The outcome of ultrasound-guided insertion of central hemodialysis catheter

Objective: To point out our experience and assess the efficacy and safety of real-time ultrasound-guided central internal jugular vein (IJV) catheterization in the treatment of hemodialysis patients. Methods: This retrospective study comprised 150 patients with end-stage renal disease (ESRD) who had real-time ultrasonography (US)-guided IJV HD catheters placed in our hospital between March 2019 and March 2021. Patients were examined for their demographic data, etiology, site of catheter insertion, type (acute or chronic) of renal failure, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered at high-operative risk. Results: All patients experienced technical success. In terms of patient clinical features, an insignificant difference was observed between the normal and high-risk groups (p-value > 0.05). Of the 150 catheters, 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal group and 72.5% for the high-risk group (p = 0.006). IJV cannulation took less time in the normal-risk group compared to the highrisk group (21.2 ± 0.09) minutes vs (35.4 ± 0.11) minutes, (p < 0.001). There were no serious complications. During the placing of the catheter in the internal jugular vein, four patients (6.4%) experienced arterial puncture in the high-risk group. Two participants in each group got a small neck hematoma. One patient developed a pneumothorax in the high-risk group, which was managed with an intercostal chest tube insertion. Conclusions: Even in the high-risk group, the real-time US-guided placement of a central catheter into the IJV is associated with a low complication rate and a high success rate. Even under US guidance, experience lowers complication rates. Real-time USguided is recommended to be used routinely during central venous catheter insertion

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

ECOTOXICITY STUDIES OF PYRIDINIUM BASED IONIC LIQUIDS

Ionic liquids (ILs) are an interesting group of compounds that possess special properties making them a potential replacement for hazardous organic solvents in industry. Notably, the usage of pyridiniurn ILs has been reported widely for different chemical and biological applications. However, the aquatic toxicity data of these compounds are not available. An adequate process design using this group of chemicals requires the assessment of the ecotoxicological risks of these chemicals. The aim is to assess the aquatic toxicity of pyridiniurn ILs using the acute toxicity test towards vital environmental elements such fish and bacteria. In this study, 22 pyridiniurn ILs with various alkyl chain lengths were synthesized using conventional and microwave-assisted techniques. Characterization data was obtained using 'H NMR and l3C NMR. The toxicity evaluation was performed based on Organisation for Economic Cooperation and Development (OECD) Guidelines towards guppy fish

ECOTOXICITY STUDIES OF PYRIDINIUM BASED IONIC LIQUIDS

Ionic liquids (ILs) are an interesting group of compounds that possess special properties making them a potential replacement for hazardous organic solvents in industry. Notably, the usage of pyridiniurn ILs has been reported widely for different chemical and biological applications. However, the aquatic toxicity data of these compounds are not available. An adequate process design using this group of chemicals requires the assessment of the ecotoxicological risks of these chemicals. The aim is to assess the aquatic toxicity of pyridiniurn ILs using the acute toxicity test towards vital environmental elements such fish and bacteria. In this study, 22 pyridiniurn ILs with various alkyl chain lengths were synthesized using conventional and microwave-assisted techniques. Characterization data was obtained using 'H NMR and l3C NMR. The toxicity evaluation was performed based on Organisation for Economic Cooperation and Development (OECD) Guidelines towards guppy fish

Exploring the Benefits of Virtual Reality Adoption for Successful Construction in a Developing Economy

Existing literature has shown that virtual reality (VR) is widely utilized in advanced economies to enhance sustainable construction practices. However, its adoption in developing economies remains limited. Therefore, the objective of this study is to explore the potential benefits of implementing VR technology in a developing country context. The study collected information on the beneficial aspects of VR from previous research and conducted questionnaire surveys to gather relevant insights from construction project experts in Nigeria. The collected data was analyzed using the Measurement of Alternatives and Ranking According to the Compromise Solution (MARCOS) method and Exploratory Factor Analysis (EFA). The MARCOS analysis revealed that the key potential benefits of VR include improved communication and collaboration, enhanced project performance, risk identification, digitalization, and safety planning. Furthermore, the study conducted an in-depth investigation of the beneficial areas of VR using EFA, which identified six component groups: pre-contract stage planning, post-contract stage planning, quality control and sustainability, design flexibility and reputation, resource management, and risk management and digitalization. The study provides a comprehensive discussion on the advantages of implementing virtual building methods in developing countries

Parametric Study on the Behavior of Steel Tube Columns with Infilled Concrete—An Analytical Study

Concrete-filled steel tube (CFST) columns are used in tall buildings and bridges, and they provide more rigidity and higher bearing capacity, but buckling affects their behavior. There is an exceptional need to study the behavior of these columns under various conditions. The numerical method is beneficial in supplementing the experimental works and is used to explore the effects of various parameters because of the limitations in cost, apparatus, and time of the experimental program. The various parameters, such as the different slenderness ratios, i.e., column-height-to-cross-section-dimension (H/D), different steel-tube-thickness-to-column-dimension (D/t), and different compressive strength of concrete to yield strength of steel tube ratio (fc/fy) under concentric axial loading are considered in this current study. Firstly, a finite element model used the “ANSYS” software program and was constructed to validate the results of the experimental works. The extensive numerical models were carried out to extensively widen the study in this field. The numerical work was conducted on sixty-four specimens. Moreover, the analytical calculations from the different international codes/standards were compared with the numerical results to test their reliability in predicting the ultimate carrying loads. The study provided results that show the improvement effect of CFST columns with the high compressive strength of infilled concrete, while no remarkable enhancement effect with the high yield strength of steel tube was observed. Increasing the columns’ diameter is more effective in enhancing the load capacity (about three times more) than increasing the tube thickness (about 1.3 times). Ring stiffeners for long CFST columns (H/D > 12) do not lead to any enhancement of the column behavior due to yielding occurring firstly at the location of the rings. ECP205-2007 is the most conservative design code in predicting the load capacity of CFST columns, while the AIJ design code is good at predicting the ultimate load failure compared to the other codes/standards. Eurocode 4 provides underestimation values of the load-carrying capacity of CFST columns

Ecotoxicity of Pyridinium Based Ionic Liquids: A Review

International audienc

Analysing multifaceted barriers to modular construction in sustainable building projects: a comprehensive evaluation using multi-criteria decision making

Modular construction (MC) is recognized as pivotal for sustainable development in developed countries. However, its implementation faces barriers in residential projects in developing nations. This study aims to address the knowledge gap resulting from the limited uptake of MC in residential projects, mainly attributed to existing barriers. To accomplish this goal, a questionnaire survey was conducted to assess the significance of thirty adoption barriers. Subsequently, an exploratory factor analysis method was applied to categorize these barriers, followed by their assessment and ranking using fuzzy synthetic evaluation. A novel aggregation and ranking method that integrates the WASPAS and TOPSIS techniques for order preference, by similarity to an ideal solution approach, was employed. The rankings derived from different decision-making methods were combined using an ensemble approach based on half-quadratic theory. Our findings reveal that the adoption barriers can be grouped into five main categories, with cost, coordination, and standards emerging as the most prominent barriers. They are followed by technical and practical barriers, inflexibility and supply chain barriers, abilities and awareness barriers, and societal and desire-related barriers. The study results offer significant insights into the barriers impeding MC adoption in developing countries' construction sectors, providing recommendations to improve its uptake.</p

Non‐classical monocytes frequency and serum vitamin D3 levels are linked to diabetic foot ulcer associated with peripheral artery disease

Abstract Aims/Introduction Peripheral artery disease (PAD) serves as a risk factor for diabetic foot ulcers (DFUs). PAD pathology involves atherosclerosis and impaired immunity. Non‐classical monocytes are believed to have an anti‐inflammatory role. 1,25‐Dihydroxy vitamin D (vitamin D3) is claimed to have immune‐modulating and lipid‐regulating roles. Vitamin D receptor is expressed on monocytes. We aimed to investigate if circulating non‐classical monocytes and vitamin D3 were implicated in DFUs associated with PAD. Materials and Methods There were two groups of DFU patients: group 1 (n = 40) included patients with first‐degree DFUs not associated with PAD, and group 2 (n = 50) included patients with DFU with PAD. The monocyte phenotypes were detected using flow cytometry. Vitamin D3 was assessed by enzyme‐linked immunosorbent assay. Results DFU patients with PAD showed a significant reduction in the frequency of non‐classical monocytes and vitamin D3 levels, when compared with DFU patients without PAD. The percentage of non‐classical monocytes positively correlated with vitamin D3 level (r = 0.4, P < 0.01) and high‐density lipoprotein (r = 0.5, P < 0.001), whereas it was negatively correlated with cholesterol (r = −0.5, P < 0.001). Vitamin D3 was negatively correlated with triglyceride/high‐density lipoprotein (r = −0.4, P < 0.01). Regression analysis showed that a high vitamin D3 serum level was a protective factor against PAD occurrence. Conclusions Non‐classical monocytes frequency and vitamin D3 levels were significantly reduced in DFU patients with PAD. Non‐classical monocytes frequency was associated with vitamin D3 in DFUs patients, and both parameters were linked to lipid profile. Vitamin D3 upregulation was a risk‐reducing factor for PAD occurrence

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially