A Suggestion of a Procedural Method for the Management of Post-War Waste

The increasing number of disasters (natural or man-made) worldwide has made post-disaster waste management an essential aspect of disaster recovery. This is obvious in Iraq where the Iraqi government faces an important challenge regarding the events of 2014 (ISIS gang conflict) and the accumulation of huge volumes of construction and demolition (C&D) waste resulting from military operations and terrorist destruction. Field surveys by the specialist teams estimated the amount of waste at about 10 million tons in the Nineveh governorate only, much of which comprises potentially useful materials that could be reused or recycled in the reconstruction process. This paper investigates the obstacles to the sustainable management of such waste in the Nineveh governorate. A pilot questionnaire survey of 76 experts working in the waste management sector was carried out to identify the obstacles to the sustainable management of accumulated waste in the Nineveh governorate. Data analysis was carried out using SPSS version 23.0. Based on the identified obstacles, a procedural method of managing post-war waste that accumulated in Iraq has been created. The paper illustrates several conclusions in the strategic, economic, social, and environmental sectors to address identified gaps in sustainable waste management in Iraq. It is hoped that this study’s results will support post-disaster sustainable development goals in Iraq

Association of Body Mass Index and Extreme Obesity With Long-Term Outcomes Following Percutaneous Coronary Intervention

Background: Previous studies have reported a protective effect of obesity compared with normal body mass index (BMI) in patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether this effect extends to the extremely obese. In this large multicenter registry‐based study, we sought to examine the relationship between BMI and long‐term clinical outcomes following PCI, and in particular to evaluate the association between extreme obesity and long‐term survival after PCI. Methods and Results: This cohort study included 25 413 patients who underwent PCI between January 1, 2005 and June 30, 2017, who were prospectively enrolled in the Melbourne Interventional Group registry. Patients were stratified by World Health Organization–defined BMI categories. The primary end point was National Death Index–linked mortality. The median length of follow‐up was 4.4 years (interquartile range 2.0‐7.6 years). Of the study cohort, 24.8% had normal BMI (18.5‐24.9 kg/m2), and 3.3% were extremely obese (BMI ≥40 kg/m2). Patients with greater degrees of obesity were younger and included a higher proportion of diabetics (P<0.001). After adjustment for age and comorbidities, a J‐shaped association was observed between different BMI categories and adjusted hazard ratio (HR) for long‐term mortality (normal BMI, HR 1.00 [ref]; overweight, HR 0.85, 95% CI 0.78‐0.93, P<0.001; mild obesity, HR 0.85, 95% CI 0.76‐0.94, P=0.002; moderate obesity, HR 0.95, 95% CI 0.80‐1.12, P=0.54; extreme obesity HR 1.33, 95% CI 1.07‐1.65, P=0.01). Conclusions: An obesity paradox is still apparent in contemporary practice, with elevated BMI up to 35 kg/m2 associated with reduced long‐term mortality after PCI. However, this protective effect appears not to extend to patients with extreme obesity

Prevalence, determinants, and clinical associations of high-sensitivity cardiac troponin in patients attending emergency departments

Background: High-sensitivity cardiac troponin assays may improve the diagnosis of myocardial infarction but increase the detection of elevated cardiac troponin in patients without acute coronary syndrome. Methods: In a prospective cohort study, we evaluated the prevalence, determinants, and outcome of patients with elevated cardiac troponin attending the emergency department without suspected acute coronary syndrome. We measured high-sensitivity cardiac troponin in 918 consecutive patients attending the emergency department without suspected acute coronary syndrome who had blood sampling performed by the attending clinician. Elevated high-sensitivity cardiac troponin I was defined as concentrations above the sex-specific 99th percentile threshold. Clinical demographics, physiological measures, and all-cause mortality at 1 year associated with elevated high-sensitivity cardiac troponin concentrations were recorded. Results: Elevated cardiac troponin concentration occurred in 114 (12.4%) patients, of whom 2 (0.2%), 3 (0.3%), and 109 (11.9%) were adjudicated as type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively. Elevated troponin concentrations were associated with increasing age, worsening renal function, multimorbidity, and adverse physiology. Across a total of 912 patient-years follow-up, cardiac troponin concentration was a strong predictor of death (hazard ratio [HR] 1.26 per 2-fold increase, 95% confidence interval [CI] 1.06 to 1.49) independent of age, sex, multimorbidity, and adverse physiology. Conclusions: High-sensitivity cardiac troponin concentrations were elevated in 1 in 8 consecutive patients without suspected acute coronary syndrome attending the emergency department and were associated with increasing age, multimorbidity, adverse physiology, and death. Elevated cardiac troponin in unselected patients predominantly reflects myocardial injury rather than myocardial infarction

Development of a few TW Ti:Sa laser system at 100 Hz for proton acceleration

[EN] We report the development of a table-top high peak power Titanium:Sapphire (Ti:Sa) CPA laser working at 100 Hz capable of delivering 205 mJ, 55 fs pulses. Every amplification stage is pumped by Nd-doped solid-state lasers and fully powered by diodes. Thermal effects in the Ti:Sa amplifiers are compensated passively with optics. This system is intended to be used for proton acceleration experiments at high repetition rates.Centro para el Desarrollo Tecnológico Industrial (CDTI, Spain) within the INNPRONTA program, Grant no. IPT-20111027.Lera, R.; Bellido-Millán, PJ.; Sánchez, I.; Mur, P.; Seimetz, M.; Benlloch Baviera, JM.; Roso, L.... (2019). Development of a few TW Ti:Sa laser system at 100 Hz for proton acceleration. Applied Physics B. 125(1):1-8. https://doi.org/10.1007/s00340-018-7113-8S181251P. Zeitoun, G. Faivre, S. Sebban, T. Mocek, A. Hallou, M. Fajardo, D. Aubert, P. Balcou, F. Burgy, D. Douillet, S. Kazamias, G. de Lachèze-Murel, T. Lefrou, S. le Pape, P. Mercère, H. Merdji, A.S. Morlens, J.P. Rousseau, C. Valentin, Nature 431(7007), 426–429 (2004)V. Malka, S. Fritzler, E. Lefebvre, M.-M. Aleonard, F. Burgy, J.-P. Chambaret, J.-F. Chemin, K. Krushelnick, G. Malka, S.P.D. Mangles, Z. Najmudin, M. Pittman, J.-P. Rousseau, J.-N. Scheurer, B. Walton, A.E. Dangor, Science 298(5598), 1596–1600 (2002)H. Daido, M. Nishiuchi, A.S. Pirozhkov, Rep. Progress Phys. 75(5), 056401 (2012)A. Macchi, M. Borghesi, M. Passoni, Rev. Mod. Phys. 85, 751–793 (2013)T. Tajima, J.M. Dawson, Phys. Rev. Lett. 43, 267–270 (1979)M. Noaman-ul Haq, H. Ahmed, T. Sokollik, L. Yu, Z. Liu, X. Yuan, F. Yuan, M. Mirzaie, X. Ge, L. Chen, J. Zhang, Phys. Rev. Accel. Beams 20, 041301 (2017)D. Strickland, G. Mourou, Opt. Commun. 53(3), 219–221 (1985)G. Cheriaux, B. Walker, L.F. Dimauro, P. Rousseau, F. Salin, J.P. Chambaret, Opt. Lett. 21(6), 414–416 (1996)P. Tournois, Opt. Commun. 140(4), 245–249 (1997)R. Soulard, A. Brignon, S. Raby, E. Durand, R. Moncorgé, Appl. Phys. B 106(2), 295–300 (2012)J. Liu, L. Ge, L. Feng, H. Jiang, H. Su, T. Zhou, J. Wang, Q. Gao, J. Li, Chin. Opt. Lett. 14(5), 051404 (2016)A. Maleki, M.K. Tehrani, H. Saghafifar, M.H.M. Dindarlu, H. Ebadian, Laser Phys. 26(2), 025003 (2016)R. Lera, F. Valle-Brozas, S. Torres-Peiró, A.R. de-la Cruz, M. Galán, P. Bellido, M. Seimetz, J.M. Benlloch, L. Roso, Appl. Opt. 55(33), 9573–9576 (2016)R. Lausten, P. Balling, J. Opt. Soc. Am. B 20(7), 1479–1485 (2003)I. Nam, M. Kim, T.H. Lee, S.W. Lee, H. Suk, Curr. Appl. Phys. 15(4), 468–472 (2015)E. Treacy, IEEE J. Quantum Electron. 5(9), 454–458 (1969)A. Trisorio, S. Grabielle, M. Divall, N. Forget, C.P. Hauri, Opt. Lett. 37(14), 2892–2894 (2012)Y.-H. Cha, Y.-W. Lee, S.M. Nam, J.M. Han, Y.J. Rhee, B.D. Yoo, B.C. Lee, Y.U. Jeong, Appl. Opt. 46(28), 6854–6858 (2007)P. Bellido, R. Lera, M. Seimetz, A.R. de la Cruz, S. Torres-Peiró, M. Galán, P. Mur, I. Sánchez, R. Zaffino, L. Vidal, A. Soriano, S. Sánchez, F. Sánchez, M. Rodríguez-Álvarez, J. Rigla, L. Moliner, A. Iborra, L. Hernández, D. Grau-Ruiz, A. González, J. García-Garrigos, E. Díaz-Caballero, P. Conde, A. Aguilar, L. Roso, J. Benlloch, J. Instrum. 12(05), T05001 (2017

Patient selection for high sensitivity cardiac troponin testing and diagnosis of myocardial infarction: prospective cohort study

Objective: To evaluate how selection of patients for high sensitivity cardiac troponin testing affects the diagnosis of myocardial infarction across different healthcare settings. Design: Prospective study of three independent consecutive patient populations presenting to emergency departments. Setting: Secondary and tertiary care hospitals in the United Kingdom and United States. Participants: High sensitivity cardiac troponin I concentrations were measured in 8500 consecutive patients presenting to emergency departments: unselected patients in the UK (n=1054) and two selected populations of patients in whom troponin testing was requested by the attending clinician in the UK (n=5815) and the US (n=1631). The final diagnosis of type 1 or type 2 myocardial infarction or myocardial injury was independently adjudicated. Main outcome measures: Positive predictive value of an elevated cardiac troponin concentration for a diagnosis of type 1 myocardial infarction. Results: Cardiac troponin concentrations were elevated in 13.7% (144/1054) of unselected patients, with a prevalence of 1.6% (17/1054) for type 1 myocardial infarction and a positive predictive value of 11.8% (95% confidence interval 7.0% to 18.2%). In selected patients, in whom troponin testing was guided by the attending clinician, the prevalence and positive predictive value were 14.5% (843/5815) and 59.7% (57.0% to 62.2%) in the UK and 4.2% (68/1631) and 16.4% (13.0% to 20.3%) in the US. Across both selected patient populations, the positive predictive value was highest in patients with chest pain, with ischaemia on the electrocardiogram, and with a history of ischaemic heart disease. Conclusions: When high sensitivity cardiac troponin testing is performed widely or without previous clinical assessment, elevated troponin concentrations are common and predominantly reflect myocardial injury rather than myocardial infarction. These observations highlight how selection of patients for cardiac troponin testing varies across healthcare settings and markedly influences the positive predictive value for a diagnosis of myocardial infarction

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Boswellic Acid Fractions Induces Apoptosis And Cell Cycle Arrest In Hepatocellular Carcinoma Cell Line (HEP-G2) Through P53 Accumulation

There has been growing interest in naturally occurring compounds with anti-cancer potential. Boswellic acid fractions (BA) are the bioactive constituent of the oleogum resin of Boswellia carterii Birdwood (Bursearceae). It has been shown to exert anti-neoplastic and anti-inflammatory effects. The antitumor activity molecular pathways of BA action are not clear. Nevertheless, BA is known to induce apoptosis by p53-dependent and p53-independent pathways in cancer cell lines. Growth inhibition is associated with induction of cellcycle arrest. In this study, the anticancer effect of BA in human HepG-2 cancercells line was investigated. BA has exhibited effective cell growth inhibition by inducing cancer cells to undergo G2/M phase arrest and apoptosis. Blockade of cell cycle was associated with increased levels of p21. BA treatment triggered the apoptotic pathway indicated by a change in caspase-8 and caspase-3 activation. We also found that, BAinduced cell growth inhibition as a result of increase in the expression level of p53. These results confirm a critical role of p53 in BAinduced G2/M arrest and apoptosis of human hepatoma cancer cells

Uterus didelphys in a buffalo heifer: a case report

Uterus didelphys or true double cervix is a congenital anatomical defect of the female genital tract of monotocous species, including cattle and humans (1). The defect is characterized by presence of completely separated cervices, each one leading to a separate uterine horn. The condition has been attributed to failure of fusion of the caudal portions of the paramesonephric ducts during embryonic development, resulting in a double cervix or a divided uterine funds (2). These cases could conceive normally, but may show dystocia due to a fetal limb entering each cervical canal (3). Case reports of uterus didelphys in cows are sporadic (4,5). A Fig 1: A- Buffalo heifer reproductive tract showing two cervical canals, B- two cervical canals leading t