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,...

This paper presents a grammatical evolution (GE)-based methodology to automatically design third generation artificial neural networks (ANNs), also known as spiking neural networks (SNNs), for solving supervised classification problems. The proposal performs the SNN design by exploring the search space of three-layered feedforward topologies with configured synaptic connections (weights and delays) so that no explicit training is carried out. Besides, the designed SNNs have partial connections between input and hidden layers which may contribute to avoid redundancies and reduce the dimensionality of input feature vectors. The proposal was tested on several well-known benchmark datasets from the UCI repository and statistically compared against a similar design methodology for second generation ANNs and an adapted version of that methodology for SNNs; also, the results of the two methodologies and the proposed one were improved by changing the fitness function in the design process. The proposed methodology shows competitive and consistent results, and the statistical tests support the conclusion that the designs produced by the proposal perform better than those produced by other methodologies.

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In recent years Grammatical Evolution (GE) has been used as a representation of Genetic Programming (GP) which has been applied to many optimization problems such as symbolic regression, classification, Boolean functions, constructed problems, and algorithmic problems. GE can use a diversity of searching strategies including Swarm Intelligence (SI). Particle Swarm Optimisation (PSO) is an algorithm of SI that has two main problems: premature convergence and poor diversity. Particle Evolutionary Swarm Optimization (PESO) is a recent and novel algorithm which is also part of SI. PESO uses two perturbations to avoid PSO’s problems. In this paper we propose using PESO and PSO in the frame of GE as strategies to generate heuristics that solve the Bin Packing Problem (BPP); it is possible however to apply this methodology to other kinds of problems using another Grammar designed for that problem. A comparison between PESO, PSO, and BPP’s heuristics is performed through the nonparametric Friedman test. The main contribution of this paper is proposing a Grammar to generate online and offline heuristics depending on the test instance trying to improve the heuristics generated by other grammars and humans; it also proposes a way to implement different algorithms as search strategies in GE like PESO to obtain better results than those obtained by PSO.