Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Water Risk Indicator (WaRisk)

Water Risk Indicator (WaRisk) is a computerized system interface entails eight elements: (1) water withdrawal, (2) significance of water withdrawal, (3) water recycled and reused, (4) water risks, (5) facility level water accounting, (6) governance and strategy, (7) compliance, complaints and senses; and (8) targets and initiatives. This study explains the water risk profile for industries after considering the 8-elements. The aims of this paper comprise of: (1) illustrating the WaRisk interface design, explanation and theoretical justification, (2) proposing a suggested tool for water risk indicator specifically for regulators and industries and (3) providing optional ways of activities after identifying the disputes in water management. A sample of 30 companies are employed from public listed companies to originate the proposed interface for this system of water risk indicator. Hence, this paper provides suggestion of interface design for WaRisk system based on the eight indicators

Design and Development of Travel Assist, An App to Support Smart Tourism

Tourism is the third largest contributor to Malaysia’s GDP, worth MYR 86.1 billion in 2019. It is expected that the number of tourists to Malaysia will reach 30 billion in 2020, translated to MYR 100 billion receipts. The Malaysian Smart Tourism 4.0 Initiative strives to unlock the full potential of the tourism industry through enabling technologies of IR 4.0. This work reports the results of an innovation project to support smart tourism in Malaysia. It entails the design and development of Travel Assist, a mobile App for visitors to Malaysia. Travel Assist integrates three common web services: Google Translate, Google Maps, and XE Converter, into one App. It was developed using MIT App Inventor and Adobe Dreamweaver, and suitable for iOS and Android 7.0 (Nougat) devices and above. The App was tested by a group of users to confirm its functionality and feasibility, and the validation results are encouraging. The underlying technology is robust enough to support future innovation ideas and services under the IR 4.0 umbrella

Design and Development of Travel Assist, An App to Support Smart Tourism

Tourism is the third largest contributor to Malaysia’s GDP, worth MYR 86.1 billion in 2019. It is expected that the number of tourists to Malaysia will reach 30 billion in 2020, translated to MYR 100 billion receipts. The Malaysian Smart Tourism 4.0 Initiative strives to unlock the full potential of the tourism industry through enabling technologies of IR 4.0. This work reports the results of an innovation project to support smart tourism in Malaysia. It entails the design and development of Travel Assist, a mobile App for visitors to Malaysia. Travel Assist integrates three common web services: Google Translate, Google Maps, and XE Converter, into one App. It was developed using MIT App Inventor and Adobe Dreamweaver, and suitable for iOS and Android 7.0 (Nougat) devices and above. The App was tested by a group of users to confirm its functionality and feasibility, and the validation results are encouraging. The underlying technology is robust enough to support future innovation ideas and services under the IR 4.0 umbrella

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London