A Simple Strategy for the Sterile Use of Reusable Laryngoscope Blades in Resource Limited Countries

The laryngoscope blade has a potential role for crossinfection due to its contamination with bacteria, blood,and microorganisms. Cleaning the laryngoscope bladehas various methods in different countries. Most operatingrooms have no guidelines for laryngoscope disinfectionafter each usage (1). Some use tap water for cleaningwhich is an inadequate method while others add disinfectantto tap water which is more effective for the controlof infection, but this may result in the emergence ofresistant bacteria. There are so many disinfectants likealdehyde-free biguanide and Chlorine dioxide or chlorhexidinewithout any international guideline for commonpractice. Cleaning with most of these disinfectants istime consuming and needs at least 10 minutes for disinfection(2). In some centers, anesthesiologists use disposableblade laryngoscopes which brings, sometimes, difficultyin airway management especially in the emergencysituations compared to standard laryngoscopes, becauseof the shape of the blade or light carrying capacity. Most ofthe single-use laryngoscopes tested were significantly inferiorto the standard Macintosh blade. This raises concernover their use in clinical practice, particularly if intubationis difficult (3). The cost of disposable blades for laryngoscopesis almost 5 to 10 dollars

Numerical analysis of underground tunnels subjected to surface blast loads

The increased terrorist attacks on important public structures and utilities have raised the vital necessity for the investigation of performance of structures under blast loads to improve the design and enhance the behavior of structures subjected to such threats. In this study, 3-D finite element analysis is used to study the effect of surface explosions on the response of RC bored tunnels. The soil behavior is modelled using Drucker-Prager Cap model. Two types of soil are investigated, and the blast load is considered through various weights of TNT explosive charges at heights of 0.50 m and 1.0 m from ground surface. To study the effect of horizontal standoff distance, six different horizontal distances are considered. The results show that the soil type has a significance effect on tunnel response due to surface blasts. Also the weight and the location of charge have a great effect on the safety of the tunnel. Finally, a parametric study is established to define the borders of the restricted area around the tunnel location to be safe

Fibromuscular Dysplasia with Spontaneous Coronary Artery Disease Presenting as Acute Myocardial Infarction

A 40-year-old female presented to a rural hospital with crushing substernal chest pain. An initial electrocardiogram showed ST elevation in lead II and aVF with elevated troponin I. She was immediately transferred to a tertiary care hospital. An emergent coronary angiogram did not show any significant coronary artery disease. On the second day, the patient experienced recurrence of severe chest pain with ST elevations in leads I, aVL, V5-V6, ST depressions in V1-V3, T-wave inversion over V2-V5. The troponin I level increased to \u3e 40 ng/ml (normal 0.0 to 0.04 ng/ml). An emergent angiogram was performed revealing local dissection of the mid to distal left main coronary artery and a totally occluded diagonal artery. It was deemed unsafe to perform percutaneous coronary intervention because it was a non-flow limiting left main coronary artery dissection and was difficult to cannulate with the guide catheter. Subsequently, an elective angiogram was performed after a 48-hour interval to evaluate the progression of dissection and to make a definitive decision for revascularization versus medical management. On the third angiogram, stenosis seen in the diagonal branch on the previous angiogram progressed to dissection, and local dissection of the left main coronary artery seen on the previous angiogram spontaneously resolved. The patient was symptom-free and hemodynamically stable. It was decided to manage the patient conservatively due to the spontaneous resolution of occlusion in the diagonal artery and dissection of the left main coronary artery. The patient was started on conservative medical treatment. A magnetic resonance angiography of the right internal carotid artery revealed a “string of beads” appearance, which confirmed the diagnosis of fibromuscular dysplasia. She was followed closely in the clinic and has remained asymptomatic for the past one year

Golinski’s Speed Reducer Problem Revisited Using Genetic Algorithm

There are many constraints that constitute the Gear Box Design. Golinski’s Speed reducer problem is studied and the weight of the Gear box is minimized. This is done by considering certain design variables of the Gear box, applying Optimization algorithms that provide results which agree upon a resulting weight that is minimum satisfying the concerned design variables

Design concepts for the Cherenkov Telescope Array CTA: an advanced facility for ground-based high-energy gamma-ray astronomy

Ground-based gamma-ray astronomy has had a major breakthrough with the impressive results obtained using systems of imaging atmospheric Cherenkov telescopes. Ground-based gamma-ray astronomy has a huge potential in astrophysics, particle physics and cosmology. CTA is an international initiative to build the next generation instrument, with a factor of 5-10 improvement in sensitivity in the 100 GeV-10 TeV range and the extension to energies well below 100 GeV and above 100 TeV. CTA will consist of two arrays (one in the north, one in the south) for full sky coverage and will be operated as open observatory. The design of CTA is based on currently available technology. This document reports on the status and presents the major design concepts of CTA

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

Search for the production of dark matter in association with top-quark pairs in the single-lepton final state in proton-proton collisions at √s=8 TeV

Peer reviewe

Measurement of top quark–antiquark pair production in association with a W or Z boson in pp collisions at √s=8 TeV

Peer reviewe

Observation of the diphoton decay of the Higgs boson and measurement of its properties

Peer reviewe