RSM and Artificial Neural Networking based production optimization of sustainable Cotton bio-lubricant and evaluation of its lubricity & tribological properties

Depletion of mineral reservoirs along with health and environmental concerns have led to a greater focus on bio-lubricants. The purpose of this study was to analyze and optimize the reaction conditions of the transesterification process for cotton biolubricant synthesis by using Response Surface Methodology (RSM). In RSM, Rotatable central composite design was selected to examine the effect of reaction input factors on the yield of cotton bio-lubricant during the transesterification process. ANOVA analysis showed that temperature was the most significant factor followed by time, pressure and catalyst-concentration. Optimum reaction conditions obtained by RSM for maximum TMP tri-ester (cotton bio-lubricant) yield of about 37.52% were 144 °C temperature, 10 h time, 25 mbar pressure, and 0.8% catalyst-concentration. RSM predicted results were successfully validated experimentally and by artificial neural networking. About 90%–94% cotton seed oil bio-lubricant was obtained after purification and its physiochemical, lubricity and tribological properties were evaluated and found comparable with ISO VG-46 and SAE-40 mineral lubricant. Hence, cottonseed oil is a potential source for the bio-lubricant industry

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

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

Ludwig’s Angina: The Importance of Oral Cavity Examination in Patients with a Neck Mass

neck mass is a common condition in primary care. the most common affected area is the cervical lymph node. the neck region is also prone infection as structurally the nodes and spaces are in close contact with the upper respiratory tract and the alimentary tract. oral cavity is one of the most common route for harbouring infection. Poor oral hygeine and periapical dental problems are the main causes. thus, it is important to perform a complete oral cavity examination even when trismus is present. Besides dental caries, floor of the mouth should be inspected for oedema that may impose threat to the upper airway. We report a case of Ludwig’s angina originating from a periapical lesion of the lower molar stressing the importance of oral examination in patient with neck mass

The role of religious loyalty in combating digital piracy: an Islamic perspective

Religiosity has been seen as a powerful determinant of human actions especially in situations of ethical dilemmas such as digital piracy. Thus, it has been addressed as a potential informal institution to curtail the phenomenon. However, previous research indicated a confounding influence of some contextual factors on the anticipated role of religious loyalty such as the dominant secular culture. As such, the main objective of this article is to investigate the role of religious loyalty in combating digital piracy from the Islamic perspective since loyalty is a core aspect of Muslim’s society as directly associated with faith. Additionally, this paper explores the contextual factors in Islamic countries that may influence the role of religious loyalty in fighting digital piracy. This study involved with qualitative data, gathered from journal articles and books, and then the data analysed using content analysis method. The analysis shows that integrating religion within the campaign toward copyright is potentially viable provided that other contextual factors are properly tackle