Generic Ownership Types for Java and the Collections Framework

Generic programming has turned out very useful in the development of reusable software. With the Java programming language, genericity is not only meant for reusability, but also for type-safety. Java generics constrain a container object (e.g., list, hash table) to store objects of a pre-specified data type. Nevertheless, safe programming with aliasing (multiple pointers in a program may point to the same object) is still a concern in object-oriented programming language research. A pointing object can mutate the state of the aliased object, reflecting the changes to all of the other pointers (aka aliases) thus affecting their behaviour. As programs grow larger and more complex, such changes in behaviour can be undesirable and difficult to detect and reason about. With respect to container objects, the iterator pattern critically violates encapsulation, allowing aliases to the state (and thereof the components) of its container. Object ownership is one of the well-researched paradigms in the area of alias management. Ownership types support hierarchical object encapsulation rather than the traditional class-level encapsulation. This thesis introduces an extension of Java 6 with support for ownership types as supplementary generic types. That is, Java generics are extended with the ability of carrying ownership information. This extension provides generic ownership support for all of Java; that is, all major language features are addressed so that programs can safely manage and express their aliasing properties. The resulting language is expressive enough to support common programming idioms, with little programming and runtime overhead. We evaluated the programmability of the language by refactoring a major (the most essential) portion of the Java Collections Framework. We also evaluated the performance impact of our refactoring by conducting a small micro-benchmark study to measure the performance time overhead the refactored collections may impose

Accuracy of Gray‑scale and Three‑dimensional Power Doppler Ultrasound Parameters in the Diagnosis of Morbidly Adherent Placenta

Background: Morbidly adherent placenta (MAP) is usually associated with excess blood loss, bladder injuries, and hysterectomies.Aim: This study was designed to evaluate the accuracy of grayscale and three-dimensional (3D) power Doppler ultrasound parameters in the diagnosis of MAP. Subjects and Methods: Fifty pregnant women ≥28 weeks’ gestation with suspected MAP were included randomly in this prospective study. Two-dimensional (2D) transabdominal gray-scale ultrasound and 3D power Doppler scans were done for studied women to confirm placental location and findings suggestive of MAP. Intraoperative findings and histopathology results of removed uteri in the cases were managed by hysterectomies compared to preoperative sonographic findings using Student’s t-test and Mann–Whitney U-test for quantitative data, Chi-square test for qualitative data to detect the accuracy of 2D transabdominal gray-scale ultrasound and 3D power Doppler parameters in the diagnosis of MAP. Results: Best 2D gray scale ultrasound parameters for the detection of emergency hysterectomies in the studied cases were disruption of uterine serosa– bladder interface (81.8% sensitivity) and exophytic mass invading bladder (94.9% specificity, 66.7% positive predictive value (PPV), and 84.1% negative predictive value [NPV]). Best 3D power Doppler parameters for the detection of emergency hysterectomies in the studied cases were disruption of uterine serosa–bladder interface (90.9% sensitivity, 68.8% specificity, and 47% PPV) and crowded vessels over peripheral subplacental zone (93.2% NPV). Conclusion: 3D power Doppler is a useful complementary tool to 2D gray-scale ultrasound for antenatal diagnosis of MAP. Crowded vessels over peripheral sub-placental zone and disruption of uterine serosa–bladder interface were the best 3D power Doppler parameters for the detection of difficult placental separation, considerable intraoperative blood loss, and emergency hysterectomies in the studied cases.KEY WORDS: Three‑dimensional power Doppler, gray-scale, morbidly adherent placent

Effect of Progesterone Therapy versus Diet Modification on Constipation during Pregnancy

Background: Pregnant women may experience constipation for the first time or their existing constipation symptoms increase in severity during pregnancy.Aim: To compare the effect of progesterone versus diet modification in the treatment of constipation during pregnancy.Subjects and Methods: Women aged ≥18 years with functional constipation according to the Rome III criteria from obstetrics outpatients’ clinic and midwife practices included in this study. Participants divided into two groups; control group managed with diet modifications and study group pregnant women with threatened miscarriage and advised to take vaginal progesterone ≥1 week. Participants completed a nonvalidated questionnaire created by the authors during the whole week before intake of progesterone or diet modifications and after treatment phase. Independent Student’s t‑test and Chi‑square (X2) test were used for statistical analysis to compare between two studied groups. Primary outcome measures; change in defecation frequency.Results: Sensation of anorectal obstruction and sensation of incomplete evacuation were significantly less in Group B (progesterone therapy) compared to Group A (diet modification) (54% [154/281] and 62.98% [177/281] vs. 89.76% [614/684] and 91.08% [623/684], respectively) (P = 0.04 and 0.03, respectively). Straining during defecation and manual maneuvers to facilitate evacuation were significantly less in Group B compared to Group A (63.7% [179/281] and 19.9% [56/281] vs. 94.59% [647/684] and 86.54% [592/684], respectively) (P < 0.01 and 0.02, respectively). Episodes of abdominal pain and presence of reflux episodes were also significantly less in Group B compared to Group A (18.5% [52/281] and 17.43% [49/281] vs. 84.11% [589/684] and 75% [513/684], respectively) (P = 0.01 and 0.03, respectively). Conclusions: Estrogen, rather than progesterone, may be a detrimental factor of constipation during pregnancy via decreased bowel movement. Progesterone therapy seems to be effective in the treatment of functional constipation during pregnancy. A randomized placebo controlled trial is required to confirm the data of this study.KEY WORDS: Constipation, diet modification, pregnancy, progesteron

The evolving SARS-CoV-2 epidemic in Africa: insights from rapidly expanding genomic surveillance

Investment in SARS-CoV-2 sequencing in Africa over the past year has led to a major increase in the number of sequences generated, now exceeding 100,000 genomes, used to track the pandemic on the continent. Our results show an increase in the number of African countries able to sequence domestically, and highlight that local sequencing enables faster turnaround time and more regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and shed light on the distinct dispersal dynamics of Variants of Concern, particularly Alpha, Beta, Delta, and Omicron, on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve, while the continent faces many emerging and re-emerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

ICAR: endoscopic skull‐base surgery

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The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

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

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

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