Estimation of key potentially toxic elements in arid agricultural soils using Vis-NIR spectroscopy with variable selection and PLSR algorithms

Potentially toxic elements (PTEs) pose a significant threat to soil and the environment. Therefore, the fast quantification of PTEs is crucial for better management of contaminated sites. Versatile technique such as Visible near-infrared spectroscopy (Vis–NIRS) (350–2,500 nm) has attracted tremendous attention for assessing PTEs and has achieved promising results combined with successful multivariate analysis. This research investigated the potential of Vis–NIRS combined with partial least squares regression (PLSR) and variable selection methods to assess key PTEs (Cd, Co, Cu, Cr, Pb, and Zn) in agricultural soils under arid conditions. The soil samples (80) were collected from a polluted area around Al-Moheet drainage, Minya Governorate–upper Egypt. The samples were scanned using an ASD FieldSpec-4 spectroradiometer. Simulated annealing (SA) and uninformative variable elimination (UVE) were used to select the effective wavelengths in predicting PTEs. PLSR was used to develop the spectral models using the full range (FR-PLS) and feature-selected spectra techniques SA (SA-PLS) and UVE (UVE-PLS). The results indicated that UVE-PLS models performed better than FR-PLS and SA-PLS models in predicting the key PTEs. The obtained coefficient of determination (R2) and the ratio of performance to deviation (RPD) were 0.74 and 2.48 (Cr), 0.72 and 2.03 (Pb), 0.62 and 1.86 (Cd), 0.59 and 1.78 (Cu), 0.52 and 1.68 (Co), and 0.46 and 1.41 (Zn), respectively. The results suggested that the UVE-PLS spectral model is promising for predicting Cr, Pb, and Cd, and can be improved for predicting Cu, Co, and Zn elements in agricultural soils

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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Assessment of Soil Contamination Using GIS and Multi-Variate Analysis: A Case Study in El-Minia Governorate, Egypt

The issue of soil contamination is one of the most important subjects that interests decision-makers all over the world. It is also related to soil fertility and food security. The soils adjacent to the drains in Egypt suffer from increasing concentration of heavy metals, which negatively affects soil and crop quality. Precise spatial distribution maps of heavy metals are an essential key to mitigating the negative impacts on the ecosystem. Sixty random soil locations adjacent to the El-Moheet drainage were chosen on the west side of the Nile River, El-Minia governorate, Egypt. Six heavy metals (Cr, Co, Cu, Cd, Pb, and Zn) were selected to generate their spatial pattern maps using ordinary Kriging (OK). Principal component analysis (PCA) and contamination factors (CF) were applied to evaluate soil contamination levels in the study area. The results showed that the Gaussiang model was a high fit for soil pH, and Pb, the Exponential model was fit for EC, Stable model was fit for OC, Co, Cu, and Cd. In addition, the Spherical model was fit for both Cr and Zn. The MSE values were close to zero in all selected metals, while the values of RMSSE were close to one. The results showed that the soil heavy metal concentrations were grouped into two clusters using PCA. Furthermore, three contamination degrees were obtained (moderate, considerable, and very high), with about 70.7% of the study area characterized by considerable heavy metals concentration, where the average heavy metals concentration (mg kg&minus;1) in this degree was 91.23 &plusmn; 19.5, 29.44 &plusmn; 5.2, 53.83 &plusmn; 10.2, 1.12 &plusmn; 0.3, 36.04 &plusmn; 18.0, and 101.29 &plusmn; 35 for Cr, Co, Cu, Cd, Pb, and Zn, respectively. The current results reflect the mismanagement and use of low-quality water for irrigation in the study area, which increased the toxic element concentration in soil surface layers. In the end, the results of spatial distribution maps of pollutants and their degrees could support decision-makers as a basis for developing appropriate mitigation plans for heavy metals

Assessment of Soil Contamination Using GIS and Multi-Variate Analysis: A Case Study in El-Minia Governorate, Egypt

The issue of soil contamination is one of the most important subjects that interests decision-makers all over the world. It is also related to soil fertility and food security. The soils adjacent to the drains in Egypt suffer from increasing concentration of heavy metals, which negatively affects soil and crop quality. Precise spatial distribution maps of heavy metals are an essential key to mitigating the negative impacts on the ecosystem. Sixty random soil locations adjacent to the El-Moheet drainage were chosen on the west side of the Nile River, El-Minia governorate, Egypt. Six heavy metals (Cr, Co, Cu, Cd, Pb, and Zn) were selected to generate their spatial pattern maps using ordinary Kriging (OK). Principal component analysis (PCA) and contamination factors (CF) were applied to evaluate soil contamination levels in the study area. The results showed that the Gaussiang model was a high fit for soil pH, and Pb, the Exponential model was fit for EC, Stable model was fit for OC, Co, Cu, and Cd. In addition, the Spherical model was fit for both Cr and Zn. The MSE values were close to zero in all selected metals, while the values of RMSSE were close to one. The results showed that the soil heavy metal concentrations were grouped into two clusters using PCA. Furthermore, three contamination degrees were obtained (moderate, considerable, and very high), with about 70.7% of the study area characterized by considerable heavy metals concentration, where the average heavy metals concentration (mg kg−1) in this degree was 91.23 ± 19.5, 29.44 ± 5.2, 53.83 ± 10.2, 1.12 ± 0.3, 36.04 ± 18.0, and 101.29 ± 35 for Cr, Co, Cu, Cd, Pb, and Zn, respectively. The current results reflect the mismanagement and use of low-quality water for irrigation in the study area, which increased the toxic element concentration in soil surface layers. In the end, the results of spatial distribution maps of pollutants and their degrees could support decision-makers as a basis for developing appropriate mitigation plans for heavy metals

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

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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P &lt; 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P &lt; 0·001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P &lt; 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P &lt; 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P &lt; 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone