Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic.

INTRODUCTION AND OBJECTIVES: The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population. METHODS: A prospective single-centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multidisciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020-15th May 2020) compared to pre-COVID-19 (18th of January 2020-17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed. RESULTS: Overall, there was a reduction in neurosurgical emergency referrals by 33.6% and operations by 55.6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75.2% of total, n=155) when compared to pre-COVID-19 (n = 198, 43.7% of total, p < 0.00001). In contrast to other published series, the 30-day perioperative mortality remained low (2.0%) with the majority of post-operative COVID-19-infected patients (n = 13) having underlying medical co-morbidities and/or suffering from post-operative complications. CONCLUSION: The capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology to run clinics and MDTs, restructuring patient pathways/facilities, and initiating the delivery of NHS care within private sector hospitals. Through this multi-modal approach we were able to minimize service disruptions, the complications, and mortality.

The presence of radioactive heavy minerals in prospecting trenches and concomitant occupational exposure.

Uranium, perhaps the most strategically important component of heavy minerals, finds particular significance in the nuclear industry. In prospecting trenches, the radioactivity of 238U and 232Th provides a good signature of the presence of heavy minerals. In the work herein, the activity concentrations of several key primordial radionuclides (238U, 232Th, and 40K) were measured in prospecting trenches (each of the latter being of approximately the same geometry and physical situation). All of these are located in the Seila area of the South Eastern desert of Egypt. A recently introduced industry standard, the portable hand-held RS-230 BGO gamma-ray spectrometer (1024 channels) was employed in the study. Based on the measured data, the trenches were classified as either non-regulated (U activity less than 1000 Bq kg-1) or regulated (with 238U activity more than 1000 Bq kg-1). Several radiological hazard parameters were calculated, statistical analysis also being performed to examine correlations between the origins of the radionuclides and their influence on the calculated values. While the radioactivity and hazard parameters exceed United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) guided limits, the mean annual effective doses of 0.49 and 1.4 mSv y-1 in non-regulated and regulated trenches respectively remain well below the International Commission on Radiological Protection (ICRP) recommended 20 mSv/y maximum occupational limit. This investigation reveals that the studied area contains high uranium content, suitable for extraction of U-minerals for use in the nuclear fuel cycle.

Influence of Nitrogen to Phosphorus Ratio and CO2 Concentration on Lipids Accumulation of Scenedesmus dimorphus for Bioenergy Production and CO2 Biofixation.

The potential of Scenedesmus dimorphus microalgae for CO2 biofixation and lipid biosynthesis for bioenergy applications was evaluated in this study. Batch experiments were conducted using synthetic tertiary municipal wastewater samples at several nitrogen to phosphorus (NP) ratios (1 : 1 to 8 : 1) and CO2 concentrations (∼0%, 2%, 4%, and 6% CO2 in supplied air). Scenedesmus dimorphus was cultivated for 25 days and the growth is highly dependent on the CO2 concentration and the NP ratio. An NP ratio of 2 : 1 produces a biomass yield of 733 mg/L when the microalga culture was supplied with air enriched with 2% CO2 . The maximum CO2 biofixation rate of 49.6 mg L-1 d-1 is at an NP ratio of 8 : 1 with 4% CO2 . A colorimetric technique depending on sulpho-phospho-vanillin (SPV) was utilized for the determination of the intracellular lipid content. The highest lipid content of 31.6% as the dry weight of the biomass is at an NP ratio of 1 : 1 and 6% CO2 . These results indicate that supplementation of suitable CO2 with favorable NP ratio has a considerable effect on lipid accumulation in the microalgae Scenedesmus dimorphus biomass.

Prevalence of infections, HIV risk behaviors and factors associated with HIV infection among male injecting drug users attending a needle/syringe exchange program in Dhaka, Bangladesh.

Injecting drug users (IDU) in Bangladesh are at the early stages of an HIV epidemic. To understand the dynamics of the HIV epidemic, male IDU (n = 561) were recruited from the needle/syringe exchange program in Dhaka in 2002, who underwent a risk-behavior survey and were tested for HIV, syphilis, hepatitis C, and hepatitis B. Correlates of HIV infection were determined by conducting bivariate and multiple regression analyses. The median age of the IDU was 35 years, 39.6% had no formal education, approximately half were married and/or living with their regular sex partner and 26% were currently homeless. The median age at first injection was 29 years. HIV was detected in 5.9% of the IDU and homelessness was the only factor independently associated with HIV (OR = 5.5). Urgent measures must be undertaken to prevent escalation of the HIV epidemic. The study's limitations are noted.

Modernising medical careers and the British surgeons of the future.

The Modernising Medical Careers reforms in medical training have led to significant changes in the way junior doctors are trained. However, not all these changes have been welcomed by both trainees and trainers. This article seeks to examine some of the issues regarding training in surgery.