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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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- Wojno, Jennifer, et al.
(författare)
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Chemical separation of disc components using RAVE
- 2016
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Ingår i: Monthly Notices of the Royal Astronomical Society. - : Oxford University Press (OUP). - 0035-8711 .- 1365-2966. ; 461:4, s. 4246-4255
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Tidskriftsartikel (refereegranskat)abstract
- We present evidence from the RAdial Velocity Experiment (RAVE) survey of chemically separated, kinematically distinct disc components in the solar neighbourhood.We apply probabilistic chemical selection criteria to separate our sample into a-low ('thin disc') and a-high ('thick disc') sequences. Using newly derived distances,which will be utilized in the upcoming RAVE DR5, we explore the kinematic trends as a function of metallicity for each of the disc components. For our a-low disc, we find a negative trend in the mean rotational velocity (Vf) as a function of iron abundance ([Fe/H]). We measure a positive gradient ∂Vφ/∂[Fe/H] for the a-high disc, consistent with results from high-resolution surveys.We also find differences between the a-low and a-high discs in all three components of velocity dispersion.We discuss the implications of an a-low, metal-rich population originating from the inner Galaxy, where the orbits of these stars have been significantly altered by radial mixing mechanisms in order to bring them into the solar neighbourhood. The probabilistic separation we propose can be extended to other data sets for which the accuracy in [a/Fe] is not sufficient to disentangle the chemical disc components a priori. For such data sets which will also have significant overlap with Gaia DR1, we can therefore make full use of the improved parallax and proper motion data as it becomes available to investigate kinematic trends in these chemical disc components.
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