Remote sensing of endangered tree species in the fragmented Dukuduku Indigenous Forest of KwaZulu-Natal, South Africa.

Doctor of Philosophy in Environmental Sciences. University of KwaZulu-Natal, Pietermaritzburg, 2016.Abstract available in PDF file

Exploring the utility of the additional WorldView-2 bands and support vector machines in mapping land use/land cover in a fragmented ecosystem, South Africa

Land use/land cover (LULC) classification is a key research field in environmental applications of remote  sensing on the earthfs surface. The advent of new high resolution multispectral sensors with unique bands has  provided an opportunity to map the spatial distribution of detailed LULC classes over a large fragmented area. The objectives of the present study were: (1) to map LULC classes using multispectral WorldView-2 (WV-2) data and SVM in a fragmented ecosystem; and (2) to compare the accuracy of three WV-2 spectral data sets in distinguishing amongst various LULC classes in a fragmented ecosystem. WV-2 image was spectrally  resized to its four standard bands (SB: blue, green, red and near infrared-1) and four strategically located  bands (AB: coastal blue, yellow, red edge and near infrared-2). WV-2 image (8bands: 8B) together with SB and AB subsets were used to classify LULC using support vector machines. Overall classification accuracies of 78.0% (total disagreement = 22.0%) for 8B, 51.0% (total disagreement = 49.0%) for SB, and 64.0% (total disagreement = 36.0%) for AB were achieved. There were significant differences between the performance of all WV-2 subset pair comparisons (8B versus SB, 8B versus AB and SB versus AB) as demonstrated by the results of McNemarfs test (Z score .1.96). This study concludes that WV-2 multispectral data and the SVM classifier have the potential to map LULC classes in a fragmented ecosystem. The study also offers relatively accurate information that is important for the indigenous forest managers in KwaZulu-Natal, South Africa for making informed decisions regarding conservation and management of LULC patterns.Keywords: land use/cover classification, fragmented ecosystem, WorldView-2, support vector  machines

Assessing edge effect on the spatial distribution of selected forest biochemical properties derived using the worldview data in Dukuduku forests, South Africa

This work explores the potential of the high‐resolution WorldView‐2 sensor in quan‐tifying edge effects on the spatial distribution of selected forest biochemical proper‐ties in fragmented Dukuduku forest in KwaZulu‐Natal, South Africa. Specifically, we sought to map fragmented patches within forested areas in Dukuduku area, using very high spatial resolution WorldView‐2 remotely sensed data and to statistically determine the effect of these fragmented patches on the spatial distribution of se‐lected forest biochemical properties

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

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 years; 78.2% included were male with a median age of 37 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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

IMPACT OF HEAT STRESS ON GROWTH PERFORMANCE AND CARCASS TRAITS IN SOME BROILER CHICKENS

Environmental heat stress is one of the most challenging conditions in the world which have adverse impact on the industry of poultry. Broiler chicken strains are delicate to heat stress primarily due to not having sweat glands. The current study was aimed to investigate the effects of heat stress exposed on growth performance and Bio-physiological characteristics for (Cobb, Hubbard and Arbor Acres broiler hybrids) under the summer season when environmental conditions of Egypt were revealed. A total of three hundred one day old (one hundred birds from each hybrid) at one day of age were brooding under the same conditions of water, diet consumed, breeding system, vaccines and medications used during the period birds life even slaughtering age. The three strains were randomly divided into twelve groups (three strains "Cobb, Hubbard and Arbor Acres" X two treatments "control group and heat exposed group" X two replicates X twenty five chicks).The degrees of environmental temperature and relative humidity during housing are (Environmental temperature = 32°±2 Celsius degree, Relative humidity =50±5 percentage) for control group and (Environmental temperature =40°±2 Celsius degree, Relative humidity= 20±5 percentage) for the heat stressed group. The body weight, body weight gain, edible parts of carcass (carcass, thigh, drum, breast muscles and giblets weight) and inedible parts of carcass (blood, feathers, head and legs weight) were recorded to heat stressed group and control group. Lymphatic organs such as spleen, thymus and bursa weight were measured also. The last results concluded that the Cobb strain showed the best growth performance and carcass characteristics under heat stress condition, while the Arbor Acres strain considered the best strain which didn't effected a lot in their rectal temperature such another strains with heat exposure. The Arbor Acres strain for each group (control and treated) have the highest viability. The control group and Hubbard strain showed an increase in bursa weight compared to heat exposed group and another strains. It was concluded that the Cobb strain has the best performance under heat stress comparing to the other strains broiler chicken

High prevalence rate of left superior vena cava determined by echocardiography in patients with congenital heart disease in Saudi Arabia

Background: Persistent left superior vena cava (LSVC) is one of the common anomalies of the systemic veins. Its prevalence is 0.1-0.3% in the general population and is more common with congenital heart disease (CHD). The importance of detecting persistent LSVC prior to cardiac surgery is paramount for systemic veins cannulations. Aim: The aim was to evaluate the prevalence of persistent LSVC in patients with CHD in Saudi Arabia. Methods: All patients referred to our institution had echocardiography. All complete studies were reviewed for the presence of persistent LSVC. A computerized database was created including the demographic data, CHD diagnoses, and the presence of persistent LSVC. Results: A total of 2,042 were examined with an age range of 1 day to 16 years. The complete echocardiographic studies were 1,832 (90%) of whom 738 (40%) patients had CHD. The prevalence of persistent LSVC in patients with CHD was 7.8% (OR 9.26, 95% CI 4.7-18.2, p <0.001). The most common cardiac defect associated with persistent LSVC was complete atrioventricular septal defect (AVSD); all patients with AVSD had Down syndrome. The total number of patients with AVSD was 41, and persistent LSVC was found in 11 (26%) of them (odds ratio 5.1, 95% CI 2.4-10.8, p <0.001). Conclusions: The prevalence of persistent LSVC in the current population is almost double the reported prevalence obtained using the same echocardiographic screening tool

Sphincter sparing resection of a large obstructive distal rectal gastrointestinal stromal tumour after neoadjuvant therapy with imatinib (Glivec)

Gastrointestinal stromal tumours (GISTs) are generally rare but are known to be the most common mesenchymal tumours of the gastrointestinal tract. We present a case of a patient who presented with persistent obstructive gastrointestinal and urological symptoms, a sense of incomplete evacuation and bleeding per rectum. A colonoscopy was performed and a biopsy was taken of a submucosal mass in the distal rectum that revealed a GIST with positive KIT immunostaining. A positron emission tomography (PET)/CT scan showed a large metabolically active distal rectal tumour of 8 cm with macroscopic invasion of surrounding structures. Neoadjuvant therapy with receptor tyrosine kinase inhibitor imatinib (400 mg orally daily) was initiated and an excellent partial response consisting of a significant decrease in the size of the tumour with complete metabolic resolution was observed within 3 months. Six months after initiation of the neoadjuvant therapy a rectum resection with manual side-to-end coloanal anastomosis was performed. Pathology showed a GIST of 5 cm located 0.1 cm from the distal section plane. Our case shows that in patients with a large invasive distal rectal GIST, neoadjuvant imatinib therapy can facilitate anal sphincter sparing surgery.status: publishe