investigación de enfermedades cardiovasculares. Recientes avances remarcan la posibilidad de usar micro-dispositivos como lung-on-a-chip, el cual ha sido desarrollado para reemplazar las funciones respiratorias del hombre en ensayos farmaceuticos. Se ha avanzado en el estudio de procesos de micro-separación a través de membranas micro-porosas desarrollando una herramienta numérica para modelar el comportamientos de los micro-dispositivos usando la geometría de los lung-on-a-chip en dos y tres dimensiones. Debido a que es un problema de múltiples escalas, el nuevo código consiste de un modelo híbrido LBM-FD (Lattice Boltzmann - Diferencias finitas) sobre una malla no uniforme que modela procesos de transferencia de masa en flujos no Newtonianos. El modelo híbrido LBM-FD fue usado para estudiar el transporte de masa a través de una membrana hidrofóbica y microporosa localizada entre un flujo co-corriente pasando a través de canales rectangulares, similar a los microdispositivos usados en el proyecto lung-on-a-chip. Con este código, un estudio paramétrico en la busqueda de la correlación entre el Peclet en el canal permeado y el Sherwood promedio ha sido realizado. Las correlaciones en el microdispositivo bi-dimensional reproduce correctamente la relación lineal de con el número de poros. Las correlaciones muestran un valor del exponencial en la ley de potencias de 1/3 ( lo que caracteriza el problema de Graetz-Leveque) de con respecto a Pe. Se han hallado las correlaciones en dos y tres dimensiones. En el caso tri-dimensional se comparan los resultados obtenidos usando el flujo del modelo del modelo de la ley de pontencias truncado con un grado de pseudo-plasticidad de n=0.7 con respecto a los resultados obtenidos para flujo Newtoniano n=1. El caso no-Newtoniano muestra un incremento del 5% en la transferencia de masa () con respecto al caso Newtoniano.Blood rheology (haemorheology) plays a key role in tissue perfusion and its alteration from physiological conditions is often the main cause of cardiovascular pathologies. Therefore, the study of blood velocity profiles and wall shear stress distribution along micro-vessels is important in the field of cardiovascular diseases research. Recent advances in organ-on-a-chip highlighted the possibility of using artificial lung-on-chips which have been developed to replace the respiratory functions of the human lungs in pharmaceutical tests. We have expanded the study of micro-separation processes through micro-porous membranes by developing a numerical tool able to model the behavior of lung-on-a-chip micro-devices in both two and three dimensional geometries. As this is a multiscale problem, the new code consists in a hybrid LBM-FD (Lattice Boltzmann - finite difference) model on a non-uniform material grid, that models mass transfer processes in non-Newtonian flows. A part from the validation of the code, results obtained include the correlations of the non-dimensional numbers involved in mass transfer processes and the dependence on porosity, and the study of concentration profiles under steady (pipe flow) and the beginning of the study in non-steady (Womersley flow) conditions. The LBM-FD hybrid model was used to study the mass transport through a hydrophobic micro-porous membrane located in-between a co-current flow passing through rectangular channels, which is similar to the micro-device used in Lung-On-a-Chip research. This code has been used to perform a parametric study to find the empirical correlation between Peclet number in the permeate channel and the mass transfer processes across the membrane which is quantified by mean of Sherwood number. The correlations in the two-dimensional micro-device reproduce correctly the linear scaling law of with the number of pores. The correlations give a power value equal to 1/3 (which characteristic of the Graetz-Leveque problem) for the scaling exponent of the average Sherwood number with Pe. This has been done in 2D and 3D models. In the three-dimensional case, we compared the results obtained using the power-law flow with a shear-thinning degree of n=0.7 against the results obtained using the Newtonian hypothesis (n=1). The non-Newtonian case

Simulación de los patrones de profundidad, velocidad y salinidad del agua de la Ciénaga Grande de Santa Marta por el método Lattice Boltzmann

La Ciénaga Grande de Santa Marta (CGSM), es la laguna costera más grande de Colombia, y una de las más estratégicas para el Caribe colombiano [30], pero la adecuación de las tierras aledañas para la ganadería extensiva ha disminuido sustancialmente la entrada de agua fresca a la laguna principal, generando una extrema hipersalinización de sus suelos que ha sido la causa principal de la mortandad masiva del manglar y de su fauna asociada [19, 16]. La evaluación de alternativas de intervención sobre la Ciénaga ha motivado la construcción y calibración de modelos numéricos de su hidrodinámica, por ejemplo con la técnica de diferencias finitas [24, 17, 37], pero existen técnicas alternativas por explorar. Una de éstas la constituyen los modelos de Lattice-Boltzmann, que desde su aparición hace veinte años han constituido una alternativa valiosa para las simulaciones hidrodinámicas [27, 42, 3]. El objetivo del presente trabajo es acoplar dos modelos de lattice-Boltzmann: un modelo generalizado (MRT-LBE) para aguas someras, y un modelo de advección-difusión para el transporte de solutos, construidos desde cero en un lenguaje de programación de alto nivel (C++), cada uno de los modelos y el modelo acoplado, fue probado reproduciendo correctamente algunos problemas típicos de la ingeniería hidráulica explorando las capacidades del método para simular flujos en diferentes condiciones. Como situación final, se construyó un modelo acoplado de lattice-Boltzmann de la Ciénaga Grande de Santa Marta y se exploró la capacidad para reproducir los patrones de nivel de superficie libre, velocidad y salinidad obtenidos en campo por Camacho [17]. Para su calibración se utilizaron algunos de los datos de campo obtenidos por Camacho [17]. El modelo as__ construido es capaz de reproducir aproximadamente los valores medios de velocidad horizontal, profundidad y salinidad medidos en campo, con una precisión algo mayor que la de los trabajos anteriores en diferencias finitas. Igualmente, el modelo estima de manera coherente el efecto de la apertura de un caño en la parte occidental de la Ciénaga, una intervención que en efecto se realizó en fecha posterior a la toma de datos. Este trabajo reporta el primer modelo de lattice-Boltzmann para la simulación de aguas someras que se compara con datos de campo y permite apreciar en una primera instancia la capacidad que puede llegar a tener el método para la modelación de lagunas costeras.Abstract. The Ciénaga Grande de Santa Marta (CGSM) is the largest coastal lagoon in Colombia, and one of the most strategic for the Colombian Caribbean. However, the adjustment of the surrounding lands for extensive livestock has decreased substantially fresh water input to the main lagoon, which as outcome creates an extreme hypersalinization of its soil which has been the main cause of the mass mortality of mangroves and associated fauna . The evaluation of alternatives of intervention on the CGSM has led to the construction and calibration of numerical models based on their hydrodynamic characteristics, for example with the technique of finite differences, although there are alternative techniques to explore. One of these is the Lattice-Boltzmann model, which since its origin twenty years ago, has been a valuable alternative to the hydrodynamic simulations. The goal of this research is to couple two lattice-Boltzmann models: a generalized model (MRT-LBE) for shallow water and an advection-diffusion model for solute transport. These models were built from zero, by using a high level (C + +) programming language. Each model and the coupled model was tested and it successfully reproduced some typical problems of hydraulic engineering, and at the same time the capabilities of the method to simulate flows under different conditions were explored. Finally, a coupled model of lattice-Boltzmann for the CGSM was constructed and its ability to reproduce the field data patterns of free surface level, velocity and salinity obtained by Camacho was explored. The model calibration used some of the field data obtained by Camacho. The constructed model is able to reproduce approximately the mean horizontal velocity, depth and salinity measured in the field, with an greater accuracy than in previous studies that used finite differences. Also, the model consistently estimates the effect of the opening of a pipe in the western part of the CGSM, an intervention that actually took place posteriorly to data collection. This study present the first lattice- Boltzmann model for the shallow water simulation compared with field data, which also allow us to appreciate the method capacity at lagoon modeling.Maestrí

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Numerical study of bio-fluids and mass transfer processes through membranes

La reologia de la sang (hemoreología) exerceix un ppel important en la perforació de teixits i l'alteració de les seves condicions fisiològiques és gairebé sempre la principal causa de patologies cardiovasculars. Per tant, l'estudi dels perfils de velocitat i l'esforç de tall de la sang al llarg de micro-venes és important en la investigació de malalties cardiovasculars. Recents avenços en organs-on-a-chip remarquen la possibilitat d'usar lung-on-a-xips el qual ha estat desenvolupat per reemplaçar les funcions respiratòries de l'home en assajos farmaceuticos. S'ha avançat en l'estudi de processos de micro-separació a través de membranes micro-poroses desenvolupant una eina numèrica per modelar el comportaments dels micro-dispositius usant la geometria dels lung-on-a-chip en dues i tres dimensions, on una membrana artificial separa dos canals amb dos diferents fluids i així dos diferents règims de flux. A causa de que és un problema de múltiples escales, el nou codi consisteix d'un model híbrid LBM-FD (Lattice Boltzmann - diferències finites) sobre una malla no uniforme que modela processos de transferència de massa en fluxos no newtonians. El model híbrid LBM-FD va ser usat per estudiar el transport de massa a través d'una membrana hidrofòbica i microporosa ocalizada entre un flux co-corrent passant a través de canals rectangulars, similar als microdispositius usats en el projecte lung-on-a- xip. Estecódigo ha estat usat per fer un estudi paramètric en la recerca de la correlació entre el nombre de Peclet al canal permeat i els processos de transferència de massa a través de la membrana (Sherwood number mitjana ). Les correlacions al microdispositiu bidimensional reprodueix correctament la relació lineal de amb el nombre de porus. Les correlacions mostren un valor de l'exponencial en la llei de potències de 1/3 (el que caracteritza el problema de Graetz-Leveque) de pel que fa a Pe. S'han trobat les correlacions en dues i tres dimensions. En el cas tridimensional es comparen els resultats obtinguts usant el flux del model de la llei de pontencias truncat amb un grau de pseudo-plasticitat de n = 0.7 pel que fa als resultats obtinguts per flux newtonià n = 1. El cas no-newtonià mostra un increment del 5% en la transferència de massa () respecte al cas newtonià.La reología de la sangre (hemoreología) desempeña un papel importante en la perforación de tejidos y la alteración de sus condiciones fisiológicas es casi siempre la principal causa de patologías cardiovasculares. Por lo tanto, el estudio de los perfiles de velocidad y el esfuerzo de corte de la sangre a lo largo de micro-venas es importante en la investigación de enfermedades cardiovasculares. Recientes avances remarcan la posibilidad de usar micro-dispositivos como lung-on-a-chip, el cual ha sido desarrollado para reemplazar las funciones respiratorias del hombre en ensayos farmaceuticos. Se ha avanzado en el estudio de procesos de micro-separación a través de membranas micro-porosas desarrollando una herramienta numérica para modelar el comportamientos de los micro-dispositivos usando la geometría de los lung-on-a-chip en dos y tres dimensiones. Debido a que es un problema de múltiples escalas, el nuevo código consiste de un modelo híbrido LBM-FD (Lattice Boltzmann - Diferencias finitas) sobre una malla no uniforme que modela procesos de transferencia de masa en flujos no Newtonianos. El modelo híbrido LBM-FD fue usado para estudiar el transporte de masa a través de una membrana hidrofóbica y microporosa localizada entre un flujo co-corriente pasando a través de canales rectangulares, similar a los microdispositivos usados en el proyecto lung-on-a-chip. Con este código, un estudio paramétrico en la busqueda de la correlación entre el Peclet en el canal permeado y el Sherwood promedio ha sido realizado. Las correlaciones en el microdispositivo bi-dimensional reproduce correctamente la relación lineal de con el número de poros. Las correlaciones muestran un valor del exponencial en la ley de potencias de 1/3 ( lo que caracteriza el problema de Graetz-Leveque) de con respecto a Pe. Se han hallado las correlaciones en dos y tres dimensiones. En el caso tri-dimensional se comparan los resultados obtenidos usando el flujo del modelo del modelo de la ley de pontencias truncado con un grado de pseudo-plasticidad de n=0.7 con respecto a los resultados obtenidos para flujo Newtoniano n=1. El caso no-Newtoniano muestra un incremento del 5% en la transferencia de masa () con respecto al caso Newtoniano.Blood rheology (haemorheology) plays a key role in tissue perfusion and its alteration from physiological conditions is often the main cause of cardiovascular pathologies. Therefore, the study of blood velocity profiles and wall shear stress distribution along micro-vessels is important in the field of cardiovascular diseases research. Recent advances in organ-on-a-chip highlighted the possibility of using artificial lung-on-chips which have been developed to replace the respiratory functions of the human lungs in pharmaceutical tests. We have expanded the study of micro-separation processes through micro-porous membranes by developing a numerical tool able to model the behavior of lung-on-a-chip micro-devices in both two and three dimensional geometries. As this is a multiscale problem, the new code consists in a hybrid LBM-FD (Lattice Boltzmann - finite difference) model on a non-uniform material grid, that models mass transfer processes in non-Newtonian flows. A part from the validation of the code, results obtained include the correlations of the non-dimensional numbers involved in mass transfer processes and the dependence on porosity, and the study of concentration profiles under steady (pipe flow) and the beginning of the study in non-steady (Womersley flow) conditions. The LBM-FD hybrid model was used to study the mass transport through a hydrophobic micro-porous membrane located in-between a co-current flow passing through rectangular channels, which is similar to the micro-device used in Lung-On-a-Chip research. This code has been used to perform a parametric study to find the empirical correlation between Peclet number in the permeate channel and the mass transfer processes across the membrane which is quantified by mean of Sherwood number. The correlations in the two-dimensional micro-device reproduce correctly the linear scaling law of with the number of pores. The correlations give a power value equal to 1/3 (which characteristic of the Graetz-Leveque problem) for the scaling exponent of the average Sherwood number with Pe. This has been done in 2D and 3D models. In the three-dimensional case, we compared the results obtained using the power-law flow with a shear-thinning degree of n=0.7 against the results obtained using the Newtonian hypothesis (n=1). The non-Newtonian case

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially