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

TOWARDS THE SUMMERS NIGHT: A MENTORING PROJECT FOR AUSTRALIAN COMPOSERS IDENTIFYING AS WOMEN

AbstractThe Summers Night Project is an ongoing composer-mentoring programme established in 2018 by musicians Cat Hope and Gabriella Smart, with the support of the Perth-based new music organisation Tura New Music. The project aims to support and mentor emerging Australian female and gender minority composers to create new compositions for performance, with the aim of growing the gender diversity of composers in music programmes across Australia. Three composers were chosen from a national call for submissions, and works were performed by an ensemble consisting of members from the Decibel and Soundstream new music ensembles. Three new works were workshopped, recorded then performed on a short tour of Perth, Adelaide and Melbourne, Australia in July 2018. The project takes its name and inspiration from Australian feminist Anne Summers, author of the ground-breaking examination of women in Australia's history Damned Whores and God's Police (1975) and was inspired by her 2017 Women's Manifesto. This article examines the rationale for such a project, the processes and results of the project itself, and plans for its future.</jats:p

Towards the Summers Night

The Summers Night Project is a composers mentoring program established in 2018 by musicians Cat Hope and Gabriella Smart, with the support of new music organization Tura New Music. The project aims to support and mentor emerging Australian composers identifying as women to create new compositions for performance, with the aim of growing the gender diversity of composers in music programs Australia-wide. Three new works were workshopped, recorded then performed on a short tour of Perth, Adelaide and Melbourne, Australia in July 2018. Three composers were chosen from a national call-out and the works were performed by an ensemble consisting of members from the Decibel and Soundstream new music ensembles

Towards the Summer Night: A Mentoring Project for Australian Composers Identifying as Women

The Summers Night Project is an ongoing composer-mentoring programme established in 2018 by musicians Cat Hope and Gabriella Smart, with the support of the Perth-based new music organisation Tura New Music. The project aims to support and mentor emerging Australian female and gender minority composers to create new compositions for performance, with the aim of growing the gender diversity of composers in music programmes across Australia. Three composers were chosen from a national call for submissions, and works were performed by an ensemble consisting of members from the Decibel and Soundstream new music ensembles. Three new works were workshopped, recorded then performed on a short tour of Perth, Adelaide and Melbourne, Australia in July 2018. The project takes its name and inspiration from Australian feminist Anne Summers, author of the ground-breaking examination of women in Australia's history Damned Whores and God's Police (1975) and was inspired by her 2017 Women's Manifesto. This article examines the rationale for such a project, the processes and results of the project itself, and plans for its futu

Carbon dioxide and methane dynamics in estuaries

We carried out a literature overview to synthesize current knowledge on CO2 and CH4 dynamics and fluxes with the atmosphere in estuarine environments. Estuarine systems are highly dynamic in terms of carbon cycling and emit CO2 to the atmosphere at rates that are quantitatively significant for the global C cycle. This emission of CO2 to the atmosphere is strongly supported by the net heterotrophic nature of these ecosystems. The robustness of the evaluation of the emission of CO2 from estuarine ecosystems has increased in last years due to increasing data availability and improvements in the surface area estimates by types. At present, the lack of sufficient data is the major limitation in the quantification of the spatial and temporal variability of CO2 fluxes in estuarine environments. Regarding future observations, there is also a need for sustained measurements to unravel inter-annual variability and long-term trends of CO2 and CH4 in estuarine environments. Indeed, due to the strong linkage with river catchements, inter-annual variability of CO2 and CH4 in estuarine environments is expected to be strong. Data used in the present synthesis were either obtained by the authors, data mined from publications or communicated by colleagues. There is a need for publicly available and quality checked data-bases for CO2 and CH4 in estuarine environments. Not only cross-system meta-analysis of data (CO2, CH4, O2, …) can be enlightening as explored in the present work, but also considering the uncertainties in the evaluation of the gas transfer velocity, there could be a need for future re-evaluations of air-water CO2 and CH4 fluxes, requiring access to the raw pCO2 and [CH4] data

Estimating Terrestrial Primary Productivity by Combining Remote Sensing and Ecosystem Simulation

Beginning in 1972 with the launch of Landsat 1, estimation of terrestrial plant production has been one of the most important applications attempted of satellite remote sensing. Initial interest focused on the prediction of regional crop yields, such as wheat (Erickson, 1984). However, changing goals, hardware capabilities, and theory have produced a steady evolution in the approaches taken to calculate net primary production (NPP) of large areas. Interest has also expanded to calculating primary production of natural vegetation. The much wider array of topography, climate, canopy geometry, and life-cycle dynamics exhibited by natural vegetation make computation of primary production much more challenging than the rather controlled, organized field conditions of a crop

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe