New water-based copolymer nanoparticles and their use as eco-friendly binders for industry of flexographic ink, part I

Purpose: The purpose of this paper is to prepare, characterise and evaluate nano-emulsions of copolymers of various compositions as eco-friendly binders for flexographic ink industry. Design/methodology/approach: Various nano-emulsions of copolymers were prepared using styrene (St), butyl acrylate (BuAc), acrylic acid (AA) and acrylamide (AAm) monomers by means of a conventional seeded emulsion polymerisation technique, using K2S2O8 as the initiator. The characterisation of the prepared emulsions was performed using Fourier transform infrared (FT-IR), thermogravimetric analysis (TGA), gel permeation chromatography (GPC) and transmission electron microscopy (TEM). A selection of copolymers was formulated with pigments and additional ingredients, as water-based flexographic inks. The inks were characterised for their viscosity, pH, degree of dispersion, water resistance and colour density. Findings: It was found that the low viscosity of the prepared copolymers may reduce the film thickness of the flexographic inks and may also increase the spreading of the ink on the surface. As a result, stable modified polyacrylate-based latex with improved physico-mechanical properties were obtained. The prepared latexes were showed improving and enhancing in water resistance; gloss values, and the print density that ranged from 2.06 to 2.51 and the maximum gloss values (39 and 48) were also obtained. Also, these binders provide excellent adhesion properties for both the pigment particles and the base paper. Practical implications: This study focuses on the preparation of new water-based copolymer nanoparticles and their use as eco-friendly binders for flexographic ink industry. Social implications: The ink formulations developed could find use in industrial-scale printing. Originality/value: Eco-friendly environment ink formulations for printing on paper substrates are novel

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

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

New water-based flexographic ink based on new ter-polymer nano-particles as eco-friendly binders – Part II

Purpose: The purpose of this study is to prepare, characterise and evaluate nano-emulsions of ter-polymers of various compositions as eco-friendly binders for flexographic ink industry. Design/methodology/approach: Various nano-emulsions of ter-polymers were prepared based on Vinyl acetate, Vinyl Versatate, butyl acrylate, acrylic acid and acrylamide monomers by means of a conventional seeded emulsion polymerisation technique, using K2S2O8 as the initiator. The characterisation of the prepared emulsions was performed using Fourier transform infrared, thermo-gravimetric analysis, gel permeation chromatography and transmission electron microscopy. A selection of co-polymers and ter-polymers were formulated with pigments and additional ingredients, as water-based flexographic inks. The inks were characterised for their rheological properties, pH, degree of dispersion, water-resistance and colour density. Findings: It was found that the low viscosity of the prepared polymers may reduce the film thickness of the flexographic inks and may also increase the spreading of the ink on the surface. As a result, stable modified poly acrylate-based latex with improved physico-mechanical properties was obtained. The prepared latexes showed improved properties such as enhanced thermal stability and better water resistance. The effect of the emulsifier type on the properties of the resulting emulsion latexes and their corresponding films were investigated. Also, as the hydrophobic monomer increases, so does the colour density and increasing the binder ratio enhances the gloss values. The improving in gloss values were obtained and provide excellent adhesion properties for both the pigment particles and the base paper. Research limitations/implications: The study focusses on the preparation of new water-based ter-polymer nano-particles and their use as eco-friendly binders for flexographic ink industry. Ink formulations based on other different type emulsion polymers could also be studied to assess the applicability of the ink formulation system found for other binders. Practical implications: The ink formulations developed could find use in industrial-scale printing. Originality/value: Eco-friendly environment and low-cost ink formulations for printing on paper substrates are novel