Mentoring the modern African surgeon: A call to arms!

Background Surgical mentorship crosses both skilled training and the gamut of career choices and surgical decision making. The challenge also lies in the ideal mentorship balance that transcends the mere transfer of surgical skills and addresses other key components such as career development and research. Objective To explore the views and perceptions of surgical residents in Kenyan Institutions on mentorship and its importance in training. Method Sixty four surgical residents were surveyed. Thirty four (56%) were involved in a mentorship program. Twenty three percent of residents within an actual mentorship program reported satisfaction with their mentorship program. Mentors were perceived to be most critical in research and competency. Expectations were lower for their role in career development, handling stress and character building. About half of respondents felt that an ideal mentorship program would entail a structured mentoring program with regular monitoring. Conclusion Current uptake of mentorship roles is suboptimal. There is need to strengthen our mentorship links to enhance the support of new residents to balance professional and private personal needs

Peer review audit of trauma deaths in a developing country

OBJECTIVES: Peer review of trauma deaths can be used to evaluate the efficacy of trauma systems. The objective of this study was to estimate teh proportion of preventable trauma deaths and the factors contributing to poor outcome using peer review in a tertiary care hospital in a developing country. METHODS: All trauma deaths during a 2-year period (1 January 1998 to 30 December 1998) were identified and registered in a computerized trauma registry, and the probability of survival was calculated for all patients. Summary data, including registry information and details of prehospital, emergency room, and definitive care, were provided to all members of the peer review committee 1 week before the committee meeting. The committee then reviewed all cases and classified each death as preventable, potentially preventable, or non-preventable.RESULTS AND CONCLUSION: A total fo 279 patients were registered in the trauma registry during the study period, including 18 trauma deaths. Peer review judged that six were preventable, seven were potentially preventable, and four were non-preventable. One patient was excluded because the record was not available for review. The proportion of preventable and potentially preventable deaths was significantly higher in our study than from developed countries. Of the multiple contributing factors identified, the most important were inadequate prehospital transfer, limited hospital resources, and an absence of integrated and organized trauma care. This study summarizes the challenges faced in trauma care in a developing country

A remark on totally smooth renormings

[EN] E. Oja, T. Viil, andD. Werner showed, in Totally smooth renormings, Archiv der Mathematik, 112, 3, (2019), 269-281, that a weakly compactly generated Banach space ( X, center dot) with the property that every linear functional on X has a unique Hahn-Banach extension to the bidual X ** (the so-called Phelps' property U in X **, also known as the Hahn-Banach smoothness property) can be renormed to have the stronger property that for every subspace Y of X, every linear functional on Y has a unique Hahn-Banach extension to X ** (the so-called total smoothness property of the space). We mention here that this result holds in full generality -without any restriction on the space- and in a stronger form, thanks to a result ofM. Raja, On dual locally uniformly rotund norms, Israel Journal of Mathematics 129 (2002), 77-91.Supported by AEI/FEDER (project MTM2017-83262-C2-2-P of Ministerio de Economia y Competitividad), by Fundacion Seneca, Region de Murcia (Grant 19368/PI/14), and Universitat Politecnica de Valencia (A. J. Guirao). Supported by AEI/FEDER (project MTM2017-83262-C2-1-P of Ministerio de Economia y Competitividad) and Universitat Politecnica de Valencia (V. Montesinos). We thank the referees for their work, that neatly improved the original version of this note to its final form.Cobollo, C.; Guirao Sánchez, AJ.; Montesinos Santalucia, V. (2020). A remark on totally smooth renormings. Revista de la Real Academia de Ciencias Exactas Físicas y Naturales Serie A Matemáticas. 114(2):1-4. https://doi.org/10.1007/s13398-020-00831-5S141142Fabian, M., Habala, P., Hájek, P., Montesinos, V., Zizler, V.: Banach space theory: the basis of linear and nonlinear analysis. Springer, New York (2011)Fabian, M., Montesinos, V., Zizler, V.: Smoothness in Banach spaces. Selected problems. Rev. R. Acad. Cien. Ser. A. Mat. RACSAM. 100(1–2), 101–125 (2006)Ferrari, S., Orihuela, J., Raja, M.: Generalized metric properties of spheres and renorming of Banach spaces. Rev. R. Acad. Cienc. Exactas Fis. Natl. Ser. A Math. RACSAM. 113, 2655–2663 (2019)Foguel, S.R.: On a theorem by A. E. Taylor. Proc. Amer. Math. Soc. 9, 325 (1958)Godefroy, G.: Points de Namioka, espaces normants, applications à la théorie isométrique de la dualité. Israel J. Math. 38, 209–220 (1981)Guirao, A.J., Montesinos, V., Zizler, V.: Open Problems in the geometry and analysis of Banach spaces. Springer International Pub, Switzerland (2016)Harmand, P., Werner, D., Werner, W.: M-ideals in Banach spaces and Banach algebras. Lecture notes in math, vol. 1547. Springer, Berlin (1993)Haydon, R.: Locally uniformly rotund norms in Banach spaces and their duals. J. Funct. Anal. 254, 2023–2039 (2008)Oja, E., Viil, T., Werner, D.: Totally smooth renormings. Archiv. der. Mathematik. 112(3), 269–281 (2019)Phelps, R.R.: Uniqueness of Hahn–Banach extensions and unique best approximation. Trans. Amer. Math. Soc. 95, 238–255 (1960)Raja, M.: On dual locally uniformly rotund norms. Israel J. Math. 129, 77–91 (2002)Smith, R.J., Troyanski, S.L.: Renormings of $$C(K)$$ spaces. Rev. R. Acad. Cienc. Exactas Fís. Natl. Ser. A Math. RACSAM 104(2), 375–412 (2010)Sullivan, F.: Geometrical properties determined by the higher duals of a Banach space. Illinois J. Math. 21, 315–331 (1977)Taylor, A.E.: The extension of linear functionals. Duke Math. J. 5, 538–547 (1939

Understanding the Role of Molecular Diffusion and Catalytic Selectivity in Liquid-Phase Beckmann Rearrangement

Understanding the role of diffusion in catalysis is essential in the design of highly active, selective, and stable industrial heterogeneous catalysts. By using a combination of advanced in situ spectroscopic characterization tools, particularly quasi-elastic and inelastic neutron scattering, we outline the crucial differences in diffusion modes and molecular interactions of active sites within solid-acid catalysts. This, coupled with 2D solid-state NMR and probe-based FTIR spectroscopy, reveals the nature of the active site in our SAPO-37 catalyst and affords detailed information on the evolution of solid-acid catalysts that can operate at temperatures as low as 130 °C, for the Beckmann rearrangement of cyclohexanone oxime to ε-caprolactam (precursor for Nylon-6). The versatility of this approach leads to structure−property correlations that contrast the dynamics of the diffusion process in the different materials studied. Our results illustrate the power of these techniques in unravelling the interplay between active site and molecular diffusion in single-site heterogeneous catalysts, which can play a vital role in designing low-temperature, sustainable catalytic processes

Designing Building Skins with Biomaterials

This chapter presents several successful examples of biomaterial facade design. It discusses facade function from aesthetical, functional, and safety perspectives. Special focus is directed on novel concepts for adaptation and special functionalities of facades. Analysis of the structure morphologies and aesthetic impressions related to the bio-based building facades is supported with photographs collected by authors in various locations. Finally, particular adaptations and special functionalities of bio-based facades going beyond traditional building envelope concept are supported by selected case studies

Mechanisms of pulmonary dysfunction after on-pump and off-pump cardiac surgery: a prospective cohort study

BACKGROUND: Pulmonary dysfunction following cardiac surgery is believed to be caused, at least in part, by a lung vascular injury and/or atelectasis following cardiopulmonary bypass (CPB) perfusion and collapse of non-ventilated lungs. METHODS: To test this hypothesis, we studied the postoperative pulmonary leak index (PLI) for (67)Ga-transferrin and (transpulmonary) extravascular lung water (EVLW) in consecutive patients undergoing on-pump (n = 31) and off-pump (n = 8) cardiac surgery. We also studied transfusion history, radiographs, ventilatory and gas exchange variables. RESULTS: The postoperative PLI and EVLW were elevated above normal in 42 and 29% after on-pump surgery and 63 and 37% after off-pump surgery, respectively (ns). Transfusion of red blood cell (RBC) concentrates, PLI, EVLW, occurrence of atelectasis, ventilatory variables and duration of mechanical ventilation did not differ between groups, whereas patients with atelectasis had higher venous admixture and airway pressures than patients without atelectasis (P = 0.037 and 0.049). The PLI related to number of RBC concentrates infused (P = 0.025). CONCLUSION: The lung vascular injury in about half of patients after cardiac surgery is not caused by CPB perfusion but by trauma necessitating RBC transfusion, so that off-pump surgery may not afford a benefit in this respect. However, atelectasis rather than lung vascular injury is a major determinant of postoperative pulmonary dysfunction, irrespective of CPB perfusion

Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate

Background: The aim of this prospective study is to evaluate the role in the onset of surgical site infections of bilateral internal thoracic arteries harvesting in patients with decompensated preoperative glycemia. Methods: 81 consecutive patients with uncontrolled diabetes mellitus underwent elective CABG harvesting single or double internal thoracic arteries. Single left ITA was harvested in 41 patients (Group 1, 50.6%), BITAs were harvested in 40 (Group 2, 49.4%). The major clinical end points analyzed in this study were infection rate, type of infection, duration of infection, infection relapse rate and total hospital length of stay. Results: Five patients developed sternal SSI in the perioperative period, 2 in group 1 and 3 in group 2 without significant difference. All sternal SSIs were superficial with no sternal dehiscence. The development of infection from the time of surgery took 18.5 ± 2.1 and 7.3 ± 3.0 days for Groups 1 and 2 respectively. The infections were treated with wound irrigation and debridement, and with VAC therapy as well as with antibiotics. The VAC system was removed after a mean of 12.8 ± 5.1 days, when sterilization was achieved. The overall survival estimate at 1 year was 98.7%. Only BMI was a significant predictor of SSI using multivariate stepwise logistic regression analysis (Odds Ratio: 1.34; 95%Conficdence Interval: 1.02–1.83; p value: 0.04). In the model, the use of BITA was not an independent predictor of SSI. Conclusion: CABG with bilateral pedicled ITAs grafting could be performed safely even in diabetics with poor preoperative glycaemic control

Treatment of Peritoneal Carcinomatosis by Targeted Delivery of the Radio-Labeled Tumor Homing Peptide 213Bi-DTPA-[F3]2 into the Nucleus of Tumor Cells

BACKGROUND: Alpha-particle emitting isotopes are effective novel tools in cancer therapy, but targeted delivery into tumors is a prerequisite of their application to avoid toxic side effects. Peritoneal carcinomatosis is a widespread dissemination of tumors throughout the peritoneal cavity. As peritoneal carcinomatosis is fatal in most cases, novel therapies are needed. F3 is a tumor homing peptide which is internalized into the nucleus of tumor cells upon binding to nucleolin on the cell surface. Therefore, F3 may be an appropriate carrier for alpha-particle emitting isotopes facilitating selective tumor therapies. PRINCIPAL FINDINGS: A dimer of the vascular tumor homing peptide F3 was chemically coupled to the alpha-emitter (213)Bi ((213)Bi-DTPA-[F3](2)). We found (213)Bi-DTPA-[F3](2) to accumulate in the nucleus of tumor cells in vitro and in intraperitoneally growing tumors in vivo. To study the anti-tumor activity of (213)Bi-DTPA-[F3](2) we treated mice bearing intraperitoneally growing xenograft tumors with (213)Bi-DTPA-[F3](2). In a tumor prevention study between the days 4-14 after inoculation of tumor cells 6x1.85 MBq (50 microCi) of (213)Bi-DTPA-[F3](2) were injected. In a tumor reduction study between the days 16-26 after inoculation of tumor cells 6x1.85 MBq of (213)Bi-DTPA-[F3](2) were injected. The survival time of the animals was increased from 51 to 93.5 days in the prevention study and from 57 days to 78 days in the tumor reduction study. No toxicity of the treatment was observed. In bio-distribution studies we found (213)Bi-DTPA-[F3](2) to accumulate in tumors but only low activities were found in control organs except for the kidneys, where (213)Bi-DTPA-[F3](2) is found due to renal excretion. CONCLUSIONS/SIGNIFICANCE: In conclusion we report that (213)Bi-DTPA-[F3](2) is a novel tool for the targeted delivery of alpha-emitters into the nucleus of tumor cells that effectively controls peritoneal carcinomatosis in preclinical models and may also be useful in oncology