Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Thermal Death Kinetics Of B. Stearothermophilus Spores In Sugarcane Must

Thermal death kinetic parameters for Bacillus stearothermophilusspores were evaluated in sugarcane must (21.5°Brix, pH = 6.14) at temperatures ranging from 98 to 130C, using the thermal-death-time tube method and survivors count. Resulting survival curves showed strong nonlinearity and different shapes according to heating temperature. The 98 and 110C curves showed an initial shoulder or thermal lag and were adjusted to the logistic model. At the temperature range of 120-125C, the two-term exponential model for population with heterogeneous heat resistance was fitted, and at 130C, the classic linear model was suitable. It was shown that rate constants are influenced by temperature according to two irreconcilable methods: the Arrhenius and the Bigelow methods. Activation energy (Ea) obtained was 249.52 kJ/mol while thermal resistance parameter (z-value) calculated from Ea and the Bigelow method were 11.48 and 9.19C, respectively. Thermal death kinetic constant, k values, varied from 0.019 to 13.63/min. © 2007, Blackwell Publishing.305625639Abraham, G., Debray, E., Candau, Y., Piar, G., Mathematical model of thermal destruction of Bacillus stearothermophilus spores (1990) Appl. Environ. Microbiol., 56 (10), pp. 3073-3080Alcarde, V.E., Yokoya, F., Efeito da população de bactérias na floculação de leveduras isoladas de processos industriais de fermentação alcoólica (2003) STAB, 21 (4), pp. 40-42Alderton, G., Snell, N., Chemical states of bacterial spores: Heat resistance and its kinetics at intermediate water activity (1970) Appl. Microbiol., 19 (4), pp. 565-572Busta, F.F., Thermal inactivation characteristics of bacterial spores at ultrahigh temperatures (1967) Appl. Microbiol., 15 (3), pp. 640-645Davies, F.L., Underwood, H.M., Perkin, A.G., Burton, H., Thermal death kinetics of Bacillus stearothermophilus spores at ultra high temperatures (1977) J. Food Technol., 12, pp. 115-129Gallo, C.R., Canhos, V.P., Contaminantes bacterianos na fermentação alcoólica-revisão (1991) STAB, 9 (4-5), pp. 35-40Geeraerd, A.H., Herremans, C.H., Van Impe, J.F., Structural model requirements to describe microbial inactivation during a mild heat treatment (2000) Int. J. Food Microbiol., 59, pp. 185-209Gouthier, H.A., Massaguer, P.R., Determinação da resistência térmica de microrganismos indicadores da esterilização em caldo de cana (1987) Brazilian Microbiology Congress, pp. 46-47. , In. XIV, Viçosa-MG. Abstract. D12, pp., Imprensa Universitária, Viçosa, BrazilHeldman, D.R., Newsome, R.L., Kinetic models for microbial survival during processing (2003) Food Technol., 57 (8), pp. 40-46Iciek, J., Papiewska, A., Molska, M., Inactivation of Bacillus stearothermophilus spores during thermal processing (2006) J. Food Eng., 77, pp. 406-410Kessler, H.G., (1981) Food Engineering and Dairy Technology., , Verlag A. Kessler, Freising, GermanyKlaushofer, H., Clarke, M.A., Rein, P.W., Mauch, W., Microbiology (1998) Sugar Technology - Beet and Cane Sugar Manufacture, pp. 993-1008. , In. P.W. van der Poel, H. Schiweck. T. Schwartz, eds.) pp., Verlag Dr. Albert Bartens KG, Berlin, GermanyLima, T.C.S., Grisi, B.M., Bonato, M.C.M., Bacteria isolated from a sugarcane agroecosystem: Their potential produtction of polyhydroxyalcanoates and resistance to antibiotics (1999) Rev. Microbiol., 30, pp. 214-224Nolasco Junior, J., (2005), Msc Thesis, pp. 38-98, Universidade Estadual de Campinas - UNICAMP-Faculdade de Engenharia de Alimentos, Campinas, São Paulo-BRAZILNolasco Junior, J., De Massaguer, P.R., Thermal degradation kinetics of sucrose, glucose and fructose in sugarcane must for bioethanol production (2006) J. Food Process Eng., 29, pp. 462-477Oliva-Neto, P., Yokoya, F., Susceptibility of Saccharomyces cerevisiae and lactic acid bactéria from the alcohol industry to several antimicrobial compounds (2001) Braz. J. Microbiol., 32, pp. 10-14Oliveira-Freguglia, R.M., Horii, J., Viabilidade celular de Saccharomyces cerevisiae em cultura mista com Lactobacillus fermentum (1998) Sci. Agric. (Piracicaba, Brazil), 55 (3), pp. 1-12Peleg, M., Modeling microbial populations with the original and modified versions of the continuous and discrete logistic equations (1997) Crit. Rev. Food Sci. Nutr., 37 (5), pp. 471-490Pflug, I.J., (1990) Microbiology and Engineering of Sterilization Processes. Environmental Sterilization Laboratory, 7th, , Ed., Environmental Sterilization Laboratory, Minneapolis, MNPruitt, K.M., Kamau, D.N., Mathematical models of bacterial growth, inhibition and death under combined stress conditions (1993) J. Indust. Microbiol., 12, pp. 221-231Ramaswamy, H.S., Van De Voort, F.R., Ghazala, S., An analysis of TDT and Arrhenius methods for handling process and kinetic data (1989) J. Food Sci., 54 (5), pp. 1322-1326Rodriguez, A.C., Smerage, G.H., Teixeira, A.A., Lindsay, J.A., Busta, F.F., Population model of bacterial spores for validation of dynamic thermal processes (1992) J. Food Process Eng., 15, pp. 1-30Stroppa, C.T., Steckelberg, C., Serra, G.E., Andrietta, M.G.S., Andrietta, S.R., Consumo de açúcar por bactérias contaminantes da fermentação alcoólica associado ao uso de antibióticos (1998) STAB, 16, pp. 35-38Stroppa, C.T., Andrietta, M.G.S., Andrietta, S.R., Steckelberg, C., Serra, G.E., Use of penicillin and monesin to control bacterial contamination of Brazilian alcohol fermentations (2000) Int. Sugar J., 102 (1214), pp. 78-82Stumbo, C.R., (1973) Thermobacteriology in Food Processing, 2nd, , Ed., Academic Press, New York, NYThal, L.A., Zervos, J.M., Occurrence and epidemiology of resistance to virginiamycin and streptogramins (1999) J. Antimicrob. Chemother., 43, pp. 171-176Trombini, M.A.M., Rovanhol, A.A., Vitti, L.S.S., Beda, D.F., Porto, R.C.B., Sá, J.S., Causas da contaminação e suas conseqüências em usinas de açúcar e álcool (1988) STAB, 16 (6), pp. 1-18Van Boekel, M.A.J.S., On the use of Weibull model to describe thermal inactivation of microbial vegetative cells (2002) Int. J. Food Microbiol., 74, pp. 139-159Van Den Bogaard, A.E., Willems, R., London, N., Top, J., Stobberingh, E.E., Antibiotic resistance of faecal enterococci in poultry slaughterers (2002) J. Antimicrob. Chemother., 49, pp. 497-505. , http://jac.oupjournals.org/cgi/content/abstract/49/3/497, Disponível em. (accessed June 20, 2004)Wescott, G.G., Fairchild, T.M., Foegeding, P.M., Bacillus cereus and Bacillus stearothermophilus spore inactivation in batch and continuous flow systems (1995) J. Food Sci., 60 (3), pp. 446-450Yokoya, F., Oliva-Neto, P., Características da floculação de leveduras por Lactobacillus fermentum (1991) Rev. Microbiol., 22 (1), pp. 12-1

Treatments of non-wood plant fibres used as reinforcement in composite materials

This paper presents a summary of the knowledge on fibres and pulps of non wood tropical plants used as reinforcement in cementitious composites accumulated during the recent years by Guadeloupean and Brazilian teams participating in collaborative work. Vegetable fibres represent a good alternative as non-conventional materials for the construction of ecological and sustainable buildings. The use of such renewable resources contributes to the development of sustainable technologies. The main objective of the paper is to emphasize the use of agricultural wastes in the production of cement based composites. The botanical, chemical, physical, morphological and mechanical properties of fibres from various plants are described. The effects of different treatments on physical, chemical and mechanical properties of fibres are presented. The most effective treatments in influencing the mechanical and physical properties are pyrolysis and alkaline ones, according to the type of plant. The final choice will have to consider fibre availability, and treatment costs

Gas6 drives Zika virus-induced neurological complications in humans and congenital syndrome in immunocompetent mice

Zika virus (ZIKV) has the ability to cross placental and brain barriers, causing congenital malformations in neonates and neurological disorders in adults. However, the pathogenic mechanisms of ZIKV-induced neurological complications in adults and congenital malformations are still not fully understood. Gas6 is a soluble TAM receptor ligand able to promote flavivirus internalization and downregulation of immune responses. Here we demonstrate that there is a correlation between ZIKV neurological complications with higher Gas6 levels and the downregulation of genes associated with anti-viral response, as type I IFN due to Socs1 upregulation. Also, Gas6 gamma-carboxylation is essential for ZIKV invasion and replication in monocytes, the main source of this protein, which was inhibited by warfarin. Conversely, Gas6 facilitates ZIKV replication in adult immunocompetent mice and enabled susceptibility to transplacental infection. Our data indicate that ZIKV promotes the upregulation of its ligand Gas6, which contributes to viral infectivity and drives the development of severe adverse outcomes during ZIKV infection

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia: The IAEA INCAPS-COVID Study

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted

Kuluttajabarometri maakunnittain 2000, 2. neljännes

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