Opportunity and Equity: Enrollment and Outcomes of Black and Latino Males in Boston Public Schools

Boston Public School (BPS) leaders commissioned this study to examine patterns of enrollment, access, engagement, and performance of Black and Latino males from School Year 2009 to School Year 2012. This quantitative analysis constitutes Phase I of a larger study that will ultimately include qualitative case studies examining promising practices in BPS schools in which Black and Latino males perform well

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Slowing down of hydrogen clusters in thin foils

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Atmospheric ammonia (NH₃) over the Paris megacity: 9 years of total column observations from ground-based infrared remote sensing

International audienceIn this paper, we present the first multi-year time series of atmospheric NH3 ground-based measurements in the Paris region (Créteil, 48.79° N, 2.44° E, France) retrieved with the mid-resolution “Observations of the Atmosphere by Solar absorption Infrared Spectroscopy” (OASIS) ground-based Fourier Transform infrared solar observatory. Located in an urban region, OASIS has previously been used for monitoring air quality (tropospheric ozone and carbon monoxide), thanks to its specific column sensitivity across the whole troposphere including the planetary boundary layer. A total of 4920 measurements of atmospheric total columns of ammonia have been obtained from 2009 to 2017, with uncertainties ranging from 20 % to 35 %, and are compared with NH3 concentrations derived from the Infrared Atmospheric Sounding Interferometer (IASI). OASIS ground-based measurements show significant interannual, and seasonal variabilities of atmospheric ammonia. NH3 total columns over the Paris megacity (12 million people) vary seasonally by 2 orders of magnitude, from approximately 1015 molecules cm−2 in winter to 1017 molecules cm−2 for spring peaks, probably due to springtime spreading of fertilizers on surrounding croplands. Also, we observe a correlation of daily NH3-OASIS total columns with daily PM2.5 in situ measurements from the closest Airparif surface station in springtime

First multi-year ground-based measurements of NH3 total columns overthe Paris region (France), from the OASIS FTIR solar observatory

No more information in the pdfInternational audienceAmmonia (NH3) is a reactive air pollutant strongly affecting both environment and human health. Massive industrial production of ammonia and the development of crops enhancing biological nitrogen fixation disturb the natural cycle and contribute to eutrophication, and acidification of various environments (lakes, streams, coastal ecosystems, soils etc.) (Vitousek et al., 1997; Howarth et al., 2000; Galloway et al., 2003). Within the troposphere, NH3 can react with H2SO4 or HNO3 to produce fine particulate matter (PM2.5) of ammonium salts (Swartz et al., 1999 ; Lin and Cheng, 2007). Thus, measuring atmospheric ammonia is necessary to better constrain particulate matter formation and reactive nitrogen budgets in air quality models. In this study, we present the first multi-year time series of NH3 ground-based measurements in Paris region (2009-2016), which is a European megacity (12 Million people) surrounded by a large rural region. To obtain it, we use the mid-resolution OASIS (Observations of the Atmosphere by Solar absorption Infrared Spectroscopy) ground based FTIR solar observatory (Viatte et al., 2011 ; Chelin et al., 2015) to derive ammonia total columns over Paris suburbs (Créteil, 48.79 N, 2.44m E, France) using the PROFFIT inversion code (Hase et al., 2004). Previously used to analyse solar absorption spectra measured at high resolution for the NDACC (Network for the Detection of Atmospheric Composition Change) or TCCON (Total Carbon Column Observing Network) stations, the retrieval code PROFFIT has been adapted to deal with spectra recorded at medium spectral resolution with a Bruker Optics Vertex 80 FTIR spectrometer. The OASIS observatory is located at the Paris megacity urban region and has been already used to the study of air quality (tropospheric ozone and CO), given its sensitivity to surface pollutant concentrations. We analyse seasonal variabilities of NH3 and study the relationship with meteorological variables. We also compare NH3 total columns derived from OASIS and those from IASI satellite measurements (Whitburn et al., 2016).References:Chelin, P. et al., E2C2 I:Environmental Chemistry of Pollutants and Wastes, Hdb Env Chem 32: 21-52, 2015.Galloway, J. et al., BioScience, 53(4): 341-356, 2003.Hase, F. et al., J. Quant. Spectrosc. Rad. Transf., 87, 25–52, 2004.Howarth, R.W. et al., Issues in Ecology, 7, 1-15, 2000.Lin, Y.C. and Cheng, M.T., Atmos. Environ., 41, 1903-1910, 2007.Swartz, E et al., J. Phys. Chem. A., 103, 8824-8833, 1999.Viatte, C. et al., Atmospheric Measurement Techniques, 4 (10): 2323 2331, 2011.Vitousek, P.M. et al., Issues in Ecology, 1, 1-17, 1997.Whitburn S. et al., J. of Geophys. Res. Atmospheres, 121 (11), 6581-6599, 201