Linear and Nonlinear Chiroptical Effects

Chiroptical effects of linear and nonlinear nature are investigated by employing a variety of spectroscopic methods, such as linear and nonlinear circular dichroism, optical rotation, vibrational Raman scattering, infrared absorption and Vibrational Circular Dichroism. (2+1) Resonance Enhanced Multiphoton Ionization Circular Dichroism (REMPICD) is a direct demonstration of the nonlinear chiroptical effects of a sample of R-(+)-3-methylcyclopentanone. Solvent effects on circular dichroism is studied for 35 common solvents, which is significantly attributed to the solute- solvent electrostatic and Van der waals interactions for CD and ORD of R3MCP. Hartree-Fock and Density Function Theoretical calculations of R3MCP CD and ORD in solvation are also employed to support the experimental findings. Enantiomers (R, S) of chiral molecules are known to exhibit optical activity effects which are equal in magnitude and opposite in sign. For some carbonyl molecules (possessing the C=O) the equatorial and axial conformers also exhibit CD and ORD of opposite sign but not necessarily the same absolute magnitude. Studies of the temperature variation of the CD and Raman spectra are shown to be a useful technique to study the conformer’s populations and energy difference. IR absorption and Vibrational Circular Dichroism (VCD) of carvone, and limonene, are also studied as an example of molecules having different conformers. IR and VCD Density Function theory (DFT) calculations of the vibrational levels are compared with experimental results in order to establish the dominate (lowest energy) conformer

Volumetric modulated arc therapy for spine SBRT patients to reduce treatment time and intrafractional motion

Volumetric modulated arc therapy (VMAT) is an efficient technique to reduce the treatment time and intrafractional motion to treat spine patients presented with severe back pain. Five patients treated with spine stereotactic body radiation therapy (SBRT) using 9 beams intensity modulated radiation therapy (IMRT) were retrospectively selected for this study. The patients were replanned using two arcs VMAT technique. The average mean dose was 104% ± 1.2% and 104.1% ± 1.0% in IMRT and VMAT, respectively (p = 0.9). Accordingly, the average conformal index (CI) was 1.3 ± 0.1 and 1.5 ± 0.3, respectively (p = 0.5). The average dose gradient (DG) distance was 1.5 ± 0.1 cm and 1.4 ± 0.1 cm, respectively (p = 0.3). The average spinal cord maximum dose was 11.6 ± 1.0 Gy and 11.8 ± 1.1 Gy (p = 0.8) and V10Gy was 7.4 ± 1.4 cc and 8.6 ± 1.7 cc (p = 0.4) for IMRT and VMAT, respectively. Accordingly, the average number of monitor units (MUs) was 6771.7 ± 1323.3 MU and 3978 ± 576.7 MU respectively (p = 0.02). The use of VMAT for spine SBRT patients with severe back pain can reduce the treatment time and intrafractional motion

Synthesis, characterization, and performance evaluation of hybrid waste sludge biochar for cod and color removal from agro-industrial effluent

Agro-waste management processes are evolving through the development of novel experimental approaches to understand the mechanisms in reducing their pollution levels efficiently and economically from industrial effluents. Agro-industrial effluent (AIE) from biorefineries that contain high concentrations of COD and color are discharged into the ecosystem. Thus, the AIE from these biorefineries requires treatment prior to discharge. Therefore, the effectiveness of a continuous flow bioreactor system (CFBS) in the treatment of AIE using hybrid waste sludge biochar (HWSB) was investigated. The use of a bioreactor with hydraulic retention time (HRT) of 1–3 days and AIE concentrations of 10–50% was used in experiments based on a statistical design. AIE concentration and HRT were optimized using response surface methodology (RSM) as the process variables. The performance of CFBS was analyzed in terms of COD and color removal. Findings indicated 76.52% and 66.97% reduction in COD and color, respectively. During biokinetic studies, the modified Stover models were found to be perfectly suited for the observed measurements with R2 values 0.9741 attained for COD. Maximum contaminants elimination was attained at 30% AIE and 2-day HRT. Thus, this study proves that the HWSB made from biomass waste can potentially help preserve nonrenewable resources and promote zero-waste attainment and principles of circular economy

Open Access Publication of Universiti Sains Malaysia: a Bibliometric Analysis

Open Access (OA) is the new publishing model that allows unrestricted access and reuse of research outputs. OA accelerates discovery in the sense that researchers can freely read and build on new findings based on other research. While public seems to welcome more involvement in OA among academics, many researchers are still discussing about the challenges that they face to publish with OA journals including the issue of article processing charge (APC) and the quality of OA journals. This paper examines several aspects relate to OA publication such as publication productivity, citation impact, subject coverage, and publishing cost of Universiti Sains Malaysia (USM) based on SCOPUS data from 2013 to 2015. The findings show that School of Medical Sciences, Physics and Pharmacy dominated the OA publications. Thus, it also indicates that science-based researchers are highly inclined towards publishing in OA as compared to non-science researchers. Top three OA journals in the list are Plos One (Multidisciplinary), Acta Chrystallographica Section E (Chemistry) and Electronic Journal of Geotechnical Engineering (Engineering, Geology). Most of the authors tend to publish in Quartile 3 journals (43%), followed by Q2 (28%), Q1 (16%) and Q4 (13%). However, with regard to citation impact per paper (average), every paper in Q1 journal received 6.25 citations, followed by Q2 (2.8 citations), Q3 (1.33 citations) and Q4 (0.87 citation). The APC range of OA publication found to be from RM0 to RM15, 000 per paper. The study provides useful insights about OA publication among USM researchers which can guide other researchers who wish to engage with OA in the future. Further study can be done by interviewing authors, to further explore on the OA research funding, strategy in choosing OA journals to publish in and also the motivation in publishing with OA

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary 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. Methods We 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. Findings We 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, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy