Search results for: primary psychiatric diagnosis

Authors: Mohammad H. Taheri, David J. Brown, Nasser Sherkat

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Engagement is one of the most important factors in determining successful outcomes and deep learning in students. Existing approaches to detect student engagement involve periodic human observations that are subject to inter-rater reliability. Our solution uses real-time multimodal multisensor data labeled by objective performance outcomes to infer the engagement of students. The study involves four students with a combined diagnosis of cerebral palsy and a learning disability who took part in a 3-month trial over 59 sessions. Multimodal multisensor data were collected while they participated in a continuous performance test. Eye gaze, electroencephalogram, body pose, and interaction data were used to create a model of student engagement through objective labeling from the continuous performance test outcomes. In order to achieve this, a type of continuous performance test is introduced, the Seek-X type. Nine features were extracted including high-level handpicked compound features. Using leave-one-out cross-validation, a series of different machine learning approaches were evaluated. Overall, the random forest classification approach achieved the best classification results. Using random forest, 93.3% classification for engagement and 42.9% accuracy for disengagement were achieved. We compared these results to outcomes from different models: AdaBoost, decision tree, k-Nearest Neighbor, naïve Bayes, neural network, and support vector machine. We showed that using a multisensor approach achieved higher accuracy than using features from any reduced set of sensors. We found that using high-level handpicked features can improve the classification accuracy in every sensor mode. Our approach is robust to both sensor fallout and occlusions. The single most important sensor feature to the classification of engagement and distraction was shown to be eye gaze. It has been shown that we can accurately predict the level of engagement of students with learning disabilities in a real-time approach that is not subject to inter-rater reliability, human observation or reliant on a single mode of sensor input. This will help teachers design interventions for a heterogeneous group of students, where teachers cannot possibly attend to each of their individual needs. Our approach can be used to identify those with the greatest learning challenges so that all students are supported to reach their full potential.

Keywords: affective computing in education, affect detection, continuous performance test, engagement, flow, HCI, interaction, learning disabilities, machine learning, multimodal, multisensor, physiological sensors, student engagement

Procedia PDF Downloads 94

Authors: Mahnaz Zarein, Hamed Shoorei

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Background: Malathion is one of the most toxic agents widely used in agriculture throughout the world. This agent has adverse effects on the functions of multiple organs such as the reproductive system in both male and female genders. On the one hand, daily use of antioxidant supplementations such as hesperidin is capable to neutralize the deleterious impacts of malathion. Therefore, in this experimental study, the protective effects of hesperidin against ovarian toxicity induced by malathion were investigated. Material & Methods: Balb/c adult mice (n=32) were randomly divided into 4 groups including 1) the control group, treated with normal saline, 2) the Mal group, treated with 30mg/kg malathion, daily for 1 month, 3) Mal + Hes group, treated with 20 mg/kg malathion and 20 mg/kg hesperidin, daily for 1 month, and 5) Hes group, treated with 20 mg/kg hesperidin. At the end of the experimental period, mice were anesthetized and their drops of blood were collected to the assessment of some hormones such as LH, FSH, E2, and P4. Also, the right ovaries were used to H&E staining, and the left ovaries were used for IHC staining (PCNA and FSHR). Results: Histopathological assessments showed that the number of follicles, i.e. primordial, primary, and secondary, significantly decreased, while the atretic follicle counts remarkably increased compared to the control group (p<0.05). Hormonal levels revealed that the production of all mentioned hormones decreased in the Mal group in comparison with the control group (p<0.05). The expression of PCNA, as a proliferative marker, and FHSR, as a marker showing maturation, decreased when mice received malathion compared to the control group (p<0.05). Interestingly, treatment with hesperidin significantly neutralized the adverse effects of malathion on all mentioned parameters. Conclusion: Daily use of antioxidant supplementations such as hesperidin could alleviate the ovarian toxicity induced by malathion.

Keywords: malathion, ovary, antioxidant hesperidin, FSHR PCNA, ovary

Procedia PDF Downloads 75

Authors: Lutendo Nendauni

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Colonialism breaks things, colonisers exploded native cultural solidarity, producing the spiritual confusion, psychic wounding, and economic exploitation of a new and dominated ‘other’. Colonialism as the cultural and economic exploitation began when the West defended in their seizure of foreign territories for the exploitation of its natural resources; this resulted in brutal socio-economic imbalances. The Western profited at the detriment of the weak Africa. However, colonialism has since passed, but the effects are still evident culturally, socially, and economically. This paper explored how postcolonial writers and critics attempt to reverse the socio-economic imbalances resulting from the fragmentation of colonialism, with a focus on the play 'I will Marry When I Want' by Ngugi wa Thiong’o and Ngugi wa Mirii, as a primary text. Using qualitative discourse-textual analysis as the research methodology, the researcher purposively extracts discourse segments from the text for analysis and interpretation. The findings reveal that Postcolonial critics and writers attempt to reverse the socio-economic effects of colonialism through various counter discourses; their literature is concerned with the destruction of colonised identity, the search for this identity, and its assertion. It is manifest in the text that writers offer corrective views about Africans; they stress that they write their literary texts to conscientise their fellow Africans. Postcolonial writers and critics argue that language is a carrier of culture and that the only way to break free from colonial influence is by not adopting a foreign language. They further through their poems, novels, plays, and music strategically shine the spotlight on the previously nameless and destitute people so that they can develop the human spirit’s desire to overcome defeat, socio-political deprivation, and isolation.

Keywords: colonialism, postcoloniality, critics, socio-economic imbalances

Procedia PDF Downloads 157

Authors: I. Gupta, B. Karmakar

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Bengal has a long history (8^th century A.D. onwards) of decorating the wall of brick-built temples with curved terracotta plaques on a diverse range of subjects. These could be considered as one of the most significant visual archives to understand the various facets of the then contemporary societies. The temples under focus include Char-bangla temple complex (circa 1755 A.D.), Bhavanishvara temple (circa 1755 A.D.) and the Gangeshvara Shiva Jor-bangla temple (circa 1753 A.D.), located within a part of the river Bhagirathi basin in Baranagar, Murshidabad, West Bengal, India. Though, a diverse range of subjects have been intricately carved mainly on the front façades of the Baranagar temple cluster, the study specifically concentrates on depictions related to religious and non-religious acts performed by practitioners of various religious sects of late medieval Bengal with the intention to acquire knowledge about the various facets of their life. Apart from this, the paper also mapped the spatial location of these religious performers on the temples’ façades to examine if any systematic plan or arrangement had been employed for connoting a particular idea. Further, an attempt is made to provide a commentary on the attire worn by followers of various religious sects of late medieval Bengal. The primary materials for the study comprise the depictions which denote religious activities carved on the terracotta plaques. The secondary material has been collected from published and unpublished theses, journals and books. These data have been further supplemented with photographic documentation, some useful line-drawings and descriptions in table format to get a clear understanding of the concerned issues.

Keywords: attire, scheme of allocation, terracotta temple, various religious sect

Procedia PDF Downloads 138

Authors: Maria Lucia G. Lourenco, Keylla H. N. P. Pereira, Vivane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Neonatal sepsis is a systemic response to the acute generalized infection caused by one or more bacterial agents, representing the main infectious cause of neonatal mortality in dogs during the first three weeks of life. This study aims to describe the incidence of sepsis in neonate dogs, as well as the main clinical signs and mortality rates. The study included 735 neonates admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, between January 2018 and November 2019. Seven hundred thirty-five neonates, 14% (98/703) presented neonatal sepsis. The main sources of infection for the neonates were intrauterine (72.5%, 71/98), lactogenic (13.2%, 13/98), umbilical (5.1%, 5/98) and unidentified sources (9.2%, 9/98). The main non-specific clinical signs observed in the newborns were weakness, depression, impaired or absent reflexes, hypothermia, hypoglycemia, dehydration, reduced muscle tonus and diarrhea. The newborns also manifested clinical signs of severe infection, such as hyperemia in the abdominal and anal regions, omphalitis, hematuria, abdomen and extremities with purplish-blue coloration necrosing injuries in the pads, bradycardia, dyspnea, epistaxis, hypotension and evolution to septic shock. Infections acquired during intrauterine life led to the onset of the clinical signs at the time of birth, with fast evolution during the first hours of life. On the other hand, infections acquired via milk or umbilical cord presented clinical signs later. The total mortality rate was 5.4% (38/703) and the mortality rate among the neonates with sepsis was 38.7% (38/98). The early mortality rate (0 to 2 days) accounted for 86.9% (33/38) and the late mortality rate (3 to 30 days) for 13.1% (5/38) of the deaths among the newborns with sepsis. The main bacterial agents observed were Staphylococcus spp., Streptococcus spp., Proteus spp. Mannheimia spp. and Escherichia coli. Neonatal sepsis evolves quickly and may lead to high mortality in a litter. The prognosis is usually favorable if the diagnosis is reached early and the antibiotic therapy instituted as soon as possible, even before the results of blood cultures and antibiograms. The therapeutic recommendations should meet the special physiological conditions of a neonate in terms of metabolism and excretion of medication. Therefore, it is of utmost importance that the veterinarian is knowledgeable regarding neonatology to provide effective intervention and improve the survival rates of these patients.

Keywords: Neonatal infection , bacteria, puppies, newborn

Procedia PDF Downloads 115

Authors: Jae-Ho Jang, Jung-Soo Kim, Byung-Jun Kim, Dae-Geun Nam, Uoo-Chang Jung, Yoon-Suk Choi

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Low alloy steels are widely used for pressure vessels, spent fuel storage, and steam generators required to withstand the internal pressure and prevent unexpected failure in nuclear power plants, which these may suffer embrittlement by high levels of radiation and heat for a long period. Therefore, it is important to improve mechanical properties of low alloy steels for the integrity of structure materials at an early stage of fabrication. Recently, it showed that a double austenitizing and tempering (DTA) process resulted in a significant improvement of strength and toughness by refinement of prior austenite grains. In this study, it was investigated that the mechanism of improving mechanical properties according to the change of microstructure by the second fully austenitizing temperature of the DAT process for low alloy steel required the structural integrity. Compared to conventional single austenitizing and tempering (SAT) process, the tensile elongation properties have improved about 5%, DBTTs have obtained result in reduction of about -65℃, and grain size has decreased by about 50% in the DAT process conditions. Grain refinement has crack propagation interference effect due to an increase of the grain boundaries and amount of energy absorption at low temperatures. The higher first austenitizing temperature in the DAT process, the more increase the spheroidized carbides and strengthening the effect of fine precipitates in the ferrite grain. The area ratio of the dimple in the transition area has increased by proportion to the effect of spheroidized carbides. This may the primary mechanisms that can improve low-temperature toughness and elongation while maintaining a similar hardness and strength.

Keywords: double austenitizing, Ductile Brittle transition temperature, grain refinement, heat treatment, low alloy steel, low-temperature toughness

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Authors: Raif Parlakkaya, Mustafa Nihat Demirci, Mehmet Nuri Salur

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Environmental pollution has detrimental effects on the quality of our life and its scope has reached such an extent that measures are being taken both at the national and international levels to reduce, prevent and mitigate its impact on social, economic and political spheres. Therefore, awareness of environmental problems has been increasing among stakeholders and accordingly among companies. It is seen that corporate reporting is expanding beyond environmental performance. Primary purpose of publishing an environmental report is to provide specific audiences with useful, meaningful information. This paper is intended to analyze the extent and qualification of environmental disclosures of Turkish publicly quoted firms and see how it varies from one sector to another. The data for the study were collected from annual activity reports of companies, listed on the corporate governance index (BIST-XKURY) of Istanbul Stock Exchange. Content analysis was the research methodology used to measure the extent of environmental disclosure. Accordingly, 2015 annual activity reports of companies that carry out business in some particular fields were acquired from Capital Market Board, websites of Public Disclosure Platform and companies’ own websites. These reports were categorized into five main aspects: Environmental policies, environmental management systems, environmental protection and conservation activities, environmental awareness and information on environmental lawsuits. Subsequently, each component was divided into several variables related to what each firm is supposed to disclose about environmental information. In this context, the nature and scope of the information disclosed on each item were assessed according to five different ways (N.I: No Information; G.E.: General Explanations; Q.E.: Qualitative Detailed Explanations; N.E.: Quantitative (numerical) Detailed Explanations; Q.&N.E.: Both Qualitative and Quantitative Explanations).

Keywords: environmental accounting, disclosure, corporate governance, content analysis

Procedia PDF Downloads 265

Authors: Ann Dashwood

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Using Standard Australian English with confidence is a cultural expectation of parents of primary school aged children who want to engage effectively with their children’s teachers and school administration. That confidence in support of their children’s learning at school is seldom experienced by parents whose first language is not English. Sharing language with competence in an intercultural environment is the common denominator for meaningful communication and engagement to occur in a school community. Experience in relevant, interactive sessions is known to enhance engagement and participation. The purpose of this paper is to identify a pedagogy for parents otherwise isolated from daily use of functional Australian cultural language learned to engage effectively in their children’s learning at school. The outcomes measure parents’ intercultural engagement with classroom teachers and attention to the school’s administrative procedures using quantitative and qualitative methods. A principled communicative task-based language learning approach, combined with intercultural communication strategies provide the theoretical base for intensive English inquiry-based learning and engagement. The quantitative analysis examines data samples collected by classroom teachers and administrators and parents’ writing samples. Interviews and observations qualitatively inform the study. Currently, significant numbers of projects are active in community centers and schools to enhance English language knowledge of parents from Language Backgrounds Other Than English (LBOTE). The study is significant to explore the effects of an intensive English pedagogy with parents of varied English language backgrounds, by targeting inquiry-based language use for social interactions in the school and wider community, specific engagement and cultural interaction with teachers and school activities and procedures.

Keywords: engagement, intercultural communication, language teaching pedagogy, LBOTE, school community

Procedia PDF Downloads 120

Authors: Ranjit Singh

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Body fat % lean body mass and body type play vital role in sports performance. A sports person who is having optional body composition can show its performance flawlessly whereas other who is not physical fit may be more prone to injury. Competitive swimming is an association of plethora of aspects like morphological, physiological, biochemical, biomechanical and psychological. The primary key of the present research is to examine the correlation among selected morphological dimensions such as height, weight, body fat%, lean body mass, somatotype and swimming performance. The present study also focused to investigate by potential deficiencies if any and to find out remedial measures to curb the training stresses. Thirty (age group 10-14 years) swimmers undergoing training under skilled and professional coaches were selected in the present study. The morphological variables and performance criterion like 50 meter swimming time and speed were calculated by using standard training methodology. Correlation coefficient among body composition, somatotype and performance variables were assessed by using standard statistical package SPSS. Mean height, weight, fat% and lean body mass of the present group is 150.97±8.68 cm, 44.0±9.34 kg., 15.97±4.42 % and 37.10±8.77 kg respectively. Somatotype of the young swimmers of this research is revealed ectomorphic mesomorph. The analysis of the results Illustrated that swimming performance is significantly correlated (p<0.05) with height, body weight, mesomorphoic component and lean body mass. Body fat is significantly and negatively correlated (p<0.05) with mesomorphic component, lean body mass and swimming speed. From this present study, it can be concluded that along with techniques and tactics other the physical attributes also play significant role in swimming performance which can help the swimmers to excel in higher level of competition and swimmers having improved morphological qualities can ultimately perform well.

Keywords: body fat, mass, mesomorphic component, somatotype

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Authors: Tatenda Manomano, Moreblessing Memory Ndonga

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In South Africa and the world over, despite an array of commendable policies to protect the rights of children, the situation on the ground indicates that HIV/AIDS continues to pose increasing challenges on the children’s’ right to education due to the death of their parents. This study sought to validate the home experiences of children that negatively impact on their right to education in South Africa with a case of HIV/AIDS orphans and vulnerable children (OVCs) in Amatole District. The study utilized a qualitative research method in collecting the feelings, views and attitudes of these children to establish the children’s home experiences. An interview guide with semi-structured questions was used to steer the one-on-one in-depth interviews with children from Parkside Primary School, Langa-Liphumile High School and one anonymous school in East London, Eastern Cape Province. 5 learners were purposively selected from each school and subjected to a one-on-one interview with the researcher. The researcher purposively selected one teacher per school, 2 members each from 3 community based organizations (CBOs) who were also subjected to a one-on-one in-depth interview. The findings indicated these negative experiences of the OVCs in their homes such as; attendance to a school was poor; academic performance was low; enrollment in schools was very low and abuse of these children was high. These researchers recommend for psychosocial support for these children to be placed in the schools; integration of HIV/AIDS programmes to target especially the OVCs; social workers should ensure that they regularly do home visits to these OVCs to establish whether the home circumstances these children are still conducive for them. It is hoped that the findings from this paper will be an asset that other researchers, policy makers, the government and NGOs/CBOs will take into consideration for the benefit of OVCs.

Keywords: orphaned and vulnerable children (OVCs), HIV, AIDS, home experiences

Procedia PDF Downloads 366

Authors: Sudhir Kumar Tewatia, Kanishck Tewatia, Anttriksh Tewatia

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Advancements in soil consolidation are discussed, and further improvements are proposed with particular reference to Tewatia’s Y-Y’ Approach, which is called the Settlement versus Rate of Settlement Approach in consolidation. A branch of calculus named Y-Y' (or y versus dy/dx) is suggested (as compared to the common X-Y', x versus dy/dx, dy/dx versus x or Newton-Leibniz branch) that solves some complicated/unsolved theoretical and practical problems in physical sciences (Physics, Chemistry, Mathematics, Biology, and allied sciences) and engineering in an amazingly simple and short manner, particularly when independent variable X is unknown and X-Y' Approach can’t be used. Complicated theoretical and practical problems in 1D, 2D, 3D Primary and Secondary consolidations with non-uniform gradual loading and irregularly shaped clays are solved with elementary school level Y-Y' Approach, and it is interesting to note that in X-Y' Approach, equations become more difficult while we move from one to three dimensions, but in Y-Y' Approach even 2D/3D equations are very simple to derive, solve, and use; rather easier sometimes. This branch of calculus will have a far-reaching impact on understanding and solving the problems in different fields of physical sciences and engineering that were hitherto unsolved or difficult to be solved by normal calculus/numerical/computer methods. Some particular cases from soil consolidation that basically creeps and diffusion equations in isolation and in combination with each other are taken for comparison with heat transfer. The Y-Y’ Approach can similarly be applied in wave equations and other fields wherever normal calculus works or fails. Soil mechanics uses mathematical analogies from other fields of physical sciences and engineering to solve theoretical and practical problems; for example, consolidation theory is a replica of the heat equation from thermodynamics with the addition of the effective stress principle. An attempt is made to give them mathematical analogies.

Keywords: calculus, clay, consolidation, creep, diffusion, heat, settlement

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Authors: Barry Majeed, Eka Febriana, Seto Julianto

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Kepulauan Seribu National Parks is a marine preservation region in Indonesia. It is located in 5°23' - 5°40' LS, 106°25' - 106°37' BT North of Jakarta City. Covered with area 107,489 ha, Kepulauan Seribu has a lot of tourism spots such as cluster islands, fringing reef and many more. Kepulauan Seribu is also nominated as Strategic Tourism Region In Indonesia (KSPN). So, these islands have a lot of potential sides more than preservation function as a national park, hence the development of sustainable geotourism. The aim of this study is for enhancing the development of eco-geotourism in Kepulauan Seribu. This study concern for three main aspect of eco-geotourism such as tourism, form and process. Study for the tourism aspect includes attractions, accommodations, tours, activities, interpretation, and planning & management in Kepulauan Seribu. Study for the form aspect focused on the carbonate platform situated between two islands. Primarily in carbonate reef such as head coral, branchy coral, platy coral that created the carbonate sequence in Kepulauan Seribu. Study for the process aspect primarily discussed the process of forming of carbonate from carbonate factory later becomes Kepulauan Seribu. Study for the regional geology of Kepulauan Seribu has been conducted and suggested that Kepulauan Seribu lithologies are mainly quarternary limestone. In this study, primary data was taken from an observation of quarternary carbonate platform between two islands from Hati Island, Macan Island, Bulat Island, Ubi Island and Kelapa Island. From this observation, the best routes for tourist have been made from Island to Island. Qualitative methods such as depth interview to the local people in purposive sampling also have been made. Finally, this study also giving education about geological site – carbonate sequence - in Kepulauan Seribu for the local wisdom so that this study can support the development of sustainable eco-geotourism in Kepulauan Seribu.

Keywords: carbonate factory, carbonate platform, geotourism, Kepulauan Seribu

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Authors: Tzu-Jung Tseng, Pei-Hsuen Han, Tsung-Hsueh Lu

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Background: Ensuring patients with ST-elevation myocardial infarction (STEMI) access to hospitals that could perform percutaneous coronary intervention (PCI) in time is an important concern of healthcare managers. One commonly used the method to assess the coverage of population access to PCI hospital is the use GIS-estimated linear distance (crow's fly distance) between the district centroid and the nearest PCI hospital. If the distance is within a given distance (such as 20 km), the entire population of that district is considered to have appropriate access to PCI. The premise of using district centroid to estimate the coverage of population resident in that district is that the people live in the district are evenly distributed. In reality, the population density is not evenly distributed within the administrative district, especially in rural districts. Fortunately, the Taiwan government released basic statistical area (on average 450 population within the area) recently, which provide us an opportunity to estimate the coverage of population access to PCI services more accurate. Objectives: We aimed in this study to compare the population covered by a give PCI hospital according to traditional administrative district versus basic statistical area. We further examined if the differences between two geographic units used would be larger in a rural area than in urban area. Method: We selected two hospitals in Tainan City for this analysis. Hospital A is in urban area, hospital B is in rural area. The population in each traditional administrative district and basic statistical area are obtained from Taiwan National Geographic Information System, Ministry of Internal Affairs. Results: Estimated population live within 20 km of hospital A and B was 1,515,846 and 323,472 according to traditional administrative district and was 1,506,325 and 428,556 according to basic statistical area. Conclusion: In urban area, the estimated access population to PCI services was similar between two geographic units. However, in rural areas, the access population would be overestimated.

Keywords: accessibility, basic statistical area, modifiable areal unit problem (MAUP), percutaneous coronary intervention (PCI)

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Authors: Neha Singh, Shristi Singh

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Accidents involving motor vehicles are more likely to cause serious injuries and fatalities. It also has a host of other perpetual issues, such as the regular loss of life and goods in accidents. To solve these issues, appropriate measures must be implemented, such as establishing an autonomous incident detection system that makes use of machine learning and artificial intelligence. In order to reduce traffic accidents, this article examines the overview of artificial intelligence and machine learning in autonomous event detection systems. The paper explores the major issues, prospective solutions, and use of artificial intelligence and machine learning in road transportation systems for minimising traffic accidents. There is a lot of discussion on additional, fresh, and developing approaches that less frequent accidents in the transportation industry. The study structured the following subtopics specifically: traffic management using machine learning and artificial intelligence and an incident detector with these two technologies. The internet of vehicles and vehicle ad hoc networks, as well as the use of wireless communication technologies like 5G wireless networks and the use of machine learning and artificial intelligence for the planning of road transportation systems, are elaborated. In addition, safety is the primary concern of road transportation. Route optimization, cargo volume forecasting, predictive fleet maintenance, real-time vehicle tracking, and traffic management, according to the review's key conclusions, are essential for ensuring the safety of road transportation networks. In addition to highlighting research trends, unanswered problems, and key research conclusions, the study also discusses the difficulties in applying artificial intelligence to road transport systems. Planning and managing the road transportation system might use the work as a resource.

Keywords: artificial intelligence, machine learning, incident detector, road transport systems, traffic management, automatic incident detection, deep learning

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Authors: Sally Naji, Julie Gwilliam

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Climate change remains a challenging matter for the human and the built environment in the 21st century, where the need to consider adaptation to climate change in the development process is paramount. However, there remains a lack of information regarding how we should prepare responses to this issue, such as through developing organized and sophisticated tools enabling the adaptation process. This study aims to build a systematic framework approach to investigate the potentials that Neighborhood Sustainability Assessment tools (NSA) might offer in enabling both the analysis of the emerging adaptive capacity to climate change. The analysis of the framework presented in this paper aims to discuss this issue in three main phases. The first part attempts to link sustainability and climate change, in the context of adaptive capacity. It is argued that in deciding to promote sustainability in the context of climate change, both the resilience and vulnerability processes become central. However, there is still a gap in the current literature regarding how the sustainable development process can respond to climate change. As well as how the resilience of practical strategies might be evaluated. It is suggested that the integration of the sustainability assessment processes with both the resilience thinking process, and vulnerability might provide important components for addressing the adaptive capacity to climate change. A critical review of existing literature is presented illustrating the current lack of work in this field, integrating these three concepts in the context of addressing the adaptive capacity to climate change. The second part aims to identify the most appropriate scale at which to address the built environment for the climate change adaptation. It is suggested that the neighborhood scale can be considered as more suitable than either the building or urban scales. It then presents the example of NSAs, and discusses the need to explore their potential role in promoting the adaptive capacity to climate change. The third part of the framework presents a comparison among three example NSAs, BREEAM Communities, LEED-ND, and CASBEE-UD. These three tools have been selected as the most developed and comprehensive assessment tools that are currently available for the neighborhood scale. This study concludes that NSAs are likely to present the basis for an organized framework to address the practical process for analyzing and yet promoting Adaptive Capacity to Climate Change. It is further argued that vulnerability (exposure & sensitivity) and resilience (Interdependence & Recovery) form essential aspects to be addressed in the future assessment of NSA’s capability to adapt to both short and long term climate change impacts. Finally, it is acknowledged that further work is now required to understand impact assessment in terms of the range of physical sectors (Water, Energy, Transportation, Building, Land Use and Ecosystems), Actor and stakeholder engagement as well as a detailed evaluation of the NSA indicators, together with a barriers diagnosis process.

Keywords: adaptive capacity, climate change, NSA tools, resilience, sustainability

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Authors: Anil Kumar Gupta, Dronadula Venkata Sai Praneeth, Brajesh Dubey, Arundhuti Devi, Suravi Kalita, Khanindra Sharma

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Increase in urbanization and industrialization have led to improve in the standard of living. However, at the same time, the challenges due to improper solid waste management are also increasing. Municipal Solid Waste management is considered as a vital step in the development of urban infrastructure. The present study focuses on developing a solid waste management plan for an urban area in a developing country. The current scenario of solid waste management practices at various urban bodies in India is summarized. Guwahati city in the northeastern part of the country and is also one of the targeted smart cities (under the governments Smart Cities program) was chosen as case study to develop and implement the solid waste management plan. The whole city was divided into various divisions and waste samples were collected according to American Society for Testing and Materials (ASTM) - D5231-92 - 2016 for each division in the city and a composite sample prepared to represent the waste from the entire city. The solid waste characterization in terms of physical and chemical which includes mainly proximate and ultimate analysis were carried out. Existing primary and secondary collection systems were studied and possibilities of enhancing the collection systems were discussed. The composition of solid waste for the overall city was found to be as: organic matters 38%, plastic 27%, paper + cardboard 15%, Textile 9%, inert 7% and others 4%. During the conference presentation, further characterization results in terms of Thermal gravimetric analysis (TGA), pH and water holding capacity will be discussed. The waste management options optimizing activities such as recycling, recovery, reuse and reduce will be presented and discussed.

Keywords: proximate, recycling, thermal gravimetric analysis (TGA), solid waste management

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Authors: Lenore Van Den Berg

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Vocabulary development is positively associated with reading development, reading comprehension, and academic achievement. It is frequently stated that South Africa is in the midst of a literacy crisis. The past 24 years since the first democratically elected government have not revolutionised the education system; rather, after various curriculum changes and continued struggles to incorporate all 11 official languages as languages of instruction, research shows that 78 per cent of South African Grade 4 learners are functionally illiterate. The study sets out to find solutions to this problem and to add to the research base on vocabulary acquisition by assessing the effect of integrating the principles of explicit, interactive vocabulary instruction, within the context of storybook reading, on Grade 1 vocabulary acquisition. Participants comprised of 69 Grade 1 English second language learners from three classes in two government primary schools. The two schools differ in socio-economic status (SES), with School A having a lower SES than School B. One Grade 1 class was randomly assigned to be the Experimental Group, while two other classes served as control groups. The intervention took place for a period of 18 weeks and consisted of 30-minute storybook reading sessions, accompanied by interactive vocabulary instruction, twice a week. The Peabody Picture Vocabulary Test IV (PPVT-IV) was the diagnostic test administered to all learners before the intervention, as a pre-test, and after the interventions as a post-test. Data regarding excising vocabulary instruction practices and approaches were also collected through classroom observations and individual, semi-structured interviews with the Experimental Group’s teacher. Findings suggest that second language storybook reading, accompanied by explicit, interactive vocabulary instruction, have a positive impact on Grade 1 vocabulary acquisition but that vocabulary teaching practices and socio-economic status also play a key role in vocabulary acquisition.

Keywords: interactive vocabulary instruction, second language vocabulary, storybook reading, vocabulary acquisition, reading development, PPVT

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Authors: Alma Gómez-Loredo, José González-Valdez, Jorge Benavides, Marco Rito-Palomares

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Fucoxanthin is a carotenoid that exerts multiple beneficial effects on human health, including antioxidant, anti-cancer, antidiabetic and anti-obesity activity; making the development of a whole process for its production and recovery an important contribution. In this work, the lab-scale production and purification of fucoxanthin in Isocrhysis galbana have been studied. In batch cultures, low light intensities (13.5 μmol/m2s) and bubble agitation were the best conditions for production of the carotenoid with product yields of up to 0.143 mg/g. After fucoxanthin ethanolic extraction from biomass and hexane partition, further recovery and purification of the carotenoid has been accomplished by means of alcohol – salt Aqueous Two-Phase System (ATPS) extraction followed by an ultrafiltration (UF) step. An ATPS comprised of ethanol and potassium phosphate (Volume Ratio (VR) =3; Tie-line Length (TLL) 60% w/w) presented a fucoxanthin recovery yield of 76.24 ± 1.60% among the studied systems and was able to remove 64.89 ± 2.64% of the carotenoid and chlorophyll pollutants. For UF, the addition of ethanol to the original recovered ethanolic ATPS stream to a final relation of 74.15% (w/w) resulted in a reduction of approximately 16% of the protein contents, increasing product purity with a recovery yield of about 63% of the compound in the permeate stream. Considering the production, extraction and primary recovery (ATPS and UF) steps, around a 45% global fucoxanthin recovery should be expected. Although other purification technologies, such as Centrifugal Partition Chromatography are able to obtain fucoxanthin recoveries of up to 83%, the process developed in the present work does not require large volumes of solvents or expensive equipment. Moreover, it has a potential for scale up to commercial scale and represents a cost-effective strategy when compared to traditional separation techniques like chromatography.

Keywords: aqueous two-phase systems, fucoxanthin, Isochrysis galbana, microalgae, ultrafiltration

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Authors: Sarieh Poortaghi, Zakiyeh Jafaryparvar, Marzieh Hasanpour, Reza Negarandeh

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Aim: This article aims to discuss how violence against health care workers especially nurses affects health care systems and the quality of care of the patients. In this paper causes of violence and strategies to reduce it have been discussed. Methods: Discourse of the literature considering the violence against nurses during the COVID-19 pandemic and its reasons and outcomes. Results: The COVID-19 pandemic has led to a significant increase in violence against healthcare providers. The attacker against nurses may be among patients, companions, visitors, colleagues such as doctors and other nurses, supervisors, and managers. Many individuals who experience violence in healthcare environments refrain from reporting it. The causes of violence against nurses include spending long periods with patients, perceiving nursing as a low-status profession, gender of nurses, direct and frequent contact with patients and their companions, inadequate facilities and high workload, weak healthcare delivery systems in public hospitals and inequality in health, nature of the department and shift type of personnel, work shifts and staff shortages, forcing nurses to work in non-standard conditions during the COVID-19 pandemic, prohibition of patient visits during the pandemic, patient death and nurses' sense of incompetence, and expressing stress through aggression. Workplace violence leads to a decrease in job satisfaction and an increase in continuous psychological stress, which has a negative impact on the personal and professional lives of nurses. Potential strategies for reducing workplace violence include protecting healthcare workers through laws, improving communication with patients and their families, critically analyzing information in social media, facilitating patient access through remote medical strategies, and improving access to primary healthcare services.

Keywords: nurses, health care workers, Covid-19, nursing

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Authors: M. Stewart, Ameer Al-Khaykan, J. M. Counsell

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Emissions are a consequence of electricity generation. A major option for low carbon generation, local energy systems featuring Combined Heat and Power with solar PV (CHPV) has significant potential to increase energy performance, increase resilience, and offer greater control of local energy prices while complementing the UK’s emissions standards and targets. Recent advances in dynamic modelling and simulation of buildings and clusters of buildings using the IDEAS framework have successfully validated a novel multi-vector (simultaneous control of both heat and electricity) approach to integrating the wide range of primary and secondary plant typical of local energy systems designs including CHP, solar PV, gas boilers, absorption chillers and thermal energy storage, and associated electrical and hot water networks, all operating under a single unified control strategy. Results from this work indicate through simulation that integrated control of thermal storage can have a pivotal role in optimizing system performance well beyond the present expectations. Environmental impact analysis and reporting of all energy systems including CHPV LES presently employ a static annual average carbon emissions intensity for grid supplied electricity. This paper focuses on establishing and validating CHPV environmental performance against conventional emissions values and assessment benchmarks to analyze emissions performance without and with an active thermal store in a notional group of non-domestic buildings. Results of this analysis are presented and discussed in context of performance validation and quantifying the reduced environmental impact of CHPV systems with active energy storage in comparison with conventional LES designs.

Keywords: CHPV, thermal storage, control, dynamic simulation

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Authors: Mahadzirah Mohamad, Nur Izzati Ab Ghani

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Worldwide, tourism sustained growth and remained to be one of the fast-growing sectors. Malaysia tourism industry experienced an unstable and declining pattern of international tourist arrival’s growth rate. The situation suggested that the industry was competitive and denoted the need to study factors that influence tourist loyalty. The primary purpose of this study was to develop a model that examined how destination image, perceived value, service quality and tourist satisfaction affect destination loyalty. The study was conducted at the Kuala Lumpur International Airport and Kota Kinabalu International Airport. The respondents were international tourists from United Kingdom and Australia and they were selected using simple random sampling method. A total of 337 respondents were subjected to data analysis using structural equation modelling. The study uncovered that perceived value and destination image was highly correlated and the model suggested that these constructs should be treated as one construct. The construct was labelled as overall destination image. Overall image had significant direct effect on service quality, satisfaction and loyalty. Service quality had a significant indirect effect on loyalty through satisfaction as a moderating variable. However, satisfaction had no mediating effect on the relationship between overall destination image and loyalty. The study suggested that more efforts should be focused on portraying the image of experiencing joy with many interesting natural scenic places to see whilst on a holiday to Malaysia. In addition, the destination management office should promote tourist visiting to Malaysia would enjoy quality service related to accommodation, information facilities, health, and shopping. Tourist satisfaction empirically proved to be an important construct that influenced destination loyalty. This study contributed to the extended knowledge that postulated overall image of a destination was measured by perceived value and destination image.

Keywords: destination image, destination loyalty, structural equation modelling, tourist satisfaction

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Authors: Adam N. Bell, Sarina J. Ergas, Michael Nystrom, Nathan P. Brennan, Kevan L. Main

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Integrated Multi-Trophic Aquaculture systems (IMTA) have the potential to improve the sustainability of seafood production, generate organic fertilizer and feed, remove waste discharges and reduce energy use. IMTA can include periphyton biofilters where algae and microbes grow on surfaces, along with caught detritus and amphipods. Periphyton biofilters provide many advantages: nitrification, denitrification, primary production and ecological diversity. The goal of this study was to determine how biofilter hydraulic residence time (τ) effects periphyton biomass production, dissolved oxygen (DO) and nutrient removal. A pilot scale recirculating aquaculture system (RAS) was designed, constructed and operated at different hydraulic residence times (τ= 1, 2, 4, 6, 8 hours per tank). For each τ, a conservative tracer study was conducted to investigate system hydrodynamics. Data on periphyton weights, pH, nitrogen species, phosphorus, temperature and DO were collected. The tracer study for τ =1 hour revealed that the normalized time < τ, indicating short-circuiting. Periphyton biomass production rate was relatively unaffected by τ (R_e<1 for all τ). Average ammonia nitrogen removal was > 75% for all trials. Nitrate and nitrite did not accumulate in the RAS for τ≥4 hours due to enhanced denitrification in anoxic zones. For τ≥4 hours DO concentration was at a maximum of 4 mg L-1 after 14:00, and decreased to 0 mg L-1 during nighttime. At τ=1 hour, the RAS stayed > 2 mg L-1 and DO was more evenly distributed. For the validation trial, the culture tank was stocked with Centropomus undecimalis (common snook) and the system was operated at τ= 1 hr. Preliminary results showed that a RAS with an integrated periphyton biofilter could support fish health with low nutrient concentrations DO > 6 mg L-1.

Keywords: sustainable aquaculture, resource recovery, nitrogen, microalgae, hydrodynamics, integrated multi-trophic aquaculture

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Authors: Astha Sinha, Anjali Kanagali

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India has been tackling with less than sophisticated legislations when it comes to recovery of debt and bankruptcy situations for a while now. There were multiple overlapping laws and adjudication forums dealing with financial failures and insolvency of companies/individuals in India without really aiding the timely recover of defaulted assets. It remained dicey for businesses to invest in India since there was a lack of legal and institutional machinery for dealing with debt defaults as per the global standards. After much deliberation, the Indian Draft Insolvency code received the presidential assent on May 28, 2016 bringing the Bankruptcy and Insolvency Code, 2016 into existence. The Code is expected to bring about great progress for the country and specifically has the two standout developments. The first is that it calls for resolution of corporate insolvency within a period of 180 days extendable by 90 days hence bringing about security in the minds of investors. Second is that it calls for the creation of a new class of insolvency professionals whose primary function shall be helping sick companies and banks with their takeovers, provides for setting up an Insolvency and Bankruptcy Board to regulate the same and provides for a two stage process of liquidation. The Code is estimated to help India move up its ranking on the World Bank’s ease of doing business index. It is currently ranked at the 130th position lower than some of the sub-saharan African countries. Besides this, however, there are various areas in which the Code falls short such as lack of provisions for aiding the issue of cross-border insolvency, impact on Medium and Small Enterprises in India etc. This paper aims to analyze the provisions of the new Bankruptcy and Insolvency Code, 2016 and its contribution in making India a more desirable location for doing business. It shall also emphasize on the cross-border insolvency issues, practices followed by other countries to resolve the same and the way forward for India to strengthen its Bankruptcy and Insolvency framework.

Keywords: bankruptcy and insolvency code 2016, cross-border insolvency provisions in the 2016 code, Ease of doing business and bankruptcy code, highlights of the new Indian bankruptcy code 2016

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Authors: Naqoosh Haidry

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Objective & Goal: Enucleation of the maxillomandibular cysts will lead to the creation of post-surgical bone defects which may take more than a year for complete bone healing. The use of bone grafts is common to aid bone regeneration in large defects. The study aimed to evaluate the healing and bone formation capabilities of polymer of injectable platelet fibrin (i-PRF) and hydroxyapatite (HA) as bone graft substitute in maxilla-mandibular postsurgical defects compared to hydroxyapatite alone. The primary objective was to find out the clinical and radiological assessment of healing postoperatively and compare the outcome of both groups. Material and Methods: After surgical enucleation of 19 maxillomandibular cysts/tumors, either HA or HA+ i-PRF graft was adapted to the defect. Clinical outcome variables such as pain (VAS score), edema, and mucosal color were evaluated on postoperative days 01, 03, and 07 while radiological outcome variables such as volume of defect (cc), density of new bone (HU) on computed tomography were evaluated at 2nd and 4th month. The results obtained were tabulated and compared with the inferential analysis. Results: Clinical parameters seem to be better in the HA + i-PRF group, but the result was non-significant. Radiologically, the mean healing ratios were significantly greater in the HA + i-PRF group (63.5 ± 2.34 at 2nd month, 90.3 ± 7.32 at 4th month) compared to the HA group (57.2 ± 5.21at 2nd month, 80.8 ± 5.33 at 4th month). When comparing the mean density of new bone, there was a statistically significant difference with a mean difference of 95.2 HU more in the HA + i-PRF (623 HU ± 42.9) compared to the HA group (528 HU ± 96.5) in 2nd month. Conclusion: The polymer of i-PRF and HA prepared as the sticky bone yields faster and better bone healing in post-enucleation maxillomandibular bony defects as compared to hydroxyapatite alone based on radiological findings till four months.

Keywords: bone defect, density of new bone, hydroxyapatite, injectable platelet rich fibrin, maxillomandibular cysts, surgical defect

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Authors: Teklay Gebrecherkos, Dawit Wolday, Muhamud Abdulkader

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Background: COVID-19 symptomatology in Africa appears significantly less serious than in the industrialized world. Our hypothesis for this phenomenon, being a different, more activated immune system due to parasite infections contributes to reduced COVID-19 outcome. We investigated this hypothesis in an endemic area in sub sub-saharan Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites, between July 2020 and March 2021. The primary outcome was the proportion of patients with severe COVID-19. SARS-CoV-2 infection was confirmed by RT-PCR on samples obtained from nasopharyngeal swabs, while direct microscopic examination, modified Ritchie concentration, and Kato-Katz methods were used to identify parasites and ova from a fresh stool sample. Ordinal logistic regression models were used to estimate the association between parasite infection and COVID-19 severity. Models were adjusted for sex, age, residence, education level, occupation, body mass index, and comorbidities. Data were analyzed using STATA version 14. P-value <0.05 was considered statistically significant. Results: A total of 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37•8%) had an intestinal parasitic infection. Only 27/255 (10•6%) severe COVID-19 patients were co-infected with intestinal parasites, while 257/496 (51•8%) non-severe COVID-19 patients appeared parasite positive (p<0.0001). Patients co-infected with parasites had lower odds of developing severe COVID-19, with an adjusted odds ratio (AOR) of 0•14 (95% CI 0•09–0•24; p<0•0001) for all parasites, AOR 0•20 ([95% CI 0•11–0•38]; p<0•0001) for protozoa, and AOR 0•13 ([95% CI 0•07–0•26]; p<0•0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolopis nana, and Schistosoma mansoni implied a lower probability of developing severe COVID-19. There were 11 deaths (1•5%), and all were among patients without parasites (p=0•009). Conclusions: Parasite co-infection is associated with a reduced risk of severe COVID-19 in African patients. Parasite-driven immunomodulatory responses may mute hyper-inflammation associated with severe COVID-19.

Keywords: COVID-19, SARS-COV-2, intestinal parasite, RT-PCR, co-infection

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Authors: Zongyao Sha

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Green vegetation plays a vital role in energy flows and matter cycles in terrestrial ecosystems, and vegetation phenology may not only be influenced by but also impose active feedback on climate changes. The phenological events of vegetation, such as the start of the season (SOS), end of the season (EOS), and length of the season (LOS), can respond to climate changes and affect gross primary productivity (GPP). Here we coupled satellite remote sensing imagery with FLUXNET observations to systematically map the shift of SOS, EOS, and LOS in global vegetated areas and explored their response to climate fluctuations and feedback on GPP during the last two decades. Results indicated that SOS advanced significantly, at an average rate of 0.19 days/year at a global scale, particularly in the northern hemisphere above the middle latitude (≥30°N) and that EOS was slightly delayed during the past two decades, resulting in prolonged LOS in 72.5% of the vegetated area. The climate factors, including seasonal temperature and precipitation, are attributed to the shifts in vegetation phenology but with a high spatial and temporal difference. The study revealed interactions between vegetation phenology and climate changes. Both temperature and precipitation affect vegetation phenology. Higher temperature as a direct consequence of global warming advanced vegetation green-up date. On the other hand, 75.9% and 20.2% of the vegetated area showed a positive correlation and significant positive correlation between annual GPP and length of vegetation growing season (LOS), likely indicating an enhancing effect on vegetation productivity and thus increased carbon uptake from the shifted vegetation phenology. Our study highlights a comprehensive view of the vegetation phenology changes of the global terrestrial ecosystems during the last two decades. The interactions between the shifted vegetation phenology and climate changes may provide useful information for better understanding the future trajectory of global climate changes. The feedback on GPP from the shifted vegetation phenology may serve as an adaptation mechanism for terrestrial ecosystems to mitigate global warming through improved carbon uptake from the atmosphere.

Keywords: vegetation phenology, growing season, NPP, correlation analysis

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Authors: Ayeshmanthe Rathnayake, Siew Goh, Carmel Fenton, Ashutosh Hardikar

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Post-Operative Atrial Fibrillation (POAF) is the most frequent complication of cardiac surgery and is associated with reduced survival, increased rates of cognitive changes and cerebrovascular accident, heart failure, renal dysfunction, infection and length of stay, and hospital costs. Cardiac tamponade, although less common, carries high morbidity and mortality. Shed mediastinal blood in the pericardial space is a major source of intrapericardial oxidative stress and inflammation that triggers POAF. The utilisation of a left posterior pericardiotomy aims to shunt blood from the pericardium into the pleural space and have a role in the prevention of POAF as well as cardiac tamponade. 2118 patients had undergone isolated Coronary Artery Bypass Graft (CABG) at Royal Hobart Hospital from 2008-2021. They were divided into pericardiotomy vs control group. Patient baseline demographics, intraoperative data, and post-operative outcomes were reviewed retrospectively. Total incidence of new POAF and cardiac tamponade was 26.1% and 0.75%, respectively. Primary outcome of both the incidence of POAF(22.9% vs27.8%OR 0.77 p<0.05) and Cardiac Tamponade (0% vs 1.1% OR 0.85 p<0.05) were less in the pericardiotomy group.Increasing age, BMI, poor left ventricular function (EF <30%), and return to theatre were independent predictors of developing POAF. There were similar rates of return to theatre for bleeding however, no cases of tamponade in the pericardiotomy group. There were no complications attributable to left posterior pericardiotomy and the time added to the duration of surgery was minimal. Left posterior pericardiotomy is associated with a significant reduction in the incidence of POAFand cardiac tamponade and issafe and efficient.

Keywords: cardiac surgery, pericardiotomy, post-operative atrial fibrillation, cardiac tamponade

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Authors: Paul J Yazaki, Michael Bouvet, John Shively

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Surgery for solid gastrointestinal (GI) cancers such as pancreatic, colorectal, and gastric adenocarcinoma remains the mainstay of curative therapy. Complete resection of the primary tumor with negative margins (R0 resection), its draining lymph nodes, and distant metastases offers the optimal surgical benefit. Real-time fluorescence guided surgery (FGS) promises to improve GI cancer outcomes and is rapidly advancing with tumor-specific antibody conjugated fluorophores that can be imaged using near infrared (NIR) technology. Carcinoembryonic Antigen (CEA) is a non-internalizing tumor antigen validated as a surface tumor marker expressed in >95% of colorectal, 80% of gastric, and 60% of pancreatic adenocarcinomas. Our humanized anti-CEA hT84.66-M5A (M5A) monoclonal antibody (mAb)was conjugated with the NHS-IRDye800CW fluorophore and shown it can rapidly and effectively NIRoptical imageorthotopically implanted human colon and pancreatic cancer in mouse models. A limitation observed is that these NIR-800 dye conjugated mAbs have a rapid clearance from the blood, leading to a narrow timeframe for FGS and requiring high doses for effective optical imaging. We developed a novel antibody-fluorophore conjugate by incorporating a PEGylated sidearm linker to shield or mask the IR800 dye’s hydrophobicity which effectively extended the agent’s blood circulation half-life leading to increased tumor sensitivity and lowered normal hepatic uptake. We hypothesized that our unique anti-CEA linked to the fluorophore, IR800 by PEGylated sidewinder, M5A-SW-IR800 will become the next generation optical imaging agent, safe, effective, and widely applicable for intraoperative image guided surgery in CEA expressing GI cancers.

Keywords: optical imaging, anti-CEA, cancer, fluorescence-guided surgery

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Authors: R. Suresh, C. B. Singh, A. K. Sarda

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Background: Over the decades, several surgical techniques have been developed to treat anal fistulas with variable success rates and complications. Large amount of work has been done in radiofrequency excision of the fistula for several years but no work has been done for ablating the tract. Therefore one can consider for obliteration ofanal fistula by Radiofrequency ablation (RFA). Material and Methods: A randomized controlled clinical trial was conducted at Lok Nayak Hospital, where a total of 40 patients were enrolled in the study and they were randomly assigned to Group I (fistulectomy)(n=20) and Group II (RFA) (n=20). Aim of the study was to compare the efficacy of RFA of fistula versus fistulectomy in the treatment of a low anal fistula and to evaluate RFA as an effective alternative to fistulectomy with respect to time taken for wound healing as primary outcome and post-operative pain, time taken to return to work as secondary outcomes. Patients with simple low anal fistulas, single internal and external opening, not more than two secondary tracts were included. Patients with high complex fistula, fistulas communicating with cavity, fistula due to condition like tuberculosis, Crohn's, malignancy were excluded from the study. Results: Both groups were comparable with respect to age, sex ratio, type of fistula. Themean healing time was significantly shorter in group II (41.02 days) than in group I(62.68 days).The mean operative time was significantly shorter in groupII (21.40 min) than in group I(28.50 min). The mean time taken to return to work was significantly shorter in group II(8.30 days)than in group I(12.01 days).There was no significant difference in the post operative hospital stay, mean postoperative pain score, wound infection and recurrence between the two groups. Conclusion: The patients who underwent RFA of fistula had shorter wound healing time, operative time and time taken to return to work when compared to those who underwent fistulectomy and therefore RFA shows outcome comparable to fistulectomy in the treatment of low anal fistula.

Keywords: fistulectomy, low anal fistula, radio frequency ablation, wound healing

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Authors: Mohamed Elkoushy, Sameer Munshi, Waseem Tayeb

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Background: Flexible ureteroscopy (fURS) has dramatically improved the minimally invasive management of complex nephrolithiasis. fUR is increasingly being used as the first-line treatment for patients with renal stones. Stone-free status (SFS) is the primary goal in the management of patients with urolithiasis. However, substantial variations exist in the reported SFS following fURS. Objectives: This study determines the predictors of SFS after a single session of fURS with holmium laser lithotripsy (HLL) for renal calculi. Methods: A retrospective review of prospectively collected data was performed for all consecutive patients undergoing fURS and HLL for renal calculi at a tertiary care center. Patients with previous ipsilateral URS for the same stones were excluded. All patients underwent JJ ureteral stent insertion at the end of the procedure. SFS was defined as the presence of no residuals or ≤4-mm non-obstructing stone and was assessed by CT/KUB imaging after 3-4 weeks post-operatively. Multivariate logistic regression was used to detect possible predictors of SFS. Results: A total of 212 patients were included with a mean age of 52.3±8.3 years and a stone burden <20 mm (49.1%), 20-30 mm (41.0%) and >30 mm (9.9%). Overall SFS after a single session of fURS was 71.7%, 92% and 52% for stones less and larger than 20 mm, respectively. Patients with stones> 20 mm need retreatment with a mean number of 1.8 (1.3-2.7) fURS. SFS was significantly associated with male gender, stone bulk <20 mm (95.7% vs. 56.2%), non-lower pole stones, hydronephrotic kidney, low stone intensity, ureteral access sheath, and preoperative stenting. SFS was associated with a lower readmission rate (5.9% vs. 38.9%) and urinary tract infections (3.8% vs. 25.9%). In multivariate regression analysis, SFS maintains its significant association with low stone burden of <20 mm (OR: 5.21), stone intensity <600 HFU (OR: 2.87), and non-lower caliceal stones (OR: 3.84). Conclusion: Best results after a single-session fURS for renal stone were obtained for the stone burden of less than 20 mm and low stone attenuation. Lower calyceal stones may influence stone clearance and need a different approach than fURS, especially for higher stone burden.

Keywords: ureteroscopy, kidney stone, lithotripsy, stone-free, predictors

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