Search results for: systematic deconstruction

Authors: Hamidreza Joudaki, Yousefali Ziari

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The appearance of city and urbanism is one of the important processes which have affected social communities. Being industrialized urbanism developed along with each other in the history. In addition, they have had simple relationship for more than six thousand years, that is, from the appearance of the first cities. In 18th century by coming out of industrial capitalism, progressive development took place in urbanism in the world. In Iran, the city of each region made its decision by itself and the capital of region (downtown) was the only central part and also the regional city without any hierarchy, controlled its realm. However, this method of ruling during these three decays, because of changing in political, social and economic issues that have caused changes in rural and urban relationship. Moreover, it has changed the variety of performance of cities and systematic urban network in Iran. Today, urban system has very vast imbalanced apace and performance. In Isfahan, the trend of urbanism is like the other part of Iran and systematic urban hierarchy is not suitable and normal. This article is a quantitative and analytical. The statistical communities are Isfahan Province cities and the changes in urban network and its hierarchy during the period of fifty years (1956 -2006) has been surveyed. In addition, those data have been analyzed by model of Rank and size and Entropy index. In this article Iran cities and also the factor of entropy of primate city and urban hierarchy of Isfahan Province have been introduced. Urban residents of this Province have been reached from 55 percent to 83% (2006). As we see the analytical data reflects that there is mismatching and imbalance between cities. Because the entropy index was.91 in 1956.And it decreased to.63 in 2006. Isfahan city is the primate city in the whole of these periods. Moreover, the second and the third cities have population gap with regard to the other cities and finally, they do not follow the system of rank-size.

Keywords: urban network, urban hierarchy, primate city, Isfahan province, urbanism, first cities

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Authors: Raheel Shakoor Siddiqui, Shahbaz Malik, Manikandar Srinivas Cheruvu, Sanjay Narayana Murthy, Livio DiMascio

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Background: elderly traumatic hip fracture patients frequently present to trauma services globally. Rising low energy falls amongst an osteoporotic aging population is the commonest cause for injury. Hip fractures in this population are a major cause for severe pain, morbidity and mortality. The term hip fracture is interchangeable with neck of femur fracture, fractured neck of femur or proximal femur fracture. Hip fracture pain management protocols and guidelines suggest conventional analgesia, nerve block and opioid based treatment as rescue analgesia. There is a current global opioid crisis with overuse, abuse and dependence. Adverse opioid related complications in vulnerable elderly patients further adds to morbidity and mortality. Systematic reviews in literature have evidenced superiority of multimodal analgesia in osteoarthritic primary joint replacements compared to opioids however, this has not yet been conducted for elderly traumatic hip fracture patients. Aims: The primary aim of this systematic review is to provide standardised evidence following Cochrane and PRISMA guidance in determining advantages of perioperative multimodal analgesia over conventional opioid based treatments in elderly traumatic hip fractures. Methods: 5 databases were searched from January 2000-2023 which identified 8 randomised controlled trials and 446 total participants. These trials met defined PICOS eligibility criteria of patient mean age ≥ 65 years presenting with a unilateral traumatic fractured neck of femur for operative intervention. Analgesic intervention with perioperative multimodal analgesia has been compared to conventional opioid based analgesia. Outcomes of interest include, primarily, the change in postoperative opioid consumption within a 0-30 postoperative period and secondarily, the change in postoperative adverse events and complications. A qualitative synthesis has been performed due to clinical heterogenicity and variance amongst trials. Results: GRADE evidence of moderate quality supports perioperative multimodal analgesia leads to a reduction in postoperative opioid consumption however, low quality evidence supports a reduction of adverse effects and complications. Conclusion: Perioperative multimodal analgesia whether used preoperative, intraoperative and/or postoperative leads to a reduction in postoperative opioid consumption for elderly traumatic hip fracture patients. This review recommends the use of perioperative multimodal analgesia as part of hip fracture pain protocols however, caution and clinical judgement should be used as the risk of adverse effects may not be lower.

Keywords: trauma, orthopaedics, hip, fracture, neck of femur fracture, analgesia, multimodal analgesia, opioid

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Authors: Jawaher F. Alsharef, Abdullah A. Ghaddaf, Mohammed S. Alomari, Abdullah A. Al Qurashi, Ahmed S. Abdulhamid, Mohammed S. Alshehri, Majed Alosaimi

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Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD=–0.28, 95% CI –0.53 to –0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR= 0.77, 95% CI –0.58 to 1.03). Conclusions: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events.

Keywords: botulinum toxin type A, limb lengthening, distraction osteogenesis, deformity correction, pain management

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Authors: Jingwen Ou

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Writing for academic purposes in a second or foreign language is one of the most important and the most demanding skills to be mastered by non-native speakers. Traditionally, the EAP writing instruction at the tertiary level encompasses the teaching of academic genre knowledge, more specifically, the disciplinary writing conventions, the rhetorical functions, and specific linguistic features. However, one of the main sources of challenges in English academic writing for L2 students at the tertiary level can still be found in proficiency in academic discourse, especially vocabulary, academic register, and organization. Data-Driven Learning (DDL) is defined as “a pedagogical approach featuring direct learner engagement with corpus data”. In the past two decades, the rising popularity of the application of the data-driven learning (DDL) approach in the field of EAP writing teaching has been noticed. Such a combination has not only transformed traditional pedagogy aided by published DDL guidebooks in classroom use but also triggered global research on corpus use in EAP classrooms. This study endeavors to delineate a systematic review of research in the intersection of DDL and EAP writing instruction by conducting a systematic literature review on both indirect and direct DDL practice in EAP writing instructional settings in China. Furthermore, the review provides a synthesis of significant discoveries emanating from prior research investigations concerning Chinese university students’ perception of Data-Driven Learning (DDL) and the subsequent impact on their academic writing performance following corpus-based training. Research papers were selected from Scopus-indexed journals and core journals from two main Chinese academic databases (CNKI and Wanfang) published in both English and Chinese over the last ten years based on keyword searches. Results indicated an insufficiency of empirical DDL research despite a noticeable upward trend in corpus research on discourse analysis and indirect corpus applications for material design by language teachers. Research on the direct use of corpora and corpus tools in DDL, particularly in combination with genre-based EAP teaching, remains a relatively small fraction of the whole body of research in Chinese higher education settings. Such scarcity is highly related to the prevailing absence of systematic training in English academic writing registers within most Chinese universities' EAP syllabi due to the Chinese English Medium Instruction policy, where only English major students are mandated to submit English dissertations. Findings also revealed that Chinese learners still held mixed attitudes towards corpus tools influenced by learner differences, limited access to language corpora, and insufficient pre-training on corpus theoretical concepts, despite their improvements in final academic writing performance.

Keywords: corpus linguistics, data-driven learning, EAP, tertiary education in China

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Authors: Hadeel Seraj, Mohammed Khoshhal, Mustafa Alhamoud, Hassan Alhashim, Anas Alsaif, Amro Abukhashabah

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Central serous chorioretinopathy (CSCR) is an idiopathic retinal disease characterized by localized serous detachment of the neurosensory retina at the macula. To date, there is no high-quality evidence of recent updates on treating acute CSCR, focusing on photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF). Hence, this review aims to systematically review the latest treatment strategies for acute CSCR. Methodology: The following electronic databases were used for a comprehensive and systematic literature review: MEDLINE, EMBASE, and Cochrane. In addition, we analyzed studies comparing PDT with placebo, anti-VEGF with placebo, or PDT with anti-VEGF in treating acute CSC eyes with no previous intervention. Results: Seven studies were included, with a total of 292 eyes. The overall positive results were significantly higher among patients who received PDT compared to control groups (OR = 7.96, 95% CI, 3.02 to 20.95, p < 0.001). The proportions of positive results were 81.0% and 97.1% among patients who received anti-VEGF and PDT, respectively, with no statistically significant differences between the groups. In addition, there were no significant differences between anti-VEGF and control groups. In contrast, PDT was significantly associated with lower recurrence odds than the control groups (OR = 0.12, 95% CI, 0.04 to 0.39, p = 0.042). Conclusion: According to our findings, PDT showed higher positive results than Anti-VEGF in acute CSCR. In addition, PDT was significantly associated with a lower recurrence rate than the control group. However, the analysis needs to be confirmed and updated by large-scale, well-designed RCTs.

Keywords: central serous chorioretinopathy, Acute CSCR, photodynamic therapy, anti-vascular endothelial growth factor

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Authors: Neha Asthana, Vishal Krishna Prasad

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Collaborative planning and forecasting are the innovative and systematic approaches towards productive integration and assimilation of data synergized into information. The changing and variable market dynamics have persuaded global business chains to incorporate collaborative planning and forecasting as an imperative tool. Thus, it is essential for the supply chains to constantly improvise, update its nature, and mould as per changing global environment.

Keywords: information transfer, forecasting, optimization, supply chain management

Procedia PDF Downloads 436

Authors: Riaz A. Agha, Ishani Barai, Shivanchan Rajmohan, Seon Lee, Mohammed O. Anwar, Alex J. Fowler, Dennis P. Orgill, Douglas G. Altman

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Introduction: Medical knowledge is growing fast. Evidence-based medicine works best if the evidence is reported well. Past studies have shown reporting quality to be lacking in the field of surgery. Reporting guidelines are an important tool for authors to optimize the reporting of their research. The objective of this study was to analyse the frequency and strength of recommendation for such reporting guidelines within surgical journals. Methods: A systematic review of the 198 journals within the Journal Citation Report 2014 (surgery category) published by Thomson Reuters was undertaken. The online guide for authors for each journal was screened by two independent groups and results were compared. Data regarding the presence and strength of recommendation to use reporting guidelines was extracted. Results: 193 journals were included (as five appeared twice having changed their name). These had a median impact factor of 1.526 (range 0.047 to 8.327), with a median of 145 articles published per journal (range 29-659), with 34,036 articles published in total over the two-year window 2012-2013. The majority (62%) of surgical journals made no mention of reporting guidelines within their guidelines for authors. Of the journals (38%) that did mention them, only 14% (10/73) required the use of all relevant reporting guidelines. The most frequently mentioned reporting guideline was CONSORT (46 journals). Conclusion: The mention of reporting guidelines within the guide for authors of surgical journals needs improvement. Authors, reviewers and editors should work to ensure that research is reported in line with the relevant reporting guidelines. Journals should consider hard-wiring adherence to them. This will allow peer-reviewers to focus on what is present, not what is missing, raising the level of scholarly discourse between authors and the scientific community and reducing frustration amongst readers.

Keywords: CONSORT, guide for authors, PRISMA, reporting guidelines, journal impact factor, citation analysis

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Authors: Umm E. Aimen Minhas, Sameen Tahira, Haneen Kamran, Syed Saad Ul Hassan, Haris Bin Khalid, Hadia Nadeem, Ahmed Sanan

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In coronary artery bypass grafting (CABG) patients, vasodilators play a key role in optimizing graft patency by preventing vasospasm and enhancing blood flow. Limited literature is available comparing the effectiveness of various vasodilators on IMA flow in CABG patients. Thus, the rationale for conducting this Network-meta-analysis is to identify the most efficacious vasodilator for increasing IMA flow in CABG patients. A systematic search of 3 databases yielded 357 studies, with 19 meeting inclusion criteria (18 RCTs, 1 observational study). The primary outcome was IMA flow, with secondary outcomes including central venous pressure (CVP) and mean arterial pressure (MAP). Analyses were conducted on an intention-to-treat basis using the net meta package in R. A frequentist random-effects model was employed, with consistency assessed via node-splitting and heterogeneity evaluated. The risk of bias was assessed using RoB 2 and ROBINS-I tools. Out of 92 possible pairwise comparisons, 11 were direct, and 3 included both direct and indirect evidence. Network ranking identified milrinone as the most effective vasodilator for improving IMA flow (SMD: 1.12; 95% CI: 0.36–1.87), followed by nitroglycerin (SMD: 0.51; 95% CI: 0.01–1.00). On the contrary, CO₂ insufflation significantly reduced IMA flow (SMD: -1.17; 95% CI: -2.28 to -0.06). Dobutamine significantly increased CVP, favoring placebo, with no notable differences in MAP across interventions. This analysis positions milrinone as a potentially superior agent for enhancing IMA flow in CABG, warranting its consideration as a first-line therapy. However, moderate to high heterogeneity and limited direct evidence highlight the need for more head-to-head trials.

Keywords: IMA flow, vasodilators, CABG, milrinone, cardiac outcomes

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Authors: T. Radu, R. Sreenivas, H. Albuflasa, A. Mustafa Khan, W. Aloqab

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The Kingdom of Bahrain, a small island country in the Gulf region, is experiencing fast economic growth resulting in a sharp increase in population and greater than ever amounts of waste being produced. However, waste management in the country is still very basic, with landfilling being the most popular option. Recycling is still a scarce practice, with small recycling businesses and initiatives emerging in recent years. This scenario is typical for other countries in the region, with similar amounts of per capita waste being produced. In this paper, we are reviewing current waste management practices in Bahrain by collecting data published by the Government and various authors, and by visiting the country’s only landfill site, Askar. In addition, we have performed a survey of the residents to learn more about the awareness and attitudes towards sustainable waste management strategies. A review of the available data on waste management indicates that the Askar landfill site is nearing its capacity. The site uses open tipping as the method of disposal. The highest percentage of disposed waste comes from the building sector (38.4%), followed by domestic (27.5%) and commercial waste (17.9%). Disposal monitoring and recording are often based on estimates of weight and without proper characterization/classification of received waste. Besides, there is a need for assessment of the environmental impact of the site with systematic monitoring of pollutants in the area and their potential spreading to the surrounding land, groundwater, and air. The results of the survey indicate low awareness of what happens with the collected waste in the country. However, the respondents have shown support for future waste reduction and recycling initiatives. This implies that the education of local communities would be very beneficial for such governmental initiatives, securing greater participation. Raising awareness of issues surrounding recycling and waste management and systematic effort to divert waste from landfills are the first steps towards securing sustainable waste management in the Kingdom of Bahrain.

Keywords: landfill, municipal solid waste, survey, waste management

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Authors: Marco Clericuzio, Alfredo Vizzini

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The secondary metabolites of Russulales (one of the main orders of phylum Basidiomycota), have been studied. They are mainly terpenoids, with sesquiterpenes being the most common ones, but also triterpenoids and prenylated phenols have been isolated. We found that classes of specific compounds seem to be often allied to systematic groupings, so that they may have chemotaxonomic significance. Moreover, the ecological implications of such metabolites, as well as their biological activities, are discussed. Lately, we have focused our attention on the anti-arthropod activity of Russula metabolites, in particular on the toxicity against mites and other crop pests.

Keywords: chemotaxonomy, fungi, insecticidal activity, russulales, terpenoids

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Authors: Ahmed Shaboub, Yusuf Jasim Althawadi, Shadi Alaa Abdelaal, Mohamed Hussein Abdalla, Hatem Amr Elzahaby, Mohamed Mohamed, Hazem S. Ghaith, Ahmed Negida

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Objectives: We aimed to compare the safety and outcomes of the minimally invasive approaches versus conventional sternotomy procedures for aortic valve replacement. Methods: We conducted a PRISMA-compliant systematic review and meta-analysis. We ran an electronic search of PubMed, Cochrane CENTRAL, Scopus, and Web of Science to identify the relevant published studies. Data were extracted and pooled as standardized mean difference (SMD) or risk ratio (RR) using StataMP version 17 for macOS. Results: Forty-one studies with a total of 15,065 patients were included in this meta-analysis (minimally invasive approaches n=7231 vs. conventional sternotomy n=7834). The pooled effect size showed that minimally invasive approaches had lower mortality rate (RR 0.76, 95%CI [0.59 to 0.99]), intensive care unit and hospital stays (SMD -0.16 and -0.31, respectively), ventilation time (SMD -0.26, 95%CI [-0.38 to -0.15]), 24-h chest tube drainage (SMD -1.03, 95%CI [-1.53 to -0.53]), RBCs transfusion (RR 0.81, 95%CI [0.70 to 0.93]), wound infection (RR 0.66, 95%CI [0.47 to 0.92]) and acute renal failure (RR 0.65, 95%CI [0.46 to 0.93]). However, minimally invasive approaches had longer operative time, cross-clamp, and bypass times (SMD 0.47, 95%CI [0.22 to 0.72], SMD 0.27, 95%CI [0.07 to 0.48], and SMD 0.37, 95%CI [0.20 to 0.45], respectively). There were no differences between the two groups in blood loss, endocarditis, cardiac tamponade, stroke, arrhythmias, pneumonia, pneumothorax, bleeding reoperation, tracheostomy, hemodialysis, or myocardial infarction (all P>0.05). Conclusion: Current evidence showed higher safety and better operative outcomes with minimally invasive aortic valve replacement compared to the conventional approach. Future RCTs with long-term follow-ups are recommended.

Keywords: aortic replacement, minimally invasive, sternotomy, mini-sternotomy, aortic valve, meta analysis

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Authors: Bagireanu Astrid, Bros-Williamson Julio, Duncheva Mila, Currie John

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Digital Twins (DT) are an innovative concept of cyber-physical integration of data between an asset and its virtual replica. They have originated in established industries such as manufacturing and aviation and have garnered increasing attention as a potentially transformative technology within the built environment. With the potential to support decision-making, real-time simulations, forecasting abilities and managing operations, DT do not fall under a singular scope. This makes defining and leveraging the potential uses of DT a potential missed opportunity. Despite its recognised potential in established industries, literature on DT in the built environment remains limited. Inadequate attention has been given to the implementation of DT in construction projects, as opposed to its operational stage applications. Additionally, the absence of a standardised definition has resulted in inconsistent interpretations of DT in both industry and academia. There is a need to consolidate research to foster a unified understanding of the DT. Such consolidation is indispensable to ensure that future research is undertaken with a solid foundation. This paper aims to present a comprehensive systematic literature review on the role of DT in the built environment. To accomplish this objective, a review and thematic analysis was conducted, encompassing relevant papers from the last five years. The identified papers are categorised based on their specific areas of focus, and the content of these papers was translated into a through classification of DT. In characterising DT and the associated data processes identified, this systematic literature review has identified 6 DT opportunities specifically relevant to the built environment: Facilitating collaborative procurement methods, Supporting net-zero and decarbonization goals, Supporting Modern Methods of Construction (MMC) and off-site manufacturing (OSM), Providing increased transparency and stakeholders collaboration, Supporting complex decision making (real-time simulations and forecasting abilities) and Seamless integration with Internet of Things (IoT), data analytics and other DT. Finally, a discussion of each area of research is provided. A table of definitions of DT across the reviewed literature is provided, seeking to delineate the current state of DT implementation in the built environment context. Gaps in knowledge are identified, as well as research challenges and opportunities for further advancements in the implementation of DT within the built environment. This paper critically assesses the existing literature to identify the potential of DT applications, aiming to harness the transformative capabilities of data in the built environment. By fostering a unified comprehension of DT, this paper contributes to advancing the effective adoption and utilisation of this technology, accelerating progress towards the realisation of smart cities, decarbonisation, and other envisioned roles for DT in the construction domain.

Keywords: built environment, design, digital twins, literature review

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Authors: Getahun Lemma

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Introduction Guinea Worm Disease (GWD), also known as dracunculiasisis, is one of the oldest diseases in the history of mankind. Dracunculiasis is caused by a parasitic nematode, Dracunculus medinensis. Infection is acquired by drinking contaminated water with copepods containing infective Guinea Worm (GW) larvae). Almost one year after the infection, the worm usually emerges out through the skin on a lower, causing severe pain and disabilities. Although there is no effective drug or vaccine against the disease, the chain of transmission can be effectively prevented with simple and cost effective public health measures. Death due to dracunculiasis is very rare. However, it results in a wide range of physical, social and economic sequels. The disease is usually common in the rural, remote places of Sub-Saharan African countries among the marginalized societies. Currently, GWD is one of the neglected tropical diseases, which is on the verge of eradication. The global Guinea Worm Eradication Program (GWEP) was started in 1980. Since then, the program has achieved a tremendous success in reducing the global burden and number of GW case from 3.5 million to only 28 human cases at the end of 2018. However, it has recently been shown that not only humans can become infected, with a total of 1,105 animal infections have been reported at the end of 2018. Therefore, the objective of this study was to identify the existing challenges in the last mile of the GWEP in order To inform Policy makers and stakeholders on potential measures to finally achieve eradication. Method Systematic literature review on articles published from January 1, 2000 until May 30, 2019. Papers listed in Cochrane Library, Google Scholar, ProQuest PubMed and Web of Science databases were searched and reviewed. Results Twenty-five articles met inclusion criteria of the study and were selected for analysis. Hence, relevant data were extracted, grouped and descriptively analyzed. Results showed the main challenges complicating the last mile of global GWEP: 1. Unusual mode of transmission; 2. Rising animal Guinea Worm infection; 3. Suboptimal surveillance; 4. Insecurity; 5. Inaccessibility; 6. Inadequate safe water points; 7. Migration; 8. Poor case containment measures, 9. Ecological changes; and 10. New geographic foci of the disease. Conclusion This systematic review identified that most of the current challenges in the GWEP have been present since the start of the campaign. However, the recent change in epidemiological patterns and nature of GWD in the last remaining endemic countries illustrates a new twist in the global GWEP. Considering the complex nature of the current challenges, there seems to be a need for a more coordinated and multidisciplinary approach of GWD prevention and control measures in the last mile of the campaign. These new strategies would help to make history by eradicating dracunculiasis as the first ever parasitic disease.

Keywords: dracunculiasis, eradication program, guinea worm, last mile

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Authors: Emily C. Shepard, Caroline Sweeney, Jessica Grimm, Sophie Jacobs, Lauren Thompson, Lisa L. Weyandt

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Adolescence is a critical phase of development in which individuals are prone to more risky behavior while also facing potentially life-changing decisions. The balance of increased behavioral risk and responsibility indicates the importance of executive functioning ability. In recent years, executive function training has emerged as a technique to enhance this cognitive ability. The aim of the present systematic review was to discuss the reported efficacy of executive functioning training techniques among adolescents. After reviewing 3110 articles, a total of 24 articles were identified which examined the role of executive functioning training techniques among adolescents (age 10-19). Articles retrieved demonstrated points of comparison across psychiatric and medical diagnosis, location of training, and stage of adolescence. Typically developing samples, as well as those with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), conduct disorder, and physical health concerns were found, allowing for the comparison of the efficacy of techniques considering physical and psychological heterogeneity. Among typically developing adolescents, executive functioning training yielded nonsignificant or low effect size improvements in executive functioning, and in some cases executive functioning ability was decreased following the training. In special populations, including those with ADHD, (ASD), conduct disorder, and physical health concerns significant differences and larger effect sizes in executive functioning were seen following treatment, particularly among individuals with ADHD. Future research is needed to identify the long-term efficacy of these treatments, as well as their generalizability to real-world conditions.

Keywords: adolescence, attention-deficit hyperactivity disorder, executive function, executive function training, traumatic brain injury

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Authors: Maatouk Mohamed, Nouira Mariem, Hamdi Kbir Gh, Mahjoubi M. F., Ben Moussa M.

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Background and aim: Preoperative biliary drainage (PBD) has been introduced to lower bilirubin levels and to control the negative effects of obstructive jaundice in patients with malignant obstructive jaundice undergoing pancreaticoduodenectomy (PD). The optimal time interval between PBD and PD is still not clear. Delaying surgery by 4 to 6 weeks is the commonly accepted practice. However, delayed PD has been shown to decrease the rate of resection and adversely affect the tumor grading and prognosis. Thus, the purpose of our systematic review and meta-analysis was to evaluate the optimal period for PBD prior to PD: short or prolonged in terms of postoperative morbidity and survival outcomes. Methods: Trials were searched in PubMed, Science Direct, Google Scholar, and Cochrane Library until November 2022. Studies using PBD in patients with malignant obstructive jaundice that compared short duration group (SDG) (surgery performed within 3-4 weeks) with prolonged duration group (PDG) (at least 3-4 weeks after PBD) were included in this study. The risk of bias was assessed using the Rob v2 and Robins-I tools. The priori protocol was published in PROSPERO (ID: CRD42022381405). Results: Seven studies comprising 1625 patients (SDG 870, PDG 882) were included. All studies were non-randomized, and only one was prospective. No significant differences were observed between the SDG and PDG in mortality (OR= 0.59; 95% CI [0.30, 1.17], p=0.13), major morbidity (Chi² = 30.28, p <0.00001; I² = 87%), pancreatic fistula (Chi² = 6.61, p = 0.25); I² = 24%), post pancreatectomy haemorrhage (OR= 1.16; 95% CI [0.67, 2.01], p=0.59), positive drainage culture (OR= 0.36; 95% CI [0.10, 1.32], p=0.12), septic complications (OR= 0.78; 95% CI [0.23, 2.72], p=0.70), wound infection (OR= 0.08, p=0.07), operative time (MD= 0.21; p=0.21). Conclusion: Early surgery within 3 or 4 weeks after biliary drainage is both safe and effective. Thus, it is reasonable to suggest early surgery following PBD for patients having resectable periampullary cancers.

Keywords: preoperative biliary drainage, pancreatic cancer, pancreatic surgery, complication

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Authors: Shadreck Muchaku, Grey Magaiza, Jerit Dube

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The high insolvency rate of female-led emerging enterprises in the Southern African mountain region reflects the various vulnerabilities that exist. Although this is the case, there is a limited understanding of how these vulnerabilities influence entrepreneurship failure. This paper focuses on female entrepreneurs because of their role in economic development. Emerging female entrepreneurs in this region often operate in uncertain environments, which makes it difficult for them to thrive. The form and nature of entrepreneurial opportunities rural women of the Afro Montane region engage in are largely unsustainable as a lot of women struggle with confidence, and they need help with understanding their skills. However, there is still a gap in the existing literature on women entrepreneurship resilience and vulnerability reduction in the Afromontane. Furthermore, a major problem is the lack of empirical studies on this matter and limited studies indicating a general profile of emerging female entrepreneurs in this region. This systematic literature review attempts to fill in the gap of knowledge on entrepreneurship resilience and vulnerability reduction of emerging female entrepreneurs in the Afromontane regions and other similar precarious environments. In this review, we focus much on highlighting the nexus between entrepreneurship resilience and vulnerability reduction of emerging female entrepreneurs in academic literature through a chronological dispersal of publications in developing countries. This review adopts an ATLAS ti.22 software-based thematic analysis to analyze results obtained from reviewed academic journal articles. As research on entrepreneurship resilience and vulnerability reduction is still developing in the Sothern African mountain region, the results of this review will contribute to the body of literature and provide recommendations and a foundation for future research. This systematic review paper provides valuable insights and methodological approaches to scholarship in a nascent area of emerging female entrepreneurs in the Afromontane.

Keywords: entrepreneurship resiliency, vulnerability reduction, female entrepreneurs, mountain regions

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Authors: Luke Power, Paul O'Leary

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Research has long described the enhancement of student engagement as a fundamental aim of delivering a consistent, lifelong benefit to student success across the multitude of dimensions a quality HE (higher education) experience offers. Engagement may take many forms, with Universities and Institutes across the world attempting to define the parameters which constitutes a successful student engagement framework and implementation strategy. These efforts broadly include empowering students, encouraging involvement, and the transfer of decision-making power through a variety of methods with the goal of obtaining a meaningful partnership between students and staff. As the Republic of Ireland continues to observe an increasing population transferring directly from secondary education to HE institutions, it falls on these institutions to research and develop effective strategies which insures the growing student population have every opportunity to engage with their education, research community, and staff. This research systematically reviews SPAs (student partnership agreements) which are currently in the process of being defined, and/or have been adopted at HE institutions, worldwide. Despite the demonstrated importance of a student-staff partnership to the overall student engagement experience, there is no obvious framework or model by which to begin this process. This work will therefore provide a novel analysis of student-staff agreements which will focus on examining the factors of success common to each and builds towards a workable and applicable framework using critical review, analysis of the key words, phraseology, student involvement, and the broadly applicable HE traits and values. Following the analysis, this work proposes SPA ‘toolkit’ with input from key stakeholders such as students, staff, faculty, and alumni. The resulting implications for future research and the lessons learned from the development and implementation of the SPA will aid the systematic implementation of student-staff agreements in Ireland and beyond.

Keywords: student engagement, student partnership agreements, student-staff partnerships, higher education, systematic review, democratising students, empowering students, student unions

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Authors: Debora Caetano Dahas

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In ‘Ethics’ and in ‘A Political Treatise’ Spinoza presents his very influential take on natural law and the principles that guide his philosophical work and observations. Spinoza’s ideas about rationalization, God, and ethical behavior are undeniably relevant to many debates in the field of legal theory. In addition, it is important to note that Spinoza's takes on body, mind, and imagination played an important role in building a certain way of understanding the female figure in western societies and of their differences in regards to the male figure. It is important to emphasize that the constant and insistent presentation of women as inferior and irrational beings corroborates the institutionalization of discriminatory public policies and practices legitimized by the legal system that cooperates with the aggravation of gender inequalities. Therefore, his arguments in relation to women and their nature have been highly criticized, especially by feminist theorists during the second half of the 21st century. The questioning of this traditional philosophy –often phallocentric– and its way of describing women as irrational and less capable than men, as well as the attempt to reformulate postulates and concepts, takes place in such a way as to create a deconstruction of classical concepts. Some of the arguments developed by Spinoza, however, can serve as a basis for elucidating in what way and to what extent the social and political construction of the feminine identity served as a basis for gender inequality. Thus, based on to the observations elaborated by Moira Gantes, the present research addresses the relationship between Spinoza and the feminist demands in the juridical and political spheres, elaborating arguments that corroborate the convergence between his philosophy and feminist critical theory. Finally, this research aims to discuss how the feminists' critics of Spinoza’s writings have deconstructed and rehabilitated his principles and, in doing so, can further help to illustrate the importance of his philosophy –and, consequently, of his notes on Natural Law– in understanding gender equality as a vital part of the effective implementation of democratic debate and inclusive political participation and representation. In doing so, philosophical and legal arguments based on the feminist re-reading of Spinoza’s principles are presented and then used to explain the controversial political reform in Brazil, especially in regards to the applicability of the legislative act known as Law n. 9.504/1997 which establishes that at least 30% of legislative seats must be occupied by women.

Keywords: natural law, feminism, politics, gender equality

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Authors: Joana Margarida Bôto, Belmira Neto, Vera Miguéis, Manuela Meireles, Ada Rocha

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The Mediterranean diet has been recognized as a sustainable model of living with benefits for the environment and human health. However, a complete assessment of its sustainability, encompassing all dimensions and aspects, to our best knowledge, has not yet been realized. This systematic literature review aimed to fill this gap by identifying and describing the indicators used to assess the sustainability of the Mediterranean diet, looking at several dimensions, and presenting the results from their application. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines methodology was used, and searches were conducted in PubMed, Scopus, Web of Science, and GreenFile. There were identified thirty-two articles evaluating the sustainability of the Mediterranean diet. The environmental impact was quantified in twenty-five of these studies, the nutritional quality was evaluated in seven studies, and the daily cost of the diet was assessed in twelve studies. A total of thirty-three indicators were identified and separated by four dimensions of sustainability, specifically, the environmental dimension (ten indicators, namely carbon, water, and ecological footprint), the nutritional dimension (eight indicators, namely Health score and Nutrient Rich Food Index), the economic dimension (one indicator, the dietary cost), the sociocultural dimension (six indicators – with no results). Only eight of the studies used combined indicators. The Mediterranean diet was considered in all articles as a sustainable dietary pattern with a lower impact than Western diets. The carbon footprint ranged between 0.9 and 6.88 kg CO₂/d per capita, the water footprint between 600 and 5280 m³/d per capita, and the ecological footprint between 2.8 and 53.42 m²/d per capita. The nutritional quality was high, obtaining 122 points using the Health score and 12.95 to 90.6 points using the Nutrient Rich Food Index. The cost of the Mediterranean diet did not significantly differ from other diets and varied between 3.33 and 14.42€/d per capita. A diverse approach to evaluating the sustainability of the Mediterranean diet was found.

Keywords: Mediterranean diet, sustainability, environmental indicators, nutritional indicators

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Authors: Perpetual Onyejelem, Kenichi Matsui

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Solid waste management has recently posed urgent challenges to environmental sustainability and public health in emerging Sub-Saharan urban centers. This paper examines solid waste management in Port Harcourt, the rapidly growing city in Nigeria, with a focus on current solid waste management practices and its health implications. To do so we analyzed past academic papers and official documents. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and its four-stage inclusion/exclusion criteria were utilized as part of a systematic literature review technique to identify papers related to solid waste management practices (Scopus and Google Scholar). In terms of policy documents, we focused on information about the implementation between 2014 and 2023. We found that the Rivers State Waste Management Policy and the National Policy on Solid Waste Management were the two most important documents to understand Port Harcourt’s practices. Past studies, however, highlighted that residents continued to dump waste in drainages as they were largely unaware of the policies that encourage them to sort waste. The studies tend to blame the city of its lack of political commitment to monitoring waste sites. Another study highlighted inefficient waste collection practices, the absence of community participation and poor resident awareness of 3R practices. Government documents and past studies tend to agree that an increase in disorderly waste management practices and the emergence of vector-borne diseases (e.g., malaria, lassa fever, cholera) co-incided in Port Harcourt. This led to increased spending for healthcare for locals, particularly low-income households. This study concludes by making some remedial recommendations.

Keywords: health effects, solid waste management practices, environmental pollution, Port Harcourt

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Authors: Modi Alsubaie, Willem Kuyken, Rebecca Abbott, Barnaby Dunn, Chris Dickens, Tina Keil, William Henley

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Background: Recently, there has been an increased interest in studying the effects of mindfulness-based interventions for people with psychological and physical problems. However, the mechanisms of action in these interventions that lead to beneficial physical and psychological outcomes have yet to be clearly identified. Purpose: The aim of this paper is to review, systematically, the evidence to date on the mechanisms of action in mindfulness interventions in populations with physical and/or psychological conditions. Method: Searches of seven databases (PsycINFO, Medline (Ovid), Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, AMED, ClinicalTrials.gov) were undertaken in June 2014 and July 2015. We evaluated to what extent the studies we identified met the criteria suggested by Kazdin for establishing mechanisms of action within a psychological treatment (2007, 2009). Results: We identified four trials examining mechanisms of mindfulness interventions in those with comorbid psychological and physical health problems and 14 in those with psychological conditions. These studies examined a diverse range of potential mechanisms, including mindfulness and rumination. Of these candidate mechanisms, the most consistent finding was that greater self-reported change in mindfulness mediated superior clinical outcomes. However, very few studies fully met the Kazdin criteria for examining treatment mechanisms. Conclusion: There was evidence that global changes in mindfulness are linked to better outcomes. This evidence pertained more to interventions targeting psychological rather than physical health conditions. While there is promising evidence that MBCT/MBSR intervention effects are mediated by hypothesised mechanisms, there is a lack of methodological rigour in the field of testing mechanisms of action for both MBCT and MBSR, which precludes definitive conclusions.

Keywords: MBCT, MBSR, mechanisms, physical conditions, psychological conditions, systematic review

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Authors: Mohamed Abdelmongy

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Autologous Blood for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review and Meta-analysis Hossam Zein1,2, Ammar Ismail1,3, Mohamed Abdelmongy1,4, Sherif Elsherif1,5,6, Ahmad Hassanen1,4, Basma Muhammad2, Fathy Assaf1,3, Ahmed Elsehili1,7, Ahmed Negida1,7, Shin Yamane9, Mohamed M. Abdel-Daim8,9 and Kazuaki Kadonosono9 https://www.ncbi.nlm.nih.gov/pubmed/30277146 BACKGROUND: Pterygium is a benign ocular lesion characterized by triangular fibrovascular growth of conjunctival tissue over the cornea. Patients complain of the bad cosmetic appearance, ocular surface irritation and decreased visual acuity if the pterygium is large enough to cause astigmatism or encroach on the pupil. The definitive treatment of pterygium is surgical removal. However, outcomes are compromised by recurrence . The aim of the current study is to systematically review the current literature to explore the efficacy and safety of fibrin glue, suture and autologous blood coagulum for conjunctivalautograft fixation in primary pterygium surgery. OBJECTIVES: To assess the effectiveness of fibrin glue compared to sutures and autologous blood coagulum in conjunctival autografting for the surgical treatment of pterygium. METHODS: During preparing this manuscript, we followed the steps adequately illustrated in the Cochrane Handbook for Systematic Reviews of Interventions version 5.3, and reported it according to the preferred reporting of systematic review and meta-analysis (PRISMA) statement guidelines. We searched PubMed, Ovid (both through Medline), ISI Web of Science, and Cochrane Central Register of Controlled Trials (Central) through January 2017, using the following keywords “Pterygium AND (blood OR glue OR suture)” SELECTION CRITERIA: We included all randomized controlled trials (RCTs) that met the following criteria: 1) comparing autologous blood vs fibrin glue for conjunctivalautograft fixation in primary pterygium surgery 2) comparing autologous blood vs sutures for conjunctivalautograft fixation in primary pterygium surgery DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed trial quality, and extracted data using standard methodological procedures expected by Cochrane. The extracted data included A) study design, sample size, and main findings, B) Baseline characteristics of patients included in this review including their age, sex, pterygium site and grade, and graft size. C) Study outcomes comprising 1) primary outcomes: recurrence rate 2) secondary outcomes: graft stability outcomes (graft retraction, graft displacement), operation time (min) and postoperative symptoms (pain, discomfort, foreign body sensation, tearing) MAIN RESULTS: We included 7 RCTs and The review included662eyes (Blood: 293; Glue: 198; Suture: 171). we assess the 1) primary outcomes: recurrence rate 2) secondary outcomes: graft stability outcomes (graft retraction, graft displacement), operation time (min) and postoperative symptoms (pain, discomfort, foreign body sensation, tearing) CONCLUSIONS: Autologous blood for conjunctivalautograft fixation in pterygium surgery is associated with lower graft stability than fibrin glue or sutures. It was not inferior to fibrin glue or sutures regarding recurrence rate. The overall quality of evidence is low. Further well designed RCTs are needed to fully explore the efficacy of this new technique.

Keywords: pterygium, autograft, ophthalmology, cornea

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Authors: Franziska Mais, Till Gramberg

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The paper presents the development of a sustainable business model for a platform-based application tailored for sawing companies in small and medium-sized enterprises (SMEs). The focus is on the integration of sustainability principles into the design of the business model to ensure a technologically advanced, legally sound, and economically efficient solution. Easy2IoT is a research project that aims to enable companies in the prefabrication sheet metal and sheet metal processing industry to enter the Industrial Internet of Things (IIoT) with a low-threshold and cost-effective approach. The methodological approach of Easy2IoT includes an in-depth requirements analysis and customer interviews with stakeholders along the value chain. Based on these insights, actions, requirements, and potential solutions for smart services are derived. The structuring of the business ecosystem within the application plays a central role, whereby the roles of the partners, the management of the IT infrastructure and services, as well as the design of a sustainable operator model are considered. The business model is developed using the value proposition canvas, whereby a detailed analysis of the requirements for the business model is carried out, taking sustainability into account. This includes coordination with the business model patterns, according to Gassmann, and integration into a business model canvas for the Easy2IoT product. Potential obstacles and problems are identified and evaluated in order to formulate a comprehensive and sustainable business model. In addition, sustainable payment models and distribution channels are developed. In summary, the article offers a well-founded insight into the systematic development of a sustainable business model for platform-based applications in SME sawmills, with a particular focus on the synergy of ecological responsibility and economic efficiency.

Keywords: business model, sustainable business model, IIoT, IIoT-platform, industrie 4.0, big data

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Authors: Vivian W. L. Tsang, Karen Lockhart, Samuel Spiegel, Annalee Yassi

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Background: Workers in the informal economy often incur exposure to well-documented occupational health hazards. Insufficient attention has been afforded to rigorously evaluating intervention programs to reduce the risks, especially in artisanal and small-scale gold mining (ASGM). Objectives: This systematic review, conducted as part of the World Health Organization’s Global Plan of Action for Workers’ Health, sought to assess the state of knowledge on occupational health programs and interventions for the informal artisanal and small-scale gold mining (ASGM) sector, an occupation which directly employs at least 50 million people. Methods: We used a comprehensive search strategy for four well-known databases relevant to health outcomes: PubMed, Engineering Village, OVID Medline, and Web of Science, and employed the PRISMA framework for our analysis. Findings: Ten studies met the inclusion criteria of a primary study focused on assessing the impact of interventions addressing occupational health concerns in ASGM. There were no studies evaluating or even identifying comprehensive occupational health and safety programs for this sector, although target interventions addressing specific hazards exist. Major areas of intervention –education and introduction of mercury-reducing/eliminating technology were identified, and the challenges and limitations of each intervention taken into the assessment. Even for these, however, there was a lack of standardization for measuring outcome or impact, let alone long-term health outcomes for miners and mining communities. Conclusion: There is an urgent need for research on comprehensive occupational health programs addressing the array of hazards faced by artisanal and small-scale miners.

Keywords: informal economy, artisanal and small-scale gold mining, occupational health, health and safety, workplace safety

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Authors: Naif A. Haddad

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Greek, Hellenistic and Roman theatre heritage are exposed to multiple risks at varied times or simultaneously. There is no single reason why a theatre building becomes ‘at risk’, as each case has different circumstances which have led to the theatre building decay. There are complicated processes of destruction and distress that show divergence in theatre building materials' decay. Theatre modern use for cultural performances causes much of the risks concerning the physical structure and authenticity of theatre sites. In addition, there are some deterioration and deformations due to previous poor quality restorations and interventions through related excavation and conservation programmes as also risks to authenticity due to new additions. For preventive conservation, theatre natural and anthropogenic risks management can provide a framework for decision making. These risks to ancient theatre heritage may stem from exposure to one or more risk or synergy of many factors. We, therefore, need to link the theatre natural risks to the risks that come from anthropogenic factors associated with social and economic development. However, this requires a holistic approach, and systematic methodology for understanding these risks from various sources while incorporating specific actions, planning and strategies for each specific risk. Elaborating on recent relevant studies, and ERATO and ATHENA EU projects for ancient theaters and odea and general surveys, this paper attempts to discuss the main aspects of the ancient Greek, Hellenistic and Roman theatres risk related issues. Relevant case studies shall also be discussed and investigated to examine frameworks for risk mitigation, and related guidelines and recommendations that provide a systematic approach for sustainable management and planning in relation mainly to ‘compatible use’ of theatre sites.

Keywords: cultural heritage management, European ancient theatres projects, Anthropogenic risks mitigation, sustainable management and planning, preventive conservation, modern use, compatible use

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Authors: Janet Modu, Jean-Francois Georgin, Laurent Briancon, Eric Antoinet

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The current practice during the repowering phase of wind turbines is deconstruction of existing foundations and construction of new foundations to accept larger wind loads or once the foundations have reached the end of their service lives. The ongoing research project FUI25 FEDRE (Fondations d’Eoliennes Durables et REpowering) therefore serves to propose scalable wind turbine foundation designs to allow reuse of the existing foundations. To undertake this research, numerical models and laboratory-scale models are currently being utilized and implemented in the GEOMAS laboratory at INSA Lyon following instrumentation of a reference wind turbine situated in the Northern part of France. Sensors placed within both the foundation and the underlying soil monitor the evolution of stresses from the foundation’s early age to stresses during service. The results from the instrumentation form the basis of validation for both the laboratory and numerical works conducted throughout the project duration. The study currently focuses on the effect of coupled mechanisms (Thermal-Hydro-Mechanical-Chemical) that induce stress during the early age of the reinforced concrete foundation, and scale factor considerations in the replication of the reference wind turbine foundation at laboratory-scale. Using THMC 3D models on COMSOL Multi-physics software, the numerical analysis performed on both the laboratory-scale and the full-scale foundations simulate the thermal deformation, hydration, shrinkage (desiccation and autogenous) and creep so as to predict the initial damage caused by internal processes during concrete setting and hardening. Results show a prominent effect of early age properties on the damage potential in full-scale wind turbine foundations. However, a prediction of the damage potential at laboratory scale shows significant differences in early age stresses in comparison to the full-scale model depending on the spatial position in the foundation. In addition to the well-known size effect phenomenon, these differences may contribute to inaccuracies encountered when predicting ultimate deformations of the on-site foundation using laboratory scale models.

Keywords: cement hydration, early age behavior, reinforced concrete, shrinkage, THMC 3D models, wind turbines

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Authors: Mahsa Tavakoli, Seyed Mohammad Hojjati, Yahya Kooch

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In this study, the effect of coal mining activities on lead and cadmium concentrations and distribution in soil was investigated in Hyrcanian forest, North Iran. 16 plots (20×20 m²) were established by systematic-randomly (60×60 m²) in an area of 4 ha (200×200 m²-mine entrance placed at center). An area adjacent to the mine was not affected by the mining activity; considered as the controlled area. In order to investigate soil lead and cadmium concentration, one sample was taken from the 0-10 cm in each plot. To study the spatial pattern of soil properties and lead and cadmium concentrations in the mining area, an area of 80×80m² (the mine as the center) was considered and 80 soil samples were systematic-randomly taken (10 m intervals). Geostatistical analysis was performed via Kriging method and GS⁺ software (version 5.1). In order to estimate the impact of coal mining activities on soil quality, pollution index was measured. Lead and cadmium concentrations were significantly higher in mine area (Pb: 10.97±0.30, Cd: 184.47±6.26 mg.kg^-1) in comparison to control area (Pb: 9.42±0.17, Cd: 131.71±15.77 mg.kg^-1). The mean values of the PI index indicate that Pb (1.16) and Cd (1.77) presented slightly polluted. Results of the NIPI index showed that Pb (1.44) and Cd (2.52) presented slight pollution and moderate pollution respectively. Results of variography and kriging method showed that it is possible to prepare interpolation maps of lead and cadmium around the mining areas in Hyrcanian forest. According to results of pollution and risk assessments, forest soil was contaminated by heavy metals (lead and cadmium); therefore, using reclamation and remediation techniques in these areas is necessary.

Keywords: traditional coal mining, heavy metals, pollution indicators, geostatistics, Caspian forest

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Authors: Nuo Xu, Sijing Chen

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Background: Childbirth is considered a critical traumatic event throughout our lives, positively or negatively impacting the mother's physiology, psychology, and even the whole family. Adverse birth experiences, such as labor pain, anxiety, and fear can negatively impact the mother. Studies had shown that the immersive nature of VR can distract attention from pain and increase focus on interventions for pain relief. However, the existing studies that applied VR to maternal delivery were still in their infancy and showed disparate results, and the small sample size is not representative, so this review analyzed the effects of VR in labor, such as on maternal pain and anxiety, with a view to providing a basis for future applications. Search strategy: We searched Pubmed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wan-Fang database from the building to November 17, 2021. Selection Criteria: Randomized controlled trials (RCTs) that intervened the pregnant women aged 18-35 years with gestational >34 weeks and without complications with VR technology were contained within this review. Data Collection and Analysis: Two researchers completed the study selection, data extraction, and assessment of study quality. For quantitative data we used MD or SMD, and RR (risk ratio) for qualitative data. Random-effects model and 95% confidence interval (95% CI) were used. Main Results: 12 studies were included. Using VR could relieve pain during labor (MD=-1.81, 95% CI (-2.04, -1.57), P< 0.00001) and active period (SMD=-0.41, 95% CI (-0.68, -0.14), P= 0.003), reduce anxiety (SMD=-1.39, 95% CI (-1.99, -0.78), P< 0.00001) and improve satisfaction (RR = 1.32; 95% CI (1.10, 1.59); P = 0.003), but the effect on the duration of first (SMD=-1.12, 95% CI (-2.38, 0.13), P=0.08) and second (SMD=-0.22, 95% CI (-0.67, 0.24), P=0.35) stage of labor was not statistically significant. Conclusions: Compared with conventional care, VR technology can relieve labor pain and anxiety and improve satisfaction. However, extensive experimental validation is still needed.

Keywords: virtual reality, delivery, labor pain, anxiety, meta-analysis, systematic review

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Authors: Despoina Andrioti Bygvraa, Ida-Maja Hassellöv, George Charalambous

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Exhaust gas cleaning systems, also known as scrubbers, are today widely used to allow for the use of High Sulphur Heavy Fuel Oil and still comply with the regulations limiting sulphur content in marine fuels. There are extensive concerns about environmental consequences, especially in the Baltic Sea, from the wide-scale use of scrubbers, as the wash water is acidic (ca pH 3) and contains high concentrations of toxic, carcinogenic, and mutagenic substances. The aim of this feasibility study is to investigate the potential adverse effects on seafarers’ health with the ultimate goal of raising awareness of chemical-related health and safety issues in the shipping environment. The project got funding from the Swedish Foundation. The team will extend previously compiled data on scrubber wash water concentrations of hazardous substances and pH to include the use of strong base in closed-loop scrubbers, and scoping assessment on handling and disposing practices. Based on the findings (a), a systematic review of risk assessment will follow to show the risk of exposures, the establishment of the hazardous levels for human health as well as the respective prevention practices. In addition, the researchers will perform (b) a systematic review to identify facilitators and barriers of the crew on compliance with the safe handling of chemicals. The study will run for 12 months, delivering (a) a risk assessment inventory with risk exposures and (b) a course description of safe handling practices. This feasibility study could provide valuable knowledge on how pollutants found in scrubbers should be considered from a human health perspective to facilitate evidence-based informed decisions in future technology- and policy development to make shipping a safer, healthier, and more attractive workplace.

Keywords: health and safety, seafarers, scrubbers, chemicals, risk exposures

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Authors: Siddarth Kannan

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Objectives: Deep Brain Stimulation (DBS) and Motor Cortex stimulation (MCS) are innovative interventions in order to treat various neuropathic pain disorders such as post-stroke pain. While each treatment has a varying degree of success in managing pain, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesised. The aim of this study was to compare the effect of pain relief offered by MCS and DBS on patients with post-stroke pain and to assess if either of these procedures offered better results. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to June 2023 were included (last search date 25 June 2023). Meta-analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using the Visual Analogue Scale (VAS). Data analysis of descriptive statistics was performed using SPSS (Version 27; IBM; Armonk; NY; USA). R statistics (Rstudio Version 4.0.1) was used to perform meta-analysis. Results: Of the 478 articles identified, 27 were included in the analysis (232 patients- 117 DBS & 115 MCS). The pooled number of patients who improved after DBS was 0.68 (95% CI, 0.57-0.77, I2=36%). The pooled number of patients who improved after MCS was 0.72 (95% CI, 0.62-0.80, I2=59%). Further sensitivity analysis was done to include only studies with a minimum of 5 patients in order to assess if there was any impact on the overall results. Nine studies each for DBS and MCS met these criteria. There seemed to be no significant difference in results. Conclusions: The use of surgical interventions such as DBS and MCS is an upcoming field for the treatment of post-stroke pain, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done in order to determine the appropriate surgical intervention for post-stroke pain.

Keywords: post-stroke pain, deep brain stimulation, motor cortex stimulation, pain relief

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