Exploiting opportunities for leadership development of surgeons within the operating theatre

AbstractIt is increasingly recognised that leadership skills are a key requirement in being successful in surgery, regardless of speciality and at all levels of experience and seniority. Where the emphasis was previously on technical ability, knowledge and diagnostic acumen, we now know that non-technical skills such as communication and leadership contribute significantly to patient safety, experience and outcomes, and should be valued.The operating theatre is a unique micro-environment which is often busier, noisier, more stressful and more physically demanding than the clinic or ward setting. As a result surgeons and their trainers, who are striving to develop leadership skills require an in-depth awareness of the challenges in this environment and the opportunities that arise from them to develop leadership effectively. This article outlines why leadership learning is so beneficial in the operating theatre, both for the team and the patient as well as what elements of daily routine activity such as the WHO checklist use, list-planning and audit can be exploited to transform the average busy operating theatre into a rich, learning environment for future leaders in surgery

Effects of nitrogen source and effective micro-organisms on vegetative growth of shrubs of selected grapefruit (Citrus paradisi Macf) cultivars

   Grapefruit (Citrus Paradisi Macf.) is one of the most important citrus fruits in the Sudan. It can be successfully grown throughout the country where there are suitable soils and sufficient water to sustain tree growth. The objectives of this study were to find out the effects of different nitrogen sources, effective microorganisms (EM) and their combinations on the vegetative growth of shrubs of selected grapefruit cultivars. A field experiment was carried out at Umbarona, Wad Medani, Gezira State, Sudan, latitude 14.38 N, longitude 33.48 E and altitude 409 masl, in June 2012. Treatments consisted of three grapefruit cultivars: Marsh Seedless, Red Blush and Shamber. Fertilizer treatments were urea (100%), chicken manure (100%), urea with chicken manure (50% each), urea with EM, chicken manure with EM, urea (50%)+ chicken manure (50%)+ EM and unfertilized control. All fertilizer treatments were applied at the rate of 43 kg N/ha. Treatments were arranged in a split- plot design with two replicates. Grapefruit cultivars were allotted to the main plots and fertilizer treatments to the sub-plots. Data were collected on plant height (cm), stem diameter (cm), number of new branches, length of new branches (cm) and diameter of new branches (cm). Results showed that Marsh Seedless cultivar had the most vigorous vegetative growth compared to the other two cultivars. The results showed that the combination of urea, chicken manure and EM significantly gave the highest vegetative growth values, followed by chicken manure with EM, urea with chicken manure, urea with EM, urea alone, chicken manure alone and the least values of growth parameters were recorded for the unfertilized control. It is recommended to grow Marsh Seedless grapefruit cultivar and fertilize it with a combination of urea, chicken manure and EM.         يعتبر القريب فروت من أهم ثمار الحمضيات في السودان ويمكن زراعته بنجاح في جميع أنحاء البلاد حيثما توفرت التربة المناسبة والمياه الكافية لنمو الأشجار. أجريت تجربة حقلية في ام بارونة، واد مدنى ولاية الجزيرة، السودان. تهدف هذه التجربة لمعرفة تأثير مصادر النتروجين المختلفة والكائنات الحية الدقيقة الفعالة ومزجها مع بعضها البعض على النمو الخضري لشجيرات أصناف منتخبة من القريب فروت. تضمنت المعاملات ثلاثة أصناف من القريب فروت وهي مارش  ورد بلش وشامبر وسبعة معاملات أسمدة وهي  اليوريا، وزرق الدواجن، يوريا مع زرق الدواجن، يوريا مع الكائنات الحية الدقيقة الفعالة، زرق الدواجن مع الكائنات الحية الدقيقة الفعالة، يوريا مع زرق الدواجن مع الكائنات الحية الدقيقة الفعالة والشاهد. تمت إضافة الأسمدة لكل المعاملات بمعدل 43 كجم نتروجين للهكتار. صممت التجارب بطريقة القطع المنشقة بحيث كانت أصناف القريب فروت هي القطع الرئيسة ومعاملات النتروجين هي القطع الثانوية. جمعت بيانات عن طول النبات (سم) وقطر الساق (سم) وعدد الأفرع الجديدة وطول الفرع (سم) وقطر الفرع (سم). أوضحت النتائج أن الصنف مارش أعطى أعلى نمو خضري مقارنة بالصنفين رد بلش وشامبر. الخليط بين سماد اليوريا وزرق الدواجن و الكائنات الحية الدقيقة الفعالة  أعطت أعلى معدل للنمو الخضري ويليه زرق الدواجن والكائنات الحية الدقيقة الفعالة ثم اليوريا والكائنات الحية الدقيقة الفعالة ثم اليوريا وزرق الدواجن ثم زرق الدواجن لوحده ثم اليوريا لوحده وأدنى معدلات  النمو كانت في الشاهد .  يوصى بزراعة الصنف قريب فروت مارش وتسميده بخليط من اليوريا وزرق الدواجن والكائنات الحية الدقيقة الفعالة

Saudi SCD patients’ symptoms and quality of life relative to the number of ED visits

Background Individuals living with sickle cell disease (SCD) have significantly increased emergency department (ED) use compared to the general population. In Saudi Arabia, health care is free for all individuals and therefore has no bearing on increased ED visits. However, little is known about the relationship between quality of life (QoL) and frequency of acute care utilization in this patient population. Methods A cross-sectional study was conducted on 366 patients with SCD who attended the outpatient department at King Fahad Hospital, Hofuf, Saudi Arabia. Data were collected through self-administered surveys, which included: demographics, SCD-related ED visits, clinical issues, and QoL levels. We assessed the ED use by asking for the number of SCD-related ED visits within a 6-month period. Results The self-report survey of ED visits was completed by 308 SCD patients. The median number of SCD-related ED visits within a 6-month time period (IQR) was four (2-7 visits). According to the unadjusted negative binomial model, the rate of SCD-related ED visits increased by (46, 39.3, 40, and 53.5 %) for patients with fever, skin redness with itching, swelling, and blood transfusion, respectively. Poor QoL tends to increase the rate of SCD-related ED visits. Well education and poor general health positively influenced the rate of SCD-related ED visits. Well education tends to increase the rate of SCD-related ED visits by 50.2 %. The rate of SCD-related ED visits decreased by 1.4 % for every point increase in general health. Conclusion Saudi patients with sickle cell disease reported a wide range of SCD-related ED visits. It was estimated that six of 10 SCD patients had at least three ED visits within a 6-month period. Well education and poor general health resulted in an increase in the rate of SCD-related ED visits

Some characteristics of the Sudanese bread (Kisra) supplement with fenugreek (Trigonella foenum-graecum L)

     In this study the chemical composition of two fenugreek seed types known locally as Sudanese and Ethiopian' types and sorghum kisras supplemented with 5%, 10% and 20% flour of the two fenugreek types after removal of the bitter taste, was determined* The two fenugreek seed types had shown slightly small differences in most of their chemical components, however, the Ethiopian type had slightly more protein (26.4+0.4 %) than that of the Sudanese type (25.5± 0.07 %). On the other hand, the Sudanese type contained more mucilage (23.5±0.04 %) than that of the Ethiopian type (22.6±0.010/0). The most significant effect of kisra supplementation was the increase in good quality protein by a range of 31-66%. It increased from 11.20% in the control kisra to the range of 14.70-18.64%. The crude fibre% of the control kisra (3.40%) increased in the supplemented kisras to the range of 4.54-5.30%. The ash% decreased from 2.42% in the control kisra, to the range of 2.20 - le20% in the supplemented kisras. The sensory analysis indicated that the fenugreek supplemented kisra was accepted by the panelists at the 5% level of fenugreek seed flour supplementation. The overall acceptance level of the different samples decreased with the increase in fenugreek seed flour used in supplementation

Intralobular pulmonary sequestration

Background: A 59-year-old non-smoking woman, with a history of gall stones, type 2 diabetes mellitus and hypertension, was referred to our hospital because of persistent coughing, night sweats, headaches and weight loss. Clinical examination revealed no abnormalities. The laboratory findings on admission were as follows: erythrocyte sedimentation rate was 39 mm/h, C-reactive protein level was 62 mg/mL and leukocyte count was 8.0 x 109/L. Bronchoscopic examination showed a normal bronchial tree

Performance Comparison for Ballistocardiogram Peak Detection Methods

Citation: Suliman, A., Carlson, C., Ade, C. J., Warren, S., & Thompson, D. E. (2019). Performance Comparison for Ballistocardiogram Peak Detection Methods. IEEE Access, 7, 53945–53955. https://doi.org/10.1109/ACCESS.2019.2912650A number of research groups have proposed methods for ballistocardiogram (BCG) peak detection toward the identification of individual cardiac cycles. However, objective comparisons of these proposed methods are lacking. This paper, therefore, conducts a systematic and objective performance evaluation and comparison of several of these approaches. Five peak-detection methods (three replicated from the literature and two adapted from code provided by the methods' authors) are compared using data from 30 volunteers. A basic cross-correlation approach was also included as a sixth method. Two high-performing methods were identified: the method proposed by Sadek et al. and the method proposed by Brüser et al. The first achieved the highest average peak-detection rate of 94%, the lowest average false alarm rate of 0.0552 false alarms per second, and a relatively small mean absolute error between the real and detected peaks: 0.0175 seconds. The second method achieved the lowest mean absolute error of 0.0088 seconds between the real and detected peaks, an average peak-detection success rate of 89%, and 0.0766 false alarms per second. All metrics are averaged across participants

Doppler ultrasound of umbilical artery in prediction of fetal outcome in pregnancy induced hypertension Sudanese population

The pregnancy induced hypertension increase the fetal mortality and morbidity and the using of Doppler umbilical artery indices decrease the fetal mortality and morbidity however, there is few complete data about the most frequently altered Doppler US parameters to predict fetal outcome in pregnancy induced hypertension . Methods This ia cohort prospective study done in two hundred and six women of second and third trimester presenting to antenatal clinic in Soba University Hospital at the department of Obstetrics & Gynecology, in the fetus unit and critical pregnancy in the period From June 2008 to April 2013 to assess the Doppler indices of umbilical artery in pregnancy induced hypertension for prediction of prenatal outcome; 105 pregnancy induced hypertension patients and 101 women with uneventful pregnancies as normal control group included in this study . Baseline investigations and color Doppler of umbilical artery were done. Statistical analysis of data were done using SPSS, Receiver Operating Characteristic (ROC) curve analysis was performed and the area under the curve (AUC) used to determine sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of umbilical artery Doppler indices to predict fetal outcome.Results The study determine that there was significant difference in Doppler indices in PIH and control group ( p<0.01, the mean indices of umbilical artery is higher in PIH group compared with normal pregnancy group , the mean different of S/D ratio was 0.40, mean difference of RI was 0.06 and the mean different of PI index was 0.16, high percentage of adverse fetal outcome had been reported in in Pregnancy Induced Hypertension group than in control , which was more in absent and reversed flow velocity in umbilical artery in Pregnancy Induced Hypertension compared with group of Pregnancy Induced Hypertension with present end diastolic flow velocity. Systolic/Diastolic ratio was most accurate in predicting adverse outcome in pregnancy induced hypertension patients, followed by the Pulastility index then the Resistance index (75%, 66% and 57% respectively).ConclusionThis study concluded that pregnancy induced hypertension leads to worsen placental insufficiently, which appears on the higher Doppler indices of umbilical artery to PIH patients when compared with normal pregnancy. A low diastolic flow and higher indices characterized the pregnancies with abnormal outcomes. Doppler of the umbilical artery was useful to predict fetal well being in PIH patients, high percentage of adverse fetal outcome had been reported in absent and reversed end diastolic flow velocity in umbilical artery compared with group of present flow velocity

Notch3 Is Dispensable for Thymocyte β-Selection and Notch1-Induced T Cell Leukemogenesis

Notch1 (N1) signaling induced by intrathymic Delta-like (DL) ligands is required for T cell lineage commitment as well as self-renewal during “β-selection” of TCRβ+ CD4−CD8− double negative 3 (DN3) T cell progenitors. However, over-expression of the N1 intracellular domain (ICN1) renders N1 activation ligand-independent and drives leukemic transformation during β-selection. DN3 progenitors also express Notch3 (N3) mRNA, and over-expression of ligand-independent mutant N3 (ICN3) influences β-selection and drives T cell leukemogenesis. However, the importance of ligand-activated N3 in promoting β-selection and ICN1-induced T cell leukemogenesis has not been examined. To address these questions we generated mice lacking functional N3. We confirmed that DN3 progenitors express N3 protein using a N3-specific antibody. Surprisingly however, N3-deficient DN3 thymocytes were not defective in generating DP thymocytes under steady state conditions or in more stringent competition assays. To determine if N3 co-operates with N1 to regulate β-selection, we generated N1;N3 compound mutants. However, N3 deficiency did not exacerbate the competitive defect of N1+/− DN3 progenitors, demonstrating that N3 does not compensate for limiting N1 during T cell development. Finally, N3 deficiency did not attenuate T cell leukemogenesis induced by conditional expression of ICN1 in DN3 thymocytes. Importantly, we showed that in contrast to N1, N3 has a low binding affinity for DL4, the most abundant intrathymic DL ligand. Thus, despite the profound effects of ectopic ligand-independent N3 activation on T cell development and leukemogenesis, physiologically activated N3 is dispensable for both processes, likely because N3 interacts poorly with intrathymic DL4

Characterization of the inclusion complex of zerumbone with hydroxypropyl--cyclodextrin

In this paper we investigated the inclusion complexation between zerumbone (ZER) and hydroxylpropyl- -cyclodextrin (HPCD) at four different temperatures: 293–318 ◦K. The thermodynamic parameters (H, S and G) for the formation of the complex were obtained from the van’t Hoff equation. The complex with HPCD was characterized by differential scanning calorimetry (DSC), X-ray diffractometry (XRD), Fourier transform infrared spectroscopy (FT-IR), and molecular modeling using PM6. The solubility of ZER was enhanced >30 fold after complexation. Calculations show that ZER penetrates completely into the cavity of HPCD. The complex retained its cytotoxic activity as shown by in vitro cell survival assay on human cervical cancer (Hela), breast cancer (MCF7 and MDA-MB 231) and human leukemic (CEMss) cell lines. HPCD is, therefore, a suitable encapsular capable of forming thermodynamically stable complex with ZER for save delivery of the compound as an anticancer drug in the future

Tsetse Fly Infection Dynamics and its Implications with Control of Trypanosomiasis in Kajo-Keji County, South Sudan

A two-year study was conducted in Kajo-keji County South Sudan to evaluate tsetse fly infection dynamics which implicate the control of trypanosomiasis in the study area.Infection dynamics ofthe flieswas assessed and monitored using biconical traps.Captured flies were identified, segregated into sexes and age examined using wing fray and ovarian techniques for males and females, respectively. RIME-LAMP test was used to detectTrypanosome species in the midguts of wild tsetse flies.The non-parametric Wilcoxon Signed Rank Test was used to assess the difference in the number of the infected flies between the dry and the wet season counts.The mean infected G.f. fuscipes were: male 6 ±1.4, female 3 ± 1.0 and male 10 ± 2.0, female 3 ± 0.7 in the dry and wet seasons of the year 2011; male,6 ± 1.4,female 6 ±1.4 and male,10 ± 2, female3 ± 0.8 in the dry and wet seasons of 2012.Infection showed significant differences (Z=-2.03,  P = 0.04) with both seasons in 2011 and no significant differences (Z=-1.41, P = 0.16) in 2012. Number of infected male and female flies was positively correlated with the fly age in the dry (Male, R2=0.94; female, R2=0.86) and wet (Male, R2=0.97; female, R2=1) seasons in 2011 and (Male, R2=0.90; female, R2=0.94) in the dry and wet (Male, R2= 0.97 female, R2=1) seasons in 2012.These results showed thatG. f.fuscipeswere  infected with T.brucei gambiense and  they were proved  to be potential vectors for HAT in the study area. Hence, the implications of Tsetse fly infection dynamics in the control of trypanosomiasis need development of further control strategies for sustainable development of livestock and human resources in Kajo-keji County.