Determinants of the demand for microenterprise finance in urban Egypt

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Performance Evaluation of Hand-Held Olive Harvesters

The aim of this research was to evaluate three types of commonly used hand-held olive harvesters in small olive farms (pulsed motion double head olive harvester, hook type hand-held olive harvester and pneumatic comb olive harvester) in the Kingdom of Saudi Arabia. The specific objectives were to (a) determine the values of some olive plant parameters including physical-mechanical properties of fruit-stem system, natural frequency of the olive fruit-stem system and suitable shaking stroke), (b) establish and determine the values of the evaluation criteria which included machine productivity, fruit removal percentage, fruit damage, specific consumed energy and olive harvesting cost, (c) determine the quality characteristic for each criterion, (d) assign the evaluating criteria their relative weights, (e ) perform field experiments to assess the performance of the three harvesters and (f) calculate the value of overall evaluation criterion. The study was carried out during the period of 2017-2018. The average values of natural frequency were 30.1, 28.1 and 24.0 Hz for full mature stage, half-ripe and full-ripe fruits, respectively. The estimated values of damping ratio were 0.103, 0.103 and 0.106 for full mature stage, half-ripe and full-ripe fruits respectively. The estimated shaking stroke was about 70 mm. The highest values of machine productivity (88.4 kg.h-1) and fruit removal percentage (98.0%) were found with the pulsed motion double head olive harvester at the speed of 1500 rpm while the lowest value of machine productivity (55.6 kg.h-1) and  fruit removal percentage (62.4%) were found with the hook type olive harvester at the 24 Hz frequency and 70 mm stroke. The highest fruit damage (5.5-6.6) was observed with the pulse motion double head harvester while the lowest fruit damage (2.0-2.5%) was observed with the hook type harvester. The specific consumed energy values ranged from 17.0 to 27.0 W.h.kg-1. The total harvesting costs were 3.62, 3.65 and 3.69 $.h-1 for the pulse motion double head harvester, the hook type harvester and the pneumatic comb harvester, respectively. The results showed that the highest value of overall evaluation criterion (OEC) was 84.9 for the pulsed motion double head olive harvester at speed of 1500 rpm). Also, the values of OEC of the pulsed motion double head olive harvester for the other two speeds (1100 and 1300 rpm) outperformed the other harvesters (at all treatments). The higher OEC of the pulse motion double head olive harvester was due to the low operating costs and increased fruit removal percentage. Based on OEC, the pulsed motion double head olive harvester came first (OEC in the range of 70.2.5-84.9 %), followed by the pneumatic comb olive harvester (OEC in the range of 42.8-70.2 %) and the hook type olive harvester olive harvesters (OEC in the range of 13.9-54.3%)

Major depression and disease activity among systemic lupus erythematosus Egyptian females

AbstractAim of the workThe aim of this study was to identify the relationship between disease activity in SLE Egyptian females and the presence, severity and pattern of major depression in these patients.Patients and methodsThe study sample included 100 female patients; fifty SLE patients and fifty healthy adults with matching age serving as control. Patients were assessed using Beck Inventory Score for the presence of major depression, SLEDAI to determine disease activity, SLICC/ACR damage index and HAQ score for functional disability.ResultsThe majority of patients had symptoms of major depression 32/50 (64%) based on Beck Inventory Score while in controls only 16/50 (36%) had major depression. The most common depressive symptoms in SLE patients were: Guilty feeling (92%), Self-dislike (91.6%), Self-criticalness (90.4%), Crying spells (87.5%), Loss of pleasure (83.3%), Change in appetite (83.3%), Agitation (82.8%) and Pessimism (82%). Patients with major depression presented a trend toward having greater severity of SLE disease activity compared with those without major depression (p=0.04). The presence of major depression was significantly associated with functional disability measured by HAQ score (p=0.01). The patients with major depression did not differ significantly from patients without major depression regarding their steroid dosage (p=0.55), SLICC/ACR damage score (p=0.16) and disease duration (p=0.69) but differed significantly as regards Beck Hopelessness Scale (p<0.0001) and suicidal ideation score (p=0.009).ConclusionMajor depression was highly presented in Egyptian SLE patients (64%); its severity was associated with disease activity, but not with steroid administration, cumulative damage or disease duration

Major depression and disease activity among systemic lupus erythematosus Egyptian females

AbstractAim of the workThe aim of this study was to identify the relationship between disease activity in SLE Egyptian females and the presence, severity and pattern of major depression in these patients.Patients and methodsThe study sample included 100 female patients; fifty SLE patients and fifty healthy adults with matching age serving as control. Patients were assessed using Beck Inventory Score for the presence of major depression, SLEDAI to determine disease activity, SLICC/ACR damage index and HAQ score for functional disability.ResultsThe majority of patients had symptoms of major depression 32/50 (64%) based on Beck Inventory Score while in controls only 16/50 (36%) had major depression. The most common depressive symptoms in SLE patients were: Guilty feeling (92%), Self-dislike (91.6%), Self-criticalness (90.4%), Crying spells (87.5%), Loss of pleasure (83.3%), Change in appetite (83.3%), Agitation (82.8%) and Pessimism (82%). Patients with major depression presented a trend toward having greater severity of SLE disease activity compared with those without major depression (p=0.04). The presence of major depression was significantly associated with functional disability measured by HAQ score (p=0.01). The patients with major depression did not differ significantly from patients without major depression regarding their steroid dosage (p=0.55), SLICC/ACR damage score (p=0.16) and disease duration (p=0.69) but differed significantly as regards Beck Hopelessness Scale (p<0.0001) and suicidal ideation score (p=0.009).ConclusionMajor depression was highly presented in Egyptian SLE patients (64%); its severity was associated with disease activity, but not with steroid administration, cumulative damage or disease duration

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Higher ethical objective (Maqasid al-Shari'ah) augmented framework for Islamic banks : assessing the ethical performance and exploring its determinants.

This study utilises higher objectives postulated in Islamic moral economy or the maqasid al-Shari’ah theoretical framework’s novel approach in evaluating the ethical, social, environmental and financial performance of Islamic banks. Maqasid al-Shari’ah is interpreted as achieving social good as a consequence in addition to well-being and, hence, it goes beyond traditional (voluntary) social responsibility. This study also explores the major determinants that affect maqasid performance as expressed through disclosure analysis. By expanding the traditional maqasid al-Shari’ah,, we develop a comprehensive evaluation framework in the form of a maqasid index, which is subjected to a rigorous disclosure analysis. Furthermore, in identifying the main determinants of the maqasid disclosure performance, panel data analysis is used by including several key variables alongside political and socio-economic environment, ownership structures, and corporate and Shari’ah governance-related factors. The sample includes 33 full-fledged Islamic banks from 12 countries for the period of 2008–2016. The findings show that although during the nine-year period the disclosure of maqasid performance of the sampled Islamic banks has improved, this is still short of ‘best practices’. Through panel data analysis, this study finds that the Muslim population indicator, CEO duality, Shari’ah governance, and leverage variables positively impact the disclosure of maqasid performance. However, the effect of GDP, financial development and human development index of the country, its political and civil rights, institutional ownership, and a higher share of independent directors have an overall negative impact on the maqasid performance. The findings reported in this study identify complex and multi-faceted relations between external market realities, corporate and Shari’ah governance mechanisms, and maqasid performance

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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