Comparative numerical study for polymer alternating gas (PAG) flooding in high permeability condition

Polymers have been used in water alternative gas, to viscosify the water and improve the overall sweep efficiency. The use of polymer alternative gas was successful in increasing the oil production in high permeability zones. However, few practical factors affecting the field applicability have been overlooked. Therefore, this study is aimed at bridging the gap between the possibility of using several EOR such as water flooding, CO2 flooding, water alternative gas, polymer flooding and polymer alternative gas. The research based on progressive comparison considering constant constraint. The numerical simulation STARS-CMG was used to predict the characteristics and behaviour of the fluid in the reservoir. The designed flooding pattern chosen was a single producer-single injection (P-I) scheme in homogeneous high permeable reservoir. The results of oil incremental recovery showed the following order compared to Water flooding < (3%) CO2 flooding < (6.8%) < Water alternative gas (11.6%) Polymer flooding < (15%) Polymer alternative gas. The impact of polymer on enhancing the water alternative gas was mostly noticeable in the reduction of water cut% (83%). The controlled conformance by polymer aided in improving the sweep efficiency as indicated by the uninform U-shape. Moreover, the delayed gas breakthrough was significant and resulted in the lowest gas oil ratio of 5.17E + 04 ft3/bbl. The low gas oil ratio observation is indication of potential capturing of CO2 in the reservoir and thus, good evidence to further implementation of CO2 as green utilization

The influence of industrial output, financial development, and renewable and non-renewable energy on environmental degradation in newly industrialized countries

The prime objective of this study is to examine the impact of industrial output and financial development on carbon dioxide emissions for a panel of 10 newly industrialized countries, namely Brazil, China, India, Indonesia, Malaysia, Mexico, Philippines, South Africa, Thailand, and Turkey. The empirical analysis was conducted between 1982 and 2019 by employing various estimation tests and techniques. The different tests account for cross-sectional dependence in different series of the model. Therefore, the relevant panel unit root was conducted, and we found that all series become stationary after the first difference. The long run parameters were estimated, and we found that there is a significant long-run relationship between the industrial output, the financial development, and the carbon emissions. The carbon emissions are found to be significantly affected by both domestic income and industrial output, while being negatively affected by financial development. Industrial production coefficient estimates are highly elastic when compared to the other estimates. The results also indicate unidirectional short-run causality from the domestic output and trade openness to carbon emissions, urban population to domestic output, and financial development to industrial output. However, there is no evidence of bidirectional causality. The study concludes that sustainable economic growth can be achieved by using contemporary and efficient production techniques, using environmentally friendly inputs in industries, and increasing vigilance of both the public and private sectors. Both the public and private sectors should therefore be pushed to use more modern, eco-friendly, and productive processing techniques. It is recommended that both the public and commercial sectors be encouraged to embrace cutting-edge, environmentally friendly, and productive processing methods.peer-reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

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

Urban water supply and groundwater governance in Arusha city

Access to clean drinking water has been mostly measured through access to utility water supply. However, the reality of urban water utilities in the global south has shown that they have been unable to supply water to the whole population or to ensure that it is reliable. Thus, there remains a large gap which is mostly filled by the users through alternative access strategies, within and outside of the formal network. The recent update on the Millennium Development Goals target for clean drinking showed that Sub-Saharan Africa did not meet its target and Tanzania also showed limited or no progress. For the urban population of Tanzania, almost 50% gained access to other improved sources such as wells and springs, compared to only 28% that gained access to formal piped network. With the limited but considerable evidence that suggests dependence on groundwater for water supply in developing cities, this study aimed to understand the role of groundwater in urban water strategies in Arusha. The main focus of the study was to explore who is using groundwater, where and why and how the use is governed for both environmental and social needs. The different strategies urban users adopt were mainly determined through interviews with domestic users from six different wards and selected commercial/industrial users. It was learnt that 41% of the current water supplied daily in Arusha city is from boreholes. The Arusha Urban Water Supply and Sanitation Authority (AUWSA) mixes groundwater with its other sources such as springs, rivers before supplying it to the city. For AUWSA, groundwater is a stable source especially during dry seasons when production from other sources reduces significantly. In the context that surface water resources in the basin are also fully allocated and exploited and there have been conflicts related to it, AUWSA is aware that groundwater is its only reliable source. The utility has been continuously exploring potential borehole locations, but has faced challenges with finding adequate volumes and acceptable fluoride levels. This study has also highlighted the role of groundwater in the strategies that other users (domestic, commercial/industrial) in Arusha adopt to meet their water needs. It found that out of the 28 strategies (different combinations of water) that domestic users adopt, more than 50% of these combinations include use of groundwater through boreholes and wells. The strategies/combinations used by the users (domestic) were analysed in terms of factors, such as socio-economic status, type of housing, availability of AUWSA network, land use and history of urban growth. It was learnt that the combinations that included use of borehole/well were mostly used by high socio-economic class. Possible reason for it could be the high costs associated with dug wells and boreholes in the city. Moreover, it was found that these combinations that high socio-economic class mostly use also include AUWSA water or bottled water. This has then showed that groundwater use was not limited to areas without formal network, it has been used in conjunction with AUWSA water. The strategies of users were also analysed from three criteria: water quality, price and unreliable supply of AUWSA water. Finally, the study has analysed how the decisions of groundwater users are shaped by the interests of the basin authority, urban water utility and the city council who have different powers on different decisions within the city. It was learnt that decisions over formalising the existing groundwater use and allowing future groundwater use are mostly shaped by the interests of AUWSA. The analysis of the current groundwater governance shows that the ii decisions over groundwater use permits are based on informal criteria that is based on interests (financial) of the basin authority and/or the urban water utility. The lack of data on where existing boreholes are located and their volume of abstractions, limited understanding of the hydrogeological condition of the aquifers and limited resources for monitoring groundwater use further validates that the decision of allowing groundwater use are mainly determined by informal criteria. Overall, this study has contributed to the current knowledge gap on groundwater needed to achieve both a sustainable and an equitable access to Arusha's water supply. The study has contributed to this by characterising the role of groundwater for urban water supply in Arusha and how and why groundwater is used by urban users (including utility). It has also provided insights into issues of equity of access to boreholes/wells alongside piped water. Moreover, the study has highlighted that there are no proper records on the total no of boreholes in the city and the total volumes of groundwater being extracted. Thus, highlighting serious concerns that remain over the sustainability of the groundwater resource given the current level of use by different users. The study concludes that the current use of groundwater is neither socially equitable nor environmentally sustainable and may bring challenges in the future if not governed properly

The emancipatory promise of participatory water governance for the urban poor : Reflections on the transition management approach in the cities of Dodowa, Ghana and Arusha, Tanzania

There has been widespread recognition in the Global South of the role of participatory governance approaches to urban development in responding to citizens’ immediate concerns. However, critiques note that participatory initiatives are often avenues for the political and economic elite to ensure their interests and profits, rather than improving the livelihoods in non- serviced urban peripheries. This article investigates how transition management (TM), as a promising participatory governance framework, can be implemented effectively to improve access to water for disadvantaged groups. First, we highlight lessons learnt from the TM applications in urban and water sectors. Second, we draw on empirical data from low-income urban areas in Ghana and Tanzania to bring the importance of social relations to the fore. By employing open-ended interviews, following the water points and conducting narrative walks, we identify three precautions that need to be addressed through adaptations of the TM approach in order to achieve the emancipatory promises of participatory governance models. In suggesting some guidelines for facilitators and active groups in participatory arenas, we discuss the importance of power dynamics in the communities, potentials and shortcoming of reflexive governance processes, and the need for capacity-building in transition teams

Incidental Finding of Deranged Renal Function in Elderly Patients Presenting with Fractures in a Tertiary Care Hospital

Objective: To determine the incidental rate of renal impairment among elderly women with fractures who reported to the Orthopaedic OPD at a tertiary care Hospital. Methodology: This prospective cohort study was done at Orthopaedic department and OPD Fauji Foundation Hospital, Rawalpindi during a period of one year from March 2022 to February 2023. A total of 147 females aged &gt;60 years presented with Hip fractures, surgically managed and who had history of normal pre-fracture renal function were included. A 5ml blood sample was obtained and sent to the Hospital diagnostic laboratory to evaluate the renal profile, serum calcium and vitamin D levels. All the information was recorded via pre-structured study proforma.  Results: The study enrolled 147 elderly participants with an average age of 66.82 years. Among the participants, 24 patients (16.3%) experienced Acute Kidney Injury (AKI), with 9.5% having stage-I AKI, 4.8% with stage II AKI, and 2.0% with stage III AKI. Before sustaining the hip fracture, the mean serum creatinine level was 67.04 µmol/L, and following the fracture, it increased to 81.95 µmol/L (p-value &lt; 0.0001). The severity of AKI did not exhibit a statistically significant correlation with the age of the patients. However, there was a statistically significant increase in serum creatinine levels among patients based on the duration of their fractures (p-value &lt; 0.001). Conclusion: The incidence of Acute Kidney Injury (AKI) in elderly patients following hip fractures was found to be 16.3%, with varying stages of severity

Long-term follow up of single-incision laparoscopic cholecystectomy compared to conventional laparoscopic cholecystectomy

Purpose: Conventional Laparoscopic Cholecystectomy (CLC) is the “gold standard” approach for patients with gallstones. Single-incision Laparoscopic Cholecystectomy (SILC) was an alternative technique, purportedly offering several postoperative benefits over CLC. Studies comparing short-term postoperative outcomes of SILC versus CLC have yielded conflicting results. Our paper aims to compare the long-term postoperative outcomes of patients undergoing SILC and CLC with a minimum follow up of seven years.Methods: A comparative retrospective study between SILC and CLC was conducted among 118 patients undergoing cholecystectomy from October 2008 to December 2010 (SILC=67/CLC=61). An initial retrospective chart review was performed. We later surveyed the patients who had undergone cholecystectomy by telephone interview at a mean(sd) of 4(0.75) years, and at 8(0.75) years. Postoperative outcomes were evaluated.&nbsp;Results: No significant difference between SILC and CLC groups for daily pain scores (p = 0.45 and 0.97, for day 1 and 2, respectively), daily narcotic requirements (p = 0.09 and 0.85, for day 1 and 2, respectively), and time to return to normal activity (p = 0.11). The mean(sd) operative time was greater in SILC group [52(2.0) mins versus 36(2.3) mins; p &lt;0.05]. There was a shorter mean(sd) length of stay postoperatively in the SILC group [2(0.11) days versus 3(0.32) days; p &lt;0.05]. The SILC group had a higher median(sd) cosmetic satisfaction score (IQR) than the CLC group at both the intermediate-term [10(10) versus 9(8 to10); p &lt;0.05] and long-term [10(10) versus 9(9to10); p &lt;0.05] follow up.Conclusion: SILC is associated with higher patient cosmetic satisfaction than CLC.&nbsp; However, the procedure is more technically challenging and associated with increased operating time and costs. The marginal cosmetic benefit at the expense of increased operative time and economic costs will likely mean that the choice of procedure will be largely patient rather than physician driven.</p