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

Production of Feshbach molecules induced by spin-orbit coupling in Fermi gases

The search for topological superconductors is a challenging task1,2. One of the most promising directions is to use spinorbit coupling through which an s-wave superconductor can induce unconventional p-wave pairing in a spin-polarized metal3,4. Recently, synthetic spin-orbit couplings have been realized in cold-atom systems5-16 where instead of a proximity effect, s-wave pairing originates from a resonant coupling between s-wave molecules and itinerant atoms17. Here we demonstrate a dynamic process in which spin-orbit coupling coherently produces s-wave Feshbach molecules from a fully polarized Fermi gas, and induces a coherent oscillation between these two. This demonstrates experimentally that spin-orbit coupling does coherently couple singlet and triplet states, and implies that the bound pairs of this system have a triplet p-wave component, which can become a topological superfluid by further cooling to condensation and confinement to one dimension.link_to_subscribed_fulltex

Rapid growth of charged particle multiplicity in high energy e+e- annihilations

Hadron production by e+e- annihilation has been studied for c.m. energies W between 13 and 31.6 GeV. As a function of 1n W the charged particle multiplicity grows faster at high energy than at lower energies. This is correlated with a rise in the plateau of the rapidity distribution. The cross section sdσ/dx is found to scale within ±30% for x > 0.2 and 5 ≤ W ≤ 31.6 GeV. © 1980