Effective catalytic deoxygenation of palm fatty acid distillate for green diesel production under hydrogen-free atmosphere over bimetallic catalyst CoMo supported on activated carbon

Palm fatty acid distillate (PFAD) is considered as an inedible and renewable feedstock for the production of green diesel. In the current study, green diesel was successfully synthesised via catalytic deoxygenation of PFAD in an environment free of H2 using a mesoporous activated carbon (AC) supported CoMo catalyst with various molybdenum (Mo) concentrations (5–20 wt%). Based on the study results, bimetallic catalyst Co10Mo10/AC formulation exhibited excellent catalytic performance with 92% hydrocarbon components (C8-C20) yield and 89% selectivity for n-(C15 + C17) with a total acid number of 24 mg KOH mg−1 . Based on a comparison study with various supports (AC, γ-Al2O3, TiO2), the AC-supported CoMo catalyst showed higher deoxygenation activity than both Co10Mo10/γ-Al2O3 and Co10Mo10/TiO2 owing to the super acid-base sites as a result of synergism between the CoMo and AC support. The Co10Mo10/AC catalyst demonstrated excellent stability during the study as it maintained the hydrocarbon components yield and selectivity of n-(C15 + C17) > 80% until the sixth run

Catalytic deoxygenation by H2-free single-step conversion of free fatty acid feedstock over a Co-Ag carbon-based catalyst for green diesel production

A family of activated carbon-supported Co-Ag catalysts, synthesised through incipient wetness impregnation, have been evaluated for the deoxygenation of palm fatty acid distillate (PFAD) and inedible feedstocks (jatropha oil and waste cooking oil) to green diesel. High deoxygenation efficiency and conversion of PFAD to hydrocarbon liquid products through decarboxylation/decarbonylation (deCOx) is observed, with Co(10wt.%)-Ag(5− 20wt.%)/AC exhibiting the greatest hydrocarbon (C8–C20) fractions yield of 92 % and 95 % (C15+C17) selectivity after 120 min reaction at 350 ◦C. These results suggested the synergistic effect between the active metals, Co-Ag, and the activated carbon support, creating acid-base Bronsted ¨ sites, which significantly facilitated the selective deCOx pathway of the fatty acid. The catalyst Co(10wt.%)-Ag(10wt.%)/AC was capable of deoxygenation the PFAD over eight cycles. Thus, it can be believed a potentially promising catalyst for the production of green diesel, at the same time providing economic opportunities and added value to the palm oil industry

Catalytic deoxygenation of waste cooking oil utilizing nickel oxide catalysts over various supports to produce renewable diesel fuel

The development of renewable diesel fuel from the deoxygenation of non-edible oil is an alternative to non-renewable fuels. Herein, the evaluation of catalytic deoxygenation of waste cooking oil (WCO) over supported Ni-based catalysts was investigated. A series of Ni-based catalysts supported on activated carbon (AC), reduced graphene oxide (rGO), and beta zeolite (Zeo) were prepared via the wet-impregnation method and later carbonised under N2 flow at 550 °C for 4 h. Addition of Ni to AC improves the good physicochemical properties of the catalyst, owing to the high number of acid-base sites, high surface area, smaller crystallite size, and high pore volume of the catalyst. From the catalytic results, Ni20/AC was the most active catalyst by giving 90% hydrocarbon yield and 89% selectivity towards n-(C15 + C17) under H2-free and solvent-free conditions for 3 h at 350 °C and 300 rpm. Furthermore, it was stable up to the fourth cycle with consistent hydrocarbon yield (85–87%) and 66–77% selectively towards n-(C15 + C17). Overall, Ni20/AC shows highly promising catalytic performance due to its good physiochemical properties and high catalyst stability

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Characterization of greater middle eastern genetic variation for enhanced disease gene discovery

The Greater Middle East (GME) has been a central hub of human migration and population admixture. The tradition of consanguinity, variably practiced in the Persian Gulf region, North Africa, and Central Asia1-3, has resulted in an elevated burden of recessive disease4. Here we generated a whole-exome GME variome from 1,111 unrelated subjects. We detected substantial diversity and admixture in continental and subregional populations, corresponding to several ancient founder populations with little evidence of bottlenecks. Measured consanguinity rates were an order of magnitude above those in other sampled populations, and the GME population exhibited an increased burden of runs of homozygosity (ROHs) but showed no evidence for reduced burden of deleterious variation due to classically theorized ‘genetic purging’. Applying this database to unsolved recessive conditions in the GME population reduced the number of potential disease-causing variants by four- to sevenfold. These results show variegated genetic architecture in GME populations and support future human genetic discoveries in Mendelian and population genetics

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Energy Efficiency in Sustainable Buildings: A Systematic Review with Taxonomy, Challenges, Motivations, Methodological Aspects, Recommendations, and Pathways for Future Research

In recent years, increasing interest has been shown in targeting energy efficiency as a roadmap for carbon mitigation, limiting energy use, improving buildings’ energy performance, and reducing energy consumption for achieving sustainable buildings. This article presents a systematic review to provide the best practices in this area and identify the challenges, motivations, recommendations, and pathways for future work. Discussing the methodological aspects gives insights for future researchers. This research used papers published on three scientific and reliable databases—Web of Science, ScienceDirect, and IEEE Xplore-from 2014 to May 23, 2021. The selected papers reached N = 134 based on inclusion and exclusion criteria and divided into review papers, proceeding conference, and articles. The review articles (N = 16/134) give an overall view on improving energy efficiency to achieve sustainability in buildings by using green building rating systems, developing and implementing policies, technology utilization, adopting techniques, and applying strategies. The conferences (N = 33/134) and articles (N = 85/134) focus more on details of different aspects of improving energy efficiency by reducing environmental, economic, social, and other impacts. A few articles proposed multiple-criteria decision-making methods to solve energy efficiency gaps for promoting sustainability in buildings. Achieving energy efficiency toward sustainable buildings is a hot topic in the sustainable development area. The outcomes from this paper will provide a valuable reference to stakeholders, governments, and decision-makers and give suggestions from the selected past studies. This review will provide motivation and attract future research endeavors in the field