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  1. Implementation of the semi-aerobic landfill system (Fukuoka method) in developing countries: a Malaysia cost analysis
    Chong TL, Matsufuji Y, Hassan MN
    Waste Manag, 2005;25(7):702-11.
    PMID: 16009304
    Most of the existing solid waste landfill sites in developing countries are practicing either open dumping or controlled dumping. Proper sanitary landfill concepts are not fully implemented due to technological and financial constraints. Implementation of a fully engineered sanitary landfill is necessary and a more economically feasible landfill design is crucial, particularly for developing countries. This study was carried out by focusing on the economics from the development of a new landfill site within a natural clay area with no cost of synthetic liner up to 10 years after its closure by using the Fukuoka method semi-aerobic landfill system. The findings of the study show that for the development of a 15-ha landfill site in Malaysia with an estimated volume of 2,000,000 m(3), the capital investment required was about US 1,312,895 dollars, or about US 0.84 dollars/tonne of waste. Assuming that the lifespan of the landfill is 20 years, the total cost of operation was about US 11,132,536 dollars or US 7.15 dollars/tonne of waste. The closure cost of the landfill was estimated to be US 1,385,526 dollars or US 0.89 dollars/tonne of waste. Therefore, the total cost required to dispose of a tonne of waste at the semi-aerobic landfill was estimated to be US 8.89 dollars. By considering an average tipping fee of about US 7.89 dollars/tonne of waste in Malaysia in the first year, and an annual increase of 3% to about US 13.84 dollars in year-20, the overall system recorded a positive revenue of US 1,734,749 dollars. This is important information for the effort of privatisation of landfill sites in Malaysia, as well as in other developing countries, in order to secure efficient and effective landfill development and management.
  2. Acute type A aortic dissection in-hours versus out-of-hours: A systematic review and meta-analysis
    Toh S, Yew DCM, Choong JJ, Chong TL, Harky A
    J Card Surg, 2020 Dec;35(12):3432-3439.
    PMID: 33001480 DOI: 10.1111/jocs.15070
    OBJECTIVE: We sought to compare clinical outcomes in patients with acute type A aortic dissection that undergone surgical repair during in-hours (IH) versus out-of-hours (OOH).

    METHODS: An electronic literature search was done till March 2020 to include studies with comparative cohorts of IH versus OOH. Primary outcomes were 30-day mortality, stroke, and reoperation for bleeding; secondary outcomes were acute kidney injury, total hospital stay, and intensive care unit stay.

    RESULTS: Six articles with a total of 3744 patients met the inclusion criteria. Mean age was similar, 60 ± 12 versus 60 ± 13 in IH versus OOH (p = .25). Aortic root and total arch replacement were similar in both cohorts, 22% in IH versus 25% in OOH (risk ratio [RR], 1.10; 95% confidence interval [CI: 0.78, 1.55]; p = .58) and 29% in IH versus 32% in OOH (RR, 0.96; 95% CI [0.89, 1.04], p = .37) respectively. Reoperation for bleeding and stroke rate were similar, with 18% in IH versus 23% in OOH (RR, 0.89; 95% CI [0.73, 1.08]; p = .24), and 12% in IH versus 13% in OOH (RR, 0.83; 95% CI [0.66, 1.03]; p = .09) respectively. Thirty-day mortality was significantly lower in IH (RR, 0.81; 95% CI [0.72, 0.90]; p = .0001).

    CONCLUSION: There was higher 30-day mortality rate during OOH surgery, yet this difference diminished following sensitivity analysis. There were no significant differences in major postoperative outcomes. Therefore, operating on such cases should be decided on clinical priority without delay.

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