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

Production of high purity uranium at a South African gold mine

ArticleThe chemistry of the Bufflex solvent-extraction process is described. Uranium is extracted by a tertiary amine solvent, from which the impurities are removed by means of dilute ammonia, and the uranium is stripped by an ammonium sulphate strip. In the pilot plant, these processes are carried out in mixer-settlers. Details of pumps, flow controllers, and materials of construction are given. The operation of the extraction, scrub, strip, precipitation and thickening, and regeneration sections is described. Comparative tests on the elution of ion-exchange resin with 10% sulphuric acid, and with nitrate, are described. The results of resin analyses and plant tests are given. A breakdown of the costs of reagents in the Bufflex process, compared with the conventional process, is given. It is concluded that a solvent-extraction process treating the sulphuric acid eluate from ion-exchange columns is technically feasible. As regards the resin itself, elution with 10% sulphuric acid is satisfactory. There is more polythionate build-up than with nitrate elution, and the capacity of the resin is slightly lower, but the difference is small. The operating cost of the Bufflex process is cheaper by at least 5 cents/lb U3O8 produced. The product satisfies the most stringent specification for nuclear-grade uranium, except as regards cobalt, molybdenum, silicon, and hafniu

Regional growth in Mexico under trade liberalization: How important are agglomeration and FDI?

The opening of the Mexican economy in the late 1980s has generated increasing levels of inward foreign direct investment (FDI) as well as substantial changes in the location pattern of economic activity within Mexico. Although these developments have coincided with marked changes in Mexico's regional growth regime, previous research has focused mainly on identifying growth effects from regional endowments of physical and human capital. In this paper, we extend on this research by conducting empirical analysis that centers explicitly on identifying the regional growth effects from agglomeration and FDI. The main findings of our analysis are threefold. First, we find that both agglomeration and FDI have acted as important drivers of regional growth in the last two decades. Second, both phenomena can be linked to the materialization of both positive and negative growth effects. The variety of growth effects that we identify is in line with the locational readjustments of economic activity that have taken place. Third, our estimations also identify clear spatial dimensions to the growth effects from agglomeration and FDI; furthermore, these spatial growth effects represent an important component of the overall spatiality of the regional growth process in Mexico. © 2010 The Author(s)