Estimation of PM10-bound As, Cd, Ni and Pb levels by means of statistical modelling: PLSR and ANN approaches

Air quality assessment regarding metals and metalloids using experimental measurements is expensive and time consuming due to the cost and time required for the analytical determination of the levels of these pollutants. According to the European Union (EU) Air Quality Framework Directive (Directive 2008/50/EC), other alternatives, such as objective estimation techniques, can be considered for ambient air quality assessment in zones and agglomerations where the level of pollutants is below a certain concentration value known as the lower assessment threshold. These conditions occur in urban areas in Cantabria (northern Spain). This work aims to estimate the levels of As, Cd, Ni and Pb in airborne PM10 at two urban sites in the Cantabria region (Castro Urdiales and Reinosa) using statistical models as objective estimation techniques. These models were developed based on three different approaches: partial least squares regression (PLSR), artificial neural networks (ANNs) and an alternative approach consisting of principal component analysis (PCA) coupled with ANNs (PCA-ANN). Additionally, these models were externally validated using previously unseen data. The results show that the models developed in this work based on PLSR and ANNs fulfil the EU uncertainty requirements for objective estimation techniques and provide an acceptable estimation of the mean values. As a consequence, they could be considered as an alternative to experimental measurements for air quality assessment regarding the aforementioned pollutants in the study areas while saving time and resources.The authors gratefully acknowledge the financial support from the Spanish Ministry of Economy and Competitiveness through the Project CMT2010-16068. The authors also thank the Regional Environment Ministry of the Cantabria Government for providing the PM10 samples at the Castro Urdiales and Reinosa sites

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

The Potential of Silver Nanoparticles for Antiviral and Antibacterial Applications: A Mechanism of Action

Rapid development of nanotechnology has been in high demand, especially for silver nanoparticles (AgNPs) since they have been proven to be useful in various fields such as medicine, textiles, and household appliances. AgNPs are very important because of their unique physicochemical and antimicrobial properties, with a myriad of activities that are applicable in various fields, including wound care management. This review aimed to elucidate the underlying mechanisms of AgNPs that are responsible for their antiviral properties and their antibacterial activity towards the microorganisms. AgNPs can be synthesized through three different methods&mdash;physical, chemical, and biological synthesis&mdash;as indicated in this review. The applications and limitations of the AgNPs such as their cytotoxicity towards humans and the environment, will be discussed. Based on the literature search obtained, the properties of AgNPs scrutinizing the antibacterial or antiviral effect shown different interaction towards bacteria which dependent on the synthesis processes followed by the morphological structure of AgNPs

Complications of laparoscopic cholecystectomy

ABSTRACT Objective: The main objective was to determine the complications of laparoscopic cholecystectomy (LC) and its causes at Isra University Hospital, Hyderabad. Methodology: This was a retrospective study carried out from July 2005 to June 2007. Data of all patients undergoing laparoscopic cholecystectomy during the study period and fulfilling the selection criteria was collected and analyzed retrospectively. Results: A total of 216 patients underwent laparoscopic cholecystectomy with an overwhelming majority of females. The overall complication rate was 5%. The complications included bleeding (4/216, 1.8%) from cystic artery and gall bladder bed, port site infection (4/216, 1.8%), bile duct injury (2/216, 0.9%) and colonic injury (1/216, 0.4%). The common causes of these complications were accidental injury to cystic artery, gross spillage of infected bile and erroneous clipping of common bile duct. Conclusions: Bleeding and Port site infections were the commonest complications followed by common bile duct and colonic injuries. The commonest cause of bleeding was cystic artery injury whereas the commonest cause of port site infection was gross spillage of infected bile