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.

The epidermal growth factor receptor (EGFR) is a protooncogene that is frequently observed with alterations in late stage gliomas, suggesting an important role of this gene in glial tumorigenesis and progression. In this study we evaluated an antisense EGFR approach as an alternative therapeutic modality for glioblastomas. We transfected U-87MG cells with an antisense EGFR construct and obtained several clones stably expressing lower or undetectable levels of EGFR protein. These clones were found to have impaired proliferation as well as a reduced transforming potential to grow in soft agarose. The number of cells positive for the cell cycle-specific nuclear antigen Ki-67 was also significantly decreased (P < 0.05) in antisense EGFR-transfected clones compared with parental or empty vector-transfected cells. Flow cytometric analysis revealed that the proportion of cells in G0/G1 phases of the cell cycle in the antisense clones increased by up to 31% compared with control cells, whereas the proportion of cells in S phase decreased by up to 58%. In addition, the antisense EGFR-transfected cells showed higher expression of glial fibrillary acidic protein and a more differentiated form, with smaller cell bodies possessing fine tapering cell processes. These results suggest that EGFR plays a major role in modulating cell growth and differentiation in glioblastoma cells. Our experimental model of antisense EGFR provides a basis for future development of antisense EGFR oligodeoxynucleotides in treatment of glioblastomas.

Nonprescription sales of antidiarrheal and antinauseant products are a good predictor of community Norovirus activity. Syndromic surveillance through monitoring of OTC product sales could be useful as an early indicator of the Norovirus season, allowing for appropriate interventions to reduce the number of infections.

In performing statistical analyses, we were able to rank from most to least important, the multiplicity of symptoms signs and test results. The most important symptoms and signs were identified for the first time, even though some of these were not included in our original selection criteria for defining the disease cohort i.e. sniffing, postnasal drip, oedematous nasal mucosa, impaired sense of smell, mouth breathing, itchy nose and many of the specific provocation factors.

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Fatal haemolytic transfusion reaction due to ABO incompatibility occurs mainly as a result of clerical error. A blood sample drawn from the wrong patient and labelled as another patient's will not be detected by the blood bank unless there is a previous ABO grouping result. We report here the detection of such clerical error by the use of a specially designed transfusion wristband. The wristband has the following special features: (i) once attached, it cannot be removed except by cutting; (ii) it has a pocket containing a transfusion label; (iii) a unique transfusion barcode is printed on each transfusion label and the corresponding wristband simultaneously by computer technology; (iv) a transfusion label removed from the wristband after attachment to the patient has a characteristic tear-mark distinguishing it from one removed prior to attachment. The blood bank only accepted those specimens bearing the tear-marked transfusion labels. All blood units for this patient were labelled with this unique transfusion code together with the patient's details. The nurses counter-checked the transfusion code on the blood units against the transfusion code on the patient's transfusion wristband prior to transfusion. If the blood sample for compatibility testing was drawn from the 'wrong' patient, the intended patient either did not carry a wristband or the transfusion codes did not match at all. Pretransfusion compatibility tests were performed on 2189 patient samples using this procedure. It was well accepted by both ward and blood bank staff. Two potential mismatched transfusions were avoided. These two clerical errors would not have been detected because neither patient had previous ABO grouping results.

Despite simulation offers tremendous promise for designing and analyzing complex production systems, manufacturing industry has been less successful in using it as a decision support tool, especially in the early conceptual phase of factory flow design. If simulation is used today for system design, it is more often used in later phases when important design decisions have already been made and costs are locked. With an aim to advocate the use of simulation in early phases of factory design and analysis, this paper introduces FACTS Analyzer, a toolset developed based on the concept of integrating model abstraction, automatic model generation and simulation-based optimization under an innovative Internet-based platform. Specifically, it addresses a novel model aggregation and generation method, which when combined together with other system components, like optimization engines, can synthetically enable simulation to become much easier to use and speed up the time-consuming model building, experimentation and optimization processes, in order to support optimal decision making. INTRODUCTIONReal-world systems in manufacturing, supply chains and public services are too complex to be modeled by analytical techniques. Therefore, discrete event simulation (DES) are very useful for performing modeling and analysis on these systems. However, DES models are by nature evaluative -instead of suggesting any optimal solutions, a DES model evaluates a given set of design variables and generates the required performance measures. For a decision maker, the process of finding a sufficiently good design setting could be too time-consuming and in many cases impossible if the search space is huge. Simulation-based optimization (SBO) is a relatively new technique applied to seek the "optimal" setting for a complex system based on one or multiple performance measures generated from simulation by using various searching methodologies. SBO is a technology that offers huge potentials to solve real-world problems and have been successfully applied in many different domains (April et al. 2004). Nevertheless, until now, virtually all of today's commercial SBO packages still possess several major limitations: (1) they work in a deterministic mode, without taking into account the stochastic outputs from DES; (2) they do not explicitly address multi-objective problems, and (3) similar to most of the DES packages, the majority of SBO tools available is traditional software that need to be installed and run locally on the users' computers. With the vision that Internet and Web technologies could enable the explosive growth in research and commercial opportunities (Fu et al. 2000;Boesel et al. 2001;Miller et al. 2001), many efforts have been paid on Web-based simulation (WBS) since the 1990s. However, as summarized recently by Byrne 2176 978-1-4577-2109-0/11/$26.00 ©2011 IEEE

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