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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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- Eklöf, Anna, et al.
(författare)
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The dimensionality of ecological networks
- 2013
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Ingår i: Ecology Letters. - : Blackwell Publishing. - 1461-023X .- 1461-0248. ; 16:5, s. 577-583
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Tidskriftsartikel (refereegranskat)abstract
- How many dimensions (trait-axes) are required to predict whether two species interact? This unansweredquestion originated with the idea of ecological niches, and yet bears relevance today for understanding whatdetermines network structure. Here, we analyse a set of 200 ecological networks, including food webs,antagonistic and mutualistic networks, and find that the number of dimensions needed to completelyexplain all interactions is small ( < 10), with model selection favouring less than five. Using 18 high-qualitywebs including several species traits, we identify which traits contribute the most to explaining networkstructure. We show that accounting for a few traits dramatically improves our understanding of the structureof ecological networks. Matching traits for resources and consumers, for example, fruit size and billgape, are the most successful combinations. These results link ecologically important species attributes tolarge-scale community structure.
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