Foreign direct investment for infrastructure development: Changing nature of risks and challenges for developing countries

Ph.DDOCTOR OF PHILOSOPH

Management of isolated distal deep vein thrombosis. A persistent conundrum?

Isolated distal deep vein thrombosis (IDDVT) accounts for approximately 50% of all patients diagnosed withDVT. While the definitive management of patients with proximal deep vein thrombosis is fairly well defined,IDDVT remains shrouded uncertainty. The great majority of patients with IDDVT may remain with little or nosymptoms and have spontaneous resolution of the thrombi. However, a small but significant fraction may showproximal thrombus extension and may proceed to cause pulmonary embolism or late deep venous reflux.Identification of this subgroup of patients with IDDVT who have a greater propensity for thrombus extension orfurther sequelae remains the cornerstone of individualized management for optimal results

Non-traumatic ulnar artery aneurysm in a middle-aged male

Aneurysms in the extremity arteries are rare and usually occur as pseudoaneurysms secondary to trauma oriatrogenic interventions. True spontaneous non-traumatic aneurysms in the extremities are extremely rare withno consensus on their aetiology or optimum management strategy. Here, we discuss a case of a young manwith an isolated spontaneous non-traumatic ulnar artery aneurysm presenting with acute pain and discomfort

PROCEDURE TO ALLOCATE UNITS IN A CONDOMINIUM IN AN URBAN RESETTLEMENT PROJECT: A SCIENTIFIC APPROACH

Many public and private sector projects provoke forced relocation of the population but fail to resettle people sustainably and thus to trigger their impoverishment. Studies also found that one root cause of such failures and impoverishment is the disposal of properties and the lack of financial support for relocation. Make a systematical way of allocating housing units in a condominium in resettlement projects using a scientific and analytical model of payment of compensation is the primary purpose of this article. The independent variables which affect to the market value of the existing lands, especially in Nawama Mawatha and Wekanda Road in Colombo 2 area, are considered, distance from the main road (accessibility), the shape of the land (regular or irregular) and availability of infrastructure and sanitary facilities (utilities). After collecting the market variables then weighted all these independent variables to run the multiple regression analysis to get the results of the study. The results of the study showed that the significant effect comes to the market value of the land is from the distance from the main road (accessibility) as it has the strong negative correlation with the market value

Bouncing back from extreme weather events: Some preliminary findings on resilience barriers facing small and medium-sized enterprises

Extreme weather events (EWEs) pose unprecedented threats to modern societies and represent a much-debated issue strongly interlinked with current development policies. Small and medium-sized enterprises (SMEs), which constitute a driving force of economic growth, employment and total value added, remain highly vulnerable to and ill prepared for such environmental perturbations. This study investigates barriers to SMEs’ resilience to EWEs in an attempt to shed light on enabling factors that can define effective organizational responses to non-linear environmental stimuli. Relying on structural equation modeling and data gathered from 109 SMEs that recently experienced EWE impacts, we link the general concept of SMEs’ resilience barriers to EWEs with a series of elements to determine specific internal and external factors that contribute the most to EWE resilience. In particular, external barriers of institutional conditions and mechanisms of support and guidance as well as internal barriers of resources and managerial perceptions are found to be the most critical ones in determining resilience. The assessment offers essential research evidence for practitioners on SME management and sets forth linkages with current mechanisms for policy interventions towards an appropriate resilience agenda for SMEs

Validity of the Postoperative Morbidity Survey after abdominal aortic aneurysm repair—a prospective observational study

BACKGROUND: Currently, there is no standardised tool used to capture morbidity following abdominal aortic aneurysm (AAA) repair. The aim of this prospective observational study was to validate the Postoperative Morbidity Survey (POMS) according to its two guiding principles: to only capture morbidity substantial enough to delay discharge from hospital and to be a rapid, simple screening tool. METHODS: A total of 64 adult patients undergoing elective infrarenal AAA repair participated in the study. Following surgery, the POMS was recorded daily, by trained research staff with the clinical teams blinded, until hospital discharge or death. We modelled the data using Cox regression, accounting for the competing risk of death, with POMS as a binary time-dependent (repeated measures) internal covariate. For each day for each patient, ‘discharged’ (yes/no) was the event, with the elapsed number of days post-surgery as the time variable. We derived the hazard ratio for any POMS morbidity (score 1–9) vs. no morbidity (zero), adjusted for type of repair (endovascular versus open), age and aneurysm size. RESULTS: The hazard ratio for alive discharge with any POMS-recorded morbidity versus no morbidity was 0.130 (95 % confidence interval 0.070 to 0.243). The median time-to-discharge was 13 days after recording any POMS morbidity vs. 2 days after scoring zero for POMS morbidity. Compliance with POMS completion was 99.5 %. CONCLUSIONS: The POMS is a valid tool for capturing short-term postoperative morbidity following elective infrarenal AAA repair that is substantial enough to delay discharge from hospital. Daily POMS measurement is recommended to fully capture morbidity and allow robust analysis. The survey could be a valuable outcome measure for use in quality improvement programmes and future research

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Pathways

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Cystic adventitial disease of the external iliac artery with disabling claudication: A case report and short review

Chronic occlusive arterial disease of the periphery is primarily caused by atherosclerotic disease. In young patients with no identifi able risk factors for atherosclerosis, who present with symptoms of claudication or critical ischemia, other rare causes need to be suspected. Cystic adventitial disease is one such condition affecting young healthy patients. Although it has been reported most commonly in relation to the popliteal artery, other sites including the iliac artery can also get affected. Isolated short segment stenosis or occlusion can lead to signifi cant disabling symptoms restricted to one side. Imaging studies show pristine arterial anatomy with no evidence of systemic atherosclerotic disease and an isolated area of luminal stenosis. Defi nitive treatment involves open surgical excision with interposition grafting for optimal long-term results. We report a case of cystic adventitial disease affecting the external iliac artery in an otherwise healthy young man.&nbsp