Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Subspace identification of fault modes for a twin-rotor system

Purpose: The purpose of this paper is to identify the fault modes of a nonlinear twin-rotor system (TRS) using the subspace technique to facilitate fault identification, diagnosis and control applications. Design/methodology/approach: For identification of fault modes, three types of system malfunctions are introduced. First malfunction resembles actuator, second internal system dynamics and third represents sensor malfunction or offset. For each fault scenario, the resulting TRS model is applied with persistently exciting inputs and corresponding outputs are recorded. The collected input–output data are invoked in NS4SID subspace system identification algorithm to obtain the unknown fault model. The identified actuator fault modes of the TRS can be used for fault diagnostics, fault isolation or fault correction applications. Findings: The identified models obtained through system identification are validated for correctness by comparing the response of the actual model under the fault condition and identified model. The results certify that the identified fault modes correctly resemble the respective fault conditions in the actual system. Originality/value: The utilization of proposed work for current research emphasized the area of fault detection, diagnosis and correction applications that makes its value significantly. These modes when used for diagnosis purposes allow users to timely get intimated and rectify the performance degradation of the plant before it gets totally malfunctioned. Moreover, the slight performance degradation is also indicated when fault diagnosis is performed

Evaluation of the Radon Levels in the Groundwater Wells of Qatar: Radiological Risk Assessment

The objective of this work is to give a holistic overview of the groundwater quality in Qatar in terms of its radon levels and provide a radiological risk assessment of elevated radon levels on human health. This study covered the analysis of groundwater collected from various locations throughout Qatar and maps using ArcGIS followed by a radiological risk assessment of radon in Qatar. There is no extensive study reported to investigate radon activity levels in groundwater across Qatar and their health effects. The radon level measurements of the Qatari groundwater ranged between 2.7 ± 0.2 and 60.7 ± 13.4 Bq/L with a mean value of 20.6 Bq/L, which is greater than the US EPA’s maximum contamination level (11 Bq/L). About 65% of the studied samples exceeded the US EPA’s MCL guidelines. The mean total annual effective dose due to radon inhalation and ingestion was 0.056 mSv/y, which is below the WHO reference level of 0.1 mSv/y. The radon radiological risk study through inhalation and ingestion clearly revealed that the contribution of the inhalation dose was higher than the ingestion dose

Melioidosis: Can tropical infections present in nonendemic areas? A case report and review of the literature

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is an important cause of sepsis in tropical areas of Eastern Asia, mainly affecting immunocompromised adults. Diabetes mellitus is the most important host risk factor. Here, we report a case of a 54-year-old Saudi male with uncontrolled diabetes mellitus for 10 years who presented to our hospital with a 6-week history of fever, cough, night sweats and weight loss. Definite diagnosis of melioidosis was not made because of insufficient facility to culture the organism in our laboratory; nevertheless, the diagnosis of melioidosis was made based on the cumulative clinical scenario. The patient was discharged with a prescription of trimethoprim–sulfamethoxazole and doxycycline for 3 months and showed dramatic improvement at follow-up. For prompt diagnosis and treatment, clinicians must maintain a high index of suspicion for melioidosis in febrile patients with a history of traveling to endemic areas, especially diabetic patients. Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is an important cause of sepsis in tropical areas of Eastern Asia, mainly affecting immunocompromised adults. Diabetes mellitus is the most important host risk factor. Here, the authors report a case of a 54-year-old Saudi male with uncontrolled diabetes mellitus for 10 years who presented to our hospital with a 6-week history of fever, cough, night sweats and weight loss. The patient was a frequent traveler to the Philippines, with his last visit being during the rainy season 2 weeks before the onset of symptoms. Definite diagnosis of melioidosis was not made because of insufficient facility to culture the organism in our laboratory; nevertheless, a diagnosis of melioidosis was made based on the cumulative clinical scenario. The patient was discharged on trimethoprim–sulfamethoxazole and doxycycline for 3 months and showed significant improvement at follow-up. For prompt diagnosis and treatment, clinicians must maintain a high index of suspicion for melioidosis in febrile patients with a history of traveling to endemic areas, especially diabetic patients

Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions

IntroductionArmed conflicts have a severe impact on the health of women and children. Global health emergencies such as pandemics and disease outbreaks further exacerbate the challenges faced by vulnerable populations in accessing maternal, neonatal, and child healthcare (MNCH). There is a lack of evidence that summarizes the challenges faced by conflict-affected pregnant women, mothers, and children in accessing MNCH services during global health emergencies, mainly the Ebola and COVID-19 pandemics. This scoping review aimed to analyze studies evaluating and addressing barriers to accessing comprehensive MNCH services during Ebola and COVID-19 emergencies in populations affected by conflict.MethodsThe search was conducted on PubMed, Scopus, and Web of Science databases using terms related to Ebola and COVID-19, conflicts, and MNCH. Original studies published between 1990 and 2022 were retrieved. Articles addressing the challenges in accessing MNCH-related services during pandemics in conflict-affected settings were included. Thematic analysis was performed to categorize the findings and identify barriers and solutions.ResultsTwenty-nine studies met the inclusion criteria. Challenges were identified in various MNCH domains, including antenatal care, intrapartum care, postnatal care, vaccination, family planning, and the management of childhood illnesses. Ebola-related supply-side challenges mainly concerned accessibility issues, health workforce constraints, and the adoption of stringent protocols. COVID-19 has resulted in barriers related to access to care, challenges pertaining to the health workforce, and new service adoption. On the demand-side, Ebola- and COVID-19-related risks and apprehensions were the leading barriers in accessing MNCH care. Community constraints on utilizing services during Ebola were caused by a lack of trust and awareness. Demand-side challenges of COVID-19 included fear of disease, language barriers, and communication difficulties. Strategies such as partnerships, strengthening of health systems, service innovation, and community-based initiatives have been employed to overcome these barriers.ConclusionGlobal health emergencies amplify the barriers to accessing MNCH services faced by conflict-affected populations. Cultural, linguistic, and supply-side factors are key challenges affecting various MNCH domains. Community-sensitive initiatives enhancing primary health care (PHC), mobile clinics, or outreach programs, and the integration of MNCH into PHC delivery should be implemented. Efforts should prioritize the well-being and empowerment of vulnerable populations. Addressing these barriers is crucial for achieving universal health coverage and the Sustainable Development Goals

Cutaneous manifestations in patients attending the hematology clinic at King Fahd Hospital of the University during a 13 week-period

Background: Cutaneous disorders are common in patients with hematological diseases especially anemia. Dermatologists usually contribute to the management of these patients in parallel with other medical specialties. Aim: To report common dermatological problems in patients attending the hematology clinic at a secondary care hospital. Materials and Methods: The study was conducted at the hematology clinic of King Fahd Hospital of the University during a thirteen week period starting 17th of November, 2013 till 31st of January, 2014. All patients were fully examined and a consultative opinion was given to the attending hematologist. Data sheet was filled and analyzed by SPSS (Statistical Package for the Social Sciences) software version 17.0. Results: 138 patients were seen during the period of 13 weeks. There were 27 males and 111 females. Hemoglobin level was less than 10 gm/dl in 40.6% of patients. The most common reported cutaneous features were diffuse alopecia, hair thinning, pallor, pruritus, fragile skin, easy brusability, dry mouth and gum bleeding in descending frequency. Conclusion: Hematology patients suffered from variable dermatological disorders which suggest the importance of the initial dermatology consultation for those patients as part of their management plan

Healthcare needs and health service utilization by Syrian refugee women in Toronto

Abstract Objective Access to healthcare is an important part of the (re)settlement process for Syrian refugees in Canada. There is growing concern about the healthcare needs of the 54,560 Syrian refugees who were admitted to Canada by May 2018, 80% of whom are women and children. We explored the healthcare needs of newcomer Syrian women, their experiences in accessing and using health services, and the factors and conditions that shape whether and how they access and utilize health services in the Greater Toronto Area (GTA). Method This community-based qualitative descriptive interpretive study was informed by Yang & Hwang (2016) health service utilization framework. Focus group discussions were held with 58 Syrian newcomer women in the GTA. These discussions were conducted in Arabic, audio-recorded with participants’ consent, translated into English and transcribed, and analyzed using thematic analysis. Results Participants’ health concerns included chronic, long-term conditions as well as new and emerging issues. Initial health insurance and coverage were enabling factors to access to services, while language and social disconnection were barriers. Other factors, such as beliefs about naturopathic medicine, settlement in suburban areas with limited public transportation, and lack of linguistically, culturally, and gender-appropriate services negatively affected access to and use of healthcare services. Conclusion Responding to the healthcare needs of Syrian newcomer women in a timely and comprehensive manner requires coordinated, multi-sector initiatives that can address the financial, social, and structural barriers to their access and use of services

Clinical description of human bocavirus viremia in children with LRTI, Eastern Province, Saudi Arabia

Human bocavirus (HBoV) is a major etiology of lower respiratory tract infection (LRTI) in young children. We tested 149 patients admitted to King Fahd Hospital of the University with diagnosis of LRTI. Viremia caused by the different studied viruses was detected in 31.5% of the total cases by Real-time Polymerase chain reaction. We report five patients who were positive for HBoV in serum samples. Clinical presentation ranged from mild to severe disease as one of them required admission to intensive care unit. Wheezing was a striking feature in most of our patients, but fever was not a consistent finding