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Background:Moringa oleifera leaf is used for diabetes due to its pharmacologic effects. Patients with hyperglycemia experience beta cell destruction. However, no research on risk awareness has been done to ascertain its safety. The present study describes the antidiabetic effect of Moringa oleifera leaf, such as the protection of pancreatic beta cells and the induction of glycogen synthesis, before addressing the secondary effects of diabetes, such as hepatic and renal toxicity. Methods: Forty‐five Wistar rats weighed 160 ± 10 g were divided into nine groups. All animal operations complied with the National Institute of Health (NIH) guidelines for the care and use of laboratory animals as approved by the Animal Ethical Committee, University of Jos. Group I was normal control and Group II was diabetic animals induced with alloxan. Insulin and extract doses of 200, 400, and 800 mg/kg were given to diabetic Groups III‐VI. Normal animals in Groups VII–IX were given extract at doses of 200, 400, and 800 mg/kg for 28 days. Tissues were retrieved for biochemical and histological investigations using standard techniques. Results: There was decrease relative body weight of diabetic animals (95.50 ± 5.50) when compared to normal control (142.75 ± 20.08) with increased levels of urea (control 6.13 ± 0.523 and diabetes 29.23 ± 1.267) and creatinine (control 0.70 ± 0.057 and diabetes 2.13 ± 0.185). Histology of the liver and pancreas also points to organ damage due to hyperglycemia. However, oral administration of extract showed antidiabetic effect with protection of pancreatic beta cells and the induction of glycogen synthesis, no glycogen was deposited in the liver, addressing the secondary effects of diabetes, such as hepatic and renal toxicity. Further discovery revealed that extract elevated antioxidant enzyme expression. Conclusion: Leaf extract from Moringa oleifera reduces blood sugar and lessens the damage caused by hyperglycemia in the pancreas and liver. [ABSTRACT FROM AUTHOR]

Targeted therapy has the potential to be used in the neoadjuvant setting for odontogenic tumors, reducing the morbidities associated with major surgery. In this regard, the aim of this study was to summarize the current evidence on the different forms of targeted therapy, effectiveness, and drawbacks of this course of treatment. Four databases were searched electronically without regard to publication date or language. Grey literature searches and manual searches were also undertaken. Publications with sufficient clinical data on targeted therapy for odontogenic tumors were required to meet the criteria for eligibility. The analysis of the data was descriptive. A total of 15 papers comprising 17 cases (15 ameloblastomas and 2 ameloblastic carcinomas) were included. Numerous mutations were found, with BRAF V600E being most common. Dabrafenib was the most utilized drug in targeted therapy. Except for one case, the treatment reduced the size of the lesion (16/17 cases), showing promise. Most of the adverse events recorded were mild, such as skin issues, voice changes, abnormal hair texture, dry eyes, and systemic symptoms (e.g., fatigue, joint pain, and nausea). It is possible to reach the conclusion that targeted therapy for ameloblastoma and ameloblastic carcinoma may be a useful treatment strategy, based on the findings of the included studies. [ABSTRACT FROM AUTHOR]

Objective: The HEART score successfully risk stratifies emergency department (ED) patients with chest pain in high‐income settings. However, this tool has not been validated in low‐income countries. Methods: This is a secondary analysis of a prospective observational study that was conducted in a Tanzanian ED from January 2019 through January 2023. Adult patients with chest pain were consecutively enrolled, and their presenting symptoms and medical history were recorded. Electrocardiograms and point‐of‐care troponin assays were obtained for all participants. Thirty‐day follow‐up was conducted, assessing for major adverse cardiac events (MACEs), defined as death, myocardial infarction, or coronary revascularization (coronary artery bypass grafting or percutaneous coronary intervention). HEART scores were calculated for all participants. Likelihood ratios, sensitivity, specificity, and negative predictive values (NPVs) were calculated for each HEART cutoff score to predict 30‐day MACEs, and area under the curve (AUC) was calculated from the receiver operating characteristic curve. Results: Of 927 participants with chest pain, the median (IQR) age was 61 (45.5–74.0) years. Of participants, 216 (23.3%) patients experienced 30‐day MACEs, including 163 (17.6%) who died, 48 (5.2%) with myocardial infarction, and 23 (2.5%) with coronary revascularization. The positive likelihood ratio for each cutoff score ranged from 1.023 (95% CI 1.004–1.042; cutoff ≥ 1) to 3.556 (95% CI 1.929–6.555; cutoff ≥ 7). The recommended cutoff of ≥4 to identify patients at high risk of MACEs yielded a sensitivity of 59.4%, specificity of 52.8%, and NPV of 74.7%. The AUC was 0.61. Conclusions: Among patients with chest pain in a Tanzanian ED, the HEART score did not perform as well as in high‐income settings. Locally validated risk stratification tools are needed for ED patients with chest pain in low‐income countries. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Gardner's syndrome with the complete manifestation of colonic and extracolonic features is uncommon. Therefore, every clinician should view extracolonic features with a high index of suspicion. This may be key to early diagnosis, definitive management in these patients and importantly, helps prevent malignant transformation of existing colonic polyps. [ABSTRACT FROM AUTHOR]

Background: Ameloblastoma is an aggressively growing, highly recurrent odontogenic jaw tumor. Its association with BRAFV600E mutation is an indication for BRAFV00E‐inhibitor therapy The study objective was to identify a sensitive low‐cost test for BRAFV600E‐positive ameloblastoma. We hypothesized that immunohistochemical staining of formalin‐fixed paraffin‐embedded tissues for BRAFV600E mutation is a low‐cost surrogate for BRAFV600E gene sequencing when laboratory resources are inadequate for molecular testing. Methods: Tissues from 40 ameloblastoma samples were retrieved from either formalin‐fixed paraffin‐embedded blocks, RNAlater™ stabilization solution or samples inadvertently pre‐fixed in formalin before transfer to RNAlater™. BRAFV600E mutation was assessed by Direct Sanger sequencing, Amplification Refractory Mutation System‐PCR and immunohistochemistry (IHC). Results: BRAFV600E mutation was detected by IHC, Amplification Refractory Mutation System‐PCR and Direct Sanger sequencing in 93.33%, 52.5% and 30% of samples respectively. Considering Direct Sanger sequencing as standard BRAFV600E detection method, there was significant difference between the three detection methods (휒2 (2) = 31.34, p < 0.0001). Sensitivity and specificity of IHC were 0.8 (95% CI: 0.64–0.90) and 0.9 (95% CI: 0.75–0.99) respectively, while positive predictive value and negative predictive value (NPV) were 0.9 and 0.8 (Fischer's test, p < 0.0001) respectively. Sensitivity and specificity of Amplification Refractory Mutation System‐PCR detection method were 0.7 (95% CI: 0.53–0.80) and 0.9 (95% CI = 0.67–0.98) respectively, while PPV and NPV were 0.9 and 0.6 respectively (Fischer's test, p < 0.0001). Conclusion: Low‐cost and less vulnerability of IHC to tissue quality make it a viable surrogate test for BRAFV600E detection in ameloblastoma. Sequential dual IHC and molecular testing for BRAFV600E will reduce equivocal results that could exclude some patients from BRAFV600E‐inhibitor therapies. [ABSTRACT FROM AUTHOR]

Background: The clinical benefits of laparoscopic appendicectomy are well recognized over open appendicectomy. However, laparoscopic procedures are not frequently conducted in many low-and middle-income countries (LMICs) for several reasons, including perceived higher costs. The aim of this study was to assess the feasibility and cost of laparoscopic appendicectomy compared to open appendicectomy in Nigeria. Methods: A multicenter, prospective, cohort study among patients undergoing appendicectomy was conducted at three tertiary hospitals in Nigeria. Data were collected from October 2020 to February 2022 and analyses compared the average healthcare costs at 30 days after surgery. Quantile regression was conducted to identify variables that had an impact on the costs, reported in Nigerian Naira (Naira) and US dollars ($), with standard deviations (SD). Findings: This study included 105 patients, of which 39 had laparoscopic appendicectomy and 66 had open appendicectomy. The average healthcare cost of laparoscopic appendicectomy (147,562 Naira (SD: 97,130) or $355 (SD: 234)) was higher than open appendicectomy (113,556 Naira (SD: 88,559) or $273 (SD: 213)). The average time for return to work was shorter with laparoscopic than open appendicectomy (mean: 8 days vs. 14 days). At the average daily income of $5.06, laparoscopic appendicectomy was associated with 9778 Naira or $24 cost savings in return to work. Further, 5.1% of laparoscopic appendicectomy patients had surgical site infections compared to 22.7% for open appendicectomy. Regression analysis results showed that laparoscopic appendicectomy was associated with $14 higher costs than open appendicectomy, albeit non-significant (p = 0.53). Interpretation: Despite selection bias in this real-world study, laparoscopic appendicectomy was associated with a slightly higher overall cost, a lower societal cost, a lower infection rate, and a faster return to work, compared to open appendicectomy. It is technically and financially feasible, and its provision in Nigeria should be expanded. [ABSTRACT FROM AUTHOR]

Additive manufacturing offers reduced lead time between design and manufacturing. Fused filament fabrication, the most common form of material extrusion additive manufacturing, enables the production of custom‐made parts with complex geometry. Despite the numerous advantages of additive manufacturing, reliability, reproducibility, and achievement of isotropic bulk properties in part remains challenging. We investigated the tensile behavior of a model polycarbonate system to explore what leads to different tensile properties, including sources of ductile versus brittle fracture. We utilized a one factor at a time (OFAT) design of experiments (DOE), printed single road‐width boxes, and performed tensile tests on specimens from these boxes. Additionally, we characterized the cross‐sections of parts printed under different conditions and their subsequent fracture behavior. The results demonstrate that isotropic bulk properties are achievable by printing at high speeds, and provide mechanisms to explain why. Highlights: Printing at high speeds leads to improved mechanical properties.Printed samples undergo a mix of ductile and brittle failure.Jagged fracture path is associated with superior adhesion.High layer times lead to worse interfacial bonding. [ABSTRACT FROM AUTHOR]

Dr. Mahathir bin Mohamad is often credited with Malaysia's dramatic economic success post-1980. It is well known that the Mahathir regime installed centralized power in the Office of the Prime Minister (PM) and greatly extended state capacity through a far-reaching clientelist system. Prima Facie, the Malaysian experience appears to validate power centralization and state capacity as complementary to economic development. Though these changes did make Malaysia more susceptible to corruption, dramatically exhibited in 2015 with the 1MDB 5 billion dollar scandal, it has been argued that the clientelist political structure installed in Malaysia generally manages corruption at tolerable levels in order to provide the state the capacity needed to implement controls for economic development that began in the 1980s. While Malaysia experienced impressive economic growth during the Mahathir administration, our test using the Synthetic Control Method finds that GDP per capita fell well below what would have been expected under the governing structures in place in the 1970s, before Mahathir took office--a loss of approximately $4000 per capita below its potential. This study provides evidence of powerful negative economic consequences attributable to greater power centralization and enhanced state capacity inaugurated under Mahathir. [ABSTRACT FROM AUTHOR]

Indonesia is an archipelagic country with abundant marine wealth that makes it the world's second largest producer of fish after China. While most of Indonesia's capture marine fisheries (80%) are consumed domestically, around 90% of blue swimming crab (BSC) products are exported, mainly in cans. This makes up almost half of all BSC products on the global market, with the United States and the European Union being the main importers. We carried out a life cycle assessment (LCA) of canned BSC products from Indonesia. Our LCA evaluated the production of "one tonne of canned BSC" at market as a functional unit (FU), with a cradle‐to‐market system boundary, encompassing wild capture, preprocessing, processing, and distribution to the port of destination at home and abroad. The processing stage was found to be the highest contributor (hotspot) for most of the impact categories considered, mainly due to the use of tin cans for packaging. Despite producing less by‐catch, BSC caught with traps resulted in around threefold greater global warming impact per FU than those caught using nets. We also concluded that BSC meat produced in Java is environmentally preferable to that from Sumatra, as most of the shells were sold as coproducts. In addition to recycling and substitution of packaging materials, environmental improvements can also be obtained by increasing the number of shell‐processing facilities outside Java. The results of this study can be used by the Indonesian government to develop more sustainable practices to avoid overexploitation of BSC and limit its environmental impacts. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic altered the ways academics work and live by creating a context during the spring of 2020 when working from home was largely mandatory and where, for cohabiting workers, the home as workplace was simultaneously occupied by all household members during working hours (and beyond). Using a multi‐method qualitative approach, we examine how academics experienced working from home during the unprecedented circumstances imposed by the first UK lockdown and social distancing measures. Our findings show that a working arrangement commonly termed 'flexible' – working from home – can actually reduce flexibility in a context of mandatory implementation, accompanied by the removal of instrumental and emotional support structures such as childcare and face‐to‐face (physical) social gatherings. Intensified workloads, increased employer monitoring, social disconnection and blurred boundaries between work and personal life collectively generate the reduction of employees' perceived flexibility‐ability. Experiences may be particularly negative for those with low flexibility‐willingness, whose pre‐pandemic preference was to separate work and home as much as possible. Employee efforts to assert agency in this context include establishing 'micro‐borders' and using time‐based strategies to create 'controlled integration'. We discuss implications for border theory and outline directions for future research. [ABSTRACT FROM AUTHOR]

Minimizing entropy generation is a technique that helps improve the effectiveness of real processes by studying the associated irreversibility of system performance of nanofluid. This study examines the entropy generation analysis of electromagnetohydrodynamic radiative Casson flow induced by a stretching Riga plate in a non‐Darcian porous medium under the influence of internal energy change, Arrhenius activation energy, chemical reaction, and melting heat transfer. The thermophysical features of the fluid are assumed constant in most of the literature. However, this current research bridges this gap by considering viscosity, conductivity, and diffusivity as temperature‐dependent variables. Also, the exponential decaying Grinberg term is used as a resistive force in this investigation due to the electromagnetic properties of the Riga plate in the momentum conservation equation. Some suitable dimensionless variables are introduced to remodel the transport equations into unitless ones and then solved numerically by employing Galerkin Weighted Residual Method. Analyses reveal that the Casson parameter declines the fluid velocity, while the existence of the melting parameter has the opposite effect. Also, this article includes some future recommendations. [ABSTRACT FROM AUTHOR]

Objectives: Studies indicate the complex nature of the genetic structure of the European Roma which has been shaped by different effects of their demographic history, while preserving their ancestral Indian origin. The primary aims of this study were to present for the first time the paternal profiles of the Roma from Bosnia and Herzegovina based on the data from Y‐chromosome STR loci, identify the components of non‐Roma paternal gene flow into the Roma, and evaluate the genetic relationships with other European Roma populations. Materials and methods: In this study, 110 DNA samples of unrelated males from Roma populations residing in different regions of Bosnia and Herzegovina were genotyped using the 23 Y‐STR loci included in the PowerPlex Y23 system. Results: The analysis of the genetic structure of the Bosnian‐Herzegovinian Roma revealed intra‐country population substructuring and indicated differing genetic affinities between the Bosnian‐Herzegovinian Roma and other European Roma populations. The paternal genetic structure of the Bosnian‐Herzegovinian Roma has two components: an ancestral component represented by haplogroup H1a1a‐M82, and European component presented by haplogroups I1‐M253, I2a1a2b‐L621, J2a1a‐L26, J2a1a1a2b2a3~Z7671, J2b2a‐M241, G2a2b2a1a1b‐L497, and E1b1b‐M215. Conclusion: Genetic relations between the Bosnian‐Herzegovinian Roma and other European Roma are shaped by different influences on their demographic history. The data suggest that the paternal gene pool of the Roma from Bosnia and Herzegovina might be a consequence of an early separation of the proto‐Roma population and the later gene flow as well as factors of the isolation that accompany the Roma populations in some Bosnian‐Herzegovinian regions. [ABSTRACT FROM AUTHOR]

Aim: The SARS‐CoV‐2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non‐delayed surgery. Methods: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January–April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90–1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69–1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID‐19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long‐term survival attributable to delays is likely to be due to micro‐metastatic disease. [ABSTRACT FROM AUTHOR]

Drawing on feminist/gender theory and the notion that women self‐allocate to occupations with which they identify, this study examines the challenges confronted by women working in male‐dominated occupations in a highly patriarchal setting. The findings reveal that women working in "male‐typed" occupations in Nigeria are "lone wolves" in a marginal revolution. They experience social ostracism, impaired spousal relationships, and a lack of support from friends and family. Furthermore, the entrenchment of patriarchal culture, the requirement of physical strength, and the lack of trust on the part of clients pose significant barriers to their success in male‐dominated professions. These problems further breed and reinforce occupational gender segregation. The prospects of reducing occupational gender segregation and the underrepresentation of women in "male‐typed" occupations appear slim due to cultural beliefs and the patriarchal orientation in the study context. [ABSTRACT FROM AUTHOR]

High‐quality data are needed to guide interventions aimed at improving breast cancer outcomes in sub‐Saharan Africa. We present data from an institutional breast cancer database to create a framework for cancer policy and development in Nigeria. An institutional database was queried for consecutive patients diagnosed with breast cancer between January 2010 and December 2018. Sociodemographic, diagnostic, histopathologic, treatment and outcome variables were analyzed. Of 607 patients, there were 597 females with a mean age of 49.8 ± 12.2 years. Most patients presented with a palpable mass (97%) and advanced disease (80.2% ≥ Stage III). Immunohistochemistry was performed on 21.6% (131/607) of specimens. Forty percent were estrogen receptor positive, 32.8% were positive for HER‐2 and 43.5% were triple negative. Surgery was performed on 49.9% (303/607) of patients, while 72% received chemotherapy and 7.9% had radiotherapy. At a median follow‐up period of 20.5 months, the overall survival was 43.6% (95% CI −37.7 to 49.5). Among patients with resectable disease, 18.8% (57/303) experienced a recurrence. Survival was significantly better for early‐stage disease (I and II) compared to late‐stage disease (III or IV) (78.6% vs 33.3%, P <.001). Receipt of adjuvant radiotherapy after systemic chemotherapy was associated with improved survival in patients with locally advanced disease (68.5%, CI −46.3 to 86 vs 51%, CI 38.6 to 61.9, P <.001). This large cohort highlights the dual burden of advanced disease and inadequate access to comprehensive breast cancer care in Nigeria. There is a significant potential for improving outcomes by promoting early diagnosis and facilitating access to multimodality treatment. What's new? Despite being a leading cause of cancer deaths in Nigeria, data on breast cancer, particularly long‐term outcomes of the disease, remain limited. In the present study, sociodemographic and disease‐related variables were analyzed among breast cancer patients, using data from a prospective institutional database on current breast cancer management in Nigeria. Analyses show that most patients had advanced disease at diagnosis and that stage at presentation significantly impacted survival. The findings highlight the importance of early diagnosis and access to care and provide a reference for current and future breast cancer interventions in Nigeria. [ABSTRACT FROM AUTHOR]

Background: The majority of women in Nigeria present with advanced‐stage breast cancer. To address the role of geospatial access, we constructed a geographic information‐system–based model to evaluate the relationship between modeled travel time, stage at presentation, and overall survival among patients with breast cancer in Nigeria. Methods: Consecutive patients were identified from a single‐institution, prospective breast cancer database (May 2009‐January 2019). Patients were geographically located, and travel time to the hospital was generated using a cost‐distance model that utilized open‐source data. The relationships between travel time, stage at presentation, and overall survival were evaluated with logistic regression and survival analyses. Models were adjusted for age, level of education, and socioeconomic status. Results: From 635 patients, 609 were successfully geographically located. The median age of the cohort was 49 years (interquartile range [IQR], 40‐58 years); 84% presented with ≥stage III disease. Overall, 46.5% underwent surgery; 70.8% received systemic chemotherapy. The median estimated travel time for the cohort was 45 minutes (IQR, 7.9‐79.3 minutes). Patients in the highest travel‐time quintile had a 2.8‐fold increase in the odds of presenting with stage III or IV disease relative to patients in the lowest travel‐time quintile (P =.006). Travel time ≥30 minutes was associated with an increased risk of death (HR, 1.65; P =.004). Conclusions: Geospatial access to a tertiary care facility is independently associated with stage at presentation and overall survival among patients with breast cancer in Nigeria. Addressing disparities in access will be essential to ensure the development of an equitable health policy. Geospatial access to cancer care is associated with cancer stage at presentation and overall survival among patients with breast cancer in Nigeria. As the country's breast cancer control system matures, measuring access will be essential to ensure the development of an equitable health policy. [ABSTRACT FROM AUTHOR]

We examined the geospatial dimension of delays to diagnosis of breast cancer in a prospective study of 1541 women newly diagnosed in the African Breast Cancer—Disparities in Outcomes (ABC‐DO) Study. Women were recruited at cancer treatment facilities in Namibia, Nigeria, Uganda and Zambia. The baseline interview included information used to generate the geospatial features: urban/rural residence, travel mode to treatment facility and straight‐line distances from home to first‐care provider and to diagnostic/treatment facility, categorized into country/ethnicity (population)‐specific quartiles. These factors were investigated in relation to delay in diagnosis (≥3 months since first symptom) and late stage at diagnosis (TNM: III, IV) using logistic regression, adjusted for population group and sociodemographic characteristics. The median (interquartile range) distances to first provider and diagnostic and treatment facilities were 5 (1‐37), 17 (3‐105) and 62 (5‐289) km, respectively. The majority had a delay in diagnosis (74%) and diagnosis at late stage (64%). Distance to first provider was not associated with delay in diagnosis or late stage at diagnosis. Rural residence was associated with delay, but the association did not persist after adjustment for sociodemographic characteristics. Distance to the diagnostic/treatment facility was associated with delay (highest vs lowest quartile: odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.08‐2.27) and late stage (overall: OR = 1.47, CI = 1.05‐2.06; without Nigerian hospitals where mostly local residents were treated: OR = 1.73, CI = 1.18‐2.54). These findings underscore the need for measures addressing the geospatial barriers to early diagnosis in sub‐Saharan African settings, including providing transport or travel allowance and decentralizing diagnostic services. What's new? Survival from breast cancer is poor in sub‐Saharan Africa, due largely to the high proportion of women who are diagnosed at advanced stages. In this study, the authors examined geospatial information to assess women's prediagnostic journey to breast cancer diagnosis, with special attention to delays in diagnosis, in the regions of Namibia, Nigeria, Uganda, and Zambia. Geospatial factors particularly long travel distances to diagnostic and treatment facilities were identified as major barriers to early diagnosis. The findings underscore the need for policies to address these barriers to ensure breast cancer diagnosis at a curable stage. [ABSTRACT FROM AUTHOR]

The presence of preexisting morbidities poses a challenge to cancer patient care. There is little information on the profile and prevalence of multi‐morbidities in breast cancer patients across middle income countries (MIC) to lower income countries (LIC) in sub‐Saharan Africa (SSA). The African Breast Cancer–Disparities in Outcomes (ABC‐DO) breast cancer cohort spans upper MICs South Africa and Namibia, lower MICs Zambia and Nigeria and LIC Uganda. At cancer diagnosis, seven morbidities were assessed: obesity, hypertension, diabetes, asthma/chronic obstructive pulmonary disease, heart disease, tuberculosis and HIV. Logistic regression models were used to assess determinants of morbidities and the influence of morbidities on advanced stage (stage III/IV) breast cancer diagnosis. Among 2189 women, morbidity prevalence was the highest for obesity (35%, country‐specific range 15‐57%), hypertension (32%, 15‐51%) and HIV (16%, 2‐26%) then for diabetes (7%, 4%‐10%), asthma (4%, 2%‐10%), tuberculosis (4%, 0%‐8%) and heart disease (3%, 1%‐7%). Obesity and hypertension were more common in upper MICs and in higher socioeconomic groups. Overall, 27% of women had at least two preexisting morbidities. Older women were more likely to have obesity (odds ratio: 1.09 per 10 years, 95% CI 1.01‐1.18), hypertension (1.98, 1.81‐2.17), diabetes (1.51, 1.32‐1.74) and heart disease (1.69, 1.37‐2.09) and were less likely to be HIV positive (0.64, 0.58‐0.71). Multi‐morbidity was not associated with stage at diagnosis, with the exception of earlier stage in obese and hypertensive women. Breast cancer patients in higher income countries and higher social groups in SSA face the additional burden of preexisting non‐communicable diseases, particularly obesity and hypertension, exacerbated by HIV in Southern/Eastern Africa. What's new? Patients who get cancer on top of other health conditions can be challenging to treat. Here, the authors analyze the prevalence of chronic conditions in women newly diagnosed with breast cancer in sub‐Saharan Africa. They looked at obesity, hypertension, diabetes, asthma/COPD, heart disease, tuberculosis, and HIV. Overall, 27% of the women had 2 pre‐existing conditions. Obesity boosts breast cancer risk, and obesity rates are rising among higher income groups. HIV is a problem in the southern African populations, and while HIV is not thought to contribute to breast cancer, reports suggest that HIV‐positive patients have poorer prognosis. [ABSTRACT FROM AUTHOR]

Most breast cancer patients in sub‐Saharan Africa are diagnosed at advanced stages after prolonged symptomatic periods. In the multicountry African Breast Cancer‐Disparities in Outcomes cohort, we dissected the diagnostic journey to inform downstaging interventions. At hospital presentation for breast cancer, women recalled their diagnostic journey, including dates of first noticing symptoms and health‐care provider (HCP) visits. Negative binomial regression models were used to identify correlates of the length of the diagnostic journey. Among 1429 women, the median (inter‐quartile range) length (months) of the diagnostic journey ranged from 11.3 (5.7‐21.2) in Ugandan, 8.2 (3.4‐16.4) in Zambian, 6.5 (2.4‐15.7) in Namibian‐black to 5.6 (2.3‐13.1) in Nigerian and 2.4 (0.6‐5.5) in Namibian‐non‐black women. Time from first HCP contact to diagnosis represented, on average, 58% to 79% of the diagnostic journey in each setting except Nigeria where most women presented directly to the diagnostic hospital with advanced disease. The median number of HCPs visited was 1 to 4 per woman, but time intervals between visits were long. Women who attributed their initial symptoms to cancer had a 4.1 months (absolute) reduced diagnostic journey than those who did not, while less‐educated (none/primary) women had a 3.6 months longer journey than more educated women. In most settings the long journey to breast cancer diagnosis was not primarily due to late first presentation but to prolonged delays after first presentation to diagnosis. Promotion of breast cancer awareness and implementation of accelerated referral pathways for women with suspicious symptoms are vital to downstaging the disease in the region. What's new? In sub‐Saharan Africa, most women with breast cancer are diagnosed long after symptoms first arise. Here, the authors studied the diagnostic journey for breast cancer among the African Breast Cancer‐Disparities in Outcome cohort. This is the largest study to quantify the length of the diagnostic journey across various settings in sub‐Saharan Africa. Time to final diagnosis decreased substantially when a woman recognized her symptoms as cancer. Most delays, they found, were due to extended time between first examination and final diagnosis. Promotion of breast cancer awareness among both women and healthcare providers could help reduce these delays. [ABSTRACT FROM AUTHOR]

Drawing on social dominance theory as a theoretical lens and based on a qualitative study of female managers and supervisors at different levels of the organization, we investigate the barriers women in Nigeria face in their careers. In their accounts of discrimination, corruption, familial/domestic responsibilities, cultural perceptions of gender, and ingrained religious beliefs, participants draw attention to the intense difficulties they face in their careers. We highlight the significance of context and argue that Nigeria is notable for an extreme attitude of male preference at work involving an intensification of career barriers that reflects the entrenched and systemic nature of male dominance in Nigerian organizations. We capture this in the concept of the "hypermasculine organization," which is characterized by exaggerated male advantage, a tendency towards gender‐based exploitation and abuse together with a justificatory logic based on rigidly enforced gender roles. These debilitating factors affecting women in organizations have potential implications for other countries in the global south. [ABSTRACT FROM AUTHOR]

Aim: Surgical site infection (SSI) is the commonest postoperative complication worldwide, representing a major burden for patients and health systems. Rates of SSI are significantly higher in low‐ and middle‐income countries (LMICs) but there is little high‐quality evidence on interventions to prevent SSI in LMICs. Method: FALCON is a pragmatic, multicentre, 2 x 2 factorial, stratified randomized controlled trial, with an internal feasibility study, which will address the need for evidence on measures to reduce rates of SSI in patients in LMICs undergoing abdominal surgery. To assess whether either (1) 2% alcoholic chlorhexidine versus 10% povidone‐iodine for skin preparation, or (2) triclosan‐coated suture versus non‐coated suture for fascial closure, can reduce surgical site infection at 30‐days post‐surgery for each of (1) clean‐contaminated and (2) contaminated/dirty surgery. Patients with predicted clean‐contaminated or contaminated/dirty wounds with abdominal skin incision ≥ 5 cm will be randomized 1:1:1:1 between (1) 2% alcoholic chlorhexidine and noncoated suture, (2) 2% alcoholic chlorhexidine and triclosan‐coated suture, (3) 10% aqueous povidone–iodine and noncoated suture and (4) 10% aqueous povidone–iodine and triclosan‐coated suture. The two strata (clean‐contaminated versus contaminated/dirty wounds) are separately powered. Overall, FALCON aims to recruit 5480 patients. The primary outcome is SSI at 30 days, based on the Centers for Disease Control definition of SSI. Conclusion: FALCON will deliver high‐quality evidence that is generalizable across a range of LMIC settings. It will influence revisions to international clinical guidelines, ensuring the global dissemination of its findings. [ABSTRACT FROM AUTHOR]

Heat from biomass is being promoted in an effort to reduce greenhouse gas emissions. However, the full life cycle environmental and economic implications of biomass heat are currently unknown and are therefore explored herein. The results indicate that heat from solid biomass can reduce global warming potential as well as depletion of fossil resources and the ozone layer by >90% compared to fossil fuels. However, acidification, eutrophication, and human and eco‐toxicities are much higher than for heat from natural gas. Biomass heat is also 23% more expensive than heat from gas boilers. However, with the subsidies available in the UK, it is 52% cheaper. Using the waste wood and energy crops available in the UK, it can meet 5% of the national heat demand and save 7.3 Mt CO2 eq. year−1 or 1.5% of UK emissions. Increasing cultivation of energy crops can provide 20% of heat demand by 2030 and save 5.1% of national emissions. Therefore, the government should continue to incentivize biomass heat while tightening regulations to prevent an increase in other impacts. However, increasing biomass heat provision will be challenging due to a large number of installations needed (27 000–85 000) and lack of district heating networks in the UK. [ABSTRACT FROM AUTHOR]

Objective: A hallmark of migraine is photophobia. In mice, photophobia‐like behavior is induced by calcitonin gene‐related peptide (CGRP), a neuropeptide known to be a key player in migraine. In this study, we sought to identify sites within the brain from which CGRP could induce photophobia. Design: We focused on the posterior thalamic region, which contains neurons responsive to both light and dural stimulation and has CGRP binding sites. We probed this area with both optogenetic stimulation and acute CGRP injections in wild‐type mice. Since the light/dark assay has historically been used to investigate anxiety‐like responses in animals, we measured anxiety in a light‐independent open field assay and asked if stimulation of a brain region, the periaqueductal gray, that induces anxiety would yield similar results to posterior thalamic stimulation. The hippocampus was used as an anatomical control to ensure that light‐aversive behaviors could not be induced by the stimulation of any brain region. Results: Optogenetic activation of neuronal cell bodies in the posterior thalamic nuclei elicited light aversion in both bright and dim light without an anxiety‐like response in an open field assay. Injection of CGRP into the posterior thalamic region triggered similar light‐aversive behavior without anxiety. In contrast to the posterior thalamic nuclei, optogenetic stimulation of dorsal periaqueductal gray cell bodies caused both light aversion and an anxiety‐like response, while CGRP injection had no effect. In the dorsal hippocampus, neither optical stimulation nor CGRP injection affected light aversion or open field behaviors. Conclusion: Stimulation of posterior thalamic nuclei is able to initiate light‐aversive signals in mice that may be modulated by CGRP to cause photophobia in migraine. [ABSTRACT FROM AUTHOR]

Background: Emergency abdominal operations carry significant risk of mortality and morbidity. The time of the day when such operations are performed has been suggested as a predictor of outcome. A retrospective comparison of outcomes of daytime and night-time emergency abdominal operations was conducted. Methods: Clinical data of patients who had abdominal operations over a five-year period were obtained. Operations were classified as 'daytime' (group A) if performed between 8.00 am and 7.59 pm or 'night time' if performed between 8.00 pm and 7.59 am (group B). Post-operative outcomes were compared. Results: A total of 267 emergency abdominal operations were analysed: 161 (60.3%) were performed in the daytime while 106 (39.7%) were performed at night. The case mix in both groups was similar with appendectomies, bowel resections and closure of bowel perforations accounting for the majority. Baseline characteristics and intra-operative parameters were similar except that 'daytime' operations had more consultant participation (p = 0.01). Mortality rates (13.7% in group A and 12.3% in group B, p = 0.2), re-operation rates (9.3% in group A and 10.4% in group B, p = 0.7) and duration of hospital stay (group A—11.1 days, group B—12.4 days p = 0.4) were similar. ASA status, re-operation and admission into the intensive care unit were identified as predictors of mortality. Conclusion: Timing of emergency abdominal operations did not influence outcomes. In resource-limited settings where access to the operating room is competitive, delaying operations till daytime may be counterproductive. Patients' clinical condition still remains the most important parameter guiding time of operation. [ABSTRACT FROM AUTHOR]

Objectives: Accurate diagnosis of salivary gland neoplasms (SGN) in many centers in Africa is limited by poor diagnostic resources and ancillary services. Hence, we have carried out a multicenter epidemiological study to understand the true burden of SGN in Nigeria. Method: In this descriptive cross‐sectional study, we have deployed resources available to members of the African Oral Pathology Consortium (AOPRC) to examine the burden of salivary gland lesions in Nigeria, using a multicenter approach. Data from seven major tertiary health institutions in northern, western, and southern Nigeria were generated using a standardized data extraction format and analyzed using the Epi‐info software (Version 7.0, Atlanta, USA). Result: Of the 497 cases examined across the seven centers, we observed that SGN occurred more in females than males. Overall, pleomorphic salivary adenoma (PA) was found to be the most common. PA was found to be the commonest benign SGN while adenocystic carcinoma (ADCC) was the commonest malignant SGN. Regional variations were observed for age group, diagnosis, and gender distribution. Significant statistical differences were found between males and females for malignant SGNs (p‐value=0.037). Conclusion: We found regional variation in the pattern of distribution of SGN in Nigeria. This is the largest multicenter study of SGN in Nigeria, and our findings are robust and representative of the epidemiology of this neoplasm in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive surgical techniques (MISTs) could have tremendous benefits in resource-poor environment. There is growing interest in MISTs in most low- and middle-income countries (LMIC), but its adoption has remained limited; this is largely due to high cost of the initial setup, lack of technological backup and limited access to training among others. An affordable laparoscopic setup will go a long way in improving access to MISTs.Methods: A common zero degrees 10 mm scope is attached on the camera of a low-price smartphone. Two elastic bands are used to fix the scope right in front of the smartphone’s main camera; alternatively, a low-cost camera coupler can be used. The device is covered with sterile transparent drapes and a light source connected with a fiber-optic cable for endoscopic use. The image can be seen in real time on a common TV screen through an HDMI connection to the smartphone, with a sterile drape.Results: We were able to perform the five tasks of the Fundamentals of Laparoscopic Surgery curriculum, using our vision system with proficiency. In a pig model, we performed a tubal ligation to simulate an appendectomy and we were able to suture. No major differences were measured between the two connection systems.Conclusions: A low-cost laparoscopic camera system can benefit surgeons and trainees in LMICs. The system is already attractive for use during training, but further studies are needed to evaluate its potential clinical role in LMICs. [ABSTRACT FROM AUTHOR]

Summary: Voltage stability has of recent been a subject of growing concern to power system utilities. In this paper, 2 techniques, one based on topological structure of power networks and the other on the conventional power flow solution, are proposed for voltage stability analysis. The network structural characteristics theory participation factor proposed is formulated to identify the weak bus of the system. The voltage stability enhancement is achieved through the incorporation of power electronic–based thyristor‐controlled series compensator device. This is done by modifying the admittance matrix and network structural characteristics theory participation factor formulated to incorporate the effect of variable reactance of thyristor‐controlled series compensator device. The second suggested approach based on power flow is also investigated. The results of both techniques are compared with the conventional approaches. The results of simulations obtained show that voltage stability enhancement can significantly be achieved from the network structural point of view, as it saves time and reduces system computational burden. [ABSTRACT FROM AUTHOR]

Abstract: Solar power deployment is expanding rapidly alongside improvements in manufacturing processes and solar technology performance. This expansion has coincided with great cost reductions and a shift in manufacturing to China, but the environmental effects of these developments remain unclear. This study uses life cycle assessment (LCA) to estimate the environmental impacts for silicon‐based photovoltaic (PV) systems installed in two locations—the United Kingdom (UK) and Spain—in the years 2005 and 2015 to assess the changes that have occurred in the past decade. Manufacturing is considered in both Europe and China to analyze the effects of the aforementioned market shift. The results show that technological improvements have reduced the environmental impacts by an average of 45 %, ranging from 29 % (eutrophication) to 80 % (ozone layer depletion); the carbon footprint has been approximately cut in half. However, the shift of manufacturing to China has increased environmental impacts by an average of 9–13 % relative to manufacturing in Europe. Acidification is much higher for Chinese‐made systems, negating all of the technological progress that has been made over the past decade. Thus, the future impacts of PV are highly dependent upon environmental improvements in the Chinese energy mix. Learning rates for environmental impacts are estimated at 6–26 %, thereby leading to expected impact reductions of 8–34 % by the year 2025, which would bring the impacts of Chinese‐made PV systems back down to the levels currently achieved by systems made in Europe. [ABSTRACT FROM AUTHOR]

Abstract: Micro‐combined heat and power (micro‐CHP) systems have gained prominence in Europe and elsewhere, often attracting government incentives. Of the various micro‐CHP technologies, Stirling engine (SE) systems are often preferred over internal combustion engines, but their economic and environmental sustainability is unclear. This study uses life cycle assessment and life cycle costing to analyze SE micro‐CHP units, comparing the results to conventional natural gas boilers and grid electricity. Assuming highly‐efficient operation (77 % thermal; 13 % electrical efficiency), the SE system is preferable to conventional electricity and heat both economically and environmentally (for nine of 11 impacts). However, at more realistic efficiencies (71 % thermal; 6 % electrical), the SE system is uncompetitive, being worse for seven environmental impacts, including global warming, and incurring 9 % higher costs, despite subsidy. The choice of electricity, heat or combined output as a functional unit greatly affects the results. At low efficiencies, per unit of electricity, the SE system has on average 44 % worse environmental performance than grid electricity. However, per unit of heat it is, on average, 30 % better environmentally than the gas boiler, but the global warming potential (GWP) is 19 % worse. For combined energy output, the SE system has on average 3 % lower impacts than conventional alternatives, but the GWP is 16 % higher. Future improvements to the environmental impacts of the electricity grid mix, including its decarbonization, would further reduce any relative benefits of the SE system, calling into question the suitability of subsidy. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) survival rates in sub‐Saharan Africa (SSA) are low in part due to advanced stage at diagnosis. As one component of a study of the entire journey of SSA women with BC, we aimed to identify shared and setting‐specific drivers of advanced stage BC. Women newly diagnosed in the multicountry African Breast Cancer–Disparities in Outcomes (ABC‐DO) study completed a baseline interview and their stage information was extracted from medical records. Ordinal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for advanced stage (I, II, III, IV) in relation to individual woman‐level, referral and biological factors. A total of 1795 women were included from Nigeria, Uganda, Zambia, and the multiracial populations of Namibia and South Africa, 1091 of whom (61%) were stage III/IV. Stage was lower in women with greater BC knowledge (OR 0.77 (95% CI: 0.70, 0.85) per point on a 6 point scale). More advanced stage was associated with being black (4.00 (2.79, 5.74)), having attended

Abstract: The phytochemical composition and antioxidant activity of Argel leaf powder (ALP) and its effect on the quality attributes of camel patties were investigated. ALP contains substantial amounts of total phenolics (1,262.50 mg GAE/100 g), and anthocyanin (60.11 µmol/g) and possesses high 2,2‐diphenyl‐1‐picrylhydrazyl (DPPH) scavenging activity (86.85%). The major phenolic compounds in ALP were isorhamnetin, (+)‐catechin, catechol, gallic acid, and protocatechuic acid. Increasing the concentration of ALP in camel patties improved (p ≤ .05) the protein and fat contents, cooking yield, moisture and fat retention, total phenolic content, DPPH, redness (a), yellowness (b), pH, and microbiological stability, while the dimensional shrinkage, TBARS, and lightness (L) were reduced. Throughout the storage period, the ALP formulated camel patties revealed better stability of the physicochemical, oxidation, microbiological, and sensory attributes compared to nonformulated patties. Generally, the findings of this study proved the antioxidant and antimicrobial potentials of 4–6% ALP as a functional additive to preserve patties. Practical applications: Natural herbs play an important role in preserving sensitive foods. Camel meat is highly subjected to microbial and chemical spoilage as they are rich in essential nutrients. The adverse effects of different chemical preservatives attract the consumer's attention to natural alternatives. Therefore, in order to increase the shelf life and quality characteristics of camel meat, new processing technologies and new ingredient systems that are associated with natural herbs are applied. These results showed that the potentiality of Argel powder in the development of novel healthy meat products with improved shelf life and superior product quality was high. [ABSTRACT FROM AUTHOR]

This paper presents an alternative approach of Inherent Structural Characteristics Theory (ISCT), for solving loss allocation to network participants as well as generation-to-load matching problems in a deregulated environment. The mathematical formulations of ISCT, based on the fundamental circuit theory laws, are revisited. A Generation-to-Load Allocation Coefficient (GLAC) matrix for solving generation-to-load allocation and network loss allocation to load problems, for efficient transmission pricing, is formulated. The allocation of real and reactive power contributions, by individual generator, required to serve the network demands is also determined on the basis of the GLAC matrix. Total network losses are determined and allocated to individual network loads based on GLAC matrix. The approach is demonstrated using the standard IEEE 30 bus network. The results obtained are compared with that obtained using graph theory approach based on the solved power flow. The comparison of the results shows that the ISCT approach is reasonable and it is a good signal, which could be useful for pricing of electricity by the market regulators. [ABSTRACT FROM AUTHOR]

Background and Purpose: CGRP is a potent vasodilator and nociceptive neuropeptide linked to migraine. CGRP receptors are heterodimers of receptor activity modifying protein 1 (RAMP1) and either calcitonin receptor-like receptor (CLR; forms canonical CGRP receptor) or calcitonin receptor (CT receptor; forms AMY1 receptor). The goal of this study was to test whether transgenic mice globally expressing human RAMP1 have increased CGRP receptor activity and whether the receptors are sensitive to human selective antagonist telcagepant.Experimental Approach: cAMP production was measured in primary cultures of aortic smooth muscle and trigeminal ganglia neurons from global hRAMP1 mice and non-transgenic littermates. Functional activity and inhibition were compared with clonal cell lines expressing combinations of CLR or CT receptors with RAMP1.Key Results: Cultured smooth muscle from global hRAMP1 mice had a 10-fold greater CGRP-induced cAMP maximal response (Rmax) than non-transgenic littermates, with similar EC50 s. In contrast, cultured trigeminal ganglia from global hRAMP1 mice had a 40-fold leftward shift of the EC50 , with similar Rmax values as littermates. In both hRAMP1 cultures, telcagepant blocked CGRP-induced cAMP production, but was not effective in non-transgenic cultures. IC50 values were closer to those observed for CT receptor/hRAMP1 than CLR/hRAMP1 in clonal cell lines.Conclusions and Implications: Overexpression of hRAMP1 increases CGRP signalling by changing the maximal response or ligand sensitivity, depending on tissue type. Furthermore, telcagepant inhibited transgenic hRAMP1 CGRP receptors, but the degree of inhibition suggests that the transgenic mice are only partially humanized or both canonical CGRP and AMY1 receptors are functional in trigeminal ganglia neurons and vascular smooth muscle. [ABSTRACT FROM AUTHOR]

The circular economy (CE) is essential for decoupling economic growth from resource consumption and environmental impacts. However, effective implementation requires a systemic change across supply chains, involving both technological and nontechnological innovations. Frameworks are beginning to emerge to foster CE thinking in organizations. However, literature review carried out as part of this research has revealed gaps in their ability to fulfil CE requirements. Furthermore, few frameworks provide support on how CE requirements may be implemented. To address these issues, this article presents a new framework, BECE (backcasting and eco-design for the circular economy), to ensure that businesses can implement CE requirements more readily. BECE empowers organizations to tackle the CE holistically by embedding the concept into corporate decision making and by bringing operational and systems thinking together, thus increasing the likelihood of successful implementation. The potential of the BECE framework was tested through a pilot workshop focusing on the development of a CE business model through redesign of products and supply chains. Using vacuum cleaners as an illustrative case study, several product design and supply-chain alternatives were identified, including the development of scenarios and action plans for their implementation at the business level. Although the case study focuses on a particular product, the BECE framework is generic and applicable across different products and business sectors. [ABSTRACT FROM AUTHOR]

Nuclear power capacity is growing rapidly in China and is expected to reach 58 GW by 2020. However, it is not clear at present if the country can meet this increasing demand for uranium. We present a comprehensive uranium flow analysis in China that covers a ten-year period from 2003 to 2012 with the aim of identifying near-future fuel demand to 2020. The findings suggest that from 2003 to 2012, 19 126 t of natural uranium were consumed, which generated 3811 t of spent fuel. Of this, only 33-58 % of natural uranium was sourced domestically, the rest of which was imported. By 2020, the uranium consumption is estimated to reach 14 426 t yr−1, around three quarters of the amount consumed over the whole ten-year period considered here. Based on the current increase in demand, the domestic natural uranium could run out by 2027 if the country relies solely on its own uranium deposits known currently. Our findings also show that China would need to expand its spent-fuel reprocessing program, expected to start in 2025, by 3-4 times as the planned capacity is insufficient given the current growth of nuclear power. [ABSTRACT FROM AUTHOR]

Electrical power grids are often susceptible to voltage instability and have been a growing concern. In this study, the authors propose techniques based on network response structural characteristics for voltage stability assessment and for the identification of important nodes in electrical power grids. First, the network response structural characteristic indices (NRSCIs) which are inherent in the conventional power grids in terms of the Kirchhoff matrix is formulated. The eigenvalue decomposition (ED) technique is then applied to a submatrix of the Kirchhoff matrix to determine the topological strength of the electrical network graph. The vertex (node) that has a minimum eigenvalue is taken as the critical mode, from which its contributions to the entire graph is identified using the proposed network response structural characteristics theory participation factor (NRSCTPF). To demonstrate the magnitude of the concept formulated, the known degree centrality is modified in terms of the established NRSCI, which are then used to determine the important nodes of the network graph. The results obtained show that the proposed NRSCTPF and the degree centrality based on the NRSCI can be used for voltage stability assessment and identification of important nodes. The proposed approach is also less computationally intensive compared with the traditional approach. [ABSTRACT FROM AUTHOR]

The growth of the shale gas industry in the US has raised expectations that other nations could boost domestic gas production, leading to lower energy prices and improved energy security. However, the degree to which the US experience is transferable to other countries is uncertain. Furthermore, sustainability implications of shale gas development remain largely unknown. In an attempt to find out if and how shale gas could be exploited in a sustainable way, this paper reviews the economic, environmental, and social aspects of shale gas. These include costs, energy security, employment, water and land pollution, greenhouse gas emissions, earthquakes, and public perception. The literature suggests that it is possible to develop shale gas in a sustainable way, but its future will depend on the industry being able to address the environmental concerns, the political will to see the industry through to maturity, and public support, with the latter most likely being the biggest determinant. [ABSTRACT FROM AUTHOR]

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Background The rate of intravenous drug use (IVDU) has been increasing nationally; however, cutaneous manifestations of IVDU have infrequently been investigated. We report a series of the clinicopathological correlation of IVDU in the skin. Methods A search of surgical pathology files between the years 2000 and 2014 was performed for cutaneous specimens from patients with a reported history of IVDU for which the histopathological findings could not be attributed to another etiology. Ten cases for which slides were available were included in the study. Results Patients had an average age of 39.7 years and had active or recent history of IVDU. Clinical impressions included ulcer, granulomatous dermatitis, vasculitis, pyoderma gangrenosum and hyperpigmentation at injection sites. Histopathology revealed leukocytoclastic vasculitis (n=2), dermal pigment deposition (n=3), non-specific ulceration/scarring (n=4) and necrobiosis lipoidica-like dermatitis (n=1). No infectious etiology or polarizable foreign material was identified in any case. Conclusions Cutaneous manifestations of IVDU should be considered in the differential as an etiology for dermatopathologic findings in high-risk patients. We report histopathological findings beyond the scope of those most commonly associated with IVDU. We aim to raise awareness of the cutaneous manifestations of IVDU to improve clinicopathological correlation and patient management in light of the ongoing epidemic. [ABSTRACT FROM AUTHOR]

There is a growing interest in producing biofuels and bio-chemicals from lignocellulosic feedstocks in integrated biorefineries. However, the sustainability implications of integrated biorefineries are still poorly understood. Using a life cycle approach, this paper examines environmental impacts of second-generation ethanol produced in thermo-chemical refineries together with chemicals and energy. Four feedstocks are considered: wheat straw, poplar, Miscanthus and forest residue. The results suggest that the production of ethanol from these feedstocks offers significant savings in eight out of 12 environmental impacts when the system is credited for the avoided impacts from producing the co-products from fossil resources. Ethanol from forest residue is the best and wheat straw the worst option for most impacts. Land use change has a significant effect on the global warming potential (GWP) of ethanol. For example, conversion of forest to grow Miscanthus increases the GWP from -234 to 6685 g CO2 eq./l of ethanol. The effect is opposite when grassland is converted to grow poplar: the GWP is reduced by two times because of carbon sequestration by poplar. The thermo-chemical route for producing ethanol from poplar and forest residue is more sustainable for most impacts than the bio-chemical conversion with the same feedstocks. Although ethanol saves up to 83% of GHG emissions per MJ of fuel compared to petrol, the savings are much smaller (~3%) for current ethanol blends of 5%. Therefore, unless a much higher proportion of ethanol was used, the contribution of second-generation ethanol to climate change mitigation would be small. [ABSTRACT FROM AUTHOR]