Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

How to attract good IT graduates for software quality assurance

A Dissertation submitted to the Department of Computer Science and Engineering for the MBABeing competitive is vital for surviving in today's global market place. A high level of Quality is a key attribute of competitiveness. Therefore Quality Assurance (QA) is a critical factor in any industry, especially in the field of Information Technology (IT). However in IT, though QA is a critical component, it is a highly misunderstood field. As a result a shortage of skilled QA Engineers exists today in Sri Lanka. This is mainly due to undergraduate IT students not considering QA as a good career path. The primary objective of this research paper is to determine why a majority of IT graduates do not consider Quality Assurance as a career option. Consideration was given to answering the question of whether QA Engineers are satisfied with their current work duties, whether the target segment of applicants for QA positions should be changed and to collect recommendations to motivate QA Engineers in Sri Lanka. In pursuit of these objectives, the research focuses on an extensive literature review. Following which, the results of an unstructured interview is presented. The set purpose of the unstructured interviews was to investigate the scope of work entrusted to QA Engineers in Sri Lanka and their perceptions, attitudes and behavioral responses towards Software Quality Assurance. Based on these results, an extended field survey was carried out targeting four different groups of individuals to answer the primary objective of the research. Based on the overall findings, the study concluded that good graduates were not interested in joining QA. Research revealed that this is due to industry salary scales, and them not considering QA as an important function of the IT sector. This negative impact on the students perceptions of QA is contributed to by the tasks currently handled by QA Engineers and their low job satisfaction levels. Therefore students perceived QA as a less desirable career option

Russia from within /

Mode of access: Internet

Design criteria for outdoor air intakes and exhaust air outlets located on an external wall

Optimal placement of outdoor air intakes and exhaust outlets is a source control measure to avoid the degradation of air quality at the air intakes. Re-entrainment is an occasional air pollution instance that happens if pollutants in the exhaust air stream, after being discharged to outdoors, are transferred back to outdoor air intake location due to unfavorable meteorological conditions and inadequate positioning of the air intakes and exhaust outlets. In engineering practice, it is impractical to always conduct detailed dispersion modeling due to the complexity of airflow phenomena in the urban environments, and therefore, engineers rely on prescriptive design guidelines or simplified empirical models published in technical literature and regulation documents. Commonly, the design guidelines to avoid the re-entrainment phenomenon are for buildings with rooftop exhaust stacks, but the exhaust outlets might also be situated on the building façade. The objective of this paper is to overview the existing designguidelines for the placement of horizontal air intakes and exhaust outlets. Technical engineering literature, including international standards, codes, and guidebooks is reviewed to extract both qualitative and quantitative design guidelines relevant to the placement of air intakes and exhausts on an external wall.Peer reviewe

Der erlöschende Halbmond : türkische Enthüllungen, von Alexander Ular and Enrico Insabato.

Mode of access: Internet