Production of activated carbon from date palm pits and its use in industrial wastewater treatment

The present study investigates, for the first time, the production of granular activated carbon (GAC) from date palm pits, a waste material. Reported data indicates.that the t. yearly production of dates in the Kingdom of Saudi Arabia (KSA) is more than 800 ktonnes of which a significant portion is de-stoned prior to sale. Hence the use of date palm pits for the production of GAC would confer two benefits, Le., reduction in waste disposal costs and concerns and production of a very useful material from this waste, Le., GAC, which at the present is imported in the KSA for several industrial applications.Considering these facts, date palm pits from a local source were used for the production of GAC. Several GAC production variables were investigated in detail, to study their effect on the BET specific surface area (SSABET), porosity, and the pore size distribution of the produced material. Variables studied included sample predrying, time of carbonization, time of activation, strength of the activating agent (i.e., phosphoric acid), acid impregnation ratio, pH, and temperature. Nitrogen adsorption isotherm data was used for the determination of respective SSABET, and porosity values.The optimum conditions that produced the best activated carbon were, H3P04 concentration equal to 70%, acid to pits ratio of 1.6:1, and carbonization temperature of 500°C. Additionally, a maximum yield of 24% was noted for the best GAC sample which showed the following characteristics 590 kg m-3 bulk density, 0.5% ash content, 1100 mg g-1 iodine number, and 1319 m2 g-1 SSABET. Furthermore, this GAC sample showed substantial capability to adsorb phenol and 2-Methylphenol (o-cresol) from the aqueous phase. The respective adsorption data fitted well to the Freundlich adsorption isotherm. Several continuous column studies (using operational variables including flowrate, initial pollutant concentration, pH, temperature and dissolved oxygen) were also conducted to find the suitability of the produced optimum GAC sample for the removal of phenol and 2-Methylphenol from the aqueous phase. For example, the adsorption of both phenol and 2-Methylphenol was influenced both by the flowrate and the initial pollutant concentration. Also, the breakthrough time decreased when the flowrate and the initial concentration values were increased, probably due to insufficient pollutant residence time. The respective optimum activated carbon was also successfully used for the reduction of total organic carbon from an industrial wastewater sample.Furthermore, to minimize waste disposal cost and concerns related to the exhausted GAC, an attempt was also made to regenerate the used GAC sample from the present work using chemical and electrochemical desorption methodologies. The electrochemical desorption method, which so far has been scantly investigated in the literature, was noted to successfully regenerate the used GAC sample, using a current density value of 50 rnA cm-2. Factorial experimental design and optimization of parameters for the production of GAC from date pits, using Response Surface Methodology (RSM), was also completed. The respective results were acid to pits ratio of 1.5:1, carbonization temperature of430°C, and H3P04 concentration of 55%. In summary, a high efficiency GAC sample was successfully produced from an otherwise waste material i.e., the palm date pits. The produced GAC was also noted to be very efficient for the removal of organic pollutants from the aqueous phase. It is suggested that the use of activated carbon produced from date pits would be economical, since date pits are a waste product and available in large quantity in the Kingdom of Saudi Arabia, and phosphoric acid is manufactured from local resources in the Kingdom

The effect of sustainability reporting on the corporate profitability of the south Asian large banks

The purpose of this paper examination the sustainability reporting (SR) and corporate profitability (CP) of the south Asian large banks. This research employs the secondary data from 134 banks for the year 2019–2022. The results of this paper display that there is a positively and significantly relationship among SR and its dimensions (community and environment) with CP. The most important issues of sustainability in banks and companies do not disclose information related to the environment and society that will effect negatively on the institutions reputation. For the researchers’ best knowledge, this research creates important support in terms of SR in south Asian large banks. In addition to this study propose the sustainability improves banks and firm’s reputation and interests customers and investors involved in sustainable problems

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Optimisation of activated carbon production from date pits

This study investigates the optimal process conditions for activated carbon production from local date palm pits using response surface methodology (RSM). Box Behnken statistical technique was used to design the production process in order to determine the influence of activation temperature (300°C to 700°C), % H3PO4 (30% to 70%) and activation time (1 to 3 hours) on the BET surface area. Second-order model developed via regression analysis to describe the BET surface area response was found to be appropriate in predicting the responses within the experimental region to a considerable extent. Analysis of variance (ANOVA) revealed that the influence of the independent variables on the BET surface area is in the order: activation temperature > % H3PO4 > activation time with only temperature and % H3PO4 possessing moderate interaction. The maximum BET surface area from RSM optimisation was estimated to be 1,337.54.2 m²%g achievable at optimum conditions of 54% H3PO4 and 547°C carbonisation temperature at an activation time of 2.067 hours

THE ROLE OF HYDROXYCHLOROQUINE AS MONOTHERAPY IN MANAGING EARLY UNDIFFERENTIATED ARTHRITIS: A PROSPECTIVE HOSPITAL-BASED STUDY

Introduction: Early undifferentiated arthritis (EUA) is a common form of arthritis comprising, joint pain, stiffness and swelling with no definitive diagnosis. Patients of EUA can progress to other forms of rheumatic arthropathies such as rheumatoid arthritis or remain in the same form or spontaneously disappear. The main focus of this study is to explore the potential effect of hydroxychloroquine (HCQ) in management of EUA as a monotherapy treatment. Methods: This is a prospective hospital-based study which was conducted in Almwada hospital in Khartoum, Sudan. The study included thirty patients of EUA. Full clinical examination and history were done by a rheumatologist, and all the related investigations were obtained, and they all received HCQ after EUA diagnosis has been established. Result: The study shows that 96% of the patients responded well to the treatment and 10% had their duration of treatment doubled to show a favorable response. We also found that female patients weremore commonly affected than male ones with higher incidence among middle aged as compared to others. After treatment with HCQ, 86.6% of the patients showed average mean decrease in erythrocyte sedimentation rate (ESR) by 44%, the other 13.4%, even though they were symptoms free after treatment they showed increased level of ESR by 30% average. Conclusion: In the present study we found out most of the EUA patients are well responded to the HCQ treatment, and most of them respond from the first course of treatment, the study also shows higher incidence among female in compared to male

An Inspirational Approach to Healthcare Positive Leadership in Regional Health Center of Jizan

Background &amp; Aim: The study was designed to investigate the inspirational approaches to positive leadership. The main objectives of the study were: (1) to find out inspirational approaches to leadership, (2) to find out the characteristics of positive leadership style, (3) to find out the relationship between inspirational approaches and positive leadership. Method: Healthcare leaders from Jazan were taken as a target population and 150 were selected as a sample from the whole population. Convenient sampling techniques were used for collecting data. The standardized inventory was used for data collection. The procedure of the study involved the personal distribution of questionnaires to healthcare leaders. The research was descriptive in nature. As recent research shows, inspiration can be activated, captured, and manipulated, and it has a major effect on training, and capacity-building style. Findings &amp; Conclusion: (i) most of the time the healthcare leaders participated in subordinates’ affairs. (ii) mostly the healthcare leaders and subordinate’s relationship are positive. (iii) occasionally healthcare leaders collaborate with their colleagues to solve subordinates’ affairs. (iv) most healthcare manages healthcare environment effectively. (v) occasionally subordinates were encouraged to innovate. Recommendations: (i) healthcare leaders colleague’s relationships may further be strengthened. (ii) it is suggested that there might be more peer directions among healthcare leaders on new ideas, topics, and training strategies. (iii) inspirational approach may be used more often in the healthcare environment while healthcare leaders and dealing with subordinates. It is further recommended that healthcare leaders may conduct research to explore the effects of an inspirational approach to positive leadership and apply the findings to improve the teaching-learning-training process. &nbsp

Knowledge and attitude regarding toxoplasmosis among Jazan University female students

Background: In Saudi Arabia, the prevalence of toxoplasmosis is high. However, to date, few studies have evaluated the degree of knowledge on toxoplasmosis among females in Saudi Arabia. Objectives: The objective of this study was to assess the knowledge, attitude and preventive behavior regarding toxoplasmosis among female students at Jazan University, Jazan, southwest Saudi Arabia. Materials and Methods: This cross-sectional study was conducted on a random sample of 440 female students at Jazan University using a semi-structured, self-administered questionnaire. Data with numerical/qualitative variables were expressed as frequency and percentage. Chi-square test was used to analyze categorical variables. P < 0.05 was used to indicate statistical significance. Results: This study found that more than three-quarters (79.1%) of the students had insufficient knowledge about toxoplasmosis. Students from healthcare faculties had higher knowledge scores (28.5%) than students from arts and humanities (20.6%) and science (18.9%) faculties; however, the differences were not statistically significant (P = 0.77). The majority of the studied sample (92.3%) was found to eat fast food on a regular basis. About 42%, 54% and 4% of the respondents reported that they never, occasionally and always ate improperly washed vegetables, respectively. Conclusions: This study found that a substantial proportion of Jazan University's female students have insufficient knowledge on toxoplasmosis. Health educational programs are necessary to increase the awareness and knowledge about toxoplasmosis and its clinical manifestations