Objective: Postoperative memory decline is an important consequence of anterior temporal lobe resection (ATLR) for temporal lobe epilepsy (TLE), and the extent of resection may be a modifiable factor. This study aimed to define optimal resection margins for cognitive outcome while maintaining a high rate of postoperative seizure freedom. Methods: This cohort study evaluated the resection extent on postoperative structural MRI using automated voxelbased methods and manual measurements in 142 consecutive patients with unilateral drug refractory TLE (74 left, 68 right TLE) who underwent standard ATLR. Results: Voxel-wise analyses revealed that postsurgical verbal memory decline correlated with resections of the posterior hippocampus and inferior temporal gyrus, whereas larger resections of the fusiform gyrus were associated with worsening of visual memory in left TLE. Limiting the posterior extent of left hippocampal resection to 55% reduced the odds of significant postoperative verbal memory decline by a factor of 8.1 (95% CI 1.5-44.4, p = 0.02). Seizure freedom was not related to posterior resection extent, but to the piriform cortex removal after left ATLR. In right TLE, variability of the posterior extent of resection was not associated with verbal and visual memory decline or seizures after surgery. Interpretation: The extent of surgical resection is an independent and modifiable risk factor for cognitive decline and seizures after left ATLR. Adapting the posterior extent of left ATLR might optimize postoperative outcome, with reduced risk of memory impairment while maintaining comparable seizure-freedom rates. The current, more lenient, approach might be appropriate for right ATLR.
Purpose The purpose of this paper is to investigate critical barriers hindering the adoption of green supply chain management (GSCM) and the opportunities that can be exploited with such an implementation in the construction industry of developing countries. It also devises strategies to avoid critical barriers in implementation and exploit opportunities for a better overall environmental performance of the construction industry. Design/methodology/approach This research relies upon an extensive literature review; data are collected from 163 professionals and 15 interviews of field professionals from 11 developing countries are conducted. The barriers and opportunities are synthesized through literature review and then data are collected over their significance from the construction professionals through an online survey. To highlight the interconnectedness of the critical barriers and opportunities, a causal loop framework is developed. Furthermore, expert opinion is sought to develop the strategies. Findings This research integrates information from different sources and provides a holistic view of the current situation of GSCM in developing countries. In total, 34 barriers and 23 opportunities are extracted from literature. The top 4 barriers fall under the “involvement and support” category, whereas the top four opportunities fall under the “environmental” category. Furthermore, the strategies to implement GSCM include suitable policies by top management to incorporate practices such as innovative green design, green procurement, green packaging, green distribution and even end-of-life management, which play a vital role in emission reduction. Originality/value This research is a first attempt at evaluating the barriers and opportunities facing GSCM in the construction sector of the developing countries. The findings encourage the stakeholders in adopting GSCM practices by presenting a clear picture of the potential benefits that can be exploited by implementing the proposed strategies to eliminate critical barriers in the construction industry.
Background. Acute kidney injury (AKI) is a common but least studied complication of lymphoma. Objective. To determine the frequency and predictors of AKI in lymphoma and to study the impact of AKI on hospital stay and mortality. Methods. Retrospective review of medical records of hospitalized lymphoma patients aged ≥14 years between January 2008 and December 2011 was done. Results. Out of 365 patients, AKI was present in 31.8% (116/365). Multivariate logistic regression analysis showed that independent predictors for AKI included sepsis (odds ratio (OR) 3.76; 95% CI 1.83–7.72), aminoglycosides (OR 4.75; 95% CI 1.15–19.52), diuretics (OR 2.96; 95% CI 1.31–6.69), tumor lysis syndrome (OR 3.85; 95% CI 1.54–9.59), and R-CVP regimen (OR 4.70; 95% CI 1.20–18.36). AKI stages 2 and 3 was associated with increased hospital stay (OR 2.01; 95% CI 1.19–3.40). Conclusion. AKI was significantly associated with sepsis, aminoglycoside, diuretics, presence of tumor lysis syndrome, and use of R-CVP regimen. Presence of AKIN (Acute Kidney Injury Network) stages 2 and 3 AKI had increased hospital stay. AKI was also associated with increased mortality.
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