Asafo Music in Context of Simpa Aboakyer Festival

The study investigated how Asafo music accompanies the Aboakyer festival celebrated by the Effutu of Winneba. It took a perfunctory look into the history of the people, the reasons for the celebration of the festival as well as a detailed study of the nature of music performed during the festival celebration. The research design used was ethnographic while interview and participant observation were used to collect the data. Audio recordings were done while musical sounds were transcribed and scored using Finale 2012 music software. It became clear that asafo music is inseparable from the Aboakyer festival as it permeates the entire activities of the festival. Asafo music performance during the festival is not restricted to any particular set of individuals but becomes a public performance where anyone who wishes to perform with an Asafo company could do so. Undoubtedly, Asafo music elements are rich and are source materials for music creative activities. Key words: Aboakyer, Asafo songs, festival, Effutu, Winneba DOI: 10.7176/RHSS/10-14-09 Publication date:July 31st 202

Schedule Delay Analysis of Construction Projects in Ghana: Objectives, Importance and Effects

The critical observance of time allocation and sequence of operation of construction activities are essential for construction project managers, as delays in construction projects have negative impact on clients and contractors. This study aims at assessing the objectives, importance and effects of schedule delay in construction project execution in Ghanaian construction industries. The research design adopted for this study was descriptive survey using quantitative method. A purposive sampling technique was used to select 80 respondents. Opinion of employees was solicited using a structured questionnaire for data collection. The data was analysed using statistical package for social sciences (SPSS) version 20. The result showed that, major objectives of scheduling in construction projects are to expose and adjust conflicts between trades or subcontractors, to serve as an effective project control tools and to resolve delay claims. The study also revealed that the primary importance of scheduling in construction are to finish projects on time, and to ensure customer satisfaction. Furthermore, it was established that lack of scheduling of construction projects contribute to delays and causes disruptions of construction projects. The study concludes that to ensure timely delivery of construction project, the project objectives, importance of scheduling and effects of scheduling are key factors to consider in order to avoid delays. Keywords: construction project, disruption, project planning, project delay, schedulin

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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Design of compositionally complex alloys with lamellar microstructures for laser cladding

In dieser Arbeit arbeiteten mehrere akademische Einrichtungen und Automobilzulieferer im Rahmen des europäischen Projekts $\textit {"Horizon 2020"}$ zusammen. Ziel war es Legierungen zu entwickeln, die zur Lebensdauerverlängerung von Warmumformwerkzeugen eingesetzt werden können. Dafür wurden die chemisch komplexen (CCA) Referenzwerkstoffe Al$_{0.6}$CoCrFeNi und Al${_0.75}$CoCrFeNi betrachtet, die eine grobe lamellare Mikrostruktur aufweisen. Zur Optimierung von Mikrostruktur und mechanischen Eigenschaften wurden verschiedene Legierungsstrategien angewandt, z.B. die Zugabe von Ti, Al und C, sowie die Substitution von Cr mit Mo. Nach eingehenden Untersuchungen wurde die Al$_{0.6}$CoCrFeNi CCA mit Ti- und C-Zusätzen ausgewählt und erfolgreich durch Laserauftragschweißen auf einen herkömmlichen H10-Werkzeugstahl aufgebracht. Aufgrund des Wärmeeintrags und der hohen Abkühlraten während des Laserauftragschweißens, zeigte die abgeschiedene CCA ein feines lamellares Gefüge mit hervorragenden mechanischen Eigenschaften.In this work, several academic institutions and automotive industry subcontractors worked together in a European project $\textit {"Horizon 2020"}$ to design new alloys that could be employed to extend the lifetime of hot forming tools used to produce B-pillars, which are key automotive parts for passenger safety. In this context, the reference materials Al$_{0.6}$CoCrFeNi and Al${_0.75}$CoCrFeNi compositionally complex alloys (CCAs), which exhibit coarse lamellar microstructures were considered. Several alloying strategies, including Ti, Al, and C additions as well as substitutions of Cr by Mo, were employed to optimize their microstructures and mechanical properties. An Al$_{0.6}$CoCrFeNi CCA with Ti and C additions was selected after thorough investigations and successfully processed by laser cladding on a conventional H10 tool steel. Owing to the thermal history and high cooling rates during laser cladding process the as-deposited CCA showed fine lamellar microstructures with superior mechanical properties

Data for: Effect of Al, Ti and C additions on Widmanstätten microstructure and mechanical properties of cast Al0.6CoCrFeNi compositionally complex alloys.

The XRD data present in this paper are 2θ versus intensity data obtained from our diffractometer for all investigated alloys. The XRD data are provided in attached Excel files and a summary of the plotted diffraction patterns is shown in Fig. A1 of supplementary material. The calculated lattice parameters together with their standard deviation for each detected phase are listed in Table 1 for all studied alloys. BSE micrographs taken at different magnifications are presented to document the effect of microalloying on microstructure. For all CCAs, five BSE micrographs are provided, one low magnification image with a remnant indent spanning all phases present in the alloy and four other high magnification micrographs. From some of these BSE images, the microstructural parameters, i.e. mean prior grain size d and average thickness of FCC plates λ listed in Table 2, were determined. The overall chemical composition averaged over all phases present in the studied CCAs were determined in an external laboratory and are listed for some alloys in Table 3. In addition, the local chemical composition of the phases measured at three different locations in a transmission electron microscope (TEM) for the Ti3C0.25 CCA are given in Table 4. The mean volume fraction of the FCC phase provided in Table 2 were determined from a mass balance, see section B of supplementary material. The raw tensile results data obtained at different temperatures are provided in the attached Excel files