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

Biological Invasions in South Africa's Urban Ecosystems: Patterns, Processes, Impacts and Management

This chapter provides an overview of the researchers and research initiatives relevant to invasion science in South Africa over the past 130 years, profiling some of the more recent personalities, particularly those who are today regarded as international leaders in the field. A number of key points arise from this review. Since 1913, South Africa has been one of a few countries that have investigated and implemented alien plant biological control on a large scale, and is regarded as a leader in this field. South Africa was also prominent in the conceptualisation and execution of the international SCOPE project on the ecology of biological invasions in the 1980s, during which South African scientists established themselves as valuable contributors to the field. The development of invasion science benefitted from a deliberate strategy to promote multi-organisational, interdisciplinary research in the 1980s. Since 1995, the Working for Water programme has provided funding for research and a host of practical questions that required research solutions. Finally, the establishment of a national centre of excellence with a focus on biological invasions has made a considerable contribution to building human capacity in the field, resulting in advances in all aspects of invasion science—primarily in terms of biology and ecology, but also in history, sociology, economics and management. South Africa has punched well above its weight in developing the field of invasion science, possibly because of the remarkable biodiversity that provided a rich template on which to carry out research, and a small, well-connected research community that was encouraged to operate in a collaborative manner

A reconstruction of extratropical Indo-Pacific sea-level pressure patterns during the Medieval Climate Anomaly

Subtropical and extratropical proxy records of wind field, sea level pressure (SLP), temperature and hydrological anomalies from South Africa, Australia/New Zealand, Patagonian South America and Antarctica were used to reconstruct the Indo-Pacific extratropical southern hemisphere sea-level pressure anomaly (SLPa) fields for the Medieval Climate Anomaly (MCA ~700–1350 CE) and transition to the Little Ice Age (LIA 1350–1450 CE). The multivariate array of proxy data were simultaneously evaluated against global climate model output in order to identify climate state analogues that are most consistent with the majority of proxy data. The mean SLP and SLP anomaly patterns derived from these analogues illustrate the evolution of low frequency changes in the extratropics. The Indo-Pacific extratropical mean climate state was dominated by a strong tropical interaction with Antarctica emanating from: (1) the eastern Indian and south-west Pacific regions prior to 1100 CE, then, (2) the eastern Pacific evolving to the central Pacific La Niña-like pattern interacting with a +ve SAM to 1300 CE. A relatively abrupt shift to –ve SAM and the central Pacific El Niño-like pattern occurred at ~1300. A poleward (equatorward) shift in the subtropical ridge occurred during the MCA (MCA–LIA transition). The Hadley Cell expansion in the Australian and Southwest Pacific, region together with the poleward shift of the zonal westerlies is contemporaneous with previously reported Hadley Cell expansion in the North Pacific and Atlantic regions, and suggests that bipolar climate symmetry was a feature of the MCA.Ian D. Goodwin, Stuart Browning, Andrew M. Lorrey, Paul A. Mayewski, Steven J. Phipps, Nancy A. N. Bertler, Ross P. Edwards, Tim J. Cohen, Tas van Ommen, Mark Curran, Cameron Barr, J. Curt Stage