Hospital length of stay (LOS) related to craniotomy for tumor resection (CTR) is a marker of neurosurgical quality of care. Limiting LOS benefits both patients and hospitals. This study examined ...which factors contribute to extended LOS (eLOS) at our academic center.
Retrospective medical record review of 139 consecutive CTRs performed between July 2020 and July 2021. Univariate and multivariable analyses determined which factors were associated with an eLOS (≥8 days).
Median LOS was 6 days (IQR 3–9 days). Fifty-one subjects (36.7%) experienced an eLOS. Upon univariate analysis, potentially modifiable factors associated with eLOS included days to occupational therapy (OT), physical therapy (PT), and case management clearance (p < .001); and discharge disposition (p < .001). Multivariable analysis revealed that pre-operative anti-coagulant use (OR 10.74, 95% CI 2.64–43.63, p = .001), Medicare (OR 4.80, 95% CI 1.07–21.52, p = .04), ED admission (OR 26.21, 95% CI 5.17–132.99, p < .001), transfer to another service post-surgery (OR 30.00, 95% CI 1.56–577.35, p = .02), and time to post-operative imaging (OR 2.91, 95% CI 1.27–6.65, p = .01) were associated with eLOS. Extended LOS was not significantly associated with ED visits (p = .45) or unplanned readmissions within 30 days of surgery (p = .35), and both (p = .04; p = .04) were less likely following a short LOS (<5 days).
While some factors driving LOS related to CTR are uncontrollable, expedient pre- and post-operative management may reduce LOS without compromising care.
Background
The impact of safety‐net status, case volume, and outcomes among geriatric head and neck cancer patients is unknown.
Methods
Chi‐square tests and Student's t tests to compare head and neck ...surgery outcomes of elderly patients between safety‐net and non‐safety‐net hospitals. Multivariable linear regressions to determine predictors of outcome variables including mortality index, ICU stays, 30‐day readmission, total direct cost, and direct cost index.
Results
Compared with non‐safety‐net hospitals, safety‐net hospitals had a higher average mortality index (1.04 vs. 0.32, p = 0.001), higher mortality rate (1% vs. 0.5%, p = 0.002), and higher direct cost index (p = 0.001). A multivariable model of mortality index found the interaction between safety‐net status and medium case volume was predictive of higher mortality index (p = 0.006).
Conclusion
Safety‐net status is correlated with higher mortality index and cost in geriatric head and neck cancer patients. The interaction between medium volume and safety‐net status is independently predictive of higher mortality index.
This dissertation examines the tension inherent in the relationship between the Economic Community of West African States (ECOWAS) as Member States Parties of the GATT/WTO and the GATT/WTO regime. It ...focuses specifically on the tension triggered off by the requirements of Article I – the Most-Favoured-Nation principle (MFN) and Article III – the National Treatment principle (NT) GATT 1994. It shows that while the non-discrimination principles are meant to promote trade liberalisation and economic growth, they produce the opposite effect in developing and least developed countries like ECOWAS and aggravate the tension between those countries and the WTO. It argues that the MFN is used to deny market access to the developing countries by exposing them to stiff but unequal competitive conditions and the NT to deny national governments the policy space to protect and promote national industries, employment and economic growth. It challenges the general assumption that the MFN and the NT are good and in the interest of all the WTO Members and rather identifies them as lynch-pins of economic development in the ECOWAS region. It also shows, contrary to the assumption of non-participation, how the ECOWAS High Contracting Parties are adapting their trading systems and harmonising their laws to the key provisions of Articles I and III of the GATT. It shows that the principles of non-discrimination are the outcome of the standard-setting procedures legally formulated as the SPS and TBT Agreements which favour the developed countries and how the Dispute Settlement Body has rejected the ‘aims-and-effect’ approach, taken a literal approach, overly emphasising trade liberalisation to the neglect of market access and economic development. This dissertation concludes that it is pre-mature for ECOWAS to assume Articles I and III obligations and recommends using the provisions of Article XXIV to build up effective influence through regional organisations and incrementally uniting to transform the GATT.
This dissertation examines the tension inherent in the relationship between the Economic Community of West African States (ECOWAS) as Member States Parties of the GATT/WTO and the GATT/WTO regime. It ...focuses specifically on the tension triggered off by the requirements of Article I – the Most-Favoured-Nation principle (MFN) and Article III – the National Treatment principle (NT) GATT 1994. It shows that while the non-discrimination principles are meant to promote trade liberalisation and economic growth, they produce the opposite effect in developing and least developed countries like ECOWAS and aggravate the tension between those countries and the WTO. It argues that the MFN is used to deny market access to the developing countries by exposing them to stiff but unequal competitive conditions and the NT to deny national governments the policy space to protect and promote national industries, employment and economic growth. It challenges the general assumption that the MFN and the NT are good and in the interest of all the WTO Members and rather identifies them as lynch-pins of economic development in the ECOWAS region. It also shows, contrary to the assumption of non-participation, how the ECOWAS High Contracting Parties are adapting their trading systems and harmonising their laws to the key provisions of Articles I and III of the GATT. It shows that the principles of non-discrimination are the outcome of the standard-setting procedures legally formulated as the SPS and TBT Agreements which favour the developed countries and how the Dispute Settlement Body has rejected the ‘aims-and-effect’ approach, taken a literal approach, overly emphasising trade liberalisation to the neglect of market access and economic development. This dissertation concludes that it is pre-mature for ECOWAS to assume Articles I and III obligations and recommends using the provisions of Article XXIV to build up effective influence through regional organisations and incrementally uniting to transform the GATT.
Cassava is an important staple in Sub-Sahara Africa. While its production has rapidly expanded to the dry savannahs of the continent, productivity is low in this ecology due to drought by farmers, ...extending the growth cycle from 12 months to 18, and sometimes 24 months to ensure better harvests. Yield is a complex trait and often difficult to manipulate for genetic gain in conventional breeding. Unfortunately, the dearth of molecular tools for decades has hampered molecular breeding (MB) to improve cassava productivity. This study was conducted to explore KASpar SNPs to generate more molecular tools to enhance genetic dissection of elite African germplasm for improved cassava productivity in dry environments of Africa where molecular resources are highly limited for crop improvement. To aid molecular genetic analysis of traits, a linkage map covering 1582.8 cM with an average resolution of 3.69 cM was constructed using 505 polymorphic SNP markers distributed over 21 linkage groups. Composite interval mapping using 267 F
progeny in initial QTL mapping identified 27 QTLs for productivity traits in the dry savannah of Nigeria. The availability of KASPar SNPs are anticipated to improve the implementation of MB for the development of high performing drought-tolerant cassava varieties in Africa.
By September 2014, an outbreak of Ebola Viral Disease (EVD) in West African countries of Guinea, Liberia, Sierra Leone, Senegal and Nigeria, had recorded over 4500 and 2200 probable or confirmed ...cases and deaths respectively. EVD, an emerging infectious disease, can create fear and panic among patients, contacts and relatives, which could be a risk factor for psychological distress. Psychological distress among this subgroup could have public health implication for control of EVD, because of potential effects on patient management and contact tracing. We determined the Prevalence, pattern and factors associated with psychological distress among survivors and contacts of EVD and their relatives.
In a descriptive cross sectional study, we used General Health Questionnaire to assess psychological distress and Oslo Social Support Scale to assess social support among 117 participants who survived EVD, listed as EVD contacts or their relatives at Ebola Emergency Operation Center in Lagos, Nigeria. Factors associated with psychological distress were determined using chi square/odds ratio and adjusted odds ratio.
The mean age and standard deviation of participants was 34 +/ - 9.6 years. Of 117 participants, 78 (66.7%) were females, 77 (65.8%) had a tertiary education and 45 (38.5%) were health workers. Most frequently occurring psychological distress were inability to concentrate (37.6%) and loss of sleep over worry (33.3%). Losing a relation to EVD outbreak (OR = 6.0, 95% CI, 1.2-32.9) was significantly associated with feeling unhappy or depressed while being a health worker was protective (OR = 0.4, 95% CI, 0.2-0.9). Adjusted Odds Ratio (AOR) showed losing a relation (AOR = 5.7, 95% CI, 1.2-28.0) was a predictor of "feeling unhappy or depressed", loss of a relation (AOR = 10.1, 95% CI, 1.7-60.7) was a predictor of inability to concentrate.
Survivors and contacts of EVD and their relations develop psychological distress. Development of psychological distress could be predicted by loss of family member. It is recommended that psychiatrists and other mental health specialists be part of case management teams. The clinical teams managing EVD patients should be trained on recognition of common psychological distress among patients. A mental health specialist should review contacts being monitored for EVD for psychological distress or disorders.
The need to control or eliminate foam in oil and gas industry processes is crucial and of great concern for smooth and efficient plant operations. The majority of the existing defoamers and antifoams ...used in the oil and gas processing facilities, most often than not, contain toxic components that are environmentally unfriendly. Sustainable and eco-friendly options that are biodegradable and environmentally friendly are more desirable. This study aims to formulate antifoam/defoamer from modified palm kernel and coconut oil through a transesterification pathway and evaluate its foam inhibition and control capacity in foamy crude petroleum oil. Vegetable oils were extracted from palm kernel and coconut using the Soxhlet extraction method. Extracted oils were synthesized through a transesterification pathway to fatty acid methyl esters (FAME). Palm kernel (PKO) and coconut (CNO) oil FAME were blended with 20% silicone oil to give samples A and B. Crude PKO and CNO were blended directly with 20% silicone oil to give samples C and D. Samples E and F were, respectively, FAMEs of CNO and PKO with 10% methanol each. Physicochemical analysis and standard foam tests, including the foam rise and mechanical agitation tests, were used to determine defoamer properties, foam characterization, and stability. From the analysis of the results, the pH value of the defoamers ranged from 5.2 to 7.0. Viscosity ranged from 2.28 to 7.75 cSt, with samples E and F in the same range as the conventional defoamer. The defoamer samples’ densities were within the range of 0.8361–0.9012 g/cm
3
, as shown by the conventional defoamer (G). The defoamers’ cloud and pour points ranged from − 24 to 0.5 °C and − 30 to 2 °C. The samples were optically clear, with no phase separation. The foam inhibition and control capacity of sample F was significantly high and compared favorably with the high-spec conventional defoamer. Fatty acid methyl ester of crude PKO is recommended for use in a blend with 10% methanol for the production of fatty alcohol defoamers (FAD).
In view of the current demand for bioenergy and environmental sustainability, utilisation of Desmodesmus subspicatus LC172266 for simultaneous remediation of cassava wastewater and accumulation of ...lipids for biodiesel production was investigated. The microalga was grown under photoautotrophic, heterotrophic and mixotrophic culture conditions using Bold's Basal Medium (BBM) and cassava wastewater as substrates. Results showed that biomass accumulation under unoptimised autotrophic, heterotrophic and mixotrophic growths conditions were 0.217, 0.63 and 1.042 g/L, respectively. The lipid contents were 15.86, 21.40 and 24.70%, respectively. Fatty acid profiles revealed that although the most abundant compounds under autotrophic conditions were those recommended for biodiesel production, oleic acid eluted under mixotrophic (19.61%) and heterotrophic (10.25%) conditions exhibited more acceptable biodiesel quality. The physical properties of the fatty acid methyl esters (FAMEs) also meet the required biodiesel standards. The percentage reduction in total dissolved solids (TDS, 84.04), electrical conductivity (EC, 82.31), biochemical oxygen demand (BOD, 85.85) and chemical oxygen demand (COD, 89.04) under heterotrophic cultivation were more favourable than their respective mixotrophic values (80.56, 74.63, 62.22, and 51.39%). Although the lipid accumulation of the microalga under mixotrophic conditions was greater, bioremediation potential of cassava wastewater was more favourable under heterotrophy.
First-time pass rates of the North American Pharmacist Licensure Examination (NAPLEX) have declined 7% from 2019 to 2022 with more than a third of schools experiencing a decline of ≥10%.
The cause of ...the decline is likely multifactorial and extends beyond the impact of the COVID-19 pandemic. Changes to the NAPLEX blueprint in 2021, curricular revisions in response to the implementation of Accreditation Council for Pharmacy Education Standards 2016, and changes to prerequisite course requirements in response to declining enrollment must also be evaluated as potential causes.
The academy must respond to this decline by scrutinizing admissions, curriculum, and assessment processes. We urge the National Association of Boards of Pharmacy to provide access to student-level data on NAPLEX performance and increase transparency in passing standard practices to inform this process.
PDF
