Analysis of a long-duration AR throughout five solar rotations: Magnetic properties and ejective events

Coronal mass ejections (CMEs), which are among the most magnificent solar eruptions, are a major driver of space weather and can thus affect diverse human technologies. Different processes have been proposed to explain the initiation and release of CMEs from solar active regions (ARs), without reaching consensus on which is the predominant scenario, and thus rendering impossible to accurately predict when a CME is going to erupt from a given AR. To investigate AR magnetic properties that favor CMEs production, we employ multi-spacecraft data to analyze a long duration AR (NOAA 11089, 11100, 11106, 11112 and 11121) throughout its complete lifetime, spanning five Carrington rotations from July to November 2010. We use data from the Solar Dynamics Observatory to study the evolution of the AR magnetic properties during the five near-side passages, and a proxy to follow the magnetic flux changes when no magnetograms are available, i.e. during far-side transits. The ejectivity is studied by characterizing the angular widths, speeds and masses of 108 CMEs that we associated to the AR, when examining a 124-day period. Such an ejectivity tracking was possible thanks to the multi-viewpoint images provided by the Solar-Terrestrial Relations Observatory and Solar and Heliospheric Observatory in a quasi-quadrature configuration. We also inspected the X-ray flares registered by the GOES satellite and found 162 to be associated to the AR under study. Given the substantial number of ejections studied, we use a statistical approach instead of a single-event analysis. We found three well defined periods of very high CMEs activity and two periods with no mass ejections that are preceded or accompanied by characteristic changes in the AR magnetic flux, free magnetic energy and/or presence of electric currents. Our large sample of CMEs and long term study of a single AR, provide further evidence relating AR magnetic activity to CME and Flare production.Fil: Iglesias, Francisco Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza; Argentina. Universidad Tecnológica Nacional. Facultad Regional de Mendoza; ArgentinaFil: Cremades Fernandez, Maria Hebe. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza; Argentina. Universidad Tecnológica Nacional. Facultad Regional de Mendoza; ArgentinaFil: Merenda, Luciano A.. Universidad Tecnológica Nacional. Facultad Regional de Mendoza; ArgentinaFil: Mandrini, Cristina Hemilse. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Lopez Fuentes, Marcelo Claudio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan. Instituto de Ciencias Astronómicas, de la Tierra y del Espacio. Universidad Nacional de San Juan. Instituto de Ciencias Astronómicas, de la Tierra y del Espacio; ArgentinaFil: Lopez Fuentes, Marcelo Claudio. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Ugarte Urra, Ignacio. Spece Sciences División. Naval Research Laboratory; Estados Unido

Two successive partial mini-filament confined ejections

Active region (AR) NOAA 11476 produced a series of confined plasma ejections, mostly accompanied by flares of X-ray class M, from 08 to 10 May 2012. The structure and evolution of the confined ejections resemble that of EUV surges; however, their origin is associated to the destabilization and eruption of a mini-filament, which lay along the photospheric inversion line (PIL) of a large rotating bipole. Our analysis indicate that the bipole rotation and flux cancellation along the PIL have a main role in destabilizing the structure and triggering the ejections. The observed bipole emerged within the main following AR polarity. Previous studies have analyzed and discussed in detail two events of this series in which the mini-filament erupted as a whole, one at 12:23 UT on 09 May and the other at 04:18 UT on 10 May. In this article we present the observations of the confined eruption and M4.1 flare on 09 May 2012 at 21:01 UT (SOL2012-05-09T21:01:00) and the previous activity in which the mini-filament was involved. For the analysis we use data in multiple wavelengths (UV, EUV, X-rays, and magnetograms) from space instruments. In this particular case, the mini-filament is seen to erupt in two different sections. The northern section erupted accompanied by a C1.6 flare and the southern section did it in association with the M4.1 flare. The global structure and direction of both confined ejections and the location of a far flare kernel, to where the plasma is seen to flow, suggest that both ejections and flares follow a similar underlying mechanism.Fil: Poisson, Mariano. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Bustos, C.. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; ArgentinaFil: Lopez Fuentes, Marcelo Claudio. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Mandrini, Cristina Hemilse. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Cristiani, Germán Diego. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; Argentin

The 3B/X3 solar flare of 27 February 1992

Analizamos la evolución de la región activa (AR) NOAA 7070 y la relacionamos con una fulguración 3B/X3, ocurrida el 27 de febrero de 1992. Las observaciones en rayos X blandos fueron obtenidas por el SXT (Soft X-ray Telescope) a bordo del satélite Yohkoh y las imágenes en Hα provienen del Observatorio de Udaipur (India). La ubicación de los núcleos y bandas de la fulguración y la forma de los arcos en rayos X se comparan con el modelo del campo magnético de la AR. Tanto las observaciones como el modelo muestran que los arcos coronales presentan alto “shear” antes de la fulguración y que la configuración se relaja luego de la liberación de la energía. Calculamos la energía magnética libre utilizando el teorema del virial, hallando un límite inferior de 2X1032 erg. Este valor concuerda con los valores típicos de energía liberada por estos fenómenos.Active region NOAA 7070 was related to a 3B/X3 solar flare that occurred on February 27, 1992. The soft X-ray flare observations were obtained by the SXT (Soft X-ray Telescope) on board the Yohkoh satellite, and those in Hα from the Udaipur Observatory. The location of the Hα kernels and ribbons, and the shape of soft X-ray loops are compared with the magnetic field model of the AR. Both, observations and model, suggest that the coronal loops are highly sheared before the flare and that the configuration relaxes after energy release. We compute the magnetic free energy at 2×1032 erg; this value is typical for the energy released by solar flares.Fil: Lopez Fuentes, Marcelo Claudio. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Mandrini, Cristina Hemilse. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Rovira, Marta Graciela. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Démoulin, Pascal. Centre National de la Recherche Scientifique. Observatoire de Paris; Franci

Scaling laws of quiet-Sun coronal loops

We study a series of relations between physical parameters in coronal loops of the quiet Sun reconstructed by combining tomographic techniques and modeling of the coronal magnetic field. We use differential emission measure tomography (DEMT) to determine the three-dimensional distribution of the electron density and temperature in the corona, and we model the magnetic field with a potential-field source-surface (PFSS) extrapolation of a synoptic magnetogram. By tracing the DEMT products along the extrapolated magnetic field lines, we obtain loop-averaged electron density and temperature. Also, loop-integrated energy-related quantities are computed for each closed magnetic field line. We apply the procedure to Carrington rotation 2082, during the activity minimum between Solar Cycles 23 and 24, using data from the Extreme Ultraviolet Imager on board the Solar Terrestrial Relations Observatory (STEREO) spacecraft. We find a scaling law between the loop-average density N and loop length L,Nm∼L-0.35, but we do not find a significant relation between loop-average temperature and loop length. We confirm though the previously found result that loop-average temperatures at the equatorial latitudes are lower than at higher latitudes. We associate this behavior with the presence at the equatorial latitudes of loops with decreasing temperatures along their length (“down” loops), which are in general colder than loops with increasing temperatures (“up” loops). We also discuss the role of “down” loops in the obtained scaling laws of heating flux versus loop length for different heliographic latitudes. We find that the obtained scalings for quiet-Sun loops do not generally agree with those found in the case of AR loops from previous observational and theoretical studies. We suggest that to better understand the relations found, it is necessary to forward model the reconstructed loops using hydrodynamic codes working under the physical conditions of the quiet-Sun corona.Fil: Mac Cormack, Cecilia. Universidad Nacional de Tres de Febrero; Argentina. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Lopez Fuentes, Marcelo Claudio. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Mandrini, Cristina Hemilse. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Lloveras, Diego Gustavo. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Poisson, Mariano. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; Argentina. Universidad Nacional de Tres de Febrero; ArgentinaFil: Vasquez, Alberto Marcos. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; Argentina. Universidad Nacional de Tres de Febrero; Argentin

Three-Dimensional Reconstruction and Thermal Modeling of Observed Loops

Due to their characteristic temperature and density, loop structures in active regions (ARs) can be seen bright in extreme ultraviolet (EUV) and soft X-ray images. The semiempirical determination of the three-dimensional (3D) distribution of basic physical parameters (electronic density and temperature, and magnetic field) is a key constraint for coronal heating models. In this work we develop a technique for the study of EUV bright loops based on differential emission measure (DEM) analysis and we first apply it to AR structures observed by the Atmospheric Imaging Assembly (AIA) on board the Solar Dynamics Observatory (SDO). The 3D structure and intensity of the magnetic field of the observed EUV loops are modeled using force-free field extrapolations based on magnetograms taken by the Helioseismic and Magnetic Imager (HMI) on board SDO. In this work we report the results obtained for several bright loops identified in different ARs. Our analysis indicates that the mean and width of the temperature distributions are nearly invariant along the loop lengths. For a particular loop we study its temporal evolution and find that these characteristics remain approximately constant for most of its life time. The appearance and disappearance of this loop occurs at time-scales much shorter than its life time of ≈ 2.5 hours. The results of this analysis are compared with numerical simulations using the zero-dimensional (0D) hydrodynamic model, Enthalpy-Based Thermal Evolution of Loops (EBTEL). We study two alternative heating scenarios: first, we apply a constant heating rate assuming loops in quasi-static equilibrium, and second, we heat the loops using impulsive events or nanoflares. We find that all the observed loops are overdense with respect to a quasi-static equilibrium solution and that the nanoflare heating better reproduces the observed densities and temperatures.Fil: Nuevo, Federico Alberto. Universidad de Buenos Aires. Ciclo Básico Común; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Mac Cormack, Cecilia. Universidad Nacional de Tres de Febrero. Departamento de Ciencia y Tecnologia.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Lopez Fuentes, Marcelo Claudio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Vasquez, Alberto Marcos. Universidad Nacional de Tres de Febrero. Departamento de Ciencia y Tecnologia.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Mandrini, Cristina Hemilse. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; Argentin

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

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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