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

Role of Severe Acute Respiratory Syndrome Coronavirus Viroporins E, 3a, and 8a in Replication and Pathogenesis

Viroporins are viral proteins with ion channel (IC) activity that play an important role in several processes, including virus replication and pathogenesis. While many coronaviruses (CoVs) encode two viroporins, severe acute respiratory syndrome CoV (SARS-CoV) encodes three: proteins 3a, E, and 8a. Additionally, proteins 3a and E have a PDZ-binding motif (PBM), which can potentially bind over 400 cellular proteins which contain a PDZ domain, making them potentially important for the control of cell function. In the present work, a comparative study of the functional motifs included within the SARS-CoV viroporins was performed, mostly focusing on the roles of the IC and PBM of E and 3a proteins. Our results showed that the full-length E and 3a proteins were required for maximal SARS-CoV replication and virulence, whereas viroporin 8a had only a minor impact on these activities. A virus missing both the E and 3a proteins was not viable, whereas the presence of either protein with a functional PBM restored virus viability. E protein IC activity and the presence of its PBM were necessary for virulence in mice. In contrast, the presence or absence of the homologous motifs in protein 3a did not influence virus pathogenicity. Therefore, dominance of the IC and PBM of protein E over those of protein 3a was demonstrated in the induction of pathogenesis in mice.Collectively, these results demonstrate key roles for the ion channel and PBM domains in optimal virus replication and pathogenesis and suggest that the viral viroporins and PBMs are suitable targets for antiviral therapy and for mutation in attenuated SARS-CoV vaccines

The history of rainfall data time-resolution in a wide variety of geographical areas

Collected rainfall records by gauges lead to key forcings in most hydrological studies. Depending on sensor type and recording systems, such data are characterized by different time-resolutions (or temporal aggregations), ta. We present an historical analysis of the time-evolution of ta based on a large database of rain gauge networks operative in many study areas. Globally, ta data were collected for 25,423 rain gauge stations across 32 geographic areas, with larger contributions from Australia, USA, Italy and Spain. For very old networks early recordings were manual with coarse time-resolution, typically daily or sometimes monthly. With a few exceptions, mechanical recordings on paper rolls began in the first half of the 20th century, typically with ta of 1 h or 30 min. Digital registrations started only during the last three decades of the 20th century. This short period limits investigations that require long time-series of sub-daily rainfall data, e.g, analyses of the effects of climate change on short-duration (sub-hourly) heavy rainfall. In addition, in the areas with rainfall data characterized for many years by coarse time-resolutions, annual maximum rainfall depths of short duration can be potentially underestimated and their use would produce errors in the results of successive applications. Currently, only 50% of the stations provide useful data at any time-resolution, that practically means ta = 1 min. However, a significant reduction of these issues can be obtained through the information content of the present database. Finally, we suggest an integration of the database by including additional rain gauge networks to enhance its usefulness particularly in a comparative analysis of the effects of climate change on extreme rainfalls of short duration available in different locations

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

STUDI KOMPARASI KONSEP PENDIDIKAN AKHLAK MENURUT KH AHMAD DAHLAN DAN ABDUL MUNIR MULKHAN

MUSTHOFA ANGGA PRASETYO. Studi Komparasi Konsep Pendidikan Akhlak Menurut KH Ahmad Dahlan dan Abdul Munir Mulkhan. Skripsi. Yogyakarta: Jurusan Pendidikan Agama Islam. Fakultas Imlu Tarbiyah dan Keguruan UIN Sunan Kalijaga, 2017. Latar belakang penelitian ini adalah tingkah laku remaja yang menyimpang akhlak sering menimbulkan kegelisahan dan permasalahan masyarakat. Penyimpangan akhlak tersebut biasanya diwujudkan dalam bentuk kenakalan atau kejahatan seperti yang belakangan ini sering terjadi yaitu seks bebas, tawuran remaja atau kampung, pergaulan bebas, penyalahgunaan narkotika, mabuk-mabukan, membolos sekolah, membully teman dan lain sebagainya. Hal tersebut dikarenakan lingkungan pergaulan yang buruk bagi remaja atau peserta didik. Selain itu juga dikarenakan rendahnya atau kurang maksimalnya pendidikan agama khususnya pendidikan akhlak dikalangan remaja atau peserta didik, sehingga nilai-nilai akhlak tidak terinternalisasi secara sempurna. Oleh karena itu, perlu adanya revitalisasi pelaksanaan pendidikan akhlak di sekolah. Pokok permasalahan dalam penelitian ini ialah bagaimana implikasi konsep pendidikan akhlak KH Ahmad Dahlan dan Abdul Munir Mulkhan daapat diterapkan dalam pembelajaran di sekolah. Penelitian ini bertujuan untuk mengetahui persamaan dan perbedaan konsep pendidikan akhlak menurut KH Ahmad Dahlan dan Abdul Munir Mulkhan serta bagaimana implikasinya terhadap pendidikan akhlak saat ini. Penelitian ini merupakan penelitian kepustakaan (library research) karena keseluruhan proses penelitian memanfaatkan berbagai macam pustaka yang relevan terhadap masalah yang diteliti. Adapun pendekatan yang digunakan dalam penelitian ini adalah pendekatan filosofis. Metode pengumpulan data yang digunakan yaitu metode dokumentasi dan wawancara. Studi dokumentasi dilakukan terhadap sumber primer dan skunder, berupa karya-karya tokoh tersebut dan juga tulisan terkait pemikiran tokoh yang relevan dengan penelitian. Penelitian ini menggunakan analisis deskriptif, yaitu analisis yang ditujukan untuk mendeskripsikaan atau menggambarkan pemikiran tokoh tersebut. Hasil penelitian menunjukkan bahwa pemikiran KH Ahmad Dahlan bersifat religious sedangkan pemikiran Abdul Munir Mulkhan bersifat rasionalis. Konsep pendidikan akhlak KH Ahmad Dahlan dan Abdul Munir Mulkhan mempunyai persamaan dan perbedaan. Persamaan tersebut meliputi 1) Pendidik 2) Metode Pendidikan Akhlak. Adapun perbedaan pemikiran keduanya terkait pendidikan akhlak meliputi 1) Pendidikan Akhlak 2) Peserta Didik 3) Materi Pendidikan Akhlak. KH Ahmad Dahlan yang membentuk perilaku keagamaan melalui ilmu dan amal, nilai-nilai akhlak diajarkan kepada peserta didik untuk kemudian dapat diamalkan dalam kehidupan sehaari-hari. Begitu juga Abdul Munir Mulkhan yang berpendapat bahwa pendidikan akhlak itu membentuk perilaku keagamaan peserta didik melalui metodologi keteladanan, pengenalan nilai, stimulai kognitif dan pengembangan empati (peran). Meskipun pendekatan yang dilakukan berbeda, akan tetapi tujuan pendidikan akhlak keduanya sama, yaitu untuk membentuk peserta didik yang berakhlakul karimah

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London

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

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London