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

The magnon dynamics and spin exchange parameters of FePS3

The spin waves in a powdered sample of a quasi-two-dimensional antiferromagnet, FePS(3), have been measured using neutron inelastic scattering. The data could be modelled and the exchange interactions determined using a two-dimensional Heisenberg Hamiltonian with single ion anisotropy. A suitable fit to the data could only be achieved by including magnetic interactions up to the third nearest neighbour, which is consistent with the findings for other members of the MPS(3) family (M = transition metal). The best fit parameters at 6 K were J(1) = 1.49 meV, J(2) = 0.04 meV, J(3) = -0.6 meV, with an anisotropy of Delta = 3.7 meV. Measurements as a function of temperature give a coarse measure of the behaviour of the anisotropy and the nature of the phase transition. © 2012, IOP Publishing LTD

The Eating Attitudes Test-26 Revisited using Exploratory Structural Equation Modeling

Most previous studies have failed to replicate the original factor structure of the 26-item version of the Eating Attitudes Test (EAT-26) among community samples of adolescents. The main objective of the present series of four studies (n = 2178) was to revisit the factor structure of this instrument among mixed gender community samples of adolescents using both exploratory structural equation modeling (ESEM) and confirmatory factor analysis (CFA). First, results from the ESEM analyses provided satisfactory goodness-of-fit statistics and reliability coefficients for a six-factor model of the EAT with 18 items (EAT-18) closely corresponding to the original seven-factor structure proposed for the 40-item version of the EAT. Second, these analyses were satisfactorily replicated among a new sample of community adolescents using CFA. The results confirmed the factor loading and intercept invariance of this model across gender and age groups (i.e.; early and late adolescence), as well as the complete invariance of the EAT-18 measurement model between ethnicities (i.e.; European versus African origins) and across weight categories (i.e.; underweight, normal weight and overweight). Finally, the last study provided support for convergent validity of the EAT-18 with the Eating Disorder Inventory and with instruments measuring global self-esteem, physical appearance, social physique anxiety and fear of negative appearance evaluation