The confounding economics of natural disaster shocks

Earthquakes, hurricanes, floods and other such disasters all cause damage in relatively restricted areas so unless the disaster makes a direct hit on an industry that is particularly critical to a country’s economy, production in the rest of the country can often buffer the effect

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Mohorovicic discontinuity in ocean basins: Some observations from seismic data

Since the late 1970s studies of the oceanic crust using airgun sources and towed hydrophone arrays have been conducted in a wide range of ocean basin settings including mid-ocean ridges and old oceanic crust. The very earliest studies were performed at the fast-spreading East Pacific Rise (EPR) and revealed a very distinct almost continuous vertical incidence reflection event at a depth corresponding to the crust–mantle transition as inferred from seismic refraction studies. This suggested that the transition was quite sharp in comparison to the source wavelength. That Moho was observed very close to or even exactly beneath the ridge crest implied that it was formed at essentially zero age. Since then, many experiments using progressively improving airgun arrays and streamer systems have expanded these observations. Here we review the literature presenting studies of “normal” oceanic crust produced at mid-ocean ridges with the objective of assessing the age of formation of Moho and the nature of variability of Moho signature in multi-channel seismic data. Moho is observed as a consistent feature for all spreading rates but appears quite variable, being very distinct in some areas, complex in form in others and absent in many regions (as much as 40%). Although fast-spread crust is associated with the strongest, simplest and most laterally continuous Moho images we see significant variability at almost all spreading rates and ages. Where Moho is absent from vertical incidence data this cannot be fully explained by the effect of scattering or attenuation in the crustal section above. Moho can be observed at zero age in only a small number of areas at or near Overlapping Spreading Centers on the EPR. After three decades of marine seismic studies many fundamental questions remain concerning the nature of the Moho that will require targeted experiments to solve

Righting the Balance: Gender Diversity in the Geosciences

The blatant barriers are down. Women are now routinely chief scientists on major cruises, lead field parties to all continents, and have risen to leadership positions in professional organizations, academic departments, and funding agencies. Nonetheless, barriers remain. Women continue to be under-represented in the Earth, ocean, and atmospheric sciences

An Experiment in Institutional Transformation: The NSF ADVANCE Program for Women at the Earth Institute at Columbia University

In response to demands for systemic change across academia, NSF developed the ADVANCE Institutional Transformation Awards in 2001. The objective of these awards is to increase the representation and advancement of women in academia. Based on the brief experience of the ADVANCE Program at Columbia and the collective experiences of ADVANCE Programs at other universities, f ve universal strategies for institutional change seem to be emerging: (1) generate awareness of the problem, (2) develop a widespread understanding of the underlying behaviors, (3) create and codify strategies to recruit and retain more women into academia, (4) provide the tools that will enable women to succeed, and (5) institutionalize accountability

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

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

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