Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

Introduction Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS) and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, interquartile range [IQR] 54–83; 55.2% male). The risk of death increased independently with increasing age (>80 versus 18–49: hazard ratio [HR] 3.57, confidence interval [CI] 2.54–5.02), frailty (CFS 8 versus 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease and cancer, but not delirium. Age, frailty (CFS 7 versus 1–3: odds ratio 7.00, CI 5.27–9.32), delirium, dementia and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusion Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age

Modelling of time-to collision for unmanned aerial vehicle using particles swarm optimization

A method for the development of Time-to-Collision (TTC) mathematical model for outdoor Unmanned Aerial Vehicle (UAV) using Particles Swarm Optimization (PSO), are presented. TTC is the time required for a UAV either to collide with any static obstacle or completely stop without applying any braking control system when the throttle is fully released. This model provides predictions of time before UAV will collide with the obstacle in the same path based on their parameter, for instance, current speed and payload. However, this paper focus on the methodology of the implementation of PSO to develop the TTC model for 5 different set of payloads. This work utilizes a quadcopter as our testbed system, that equipped with a Global Positioning System (GPS) receiver unit, a flight controller with data recording capability and ground control station for real-time monitoring. The recorded onboard flight mission data for 5 different set of payloads has been analyzed to develop a mathematical model of TTC through the PSO approach. The horizontal ground speed, throttle magnitudes and flight time stamp are extracted from the on-board quadcopter flight mission. PSO algorithm is used to find the optimal linear TTC model function, while the mean square error is used to evaluate the best fitness of the solution. The results of the TTC mathematical model for each payload are described.</jats:p

Investigation of cell parameters, microstructures and electrochemical behaviour of LiMn2O4 normal and nano powders.

Nano materials are usually difficult to prepare. This work presents a simple way of preparing LiMn2O4 nano powders using the high-energy ball milling method. This method has the advantage of producing pure, single-phase and crystalline nano powders. The milling method is carefully controlled to avoid unwanted chemical reactions that may change the stoichiometry of the material. Nano powders of between 30 and 50 nm are obtained. Structural studies of the nano powders, as well as the more-conventional micron-sized LiMn2O4, are made using X-ray diffraction and neutron diffraction methods. Electrochemical evaluation of the materials is undertaken with a three-probe cyclic voltammetry technique and galvanostatic charge-discharge measurements. Structural studies reveal that not only are the crystallites of the nano powders much reduced in size from the normal powders, but their cell parameters are also smaller. The performance characteristics of the nano material show an improvement over that of the micron-sized material by about 17% in the 1st cycle and 70.6% in the 5th cycle, at which the capacity is 132 mAh g(-1). The normal material suffers from severe capacity fading but the nano material shows much improved capacity retention. © 2008, Elsevier Ltd

Nutritional Value of Dry Fish in Bangladesh and Its Potential Contribution to Addressing Malnutrition: A Narrative Review

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Nutritional Value of Dry Fish in Bangladesh and Its Potential Contribution to Addressing Malnutrition: A Narrative Review

Banna MHA, Al Zaber A, Rahman N, et al. Nutritional Value of Dry Fish in Bangladesh and Its Potential Contribution to Addressing Malnutrition: A Narrative Review. Fishes. 2022;7(5):1-18.Understanding the linkage between the nutrient composition of foods and individuals’ recommended nutrient intake is important to address malnutrition. Despite it being a traditional and popular food item in Bangladesh, the nutrient composition of dry fish has not been reviewed yet. This study used a narrative review to assess the nutrient composition of dry fish and estimated its potential contribution to addressing some common nutritional deficiencies among children and pregnant and lactating women in Bangladesh. Records were collected from different databases, including the Web of Science, Google Scholar, PubMed, ScienceDirect, Banglajol, and ResearchGate. Data were extracted from 48 articles containing 1128 entries regarding nutrient composition. Most of the nutrient analyses estimated the proximate composition, whereas vitamin, mineral, amino acid, and fatty acid compositions were scarce in the literature. We found that dry fish has high protein and mineral content and could contribute highly to meeting the recommended nutrient intake of protein, iron, zinc, and calcium for children and pregnant and lactating women. The summarized nutrient composition data could be useful for further research to observe how dry fish could be best utilized to address malnutrition in Bangladesh. This narrative review recommends that further nutrient analysis, with emphasis on vitamin, mineral, and fatty acid compositions