Letter from Geraldine Ferraro to an Aspiring Journalist in Italy

Letter from Geraldine Ferraro to an aspiring journalist in Italy.https://ir.lawnet.fordham.edu/vice_presidential_campaign_correspondence_1984_international/1338/thumbnail.jp

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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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

The disbudding (nipping) x genotype interaction demonstrates different perennial habits in castor-oil plant (Ricinus communis L.).

In castor-oil plant the perennial habit contrasts with the combine harvester. A hypothetical non-branching annual castor plant is based on the stop of the meristem activity in the axillary buds and/or in the cambium. To investigate the relationship between the cambial activity and the axillary bud outgrowth, an experiment on the axillary bud excision was carried out in the field with 64 inbred lines. The stems of treated plants were disbudded, while, as control, the same number of plants was untreated. At the harvest of the first raceme, the treated plants had obviously only the main stem whereas the control plants resulted normally branched. The disbudding treatment heavily affected the stem diameter and interacted with the genotypes. The seed production and the 1000-seed weight were significantly affected by the disbudding treatment. This research, aimed at solving a cultivation problem, can also contribute to better know the semelparity in plants

Letter from Geraldine Ferraro to an Aspiring Journalist in Italy

Letter from Geraldine Ferraro to an aspiring journalist in Italy.https://ir.lawnet.fordham.edu/vice_presidential_campaign_correspondence_1984_international/1338/thumbnail.jp

New perspectives on ultrafast Förster Resonant Energy Transfer

We show that perylene diimide dyads based on a donor-spacer-acceptor motif violate Förster's dipole-dipole interaction picture for energy transfer in the low picosecond to sub-100 femtosecond regime. First theoretical explanations are presented

The weak hydrogen bond in the fluorobenzene-ammonia van der Waals complex: Insights into the effects of electron withdrawing substituents on p versus in-plane bonding

Author Institution: Department of Chemistry, University of York, Heslington, York YO10 5DD, UK.The fluorobenzene-ammonia van der Waals complex has been studied using a combination of two-colour resonance enhanced multiphoton ionisation spectroscopy (REMPI), high-level ab initio calculations of both ground and first excited electronic states and multidimensional Franck-Condon calculations. The experimental REMPI spectrum is characterised by a dominant, blue-shifted band origin, with weak activity in intermolecular vibrational modes. Second order approximate coupled cluster with singles and doubles (RICC2) geometry optimisations and numerical vibrational frequency calculations have been performed on a number of different structural isomers of the complex. Ground state counterpoise-corrected zero point binding energies show the in-plane complex, forming a pseudo-six membered ring connecting the fluorine atom and ortho hydrogen, to be consistently the most stable of all six conformations considered, at all levels of theory. Comparison of computed zero-point excitation energies for the most stable $\pi$ and in-plane conformers with fluorobenzene show that the in-plane complex is the only conformer predicted to exhibit a spectral blue-shift upon electronic excitation. The pattern of computed shifts in fluorobenzene S${_1}$ state intramolecular modes were also found to be unique for each conformer, thereby providing an additional aid to assignment of the experimental spectrum. The computed ground and first excited state geometries and frequencies were used to perform multidimensional Franck-Condon simulations of the S${_1}$-S${_0}$ vibronic spectrum for each of the most stable conformers. The simulations yielded a null spectrum for the $\pi$ complex but showed remarkable agreement with experiment for the in-plane complex, allowing an almost complete vibrational assignment. Molecular electrostatic potential calculations show that, in comparison to benzene, the effect of the fluorine substituent in fluorobenzene is to withdraw electron density from the aromatic $\pi$-system, thereby destabilising the $\pi$-bound conformer with respect to the in-plane conformer.} accepted for publication, 2007.