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,...

Computer simulation of dense crowds is finding increased use in event planning, congestion prediction, and threat assessment. State-of-the-art particle-based crowd methods assume and aim for collision-free trajectories. That is an idealistic yet not overly realistic expectation, as near-collisions increase in dense and rushed settings compared with typically sparse pedestrian scenarios. Centroidal particle dynamics (CPD) is a method we defined that explicitly models the compressible personal space area surrounding each entity to inform its local pathing and collision-avoidance decisions. We illustrate how our proposed agent-based method for local dynamics can reproduce several key emergent dense crowd phenomena at the microscopic level with higher congruence to real trajectory data and with more visually convincing collision-avoidance paths than the existing state of the art. We present advanced models in which we consider distraction of the pedestrians in the crowd, flocking behavior, interaction with vehicles (ambulances, police) and other advanced models that show that emergent behavior in the simulated crowds is similar to the behavior observed in reality. We discuss how to increase confidence in CPD, potentially making it also suitable for use in safety-critical applications, including urban design, evacuation analysis, and crowd-safety planning.

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Crowd simulation demands careful consideration in regard to the classic trade-off between accuracy and efficiency. Particle-based methods have seen success in various applications in architecture, military, urban planning, and entertainment. This method focuses on local dynamics of individuals in large crowds, with a focus on serious games and entertainment. The technique uses an area-based penalty force that captures the infringement of each entity's personal space. This method does not need a costly nearest-neighbor search and allows for an inherently data-parallel implementation capable of simulating thousands of entities at interactive frame rates. The algorithm reproduces personal space compression around motion barriers for moving crowds and around points of interest for static crowds.