Will cool roofs improve the thermal performance of our built environment? A study assessing roof systems in Bahrain

A number of international campaigns have recently proposed the use of cool roofs worldwide in order to cope with the summer urban heat island (UHI) effect. This work investigates cool roof strategy and examines the potential of such a strategy for Bahrain. Full-scale measurement, meteorological modelling and thermal simulation of five standard roofs were performed during particular summer days due to the high intensity levels of solar irradiation. This work shows that the light tile roof and metal decking are relatively cooler and more comfortable than others and that the maximum reduction in heat gain occurs for a light tile roof with thermal insulation materials. Nevertheless, without insulation the cooling load is increased by only 1.3%. This percentage seems not to be cost-effective where economics and building construction are concerned. In contrast, the reduction percentage due to the use of thermal insulation in the case of dark tile roof, felt bitumen roof and screed roof increases to 5–7%, which is more cost effective. This work concludes that the cool roof strategy is the most cost-effective for the hot climate of Bahrain, which has a long cooling season. With the current levels of urban development in Bahrain, cool roofs can reduce UHI intensity and building cooling loads, lowering demand for electricity and greenhouse gas emissions from power plants. To avoid any negative consequences from using this strategy, however, trade-offs between urban mitigation and adoptation strategies and complementary technologies should be accounted for in future urban development plans

Development and evaluation of ibuprofen transdermal gel formulations

Purpose: To develop an ibuprofen transdermal gel with a capability for both topical and systemic drug delivery. Methods: Ibuprofen gel formulations, incorporating various permeation enhancers, were prepared using chitosan as a gelling agent. The formulations were examined for their in vitro characteristics including viscosity, pH and drug release as well as in vivo pharmacological activities. Carrageenan-induced rat paw oedema model was used for the evaluation of their analgesic and anti-inflammatory activities. A commercial ibuprofen gel product (Ibutop®) was used as a reference. Results: The formulations containing 5 % of either menthol or glycerol as permeation enhancers gave drug release patterns comparable to that of the reference product. Propanol increased the apparent viscosity of the test gels to the same extent as that of the reference. Drug release from the formulationsfitted best to the Higuchi model. A significant in vivo analgesic effect was produced by the test formulations containing 5 % menthol and 20 % propylene glycol and the effect was superior to that obtained with the reference product. However, no significant anti-inflammatory activity was exerted by any of the test gel formulations (p > 0.05).Conclusion: Ibuprofen gel preparations containing 5 % menthol and 20 % propylene glycol, respectively, exhibited pronounced analgesic activity and could be further developed for topical and systemic delivery of ibuprofen.Keywords:  Transdermal gel, Chitosan, Ibuprofen, Menthol, Propylene glycol, Penetration enhance

Fahmy's four quadrant sutures: a new technique for control of blood loss during cesarean delivery for placenta previa

Background: The objective of this study is to assess the efficacy and safety of Fahmy's four quadrant suture technique (FFQS) in controlling blood loss during cesarean delivery for placenta previa (PP).Methods: The study was carried out in a tertiary University Hospital between January 2017 to December 2017 involved 12 women with heavy bleeding occurred after removal of the placenta from the lower section during cesarean delivery for PP. The FFQS technique consisted of two sutures to ligate the uterine branches on both sides and two sutures on the anterior and posterior wall of the lower uterine segment. Details regarding the management and maternal outcomes were recorded.Results: The mean age of the study participants was 29.58±5.29 years and the mean parity was 2.25±1.14. The mean gestational age at termination of pregnancy was 36.91±1.38 weeks.  The mean duration of the whole surgery was 78.75±43.28 minutes, while the mean duration of FFQS technique was only 10±2.09 minutes. The technique was exclusively effective in 8 out of 12 cases (66.67%) while 2 cases needed bilateral internal iliac artery ligation and 2 cases needed hysterectomy. The mean amount of blood loss in all cases was 2433.33±833.76 ml. the mean amount of transfused packed RBCs was 3.92±1.68 units and fresh frozen plasma (FFP) was 3.42±1.44 units. All cases had uneventful postoperative course and no mortality cases in present series.Conclusions: The new technique; FFQS represents a rapid, effective, and inexpensive opportunity for women with bleeding from the lower segment of uterus due to PP. This simple procedure should be attempted before other complex measures to achieve good hemostasis

A theoretically based cross-sectional survey on the behaviors and experiences of clinical pharmacists caring for patients with chronic kidney disease.

The literature shows a lack of evidence on pharmacists contributing to chronic kidney disease services. The aim was to determine pharmacists’ behaviors and experiences and perceptions of barriers and facilitators to implementation of models of care. A theoretically informed survey was developed and sent to pharmacist members of the United Kingdom renal pharmacy group. Sections included: demographics, clinical practice and prescribing practice. Questions were of various types; closed type and some open for comments. Attitudinal items on clinical/prescribing used 5-point Likert scale. Development/implementation items were derived from the Consolidated Framework for Implementation Research (CFIR). Analysis used descriptive statistics and open comments were analysed thematically. Ethical approval was granted by an academic institution. Response rate; 50% (n = 71), seven were incomplete and excluded. Respondents provided; inpatient general pharmaceutical care (n = 56, 87.5%), to those receiving dialysis (n = 54, 84.4%) and transplantation. Non-clinical roles; audits (n = 46, 71.9%), patient education (n = 31, 48.4%), only 7.8% (n = 5) doing academic research. For barrier/facilitators most strongly agreed/agreed with most CFIR items relating to clinical practice. A majority (n = 44, 68.7%) disagreed that they had sufficient time to practice clinically and 44 (68.7%) disagreed there was sufficient cover for services. For prescribing roles, 90.5% (n = 48) were currently actively prescribing. Although prescribing related CFIR items were largely positive, 39.6% (n = 19) disagreed about sufficient time to practice and 18.7% (n = 9) were neutral. Two thirds (n = 33, 68.7%) disagreed that there was sufficient cover for the prescribing. The majority of respondents provided general pharmaceutical care to dialysis and transplant patients, were confident in their abilities and tried new ways of working including independent prescribing. Many expressed that lack of resources was the main barrier to providing more advanced care. Further work is needed to explore these matters in more depth

Substitusi Tepung Bengkuang pada Pembuatan Brownies

Brownies bengkuang merupakan salah satu bentuk pengaplikasian tepung bengkuang pada produk pangan. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh substitusi tepung terigu dengan tepung bengkuang pada pembuatan brownies. Pada penelitian ini dilakukan subtitusi tepung terigu dengan tepung bengkuang dengan perlakuan kontrol, 60%, 70%, 80% dan 100%. Analisa yang dilakukan pada brownis bengkuang adalah analisis proksimat dan analisis organoleptik. Analisis proksimat yang dilakukan meliputi analisis kadar air, kadar karbohidrat, kadar lemak, kadar protein, kadar abu dan kadar serat kasar. Hasil analisis menunjukkan bahwa substitusi tepung bengkuang pada pembuatan brownies memberikan pengaruh yang berbeda nyata pada karbohidrat, protein dan serat kasar brownies bengkuang. Berdasarkan analisis organoleptik yang telah dilakukan diketahui bahwa semakin banyak penambahan tepung bengkuang, brownies yang dihasilkan memiliki tekstur yang semakin padat dan berserat. Hasil analisis organoleptik menunjukkan substitusi tepung bengkuang yang paling disukai panelis adalah brownies yang disubstitusi tepung bengkuang 60%, dengan memberikan penilaian terhadap warna 4,20 (agak suka), aroma 3,92 (agak suka), rasa 4,20 (agak suka), dan tekstur 3,96 (agak suka). Brownies dengan substitusi tepung bengkuang 60% memiliki kadar air 31,24%, kadar karbohidrat 43,42%, kadar lemak 14,14%, kadar protein 10,57%, kadar abu 0,63%, dan kadar serat kasar 1,81%

3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgery

Background Numerous Dupuytren’s fasciectomy techniques have been described, each associated with unique surgical challenges, complications and recurrence rates. We describe a common ground surgical approach to Dupuytren’s disease; 3-dimensional fasciectomy (3DF). 3DF aims to address the potential contributors to the high recurrence rate of Dupuytren’s disease and unite current limited fasciectomy practice that varies considerably between surgeons. Methods We describe the 3DF principles; raising thin skin flaps (addressing dermal involvement), excising diseased palmar fascia with a 3−5 mm clearance margin (treating highly locally recurrent conditions) and excising the vertical septae of Legueu and Juvara (providing deep clearance, hence addressing all potentially involved pathological tissue). The surgical outcomes between traditional limited fasciectomy (LF) and 3DF are compared. Results From the 786 operations included (n=585), postoperative recurrence rates were significantly lower for the 3DF group (2/145, 1.4%) than the LF group (72/641, 11.2%) (P=0.001), and the time to recurrence was significantly longer (5.0±0 years vs. 4.0±0.2 years; P&lt;0.0001). With recurrence excluded, there were no differences between the postoperative complication rates for 3DF (5/145, 3.5%) and LF (41/641, 6.4%) (P=0.4). Conclusions Our results suggest that 3DF leads to lower recurrence rates and a longer disease-free period for patients, without increasing complications. 3DF provides a safe, efficacious, common ground surgical approach in the treatment of Dupuytren’s flexion deformity.</jats:p

Opportunistic salpingectomy during hysterectomy for benign indications in women at low and high risk for ovarian cancer: a cross-sectional study

Objective Our study aims to evaluate the role of pathology evaluation of fallopian tubesduring hysterectomy for benign indications for the purpose ofearly detection of serous tubal intraepithelial carcinoma (STIC) in women at high and low risk for ovarian cancer. Material and methods This cross-sectional study was conducted at Minia Maternity University Hospital, Egypt, between June 2015 and December 2017. Our study included all women undergoing hysterectomy for benign conditions in the genital tract. Appropriate histories were taken, as well as physical exams, and laboratory and ultrasound evaluations were done prior to scheduling surgery. Abdominal hysterectomies including opportunistic salpingectomies were performed and the whole specimens including the tubal fimbria were sent to the pathology lab for histo-pathological examination. Results A total of 526 patients met inclusion criteria for this study. The mean age of the study participants was 49.75±8.95 years, the mean parity was 3.91±1.62 and the mean BMI was 24.21±2.38 Kg/m2. The most common surgical indications for hysterectomy were postmenopausal bleeding (34.6%), a clinically benign adnexal/pelvic mass (31.7%), and menorrhagia (24.7%). The fallopian tubes were found to have either no pathology or benign conditions in 500 out of the 526 patients. Among these patients, 56% had no pathologic abnormality. The most common benign conditions were paratubal cysts (25%), endometriosis (9%), torsion (2%) and hydrosalpinx (1%). STIC was identified in the fallopian tubes of 8 out of 526 patients. Conclusions Microscopic examination of the entire fimbriae from all patients regardless of the clinical context represents a novel method of early detection of sporadic tubal carcinoma, a putative precursor to advanced-stage pelvic cancer

A theoretically based cross-sectional survey on the behaviors and experiences of clinical pharmacists caring for patients with chronic kidney disease

The literature shows a lack of evidence on pharmacists contributing to chronic kidney disease services. The aim was to determine pharmacists’ behaviors and experiences and perceptions of barriers and facilitators to implementation of models of care.A theoretically informed survey was developed and sent to pharmacist members of the United Kingdom renal pharmacy group. Sections included: demographics, clinical practice and prescribing practice. Questions were of various types; closed type and some open for comments. Attitudinal items on clinical/prescribing used 5-point Likert scale. Development/implementation items were derived from the Consolidated Framework for Implementation Research (CFIR). Analysis used descriptive statistics and open comments were analysed thematically. Ethical approval was granted by an academic institution.Response rate; 50% (n = 71), seven were incomplete and excluded. Respondents provided; inpatient general pharmaceutical care (n = 56, 87.5%), to those receiving dialysis (n = 54, 84.4%) and transplantation. Non-clinical roles; audits (n = 46, 71.9%), patient education (n = 31, 48.4%), only 7.8% (n = 5) doing academic research. For barrier/facilitators most strongly agreed/agreed with most CFIR items relating to clinical practice. A majority (n = 44, 68.7%) disagreed that they had sufficient time to practice clinically and 44 (68.7%) disagreed there was sufficient cover for services. For prescribing roles, 90.5% (n = 48) were currently actively prescribing. Although prescribing related CFIR items were largely positive, 39.6% (n = 19) disagreed about sufficient time to practice and 18.7% (n = 9) were neutral. Two thirds (n = 33, 68.7%) disagreed that there was sufficient cover for the prescribing.The majority of respondents provided general pharmaceutical care to dialysis and transplant patients, were confident in their abilities and tried new ways of working including independent prescribing. Many expressed that lack of resources was the main barrier to providing more advanced care. Further work is needed to explore these matters in more depth