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

Testen van proces-communicatie en synchronisatie van LoadBalancer software via model-checking

Contains fulltext : 35344.pdf (preprint version ) (Open Access

Testing of inter-process communication and synchronization of ITP LoadBalancer software via model-checking

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Modeling and verifying a Real-Life Industrial Session-Layer Protocol in μ\muCRL2.

This report describes the analysis of an industrial implementation of the session-layer of a load-balancing software system. This software comprises 7.5 thousand lines of C code. It is used for distribution of the print jobs among several document processors (workers). A large part of this commercially used software system has been modeled closely and analyzed using process-algebraic techniques. Several critical issues were discovered. Since the model was close to the code, all problems that were found in the model, could be traced back to the actual code resulting in concrete suggestions for improvement of the code. All in all, the analysis significantly improved the quality of this real-life system

Analysis of a Session-Layer Protocol in mCRL2. Verification of a Real-Life Industrial Implementation

This paper reports the analysis of an industrial implementation of the session-layer of a load-balancing software system. This software comprises 7.5 thousand lines of C code. It is used for distribution of the print jobs among several document processors (workers). A large part of this commercially used software system has been modeled closely and analyzed using process-algebraic techniques. Several critical issues were discovered. Since the model was close to the code, all problems that were found in the model, could be traced back to the actual code resulting in concrete suggestions for improvement of the code. All in all, the analysis significantly improved the quality of this real-life system. This research was supported by SenterNovem Innovation Voucher Inv053967. The fourth author has also been supported by NWO Hefboom project 641.000.407

Meeting report ESC forum on drug eluting stents, European Heart House, Nice, 27-28 September 2007

peer reviewe

Recessive mutations in EPG5 cause Vici syndrome, a multisystem disorder with defective autophagy

Vici syndrome is a recessively inherited multisystem disorder characterized by callosal agenesis, cataracts, cardiomyopathy, combined immunodeficiency and hypopigmentation. To investigate the molecular basis of Vici syndrome, we carried out exome and Sanger sequence analysis in a cohort of 18 affected individuals. We identified recessive mutations in EPG5 (previously KIAA1632), indicating a causative role in Vici syndrome. EPG5 is the human homolog of the metazoan-specific autophagy gene epg-5, encoding a key autophagy regulator (ectopic P-granules autophagy protein 5) implicated in the formation of autolysosomes. Further studies showed a severe block in autophagosomal clearance in muscle and fibroblasts from individuals with mutant EPG5, resulting in the accumulation of autophagic cargo in autophagosomes. These findings position Vici syndrome as a paradigm of human multisystem disorders associated with defective autophagy and suggest a fundamental role of the autophagy pathway in the immune system and the anatomical and functional formation of organs such as the brain and hear