The invisible evil twin of an adrenal adenoma / Aimi Fadilah M … [et al.]

Primary aldosteronism (PA) causes a persistently elevated blood pressure (BP) due to excessive release of the hormone aldosterone from the adrenal glands. Classically, it is called Conn’s syndrome and is described as the triad of hypertension and hypokalemia with the presence of unilateral adrenal adenoma. It can be cured with surgical resection of the aldosterone-secreting adenoma leading to resolution of hypertension, hypokalemia and increased cardiovascular risk associated with hyperaldosteronism. We present a case of a man with previous ischemic heart disease (IHD) who presented with resistant hypertension. Investigations for secondary causes of hypertension revealed an elevated aldosterone level and saline suppression test confirmed the diagnosis of PA. Radiological examination revealed a left adrenal adenoma and a normal right adrenal gland. However, adrenal venous sampling showed lateralization of aldosterone secretion towards the right. He subsequently underwent a laparoscopic right adrenalectomy which improved his BP control promptly. This case highlights the importance of recognizing the need to investigate for secondary causes of hypertension. It also underscores the importance of dynamic tests, which may not be easily accessible to most clinicians but should pursue, to allow a definitive diagnosis and effective treatment

Prioritization of zoonoses for multisectoral, One Health collaboration in Somalia, 2023

Background: The human population of Somalia is vulnerable to zoonoses due to a high reliance on animal husbandry. This disease risk is exacerbated by relatively low income (poverty) and weak state capacity for health service delivery in the country as well as climate extremes and geopolitical instability in the region. To address this threat to public health efficiently and effectively, it is essential that all sectors have a common understanding of the priority zoonotic diseases of greatest concern to the country. Methods: Representatives from human, animal (domestic and wildlife), agriculture, and environmental health sectors undertook a multisectoral prioritization exercise using the One Health Zoonotic Disease Prioritization (OHZDP) tool developed by the United States CDC. The process involved: reviewing available literature and creating a longlist of zoonotic diseases for potential inclusion; developing and weighting criteria for establishing the importance of each zoonoses; formulating categorical questions (indicators) for each criteria; scoring each disease according to the criteria; and finally ranking the diseases based on the final score. Participants then brainstormed and suggested strategic action plans to prevent, and control prioritized zoonotic diseases. Results: Thirty-three zoonoses were initially considered for prioritization. Final criteria for ranking included: 1) socioeconomic impact (including sensitivity) in Somalia; 2) burden of disease in humans in Somalia); 3) availability of intervention in Somalia; 4) environmental factors/determinants; and 5) burden of disease in animals in Somalia. Following scoring of each zoonotic disease against these criteria, and further discussion of the OHZDP tool outputs, seven priority zoonoses were identified for Somalia: Rift Valley fever, Middle East respiratory syndrome, anthrax, trypanosomiasis, brucellosis, zoonotic enteric parasites (including Giardia and Cryptosporidium), and zoonotic influenza viruses. Conclusions: The final list of seven priority zoonotic diseases will serve as a foundation for strengthening One Health approaches for disease prevention and control in Somalia. It will be used to: shape improved multisectoral linkages for integrated surveillance systems and laboratory networks for improved human, animal, and environmental health; establish multisectoral public health emergency preparedness and response plans using One Health approaches; and enhance workforce capacity to prevent, control and respond to priority zoonotic diseases

The impact of occupants’ behaviours on building energy analysis: A research review

Over the past 15 years, the evaluation of energy demand and use in buildings has become increasingly acute due to growing scientific and political pressure around the world in response to climate change. The estimation of the use of energy in buildings is therefore a critical process during the design stage. This paper presents a review of the literature published in leading journals through Science Direct and Scopus databases within this research domain to establish research trends, and importantly, to identify research gaps for future investigation. It has been widely acknowledged in the literature that there is an alarming performance gap between the predicted and actual energy consumption of buildings (sometimes this has been up to 300% difference). Analysis of the impact of occupants’ behaviour has been largely overlooked in building energy performance analysis. In short, energy simulation tools utilise climatic data and physical/ thermal properties of building elements in their calculations, and the impact of occupants is only considered through means of fixed and scheduled patterns of behaviour. This research review identified a number of areas for future research including: larger scale analysis (e.g. urban analysis); interior design, in terms of space layout, and fixtures and fittings on occupants’ behaviour; psychological cognitive behavioural methods; and the integration of quantitative and qualitative research findings in energy simulation tools to name but a few

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Terveysalan kuvasanasto suomi–somali-kuvasanasto sisäelimistä tulkin avuksi

Opinnäytetyössä laadittiin työelämälähtöinen tarpeellinen terveysalan suomi–somali-kuvasanasto sisäelimistä. Terveysalan kuvasanasto on tarkoitettu asioimistulkeille, asioimistulkkiopiskelijoille, tulkkausalan opettajille, terveydenhuoltoalan työntekijöille, kuten terveydenhoitajalle, akateemisille tutkijoille ja muille suomi–somali-sanastosta kiinnostuneille. Kuvasanasto on käytännöllinen terveysalan asioimistulkkaus- ja tulkkausalan opetustyössä. Opinnäytetyön liitteenä olevassa kuvasanastossa on 14 sisäelimen nimitykset suomeksi, niiden vastineet somaliksi sekä sisäelimien määritelmät ja lisäksi sanasto liittyen sisäelimien rakenteeseen, toimintaan ja tauteihin. Opinnäytetyössä hyödynnettiin alan kirjallisuutta ja muita lähteitä, kuten internet, jonka myötä syntyi kuvasanasto. Sisäelimien sanat on kerätty tulkkaustoimeksiannoista terveysalalla ja olennaisista terveysalan lähteistä. Sanaston laatu ja korrektius on varmistettu lähteistä, kuten suomi–somali-sanakirja.The thesis was formed as a work field based necessary healthcare picture glossary of internal organs in the language pair Finnish–Somali. The healthcare glossary is intended for community interpreters, community interpreter students, teachers of interpreting, healthcare employees such as nurses, academic researchers and for those who have an interest in the Finnish–Somali glossary. The picture glossary is practical in healthcare community interpreting and in teaching interpreting. The thesis includes picture glossary appendices which contain 14 terms of in-ternal organs in Finnish, equivalents in Somali and term definitions. Also, the glossary includes a glossary that is related to the structure of internal organs, performance and diseases. In the study, field literature and other references such as the internet were used. That is how the picture glossary was formed. The terms of internal organs have been gathered during healthcare interpreting work in practice and also from essential healthcare references. The glossary quality and correctness have been ensured from numerous references, for example a Finnish–Somali glossary.Buuggan qalinjebinta waxaa loo qoray baahi shaqada laanta caafimaadka ka jirta awgeed. Eraybixin af- finnish- af-somali ah xubnaha uurkujirta ka hadleyso waxaa loogu talagalay turjubaanada, ardayda turjubaanimada baraneyso, macalimiinta laanta turjubaanada, shaqaalaha laanta daryeelka caafimaadka, sida kalkaalisooyinka, cilmibaarayaasha iyo inta kale oo xiiseyso eraybixinta af-somaliga iyo af-finniska ah. Eraybixinta sawirka leh oo laanta caafimaadka ah, waa mid waxtar u leh turjubaanada soo daneysiga iyo shaqada waxbarida ee laanta turjubaanada. Buugga qalinjebinta waxaa la socdo oo ku lifaaqan eraybixin sawir leh 14 xubin oo uurkujir ah magacyadooda oo af-finnish ah iyo dhigooda oo af-somali ah iyo qeexida xubnaha uurkujirta iyo eraybixin la xiriirta xubnaha uurkujirta dhismahooda, shaqadooda iyo cudurada ku dhaca. Buugga qalinjebinta qoraalkiisa waxaan ka faa’iideystay buuggaagta laanta caafimaadka iyo ilo kale, sida interneydka, sidaas ayuu iigu qabsoomay eraybixintan. Erayada xubnaha uurkujirta waxaan ka soo uruuriyay markii shaqada turjubaanka laanta caafimaadka la iidiro iyo ilo badan oo laanta caafimaadka ah. Eraybixinta waxaa tayadeeda iyo sax ahaanteeda laga hubiyay ilo badan, sida qaamuuska af-finnish- af-somalig

The implications of Hawala remittance system to the Somali businesses: a case study of Eastleigh, Nairobi.

A Project Report Submitted to Chandaria School of Business in Partial Fulfillment of the Requirement for the Degree of Masters in Business Administration (MBA)The general objective of this study was to investigate the implications of the Hawala Remittance Systems to the Somali Businesses. The study was guided by the following research objectives: To determine the role of the Hawala system in Somali businesses in Eastliegh, to identify the factors that motivate the Somali businesses in eastliegh to use Hawala system and to assess the challenges faced by Hawala system as a financial transaction system. The study used descriptive research design that focused on the Somali business people, employees, individuals and hawala dealers based in Eastliegh. The subjects and participants of this study were homogeneous and constituted of only business people of the Somali origin living and working in Eastliegh, Nairobi, Kenya. The population comprised of 270 respondents. Simple random sampling was used to obtain a sample size of 30, comprising of business owners, employees, hawaladars and individual hawala users. Questionnaires were designed and used to collect data and analysed using descriptive statistics by use of Statistical Package for Social Sciences (SPSS) software and Microsoft Excel. The study assessed operation, development, growth of the business and banking system as the major roles of the Hawala System. The study revealed that hawala had the role of being used as a banking system, for instance it was found out that 96.7% of the respondents agreed that hawala systems were also used as banking system, where these respondents deposited huge amounts of money in dollars in these systems after making profits from their businesses in eastliegh, before they transferred to a normal bank account safely. However the study showed that Hawala system had no major role in development, growth and operation of Somali Businesses in eastliegh, and infact Islamic banks like First Community Bank and also Gulf Bank were major financers of eastliegh businesses The study showed speed of service delivery, cheap transaction, cultural convenience and versatility issues as the major factors motivating Somali Businesses to use Hawala systems. The study revealed that hawala remittance system was very fast in terms of financial transactions in businesses and also the cheapest mode of money transfer as compared to banks, reason being that the system’s limited overheads and the virtual lack of regulation and taxation, hence lower overall operation cost. The study further revealed that government issues were the major challenges facing Hawala system and on the other hand the study demonstrated that security was not viewed as a challenge facing Hawala system; since it was found out that Hawaladars have put strict security measures. For example, it was discovered that Dahabshiil has hired security guards, who screen customers before letting them into the building to conduct their businesses. Further more the study revealed that hawala was not used for illegal money laundering activities here in Kenya, which lead to crimes and law violations. It was concluded that in order to solve the challenges facing Hawala systems, the government, through the Ministry of Trade, should introduce bills or laws that cover and legalizes the use of the Hawala systems without any inhibitions. It was also established in the study, that new innovations should be introduced by the Hawala owners; like the introduction of personal and business accounts that will encourage more people who are not Somalis to use the system. The government should also start introducing courses about Hawala System in schools and universities to make its citizens aware of its benefits and implications so that the citizens or even foreigners living in Kenya are aware of the business opportunities this system creates. The Media should also dedicate a section of the business news to educative topics on Hawala and its performance in order to make the citizens and foreigners in Kenya aware of alternative financial transactions. The study recommends that the government should introduce policies that will give Hawala system a fair chance of operating in Kenya just like other financial transactions that are already n operation. This move will enable the government to create jobs for its active unemployed youth and also revenue which will accrue from the taxes collected from these Hawalas that generate a lot of money. The study further recommends that auditing of accounting books of the hawala remittance system should be conducted since, no financial statements had ever been printed and released, and this will help the government when making policies for development purposes. The researcher recommends that the government should develop Hawala Remittance Act that will create more favourable conducive environment to smooth the operations of the Hawala Systems, and implement it

An Assessment of Strategy Implementation in Organizations: A Case of KENBRO Industries

A Research Project Report Submitted to Chandaria School of Business in Partial Fulfillment of the Requirement for the Degree of Masters of Business Administration (MBA)The purpose of the study was to assess strategy implementation in organizations. Kenbro Industries was used as a case. The study was guided by the following research questions; What are the roles of top management in strategy implementation? What are the benefits of strategy implementation in Kenbro Industries? What are the challenges faced in strategy implementation at Kenbro Industries? The study employed a descriptive cross-sectional survey. The population for this study comprised of all the fifty top management and middle management of Kenbro Industries. Judgmental sampling technique was used in the study due to the fact that top management and middle management are responsible for strategy implementation. The data collection was carried out in the month of June 2015 through the use of structured questionnaires. The analysis involved descriptive statistics, regression analysis and crosstabulations to draw inferences about the characteristics of the entire population. Tables and figures were used in the presentation of the results. The first research question sought to determine the roles of top management in strategy implementation at Kenbro industries. The study showed that in the process of strategy implementation, top leadership at Kenbro industries determine the strategic direction for their organizations; create a balanced organizational control; and encourage ethical practices. The second research question sought to determine the benefits of strategy implementation at Kenbro industries. The study showed that strategy implementation acts a source of competitive advantage; and lead to greater environmental awareness. On the other side, there was no evidence to show that strategy implementation leads to reduced resistance to change; and enhanced staff morale and productivity at Kenbro industries. The third research question sought to determine the challenges that affect strategy implementation at Kenbro industries. The study showed that the communication of organizational strategy during implementation presented a challenge to Kenbro industries. On the other hand, the study disagreed that there is a conflict between the workforce goals and organizational strategies. The study also disagreed that human capital at Kenbro industries is ineffective in strategy implementation. Lastly the study disagreed that that resource allocation at Kenbro is not aligned with the strategy implementation. The study recommends that, since the study has demonstrated that the Kenbro industries have put measures to ensure that there is top management support for strategy implementation, yet the level of agreement as to whether the top leadership sets strategic direction for their organizations; create a balanced organizational control; and encourage ethical practices each scores less than 70 percent. To fully benefit, Kenbro industries needs to ensure visible and complete support from the top management. While the study showed that strategy implementation acts a source of competitive advantage as it leads to superior service quality; highly differentiated products; and makes the organization to be the organization of choice, the study further showed that majority disagreed that strategy implementation leads to lowest prices for value offered compared to other competitors. There seems to be contradictions in these two findings. Therefore more studies would be welcome to clarify the issue. The study also showed lack of evidence as to whether strategy implementation leads to enhanced staff morale and productivity at Kenbro industries contrary to existing literature and the fact that it leads to low staff turnover; and highly efficient staff. Further studies would be welcome to support this position. Further, the study identified communication as the weakest link in strategy implementation at Kenbro industries. The organization should put measures to ensure that the organizations’ strategy effectively communicated to the entire workforce; and make sure that all employees are in a position to expressly communicate the organization’s vision. Finally, since the current study was only limited to top management, furthers studies covering the entire workforce would be welcome. Furthermore studies carried out at different time zones would enrich validation of the current findings

Kl-trä i Byggnader : Utmaningar att bygga hus i KL-trä med fokus till fukt, brand och förband aspekter.

Purpose: Sustainability and reduced environmental impact are increasingly pressing challenges within the construction sector. Wood has become a sought-after building material due to its renewability and lower energy intensity during manufacturing. However, the growing demand for buildings coupled with diminishing available land has led to vertical construction emerging as a solution. Multi-story buildings that primarily utilize wood as their construction material, however, face a range of challenges, including fire hazards, moisture-related issues, and requirements for strong connections between various components of the structure. Method: The research methodology employed in this study is based on a systematic review of relevant literature to investigate the use of CLT in tall buildings. The three selected aspects for this study will then be examined to gain in-depth knowledge of the challenges that arise. Interviews will be conducted regarding moisture and fire aspects to obtain firsthand insights from industry experts on how these challenges are addressed. The third component, concerning connections, will be investigated using literature on various types of connections used in CLT buildings. Two different solutions will be evaluated and compared based on observations and documentation from sitevisits. Results: CLT is a building material that exhibits certain challenges regarding connections, fire resistance, and moisture. This study investigated various solutions to address these three aspects. Moisture control can be achieved through different measures such as weather protection, moisture measurements, and on-site or pre-manufacturing drying of CLT. Fire solutions commonly employed include fire-retardant coatings, sprinklersystems, and fire-resistant gypsum boards. Another viable approach is oversizing, taking advantage of wood's natural charring process. The two most common connection solutions for the selected joints are angle brackets and long timber screws. These solutions yield comparable results in terms of load-bearing capacities but require distinct approaches to installation and fireinsulation. Conclusions: This study investigated challenges related to three aspects in order to develop effective solutions for these various challenges. The solutions examined in this work are viable and applicable, but careful consideration must be given to their practical implementation. All three aspects require meticulous planning and expertise, and the application should also be carried out correctly

Kl-trä i Byggnader : Utmaningar att bygga hus i KL-trä med fokus till fukt, brand och förband aspekter.

Purpose: Sustainability and reduced environmental impact are increasingly pressing challenges within the construction sector. Wood has become a sought-after building material due to its renewability and lower energy intensity during manufacturing. However, the growing demand for buildings coupled with diminishing available land has led to vertical construction emerging as a solution. Multi-story buildings that primarily utilize wood as their construction material, however, face a range of challenges, including fire hazards, moisture-related issues, and requirements for strong connections between various components of the structure. Method: The research methodology employed in this study is based on a systematic review of relevant literature to investigate the use of CLT in tall buildings. The three selected aspects for this study will then be examined to gain in-depth knowledge of the challenges that arise. Interviews will be conducted regarding moisture and fire aspects to obtain firsthand insights from industry experts on how these challenges are addressed. The third component, concerning connections, will be investigated using literature on various types of connections used in CLT buildings. Two different solutions will be evaluated and compared based on observations and documentation from sitevisits. Results: CLT is a building material that exhibits certain challenges regarding connections, fire resistance, and moisture. This study investigated various solutions to address these three aspects. Moisture control can be achieved through different measures such as weather protection, moisture measurements, and on-site or pre-manufacturing drying of CLT. Fire solutions commonly employed include fire-retardant coatings, sprinklersystems, and fire-resistant gypsum boards. Another viable approach is oversizing, taking advantage of wood's natural charring process. The two most common connection solutions for the selected joints are angle brackets and long timber screws. These solutions yield comparable results in terms of load-bearing capacities but require distinct approaches to installation and fireinsulation. Conclusions: This study investigated challenges related to three aspects in order to develop effective solutions for these various challenges. The solutions examined in this work are viable and applicable, but careful consideration must be given to their practical implementation. All three aspects require meticulous planning and expertise, and the application should also be carried out correctly