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

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Signification des âges ⁴⁰Ar/³⁹ Ar le long de détachements crustaux : exemples de l'île d'Ikaria (Cyclades, Grèce) et du massif du Tende (Corse alpine, France)

Numerous studies have shown the impact of deformation on the K-Ar system, and therefore ⁴⁰Ar/³⁹ Ar ages. These studies often do not provide data characterizing deformation and are limited to a comparison of the ages obtained indeformed rocks and an undeformed protolith. The first part of this study thus consisted in studying the strain distribution at different scales and finely describing strain intensity gradients. The study focused on two granitic protoliths, associated respectively with a difference in age between the formation of the protolith and the age of the tectonometamorphic events that is low ( 240 Ma ; Tenda massif). In the firstcase study, deformation results in a 40Ar loss in K-bearing phases, interpreted as resulting from the reduction of diffusion domains sizes which is not accentuated by an increasing strain intensity. In the second case study, the 40Arinheritance of the protolith results in fluids and extraneous 40Ar circulation through the actively deforming structures,ages in phengite being increasingly older approaching the most localizing structures in some sections, while others behave in an opposite way, more in line with the progressive strain localization in time. For both cases, interpretation of ages obtained in the newly formed phases during deformation is ambiguous between cooling, crystallization and mixing, and requires a detailed examination of the data confronted with the possible closing temperatures.Interpretations indicate for the Ikaria case study a strain localization in less than 1-3 Ma along a second order gradient of about ten meters in thickness. Strain localization at the scale of a shear zone occurs more rapidly in the case of a post-orogenic exhumation of a MCC (~ 7 Ma) than in the case of the exhumation of continental material involved in a subduction prism (~ 14-10 Ma).De nombreuses études ont montré l’impact de la déformation sur le système K-Ar, et donc les âges ⁴⁰Ar/³⁹ Ar. Ces études se limitent souvent à une comparaison des âges obtenus dans des roches déformées et un protolithe indemne de déformation. La première partie de cette étude a inversement consisté à étudier la distribution de la déformation à différentes échelles et à décrire finement les gradients d’intensité de la déformation. L’étude a porté sur deux protolithes de nature granitique, associés à une différence d’âge entre leur formation et les évènements tectonométamorphiques faible (240 Ma ; massif du Tende). Pour le premier cas, la déformation entraine une perte de 40Ar dans les clastes des phases potassiques, interprétée comme résultant de la réduction des tailles des domaines de diffusion qui n’est pas accentuée par une intensité de déformation croissante. Pour le second cas, l’héritageen 40Ar du protolithe se traduit par la circulation de fluides et de 40Ar externe au système via les structures se déformant activement, produisant parfois un vieillissement des âges grandissant dans la phengite des structures les plus localisantes, alors que sur d’autres coupes il est observé un rajeunissement plus logique. Pour les deux cas,l’interprétation des âges obtenus dans les phases néoformées pendant la déformation est ambiguë entre refroidissement,cristallisation et mélange, et nécessite un examen détaillé des données confrontées aux températures de fermeture possibles. Les interprétations indiquent pour le cas d’Ikaria une localisation de la déformation ductile en moins de 1-3Ma le long d’un gradient de second ordre d’une dizaine de mètre d’épaisseur. La localisation de la déformation à l’échelle d’une zone de cisaillement se réalise plus rapidement dans le cas de l’exhumation post-orogénique d’un MCC(~7 Ma) que dans le cas de l’exhumation de matériel continental impliqué dans un prisme de subduction (~14-10 Ma)

Mammals of the Harte Ranch area of Big Bend National Park, Brewster County, Texas

Volume: 253Start Page: 1End Page: 1

Mammals of the Harte Ranch area of Big Bend National Park, Brewster County, Texas /

no.253 (2006

Annotated checklist of recent land mammals of Texas, 2008 /

no.278 (2008

Musiqi arxeologiyasının perspektivləri

This article is devoted to the problems of musical archaeology, which is characterised by the interdisciplinary methods to the study of artifacts, texts and ethnographical facts. Various approaches are demonstrated on the base of the articles written by the members of the Study Group on Music Archaelogy and is able to open new perspectives in the developments of ethnoorganology in Azerbaijan

The mammals of Kimble County, Texas /

no.160 (1996