Search results for: fuel rate

Authors: Dharminder Singh, Sanjeev Yadav, Pravakar Mohanty

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In this work, study of temperature profile in a pilot scale air bubbling fluidized bed (ABFB) gasifier for rice husk gasification was carried out. Effects of different factors such as multiple cyclones, gas cooling system, ventilate gas pipe length, and catalyst on temperature profile was examined. ABFB gasifier used in this study had two sections, one is bed section and the other is freeboard section. River sand was used as bed material with air as gasification agent, and conventional charcoal as start-up heating medium in this gasifier. Temperature of different point in both sections of ABFB gasifier was recorded at different ER value and ER value was changed by changing the feed rate of biomass (rice husk) and by keeping the air flow rate constant for long durational of gasifier operation. ABFB with double cyclone with gas coolant system and with short length ventilate gas pipe was found out to be optimal gasifier design to give temperature profile required for high gasification performance in long duration operation. This optimal design was tested with different ER values and it was found that ER of 0.33 was most favourable for long duration operation (8 hr continuous operation), giving highest carbon conversion efficiency. At optimal ER of 0.33, bed temperature was found to be stable at 700 °C, above bed temperature was found to be at 628.63 °C, bottom of freeboard temperature was found to be at 600 °C, top of freeboard temperature was found to be at 517.5 °C, gas temperature was found to be at 195 °C, and flame temperature was found to be 676 °C. Temperature at all the points showed fluctuations of 10 – 20 °C. Effect of catalyst i.e. dolomite (20% with sand bed) was also examined on temperature profile, and it was found that at optimal ER of 0.33, the bed temperature got increased to 795 °C, above bed temperature got decreased to 523 °C, bottom of freeboard temperature got decreased to 548 °C, top of freeboard got decreased to 475 °C, gas temperature got decreased to 220 °C, and flame temperature got increased to 703 °C. Increase in bed temperature leads to higher flame temperature due to presence of more hydrocarbons generated from more tar cracking at higher temperature. It was also found that the use of dolomite with sand bed eliminated the agglomeration in the reactor at such high bed temperature (795 °C).

Keywords: air bubbling fluidized bed gasifier, bed temperature, charcoal heating, dolomite, flame temperature, rice husk

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Authors: Sita Lakshmi Thyagarajan

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Nanofibers will leave no field untouched by its scientific innovations; the medical field is no exception. Electrospinning has proven to be an excellent method for the synthesis of nanofibers which, have attracted the interest for many biomedical applications. The formation of biofilms in wounds often leads to chronic infections that are difficult to treat with antibiotics. In order to minimize the biofilms and enhance the wound healing, preparation of potential nanofibers was focused. In this study, siderophore incorporated nanofibers were electrospun using biocompatible polymers onto the collagen scaffold and were fabricated into a biomaterial suitable for the inhibition of biofilm formation. The purified microbial siderophore was blended with Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO in a suitable solvent. Fabrication of siderophore blended nanofibers onto the collagen surface was done using standard protocols. The fabricated scaffold was subjected to physical-chemical characterization. The results indicated that the fabrication processing parameters of nanofiberous scaffold was found to possess the characteristics expected of the potential scaffold with nanoscale morphology and microscale arrangement. The influence of Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO solution concentration, applied voltage, tip-to-collector distance, feeding rate, and collector speed were studied. The optimal parameters such as the ratio of Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO concentration, applied voltage, tip-to-collector distance, feeding rate, collector speed were finalized based on the trial and error experiments. The fibers were found to have a uniform diameter with an aligned morphology. The overall study suggests that the prepared siderophore entrapped nanofibers could be used as a potent tool for wound dressing material for inhibition of biofilm formation.

Keywords: biofilms, electrospinning, nano-fibers, siderophore, tissue engineering scaffold

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Authors: Elnaz Abbasian, Mohsen Faizi

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In its thousand-year development, architecture has gained valuable patterns. Iran’s desert regions possess developed patterns of traditional architecture and outstanding skeletal features. Unfortunately increasing population and urbanization growth in the past decade as well as the lack of harmony with environment’s texture has destroyed such permanent concepts in the building’s skeleton, causing a lot of energy waste in the modern architecture. The important question is how cooling patterns of Iran’s traditional architecture can be used in a new way in the modern architecture of residential buildings? This research is library-based and documental that looks at sustainable development, analyzes the features of Iranian architecture in hot and dry climate in terms of sustainability as well as historical patterns, and makes a model for real environment. By methodological analysis of past, it intends to suggest a new pattern for residential buildings’ cooling in Iran’s hot and dry climate which is in full accordance to the ecology of the design and at the same time possesses the architectural indices of the past. In the process of cities’ physical development, ecological measures, in proportion to desert’s natural background and climate conditions, has kept the natural fences, preventing buildings from facing climate adversities. Designing and construction of buildings with this viewpoint can reduce the energy needed for maintaining and regulating environmental conditions and with the use of appropriate building technology help minimizing the consumption of fossil fuels while having permanent patterns of desert buildings’ architecture.

Keywords: sustainability concepts, sustainable development, energy climate architecture, fossil fuel, hot and dry climate, patterns of traditional sustainability for residential buildings, modern pattern of cooling

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Authors: Diana C. El Assal, Fatima Monteiro, Caroline May, Peter Barbuti, Silvia Bolognin, Averina Nicolae, Hulda Haraldsdottir, Lemmer R. P. El Assal, Swagatika Sahoo, Longfei Mao, Jens Schwamborn, Rejko Kruger, Ines Thiele, Kathrin Marcus, Ronan M. T. Fleming

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Degeneration of substantia nigra pars compacta dopaminergic neurons is one of the hallmarks of Parkinson's disease. These neurons have a highly complex axonal arborisation and a high energy demand, so any reduction in ATP synthesis could lead to an imbalance between supply and demand, thereby impeding normal neuronal bioenergetic requirements. Synaptic mitochondria exhibit increased vulnerability to dysfunction in Parkinson's disease. After biogenesis in and transport from the cell body, synaptic mitochondria become highly dependent upon oxidative phosphorylation. We applied a systems biochemistry approach to identify the metabolic pathways used by neuronal mitochondria for energy generation. The mitochondrial component of an existing manual reconstruction of human metabolism was extended with manual curation of the biochemical literature and specialised using omics data from Parkinson's disease patients and controls, to generate reconstructions of synaptic and somal mitochondrial metabolism. These reconstructions were converted into stoichiometrically- and fluxconsistent constraint-based computational models. These models predict that Parkinson's disease is accompanied by an increase in the rate of glycolysis and a decrease in the rate of oxidative phosphorylation within synaptic mitochondria. This is consistent with independent experimental reports of a compensatory switching of bioenergetic pathways in the putamen of post-mortem Parkinson's disease patients. Ongoing work, in the context of the SysMedPD project is aimed at computational prediction of mitochondrial drug targets to slow the progression of neurodegeneration in the subset of Parkinson's disease patients with overt mitochondrial dysfunction.

Keywords: bioenergetics, mitochondria, Parkinson's disease, systems biochemistry

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Authors: Theodore Panton

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As cities in the United States experience critical housing shortages, mass timber presents the opportunity to address this crisis in housing supply while taking advantage of the carbon-positive benefits of sustainably forested wood fiber. Mass timber, however, currently has a low level of adoption in residential multifamily structures due to the risk-averse nature of change within the construction financing, Architecture / Engineering / Contracting (AEC) communities, as well as various agency approval challenges. This study demonstrates how mass timber can be used within the cost and feasibility parameters of a typical multistory residential structure and ultimately address the need for dense urban housing. This study will utilize The Garden District, a mixed-use market-rate housing project in Woodinville, Washington, as a case study to illuminate the potential of mass timber in this application. The Garden District is currently in final stages of permit approval and will commence construction in 2023. It will be the tallest dowel-laminated timber (DLT) residential structure in the United States when completed. This case study includes economic, technical, and design reference points to demonstrate the relevance of the use of this system and its ability to deliver “triple bottom line” results. In terms of results, the study establishes scalable and repeatable approaches to project design and delivery of mass timber in multifamily residential uses and includes economic data, technical solutions, and a summary of end-user advantages. This study discusses the third party tested systems for satisfying acoustical requirements within dwelling units, a key to resolving the use of mass timber within multistory residential use. Lastly, the study will also compare the mass timber solution with a comparable cold formed steel (CFS) system with a similar program, which indicates a net carbon savings of over three million tons over the life cycle of the building.

Keywords: DLT, dowell laminated timber, mass timber, market rate multifamily

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Authors: Youssef Mazloum, Haytham Sayah, Maroun Nemer

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The penetration of renewable energy sources into the electric grid is significantly increasing. However, the intermittence of these sources breaks the balance between supply and demand for electricity. Hence, the importance of the energy storage technologies, they permit restoring the balance and reducing the drawbacks of intermittence of the renewable energies. This paper discusses the modeling and the cost-effectiveness of an isobaric adiabatic compressed air energy storage (IA-CAES) system. The proposed system is a combination among a compressed air energy storage (CAES) system with pumped hydro storage system and thermal energy storage system. The aim of this combination is to overcome the disadvantages of the conventional CAES system such as the losses due to the storage pressure variation, the loss of the compression heat and the use of fossil fuel sources. A steady state model is developed to perform an energy and exergy analyses of the IA-CAES system and calculate the distribution of the exergy losses in the latter system. A sensitivity analysis is also carried out to estimate the effects of some key parameters on the system’s efficiency, such as the pinch of the heat exchangers, the isentropic efficiency of the rotating machinery and the pressure losses. The conducted sensitivity analysis is a local analysis since the sensibility of each parameter changes with the variation of the other parameters. Therefore, an exergoeconomic study is achieved as well as a cost optimization in order to reduce the electricity cost produced during the production phase. The optimizer used is OmOptim which is a genetic algorithms based optimizer.

Keywords: cost-effectiveness, Exergoeconomic analysis, isobaric adiabatic compressed air energy storage (IA-CAES) system, thermodynamic modeling

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Authors: Inayat Shah, Muhammad Omar Malik, Ghareeb Alshuwaier, Ronald H. Baxendale

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Background: The balance between angiogenesis and angiostasis is important in growth and developmental processes in the body. Angiogenic and angiostatic mediators control this balance. Endostatin is one of the prominent angiostatic mediators. The marked angiostatic effect of endostatin includes inhibiting endothelial cell migration, proliferation and apoptosis. Physical activity decreases the risk and development of many angiogenesis related health problems including atherosclerosis and numerous cancers. Physiological influences of different physical activities on plasma endostatin concentration are controversial and not completely clear. Moreover, correlation of physical characteristics and metabolic predictors during physical activity on circulating endostatin is indistinct and poorly speculated. The study aimed to determine the effects of mild, moderate and vigorous exercise on the concentration of endostatin in plasma. Methodology: 22 participants, 16 males (age = 30.6 ± 7.8 years) and 6 females (age = 26.5 ± 5 years) were recruited. Weekly session of different intensities exercise based on the predicted maximum heart of the participants [60%(low), 70% (moderate) and 80% (vigorous)] were carried out. The duration and work rate for each participant was determined through sub-maximal exercise. Standardization of the session was done on total energy expenditure of the participants per session. One pre exercise and two post exercise samples were taken at intervals of 10 and 60 minutes. Results: Pre-exercise mean endostatin was 101 ± 20 ng/dl. Low intensity exercise insignificantly decreased the endostatin concentration in plasma at 10 and 60 minutes 97 ± 20 ng/dl (p= 0.5), 98 ± 23 ng/dl (p= 0.8)). However, moderate (p= 0.022, 0.004) and vigorous intensities (p ≤ 0.001, 0.02) increased the endostatin concentrations significantly at both 10 and 60 minutes intervals respectively. The effects were not significantly influenced by gender, exercise mode (walking vs. running), components of exercise (HR, Speed, Gradients, distance, duration) or metabolism during exercise (VO₂ max, VCO₂, RER, energy expenditure, rate of carbohydrate or fats oxidation). Conclusion: Low intensity exercises did not influence endostatin concentration. However, moderate to high intensity exercises significantly increase endostatin concentration and may have potential benefits.

Keywords: angiogenesis, exercise, endostatin, physical activity

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Authors: María José Carrero, Ana M. Borreguero, Juan F. Rodríguez, María M. Velencoso, Ángel Serrano, María Jesús Ramos

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Flame-retardants are incorporated in different materials in order to reduce the risk of fire, either by providing increased resistance to ignition, or by acting to slow down combustion and thereby delay the spread of flames. In this work, polyether polyols with fire retardant properties were synthesized due to their wide application in the polyurethanes formulation. The combustion of polyurethanes is primarily dependent on the thermal properties of the polymer, the presence of impurities and formulation residue in the polymer as well as the supply of oxygen. There are many types of flame retardants, most of them are phosphorous compounds of different nature and functionality. The addition of these compounds is the most common method for the incorporation of flame retardant properties. The employment of glycerol phosphate sodium salt as initiator for the polyol synthesis allows obtaining polyols with phosphate groups in their structure. However, some of the critical points of the use of glycerol phosphate salt are: the lower reactivity of the salt and the necessity of a solvent (dimethyl sulfoxide, DMSO). Thus, the main aim in the present work was to determine the amount of the solvent needed to get a good solubility of the initiator salt. Although the anionic polymerization mechanism of polyether formation is well known, it seems convenient to clarify the role that DMSO plays at the starting point of the polymerization process. Regarding the fact that the catalyst deprotonizes the hydroxyl groups of the initiator and as a result of this, two water molecules and glycerol phosphate alkoxide are formed. This alkoxide, together with DMSO, has to form a homogeneous mixture where the initiator (solid) and the propylene oxide (PO) are soluble enough to mutually interact. The addition rate of PO increased when the solvent/initiator ratios studied were increased, observing that it also made the initiation step shorter. Furthermore, the molecular weight of the polyol decreased when higher solvent/initiator ratios were used, what revealed that more amount of salt was activated, initiating more chains of lower length but allowing to react more phosphate molecules and to increase the percentage of phosphorous in the final polyol. However, the final phosphorous content was lower than the theoretical one because only a percentage of salt was activated. On the other hand, glycerol phosphate disodium salt was still partially insoluble in DMSO studied proportions, thus, the recovery and reuse of this part of the salt for the synthesis of new flame retardant polyols was evaluated. In the recovered salt case, the rate of addition of PO remained the same than in the commercial salt but a shorter induction period was observed, this is because the recovered salt presents a higher amount of deprotonated hydroxyl groups. Besides, according to molecular weight, polydispersity index, FT-IR spectrum and thermal stability, there were no differences between both synthesized polyols. Thus, it is possible to use the recovered glycerol phosphate disodium salt in the same way that the commercial one.

Keywords: DMSO, fire retardants, glycerol phosphate disodium salt, recovered initiator, solvent

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Authors: Simon Oga Egboja

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In Africa, particularly in Nigeria, unemployment is a serious issue of concern to every citizen. Hence, this paper focuses on the employment situation and trends in Nigeria. It also investigated the causes why unemployment persists in the country. Prominent among them is the population explosion and rapid expansion of education opportunities all over the country without a corresponding increase in industrial establishment. The paper also discusses the way of reducing the rate of unemployment by encouraging graduates of tertiary institutions in Nigeria to read professional courses and also to indulge in the habit of establishing small-scale enterprises so that after them school they can be self-employed rather than relying solely on government for employment.

Keywords: causes, population, remedy, unemployment

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Authors: Lawrence Emah

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Nigeria, Africa’s most populous nation is undoubtedly, currently going through one of the most difficult phases in her 55 years of existence as an independent nation. At no other time in her history is she under so much pressure of social unrest and unacceptable rate of crime and criminality than it is today. From the North where there is an insurgency to contend with, then to the South where kidnapping and armed robbery hold sway. These issues did not just sprout from nowhere; they have a root somewhere. This is why this paper seeks to bring to the fore poverty and illiteracy as leading causes of these twin social ills– crime and social restiveness as well as suggest practical solutions to the problems.

Keywords: crime, illiteracy, poverty, unrest

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Authors: Chengyu Dong, Shao-Yuan Leu

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Cellulosic ethanol production from lignocellulosic biomass can reduce our reliance on fossil fuel, mitigate climate change, and stimulate rural economic development. The relative low ethanol production (60 g/L) limits the economic viable of lignocellulose-based biorefinery. The ethanol production can be increased up to 80 g/L by removing nearly all the non-cellulosic materials, while the capital of the pretreatment process increased significantly. In this study, a fed-batch prehydrolysis simultaneously saccharification and fermentation process (PSSF) was designed to converse the sulfite pretreated softwood (~30% residual lignin) to high concentrations of ethanol (80 g/L). The liquefaction time of hydrolysis process was shortened down to 24 h by employing the fed-batch strategy. Washing out the spent liquor with water could eliminate the inhibition of the pretreatment spent liquor. However, the ethanol yield of lignocellulose was reduced as the fermentable sugars were also lost during the process. Fed-batch prehydrolyzing the while slurry (i.e. liquid plus solid fraction) pretreated softwood for 24 h followed by simultaneously saccharification and fermentation process at 28 °C can generate 80 g/L ethanol production. Fed-batch strategy is very effectively to eliminate the “solid effect” of the high gravity saccharification, so concentrating the cellulose to nearly 90% by the pretreatment process is not a necessary step to get high ethanol production. Detoxification of the pretreatment spent liquor caused the loss of sugar and reduced the ethanol yield consequently. The tolerance of yeast to inhibitors was better at 28 °C, therefore, reducing the temperature of the following fermentation process is a simple and valid method to produce high ethanol production.

Keywords: cellulosic ethanol, sulfite pretreatment, Fed batch PSSF, temperature

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Authors: Abdul Fatah, Naveenchandra Acharya, Vamshi Krishna, T. Shivaprasad, Ramesh Ramayya

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Background: Significant number of patients with bladder outlet obstruction due to BPH are on anti-platelets and anticoagulants. Prostate surgery in this group of patients either in the form of TURP or Open prostatectomy is associated with increased risk of bleeding complications requiring transfusions, packing of the prostatic fossa or ligation or embolization of internal iliac arteries. Withholding of antiplatelets and anticoagulants may be associated with cardiac and other complications. Efficacy of Thulium Laser in the above group of patients was evaluated in terms of peri-operative, postoperative and delayed bleeding complications as well as cardiac events in peri-operative and immediate postoperative period. Methods: 217 patients with a mean age of 68.8 years were enrolled between March 2009 and March 2013 (36 months), and treated for BPH with ThuLEP. Every patient was evaluated at base line according to: Digital Rectal Examination (DRE), prostate volume, Post-Voided volume (PVR), International Prostate Symptoms Score (I-PSS), PSA values, urine analysis and urine culture, uroflowmetry. The post operative complications in the form of drop in hemoglobin level, transfusion rates, post –operative cardiac events within a period of 30 days, delayed hematuria and events like deep vein thrombosis and pulmonary embolism were noted. Results: Our data showed a better post-operative outcome in terms of, postoperative bleeding requiring intervention 7 (3.2%), transfusion rate 4 (1.8%) and cardiac events within a period of 30 days 4(1.8%), delayed hematuria within 6 months 2(0.9 %) compared other series of prostatectomies. Conclusion: The thulium LASER prostatectomy is a safe and effective option for patients with cardiac comorbidties and those patients who are on antiplatelet agents and anticoagulants. The complication rate is less as compared to larger series reported with open and transurethral prostatectomies.

Keywords: thulium laser, prostatectomy, antiplatelet agents, bleeding

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Authors: Qi LI, Xu Lin, Nengming Lin

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Objective: The aim of this study was to investigate the role of desmocollin 2 (DSC2) protein in the proliferation, migration and drug resistance of lung cancer cells. Method: CCK-8 assays and colony formation assays were used to evaluate the effect of dsc2 regulation on cancer cell viability and colony formation. Transwell assays and wound healing assays were also performed. Cell flow double staining was used to detect the apoptosis rate of cells with DSC2, which was added cisplatin. Western blot assay was used to detect cell cycle, PI3k/Akt and apoptosis-related proteins. Results: Our data showed that dsc2 is upregulated in clinical lung cancer tissues compared with pericarcinomatous tissues, and it is differentially expressed in lung cancer cell lines. The down-regulation of dsc2 in A549 and H358 lung cancer cells significantly suppressed the cell proliferation, metastasis, and motility. In contrast, the opposite effects were observed in overexpression of dsc2 both in H23 and PC9 cell lines. In addition to lung adenocarcinoma cell lines, we also examined its expression in lung squamous cell lines, such as H226. Western blotting showed that dsc2 could reduce the level of phosphorylated Akt (Ser 473) and p-mTOR. Thus, it is speculated that dsc2 up-regulation promotes proliferation and invasiveness through activation of the PI3K/AKT pathway. Also, knockdown of dsc2 in A549 and H226 could significantly decreased in the levels of cyclinB and wee1 protein. Additionally, flow cytometry showed that dsc2 knockdown combined with cisplatin could significantly enhance cell apoptosis rate. Conclusion: These data suggest that dsc2 promotes the proliferation and migration of lung cancer cells in vitro. Also, the results suggested that dsc2 could affect the cell cycle and apoptosis of lung cells. Furthermore, knockdown of dsc2 could sensitize cisplatin in both lung adenocarcinoma and lung squamous cell lines. Thus we suggested that dsc2 can be used as a therapeutic target for lung cancer.

Keywords: desmocollin 2, cisplatin, lung cancer, PI3K/AKT, lung squamous cell

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Authors: Jung-Soo Lee, Ujjal Kumar Nath, IllSup Nou, Dulal Chandra

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Leaf lettuce is one of the most important leafy vegetables that is used as raw for salad and part of everyday dishes in many parts of the world including Asian countries. Since it is used as fresh, its quality maintenance is crucial which depends on several pre- and postharvest factors. In order to investigate the effects of pre-fix factors on the postharvest quality, the interaction of pre-fix factors such as growing conditions and fixed factor like cultivars were evaluated. Four Korean leaf lettuce cultivars ‘Cheongchima’, ‘Cheongchuckmyeon’, ‘Geockchima’ and ‘Geockchuckmyeon’ were grown under natural condition (as control) and altered growing condition (green house) with excess soil water and 50% shading to monitor their postharvest qualities. Several growth parameters like plant height, number of leaves, leaf thickness, fresh biomass yield as well as postharvest qualities like fresh weight loss, respiration rate, changes in color and shelf-life were measured in lettuce during storage up to 36 days at 5°C. Plant height and the number of leaves were affected by both pre-fix growing conditions as well as the cultivars. However, fresh biomass yield was affected by only growing condition, whereas leaf thickness was affected by cultivars. Additionally, the degrees of fresh weight loss and respiration rate of leaf lettuce at postharvest stages were influenced by pre-fix growing conditions and cultivars. However, changes in color of leaves during storage were less remarkable in samples harvested from of ‘Cheongchima’ and ‘Cheongchuckmyeon’ cultivars grown in excess watering with 50% shade than that grown in control condition. Consequently, these two cultivars also showed longer shelf-life when they were grown in excess watering with 50% shade than other cultivars or samples were grown in control condition. Based on the measured parameters, it can be concluded that postharvest quality of leaf lettuce might be accelerated by growing lettuce under excess soil water with 50% shading.

Keywords: cultivar, growing condition, leaf lettuce, postharvest quality, shelf-life

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Authors: Robert E. Kenney, Efrain Antunez, Samuel Nodal, Ameer Malik, Richard B. Aguilar

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Physician burnout has gained much attention during the COVID pandemic. After-hours workload, HCC coding, HEDIS metrics, and clinical documentation negatively impact career satisfaction. These and other influences have increased the rate of physicians leaving the workforce. In addition, roughly 1% of the entire physician workforce will be retiring earlier than expected based on pre-pandemic trends. The two Medical Specialties with the highest rates of burnout are Family Medicine and Primary Care. With a predicted shortage of primary care physicians looming, the need to address physician burnout is crucial. Commonly reported issues leading to clinician burnout are clerical documentation requirements, increased time working on Electronic Health Records (EHR) after hours, and a decrease in work-life balance. Clinicians experiencing burnout with physical and emotional exhaustion are at an increased likelihood of providing lower quality and less efficient patient care. This may include a lack of suitable clinical documentation, medication reconciliation, clinical assessment, and treatment plans. While the annual baseline turnover rates of physicians hover around 6-7%, the COVID pandemic profoundly disrupted the delivery of healthcare. A report found that 43% of physicians switched jobs during the initial two years of the COVID pandemic (2020 and 2021), tripling the expected average annual rate to 21.5 %/yr. During this same time, an average of 4% and 1.5% of physicians retired or left the workforce for a non-clinical career, respectively. The report notes that 35.2% made career changes for a better work-life balance and another 35% reported the reason as being unhappy with their administration’s response to the pandemic. A physician-led primary care-focused health organization, Cano Health (CH), based out of Florida, sought to preemptively address this problem by implementing several supportive measures. Working with >120 clinics and >280 PCPs from Miami to Tampa and Orlando, managing nearly 120,000 Medicare Advantage lives, CH implemented a number of changes to assist with the clinician’s workload. Supportive services such as after hour and home visits by APRNs, in-clinic care managers, and patient educators were implemented. In 2021, assistive Artificial Intelligence Software (AIS) was integrated into the EHR platform. This AIS converts free text within PDF files into a usable (copy-paste) format facilitating documentation. The software also systematically and chronologically organizes clinical data, including labs, medical records, consultations, diagnostic images, medications, etc., into an easy-to-use organ system or chronic disease state format. This reduced the excess time and documentation burden required to meet payor and CMS guidelines. A clinician Documentation Support team was employed to improve the billing/coding performance. The effects of these newly designed workflow interventions were measured via analysis of clinician turnover from CH’s hiring and termination reporting software. CH’s annualized average clinician turnover rate in 2020 and 2021 were 17.7% and 12.6%, respectively. This represents a 30% relative reduction in turnover rate compared to the reported national average of 21.5%. Retirement rates during both years were 0.1%, demonstrating a relative reduction of >95% compared to the national average (4%). This model successfully promoted the retention of clinicians in a Value-Based Care setting.

Keywords: clinician burnout, COVID-19, value-based care, burnout, clinician retirement

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Authors: Marina Shakleina, Konstantin Shaklein, Stanislav Yakiro

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The digitalization of modern human life over the last decade has facilitated the acquisition, storage, and processing of data, which are used to detect changes in consumer preferences and to improve the internal efficiency of the production process. This emerging trend has attracted academic interest in the use of big data in research. The study focuses on modeling the social comfort of the Russian population for the period 2010-2021 using big data. Big data provides enormous opportunities for understanding human interactions at the scale of society with plenty of space and time dynamics. One of the most popular big data sources is Google Trends. The methodology for assessing social comfort using big data involves several steps: 1. 574 words were selected based on the Harvard IV-4 Dictionary adjusted to fit the reality of everyday Russian life. The set of keywords was further cleansed by excluding queries consisting of verbs and words with several lexical meanings. 2. Search queries were processed to ensure comparability of results: the transformation of data to a 10-point scale, elimination of popularity peaks, detrending, and deseasoning. The proposed methodology for keyword search and Google Trends processing was implemented in the form of a script in the Python programming language. 3. Block and summary integral indicators of social comfort were constructed using the first modified principal component resulting in weighting coefficients values of block components. According to the study, social comfort is described by 12 blocks: ‘health’, ‘education’, ‘social support’, ‘financial situation’, ‘employment’, ‘housing’, ‘ethical norms’, ‘security’, ‘political stability’, ‘leisure’, ‘environment’, ‘infrastructure’. According to the model, the summary integral indicator increased by 54% and was 4.631 points; the average annual rate was 3.6%, which is higher than the rate of economic growth by 2.7 p.p. The value of the indicator describing social comfort in Russia is determined by 26% by ‘social support’, 24% by ‘education’, 12% by ‘infrastructure’, 10% by ‘leisure’, and the remaining 28% by others. Among 25% of the most popular searches, 85% are of negative nature and are mainly related to the blocks ‘security’, ‘political stability’, ‘health’, for example, ‘crime rate’, ‘vulnerability’. Among the 25% most unpopular queries, 99% of the queries were positive and mostly related to the blocks ‘ethical norms’, ‘education’, ‘employment’, for example, ‘social package’, ‘recycling’. In conclusion, the introduction of the latent category ‘social comfort’ into the scientific vocabulary deepens the theory of the quality of life of the population in terms of the study of the involvement of an individual in the society and expanding the subjective aspect of the measurements of various indicators. Integral assessment of social comfort demonstrates the overall picture of the development of the phenomenon over time and space and quantitatively evaluates ongoing socio-economic policy. The application of big data in the assessment of latent categories gives stable results, which opens up possibilities for their practical implementation.

Keywords: big data, Google trends, integral indicator, social comfort

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Authors: Oliver Ikechukwu Inyiama, Boniface Uche Ugwuanyi

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The aim of the research is to evaluate the key financial performance indicators that help both managers and their shareholders of Nigerian Banks to determine the appropriate dividend payout to their ordinary shareholders in an accounting year. Profitability, total asset, and earnings of commercial banks were selected as key performance indicators in Nigeria Banking Sector. They represent the independent variables of the study while dividend per share is the proxy for the dividend paid on ordinary shares which represent the dependent variable. The effect of profitability, total asset and earnings on dividend per share were evaluated through the ordinary least square method of multiple regression analysis. Test for normality of frequency distribution was conducted through descriptive statistics such as Jacque Bera Statistic, skewness and kurtosis. Rate of dividend payout was subsequently applied as an alternate dependent variable to test for robustness of the earlier results. The 64% adjusted R-squared of the pooled data indicates that profitability, total asset, and earnings explain the variation in dividend per share during the period under research while the remaining 36% variation in dividend per share could be explained by changes in other variables not captured by this study as well as the error term. The study concentrated on four leading Nigeria Commercial Banks namely; First Bank of Nigeria Plc, GTBank Plc, United Bank for Africa Plc and Zenith International Bank Plc. Dividend per share was found to be positively affected by total assets and earnings of the commercial banks. However, profitability which was proxied by profit after tax had a negative effect on dividend per share. The implication of the findings is that commercial banks in Nigeria pay more dividend when they are having a dwindling fortune in order to retain the confidence of the shareholders provided their gross earnings and size is on the increase. Therefore, the management and board of directors of Nigeria commercial banks should apply decent marketing strategies to enhance earnings through investment in profitable ventures for an improved dividend payout rate.

Keywords: assets, banks, indicators, performance, profitability, shares

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Authors: Anees Raza, Liu Chunyan

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Renewable energy technologies are need of the time and are already making the big impact in the climatic outlook of the world. Biogas technology is one of those, and it has a lot of benefits for its users. It is cost effective because it is produced from the raw material which is available free of cost to the livestock farmers. Bio-slurry, a by-product of biogas, is being used as fertilizer for the crops production and increasing soil fertility. There are many other household benefits of technology. Research paper discusses the benefits of biogas as perceived by the biogas users as well as non-users of Tehsil Jhang. Data were collected from 60 respondents (30 users and 30 non-users) selected purposively through validated and pre-tested interview schedule from the respondents. Collected data were analyzed by using Statistical Package for Social Sciences (SPSS). Household benefits like ‘makes cooking easy,’ ‘Less breathing issues for working women in kitchens’ and ‘Use of bio-slurry as organic fertilizer’ had the highly significant relationship between them with t-values of 3.24, 4.39 and 2.80 respectively. Responses of the respondents about environmental benefits of biogas technology showed that ‘less air pollution’ had a significant relationship between them while ‘less temperature rise up than due to the burning of wood /dung’ had the non-significant relationship in the responses of interviewed respondents. It was clear from the research that biogas users were becoming influential in convincing non-users to adopt this technology due to its noticeable benefits. Research area where people were depending on wood to be used as fire fuel could be helped in reduction of cutting of trees which will help in controlling deforestation and saving the environment.People should be encouraged in using of biogas technology through providing them subsidies and low mark up loans.

Keywords: biogas technology, deforestation, environmental benefits, renewable energy

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Authors: Showkat Ahmad Bhat, M. S. Bhatt

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The study evaluates the ex-post impact of institutional credit on agricultural output. It first examines the key factors that influence the accessibility of institutional credit by farm households. For quantitative analysis both program participant and non-participant respondents were drawn and cross-sectional survey data were collected from 412 households in Pulwama District of Jammu & Kashmir (India). Propensity Score Matching Method was employed to analyze the impact of the institutional credit on agricultural output. Results show that institutional credit has a positive and significant impact on the agricultural output measured in terms of farm income and crop productivity. To estimate the accessibility of credit, an examination of both demand side and supply side factors were carried out. The demand for credit was measured with respect to respondents who applied for credit. Supply side credit allocation measured in terms of the proportion of ‘credit amount’ farmers obtained. Logit and Two-limit Tobit Regression Models were used to investigate the determinants that influence the accessibility of formal credit for Demand for and supply of credit respectively. The estimated results suggested that the demand for credit is positively and significantly affected by the factors such as: age of the household head, formal education, membership, cash crop grown, farm size and saving account. All the variables were found significantly increasing the household’s likelihood to demand for and supply of credit from banks. However, the impact of these factors varies considerably across the credit markets. Factors which were found negatively and significantly influencing the accessibility of credit were: ‘square of the age’, household assets and rate of interest. The credit constraints analysis suggested that square of the age; household assets and rate of interest were the three most important factors that increased the probability of being constrained. The study finally discusses these results in detail and draws some recommendations.

Keywords: institutional credit, agriculture, propensity score matching logit model, Tobit model

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Authors: S. van Schalkwyk

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On international levels and across disciplines gender scholars have argued that patriarchal scripts of masculinity and femininity are harmful as they negatively impact constructions of selfhood and relations between women and men. Patriarchal ideologies serve as a scaffolding for dominance and subordination and fuel violence against women. Toxic masculinity—social discourses of men as violent, unemotional, and sexually dominant—are embedded in South African culture and are rooted in the high rates of gender violence occurring in the country. Finding strategies that can open up space for the interrogation of toxic masculinity is crucial in order to disrupt the destructive consequences of patriarchy in educational and social contexts. The University of the Free State (UFS) in South Africa in collaboration with the non-profit organization Gender Reconciliation International conducted a year-long series of workshops with male and female students. The aim of these workshops was to facilitate healing between men and women through collective dialogue processes. Drawing on a collective biography methodology outlined by feminist poststructuralists, this paper explores the impact of these workshops on gender relations. Findings show that the students experienced significant psychological connections with others during these dialogues, through which they began to interrogate their own gendered conditioning and harmful patriarchal assumptions and practices. This paper enhances insights into the possibilities for disrupting patriarchy in South African universities through feminist collective research efforts.

Keywords: collective biography methodology, South Africa, toxic masculinity, transforming gender oppression, violence against women

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Authors: A. Fernandez Zuvich, I. Gana Watkins, H. Zolotucho, H. Troiani, A. Caneiro, M. Prado, A. L. Soldati

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The study of actinide nanoparticles (NPs) has attracted the attention of the scientific community not only because the lack of information about their ecotoxicological effects but also because the use of NPs could open a new way in the production of nuclear energy. Indeed, it was recently demonstrated that UO2 NPs sintered pellets exhibit closed porosity with improved fission gas retention and radiation-tolerance , ameliorated mechanical properties, and less detriment of the thermal conductivity upon use, making them an interesting option for new nuclear fuels. In this work, we used a combination of diffraction and microscopy tools to characterize the morphology, the crystalline structure and the composition of UO2 nanoparticles doped with 10%wt Gd2O3. The particles were synthesized by a modified sol-gel method at low temperatures. X-ray Diffraction (XRD) studies determined the presence of a unique phase with the cubic structure and Fm3m spatial group, supporting that Gd atoms substitute U atoms in the fluorite structure of UO2. In addition, Field Emission Gun Scanning (FEG-SEM) and Transmission (FEG-TEM) Electron Microscopy images revealed the presence of micrometric agglomerates of nanoparticles, with rounded morphology and an average crystallite size < 50 nm. Energy Dispersive Spectroscopy (EDS) coupled to TEM determined the presence of Gd in all the analyzed crystallites. Besides, FEG-SEM-EDS showed a homogeneous concentration distribution at the micrometer scale indicating that the small size of the crystallites compensates the variation in composition by averaging a large number of crystallites. These techniques, as combined tools resulted thus essential to find out details of morphology and composition distribution at the sub-micrometer scale, and set a standard for developing and analyzing nanoparticulated nuclear fuels.

Keywords: actinide nanoparticles, burnable poison, nuclear fuel, sol-gel

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Authors: Ahmad Odeh

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Researchers are currently more concerned about the calculations of energy at the operational stage, mainly due to its larger environmental impact, but the fact remains, embodied energies represent a substantial contributor unaccounted for in the overall energy computation method. The calculation of materials’ embodied energy during the construction stage is complicated. This is due to the various factors involved. The equipment used, fuel needed, and electricity required for each type of materials varies with location and thus the embodied energy will differ for each project. Moreover, the method used in manufacturing, transporting and putting in place will have significant influence on the materials’ embodied energy. This anomaly has made it difficult to calculate or even bench mark the usage of such energies. This paper presents a model aimed at calculating embodied energies based on such variabilities. It presents a systematic approach that uses an efficient method of calculation to provide a new insight for the selection of construction materials. The model is developed in a BIM environment. The quantification of materials’ energy is determined over the three main stages of their lifecycle: manufacturing, transporting and placing. The model uses three major databases each of which contains set of the construction materials that are most commonly used in building projects. The first dataset holds information about the energy required to manufacture any type of materials, the second includes information about the energy required for transporting the materials while the third stores information about the energy required by machinery to place the materials in their intended locations. Through geospatial data analysis, the model automatically calculates the distances between the suppliers and construction sites and then uses dataset information for energy computations. The computational sum of all the energies is automatically calculated and then the model provides designers with a list of usable equipment along with the associated embodied energies.

Keywords: BIM, lifecycle energy assessment, building automation, energy conservation

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Authors: A. Guemache, M. Omari

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Oxides with formula Ca1-xSrx MnO3 (0≤x≤0.2) were synthesized using co-precipitation method. The identification of the obtained phase was carried out using infrared spectroscopy and X-ray diffraction. Thermogravimetric and differential analysis was permitted to characterize different transformations of precursors which take place during one heating cycle. The study of electrochemical behavior was carried out by cyclic voltammetry and impedance spectroscopy. The obtained results show that apparent catalytic activity improved when increasing the concentration of strontium. Anodic current densities varies from 1.3 to 5.9 mA/cm2 at the rate scan of 20 mV.s-1 and a potential 0.8 V for oxides with composition x=0 to 0.2.

Keywords: oxide, co-precipitation, electrochemical properties, cathode-type

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Authors: S. Ghosh, L. Ramos, A. N. Kouamé, A.-L. Teillout, H. Remita

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Catalytic materials have attracted continuous attention due to their promising applications in a variety of energy and environmental applications including clean energy, energy conversion and storage, purification and separation, degradation of pollutants and electrochemical reactions etc. With the advanced synthetic technologies, polymer nanostructures and nanocomposites can be directly synthesized through soft template mediated approach using swollen hexagonal mesophases and modulate the size, morphology, and structure of polymer nanostructures. As an alternative to conventional catalytic materials, one-dimensional PDPB polymer nanostructures shows high photocatalytic activity under visible light for the degradation of pollutants. These photocatalysts are very stable with cycling. Transmission electron microscopy (TEM), and AFM-IR characterizations reveal that the morphology and structure of the polymer nanostructures do not change after photocatalysis. These stable and cheap polymer nanofibers and metal polymer nanocomposites are easy to process and can be reused without appreciable loss of activity. The polymer nanocomposites formed via one pot chemical redox reaction with 3.4 nm Pd nanoparticles on poly(diphenylbutadiyne) (PDPB) nanofibers (30 nm). The reduction of Pd (II) ions is accompanied by oxidative polymerization leading to composites materials. Hybrid Pd/PDPB nanocomposites used as electrode materials for the electrocatalytic oxidation of ethanol without using support of proton exchange Nafion membrane. Hence, these conducting polymer nanofibers and nanocomposites offer the perspective of developing a new generation of efficient photocatalysts for environmental protection and in electrocatalysis for fuel cell applications.

Keywords: conducting polymer, swollen hexagonal mesophases, solar photocatalysis, electrocatalysis, water depollution

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Authors: Abu Yousuf, Maksudur Rahman Khan, Ahasanul Karim, Amirul Islam, Minhaj Uddin Monir, Sharmin Sultana, Domenico Pirozzi

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Traditional biodiesel feedstock like edible oils or plant oils, animal fats and cooking waste oil have been replaced by microbial oil in recent research of biodiesel synthesis. The well-known community of microbial oil producers includes microalgae, oleaginous yeast and seaweeds. Conventional transesterification of microbial oil to produce biodiesel is lethargic, energy consuming, cost-ineffective and environmentally unhealthy. This process follows several steps such as microbial biomass drying, cell disruption, oil extraction, solvent recovery, oil separation and transesterification. Therefore, direct transesterification of biodiesel synthesis has been studying for last few years. It combines all the steps in a single reactor and it eliminates the steps of biomass drying, oil extraction and separation from solvent. Apparently, it seems to be cost-effective and faster process but number of difficulties need to be solved to make it large scale applicable. The main challenges are microbial cell disruption in bulk volume and make faster the esterification reaction, because water contents of the medium sluggish the reaction rate. Several methods have been proposed but none of them is up to the level to implement in large scale. It is still a great challenge to extract maximum lipid from microbial cells (yeast, fungi, algae) investing minimum energy. Electroporation technique results a significant increase in cell conductivity and permeability caused due to the application of an external electric field. Electroporation is required to alter the size and structure of the cells to increase their porosity as well as to disrupt the microbial cell walls within few seconds to leak out the intracellular lipid to the solution. Therefore, incorporation of electroporation techniques contributed in direct transesterification of microbial lipids by increasing the efficiency of biodiesel production rate.

Keywords: biodiesel, electroporation, microbial lipids, transesterification

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Authors: Gudakesh Yadav

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Utter Pradesh, which is one of the largest states of India with unequal distribution of resources and different socioeconomic and cultural characteristics, level of different new born health care indicators varies a lot from one district to another district. State shared more than 21 percent of total live births of India; whereas, it accounts for 28 percent of total infant deaths of the country, with the 53 per thousand infant mortality rate. The present paper attempts to examine tempo-spatial changes in new born care practices during NFHS-1 to NFHS-3 and DLHS-2 to DLHS-3 in Uttar Pradesh and different regions. Descriptive statistics, rate-ratios, concentration index, multivariate and decomposition analysis has been used for the study. Findings of the study reveal that new born care practices have improved over the time in the state and across all the regions because of giving more emphasis on venerable groups like poor, rural, less educated mothers and scheduled caste & tribes but still it did not achieve the desired successes. Regional analysis of third rounds of DLHS shows that, coverage of intuitional delivery was the lowest in the central region. Performance of the southern region was the lowest in terms of initiation of breastfeeding, keeping baby warm and dry after the birth. The study calls for proper follow up of new born children to accelerate new born and child health care service and prioritises increasing antenatal check-ups and institutional delivery, which helps to improve level of other new born care services. At the policy level there is need to reach venerable groups like scheduled caste and tribes, poor and uneducated, and new mother especially in rural areas. High focused district should be allocated for better implementation of new born care promotion programme in low performing districts. Partnership with the private sector health professional is necessary to reach the every part of population.

Keywords: decomposition, inequality, initiation of breastfeeding, institutional delivery

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Authors: Shan Huang, Guanjun Huang, Yongjun Zeng, Haiyuan Wang

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The impacts of whole-growth warming on grain yield and quality in double rice cropping systems still remain largely unknown. In this study, a two-year field whole-growth warming experiment was conducted with two inbred indica rice cultivars (Zhongjiazao 17 and Xiangzaoxian 45) for early season and two hybrid indica rice cultivars (Wanxiangyouhuazhan and Tianyouhuazhan) for late season. The results showed that whole-growth warming did not affect early rice yield but significantly decreased late rice yield, which was caused by the decreased grain weight that may be related to the increased plant respiration and reduced translocation of dry matter accumulated during the pre-heading phase under warming. Whole-growth warming improved the milling quality of late rice but decreased that of early rice; however, the chalky rice rate and chalkiness degree were increased by 20.7% and 33.9% for early rice and 37.6 % and 51.6% for late rice under warming, respectively. We found that the crude protein content of milled rice was significantly increased by warming in both early and late rice, which would result in deterioration of eating quality. Besides, compared with the control treatment, the setback of late rice was significantly reduced by 17.8 % under warming, while that of early rice was not significantly affected by warming. These results suggest that the negative impacts of whole-growth warming on grain quality may be more severe in early rice than in late rice. Therefore, adaptation in both rice breeding and agronomic practices is needed to alleviate climate warming on the production of a double rice cropping system. Climate-smart agricultural practices ought to be implemented to mitigate the detrimental effects of warming on rice grain quality. For instance, fine-tuning the application rate and timing of inorganic nitrogen fertilizers, along with the introduction of organic amendments and the cultivation of heat-tolerant rice varieties, can help reduce the negative impact of rising temperatures on rice quality. Furthermore, to comprehensively understand the influence of climate warming on rice grain quality, future research should encompass a wider range of rice cultivars and experimental sites.

Keywords: climate warming, double rice cropping, dry matter, grain quality, grain yield

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Authors: Anna S. Tolkacheva, Sergey N. Shkerin, Kirill G. Zemlyanoi, Olga G. Reznitskikh, Pavel D. Khavlyuk

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Calcium oxovanadates with garnet related structure are multifunctional oxides in various fields like photoluminescence, microwave dielectrics, and magneto-dielectrics. For example, vanadate garnets are self-luminescent compounds. They attract attention as RE-free broadband excitation and emission phosphors and are candidate materials for UV-based white light-emitting diodes (WLEDs). Ca₅M₄(VO₄)₆ (M = Mg, Zn, Co, Ni, Mn) compounds are also considered promising for application in microwave devices as substrate materials. However, the relation between their structure, composition and physical/chemical properties remains unclear. Given the above-listed observations, goals of this study are to synthesise Ca₅M₄(VO₄)₆ (M = Mg, Zn, Ni) and to study their thermal and electrical properties. Solid solutions Ca₅Mg₄₋ₓMₓ(VO₄)₆ (0 ≤ x ≤ 4) where M is Zn and Ni have been synthesized by sol-gel method. The single-phase character of the final products was checked by powder X-ray diffraction on a Rigaku D/MAX-2200 X-ray diffractometer using Cu Kα radiation in the 2θ range from 15° to 70°. The dependence of thermal properties on chemical composition of solid solutions was studied using simultaneous thermal analyses (DSC and TG). Thermal analyses were conducted in a Netzch simultaneous analyser STA 449C Jupiter, in Ar atmosphere, in temperature range from 25 to 1100°C heat rate was 10 K·min⁻¹. Coefficients of thermal expansion (CTE) were obtained by dilatometry measurements in air up to 800°C using a Netzsch 402PC dilatometer; heat rate was 1 K·min⁻¹. Impedance spectra were obtained via the two-probe technique with an impedance meter Parstat 2273 in air up to 700°C with the variation of pH₂O from 0.04 to 3.35 kPa. Cation deficiency in Ca and Mg sublattice under the substitution of MgO with ZnO up to 1/6 was observed using Rietveld refinement of the crystal structure. Melting point was found to decrease with x changing from 0 to 4 in Ca₅Mg₄₋ₓMₓ(VO₄)₆ where M is Zn and Ni. It was observed that electrical conductivity does not depend on air humidity. The reported study was funded by the RFBR Grant No. 17–03–01280. Sample attestation was carried out in the Shared Access Centers at the IHTE UB RAS.

Keywords: garnet structure, electrical conductivity, thermal expansion, thermal properties

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Authors: Saeed Khodabakhshi, Alimorad Rashidi, Ziba Tavakoli, Sajad Kiani, Sadegh Dastkhoon

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Alumina nanoparticles (γ-Al2O3 NPs) were prepared via a new and simple synthetic route and characterized by field emission scanning electron microscope, X-ray diffraction, and Fourier transform infrared spectroscopy. The catalytic activity of prepared γ-Al2O3 NPs was investigated for the one-pot, four-component synthesis of fused tri-heterocyclic compounds containing pyrazole, pyran, and pyrimidine. This procedure has some advantages such as high efficiency, simplicity, high rate and environmental safety.

Keywords: alumina nanoparticles, one-pot, fused tri-heterocyclic compounds, pyran

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Authors: Richa Jaiswal, Vidisha Sharma, Amulya Rattan, Sushma Sagar, Subodh Kumar, Amit Gupta, Biplab Mishra, Maneesh Singhal

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Background: Adequate nutritional support and daily patient monitoring have an independent therapeutic role in the successful management of high output fistulae and early recovery after abdominal trauma. Case presentation: An 18-year-old girl was brought to AIIMS emergency with alleged history of fall of a heavy weight (electric motor) over abdomen. She was evaluated as per Advanced Trauma Life Support(ATLS) protocols and diagnosed to have significant abdominal trauma. After stabilization, she was referred to Trauma center. Abdomen was guarded and focused assessment with sonography for trauma(FAST) was found positive. Complete duodenojejunal(DJ) junction transection was found at laparotomy, and end-to-end repair was done. However, patient was re-explored in view of biliary peritonitis on post-operative day3, and anastomotic leak was found with sloughing of duodenal end. Resection of non-viable segments was done followed by side-to-side anastomosis. Unfortunately, the anastomosis leaked again, this time due to a post-anastomotic kink, diagnosed on dye study. Due to hostile abdomen, the patient was planned for supportive care, with plan of build-up and delayed definitive surgery. Percutaneous transheptic biliary drainage (PTBD) and STSG were required in the course as well. Nutrition: In intensive care unit (ICU), major goals of nutritional therapy were to improve wound healing, optimize nutrition, minimize enteral feed associated complications, reduce biliary fistula output, and prepare the patient for definitive surgeries. Feeding jejunostomy (FJ) was started from day 4 at the rate of 30ml/h along with total parenteral nutrition (TPN) and intra-venous (IV) micronutrients support. Due to high bile output, bile refeed started from day 13.After 23 days of ICU stay, patient was transferred to general ward with body mass index (BMI)<11kg/m2 and serum albumin –1.5gm%. Patient was received in the ward in catabolic phase with high risk of refeeding syndrome. Patient was kept on FJ bolus feed at the rate of 30–50 ml/h. After 3–4 days, while maintaining patient diet book log it was observed that patient use to refuse feed at night and started becoming less responsive with every passing day. After few minutes of conversation with the patient for a couple of days, she complained about enteral feed discharge in urine, mild pain and sign of dumping syndrome. Dye study was done, which ruled out any enterovesical fistula and conservative management were planned. At this time, decision was taken for continuous slow rate feeding through commercial feeding pump at the rate of 2–3ml/min. Drastic improvement was observed from the second day in gastro-intestinal symptoms and general condition of the patient. Nutritional composition of feed, TPN and diet ranged between 800 and 2100 kcal and 50–95 g protein. After STSG, TPN was stopped. Periodic diet counselling was given to improve oral intake. At the time of discharge, serum albumin level was 2.1g%, weight – 38.6, BMI – 15.19 kg/m2. Patient got discharge on an oral diet. Conclusion: Successful management of post-traumatic proximal high output fistulae is a challenging task, due to impaired nutrient absorption and enteral feed associated complications. Strategic- and goal-based nutrition support can salvage such critically ill patients, as demonstrated in the present case.

Keywords: nutritional monitoring, nutritional support, duodenal fistula, abdominal trauma

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