What Is Historic Integrity Worth to the General Public? Evidence from a Proposed Relocation of a West Virginia Agricultural Mill

While historians believe that preserving a historic building in its original location is important to maintain its historic integrity, the general publicÂ’s opinion is unknown. Survey data were gathered from local residents regarding a proposed relocation of a historic mill in rural West Virginia. Only a minority of the sample population supported preserving the mill at its original location. Willingness to pay for preservation was estimated at $8.45 for a one-time donation for the sample and$2.29 after adjusting for non-respondents using characteristics of the local population.contingent valuation, historic preservation, Tobit model, willingness to pay, Demand and Price Analysis, Resource /Energy Economics and Policy,

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 < 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 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

What Is Historic Integrity Worth to the General Public? Evidence from a Proposed Relocation of a West Virginia Agricultural Mill

While historians believe that preserving a historic building in its original location is important to maintain its historic integrity, the general public's opinion is unknown. Survey data were gathered from local residents regarding a proposed relocation of a historic mill in rural West Virginia. Only a minority of the sample population supported preserving the mill at its original location. Willingness to pay for preservation was estimated at $8.45 for a one-time donation for the sample and$2.29 after adjusting for non-respondents using characteristics of the local population

Octreotide ameliorates gastric lesions in chronically mild stressed rats

AIM: To evaluate the effect of chronic mild stress (CMS) on the emergence of gastric ulcers and possible modulation by octreotide, a synthetic somatostatin analogue

Efficiency performance of Ag-CdSe quantum dots nanocomposite sensitized solar cells

An in-depth analysis of a solar cell with a photoanode made of glass/FTO/TiO2, and Ag- CdSe quantum dots (QD) nanocomposite, an electrolyte of iodide and triiodide, and a Pt electrode is presented in this work. We looked at how CdSe QD filling factors and Ag nanoparticles affect the solar cell's ability to absorb light. Additionally, the effects of nanocomposite layer thicknesses, Iodide/triiodide layer thicknesses, and TiO2 layer thicknesses on the absorption are investigated. It has been discovered that the Ag nanoparticles have an effect on the absorbance around 700 nm, dropping around 800 nm while keeping the range from 400 nm to 600 nm constant as the fraction of silver increases. With the switch to CdSe, the solar cell's performance was only marginally altered. When the composite thickness is increased to 200 nm, the value of A has the highest values and is expanded to include longer wavelengths. While altering the thickness of the iodide/triiodide layer (di) causes the highest values of A to expand at di = 200 nm. However, the performance of the solar cell is unaffected by the TiO2 layer's thickness (dt). As a result, we gave a solar cell the variables that impacted its performance

35. Incomplete right ventricular remodeling after transcatheter atrial septal defect closure in pediatric age

Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age group are scarce. Objective: To assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). Patients &Methods: The study included 37 consecutive patients diagnosed as ASD II by TTE and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt from October 2010 to July 2013. 37 age and sex matched was selected as control group. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and interventricular septum (lateral mitral annulus) and myocardial performance index (MPI) was calculated at 1, 6 and 12 months post device closure. Results: Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards age, gender, weight or BSA. By TDI, patients with ASD had significantly prolonged IVCT, IVRT and MPI compared to control group. Decreased tissue Doppler velocities of RV and LV began at 1 month post-closure compared to the controls. Improvement of RVMPI and LVMPI began at 1 month post-closure but still they are prolonged till 1 year. Conclusion: Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure but didn’t completely return to normal even after 1 year follow-up by TDI

Oral gel loaded with penciclovir–lavender oil nanoemulsion to enhance bioavailability and alleviate pain associated with herpes labialis

Herpes labialis, caused by herpes simplex virus type 1, is usually characterized by painful skin or mucosal lesions. Penciclovir (PV) tablets are found to be effective against herpes labialis but suffer from poor oral bioavailability. This study aimed to combine the benefits of PV and lavender oil (LO), which exhibits anesthetic activity, in the form of a self-nanoemulsifying drug delivery system (SNEDDS) for the treatment of herpes labialis. Toward this purpose, LO (oil), Labrasol:Labrafil M1944 CS in the ratio of 6:4 (surfactant mixture), and Lauroglycol-FCC (co-surfactant, selected based on the solubility of PV) were evaluated as the independent factors using a distance quadratic mixture design. The formulation was optimized for the minimum globule size and maximum stability index and was determined to contain 14% LO, 40.5% Labrasol:Labrafil 1944 (6:4), and 45.5% Lauroglycol-FCC. The optimized PV-LO-SNEDDS was embedded in chitosan hydrogel and the resulting formulations coded by (O3) were prepared and evaluated. The rheological studies demonstrated a combined pseudoplastic and thixotropic behavior with the highest flux of PV permeation across sheep buccal mucosa. Compared to a marketed 1% PV cream, the O3 formulation exhibited a significantly higher and sustained PV release, nearly twice the PV permeability, and a relative bioavailability of 180%. Overall, results confirm that the O3 formulation can provide an efficient delivery system for PV to reach oral mucosa and subsequent prolonged PV release. Thus, the PV-LO-SNEDDS embedded oral gel is promising and can be further evaluated in clinical settings to establish its therapeutic use in herpes labialis