Size-class structure and growth traits of Anastatica hierochuntica L. populations as rainfall indicators in aridlands

AbstractField data verified by green house experiment were used to evaluate the response of Anastatica hierochuntica L. to the amount of rainfall. Field study of the populations was carried out in the runnel and depression microhabitats of gravel and sand sites. Four water treatments, equivalent to 100, 200, 500 and 1000mm rainfall, were used to simulate different levels of water availability. Under 500 and 1000mm rainfall, the size-class structure of A. hierochuntica populations consists of a high proportion of large size-class individuals, while a higher proportion of small size-class individuals was obtained under 100 and 200mm rainfall. The dry skeletons of A. hierochuntica can be used as a “rain gauge” to predict the amount of rain or water received. The dominance of small size-classes (from <1 to 8cm3) gives a prediction of less than 200mm rainfall received. Intermediate size-classes (8–64cm3) characterize habitats with 200–500mm rainfall, while habitats with >500mm rainfall produce large size-classes (>64cm3). Small size-class individuals produced under low amounts of rainfall allocated up to 60% of their phytomass to the reproductive organs. Allocation to reproductive organs decreased with the increase in the amount of rainfall, while allocation to the stem increased in large size-class individuals produced under the highest amount of rainfall (1000mm) reaching 54%. Increased allocation to stem in large-sized individuals favours the hygrochastic seed dispersal role in the plant. The root/shoot ratio decreased with the increase of the individual size-class, i.e. under high rainfall treatments. Higher values of relative growth rate, net assimilation rate and leaf area index were obtained under high water treatments. Conversely, less expanded leaves, i.e. lower specific leaf area, were manifested in the lowest water treatments

Diversity of active constituents in Cichorium endivia and Cynara cornigera extracts

The present study attempts to explore the phytochemical constituents of different extracts from Cynara cornigera and Cichorium endivia plant materials. The two species studied are native in Egypt. Five different solvents, viz., aqueous, methylene chloride, petroleum ether, ethyl acetate, and n-butanol were used. Phytochemical analysis revealed the presence of phenols, flavonoids, sterols (stigmasterol and beta-sitosterol), terpenes (α-amyrin, ursolic and oleanolic acid), and hydrocarbons (n-alkane), the latter found in low amount. The ethyl acetate and water extracts of C. cornigera root showed lower mass fractions of phenolic compounds ranged from 20 to 81 g/100 g, and higher amounts in ethyl acetate extract of the inflorescences and butanol extract of the root where values ranged from 195 to 399 g/100 g. The β-sitosterol and stigmasterol were present in all plant extracts. Oleanolic and ursolic acids were detected in roots, leaves and inflorescences of C. cornigera and in C. endivia shoot. The ethyl acetate extracts from C. cornigera leaf and inflorescence attained higher chemical diversity than the other extracts. Alternatively, sterols and triterpenes were the major constituents. The high chemical diversity of active constituents justifies the future potential use of the two species at commercial level

Native Umbilical Defect for Laparoscopic Entry

Background: The presence of defects in native umbilical in adults and its use as laparoscopic first entry site is poorly documented. It would likely be a safer method than the Veress needle and direct trocar insertion. This work aimed to report the prevalence and size of native umbilical defects, and their relationship with gender, age and body mass index. Methods: In 160 consecutive laparoscopic operations, a trans-umbilical incision was made and a defect at its base was looked for. When found, the defect was measured and used as the first port entry site. Relationships of presence of native defects and their sizes in relation to gender, age and BMI were analyzed. Results: The prevalence of a native defect in this series was 90%. Its presence had no relation with gender, age or BMI. Its size, however, positively correlated with age and BMI. No complications were related to the defect’s use for first laparoscopic entry site. Conclusion: A native umbilical defect is present in 90% of adults. Whenever present, it is recommended for use as the first port entry site by an open technique. This method is simple and safe and avoids unnecessarily inducing another defect. Keywords: Laparoscopy, Open technique, Access, Native defect, Umbilical defec

The Leading World’s Most Innovative Universities

This open access book is unique in its contents. No other title in the book market has tackled this important subject. It introduces innovation as a way of practice for world-class universities. It, then, discusses the criteria for being innovative in the academic world. The book selects some of the top innovative world-class universities to study the factors that qualified them to be innovative, so that any other university can follow their steps to become innovative. The final chapter of the book presents some recommendations in this regard

Patients’ satisfaction with sedoanalgesia versus subarachnoid analgesia in endourology

AbstractObjectiveIn this study the effectiveness and safety of sedoanalgesia technique compared to spinal anesthesia in endourology procedure as well as patients’ satisfaction was assessed.Patients and methodsA prospective randomized study was performed in 80 adult patients, ASA I, II, and III who underwent various endoscopic procedures randomly allocated into two groups 40 patients each: Sedoanalgesia group, received local anesthesia (2% lignocaine gel), i.v. midazolam incremental doses 0.015mg/kg on demand, and i.v. fentanyl 2μg/kg, and 0.5μg/kg on demand interaoperative, and Spinal anesthesia group received 2.5ml heavy bupivacaine 0.5% to achieve around T10 level. We recorded vital parameters, and the number of cases with hemodynamic, respiratory complications, nausea and vomiting, and conversion to general anesthesia (failure). Postoperatively the intensity of pain (VAS 0-100mm), time to first analgesic request (VAS ⩾30), patient satisfaction (complete, partial or not satisfied) and time to readiness for discharge were assessed.ResultsThere was no significant difference in intra, postoperative hemodynamic changes and complications between groups but hypotension was more frequent in Spinal group. Immediate postoperative, there was no significant difference in pain score between groups, but 1 and 2h postoperatively there were higher pain scores in Sedoanalgesia group. Time to first analgesic request and readiness for discharge were significantly less in Sedoanalgesia group, but the difference was not significant as regard satisfaction scores.ConclusionSedoanalgesia is an effective, safe and simple alternative to Spinal anesthesia for endourology, with good patients’ satisfaction and less time to discharge

The possible role of cerium oxide (CeO2) nanoparticles in prevention of neurobehavioral and neurochemical changes in 6-hydroxydopamineinduced parkinsonian disease

Cerium oxide nanoparticles (CeO2NPs) is an efficient neuroprotective agent and showed promising effects in some neurodegenerative diseases such as Alzheimer’s disease and multiple sclerosis. However, the implication of CeO2NPs in Parkinsonism remains to be investigated. The aim of this study was to assess the possible role of CeO2NPs as a neuroprotective agent against the development of behavioral and biochemical changes in rat model of Parkinson’s disease. Thirty rats were included and received left intrastriatal injection of either saline (controls, n = 10) or 6-hydroxy dopamine (6-OHDA) in untreated group (n = 10) and 10 rats were received intraperitoneal injection of low dose CeO2NPs two hours before surgery, and continued once daily for 6 weeks (preventive group). At the end of experimental period, rats were subjected to behavioral assessment and then killed for biochemical analysis of striatal dopamine levels, oxidative stress markers and caspase-3 activity. Results showed that CeO2NPs resulted in partial neuroprotection against disturbances in motor performance. It also partially decreased apoptosis and oxidative stress in preventive group, while it failed to increase striatal dopamine level as compared to untreated rats. The present study verified some neuroprotective effects of CeO2NPs in 6-OHDA-induced Parkinsonian rats through their antioxidant and anti apoptotic effects. Some of these effects persisted till the end of six weeks whereas others declined after three weeks. A larger dose may be needed to produce more valuable effects and to maintain protection for a longer period

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. Methods: Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds. Findings: We estimated that, in 2019, the world had 104·0 million (95% uncertainty interval 83·5–128·0) health workers, including 12·8 million (9·7–16·6) physicians, 29·8 million (23·3–37·7) nurses and midwives, 4·6 million (3·6–6·0) dentistry personnel, and 5·2 million (4·0–6·7) pharmaceutical personnel. We calculated a global physician density of 16·7 (12·6–21·6) per 10 000 population, and a nurse and midwife density of 38·6 (30·1–48·8) per 10 000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10 000 population, at least 20·7 physicians, 70·6 nurses and midwives, 8·2 dentistry personnel, and 9·4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6·4 million physicians, 30·6 million nurses and midwives, 3·3 million dentistry personnel, and 2·9 million pharmaceutical personnel. Interpretation: Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment

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&nbsp;years; 78.2% included were male with a median age of 37&nbsp;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