The Latvian continuative construction runāt vienā runāšanā ‘talk in one talking’ = ‘keep talking’

Latvian may express continuative aspect by means of a complex construction which consists of a verb and a locative phrase headed by an action noun from the same verb. The construction is productive and attested with a variety of durative verbs. Salient exemplars are some verbs of talking and crying. In a clause the construction most often is treated in the same way as simple verb forms. Formally and functionally the construction is related to three other cognate constructions in Latvian as well as to iteration of the type talk and talk. However, in these other constructions continuative meaning arises only as an implicature or contains more specific nuances. It is proposed that cognate constructions may form a link between morphological reduplication and syntactic iteration

The passive family in Baltic

Predicative constructions with passive participles in Latvian and Lithuanian exhibit great variation in form, meaning and function, ranging from pure passive to various temporal, aspectual and modal meanings. This paper uses a set of formal and functional parameters to distinguish and profile several types and subtypes of such constructions. These types are mutually related by family resemblance and constitute a ‘Passive Family’. They include dynamic and stative passives, three types of resultatives, several types of subjectless (impersonal) passives, modal constructions expressing possibility or necessity, and evidential constructions. Based on a thorough study of corpus data, the paper not only adds new insights about constructions that were already known, but also presents construction types that have not been discussed in the literature on the Baltic passive before: the Lithuanian cumulative-retrospective construction and the Latvian cumulative-experiential subtype

Impersonal constructions with personal reference. Referents of deleted actors in Baltic and Estonian

This paper explores referential features of deleted actors in impersonal passive and impersonal constructions in three languages: Latvian, Lithuanian and Estonian. Though cross-linguistically passive or impersonal verb forms of intransitive verbs are generally associated with indefinite human agency, our study shows that this correlation is not absolute: in the investigated languages passives and impersonals of intransitives, apart from generic and indefinite actors, may also imply contextually given, definite actors, and for some constructions, e.g. Estonian impersonals with the auxiliary saama ‘get’, this is actually their main use. Data for our study comes from large comparable corpora of web resources. In a small quantitative study we determine the factors that condition a personal use of an impersonal verb form in the three languages. The most important factors are verbal lexeme (certain lexemes show a greater preference for certain types of covert actors), as well as construction type: of two formally distinct impersonal (passive) constructions, one is preferred in non-impersonal functions where the covert actor is a contextually given person

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