Risk of postoperative pulmonary complications in adult surgical patients with metabolic syndrome: a systematic review and meta-analysis protocol

Background: Metabolic syndrome (MetS) is defined as an accumulation of risk factors that include chronic hypertension, dyslipidaemia, insulin resistance and obesity and leads to an increased risk for diabetes, cardiovascular disease and stroke. MetS is widespread and estimated to affect up to a quarter of the global population. Patients with MetS who undergo surgery are associated with an increased risk of postoperative complications when compared with patients with a non-MetS profile. An emerging body of literature points to MetS being associated with a greater risk of postoperative pulmonary complications (PPC) in the surgical patient. PPC are associated with increased postoperative morbidity and mortality, Intensive care unit (ICU) admission, length of stay (ICU and hospital), health care costs, resource usage, unplanned re-intubation and prolonged ventilatory time. Methods/design: We will search for relevant studies in the following electronic bibliographic databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus as well as scan the reference lists of included studies for potential additional literature. Two authors will independently screen titles and abstracts to identify potentially relevant studies for inclusion based on predefined inclusion and exclusion criteria. The Cochrane Collaboration Review Manager (Review Manager 5) statistical software will be used to conduct this systematic review and meta-analysis and generate forest plots to demonstrate comparison of findings across studies included for meta analysis. Subgroup and sensitivity analysis will be performed to assess the heterogeneity of included studies. A descriptive synthesis of the statistical data will be provided to summarise the results and findings of the systematic review and meta-analysis. Discussion: This review will be the first to report and summarise the risk for and incidence of PPC in adult patients with MetS undergoing surgery across a range of surgical specialities. The results have the potential to inform the development of evidenced-based interventions to improve the management of PPC in the surgical patient with MetS. Findings from this systematic review and meta-analysis will inform a subsequent Delphi study on priorities and responses to PPC in patients with MetS. We will also disseminate our results through publication in scientific peerreviewed journals, conference presentations and promotion throughout our network of surgical safety champions in clinical settings

Predictors of health care use in Australian cancer patients

Objective: The purpose of this study is to measure health care utilization in Australian cancer patients based on their demographic, geographic and socioeconomic backgrounds. Method: A total of 13,609 participants (aged 15 and over) from 7,230 households were interviewed as part of Wave 13 of the national Household, Income and Labour Dynamics in Australia (HILDA) survey. Five hundred and seventeen participants indicated a current cancer diagnosis with 90% of those receiving active treatment at the time of interview. Independent sample t-tests, Pearson Chi-sq tests, Kruskal‒Wallis H test, binary logistic regression and a zero-inflated Poisson regression were used to examine inequality in health care use. Results: Demographic and sociocultural factors such as advancing age, gender, low income, low education status, rurality, no private health insurance, increased psychological distress and less access to specialist care are associated with lower health care utilization among cancer patients. However, models of care such as general practitioner-led cancer care is preferable in younger individuals with cancer, while accessing specialist care is associated with lower rates of hospitalization and higher levels of psychological distress increases hospital length of stay. Conclusions: The findings of lower health care utilization by those cancer patients with characteristics of disadvantage have implications for policy development and intervention design. Broadly, policies targeting structural social inequities are likely to increase health care utilization among the most affected/disadvantaged populations. Further investigation is needed to identify potential links between health care utilization and cancer outcomes as a step toward targeted interventions for improving outcomes in the adversely affected groups

Method for Aqueous Gold Thiosulfate Extraction Using Copper-Cyanide Pretreated Carbon Asdortion

A gold thiosulfate leaching process uses carbon to remove gold from the leach liquor. The activated carbon is pretreated with copper cyanide. A copper (on the carbon) to gold (in solution) ration of at least 1.5 optimizes gold recovery from solution. To recover the gold from the carbon, conventional elution technology works but is dependent on the copper to gold ratio on the carbon

Effects of economic growth, foreign direct investment and internet use on child health outcomes : empirical evidence from South Africa

CITATION: Salahuddin, M. et al. 2020. Effects of economic growth, foreign direct investment and internet use on child health outcomes : empirical evidence from South Africa. , Development Studies Research, 7:1:1-17, doi:10.1080/21665095.2020.1717362.The original publication is available at https://www.tandfonline.comThis study examines the effects of economic growth and foreign direct investment (FDI) on child health outcomes measured by Infant Mortality Rate (IMR) and Child Mortality Rate Under 5 (CMRU5) with several control variables such as corruption, inequality and HIV among others. It analyzes South Africa's annual time series data for the period 1985–2016. As variables were found with mixed order of integration, Autoregressive Distributed Lag (ARDL) model is applied to determine cointegration and estimate short-run and long-run coefficients. Results indicate that economic growth and FDI have negative significant effects on both indicators of child health outcomes in both the short run and the long run. This implies that both economic growth and FDI contribute towards reducing IMR and CMRU5 in South Africa and thus help improve child health outcomes. Toda and Yamamoto (TY) causality test confirms causal association between these variables. Policy implications are discussed.Publisher's versio

Effect of a thermal care bundle on the prevention, detection and treatment of perioperative inadvertent hypothermia

Aims and Objectives: To improve the prevention, detection, and treatment of perioperative inadvertent hypothermia (PIH) in adult surgical patients by implementing a Thermal Care Bundle. Background: Keeping patients normothermic perioperatively prevents adverse surgical outcomes. Hypothermia leads to serious complications including increased risk of surgical bleeding, surgical site infections, and morbid cardiac events. The Thermal Care Bundle consists of three elements: 1) assess risk; 2) record temperature; and (3) actively warm. Design: A pre-post implementation study was conducted to determine the impact of the Thermal Care Bundle on the prevention, detection and treatment of PIH. Methods: The Thermal Care Bundle was implemented using an adapted version of the Institute of Healthcare Improvement's Breakthrough Series Collaborative Model. Data were collected from auditing medical records. Results: Data from 729 patients (pre-implementation: n=351; post-implementation: n=378) at four sites were collected between December 2014 to January 2016. Improvements were recorded in the percentage of patients with a risk assessment; at least one documented temperature recording per perioperative stage; and appropriate active warming. Despite this, the overall incidence of PIH increased post-implementation. Conclusion: The Thermal Care Bundle facilitated improved management of PIH through increased risk assessment, temperature recording, and active warming but did not impact on PIH incidence. Increased temperature recording may have more accurately revealed the true extent of PIH in this population

Hospital costs of post-operative delirium: A systematic review

Aims: In this systematic review, the primary aim is to investigate the hospital cost burden attributed to post-operative delirium (POD). A secondary aim is to examine how patient length of stay (LOS) in hospital varies across the selected studies. Background: POD is a common occurrence after major surgery and leads to serious medical complications. It is associated with increased morbidity and double the risk of mortality from surgery compared to non-delirious patients. POD increases patient LOS in hospital and increases the economic burden on patients and the health system. Design: A systematic review was conducted. Method: Published articles in English over the period 2010 to 2020 were searched using the PubMed and MEDLINE databases. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. The study quality and risks of bias of included studies were assessed using the Newcastle–Ottawa Quality Assessment Scale (NOS). Results: A total of 2539 published records were initially screened and ultimately ten studies were found to be relevant to the review criteria. Six studies were from the United States of America (USA) and the others from South Korea, Australia, and Canada. The additional costs for patients with POD ranged from a minimum of US$1551 to a maximum of US$23 698 compared to non-delirious patients. Costs were higher in the USA than other countries. Studies reported most surgical patients experiencing POD were aged 70 years or older which dramatically increases the risk of its occurrence and increases LOS and hospital related costs. The difference in LOS between POD and non-delirious patients ranged from 0.8 to 7.3 days and this increased significantly if POD patients were in intensive care. Conclusions: Increased LOS and increased hospital costs are strongly associated with POD after major surgery

Potential for positive biodiversity outcomes under diet-driven land use change in Great Britain

Background: A shift toward human diets that include more fruit and vegetables, and less meat is a potential pathway to improve public health and reduce food system-related greenhouse gas emissions. Associated changes in land use could include conversion of grazing land into horticulture, which makes more efficient use of land per unit of dietary energy and frees-up land for other uses. Methods: Here we use Great Britain as a case study to estimate potential impacts on biodiversity from converting grazing land to a mixture of horticulture and natural land covers by fitting species distribution models for over 800 species, including pollinating insects and species of conservation priority. Results: Across several land use scenarios that consider the current ratio of domestic fruit and vegetable production to imports, our statistical models suggest a potential for gains to biodiversity, including a tendency for more species to gain habitable area than to lose habitable area. Moreover, the models suggest that climate change impacts on biodiversity could be mitigated to a degree by land use changes associated with dietary shifts. Conclusions: Our analysis demonstrates that options exist for changing agricultural land uses in a way that can generate win-win-win outcomes for biodiversity, adaptation to climate change and public healt

Heterogeneous Trimetallic Nanoparticles as Catalysts

The development and application of trimetallic nanoparticles continues to accelerate rapidly as a result of advances in materials design, synthetic control, and reaction characterization. Following the technological successes of multicomponent materials in automotive exhausts and photovoltaics, synergistic effects are now accessible through the careful preparation of multielement particles, presenting exciting opportunities in the field of catalysis. In this review, we explore the methods currently used in the design, synthesis, analysis, and application of trimetallic nanoparticles across both the experimental and computational realms and provide a critical perspective on the emergent field of trimetallic nanocatalysts. Trimetallic nanoparticles are typically supported on high-surface-area metal oxides for catalytic applications, synthesized via preparative conditions that are comparable to those applied for mono- and bimetallic nanoparticles. However, controlled elemental segregation and subsequent characterization remain challenging because of the heterogeneous nature of the systems. The multielement composition exhibits beneficial synergy for important oxidation, dehydrogenation, and hydrogenation reactions; in some cases, this is realized through higher selectivity, while activity improvements are also observed. However, challenges related to identifying and harnessing influential characteristics for maximum productivity remain. Computation provides support for the experimental endeavors, for example in electrocatalysis, and a clear need is identified for the marriage of simulation, with respect to both combinatorial element screening and optimal reaction design, to experiment in order to maximize productivity from this nascent field. Clear challenges remain with respect to identifying, making, and applying trimetallic catalysts efficiently, but the foundations are now visible, and the outlook is strong for this exciting chemical field