Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

<p>Abstract</p> <p>Background</p> <p>It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.</p> <p>Methods</p> <p>Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.</p> <p>Results</p> <p>Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.</p> <p>Conclusions</p> <p>We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.</p

Flavor Symmetric Sectors and Collider Physics

We discuss the phenomenology of effective field theories with new scalar or vector representations of the Standard Model quark flavor symmetry group, allowing for large flavor breaking involving the third generation. Such field content can have a relatively low mass scale \lesssim TeV and O(1) couplings to quarks, while being naturally consistent with both flavor violating and flavor diagonal constraints. These theories therefore have the potential for early discovery at LHC, and provide a flavor safe "tool box" for addressing anomalies at colliders and low energy experiments. We catalogue the possible flavor symmetric representations, and consider applications to the anomalous Tevatron t-tbar forward backward asymmetry and B_s mixing measurements, individually or concurrently. Collider signatures and constraints on flavor symmetric models are also studied more generally. In our examination of the t-tbar forward backward asymmetry we determine model independent acceptance corrections appropriate for comparing against CDF data that can be applied to any model seeking to explain the t-tbar forward backward asymmetry.Comment: 71 pages, 14 Figures, 12 Table

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Modality dominance in the perception of incongruent bimodal emotion expressions

Zupan, BA ORCiD: 0000-0002-4603-333XWe report a preliminary investigation of how perception of congruent and incongruent visual and auditory cues of emotion changes from early childhood to adulthood. Research has shown that for speech perception, children prefer auditory cues whereas adults prefer visual cues. Forty listeners participated, ten in each of the following age groups: preschool, school-aged, early adolescents, and adults. Participants were exposed to a total of 184 semantically neutral sentences (60 congruent visual- auditory) portrayed by one male and female speaker with happy, sad, angry, or fearful emotional expressions. As expected, increased accuracy in identifying the emotion portrayed was seen for congruent stimuli in comparison to incongruent stimuli. Although a clear auditory dominance by preschool children was not indicated, they produced significantly fewer visually- based responses for incongruent visual-auditory signals compared to older children and adults. Explanation for this may include a difference in the salience of visual versus auditory emotion cues for this age group, the limited number of emotion categories included in the current study, and small participant groups