30 Years of Gender Inequality and Implications on Curriculum Design in Open and Distance Learning

Gender inequality is a pressing issue on a global scale, yet studies on this important issue have stayed on the margins of open and distance learning (ODL) literature. In this study, we critically analyse a batch of ODL literature that is focused on gender inequality in post-secondary and higher education contexts. We use Therborn’s social justice framework to inform and guide the study. This is a comprehensive social justice lens that sees inequality as “a life and death issue,” approaching empowerment as a central area of concern. Qualitative content analysis of 30 years of peer-reviewed literature reveals patriarchy and androcentrism as significant mechanisms that continue to produce gender inequality, in particular in women’s access to educational resources and formal learning opportunities. We highlight three themes that emerged in the content analysis: (1) ODL and equal opportunity; (2) Feminism and gender-sensitive curriculum design; and (3) Culturally relevant curriculum design. We critique views of access to technology-enabled education as an instrument for social justice, and provide a pedagogical model for an ODL curriculum centred on empowerment and agency, two concepts closely linked to existential inequality. We argue that such a curriculum is public service and requires a model of education that is based on participation and co-construction, and lies at the intersection of critical, feminist, and culturally relevant pedagogical practices

Assessment of landslide generated impulse waves in dam reservoirs using empirical relations: a case study on Borçka Dam

Bu çalışmada Borçka Baraj Rezervuarında baraj gövdesine 4 km uzaklıkta bulunan paleo-heyelan malzemesinin aktif hale gelmesi durumunda oluşacak itki dalgalarının çevresel etkilerinin ampirik ilişkiler kullanılarak belirlenmesi amaçlanmıştır. Çalışmada, heyelan malzemesine ait farklı kalınlık ve genişlik değerleri dikkate alınarak, 0.5 ile 1 milyon metreküp arasında değişen hacimlerde malzemenin rezervuara akması durumu için 3 farklı senaryo geliştirilmiştir. Heyelan kaynaklı dalganın rezervuarda her yöne dairesel olarak yayılacağı belirlenmiş, dalga özellikleri 3 boyutlu ampirik yaklaşımlarla değerlendirilmiştir. Farklı senaryolar için, dalga hızının 27.1 ile 27.7 m/s arasında değişeceği, en yüksek hız değeri için karşı kıyıya ulaşacak dalga yüksekliğinin 23 metre olacağı ve bu dalganın karşı kıyıda yamaç boyunca 42.3 metre yükseleceği hesaplanmıştır. En düşük dalga hızı değeri için ise dalga yüksekliği 18.5 m ve yamaç boyunca ilerleme yüksekliği ise 32.5 metre olacaktır. Baraja ait 4 metrelik dalga payı değeri dikkate alındığında, rezervuar boyunca ilerleyerek baraj gövdesine ulaşacak dalganın gövde için bir tehlike oluşturmayacağı belirlenmiştir. Basit rezervuar geometrileri ve kısa mesafeler için heyelan kaynaklı dalga özelliklerinin hesaplanmasında ampirik eşitliklerin kullanılması önerilirken, kompleks rezervuar geometrileri için mutlaka 3 boyutlu sayısal modellerin kullanılması, bu modellerde ise sayısal tabanlı yamaç duraylılık analizleri uygulanarak hesaplanacak heyelan hacmi değerinin kullanılması gerekliliği göz ardı edilmemelidirThe aim of this study is to investigate environmental effects of impulse waves originated from reactivation of a paleo-landslide located 4 km far from the dam body in Borçka Dam reservoir using empirical relations. Considering different values of landslide width and thickness, 3 different scenarios were defined for the slide of landslide material in volumes ranging from 0.5 to 1 million cubic meters. The wave propagation in the reservoir was defined as radially, and properties of landslide generated impulse waves were evaluated using 3D empirical approaches. For different scenarios, it is determined that the wave height values range between 27.1 and 27.7 m/s, the wave height value for opposite shore reaches 23 m and run-up height value is 42.3 m for highest wave celerity value. The values of wave height and run-up height were calculated as 18.5 m and 32.5 m respectively for lowest wave celerity value. Considering the 4-meter freeboard for the dam, it was determined that the wave propagating through the reservoir and reaching the dam body would not create a danger for the body. Empirical equations can be used for the calculation of landslide-induced wave characteristics for simple reservoir geometries and short distances. But 3D numerical models should be preferred for complex reservoir geometries, and the need to use the landslide volume value to be calculated by applying numerical based slope stability analyzes should not be ignored in these models

Determination of adaptation capabilities of some durum wheat genotypes of foreign origin in Southeast Anatolian Region

Güneydoğu Anadolu Bölgesinin iki önemli alt bölgesini temsil eden Diyarbakır ve Kızıltepe lokasyonlarında 2011-2012 yetiştirme sezonunda yürütülen bu çalışma, adaptasyon kabiliyeti ve kalite özellikleri yönünden üstün durum buğday genotiplerini belirlemek ve ıslah programlarında kullanmak amacıyla yürütülmüştür. Çalışmada, ICARDA (International Center for Agricultural Research in the Dry Areas)’dan temin edilen 18 hat ile 5 kontrol çeşit (Omrabi5, Younes1, Korifla, Waha, Miki2) ile beraber, bölgede ekilen Zühre çeşidi standart olarak kullanılmıştır. Deneme, tesadüf blokları deneme dese-nine göre iki lokasyonda ve üç tekerrürlü olarak kurulmuştur. Çalışmada tane verimi, bin tane ağırlığı, hektolitre ağırlığı, pro-tein içeriği, irmik rengi ile SDS değeri incelenmiştir. Yapılan bileşik analize göre, hektolitre ağırlığı dışındaki bütün paramet-reler açısından genotipler arasında önemli farklılıklar tespit edilmiştir. Lokasyonlar arasında tane verimi ve bin tane ağırlığı; genotip x lokasyon interaksiyonunda ise tane verimi, bin tane ağırlığı ve protein oranı bakımından önemli farklılıklar göz-lenmiştir. Ayrıca özellikler arası ve genotip-özellik ilişkilerini değerlendirmek amacıyla Biplot analizi uygulanmıştır. Bu ana-liz yöntemiyle, birbirleriyle ilişkili özellikler ve belirli özellikler açısından öne çıkan genotipler görsel olarak gösterilmiştir. İki lokasyon ortalamasına göre verim ve kalite özellikleri ile ilgili umut vadeden genotipler, ıslah programının ileri kademele-rine alınmıştır.This study was performed in growing season of 2011-2012 in Diyarbakır and Kızıltepe, representing two important subregions of Southeast Anatolia Region, in order to identify durum wheat genotypes having superior adaptaptation capabilities and quality features to be used in breeding programs. The material used in the study included 18 lines and 5 control varieties (Omrabi5, Younes1, Korifla, Waha, Miki2) obtained from ICARDA (International Center for Agricultural Research in the Dry Areas)and Zühre durum wheat variety cultivated in the region as the standart. The trials were performed as a randomized complete block design experiment with three replications in two locations. Grain yield, thousand kernel weight, hectoliter weight, protein content, semolina color and SDS value were evaluated in the study. The results of the analyses of compound variances revealed significant differences between genotypes in all the parameters except hectoliter weight. Significant differences were found between locations in terms of grain yield and thousand kernel weight and in terms of grain yield, thousand kernel weight and protein content between the genotype x location interaction. A biplot analysis method was performed to evaluate inter-trait and genotype-trait relationships. Traits related to each other and the genotypes featured in terms of particular traits were visually shown by this analysis. Promising genotypes according to the grain yield and quality characteristics based on two location averages were taken to the advanced stages of the breeding progra

The Paradox of Distance Education in Girls' Education

Distance education has a vital role in creating and providing access to education for all. However, the role of distance education can be paradoxical in girls’ education. On one hand, socio-economic conditions, health issues, and geographical distance are noted as some major barriers to girls’ educational attainment. One of the most disadvantaged groups is out-ofschool children who cannot continue their formal education for different reasons including armed conflict and war, poverty, and social discrimination. In that sense, distance education plays a significant role in creating access to education as a human right. On the other hand, from the perspective of feminism and social reproduction theory, distance education may reproduce and perpetuate existing inequalities. For example, if education is confined to homes with distance education, this may reinforce or even legitimize the idea of females living in isolation, away from public spheres. Taking these issues into account, we highlight some ethical issues in the provision of distance education for girls’ education through a qualitative analysis of reports and peer-reviewed articles

Denizlerdeki Mikrobiyal Reaksiyonların Yeni Yaklaşımlar Kullanılarak Araştırılması: Genetik, Biyojeokimya ve Modelleme

TÜBİTAK ÇAYDAG15.10.2018ODTÜ Deniz Bilimleri Enstitüsü tarafından Mersin Körfezi?nde 1997 yılından bu yanasürdürülen Erdemli Zaman Serisi (ETS) programı dahilinde ölçülen degiskenlere ek olarak, buproje kapsamında toplam su kolonu derinligi 200 metre olan istasyonda altı farklı derinliktenbir yıl boyunca aylık periyotlarda deniz suyu örneklemesi yapılmıstır. Bu örneklerde yeni nesildizileme yönteminin kullanıldıgı amplikon dizilemesi (metagenomik) analizleri yapılarakbiyojeokimyasal döngülerde önemli roller oynayan bakteri türleri tayin edilmis, topluluk yapılarıve bolluklarının zamansal degisimi belirlenmistir. Taksalar arasında Pelagibacteriacea?ya aitolan SAR11 kladının tüm derinlikler ve aylarda baskınlıgı gözlenmistir. Bu kladın üyelerifonksiyonel olarak organik maddeyi oksitleyerek karbondioksit üreten heterotrofik bakterilerdirve dolayısıyla biyojeokimyasal döngülerin remineralizasyon ayagında rol almaktadırlar.SAR11 kladının bollugu yıl boyunca %22 ve %64 arasında degisim göstermistir. SAR11kladının ekotipleri olan Clade Ia ve Clade Ib ise derinlige baglı yayılım göstermektedirler.Clade Ia yüzey sularında baskınlık gösterirken Clade Ib?nin derin sularda komüniteye katkısıdaha fazla olmaktadır. Bunun yanı sıra komünite yapısını belirleyen en önemli çevreselfaktörler sıcaklık, nitrat, görünür oksijen kullanımı, sezon ve ısıklı tabaka derinligi olarakbelirlenmistir. Sezonlar arasındaki filogenetik çesitlilik, belirgin olarak farklı bulunmustur.Bunun yanı sıra bakterilerin aktif metabolizmalarını tayin etmek için sezonluk olarak mRNAörneklemesi yapılmıs ve örnekler metatranskriptom yöntemi ile analiz edilmistir. Bu yöntemaracılıgı ile bakteriler tarafından gerçeklestirilen biyokimyasal reaksiyonların aktif ve inaktifoldukları dönemler saptanmıstır. Nitrifikasyonun ilk basamagı olan amonyak oksitilenmesiKasım ayında oldukça yüksek bulunmustur. Ancak nitrifikasyonun ikinci basamagı olan nitritinnitrata oksitlenme sürecine ait olan belirteç genlere herhangi bir örnekde rastlanmamıstır.Sisteme yeni azot girdisi saglayan azot fiksasyonuna mRNA ifadelerinde rastlanmamıstır.Metatranskriptom yöntemine elde edilen bulgulara ek olarak nitrifikasyon ve azot fiksasyonsüreçleri izotop yöntemi ile de her ay dört farklı derinlikten yapılan örneklemeler ilearastırılmıstır. Nitrifikasyonun sadece afotik bölgede gerçeklesmedigi görülmüstür. Azotfiksasyonu belirteç genlerine rastlanmadıgı halde izotop yöntemi ile yapılan çalısmada azotfiksasyonu tüm yıl boyunca ve tüm derinliklerde çok düsük de olsa tespit edilmistir. Azotdöngüsüne ek olarak, metatranskriptom çalısması ile kısıtlı inorganik fosfat varlıgında aktiveolan alkalin fosfataz?ın sezonluk degisimi de göstermistir. Buna göre, ortamda düsük fosfatkonsantrasyonları gözlemlendiginde bakterilerin diger fosfor kaynaklarına yöneldigigözlemlenmistir.Bunlara ek olarak denizdeki biyokimyasal döngüleri sayısal olarak temsil eden ve tahminleridirekt olarak ölçümlerle karsılastırılabilecek bir modelleme sistemi bölgeye uyarlanmıstır. Bumodelleme sistemi bir parametre tahmin algoritması ve proje kapsamında yapılan ölçümverileri ile birlestirilerek modelde reaksiyon hızlarını kontrol eden parametrelerin tahminiyapılmıstır. Bu tahmin sonucunda ortaya çıkan nitrifikasyon hızları izotop yöntemi ile yapılannitrifikasyon hızları ile karsılastırılmıstır. Bu karsılastırma reaksiyon hızları tahmini içinmodelleme sistemi ve parametre tahmini kullanımının zor olan izotop yöntemine alternatif biryöntem olma potansiyelini göstermistir.Yapılan bir yıllık gözlemler, kullanılan izotop yöntemleri ve modelleme yaklasımı bölgedekibilimsel bilgiye önemli katkılar saglamıstır. Bakteri topluluk yapıları Türkiye kıyılarında ilk defakültür bagımsız yöntemlerle ortaya konmustur. Bunun yanı sıra izotop yöntemleri ve yapılanmetatranscriptom çalısması bölgede azot fiksasyonunun baskın bir süreç olmadıgını ortayakoymustur. Biyojeokimyasal bir modelleme sistemi basarıyla bölgeye uyarlanmıstır.In addition to the measured variables within the Erdemli Time Series (ETS) monitoring programcarried out in Mersin Bay since 1997 by the METU-Institute of Marine Sciences, sea watersampling was performed where the total water column depth is 200 meters and from sixdifferent depths monthly for one year. These samples were analyzed by next generationsequencing using amplicon sequencing (metagenomic) approach and the bacterial speciesthat play important roles in biogeochemical cycles and the temporal changes of communitystructures and abundances were determined. SAR11 clade belonging to Pelagibacteriaceawas the most dominant taxa in all depths and months. SAR11 is ubiquitous in the seas andreplicate under the most limiting nutrient conditions. The abundance of the SAR11 cladethroughout the year ranged between 22% and 64%. Clade Ia and Clade Ib, the ecotypes ofthe SAR11 clade, showed depth-dependent distribution. Clade Ia dominated the surfacewaters, while Clade Ib contributes the most to the community in deeper waters. The mostimportant environmental factors that determine the community composition were determinedto be; temperature, nitrate, apparent oxygen utilization, season and euphotic zone depth.Phylogenetic diversity between seasons was found to be significantly different.Furthermore, to determine the active metabolism of bacteria mRNA samples were collectedseasonally and analyzed by metatranscriptomics approach. By using this approach, active andinactive periods of biochemical reactions mediated by bacteria was discovered. Ammoniaoxidation, the first step of nitrification, was found to be high in November. However, markergenes that are belong to nitrite oxidation to nitrate which is the second step of nitrification, havenot been detected in any samples. Indicator genes of nitrogen fixation which provides newnitrogen to the system was not found in mRNA expressions. In addition to the findings obtainedfrom the metatranscriptomics study, nitrification and nitrogen fixation processes wereinvestigated using isotope measurements from four different depths each month. It wasobserved that the nitrification did not occur only in the aphotic zone. Nitrogen fixation was notdetected in the indicator genes, but in the study conducted with isotope method, even with lowlevels, nitrogen fixation was determined throughout the year and depths. Additionally, to thenitrogen cycle, the seasonal change of alkaline phosphatase activity which is active especiallyduring inorganic phosphate limitation was also identified by the metatranscriptomics study.Accordingly, when low phosphate concentrations were observed in the environment, it wasobserved that bacteria adapt to use other phosphorus sources.Furthermore, a modeling system that represents the marine biochemical cycles numericallyand whose estimates can be compared directly with the measurements was adapted to theregion. This modeling system was combined with a parameter estimation scheme and measurements obtained in the project, and the parameters controlling the reaction rates in themodel were estimated. Nitrification rates according to the estimations were cpmpared with theresults of nitrification rates obtained by isotopic measurements. This comparison showed thepotential of using modeling system and parameter estimation as an alternative approach to thehard isotope measurements for estimating reaction rates.One-year long observations, isotope methods used and modeling approach have madesignificant contributions to scientific knowledge in the region. Bacterial community structurehave been revealed by culture-independent method for the first time in the coasts of Turkey.In addition, isotope methods and metatranscriptom study showed that nitrogen fixation is nota dominant process in the region. And a biogeochemical modeling system has beensuccessfully adapted to the region

Efeito do levosimendan em pacientes com insuficiência cardíaca sistólica severa e agravamento da função renal

FUNDAMENTO: O levosimendan, um sensibilizador de cálcio, aumenta a sensibilidade do coração para o cálcio, aumentando assim a contratilidade miocárdica, sem aumento do cálcio intracelular. Recentemente foi demonstrado que o levosimendan era benéfico na melhoria da função renal. No entanto, fica por determinar que o efeito benéfico esteja relacionado em forma diferencial ao status renal durante o evento-índice. OBJETIVO: O objetivo do presente estudo foi determinar se o levosimendan pode melhorar o resultado renal em pacientes com insuficiência cardíaca aguda descompensada com e sem agravamento da função renal. MÉTODOS: Quarenta e cinco pacientes consecutivos que tiveram uma taxa de filtração glomerular reduzida e pelo menos dois dados consecutivos quanto à função renal, antes da administração de levosimendan, foram incluídos no estudo. Os pacientes foram classificados em dois grupos, com e sem agravamento da função renal com base no aumento da creatinina sérica > 0,3 mg/dL. RESULTADOS: Uma melhoria significativa foi observada na função renal em pacientes com agravamento da função renal (creatinina sérica de 1,4 ± 0,16 a 1,21 ± 0,23 mg/dL, p = 0,001 e taxa de filtração glomerular de 48,9 ± 15 a 59,3 ± 21,8 mL/min/m², p = 0,011), apesar de que não houve melhoria significativa em aqueles sem agravamento da função renal (creatinina sérica de 1,29 ± 0,33 a 1,37 ± 0,66 mg/dL, p = 0,240 e taxa de filtração glomerular de 53,7 ± 17,6 a 52,9 ± 21,4 mL/min/m², p = 0,850). CONCLUSÃO: O levosimendan parece proporcionar um efeito de realce renal em pacientes com severa insuficiência cardíaca sistólica descompensada aguda e agravamento da função renal. Considerar esse efeito diferencial poderia contribuir a obter resultados renais benéficos. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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