Analysis of road traffic crashes in the State of Qatar

Road traffic crashes (RTCs) are globally acknowledged as increasing threat to society, because they can affect many lives when they result in severe injury or fatality. In the State of Qatar RTCs are getting more awareness and attention, aiming to improve the traffic safety in the country. This study is an exploratory research providing different analyses of the crash data for seven consecutive years, ranging from 2010 to 2016, which is obtained from the Traffic Department in the Ministry of Interior for the State of Qatar. The objectives aim to evaluate the trend of RTC rate over time and create understanding of the influencing factors related to RTC frequency. Time series analyses show an increasing trend of RTCs leading to severe injury and a slight decreasing trend for fatal RTCs. Secondly, different RTC severity levels are related to diverse RTC causes. Furthermore, the results revealed that crashes with severe injuries or fatality for drivers as well as pedestrians are found to be significantly affected by seasonal weather variations, with the highest vulnerability in winter and autumn season. This study therefore suggests the implementation of strategies to prioritize the traffic safety of road users during the crash-prone winter and autumn seasons. - 2019, - 2019 Informa UK Limited, trading as Taylor & Francis Group.This publication was made possible by the NPRP award [NPRP 9-360-2-150] from the Qatar National Research Fund (a member of The Qatar Foundation). The statements made herein are solely the responsibility of the authors.Scopu

Effect of reducing barley grain degradability on lambs weight, colostrum, milk production, their composition and some biochemical blood trats in Awassi ewes

This study was conducted in research department of animal resource / Al-Rashidiya, by using 21 of Awassi ewes in the last two months of gestation, ewes were divided according to their body weight, age and milk production during the previous season into three groups, daily feed intake in all groups was restricted with 1.5 kg / ewe on rations consist of barley, wheat bran, soybean meal, urea and straw. the first group was fed on ration contained barley untreated with formaldehyde (T1), while barley grain treated with formaldehyde in the ration of second group (T2), the third group fed on formaldehyde treated barley in late gestation and switch directly after lambing to the untreated barley (T3). Results indicated that differences was non-significant in colostrum yield 138±16.41, 163±19.26 and 127±19.43 g/ hr and in its components, milk yield was increased (P<0.05) in T2 1411±99.04 g/ day as compared with T1 and T2 1080±77.02 and 940±34.54 g/ day respectively, while no significant differences was noted in milk composition. Efficiency of protein and energy intake for milk production significantly higher (P<0.01) in T2 which were 26.42±2.01 and 42.24±3.55% compared to T1 (20.56±1.59 and 34.31±2.99%) and only in energy efficiency as compared with T3 which were (17.70±0.78 and 30.62±1.34%). Result of blood parameters after four week postpartum was indicated a significant (P<0.05) increase in cholesterol concentration in T1 69.60±4.85 mg/ dl compared to T2 and T3 56.55±3.67 and 54.73±3.99 mg/ dl, blood creatinine concentration decreased (P<0.05) in T3 5.03±0.53 mg/ dl as compared to T1 and T2 which were 9.60±0.77 and 9.35±0.53 mg/ dl respectively. In conclusion, reducing barley grain degradability improve feed efficiency and ewes performance, while the directly change of the feeding after lambing from low degraded barley to the normal barley grain had a negative effect in performance

Citrulline as a Diagnostic Parameter and a Major Amino Acid Constituent of Cerebrospinal Fluid in Hepatic Coma

Peer Reviewe

Tyrannobdella rex N. Gen. N. Sp. and the Evolutionary Origins of Mucosal Leech Infestations

BACKGROUND: Leeches have gained a fearsome reputation by feeding externally on blood, often from human hosts. Orificial hirudiniasis is a condition in which a leech enters a body orifice, most often the nasopharyngeal region, but there are many cases of leeches infesting the eyes, urethra, vagina, or rectum. Several leech species particularly in Africa and Asia are well-known for their propensity to afflict humans. Because there has not previously been any data suggesting a close relationship for such geographically disparate species, this unnerving tendency to be invasive has been regarded only as a loathsome oddity and not a unifying character for a group of related organisms. PRINCIPAL FINDINGS: A new genus and species of leech from Perú was found feeding from the nasopharynx of humans. Unlike any other leech previously described, this new taxon has but a single jaw with very large teeth. Phylogenetic analyses of nuclear and mitochondrial genes using parsimony and Bayesian inference demonstrate that the new species belongs among a larger, global clade of leeches, all of which feed from the mucosal surfaces of mammals. CONCLUSIONS: This new species, found feeding from the upper respiratory tract of humans in Perú, clarifies an expansion of the family Praobdellidae to include the new species Tyrannobdella rex n. gen. n. sp., along with others in the genera Dinobdella, Myxobdella, Praobdella and Pintobdella. Moreover, the results clarify a single evolutionary origin of a group of leeches that specializes on mucous membranes, thus, posing a distinct threat to human health

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

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. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Improved Road Safety at Work Zones Using Advanced Traveler Information Systems

Work zones are road sections where road construction or maintenance activities take place. These work zones usually have different alignment and furniture than the original road and thus temporary lower speeds are adopted at these locations. However, drivers usually face difficulty in adopting the new speed limit and maneuvering safely due to the change in alignment. Therefore, work zones are commonly considered as hazardous locations with higher crash rates and severities as reported in the literature. This study aims to investigate the effectiveness of a variable message signs (VMSs) based system for work zone advance warning area. The proposed system aims at enhancing driver adaptation of the reduced speed limit, encourage early lane changing maneuvers and improve the cooperative driving behavior in the pre-work zone road section. The study was conducted using a driving simulator at the College of Engineering of Qatar University. Seventy volunteers holding a valid Qatari passenger car driving license participated in this study. In the simulator experiment, we have two scenarios (control and treatment). The control scenario was designed based on the Qatar Work Zone Traffic Management Guide (QWZTMG), where the length of the advance warning area is 1000 m. Meanwhile, the treatment scenario contains six newly designed variable message signs where two of them were animation-based. The VMSs were placed at the same locations of the static signs in the control scenario. Both scenarios were tested for two situations. In the first situation, the participants were asked to drive on the left lane while in the second situation, they were instructed to drive on the second lane. The study results showed that the proposed system was effective in motivating drivers to reduce their traveling speed in advance. Compared to the control scenario, drivers' mean speed was significantly 6.3 and 11.1 kph lower in the VMS scenario in the first and second situations, respectively. Furthermore, the VMS scenario encouraged early lane changing maneuvers. In the VMS scenario, drivers changed their lanes in advance by 150 m compared to the control scenario. In addition, the proposed system was effective in motivating drivers to keep larger headways with the frontal merging vehicle. Taking into account the results from this study, we recommend the proposed VMS based system as a potentially effective treatment to improve traffic safety at work zones