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Patients with chronic obstructive pulmonary disorder (COPD) experience increased risk of readmission following hospitalization. A quality improvement project was implemented using a COPD bundle within a transitional care clinic to improve outcomes and reduce readmissions., Literature Summary * Despite multiple nationwide strategies, chronic obstructive pulmonary disorder (COPD) readmissions continue to remain problematic (Kong & Wilkinson, 2019). * Multiple studies have demonstrated decreased unplanned hospital visits [...]

ABSTRACT This article examines the impact of micro health insurance on poverty reduction in rural areas of Bangladesh. The research is based on household-level primary data collected from the operating [...]

The Gulf Cooperation Council (GCC) ranks ninth among the world's basic petrochemicals producers. Producers in the region are increasing their capacities for propylene, aromatics, and butadiene-based petrochemicals. In 1995, GCC [...]

By the end of 1996, the Gulf Cooperation Council (GCC) countries held 466 billion bbl of crude oil reserves and 22,545 billion cu m of natural gas, representing, respectively, about [...]

Exploitation of natural gas resources of most Middle Eastern countries will grow in the future. Increasing demand for the fuel in processes such as power generation, petrochemical production and synthetic fuel synthesis will help drive this growth. Current natural gas reserves in the Middle East are 45 trillion cubic meters, and annual gas production has reached 204 billion cubic meters., Natural gas is increasingly becoming a major contributor in the industrial development of most Middle Eastern countries. Demand there will rise steeply in coming years. This is because of the [...]

This study surveys 622 Bangladeshi civil servants of all administrative jurisdictions and elicits their preference for health insurance schemes. The latter vary in the amount of sum assured as well as in terms of premium sharing rules with the government. The paper also explores the financial burden that the premium subsidy may impose on the exchequer and the state’s fiscal capacity to shoulder it. We discover a very high willingness to join the scheme. Though all three premium-sharing options posit flat rates common for all employment ranks, respondents appear to prefer premiums proportional to their basic salary.

IMPORTANCE: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child’s life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. OBJECTIVES: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. DESIGN, SETTING, AND PARTICIPANTS: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. MAIN OUTCOMES AND MEASURES: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. RESULTS: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle–income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle–income countries vs upper-middle–income countries and HICs, 5.74 [95% CI, 4.30-7.68]). CONCLUSIONS AND RELEVANCE: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

The utilization of condensates and refinery-derived feedstocks will fill the gap in the GCC's current petrochemical slate. But numerous opportunities exist for further development of the region's petrochemical industry during [...]

Background:appropriate prescribing of antimicrobial prophylaxis (AP) is a main strategy of the antimicrobial stewardship programme.Aim:to investigate the prescribing practices of antimicrobial prophylaxis and adherence to recommended protocols in older patients in the surgical wards at a 600-bed teaching hospital in Islamabad, Pakistan.Method:researchers selected 240 surgical procedures retrospectively for patients aged 65 years and older admitted to four surgical specialties (abdominal, orthopaedic, urological and neurosurgery) during 1 year. The different parameters of antimicrobial prescription were compared with international clinical practice guidelines.Findings:There were more ‘clean’ surgical wound procedures (n=104; 43.3%) than ‘clean contaminated’ (n=97; 40.4%) and most of these were elective surgical procedures (n=226; 94%). The indication, selection, route, dose, and timing of antimicrobial were found to have adhered with the standard guidelines in 89.6%, 32.5%, 100%, 100% and 55.3% of cases, respectively (optimal value 100%). A statistically significant difference was observed between antimicrobial practices and surgical procedures (P< 0.001). The commonly prescribed antimicrobials were ceftriaxone followed by cefazolin.Conclusion:about 89% of participants who underwent surgical procedures received antimicrobials. The selection of therapeutic agent, the timing and use of broad-spectrum antimicrobial were the common problems in our setting.

Unbonded flexible pipes have become a new trend in the oil and gas sector for transporting hydrocarbon products due to good service, reliability, and ease of installation, which can be translated to cheaper cost during design, manufacturing, installation, and operations. However, due to limited inspection options during operation, unbonded flexible pipes are exposed to a greater risk of failure compared with conventional steel pipes. This paper investigates a new inspection approach to perform complete site integrity assessments of unbonded flexible pipes, which can be divided into three sub-activities: ultrasonic testing (UT), visual testing (VT), and cathodic protection survey. These activities will be conducted consecutively prior to performing any repairs. This paper also discusses mitigations and repair measures when there is damage to the unbonded flexible pipe. [ABSTRACT FROM AUTHOR]

The purpose of these studies was to determine the suitability of bisacodyl for stimulating high‐amplitude‐propagating contractions in pediatric studies of colonic manometry. Water‐perfused manometry catheters were inserted into the right colon of children referred for evaluations related to defecation disorders. Colonic motility was measured in a 3‐hour test session: an hour fasting, an hour after a meal, and 30 minutes after administration of a provocative agent. Bisacodyl was superior to edrophonium as a stimulant for inducing high‐amplitude‐propagating contractions. Bisacodyl‐induced high‐amplitude‐propagating contractions were similar in amplitude, duration, propagation velocity, and sites of origin and extinction to naturally occurring high‐amplitude‐propagating contractions. The effect of intrarectal bisacodyl was similar to that of intracecal bisacodyl, except for a delay of 10 minutes in onset. Bisacodyl induced high‐amplitude‐propagating contractions in all 28 children (22 with spontaneous high‐amplitude‐propagating contractions) without evidence of neuromuscular disease and in 2 of 9 children with a colonic neuromuscular disorder and no spontaneous high‐amplitude‐propagating contractions. Bisacodyl‐induced high‐amplitude‐propagating contractions were quantitatively and qualitatively similar to naturally occurring high‐amplitude‐propagating contractions. In selected cases, such as in children receiving total parenteral nutrition or restricted fluid intake, it may be possible to shorten diagnostic colonic manometry using bisacodyl rather than waiting for spontaneous high‐amplitude‐propagating contractions.

An experimental investigation was carried out to evaluate the efficiencies of different selective solvents used for the extraction of aromatic hydrocarbons from naphtha (boiling range IBP-200°C) distilled from Saudi Arabian light crude oil. The solvents used were 3-methoxypropionitrile, ethylene glycol, dimethylsulfoxide, sulfolane, phenol, and nitrobenzene. The parameters studied were operating temperature (range 20°-125°C), solvent-to-oil ratio (range 1:1-3:1), selectivity, and solvent capacity. The results indicate that sulfolane exhibits excellent extraction properties in comparison with other solvents. In addition, sulfolane has the advantage of having good solvent properties such as high density, low heat capacity, and appropriate boiling point, which helps simplify separation of the solvent from extract. Sulfolane is also commercially feasible as a solvent for aromatic extraction.

Economic evaluation of the methyl tertiary butyl ether (MTBE) complex was carried out staring from n-butane and by captive production of methanol from natural gas. The processing steps consist of isomerization of n-butane to isobutane, dehydrogenation of isobutane to make isobutene, and finally, the reaction of isobutene with methanol to produce MTBE. Two different plant sizes were considered, and the effect of 30% lower feedback prices on profitability was studied. It was found that the raw materials cost is a dominant component, composing about 55% of the total production cost. An internal rate of return of 19% could be realized for 500,000 tons per annum MTBE complex based on economic data in mid-1993. The payback period estimated at this capacity was 3.8 years, and the break-even capacity was 36.6%.

A liquid crystalline polymer (LCP) was synthesized by an interfacial polycondensation reaction at room temperature from terephthaloyl chloride and p,p'-dihydroxydiphenyl sulfone. The LCP synthesized was so stable and molecularly rigid that it did not show any phase transition until it degraded at about 320°C. Composites of the LCP with polycarbonate (PC), polystyrene (PS), and sulfonated polystyrene (SPS) were formed by compression molding at a temperature at which the thermoplastic matrix was in the melt state. They were thermally analyzed by differential scanning calorimetry. Tensile specimens were cut from the compression-molded plates, and mechanical tests were performed. The morphology of the material systems was studied by performing scanning electron microscopy analysis on cryogenically fractured specimens. For LCP/PS and LCP/SPS systems, a sharp two-phase morphology was formed, which suggested poor interfacial adhesion. The tensile strength of both systems decreased with LCP addition. The LCP/PC system also revealed a two-phase morphology; however, the interfaces between the LCP domains and the PC matrix were not so well defined, showing better interfacial adhesion than the two previous systems studied. Stronger bonding between the LCP and PC resulted in a significant improvement in the mechanical behavior of PC by LCP addition. © 1997 John Wiley & Sons, Inc. J Appl Polym Sci 64: 645–652, 1997

Plastics degrade through the influence of such factors as the sun's radiation, temperature, humidity, rain, the oxygen content of the air, and atmospheric pollutants. The most deleterious of these effects is radiation, which is responsible for breaking up polymer chains. The sun emits a complete spectrum of energy radiation, with waves similar in physical structure but varying in length and therefore in photon energy. Wavelength has an inverse relationship to quantum energy, as shown in Fig. 1.

The effect of blending MTBE in the gasoline was evaluated. MTBE effectively boost the octane numbers of gasoline without adversely effecting its other properties. However, MTBE is not as efficient as leadalkyl compounds as far as the specific octane number improvements are concerned. The addition of 5 to 30 volume percent MTBE increases 1.9 to 11.8 RON of a typical gasoline. MTBE addition also extends the volume of gasoline produces for a given crude by adding volume to the gasoline pool. MTBE provides much higher FEON to the gasoline in comparison with other gasoline components. A higher FEON increases the efficiency of the engine. MTBE is not affected by the lead level of the gasoline. For this reason, lost octane in future lead reductions of the gasoline in Saudi Arabia can be made up with MTBE. MTBE addition to the Saudi gasoline increases the RVP but within the specification of the gasoline. MTBE has favorable effect on the distillation characteristics of the gasoline. MTBE addition lowers the distillation temperature which improves driveability and cold engine operation. MTBEgasoline blends were found free of gums and peroxides after long term storage and pose no phase separation problems in the presence of water. MTBE is miscible in gasoline in all proportions and its solubility in water is low.