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

Iodine Status in European Women in New Zealand With Moderate Selenium Deficiency

For the optimal function of thyroid gland, adequate intakes of iodine and selenium are required. Since iodine is essential component of the thyroid hormones, its insufficiency leads to inadequate hormone production and further to inadequate tissue response (hypothyroidism), goitre, stillbirth and miscarriages, and growth retardation. According to the World Health Organisation the recommended median urinary iodine concentrations (UIC) are the best indicators of iodine nutrition. The WHO defines iodine sufficiency in an adult population as a median UIC of > 100 µg/L in spot urine samples. Iodine deficiency was and still is a problem in New Zealand. In September 2009 the mandatory fortification of all bread with iodized salt was introduced. Therefore, the primary aim of the study was to determine the levels of iodine in both groups, and the secondary aim of the study was to determine whether there is a relationship between selenium and iodine, and iodine and thyroid hormones in two groups of European women. Urinary iodine concentration was determined in spot samples by the new method called “Fast B”, which is improved Sandell-Kolthoff reaction. The results of the study showed the mean urinary iodine level in the control group and the group of women with the Hashimoto’s thyroiditis was 120.77± 59.35 (median UIC was128.00 µg/L), and 98.64 ± 62.83 (median UIC was 95.00 µg/L), respectively. Estimated daily iodine intake of 150µg/day was achieved in five participants in the control group, and four participants in the group of women with Hashimoto’s thyroiditis. Estimated median iodine intake in the control group and Hashimoto’s group was 142.22 and 105.55, respectively, indicating mild iodine deficiency. There was no significant relationships found between iodine and selenium, and iodine and thyroid hormones in both groups. The results of the current study are in line with the results from larger studies carried out in New Zealand. Iodine intakes appear to have improved after the mandatory fortification of bread with iodised salt in 2009, although iodine deficiency is still a problem in New Zealand. Using an iodine fortified bread clearly made an impact on the overall iodine intake but not to the expected level. There was no association found between iodine and selenium, and iodine and thyroid hormones. Any possible interaction between selenium and iodine is still unclear

In situ mapping of chemical segregation using synchrotron x-ray imaging

Synchrotron x-rays are a powerful tool to probe real-time changes in the microstructure of materials as they respond to an external stimulus, such as phase transformations that take place in response to a change in temperature. X-ray imaging techniques include radiography and tomography, and have been steadily improved over the last decades so that they can now resolve micrometer-scale or even finer structural changes in bulk specimens over time scales of a second or less. Under certain conditions, these imaging approaches can also give spatially resolved chemical information. In this article, we focus on the liquid to solid transformation of metallic alloys and the temporal and spatial resolution of the accompanying segregation of alloying elements. The solidification of alloys provides an excellent case study for x-ray imaging because it is usually accompanied by the progressive, preferential segregation of one or more of the alloying elements to either the solid or the liquid, and gives rise to surprisingly complex chemical segregation patterns. We describe chemical mapping investigations of binary and quasi-binary alloys using radiography and tomography, and recent developments in x-ray fluorescence imaging that offer the prospect of a more general, multielement mapping technique. Future developments for synchrotron-based chemical mapping are also considered