Development of a highly sensitive electrochemical sensing platform for the trace level detection of lead ions.

Herein we report for the first time a highly sensitive electrochemical platform for the trace level detection of Pb (ӏӏ) using glassy carbon electrode modifiedwith 1-dodecanoyl-3-phenylthiourea (DPT). The performance of the designed sensor was tested by electrochemical impedance spectroscopy, chronocoulometry, cyclic voltammetry and Square Wave Anodic Stripping Voltammetry (SWASV). The DPT was found to play an efficient role in enhancing the sensing response of the electrode for the detection of lead ions in aqueous samples. A number of experimental conditions such as deposition potential, accumulation time, surfactant concentration, pH, number of scans and supporting electrolytes were examined to optimize conditions for getting intense signal of the target analyte. Linear calibration curve was obtained using SWAS voltammetric data obtained under optimized conditions. The limit of detection with a value of 0.695 μg/L suggests that the designed sensor can sense lead ions even below the permissible concentration level (10 μg/L) recommended by the World Health Organization and Environmental Protection Agency of USA. The designed sensor demonstrated sensitivity, selectivity and stability for the targeted analyte. Percentage recoveries from real water samples with standard deviations of less than 2% suggested precision of the proposed method. Moreover, computational findings supported the experimental outcomes

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Economic vulnerability and resilience of small states

The Maldives is a small island developing state, heavily dependent on fisheries and tourism, which are major sources of foreign exchange earnings and government revenue, and which together account for about 40 percent of gross domestic product. The success of these industries depends on climatic conditions. This renders the country very vulnerable economically and environmentally. The Least Developed Country status of the Maldives is under threat because the country has experienced relative economic improvements that, ironically, have to a large extent been possible by virtue of the support accorded to the Maldives as an LDC. This chapter argues that the criteria used in assessing LDC status need to be refined so as to give more weight to economic vulnerability. The chapter also proposes that no country should be graduated until the criteria are appropriately refined, so as to avoid the risk that the country in question ends up worse-off in spite of its economic successes.peer-reviewe

Assessment Of Emergency And Primary Dental Care At King Saud University College Of Dentistry

A retrospective study of the emergency and primary dental care patients treated at King Saud University College of Dentistry was carried out for the years 1987 and 1988. The total number of patients treated was 17,653 during 1987 and 16,221 during 1988. Restorative treatment constituted the major category followed by consultations, screenings and extractions. Periodontal and prosthetic treatment was much less compared with other categories of dental care. There was an improvement in dentist-to-patient ratio during 1988 as compared to 1987. The overall trend of dental care could be gauged only by a comprehensive analyses of dental treatment at the primary care clinics, students and specialist clinics of the College

A Unique Case of Low-Grade Mucinous Neoplasm in Stump Appendectomy

Background. We describe a case of a young male with a history of appendectomy one year ago, who developed symptoms of stump appendicitis, and after removing this stump, histopathology showed low grade neoplasm. Summary. Stump appendicitis is an uncommon complication after appendectomy and may lead to serious complications. Management of low-grade appendiceal mucinous neoplasm (LAMN) is controversial, and we discuss the importance of the case. Conclusion. The case of young male post stump appendectomy with histopathology showing LAMN in the stump of the appendix, which to our knowledge, is the first in the medical literature and, discuss the stump appendicitis and incomplete appendectomy concerning malignancy, mucinous neoplasm, and adenocarcinoma

Incidence, risk factors and outcomes of acute kidney injury in surgical intensive care unit octogenarians at the Jordan University Hospital

Abstract Background Acute kidney damage (AKI) is among the most severe consequences observed in surgical intensive care units (SICUs). We aim to observe the incidence, risk factors, and outcomes of acute kidney injury in SICU octogenarians. Methods A cross-sectional retrospective study was conducted at the SICU of Jordan University Hospital (JUH), a tertiary teaching hospital in a developing country, between January 2018 and December 2019. Patients who were 80 years or older at the time of data collection were included. The definition of AKI was based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Demographic, clinical, and laboratory data were reviewed. Results A total number of 168 patients were included. The mean age was 84.0 ± 3.8 years, and 54.8% of the participants were women. Of those, 115 (68.5%) had surgery before or during ICU stay, and 28.7% of the patients’ surgeries were an emergency surgery. Also, 47.8% of surgeries were considered by anesthesia to be high-risk surgeries. A total of 55 patients (32.7%) developed AKI during their SICU stay. The factors that were significantly associated with AKI in the ICU patients included use of beta blocker [AOR: 3.7; 95% CI: 1.2–11.8; p = 0.025], and inotropes [AOR:4.0; 95% CI: 1.2–13.3; p = 0.03]. The factors that were significantly associated with mortality in the ICU included using mechanical ventilation [AOR:18.7; 95% CI: 2.4-141.9; p = 0.005] and inotropes use [AOR: 12.3; 95% CI: 1.2-120.7; p = 0.031]. Conclusions The incidence of AKI during SICU stay in this study was 32.7% and it was significantly associated with the use of beta blockers, mechanical ventilation, and inotropes. The mortality rate among octogenarians who developed AKI during SICU stay was 36.4%. Further studies are needed globally to assess the incidence of AKI in octogenarian surgical patients and identify risk factors to provide preventative measurements and strategies

Key economic sectors and services

Introduction and Context This chapter discusses the implications of climate change on key economic sectors and services, for example, economic activity. Other chapters discuss impacts from a physical, chemical, biological, or social perspective. Economic impacts cannot be isolated; therefore, there are a large number of cross-references to sections in other chapters of this report. In some cases, particularly agriculture, the discussion of the economic impacts is integrated with the other impacts. Focusing on the potential impact of climate change on economic activity, this chapter addresses questions such as: How does climate change affect the demand for a particular good or service? What is the impact on its supply? How do supply and demand interact in the market? What are the effects on producers and consumers? What is the effect on the overall economy, and on welfare? An inclusive approach was taken, discussing all sectors of the economy. Section SM10.1 found in this chapter’s on-line supplementary material shows the list of sectors according to the International Standard Industrial Classification. This assessment reflects the breadth and depth of the state of knowledge across these sectors; many of which have not been evaluated in the literature. We extensively discuss five sectors: energy (Section 10.2), water (Section 10.3), transport (Section 10.4), tourism (Section 10.6), and insurance (Section 10.7). Other primary and secondary sectors are discussed in Section 10.5, and Section 10.8 is devoted to other service sectors. Food and agriculture is addressed in Chapter 7. Sections 10.2 through 10.8 discuss individual sectors in isolation. Markets are connected, however. Section 10.9 therefore assesses the implications of changes in any one sector on the rest of the economy. It also discusses the effect of the impacts of climate change on economic growth and development. Chapter 19 assesses the impact of climate change on economic welfare-that is, the sum of changes in consumer and producer surplus, including for goods and services not traded within the formal economy