The lung collectins, SP-A and SP-D, are important components of the innate immune response to microbial challenge and participate in other aspects of immune and inflammatory regulation within the lung. Both proteins bind to surface structures expressed by a wide variety of microorganisms and have the capacity to modulate multiple leukocyte functions, including the enhanced internalization and killing of certain microorganisms in vitro. In addition, transgenic mice with deficiencies in SP-A and SP-D show defective or altered responses to challenge with bacterial, fungal, and viral microorganisms and to bacterial lipopolysaccharides in vivo. Thus collectins could play particularly important roles in settings of inadequate or impaired specific immunity, and acquired alterations in the levels of active collectins within the airspaces and distal airways may increase susceptibility to infection.

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.

Although cosmetic tanning and unprotected solar exposure are common, little is known about general attitudes, beliefs and behaviour regarding the use of sunbeds. We sought to determine the frequency of sunbeds use in a select sample and to assess the knowledge and beliefs regarding this behaviour. A self-administered anonymous questionnaire was distributed to a sample of 648 employees work for Bradford Hospitals NHS Trust. The questionnaire explored demographic information (including hair and skin type, family history with skin cancer), frequency of sunbeds use, knowledge about the risks of UV exposure and motivations for practising this behaviour. Four hundred and eighteen women and 52 men completed the questionnaire, making a response rate of 73%. Nearly half of respondents (207; 44%) reported using sunbeds to some extent; of those 12% reported frequent use. Appearance ('to look better') was the most popular reason given by respondents for using sunbeds, followed by 'feel healthy'. Frequency of using sunbeds was found to be negatively correlated with the age of respondents and the existence of family experience with skin cancer, and strongly associated with the opinion that it is safer to use a sunbed than subathing outdoors, the female sex and smoking. It is clear from this study that the psychological factors that influence sunbeds use are complex and that so far public education campaigns have had little impact on it. This study highlights some of these psychological factors.

Summary. Although complex categorizations are in vogue, "heavy oils" can be defined simply in terms of their flow properties in the reservoir e.g., a 100-cp [100-mPas] or greater viscosity. Such heavy oils are a major world hydrocarbon resource that is exploited where indigenous demand exists. Efficient methods of production require enthalpy input to the reservoir by hot-fluid injection or by creation of heat in the reservoir. Heat losses must be minimized to achieve maximum production efficiency. The widely used cyclic-steam-injection process is examined analytically to indicate which parameters govern successful exploitation. Steamflood and in-situ combustion techniques are discussed with reference to recent developments. Heavy-oil recovery from the more difficult carbonate reservoirs, such as those of the Middle East, is reviewed and potential production mechanisms are examined. Production techniques are described together with export handling schemes. Introduction Heavy-oil recovery is traditionally thought of as thermal stimulation of low-API-gravity oil, which may range from 4 to 20 degrees API [1.04 to 0.93 g/cm3]. Heavy oil is defined as having an API gravity of less than 20 degrees API [greater than 0.93 g/cm3]. Standard practice in the U.S. also uses this gravity definition. The API gravity, however, does not fully describe the flow properties of the crude; this is better represented by the oil viscosity. For instance, some crudes may be heavy (low gravity) but have a relatively low viscosity at reservoir temperature compared with some lighter crudes (Table 1). The oil viscosity and its response to increased temperature control the flow rate under thermal stimulation, and because the flow rate is a much more important factor in the economic exploitation of the reserve than the oil gravity, it is proposed that heavy oilsi.e., those requiring stimulation by heat or by other meansbe defined as crudes having viscosities greater than 100 cp [greater than 100 mPas] at reservoir conditions. Normally, pumped cold-oil production rates will be less than 10 B/D [1.6 m3/d] when the oil viscosity exceeds 100 cp [100 mPas]. The term "bitumen" is used interchangeably with heavy oil although its use does tend to signify the heavier end of the heavy-oil spectrum. The United Nations Inst. for Training and Research proposes that bitumen be defined as having a viscosity greater than 10(4) cp [greater than 10(4) mPas] and an API gravity less than 10 degrees [less than 1 g/cm3]. Another definition of bitumen is a naturally occurring viscous mixture consisting mainly of hydrocarbons heavier than pentane that may contain sulfur compounds and that, in its naturally occurring viscous state, is not recoverable at an economical rate through a well. The term "tar sand" is often applied to such deposits found in the Canadian Athabasca sands, which are shallower and accessible by mining. Heavy oil in this paper refers only to those deposits that have to be exploited in situ and that will normally be located at depths ranging between 1,000 and 4,000 ft [300 and 1200 m]. In common with tar-sand oil, heavy oils frequently have high asphaltene, sulfur, and metal contents compared with conventional oils. The nonhydrocarbon content tends to increase with decreasing API gravity, which, in combination with decreasing quantities of lighter ends, reduces the market value of the crude. Table 2 compares typical heavy-oil properties with conventional oil. Main Locations of World Heavy Oil We have estimated the total discovered heavy oil in place in the world to be 4,600 × 10(9) bbl [730 × 10(9) m3]. This should be compared with our estimate of remaining proved and probable conventional oil reserves as of Jan. 1, 1986, of some 700 × 10(9) bbl [110 X 10(9) m3]. As can be seen, an average heavy-oil recovery factor of 15 % would be required to equate heavy-oil reserves with the remaining conventional reserves. The total world consumption of oil as of Jan. 1, 1986, was about 537 × 10(9) bbl [85 × 10(9)m3], which shows that the heavy-oil resources are important long-term supplies of petroleum. The main known heavy-oil deposits are summarized in Table 3. The largest heavy-oil deposits are located in Canada, Venezuela, and the Soviet Union and represent over 90% of the known heavy oil in place in the world. Of these deposits, sandstone reservoirs are estimated to contain 3,000 × 10(9) bbl [480 × 10(9) m3], with the remaining 1,600 × 10(9) bbl [250 × 10(9) m3] contained in carbonate reservoirs. Table 4 shows the distribution of the 1985 world production by thermal techniques, which averaged 923,000 B/D [147 × 10(3) m3/d]. In the past, economics have dictated that a high oil price is necessary before heavy-oil production becomes attractive on a large scale. In many areas of the world, however, conventional oil reservoirs are becoming increasingly marginal as the giant fields remaining to be discovered become fewer and the exploration risks for offshore fields and their development costs become large. There are risks associated with developing offshore fields because very few early appraisal data can be collected and no long-term well performance observations are possible. In most cases, pressure maintenance will be required from the outset and has to be based on theoretical estimates and not pilot results. Thus, these conventional oil prospects require front-end capital, the majority of which is at risk should the project fail. In addition, the uncertainty of future oil prices and the currently perceived low-price scenarios reduce the estimate of potential reward. In contrast, large quantities of heavy oil have already been discovered; therefore, no exploration cost is required. In addition, these discoveries awaiting development are mainly onshore and are at shallow depth. Development wells are low cost and the capital expenditure (capex) profile is continuous throughout the project, rather than being front-end loaded. Such thermal processes as cyclic steam injection are well understood, and the technical and geologic risks are therefore small. These advantages, even though the heavy-oil price will be discounted, allow potential heavy-oil production to compare favorably with many high-risk conventional oil plays. Typical predicted cash-flow profiles for a marginal North Sea development and a heavy-oil development are compared in Fig. 1. Table 5 summarizes the resource and development economics of the two fields. Carbonate reservoirs also contain large quantities of heavy oil, but the technology and experience of producing such heavy-oil reservoirs are not well developed. Nevertheless, they are important development targets. The potential production mechanisms that may take place during the thermal stimulation of these reservoirs are discussed later. JPT P. 206^

IntroductionCongenital anomalies are the fifth leading cause of death in children <5 years of age globally, contributing an estimated half a million deaths per year. Very limited literature exists from low and middle income countries (LMICs) where most of these deaths occur. The Global PaedSurg Research Collaboration aims to undertake the first multicentre, international, prospective cohort study of a selection of common congenital anomalies comparing management and outcomes between low, middle and high income countries (HICs) globally.Methods and analysisThe Global PaedSurg Research Collaboration consists of surgeons, paediatricians, anaesthetists and allied healthcare professionals involved in the surgical care of children globally. Collaborators will prospectively collect observational data on consecutive patients presenting for the first time, with one of seven common congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation and Hirschsprung's disease).Patient recruitment will be for a minimum of 1 month from October 2018 to April 2019 with a 30-day post-primary intervention follow-up period. Anonymous data will be collected on patient demographics, clinical status, interventions and outcomes using REDCap. Collaborators will complete a survey regarding the resources and facilities for neonatal and paediatric surgery at their centre.The primary outcome is all-cause in-hospital mortality. Secondary outcomes include the occurrence of post-operative complications. Chi-squared analysis will be used to compare mortality between LMICs and HICs. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.Ethics and disseminationAt the host centre, this study is classified as an audit not requiring ethical approval. All participating collaborators have gained local approval in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for open access publication in a peer reviewed journal.Trial registration numberNCT03666767

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Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...