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

Diploid and tetraploid progenitors of wheat are valuable sources of resistance to the root lesion nematode Pratylenchus thornei

The root lesion nematode Pratylenchusthornei is widely distributed in Australian wheat (Triticumaestivum) producing regions and can reduce yield by more than 50%, costing the industry AU$50 M/year. Genetic resistance is the most effective form of management but no commercial cultivars are resistant (R) and the best parental lines are only moderately R. The wild relatives of wheat have evolved in P. thornei-infested soil for millennia and may have superior levels of resistance that can be transferred to commercial wheats. To evaluate this hypothesis, a collection of 251 accessions of wheat and related species was tested for resistance to P. thornei under controlled conditions in glasshouse pot experiments over two consecutive years. Diploid accessions were more R than tetraploid accessions which proved more R than hexaploid accessions. Of the diploid accessions, 11 (52%) Aegilopsspeltoides (S-[B]-genome), 10 (43%) Triticummonococcum (A m-genome) and 5 (24%) Triticumurartu (A u-genome) accessions were R. One tetraploid accession (Triticumdicoccoides) was R. This establishes for the first time that P. thornei resistance is located on the A-genome and confirms resistance on the B-genome. Since previous research has shown that the moderate levels of P. thornei resistance in hexaploid wheat are dose-dependent, additive and located on the B and D-genomes, it would seem efficient to target A-genome resistance for introduction to hexaploid lines through direct crossing, using durum wheat as a bridging species and/or through the development of amphiploids. This would allow resistances from each genome to be combined to generate a higher level of resistance than is currently available in hexaploid wheat

Electrochemical and physical characterisation of lead-based anodes in comparison to Ti–(70%) IrO2/(30%) Ta2O5 dimensionally stable anodes for use in copper electrowinning

The suitability of various dimensionally stable anodes (DSAs®) was investigated in comparison to the conventional lead alloy anodes in the electrowinning of copper. DSA® plate and mesh specimens of composition Ti–(70%) IrO2/(30%) Ta2O5 and lead–(6%) antimony were evaluated. The electrochemical behaviour of these anodes was studied by carrying out open circuit potential measurements, galvanostatic chronopotentiometry, cyclic voltammetry and chronoamperometry. Physical characterisation was done using a scanning electron microscope. It was observed that the DSA® plate anode exhibited the highest corrosion resistance followed by the DSA® mesh and lead anodes, respectively. The results also showed that during copper electrowinning using lead anodes, dissolution of the anode occurs while for both DSAs® marginal loss of coating was observed. The lead anode had the highest anode potential followed by the DSA® plate and mesh anodes, respectively. Overall, it was demonstrated that the DSA® plate anode is the most suitable anode for copper electrowinning