There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical ...outcomes in Africa.
We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899).
We recruited 11 422 patients (median 29 IQR 10–70) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2–1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years SD 16·1), with a lower risk profile (American Society of Anesthesiologists median score 1 IQR 1–2) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4–18·9) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 10·2% of 10 970 patients), of whom 112 (9·7%) died.
Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective.
Medical Research Council of South Africa.
•Differences between conventional and precision irrigation investigated.•Water balance modelling used to assess potential water saving.•Challenges in deriving irrigation management zones were ...assessed.•Precision irrigation in humid climate appears to be modest.
There is growing scientific interest in the potential role that precision irrigation (PI) can make towards improving crop productivity, and increasing water and energy efficiency in irrigated agriculture. Most progress has been made in arid and semi-arid climates for use in high value crop production where irrigation costs coupled with concerns regarding water scarcity have stimulated PI innovation and development. In temperate and humid climates where irrigation is supplemental to rainfall, PI is less developed but nevertheless offers scope to make more effective use of rainfall, help reduce the non-beneficial losses associated with irrigation (deep drainage, nitrate leaching) and provide farmers with evidence to demonstrate environmentally sustainable practices to processors and retailers. This paper reports on recent experiences in developing precision irrigation in UK field-scale agriculture, drawing on evidence from field research and modelling studies. By combining data from these sources, a critical evaluation focusing on selected technical, agronomic and engineering challenges that need to be overcome are described, including issues regarding PI scheduling, and the delineation of irrigation management zones to ensure compatibility with existing methods of overhead irrigation. The findings have relevance to other countries where irrigation is supplemental and where precision agriculture is gaining popularity.
New radio (MeerKAT and Parkes) and X-ray (XMM-Newton, Swift, Chandra, and NuSTAR) observations of PSR J1622-4950 indicate that the magnetar, in a quiescent state since at least early 2015, ...reactivated between 2017 March 19 and April 5. The radio flux density, while variable, is approximately 100× larger than during its dormant state. The X-ray flux one month after reactivation was at least 800× larger than during quiescence, and has been decaying exponentially on a 111 19 day timescale. This high-flux state, together with a radio-derived rotational ephemeris, enabled for the first time the detection of X-ray pulsations for this magnetar. At 5%, the 0.3-6 keV pulsed fraction is comparable to the smallest observed for magnetars. The overall pulsar geometry inferred from polarized radio emission appears to be broadly consistent with that determined 6-8 years earlier. However, rotating vector model fits suggest that we are now seeing radio emission from a different location in the magnetosphere than previously. This indicates a novel way in which radio emission from magnetars can differ from that of ordinary pulsars. The torque on the neutron star is varying rapidly and unsteadily, as is common for magnetars following outburst, having changed by a factor of 7 within six months of reactivation.
We are obtaining spectra, spectral types, and basic physical parameters for the nearly 3600 dwarf and giant stars earlier than M0 in the Hipparcos catalog within 40 pc of the Sun. Here we report on ...results for 1676 stars in the southern hemisphere observed at Cerro Tololo Inter-American Observatory and Steward Observatory. These results include new, precise, homogeneous spectral types, basic physical parameters (including the effective temperature, surface gravity, and metallicity M/H), and measures of the chromospheric activity of our program stars. We include notes on astrophysically interesting stars in this sample, the metallicity distribution of the solar neighborhood, and a table of solar analogs. We also demonstrate that the bimodal nature of the distribution of the chromospheric activity parameter log R depends strongly on the metallicity, and we explore the nature of the 'low-metallicity' chromospherically active K-type dwarfs.
Globally, the area of sugarcane is rising rapidly in response to growing demands for bioethanol and increased sugar demand for human consumption. Despite considerable diversity in production systems ...and contexts, sugarcane is a particularly “high impact” crop with significant positive and negative environmental and socio-economic impacts. Our analysis is focused on Sub-Saharan Africa (SSA), which is a critical region for continued expansion, due to its high production potential, low cost of production and proximity, and access, to European markets. Drawing on a systematic review of scientific evidence, combined with information from key informants, stakeholders and a research-industry workshop, we critically assess the impacts of sugarcane development on water, soil and air quality, employment, food security and human health. Our analysis shows that sugarcane production is, in general, neither explicitly good nor bad, sustainable nor unsustainable. The impacts of expansion of sugarcane production on the environment and society depend on the global political economy of sugar, local context, quality of scheme, nature of the production system and farm management. Despite threats from climate change and forthcoming changes in the trade relationship with the European Union, agricultural development policies are driving national and international interest and investment in sugarcane in SSA, with expansion likely to play an important role in sustainable development in the region. Our findings will help guide researchers and policy makers with new insights in understanding the situated environmental and social impacts associated with alternative sugar economy models, production technologies and qualities of management.
•Estimates of yield losses due to drought risk are sensitive to the assessment method•Drought severity indicators (DSI) likely under-estimate future average yield losses•Integrating DSI with crop ...modelling provides a powerful approach
Droughts pose a major risk to agricultural production. By comparing the outputs from an ecophysiological crop model (Sirius) with four drought severity indicators (DSI), a comparative assessment of the impacts of drought risk on wheat yield losses has been evaluated under current (baseline) and two future climate scenarios. The rationale was to better understand the relative merits and limitations of each approach from the perspective of quantifying agricultural drought impacts on crop productivity. Modelled yield losses were regressed against the highest correlated variant for each DSI. A cumulative distribution function of yield loss for each scenario (baseline, near and far future) was calculated as a function of the best fitting DSI (SPEI-5July) and with the equivalent outputs from the Sirius model. Comparative analysis between the two approaches highlighted large differences in estimated yield loss attributed to drought, both in terms of magnitude and direction of change, for both the baseline and future scenario. For the baseline, the average year differences were large (0.25 t ha−1 and 1.4 t ha−1 for the DSI and Sirius approaches, respectively). However, for the dry year, baseline differences were substantial (0.7 t ha−1 and 2.7 t ha−1). For the DSI approach, future yield losses increased up to 1.25 t ha−1 and 2.8 t ha−1 (for average and dry years, respectively). In contrast, the Sirius modelling showed a reduction in future average yield loss, down from a baseline 1.4 t ha−1 to 1.0 t ha−1, and a marginal reduction for a future dry year from a baseline of 2.7 t ha−1 down to 2.6 t ha−1. The comparison highlighted the risks in adopting a DSI response function approach, particularly for estimating future drought related yield losses, where changing crop calendars and the impacts of CO2 fertilisation on yield are not incorporated. The challenge lies in integrating knowledge from DSIs to understand the onset, extent and severity of an agricultural drought with ecophysiological crop modelling to understand the yield responses and water use relations with respect to changing soil moisture conditions.
We present a measurement of the angular power spectrum of the cosmic microwave background (CMB) using data from the South Pole Telescope (SPT). The data consist of 790 deg2 of sky observed at 150 GHz ...during 2008 and 2009. Here we present the power spectrum over the multipole range 650 < l < 3000, where it is dominated by primary CMB anisotropy. We combine this power spectrum with the power spectra from the seven-year Wilkinson Microwave Anisotropy Probe (WMAP) data release to constrain cosmological models. We find that the SPT and WMAP data are consistent with each other and, when combined, are well fit by a spatially flat, Delta *LCDM cosmological model. The SPT+WMAP constraint on the spectral index of scalar fluctuations is ns = 0.9663 ? 0.0112. We detect, at ~5 Delta *s significance, the effect of gravitational lensing on the CMB power spectrum, and find its amplitude to be consistent with the Delta *LCDM cosmological model. We explore a number of extensions beyond the Delta *LCDM model. Each extension is tested independently, although there are degeneracies between some of the extension parameters. We constrain the tensor-to-scalar ratio to be r < 0.21 (95% CL) and constrain the running of the scalar spectral index to be dns /dln k = --0.024 ? 0.013. We strongly detect the effects of primordial helium and neutrinos on the CMB; a model without helium is rejected at 7.7 Delta *s, while a model without neutrinos is rejected at 7.5 Delta *s. The primordial helium abundance is measured to be Yp = 0.296 ? 0.030, and the effective number of relativistic species is measured to be N eff = 3.85 ? 0.62. The constraints on these models are strengthened when the CMB data are combined with measurements of the Hubble constant and the baryon acoustic oscillation feature. Notable improvements include ns = 0.9668 ? 0.0093, r < 0.17 (95% CL), and N eff = 3.86 ? 0.42. The SPT+WMAP data show a mild preference for low power in the CMB damping tail, and while this preference may be accommodated by models that have a negative spectral running, a high primordial helium abundance, or a high effective number of relativistic species, such models are disfavored by the abundance of low-redshift galaxy clusters.
We report a B-mode power spectrum measurement from the cosmic microwave background (CMB) polarization anisotropy observations made using the SPTpol instrument on the South Pole Telescope. This work ...uses 500 deg2 of SPTpol data, a five-fold increase over the last SPTpol B-mode release. As a result, the bandpower uncertainties have been reduced by more than a factor of two, and the measurement extends to lower multipoles: 52 < ℓ < 2301 . Data from both 95 and 150 GHz are used, allowing for three cross-spectra: 95 GHz × 95 GHz , 95 GHz × 150 GHz , and 150 GHz × 150 GHz . B -mode power is detected at very high significance; we find P ( B B < 0 ) = 5.8 × 10−71, corresponding to a 18.1σ detection of power. With a prior on the galactic dust from Planck, WMAP and BICEP2/Keck observations, the SPTpol B-mode data can be used to set an upper limit on the tensor-to-scalar ratio, r < 0.44 at 95% confidence (the expected 1σ constraint on r given the measurement uncertainties is 0.22). We find the measured B-mode power is consistent with the Planck best-fit Λ CDM model predictions. Scaling the predicted lensing B-mode power in this model by a factor Alens, the data prefer Alens = 1.17 ± 0.13 . These data are currently the most precise measurements of B-mode power at ℓ > 320.
RECORD-3 compared everolimus and sunitinib as first-line therapy, and the sequence of everolimus followed by sunitinib at progression compared with the opposite (standard) sequence in patients with ...metastatic renal cell carcinoma (mRCC). This final overall survival (OS) analysis evaluated mature data for secondary end points.
Patients received either first-line everolimus followed by second-line sunitinib at progression (n = 238) or first-line sunitinib followed by second-line everolimus (n = 233). Secondary end points were combined first- and second-line progression-free survival (PFS), OS, and safety. The impacts of neutrophil lymphocyte ratio (NLR) and baseline levels of soluble biomarkers on OS were explored.
At final analysis, median duration of exposure was 5.6 months for everolimus and 8.3 months for sunitinib. Median combined PFS was 21.7 months 95% confidence interval (CI) 15.1–26.7 with everolimus-sunitinib and 22.2 months (95% CI 16.0–29.8) with sunitinib-everolimus hazard ratio (HR)EVE-SUN/SUN-EVE, 1.2; 95% CI 0.9–1.6. Median OS was 22.4 months (95% CI 18.6–33.3) for everolimus-sunitinib and 29.5 months (95% CI 22.8–33.1) for sunitinib-everolimus (HREVE-SUN/SUN-EVE, 1.1; 95% CI 0.9–1.4). The rates of grade 3 and 4 adverse events suspected to be related to second-line therapy were 47% with everolimus and 57% with sunitinib. Higher NLR and 12 soluble biomarker levels were identified as prognostic markers for poor OS with the association being largely independent of treatment sequences.
Results of this final OS analysis support the sequence of sunitinib followed by everolimus at progression in patients with mRCC. The safety profiles of everolimus and sunitinib were consistent with those previously reported, and there were no unexpected safety signals.
ClinicalTrials.gov identifier, NCT00903175
Here, we present a sample-variance-limited measurement of the temperature power spectrum (TT) of the cosmic microwave background using observations of a ~1500 deg2 field made by the SPT-3G in 2018. ...We report multifrequency power spectrum measurements at 95, 150, and 220 GHz covering the angular multipole range 750 ≤ ℓ < 3000. We combine this TT measurement with the published polarization power spectrum measurements from the 2018 observing season and update their associated covariance matrix to complete the SPT-3G 2018 TT/TE/EE dataset. This is the first analysis to present cosmological constraints from SPT TT, TE, and EE power spectrum measurements jointly. We blind the cosmological results and subject the dataset to a series of consistency tests at the power spectrum and parameter level. We find excellent agreement between frequencies and spectrum types and our results are robust to the modeling of astrophysical foregrounds. We report results for Λ CDM and a series of extensions, drawing on the following parameters: the amplitude of the gravitational lensing effect on primary power spectra AL, the effective number of neutrino species Neff, the primordial helium abundance YP, and the baryon clumping factor due to primordial magnetic fields b. We find that the SPT-3G 2018 TT/TE/EE data are well fit by Λ CDM with a probability to exceed of 15%. For Λ CDM, we constrain the expansion rate today to H0 = 68.3 ± 1.5 km s–1 Mpc–1 and the combined structure growth parameter to S8 = 0.797 ± 0.042. The SPT-based results are effectively independent of Planck, and the cosmological parameter constraints from either dataset are within <1σ of each other. The addition of temperature data to the SPT-3G TE/EE power spectra improves constraints by 8–27% for each of the Λ CDM cosmological parameters. When additionally fitting AL, Neff, or Neff + YP, the posteriors of these parameters tighten by 5–24%. In the case of primordial magnetic fields, complete TT/TE/EE power spectrum measurements are necessary to break the degeneracy between b and ns, the spectral index of primordial density perturbations. We report a 95% confidence upper limit from SPT-3G data of b<1.0. The cosmological constraints in this work are the tightest from SPT primary power spectrum measurements to date and the analysis forms a new framework for future SPT analyses.
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