SummaryBackgroundSurgical 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.MethodsThis 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.FindingsBetween 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).InterpretationCountries 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.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

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The electronic transport in low-dimensional materials is controlled by quantum coherence and non-equilibrium statistics. The scope of the present investigation is to search for the origins of negative-differential resistance (NDR) behavior in N-doped ultra-narrow zigzag-edge ZnO nano-ribbons (ZnO-NRs). A state-of-the-art technique, based on a combination of density-functional theory (DFT) and non-equilibrium Green’s function (NEGF) formalism, is employed to probe the electronic and transport properties. The effect of location of N dopant, with respect to the NR edges, on IV-curve and NDR is tested and three different positions for N-atom are considered: (i) at the oxygen-rich edge; (ii) at the center; and (iii) at the Zn-rich edge. The results show that both resistance and top-to-valley current ratio (TVCR) reduce when N-atom is displaced from O-rich edge to center to Zn-rich edge, respectively. After an analysis based on the calculations of transmission coefficient versus bias, band structures, and charge-density plots of HOMO/LUMO states, one is able to draw a conclusion about the origins of NDR. The unpaired electron of N dopant is causing the curdling/localization of wave-function, which in turn causes strong back-scattering and suppression of conductive channels. These effects manifest themselves in the drawback of electric current (or so called NDR). The relevance of NDR for applications in nano-electronic devices (e.g., switches, rectifiers, amplifiers, gas sensing) is further discussed.

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