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,...

The virtual world economy is a multibillion-dollar industry. There is significant evidence for the growth of virtual economies within a variety of virtual worlds. There is an increasing demand from users to buy, sell, and invest in virtual items and services, including virtual properties. However, there is also evidence suggesting that many companies struggle to succeed in the virtual economy platform. In order to facilitate and drive success in virtual business strategies, it is necessary to have a framework for classifying elements of virtual economies. This paper proposes a classification framework of virtual economy elements based upon the characteristics of products and services, the transaction and marketplace, as well as the currency and exchange systems present in these economic environments. In addition, this research highlights the opportunities and challenges presented to both users and companies within the virtual economy platform.

This paper presents a set of data relating to the investigation of RMT in the virtual world (VW) and social capital associated with RMT platforms. The investigation is carried out using five main research databases: Science Direct; Emerald Insight; Springer Link; Proquest Database; and IEEE Xplore; with a total of 161 research papers. The objective of this survey study is to highlight areas of strength and weakness in current RMT research in VW and its social capital. This study also presents the basic RMT classification based on these previous studies.

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This paper presents a set of data relating to the investigation of RMT in the virtual world (VW) and social capital associated with RMT platforms. The investigation is carried out using five main research databases: Science Direct; Emerald Insight; Springer Link; Proquest Database; and IEEE Xplore; with a total of 161 research papers. The objective of this survey study is to highlight areas of strength and weakness in current RMT research in VW and its social capital. This study also presents the basic RMT classification based on these previous studies.