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

Anatomical and morphological variation in species and among populations of Opuntia in Southern Chihuahuan Desert [Variación anatómica y morfológica en especies y entre poblaciones de opuntia en la porciZapotitlánn sur del Desierto Chihuahuense]

Phenotypic variation in different populations of Opuntia cantabrigiensis, O. leucotricha, O. rastrera, O. robusta and O. streptacantha was evaluated by examining 28 anatomical and morphologic variables through discriminant analysis. These populations are separated from each other by distances ranging between 32 and 110 km. Altitude and annual average temperature showed no variation in the study area. Discriminant analysis separated populations of O. cantabrigiensis, which is the species having the lowest density (13 individuals ha-1), whilst some populations of other Opuntia species, whose densities were as high as 1,852 individuals ha-1, overlapped. No different ploidy levels were found among populations, although we recorded levels of ploidy between species that ranged from diploid (O. rastrera) to octoploid (O. streptacantha). Therefore, phenotypic differences between populations appear to be related to the density of individuals rather than to environmental variables, given the lack of environmental gradients or change in level ploidy

Anatomical and morphological variation in species and among populations of Opuntia in Southern Chihuahuan Desert [Variación anatómica y morfológica en especies y entre poblaciones de opuntia en la porción sur del Desierto Chihuahuense]

Phenotypic variation in different populations of Opuntia cantabrigiensis, O. leucotricha, O. rastrera, O. robusta and O. streptacantha was evaluated by examining 28 anatomical and morphologic variables through discriminant analysis. These populations are separated from each other by distances ranging between 32 and 110 km. Altitude and annual average temperature showed no variation in the study area. Discriminant analysis separated populations of O. cantabrigiensis, which is the species having the lowest density (13 individuals ha-1), whilst some populations of other Opuntia species, whose densities were as high as 1,852 individuals ha-1, overlapped. No different ploidy levels were found among populations, although we recorded levels of ploidy between species that ranged from diploid (O. rastrera) to octoploid (O. streptacantha). Therefore, phenotypic differences between populations appear to be related to the density of individuals rather than to environmental variables, given the lack of environmental gradients or change in level ploidy

Effects of benomyl and drought on the mycorrhizal development and daily net CO2 uptake of a wild platyopuntia in a rocky semi-arid environment

The effects of drought and the fungicide benomyl on a wild platyopuntia, Opuntia robusta Wendl., growing in a rocky semi-arid environment were assessed. Cladode phosphorus content, cladode water potential and daily net CO2 uptake were measured monthly in 2000 and 2001 before, during and after the summer rainy period. During 2000, the formation of new roots and new cladodes was severely suppressed in response to a prolonged drought, impairing the development of the symbiotic relationship between the arbuscular mycorrhizal (AM) fungi and the roots. Hence no effect of benomyl application was observed on daily carbon assimilation by this Crassulacean acid metabolism plant. During 2001, drought was interrupted, and new cladodes and roots were formed in response to rainfall. Benomyl was highly effective in suppressing root colonization by AM-fungi; however, daily C assimilation was reduced by benomyl application only in October. Thus, the inhibition of AM-fungal colonization by benomyl did not affect photosynthesis, water uptake and P uptake under prolonged drought. Zapotitlán 2003 Annals of Botany Company

Reproductive isolation in fragmented wild populations of Opuntia streptacantha

During pre-Hispanic times, there were extensive Opuntia forests in the semiarid regions of central Mexico. In the colonial period the migration of the Spanish to these regions promoted land clearing for agricultural activities, a tendency that continues in modern times, ultimately leading to deforestation and fragmentation of wild Opuntia populations. The main objective of this work is to evaluate the effects of fragmentation of Opuntia streptacantha populations on the reproductive success. Pollen-grain germination, rates of pollen-tube growth, fruit and seed set were evaluated in cross-pollinations between isolated populations and compared to within-population crosses. The activity of insects was recorded during the blooming period and chromosome number was recorded in the isolated populations under study. Cross-pollinations between populations significantly reduced the number of pollen tubes that reached the base of style and the ovules, affecting the values of fruit and seed set. This seemed to explain the differences obtained between the control (open pollination) and cross-pollination within population. The two populations under study are octaploid. Cross-pollinations between individuals of isolated populations of O. streptacantha showed low performance of out-crossing as indicated by the low number of pollen tubes that reached the base of the style, the ovules, and the low values of fruit set and seed set

Reproductive isolation in fragmented wild populations of Opuntia streptacantha

During pre-Hispanic times, there were extensive Opuntia forests in the semiarid regions of central Mexico. In the colonial period the migration of the Spanish to these regions promoted land clearing for agricultural activities, a tendency that continues in modern times, ultimately leading to deforestation and fragmentation of wild Opuntia populations. The main objective of this work is to evaluate the effects of fragmentation of Opuntia streptacantha populations on the reproductive success. Pollen-grain germination, rates of pollen-tube growth, fruit and seed set were evaluated in cross-pollinations between isolated populations and compared to within-population crosses. The activity of insects was recorded during the blooming period and chromosome number was recorded in the isolated populations under study. Cross-pollinations between populations significantly reduced the number of pollen tubes that reached the base of style and the ovules, affecting the values of fruit and seed set. This seemed to explain the differences obtained between the control (open pollination) and cross-pollination within population. The two populations under study are octaploid. Cross-pollinations between individuals of isolated populations of O. streptacantha showed low performance of out-crossing as indicated by the low number of pollen tubes that reached the base of the style, the ovules, and the low values of fruit set and seed set

[Production systems of Spondias purpurea (Anacardiaceae) in Central West Mexico]

Morphological, physical and chemical traits related with fruit quality characteristics of Spondias purpurea L. agroecosystems were studied in Central-West Mexico for wild and cultivated populations. Spondias purpurea regularly thrive in shallow, rocky infertile soils unsuitable for conventional crops. The weight, axial and radial length, pH, total soluble solids (SST), reducing sugars, proteins and mineral content in fruits were recorded. The mean fresh fruit weight was superior in the cultivated varieties (20 g) than in the wild (16 g). Similarly the highest values of pH, SST, reducing sugars and protein content (3.3, 12.15 degrees Brix, 0.38 g/100 g and 1.18 g/100 g, respectively) were observed in the cultivated plantations compared with wild populations (3.0, 8.31 degrees Brix, 0.24 g/100 g and 0.14 g/100 g, respectively). In cultivated plantations, productivity ranged from 0.15 ton ha(-1) to 5.0 ton ha(-1), and must be considered satisfactory, considering the low inputs of fertilizers and pesticides applied to orchards. The fruits of S. purpurea are similar in nutrimental content to more important commercial fruit species; it produces fresh fruits during the dry months of spring, when few fresh fruits are available in the local markets. In addition, S. purpurea is a source of water and food for domestic animals and wild fauna. These traits emphasize their agronomical and ecological importance for tropical and subtropical environments, where it can also be used in reforestation programs because it can grow in infertile rocky soils, and in agroecosystems inhabited by low income farmers that practice subsistence agriculture. In fact, the cultivation of Spondias has helped convert marginal lands into productive lands

Production systems of Spondias purpurea (Anacardiaceae) in Central West M�xico [Sistemas de producci�n de Spondias purpurea (Anacardiaceae) en el centro-occidente de M�xico]

Morphological, physical and chemical traits related with fruit quality characteristics of Spondias purpurea L. agroecosystems were studied in Central-West Mexico for wild and cultivated populations. Spondias purpurea regularly thrive in shallow, rocky infertile soils unsuitable for conventional crops. The weight, axial and radial length, pH, total soluble solids (SST), reducing sugars, proteins and mineral content in fruits were recorded. The mean fresh fruit weight was superior in the cultivated varieties (20 g) than in the wild (16 g). Similarly the highest values of pH, SST, reducing sugars and protein content (3.3, 12.15� Brix, 0.38 g/100 g and 1.18 g/100 g, respectively) were observed in the cultivated plantations compared with wild populations (3.0, 8.31� Brix, 0.24 g/100 g and 0.14 g/100 g, respectively). In cultivated plantations, productivity ranged from 0.15 ton ha-1 to 5.0 ton ha-1, and must be considered satisfactory, considering the low inputs of fertilizers and pesticides applied to orchards. The fruits of S. purpurea are similar in nutrimental content to more important commercial fruit species; it produces fresh fruits during the dry months of spring, when few fresh fruits are available in the local markets. In addition, S. purpurea is a source of water and food for domestic animals and wild fauna. These traits emphasize their agronomical and ecological importance for tropical and subtropical environments, where it can also be used in reforestation programs because it can grow in infertile rocky soils, and in agroecosystems inhabited by low income farmers that practice subsistence agriculture. In fact, the cultivation of Spondias has helped convert marginal lands into productive lands

Production systems of Spondias purpurea (Anacardiaceae) in Central West México [Sistemas de producción de Spondias purpurea (Anacardiaceae) en el centro-occidente de México]

Morphological, physical and chemical traits related with fruit quality characteristics of Spondias purpurea L. agroecosystems were studied in Central-West Mexico for wild and cultivated populations. Spondias purpurea regularly thrive in shallow, rocky infertile soils unsuitable for conventional crops. The weight, axial and radial length, pH, total soluble solids (SST), reducing sugars, proteins and mineral content in fruits were recorded. The mean fresh fruit weight was superior in the cultivated varieties (20 g) than in the wild (16 g). Similarly the highest values of pH, SST, reducing sugars and protein content (3.3, 12.15° Brix, 0.38 g/100 g and 1.18 g/100 g, respectively) were observed in the cultivated plantations compared with wild populations (3.0, 8.31° Brix, 0.24 g/100 g and 0.14 g/100 g, respectively). In cultivated plantations, productivity ranged from 0.15 ton ha-1 to 5.0 ton ha-1, and must be considered satisfactory, considering the low inputs of fertilizers and pesticides applied to orchards. The fruits of S. purpurea are similar in nutrimental content to more important commercial fruit species; it produces fresh fruits during the dry months of spring, when few fresh fruits are available in the local markets. In addition, S. purpurea is a source of water and food for domestic animals and wild fauna. These traits emphasize their agronomical and ecological importance for tropical and subtropical environments, where it can also be used in reforestation programs because it can grow in infertile rocky soils, and in agroecosystems inhabited by low income farmers that practice subsistence agriculture. In fact, the cultivation of Spondias has helped convert marginal lands into productive lands