A Review of Effective Urban Strategies for Enhancing Pedestrian Thermal Comfort in High-Temperature Urban Environments

Abstract- Pedestrian well-being is significantly influenced by the feeling of being thermally comfortable, and enhancing this comfort level contributes to the overall walkability. This study extensively compares the impact of different approaches in enhancing thermal comfort for pedestrians. The evaluation encompasses both fieldwork observations and computer simulations results. The investigated strategies include the urban geometry (arrangement, orientation and shape of urban structures), vegetation, solar-reflective materials, and water features. These strategies are considered the most effective means for improving outdoor thermal comfort. The findings reveal that the key climatic factors influencing outdoor thermal comfort in a microclimate are mean radiant temperature, wind speed, and wind direction. Among the various heat-mitigation tactics, vegetation, particularly trees, proves to be the most successful due to their shading properties. Another significant aspect is the height-to-width ratio in urban canyons, where increasing this ratio leads to a higher level of thermal comfort. However, caution should be exercised when using highly reflective materials in urban canyons, as studies indicate that they may reflect solar radiation onto pedestrians. Furthermore, the study emphasizes the importance of considering both physiological and psychological factors together to achieve a satisfactory level of thermal comfort

Dexmedetomidine vs dexamethasone as adjuvants to levobupivacaine in ultrasound-guided erector spinae plane block for patients undergoing modified radical mastectomy: a randomized double-blind study

Background &amp; Objective: Erector Spinae Plane block (ESPB) is used in patients subjected to modified radical mastectomy (MRM) as a part of balanced anesthesia technique, and to offer prolonged postoperative analgesia. Local anesthetic agents are usually combined with various adjuvants to augment the effect. We compared dexmedetomidine (Dex) versus dexamethasone as adjuvants to ESPB in patients undergoing MRM.&#x0D; Methodology: This randomized controlled study involved 90 patients subjected to MRM under general anesthesia with preoperative ESPB using 30 ml levobupivacaine 0.25%. They were randomly assigned into three equal groups according to the adjuvants used. Dex Group (n = 30) received 1 µg/kg dexmedetomidine, Dexa Group (n = 30) received 10 mg dexamethasone, and ESPB Group (n = 30) received no adjuvants. Patients were monitored for pain using VAS scores and vital signs. The primary outcome measure was total morphine consumption. The secondary outcomes were intraoperative fentanyl consumption, pain intensity, and analgesia duration.&#x0D; Results: The postoperative analgesia duration was significantly longer in the Dex group compared with the ESPB group (P = 0.029) but not in the dexamethasone group. Intraoperative fentanyl and postoperative morphine consumption were significantly lower in the Dex group than in the ESPB group. VAS scores were significantly lower in the Dex group than in the ESPB group at rest and movement. VAS scores of the Dexamethasone group were similar to that of the ESPB group at rest and movement.&#x0D; Conclusion: As an adjuvant to levobupivacaine in erector spinae plane block, dexmedetomidine reduces pain at rest and with movement, reduces intraoperative fentanyl and postoperative morphine consumption, and prolongs the analgesia duration. It is superior to dexamethasone in pain reduction and duration of analgesia.&#x0D; Key words: Analgesia; Dexamethasone; Dexmedetomidine; Erector Spinae Plane Block; Radical Mastectomy; Postoperative Pain&#x0D; Citation: Ahmed HI, Ali AR, El Emam NH, Magdy M, Gamal RM. Dexmedetomidine vs dexamethasone as adjuvants to levobupivacaine in ultrasound-guided erector spinae plane block for patients undergoing modified radical mastectomy: a randomized double-blind study. Anaesth. pain intensive care 2022;27(1):65−72.&#x0D; DOI: 10.35975/apic.v27i1.2122&#x0D; Received: Oct 08, 2022; Reviewed: Nov 10, 2022; Accepted: Nov 22, 2022</jats:p

Molecular and physiochemical evaluation of buck semen cryopreserved with antioxidants

The current study evaluated the physiochemical quality and gene expression profile of post-thawed buck semen after supplementation with antioxidants [melatonin (M), L-carnitine (LC), cysteine (Cys), LC + M, M + Cys, LC + Cys, LC + Cys + M] in comparison with the non-treated control group. Physical and biochemical characteristics of semen were evaluated following freezing and thawing. Transcript abundance of six selected candidate genes was profile using quantitative real-time PCR. The data demonstrated significant enhancement of post-freezing total motility, progressive motility, percentage of live sperm, CASA parameters, plasma membrane and acrosome integrity in all groups supplemented with Cys, LC, M + Cys and LC + Cys compared with the control group. The biochemical analysis of semen indicated that semen groups supplemented with LC and LC + Cys recorded increased levels of GPX and SOD that were coupled with up-regulation of antioxidant genes (SOD1, GPX1 and NRF2) and mitochondrial transcripts (CPT2 and ATP5F1A). Moreover, H2O2 level and DNA fragmentation percentage were reduced compared with other groups. In conclusion, supplementation of Cys alone or in combination with LC positively improved the post-thaw physiochemical properties of rabbit semen through activation of bioenergetics-related mitochondrial genes and cellular antioxidant defence mechanism

New Challenges and Prospective Applications of Three-Dimensional Bioactive Polymeric Hydrogels in Oral and Craniofacial Tissue Engineering: A Narrative Review

Regenerative medicine, and dentistry offers enormous potential for enhancing treatment results and has been fueled by bioengineering breakthroughs over the previous few decades. Bioengineered tissues and constructing functional structures capable of healing, maintaining, and regenerating damaged tissues and organs have had a broad influence on medicine and dentistry. Approaches for combining bioinspired materials, cells, and therapeutic chemicals are critical in stimulating tissue regeneration or as medicinal systems. Because of its capacity to maintain an unique 3D form, offer physical stability for the cells in produced tissues, and replicate the native tissues, hydrogels have been utilized as one of the most frequent tissue engineering scaffolds during the last twenty years. Hydrogels&rsquo; high water content can provide an excellent conditions for cell viability as well as an architecture that mimics real tissues, bone, and cartilage. Hydrogels have been used to enable cell immobilization and growth factor application. This paper summarizes the features, structure, synthesis and production methods, uses, new challenges, and future prospects of bioactive polymeric hydrogels in dental and osseous tissue engineering of clinical, exploring, systematical and scientific applications

Use of photomodeler as a measuring and management tool in construction projects

Photogrammetry can contribute not only with precision, but especially with speed and efficiency regarding to documentation; it is an ideal system for producing 3D models, for creating data bases, and offering efficient solutions in emergency cases, etc. There are here some examples of the use of digital photogrammetry based on systems and methods which make possible to operate reducing the working time in the site, and operating very light and inexpensive equipment. This system is specially adapted to emergency works and archaeology, when it is needed to work on field without the full support of complete office equipment.</jats:p

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research