Trace metals in the surface sediments of the South China Sea, Area I: Gulf of Thailand and east coast of Peninsular Malaysia

The trace metal distribution in the surface sediments of the Gulf of Thailand and the South China Sea were studied. Samples were obtained from two cruises of the MV SEAFDEC Total metal content were measured in the 63mm fraction of dried sediment. For the first cruise (Pre-Northeast monsoon) results, metal concentration ranges were between 0.41- 0.19mgg-1Cd, 10-36mgg-1Cu, 7.02-27.8mgg-1Pb, 15.3-352mgg-1Zn, 20.5-122mgg-1 Cr, 209-720mgg-1Mn, 0.79-5.96%Al and 0.71-2.82%Fe. Similar results were obtained for the second cruise (Post-Northeast monsoon) results, with metal concentrations in the range of 0.10-0.94 mgg-1Cd, 10.3-61.4 mgg-1Cu, 5.24-78.2 mgg-1Pb, 18.1-98 mgg-1Zn, 21.1-101 mgg-1Cr, 117-797 mgg-1Mn, 1.89-7.22 %Al and 0.70-2.38 %Fe. The concentrations of Al, Cr, Cu and Mn were significantly higher in the Gulf of Thailand in the pre-monsoon while concentrations of Fe, Cd and Zn were similar for both areas. For the postmonsoon Al, Cu and Mn concentrations were higher in Gulf sediments. Differences in metal concentrations were noted between the pre- and the post monsoon samples. Fe, Cr and Mn concentrations were generally higher in the pre-monsoon period for both areas but the distribution of Pb was higher in the post-monsoon while Zn and Cu distribution differed between the Gulf and the South China Sea areas. However normalisation of the metal data to aluminium content of the sediment showed generally uniform concentration of the metals studied over most of the area studied. Some enrichment by Cu in sediments from two sampling stations in the upper Gulf of Thailand is indicated by Cu:Al ratios exceeding normal crustal abundances of these metals. However low Cu:Al ratios in sediments from some areas of the South China Sea may indicate depletion of Cu in the sediments

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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

Trace Metals in the Surface Sediments of the South China Sea, Area I: Gulf of Thailand and East Coast of Peninsular Malaysia

The trace metal distribution in the surface sediments of the Gulf of Thailand and the South China Sea were studied. Samples were obtained from two cruises of the MV SEAFDEC Total metal content were measured in the 63mm fraction of dried sediment. For the first cruise (Pre-Northeast monsoon) results, metal concentration ranges were between 0.41- 0.19mgg-1Cd, 10-36mgg-1Cu, 7.02-27.8mgg-1Pb, 15.3-352mgg-1Zn, 20.5-122mgg-1 Cr, 209-720mgg-1Mn, 0.79-5.96%Al and 0.71-2.82%Fe. Similar results were obtained for the second cruise (Post-Northeast monsoon) results, with metal concentrations in the range of 0.10-0.94 mgg-1Cd, 10.3-61.4 mgg-1Cu, 5.24-78.2 mgg-1Pb, 18.1-98 mgg-1Zn, 21.1-101 mgg-1Cr, 117-797 mgg-1Mn, 1.89-7.22 %Al and 0.70-2.38 %Fe. The concentrations of Al, Cr, Cu and Mn were significantly higher in the Gulf of Thailand in the pre-monsoon while concentrations of Fe, Cd and Zn were similar for both areas. For the postmonsoon Al, Cu and Mn concentrations were higher in Gulf sediments. Differences in metal concentrations were noted between the pre- and the post monsoon samples. Fe, Cr and Mn concentrations were generally higher in the pre-monsoon period for both areas but the distribution of Pb was higher in the post-monsoon while Zn and Cu distribution differed between the Gulf and the South China Sea areas. However normalisation of the metal data to aluminium content of the sediment showed generally uniform concentration of the metals studied over most of the area studied. Some enrichment by Cu in sediments from two sampling stations in the upper Gulf of Thailand is indicated by Cu:Al ratios exceeding normal crustal abundances of these metals. However low Cu:Al ratios in sediments from some areas of the South China Sea may indicate depletion of Cu in the sediments

L-band Q-switched fiber laser with gallium/thulium-doped silica fiber saturable absorber

An L-band Q-switched fiber laser was demonstrated using gallium/thulium-doped silica fiber saturable absorber. At 10 cm in length, the saturable absorber generated Q-switched fiber laser at a pump power threshold of 39.6 mW and a central wavelength of 1601.93 nm. Beyond 53.3 mW, a spectrum with a central wavelength at 1602.00 nm was generated. On the other hand, the pulse repetition rate was obtained from 3.44 to 7.47 kHz whereas the pulse width reduces from 100.2 to 58.6 µs for pump power ranges from 39.6 to 53.3 mW. Within this range, the pulse energy is attained between 0.2600 and 0.2843 µJ, at a laser power slope efficiency of 6.94%. The constantly operated Q-switched fiber laser over 50 min observation time at 53.3 mW pump power ensures the feasibility of this pulse laser source as a practical device

The effective and sustainable application of a green amino acid-based corrosion Inhibitor for Cu metal

The human body is a remarkably aggressive medium and applied materials must be extremely resistant to corrosion and destruction, so copper, which is a biological material and is widely used in medicine, is being considered. Copper corrosion may be associated with inflammation in body because it releases ions that are toxic to humans. In aggressive solutions, biomolecules called amino acids act as corrosion inhibitors. In the present research, the purpose is to study the inhibitory action of l-alanine (L-Ala) and l-Leucine (L-Leu) amino acids on the corrosion of Cu. By density functional theory (DFT), inhibition behavior of l-Ala-and l-Leu-and their conformers against Cu corrosion have been investigated. According to values of back-donation of electrons (Eback-d), fraction of electron transferred (ΔN), electrophilicity (ω), electronegativity (χ), softness (σ), hardness (η), energy gap (Eg), ELUMO, and EHOMO computed reactivity factors between copper surface and inhibitors are studied. l-Leu's theoretical indicators confirm its tendency towards adsorption. l-Leu-activity against corrosion has been investigated and favorable results have been obtained

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit