Justification of Urgent Brain CT Examinations at Medium Size Hospital, Jerusalem

We studied requested urgent Brain CT Scan procedures justification. In addition, we addressed referrer’s (physician’s) awareness of radiation risks. In doing so, we considered two aspects to the issue. First, we reviewed the records of the requested urgent CT scan procedures for a sample of 339 patients at Al-Maqassed Hospital, a major hospital in Palestine. Secondly, we surveyed a sample of forty-two referrer’s from the same hospital to test their awareness of radiation risks. Our study shows that out of the 339 urgent brain CT requests, 69.6% were justified requests and 30.4% were unjustified. Statistically, these observations implied the following general statement: At least, 25% of the CT requests at this Hospital are unjustified with a p-value of 0.011. On the other hand, our survey on referrers shows that 42% of respondents knew the effective dose of a brain CT scan, 24% of respondents knew the radiation risks and 14% of respondents knew about radiation protection. Although the study is limited, yet it shows the need to reduce the number of brain CT examinations and the need to improve their justification. Consequently, the need for regular education and guideline implementation at least in this country is of paramount importance

The effect of iso‐butanol‐diesel blends on engine performance

The effect of iso‐butanol addition to diesel fuel on engine performance parameters has been experimentally investigated. The used engine was a single cylinder four stroke CI engine Type Lister 1–8. The tests were performed at engine speed that ranges from 375 to 625 with an increment of 42 rpm at different loads and with 10, 20, 30 and 40% v/v iso‐butanol‐diesel fuel blends. The overall engine performance parameters measured included air‐fuel ratio (AFR), exhaust gas temperature, brake power (Bp ), brake specific fuel consumption (bsfc) and brake thermal efficiency (η th ). The experimental results show that AFR, exhaust gas temperature, (Bp ) and (ηbth ) decreased and bsfc increased with iso‐butanol addition compared to net diesel fuel. Also, the obtained results indicate that the engine performance parameters when using up to 30% iso‐butanol in fuel blends are better than that of 40%. First published online: 27 Oct 201

Diversity and Inclusion in International Communications: Applications for Today’s Work World

Verna Myers (2016) advocated that “Diversity is being invited to the party, but inclusion is being asked to dance.” Cultural competence demands a strategic understanding of the importance of harnessing the power of diversity and inclusion in every action in organizations, communities, and nations throughout the world. Today’s work world cannot undervalue the importance of having diverse and inclusive representation in all areas of the organization, especially including international communication. By creating an environment that continually asks questions, values and embraces diversity - then collaborates and reconciles potential solutions to create positive outcomes - creates an inclusive environment in which all can thrive

Copper stearate as a catalyst for improving the oxidation performance of heavy oil in in-situ combustion process

© 2018 Elsevier B.V. Copper stearate was applied as a catalyst for the oxidation of heavy oils. The catalytic effect was investigated by high-pressure differential scanning calorimetry (HP-DSC) and accelerating rate calorimetry (ARC). The results showed that copper stearate significantly improved the oxidation performance including decreasing activation energies, enhancing combustion efficiency of coke, and reducing induction time and ignition temperature. CuO nanoparticles were in-situ formed due to the decomposition of copper stearate. To understand the catalytic mechanism, the catalytic effect of copper stearate was compared with nickel stearate, iron stearate and CuO. Furthermore, the existed form and transition of copper stearate during the oxidation process of crude oil were investigated using thermogravimetric analyser coupled with FTIR-spectrometer (TG-FTIR), HP-DSC, X-ray diffraction (XRD), scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). The results indicated that copper stearate and in-situ formed CuO nanoparticles played their catalytic roles as a homogeneous and heterogenous catalyst in low and high-temperature ranges, respectively. It was believed that the high catalytic activity of CuO can be not only attributed to those well-known catalytic mechanisms, but also benefits from the well-distribution of both copper stearate and in-situ formed CuO nanoparticles

Characteristics of post hoc subgroup analyses of oncology clinical trials: A systematic review

BACKGROUND: Subgroup analyses in clinical trials assess intervention effects on specific patient subgroups, ensuring generalizability. However, they are usually only able to generate hypotheses rather than definitive conclusions. This study examined the prevalence and characteristics of post hoc subgroup analysis in oncology. METHODS: We systematically reviewed published subgroup analyses from 2000 to 2022. We included articles presenting secondary, post hoc, or subgroup analyses of interventional clinical trials in oncology, cancer survivorship, or cancer screening, published separately from the original clinical trial publication. We collected cancer type, year of publication, where and how subgroup analyses were reported, and funding. RESULTS: Out of 16 487 screened publications, 1612 studies were included, primarily subgroup analyses of treatment trials for solid tumors (82%). Medical writers contributed to 31% of articles, and 58% of articles reported conflicts of interest. Subgroup analyses increased significantly over time, with 695 published between 2019 and 2022, compared to 384 from 2000 to 2014. Gastrointestinal tumors (25%) and lymphoid lineage tumors (39%) were the most frequently studied solid and hematological malignancies, respectively. Industry funding and reporting of conflicts of interest increased over time. Subgroup analyses often neglected to indicate their secondary nature in the title. Most authors were from high-income countries, most commonly North America (45%). CONCLUSIONS: This study demonstrates the rapidly growing use of post hoc subgroup analysis of oncology clinical trials, revealing that the majority are supported by pharmaceutical companies, and they frequently fail to indicate their secondary nature in the title. Given the known methodological limitations of subgroup analyses, caution is recommended among authors, readers, and reviewers when conducting and interpreting these studies

Ethical issues in human genomics research in developing countries

<p>Abstract</p> <p>Background</p> <p>Genome-wide association studies (GWAS) provide a powerful means of identifying genetic variants that play a role in common diseases. Such studies present important ethical challenges. An increasing number of GWAS is taking place in lower income countries and there is a pressing need to identify the particular ethical challenges arising in such contexts. In this paper, we draw upon the experiences of the MalariaGEN Consortium to identify specific ethical issues raised by such research in Africa, Asia and Oceania.</p> <p>Discussion</p> <p>We explore ethical issues in three key areas: protecting the interests of research participants, regulation of international collaborative genomics research and protecting the interests of scientists in low income countries. With regard to participants, important challenges are raised about community consultation and consent. Genomics research raises ethical and governance issues about sample export and ownership, about the use of archived samples and about the complexity of reviewing such large international projects. In the context of protecting the interests of researchers in low income countries, we discuss aspects of data sharing and capacity building that need to be considered for sustainable and mutually beneficial collaborations.</p> <p>Summary</p> <p>Many ethical issues are raised when genomics research is conducted on populations that are characterised by lower average income and literacy levels, such as the populations included in MalariaGEN. It is important that such issues are appropriately addressed in such research. Our experience suggests that the ethical issues in genomics research can best be identified, analysed and addressed where ethics is embedded in the design and implementation of such research projects.</p

Role of nano-capacitor on dielectric constant enhancement in PEO:NH4SCN:xCeO2 polymer nano-composites: Electrical and electrochemical properties

Solution casting technique has been successfully employed to prepare nano-composite films. Various weight ratios of cerium oxide (CeO2) nanoparticle were added to a PEO:NH4SCN:xCeO2 polymer matrix to enhance the ionic conductivity at ambient temperature. The electrical and electrochemical properties of the composite electrolyte systems have been investigated using impedance, dielectric properties (ɛ*, tanδ, and M*), transfer number measurement (TNM), linear sweep voltammetry (LSV), and cyclic voltammetry (CV) techniques. The highest ionic conductivity of ∼8.57 × 10−4 S/cm is obtained for the system incorporated with 3 wt.% of CeO2 filler. This study presented a new approach and the complex permittivity confirmed that the real part value of dielectric constant (ɛ′) for all samples has found to be much higher than the imaginary part (ɛ″) value. The appearance of the peaks at a characteristic frequency in the loss tangent indicates the existence of relaxation. Low dielectric modulus is observed for 3 wt.% of CeO2 incorporated. The TNM measurements confirmed the ionic conductivity of NCSPEs and ion transport tion of films have been found to be 0.84, 0.96 and 0.92 for 1 wt.%, 3 wt.%, and 5 wt.% of CeO2, respectively. The system incorporated with 3 wt.% of CeO2 has discovered to be electrochemically stable up to 1.4 V. From the CV analysis it is noticeable that the energy storage mechanism of the EDLC is a combination of double-layer capacitance and pseudo capacitance. A value of 88.9 F/g is achieved at 20 mV/s

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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century