Search results for: pathwise sensitivities

Authors: Cihat Aşan

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Istanbul Strait is a crucial and narrow waterway, not only having a role in linking two continents but also has a crossover mission for the petroleum, which is the biggest energy resource, between its supply and demand sources. Besides its substantial features, sensitivities like around 18 million populations in surroundings, military facilities, ports, oil lay down areas etc. also brings the high risk to use of Istanbul Strait. Based on the statistics of Turkish Ministry of Transportation, Maritime and Communication, although the number of vessel passage in Istanbul Strait is declining, tonnage of hazardous and flammable cargo like oil and chemical transportation is increasing and subsequently the risk of oil pollution, loss of life and property is also rising. Based on the mentioned above; it is crucial to be prepared for the initial and subsequent response to eventual ship sourced oil spill which may cause to block the Strait for an unbearable duration. In this study; preconditioned Istanbul Strait sensitive areas studies has been taken into account and possible oil spill scenario is loaded to PISCES 2 (Potential Incident Simulation Control and Evaluation System) decision support system for the determined specific sea area. Consequences of the simulation like oil expanding process, required number and types of assets to response, had in hand and evaluated.

Keywords: Istanbul strait, oil spill, PISCES simulator, initial response

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Authors: Eloise C. Tredenick, Troy W. Farrell, W. Alison Forster, Steven T. P. Psaltis

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The agriculture industry requires improved efficacy of sprays being applied to crops. More efficacious sprays provide many environmental and financial benefits. The plant leaf cuticle is known to be the main barrier to diffusion of agrochemicals within the leaf. The importance of a mathematical model to simulate uptake of agrochemicals in plant cuticles has been noted, as the results of each uptake experiments are specific to each formulation of active ingredient and plant species. In this work we develop a mathematical model and numerical simulation for the uptake of ionic agrochemicals through aqueous pores in plant cuticles. We propose a nonlinear porous diffusion model of ionic agrochemicals in isolated cuticles, which provides additions to a simple diffusion model through the incorporation of parameters capable of simulating plant species' variations, evaporation of surface droplet solutions and swelling of the aqueous pores with water. The model could feasibly be adapted to other ionic active ingredients diffusing through other plant species' cuticles. We validate our theoretical results against appropriate experimental data, discuss the key sensitivities in the model and relate theoretical predictions to appropriate physical mechanisms.

Keywords: aqueous pores, ionic active ingredient, mathematical model, plant cuticle, porous diffusion

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Authors: Nasser A. Al-Shabib

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Food allergens are most common non-native form when exposed to the immune system. Most food proteins undergo various treatments (e.g. thermal or proteolytic processing) during food manufacturing. Such treatments have the potential to impact the chemical structure of food allergens so as to convert them to more denatured or unfolded forms. The conformational changes in the proteins may affect the allergenicity of treated-allergens. However, most allergenic proteins possess high resistance against thermal modification or digestive enzymes. In the present study, ovomucoid (a major allergenic protein of egg white) was heated in phosphate-buffered saline (pH 7.4) at different temperatures, aqueous solutions and on different surfaces for various times. The results indicated that different antibody-based methods had different sensitivities in detecting the heated ovomucoid. When using one particular immunoassay‚ the immunoreactivity of ovomucoid increased rapidly after heating in water whereas immunoreactivity declined after heating in alkaline buffer (pH 10). Ovomucoid appeared more immunoreactive when dissolved in PBS (pH 7.4) and heated on a stainless steel surface. To the best of our knowledge‚ this is the first time that antibody-based methods have been applied for the detection of ovomucoid adsorbed onto different surfaces under various conditions. The results obtained suggest that use of antibodies to detect ovomucoid after food processing may be problematic. False assurance will be given with the use of inappropriate‚ non-validated immunoassays such as those available commercially as ‘Swab’ tests. A greater understanding of antibody-protein interaction after processing of a protein is required.

Keywords: ovomucoid, thermal treatment, solutions, surfaces

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Authors: Emine Yilmaz, Ismail Yilmaz, Harun Uran

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Food-borne problems have been placed among the most leading problems of the society especially in recent years. This state arises as a problem which affects the society wholly such as the supply of food stuffs that are necessary for an individual to perform his physiological and biological functions, their amount, compound, their effects on health and distribution by individuals. This study was conducted in order to determine the sensitivities and criteria of people, who have different socio-economic backgrounds and live in Süleymanpasa Town of Tekirdag City, in their preference of food stuffs. The research data were collected by means of Interview Technique with individuals within the scope of the study (300) and applying surveys with convenience sampling. According to the research results, quality appears in the first rank among the factors by which consumers are affected while buying food stuffs. Consumers stated that they try to be careful with not buying food sold outdoors. The most preferred food among the ones being sold outdoor were found to be breakfast food. Also, food stuff which consumers become the most selective for while buying was determined to be meat and meat products. Due to general knowledge about the food stuff consumed in human nutrition may affect their health negatively; consumers expressed that they are very relevant with their diets and this circumstances affects their purchase preferences.  

Keywords: consumption, food safety, consumer behaviour, purchase preferences

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Authors: Wajid Mumtaz, Aamir Saeed Malik, Syed Saad Azhar Ali, Mohd Azhar Mohd Yasin

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In this paper, a technique based on electroencephalogram (EEG) analysis is presented, aiming for diagnosing major depressive disorder (MDD) among a potential population of MDD patients and healthy controls. EEG is recognized as a clinical modality during applications such as seizure diagnosis, index for anesthesia, detection of brain death or stroke. However, its usability for psychiatric illnesses such as MDD is less studied. Therefore, in this study, for the sake of diagnosis, 2 groups of study participants were recruited, 1) MDD patients, 2) healthy people as controls. EEG data acquired from both groups were analyzed involving inter-hemispheric asymmetry and composite permutation entropy index (CPEI). To automate the process, derived quantities from EEG were utilized as inputs to classifier such as logistic regression (LR) and support vector machine (SVM). The learning of these classification models was tested with a test dataset. Their learning efficiency is provided as accuracy of classifying MDD patients from controls, their sensitivities and specificities were reported, accordingly (LR =81.7 % and SVM =81.5 %). Based on the results, it is concluded that the derived measures are indicators for diagnosing MDD from a potential population of normal controls. In addition, the results motivate further exploring other measures for the same purpose.

Keywords: major depressive disorder, diagnosis based on EEG, EEG derived features, CPEI, inter-hemispheric asymmetry

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Authors: Kusuma Urs M. B., Navakant Bhat, Vinayak B. Kamble

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Metal oxide semiconductors (MOS) are known to be excellent candidates for solid-state gas sensor devices. However, in spite of high sensitivities, their high operating temperatures and lack of selectivity is a big concern limiting their practical applications. A lot of research has been devoted so far to enhance their sensitivity and selectivity, often empirically. Some of the promising routes to achieve the same are reducing dimensionality and formation of heterostructures. These heterostructures offer improved sensitivity, selectivity even at relatively low operating temperatures compared to bare metal oxides. Thus, a combination of n-type and p-type metal oxides leads to the formation of p-n junction at the interface resulting in the diffusion of the carriers across the barrier along with the surface adsorption. In order to achieve this and to study their sensing mechanism, we have designed and lithographically fabricated a suspended nanobeam of NiO, which is a p-type semiconductor. The response of the same has been studied for various gases and is found to exhibit selective response towards hydrogen gas at room temperature. Further, the same has been radially coated with TiO₂ shell of varying thicknesses, in order to study the effect of radial p-n junction thus formed. Subsequently, efforts have been made to study the effect of shell thickness on the space charge region and to shed some light on the basic mechanism involved in gas sensing of MOS sensors.

Keywords: gas sensing, heterostructure, metal oxide semiconductor, space charge region

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Authors: Yahia Mosleh

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Both Scenedesmus obliquus and Cosmarium leave were subjected to different concentrations (5, 10, 20, 50, and 80 %) of highly polluted water collected from Haddows drainage, which receives high amount of domestic sewage, and also the increasing agriculture run off and industrial effluent, then disbursed it in El-Salam fresh water canal. The water in that canal dramatically used as drinking water alongside using in irrigation. A total of 25 physicochemical parameters were determined within the drainage polluted water and also up-stream of El-Salam fresh water canal's water. The effect of five concentrations of the tested polluted water were determined on growth density, dry algal biomass, net photosynthetic oxygen production, catalase activity and ascorbic acid content on the two algae "Scenedesmus obliquus and Cosmarium leave". The result reveal that, low concentration support the growth and the physiological activities of both algae. However, the situation is different in the case of high concentrations, where it encourage the growth of Scenedesmus obliquus , meanwhile the same concentration were inhibited the growth and physiological activities of Cosmarium leave. Which indicated that, Scenedesmus obliquus tolerated high pollution better than Cosmarium leave. Finally it can be concluded that, different organisms, however, have different sensitivities to the same pollutants and the same organisms may be more or less damaged by different pollutant. Also, the inhibitory and stimulatory effects of different species varied with concentrations.

Keywords: catalase activity, ascorbic acid content, Scenedesmus, Cosmarium, pollution, biomass

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Authors: Saeed Pourhassan, Nastaran Maghbouli

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1) Background It has been hypothesized that, in individuals with diabetes mellitus, the peripheral nerve is swollen due to sorbitol over-accumulation. Additionally growing evidence supported electro diagnostic study of diabetes induced neuropathy as a method having some challenges. 2) Objective To examine the performance of sonographic cross-sectional area (CSA) measurements in the diagnosis of diabetic polyneuropathy (DPN). 3) Data Sources Electronic databases, comprising PubMed and EMBASE and Google scholar, were searched for the appropriate studies before Jan 1, 2020. 4) Study Selection Eleven trials comparing different peripheral nerve CSA measurements between participants with and without DPN were included. 5) Data Extraction Study design, participants' demographic characteristics, diagnostic reference of DPN, and evaluated peripheral nerves and methods of CSA measurement. 6) Data Synthesis Among different peripheral nerves, Tibial nerve diagnostic odds ratios pooled from five studies (713 participants) were 4.46 (95% CI, 0.35–8.57) and the largest one with P<0.0001, I²:64%. Median nerve CSA at wrist and mid-arm took second and third place with ORs= 2.82 (1.50-4.15), 2.02(0.26-3.77) respectively. The sensitivities and specificities pooled from two studies for Sural nerve were 0.78 (95% CI, 0.68–0.89), and 0.68 (95% CI, 0.53–0.74). Included studies for other nerves were limited to one study. The largest sensitivity was for Sural nerve and the largest specificity was for Tibial nerve. 7) Conclusions The peripheral nerves CSA measured by ultrasound imaging is useful for the diagnosis of DPN and is most significantly different between patients and participants without DPN at the Tibial nerve. Because the Tibial nerve CSA in healthy participants, at various locations, rarely exceeds 24 mm2, this value can be considered as a cutoff point for diagnosing DPN.

Keywords: diabetes, diagnosis, polyneuropathy, ultrasound

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Authors: P. B. Sob, A. A. Alugongo, T. B. Tengen

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The activation volume of 6082T6 aluminum is investigated at different temperatures on grain size variants. The deformation activation volume was computed on the basis of the relationship between the Boltzmann’s constant k, the testing temperatures, the material strain rate sensitivity and the material yield stress of grain size variants. The material strain rate sensitivity is computed as a function of yield stress and strain rate of grain size variants. The effect of the material strain rate sensitivity and the deformation activation volume of 6082T6 aluminum at different temperatures of 3-D grain are discussed. It is shown that the strain rate sensitivities and activation volume are negative for the grain size variants during the deformation of nanostructured materials. It is also observed that the activation volume vary in different ways with the equivalent radius, semi minor axis radius, semi major axis radius and major axis radius. From the obtained results it is shown that the variation of activation volume increased and decreased with the testing temperature. It was revealed that, increased in strain rate sensitivity led to decrease in activation volume whereas increased in activation volume led to decrease in strain rate sensitivity.

Keywords: nanostructured materials, grain size variants, temperature, yield stress, strain rate sensitivity, activation volume

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Authors: James Killian, Sarah Cox

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The use of stability criteria within geotechnical engineering is the way the results of analyses are conveyed, and sensitivities and risk assessments are performed. Historically, the primary stability criteria for slope design has been the Factor of Safety (FOS) coming from a limit calculation. Increasingly, the value derived from Strength Reduction Factor (SRF) analysis is being used as the criteria for stability analysis. The purpose of this work was to study in detail the relationship between SRF values produced from a numerical modeling technique and the traditional FOS values produced from Limit Equilibrium (LEM) analyses. This study utilized a model of a 3000-foot-high slope with a 45-degree slope angle, assuming a perfectly plastic mohr-coulomb constitutive model with high cohesion and friction angle values typical of a large hard rock mine slope. A number of variables affecting the values of the SRF in a numerical analysis were tested, including zone size, in-situ stress, tensile strength, and dilation angle. This paper demonstrates that in most cases, SRF values are lower than the corresponding LEM FOS values. Modeled zone size has the greatest effect on the estimated SRF value, which can vary as much as 15% to the downside compared to FOS. For consistency when using SRF as a stability criteria, the authors suggest that numerical model zone sizes should not be constructed to be smaller than about 1% of the overall problem slope height and shouldn’t be greater than 2%. Future work could include investigations of the effect of anisotropic strength assumptions or advanced constitutive models.

Keywords: FOS, SRF, LEM, comparison

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Authors: Anahita Izadyar, My Ni Van, Kayleigh Amber Rodriguez, Ilwoo Seok, Elizabeth E. Hood

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Using a recombinant enzyme derived from corn and a simple modification, we fabricated a facile, fast, and cost-beneficial biosensor to measure glucose. The Nafion/ Plant Produced Mn Peroxidase (PPMP)– glucose oxidase (GOx)- Bovine serum albumin (BSA) /Au electrode showed an excellent amperometric response to detect glucose. This biosensor is capable of responding to a wide range of glucose—20.0 µM−15.0 mM and has a lower detection limit (LOD) of 2.90µM. The reproducibility response using six electrodes is also very substantial and indicates the high capability of this biosensor to detect a wide range of 3.10±0.19µM to 13.2±1.8 mM glucose concentration. Selectivity of this electrode was investigated in an optimized experimental solution contains 10% diet green tea with citrus containing ascorbic acid (AA), and citric acid (CA) in a wide concentration of glucose at 0.02 to 14.0mM with an LOD of 3.10µM. Reproducibility was also investigated using 4 electrodes in this sample and shows notable results in the wide concentration range of 3.35±0.45µM to of 13.0 ± 0.81 mM. We also used other voltammetry methods to evaluate this biosensor. We applied linear sweep voltammetry (LSV) and this technique shows a wide range of 0.10−15.0 mM to detect glucose with a lower detection limit of 19.5µM. The performance and strength of this enzyme biosensor were the simplicity, wide linear ranges, sensitivities, selectivity, and low limits of detection. We expect that the modified biosensor has the potential for monitoring various biofluids.

Keywords: plant-produced manganese peroxidase, enzyme-based biosensors, glucose, modified gold electrode, glucose oxidase

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Authors: Jae Ni Jang, SoYoon Park, Sukhee Park, Yumin Song, Jae Won Kim, Keum Nae Kang, Young Uk Kim

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Objectives: Patellofemoral pain syndrome (PFPS) is a common clinical condition characterized by anterior knee pain. Here, we investigated the quadriceps tendon cross-sectional area (QTCSA) as a novel predictor for the diagnosis of PFPS. By examining the association between the QTCSA and PFPS, we aimed to provide a more valuable diagnostic parameter and more equivocal assessment of the diagnostic potential of PFPS by comparing the QTCSA with the quadriceps tendon thickness (QTT), a traditional measure of quadriceps tendon hypertrophy. Patients and Methods: This retrospective study included 30 patients with PFPS and 30 healthy participants who underwent knee magnetic resonance imaging. T1-weighted turbo spin echo transverse magnetic resonance images were obtained. The QTCSA was measured on the axial-angled phases of the images by drawing outlines, and the QTT was measured at the most hypertrophied quadriceps tendon. Results: The average QTT and QTCSA for patients with PFPS (6.33±0.80 mm and 155.77±36.60 mm², respectively) were significantly greater than those for healthy participants (5.77±0.36 mm and 111.90±24.10 mm2, respectively; both P<0.001). We used a receiver operating characteristic curve to confirm the sensitivities and specificities for both the QTT and QTCSA as predictors of PFPS. The optimal diagnostic cutoff value for QTT was 5.98 mm, with a sensitivity of 66.7%, a specificity of 70.0%, and an area under the curve of 0.75 (0.62–0.88). The optimal diagnostic cutoff value for QTCSA was 121.04 mm², with a sensitivity of 73.3%, a specificity of 70.0%, and an area under the curve of 0.83 (0.74–0.93). Conclusion: The QTCSA was found to be a more reliable diagnostic indicator for PFPS than QTT.

Keywords: patellofemoral pain syndrome, quadriceps muscle, hypertrophy, magnetic resonance imaging

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Authors: Venkataraman Sankaranarayanan, Sougata Ray

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While extant research has examined many aspects of differential corporate environmental outcomes and behavior, a holistic and integrated view of heterogeneity in corporate environment sustainability (CES) practices remains a puzzle to be fully unraveled – its extent and nature, its relationship to macro or micro level influences, or strategic orientations. Such a perspective would be meaningful for the field given notable strides in CES practices and the corporate social responsibility agenda over the last two decades, in the backdrop of altered global socio-political sensitivities and technological advances. To partly address this gap, this exploratory research adopted a content analysis approach to code patterns in the sustainability disclosures of the 160 largest global firms spread over 8 years. The sample of firms spanned seven industries, nine countries and three continents thereby presenting data rich and diverse enough in several dimensions to be representative of global heterogeneity in CES practices. Through a factor analysis of the coded data, four strategic CES orientations were extracted through the analysis, that effectively straddles most of the variation observed in current CES practices – one that seeks to reduce environmental damage on account of the firm’s operations, another that prioritizes minimalism, a third that focuses on broader ecological status quo, and a final one that champions the ‘business of green’, extending the CES agenda beyond the firm’s boundaries. These environment sustainability strategy orientations are further examined to elicit prominent patterns and explore plausible antecedents.

Keywords: corporate social responsibility, corporate sustainability, environmental management, heterogeneity, strategic orientation

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Authors: Shankar Dhakal, Andrew Jones, Geoffrey W. Lummis

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The Federal Democratic Republic of Nepal is a linguistically, culturally, and ethnically diverse country with approximately 123 different spoken languages that represent several ethnic, cultural, and religious groups of people. With a population of about 30 million, long-standing disparities and inequalities in access and achievement in education have constantly been challenging to provide equitable educational opportunities for all students. While the new constitution of federal Nepal (2015) stipulates that all schools serve the interests of diverse communities, leadership practices have failed to adopt local contextual sensitivities, leading to traditional, authoritarian approaches and entrenched inequalities. However, little is known about how Nepali secondary school principals can adapt and implement context-responsive and equitable strategies to ensure equity and inclusiveness in its enormously diverse socio-cultural contexts. To fill this gap, this study explores how educational leadership approaches and philosophies are transformed using a multi-case automated/ethnographic research methodology underpinned by the paradigm of critical constructivism. This paper reconstructs to see if school leadership in Nepal can produce more equitable and contextual outcomes. The results of this study highlight the need for a paradigm shift and the adoption of innovative leadership approaches that foster humility, empathy, and compassion in school leaders to achieve better school outcomes. This research provides valuable insights into existing literary gaps and provides guidance for future school leadership policies and practices at the personal, cultural, and political levels.

Keywords: school leadership, auto/ethnography, equitable and context-responsive leadership, Nepal

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Authors: Marwa A. A. Ragab, Amira F. El-Yazbi, Amr El-Hawiet

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The analysis of heavy metals in honey samples is crucial. When found in honey, they denote environmental pollution. Some of these heavy metals as lead either present at low or high concentrations are considered to be toxic. Other heavy metals, for example, copper and zinc, if present at low concentrations, they considered safe even vital minerals. On the contrary, if they present at high concentrations, they are toxic. Their voltammetric determination in honey represents a challenge due to the presence of other electro-active components as vitamins, which may overlap with the peaks of the metal, hindering their accurate and precise determination. The simultaneous analysis of some vitamins: nicotinic acid (B3) and riboflavin (B2), and heavy metals: lead, cadmium, and zinc, in honey samples, was addressed. The analysis was done in 0.1 M Potassium Chloride (KCl) using a hanging mercury drop electrode (HMDE), followed by chemometric manipulation of the voltammetric data using the derivative method. Then the derivative data were convoluted using discrete Fourier functions. The proposed method allowed the simultaneous analysis of vitamins and metals though their varied responses and sensitivities. Although their peaks were overlapped, the proposed chemometric method allowed their accurate and precise analysis. After the chemometric treatment of the data, metals were successfully quantified at low levels in the presence of vitamins (1: 2000). The heavy metals limit of detection (LOD) values after the chemometric treatment of data decreased by more than 60% than those obtained from the direct voltammetric method. The method applicability was tested by analyzing the selected metals and vitamins in real honey samples obtained from different botanical origins.

Keywords: chemometrics, overlapped voltammetric peaks, derivative and convoluted derivative methods, metals and vitamins

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Authors: Sonia Nemakallu, Pota Kalima

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Introduction: Vancomycin is a glycopeptide antibiotic, commonly used to treat gram-positive bacteraemia. It has been increasingly used in the critical care setting due to an increased awareness of resistant gram positive organisms. In Edinburgh both tertiary hospitals, The Western General Hospital and The Royal Infirmary Of Edinburgh, commonly use Vancomycin for a variety of infections. Administration of Vancomyicn in these hospitals is by continuous infusion as it is thought to maintain serum concentrations easier and is a simpler monitoring system. Purpose: The aim of the study was to evaluate the efficacy and reliability in which Vancomycin is used. Material and Methods: A retrospective study, over a 6-month period from January 2014 to June 2014. 91 admissions were included, all received Vancomycin by continuous infusion during their critical care stay. Results: The number one use for Vancomycin in critical care settings was in the treatment of ventilator or hospital-acquired pneumonia. Only 3% of population had MRSA. 49% of admissions were not therapeutic on day 1 post loading dose. Of those that were therapeutic on day 1 post loading dose, 39% of admissions showed no organisms in any cultures taken, 42% had organisms sensitive to Vancomycin and 19% had only organisms resistant to Vancomycin. Those that were not therapeutic on day 1 showed similar organism sensitivities. 15% of admissions had Vancomycin levels above 25 (levels should be maintained between 15-25). An increase in creatinine was proportionally seen with an increase in Vancomycin levels. Conclusion: Within Edinburgh Vancomycin is being overused in the critical care setting with only 3% of the population having highly resistant organisms. Continuous infusion have not ruled out the complexity of maintaining therapeutic levels, with a large proportion of patients not being therapeutic on day 1. Further research is also required into the nephrotoxic effects of using higher doses of Vancomycin.

Keywords: Vancomycin, continuous infusion, multi resistant organisms, sepsis, renal toxicity

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Authors: Lucile Soudani, Hervé Illy, Rémi Bouchié

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Mould growth in living environments has been widely reported for decades all throughout the world. A higher level of moisture in housings can lead to building degradation, chemical component emissions from construction materials as well as enhancing mould growth within the envelope elements or on the internal surfaces. Moreover, a significant number of studies have highlighted the link between mould presence and the prevalence of respiratory diseases. In recent years, the proportion of biobased materials used in construction has been increasing, as seen as an effective lever to reduce the environmental impact of the building sector. Besides, bio-based materials are also hygroscopic materials: when in contact with the wet air of a surrounding environment, their porous structures enable a better capture of water molecules, thus providing a more suitable background for mould growth. Many studies have been conducted to develop reliable models to be able to predict mould appearance, growth, and decay over many building materials and external exposures. Some of them require information about temperature and/or relative humidity, exposure times, material sensitivities, etc. Nevertheless, several studies have highlighted a large disparity between predictions and actual mould growth in experimental settings as well as in occupied buildings. The difficulty of considering the influence of all parameters appears to be the most challenging issue. As many complex phenomena take place simultaneously, a preliminary study has been carried out to evaluate the feasibility to sadopt a reliability approach rather than a deterministic approach. Both epistemic and random uncertainties were identified specifically for the prediction of mould appearance and growth. Several studies published in the literature were selected and analysed, from the agri-food or automotive sectors, as the deployed methodology appeared promising.

Keywords: bio-based materials, mould growth, numerical prediction, reliability approach

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Authors: Amber C. W. Vandepoele, Michael A. Marciano

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Biological analyses frequently focus on single organisms, however many times, the biological sample consists of more than the target organism; for example, human microbiome research targets bacterial DNA, yet most samples consist largely of human DNA. Therefore, there would be an advantage to removing these contaminating organisms. Conversely, some analyses focus on a single organism but would greatly benefit from the additional information regarding the other organismal components of the sample. Forensic analysis is one such example, wherein most forensic casework, human DNA is targeted; however, it typically exists in complex non-pristine sample substrates such as soil or unclean surfaces. These complex samples are commonly comprised of not just human tissue but also microbial and plant life, where these organisms may help gain more forensically relevant information about a specific location or interaction. This project aims to optimize a ‘phylogenetic’ differential extraction method that will separate mammalian, bacterial and plant cells in a mixed sample. This is accomplished through the use of size exclusion separation, whereby the different cell types are separated through multiple filtrations using 5 μm filters. The components are then lysed via differential enzymatic sensitivities among the cells and extracted with minimal contribution from the preceding component. This extraction method will then allow complex DNA samples to be more easily interpreted through non-targeting sequencing since the data will not be skewed toward the smaller and usually more numerous bacterial DNAs. This research project has demonstrated that this ‘phylogenetic’ differential extraction method successfully separated the epithelial and bacterial cells from each other with minimal cell loss. We will take this one step further, showing that when adding the plant cells into the mixture, they will be separated and extracted from the sample. Research is ongoing, and results are pending.

Keywords: DNA isolation, geolocation, non-human, phylogenetic separation

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Authors: Othman Maklouf, Abdunnaser Tresh

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Land vehicle navigation is subject of great interest today. Global Positioning System (GPS) is the main navigation system for positioning in such systems. GPS alone is incapable of providing continuous and reliable positioning, because of its inherent dependency on external electromagnetic signals. Inertial Navigation (INS) is the implementation of inertial sensors to determine the position and orientation of a vehicle. The availability of low-cost Micro-Electro-Mechanical-System (MEMS) inertial sensors is now making it feasible to develop INS using an inertial measurement unit (IMU). INS has unbounded error growth since the error accumulates at each step. Usually, GPS and INS are integrated with a loosely coupled scheme. With the development of low-cost, MEMS inertial sensors and GPS technology, integrated INS/GPS systems are beginning to meet the growing demands of lower cost, smaller size, and seamless navigation solutions for land vehicles. Although MEMS inertial sensors are very inexpensive compared to conventional sensors, their cost (especially MEMS gyros) is still not acceptable for many low-end civilian applications (for example, commercial car navigation or personal location systems). An efficient way to reduce the expense of these systems is to reduce the number of gyros and accelerometers, therefore, to use a partial IMU (ParIMU) configuration. For land vehicular use, the most important gyroscope is the vertical gyro that senses the heading of the vehicle and two horizontal accelerometers for determining the velocity of the vehicle. This paper presents a field experiment for a low-cost strap down (ParIMU)\GPS combination, with data post processing for the determination of 2-D components of position (trajectory), velocity and heading. In the present approach, we have neglected earth rotation and gravity variations, because of the poor gyroscope sensitivities of our low-cost IMU (Inertial Measurement Unit) and because of the relatively small area of the trajectory.

Keywords: GPS, IMU, Kalman filter, materials engineering

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Authors: Yazeed Al-Sheikh

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Pregnancy represents a risk factor in the occurrence of vulvovaginal candidiasis. To investigate the prevalence rate of vaginal carriage of Candida species in Saudi pregnant and non-pregnant women, high vaginal swab (HVS) specimens (707) were examined by direct microscopy (10% KOH and Giemsa staining) and parallel cultured on Sabouraud Dextrose Agar (SDA) as well as on “CHROM agar Candida” medium. As expected, Candida-positive cultures were frequently observed in pregnant-test group (24%) than in non-pregnant group (17%). The frequency of culture positive was correlated to pregnancy (P=0.047), parity (P=0.001), use of contraceptive (P=0.146), or antibiotics (P=0.128), and diabetic-patients (P < 0.0001). Out of 707 HVS examined specimens, 157 specimens were yeast-positive culture (22%) on Sabouraud Dextrose Agar or “CHROM agar Candida”. In comparison, the sensitivities of the direct 10% KOH and the Giemsa stain microscopic examination methods were 84% (132/157) and 95% (149/157) respectively but both with 100% specificity. As for the identity of recovered 157 yeast isolates, based on API 20C biotype carbohydrate assimilation, germ tube and chlamydospore formation, C. albicansand C. glabrata constitute 80.3 and 12.7% respectively. Rates of C. tropicalis, C. kefyr, C. famata or C. utilis were 2.6, 1.3, and 0.6% respectively. Sachromyces cerevisiae and Rhodotorula mucilaginosa yeasts were also encountered at a frequency of 1.3 and 0.6% respectively. Finally, among all recovered 157 yeast-isolates, strains resistant to ketoconazole were not detected, whereas 5% of the C. albicans and as high as 55% of the non-albicans yeast isolates (majority C. glabrata) showed resistance to fluconazole. Our findings may prove helpful for continuous determination of the existing vaginal candidiasis causative species during pregnancy, its lab-diagnosis and/or control and possible measures to minimize the incidence of the disease-associated pre-term delivery.

Keywords: vaginal candidiasis, Candida spp., pregnancy, risk factors, API 20C-yeast biotypes, giemsa stain, antifungal agents

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Authors: Avirup Chowdhury, Angus K. McFadyen, Linsey Batchelor

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Blood cultures (BCs) are an important aspect of management of the septic patient, identifying the underlying pathogen and its antibiotic sensitivities. However, while the current literature outlines indications for initial BCs to be taken, there is little guidance for repeat sampling in the following 5-day period and little information on how antibiotic use can affect the usefulness of this investigation. A retrospective cohort study was conducted using inpatients who had undergone 2 or more BCs within 5 days between April 2016 and April 2017 at a 400-bed hospital in the west of Scotland and received antibiotic therapy between the first and second BCs. The data for BC sampling was collected from the electronic microbiology database, and cross-referenced with data from the hospital electronic prescribing system. Overall, 283 BCs were included in the study, taken from 92 patients (mean 3.08 cultures per patient, range 2-10). All 92 patients had initial BCs, of which 83 were positive (90%). 65 had a further sample within 24 hours of commencement of antibiotics, with 35 positive (54%). 23 had samples within 24-48 hours, with 4 (17%) positive; 12 patients had sampling at 48-72 hours, 12 at 72-96 hours, and 10 at 96-120 hours, with none positive. McNemar’s Exact Test was used to calculate statistical significance for patients who received blood cultures in multiple time blocks (Initial, < 24h, 24-120h, > 120h). For initial vs. < 24h-post BCs (53 patients tested), the proportion of positives fell from 46/53 to 29/53 (one-tailed P=0.002, OR 3.43, 95% CI 1.48-7.96). For initial vs 24-120h (n=42), the proportions were 38/42 and 4/42 respectively (P < 0.001, OR 35.0, 95% CI 4.79-255.48). For initial vs > 120h (n=36), these were 33/36 and 2/36 (P < 0.001,OR ∞). These were also calculated for a positive in initial or < 24h vs. 24-120h (n=42), with proportions of 41/42 and 4/42 (P < 0.001, OR 38.0, 95% CI 5.22-276.78); and for initial or < 24h vs > 120h (n=36), with proportions of 35/36 and 2/36 respectively (P < 0.001, OR ∞). This data appears to show that taking an initial BC followed by a BC within 24 hours of antibiotic commencement would maximise blood culture yield while minimising the risk of false negative results. This could potentially remove the need for as many as 46% of BC samples without adversely affecting patient care. BC yield decreases sharply after 48 hours of antibiotic use, and may not provide any clinically useful information after this time. Further multi-centre studies would validate these findings, and provide a foundation for future health policy generation.

Keywords: antibiotics, blood culture, efficacy, inpatient

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Authors: Victor Toom

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Albeit it is never possible to anticipate the full range of difficulties after a catastrophe, efforts to identify victims of mass casualty events have become institutionalized and standardized with the aim of effectively and efficiently addressing the many challenges and contingencies. Such ‘disaster victim identification’ (DVI) practices are dependent on the forensic sciences, are subject of national legislation, and are reliant on technical and organizational protocols to mitigate the many complexities in the wake of catastrophe. Apart from such technological, legal and bureaucratic elements constituting a DVI operation, victims’ families and their emotions are also part and parcel of any effort to identify casualties of mass human fatality incidents. Take for example the fact that forensic experts require (antemortem) information from the group of relatives to make identification possible. An identified body or body part is also repatriated to kin. Relatives are thus main stakeholders in DVI operations. Much has been achieved in years past regarding facilitating victims’ families’ issues and their emotions. Yet, how families are dealt with by experts and authorities is still considered a difficult topic. Due to sensitivities and required emphatic interaction with families on the one hand, and the rationalized DVI efforts, on the other hand, there is still scope for improving communication, providing information and meaningful inclusion of relatives in the DVI effort. This paper aims to bridge the standardized world of DVI efforts and families’ experienced realities and makes suggestions to further improve DVI efforts through inclusion of victims’ families. Based on qualitative interviews, the paper narrates involvement and experiences of inter alia DVI practitioners, victims’ families, advocates and clergy in the wake of the 1995 Srebrenica genocide which killed approximately 8,000 men, and the 9/11 in New York City with 2,750 victims. The paper shows that there are several models of including victims’ families into a DVI operation, and it argues for a model of where victims’ families become a partner in DVI operations.

Keywords: disaster victim identification (DVI), victims’ families, social science (qualitative), 9/11 attacks, Srebrenica genocide

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Authors: Ozlem Oral, Seval Kilic, Ozlem Yedier, Serap Dokmeci, Devrim Gozuacik

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Autophagy is a degradation pathway, activating under stress conditions. It digests macromolecules, such as abnormal proteins and long-lived organelles by engulfing them and by subsequent delivery of the cargo to lysosomes. The members of the phospholipid-dependent serine/threonine kinases, involved in many signaling pathways, which are necessary for the regulation of cellular metabolic activation. Previous studies implicate that, serine/threonine kinases have crucial roles in the mechanism of many diseases depend on the activated and/or inactivated signaling pathway. Data indicates, the signaling pathways activated by serine/threonine kinases are also involved in activation of autophagy mechanism. However, the information about the effect of serine/threonine kinases on autophagy mechanism and the roles of these effects in disease formation is limited. In this study, we investigated the effect of activated serine/threonine kinases on autophagic pathway. We performed a commonly used autophagy technique, GFP-LC3 dot formation and by using microscopy analyses, we evaluated promotion and/or inhibition of autophagy in serine/threonine kinase-overexpressed fibroblasts as well as cancer cells. In addition, we carried out confocal microscopy analyses and examined autophagic flux by utilizing the differential pH sensitivities of RFP and GFP in mRFP-GFP-LC3 probe. Based on the shRNA-library based screening, we identified autophagy-related proteins affected by serine/threonine kinases. We further studied the involvement of serine/threonine kinases on the molecular mechanism of newly identified autophagy proteins and found that, autophagic pathway is indirectly controlled by serine/threonine kinases via specific autophagic proteins. Our data indicate the molecular connection between two critical cellular mechanisms, which have important roles in the formation of many disease pathologies, particularly cancer. This project is supported by TUBITAK-1001-Scientific and Technological Research Projects Funding Program, Project No: 114Z836.

Keywords: autophagy, GFP-LC3 dot formation assay, serine/threonine kinases, shRNA-library screening

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Authors: Ali Heyder Alatas, D. Xin, L. Nai Ming

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An oil spill emergency can vary in size and complexity, subject to factors such as volume and characteristics of spilled oil, incident location, impacted sensitivities and resources required. A major incident typically involves numerous stakeholders; these include the responsible party, response organisations, government authorities across multiple jurisdictions, local communities, and a spectrum of technical experts. An incident management team will encounter numerous challenges. Factors such as limited access to location, adverse weather, poor communication, and lack of pre-identified resources can impede a response; delays caused by an inefficient response can exacerbate impacts caused to the wider environment, socio-economic and cultural resources. It is essential that all parties work based on defined roles, responsibilities and authority, and ensure the availability of sufficient resources. To promote steadfast coordination and overcome the challenges highlighted, an Incident Management System (IMS) offers an essential tool for oil spill response. It provides clarity in command and control, improves communication and coordination, facilitates the cooperation between stakeholders, and integrates resources committed. Following the preceding discussion, a comprehensive review of existing literature serves to illustrate the application of IMS in oil spill response to overcome common challenges faced in a major-scaled incident. With a primary audience comprising practitioners in mind, this study will discuss key principles of incident management which enables an effective response, along with pitfalls and challenges, particularly, the tension between government and industry; case studies will be used to frame learning and issues consolidated from previous research, and provide the context to link practice with theory. It will also feature the industry approach to incident management which was further crystallized as part of a review by the Joint Industry Project (JIP) established in the wake of the Macondo well control incident. The authors posit that a common IMS which can be adopted across the industry not only enhances response capacity towards a major oil spill incident but is essential to the global preparedness effort.

Keywords: command and control, incident management system, oil spill response, response organisation

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Authors: Ozlem Oral, Emre Taskin, Aysel Yuce, Serap Dokmeci, Devrim Gozuacik

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Autophagy is an evolutionary conserved lysosome-dependent catabolic pathway, responsible for the degradation of long-lived proteins, abnormal aggregates and damaged organelles which cannot be degraded by the ubiquitin-proteasome system. Lysosomes degrade the substrates through the activity of lysosomal hydrolases and lysosomal membrane-bound proteins. Mutations in the coding region of these proteins cause malfunctional lysosomes, which contributes to the pathogenesis of lysosomal storage diseases. Gaucher disease is a lysosomal storage disease resulting from the mutation of a lysosomal membrane-associated glycoprotein called glucocerebrosidase and its cofactor saposin C. The disease leads to intracellular accumulation of glucosylceramide and other glycolipids. Because of the essential role of lysosomes in autophagic degradation, Gaucher disease may directly be linked to this pathway. In this study, we investigated the expression of autophagy and/or lysosome-related genes and proteins in fibroblast cells isolated from patients with different mutations. We carried out confocal microscopy analysis and examined autophagic flux by utilizing the differential pH sensitivities of RFP and GFP in mRFP-GFP-LC3 probe. We also evaluated lysosomal pH by active lysosome staining and lysosomal enzyme activity. Beside lysosomes, we also performed proteasomal activity and cell death analysis in patient samples. Our data showed significant attenuation in the expression of key autophagy-related genes and accumulation of their proteins in mutant cells. We found decreased the ability of autophagosomes to fuse with lysosomes, associated with elevated lysosomal pH and reduced lysosomal enzyme activity. Proteasomal degradation and cell death analysis showed reduced proteolytic activity of the proteasome, which consequently leads to increased susceptibility to cell death. Our data indicate that the major degradation pathways are affected by multifunctional lysosomes in mutant patient cells and may underlie in the mechanism of clinical severity of Gaucher patients. (This project is supported by TUBITAK-3501-National Young Researchers Career Development Program, Project No: 112T130).

Keywords: autophagy, Gaucher's disease, glucocerebrosidase, mutant fibroblasts

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Authors: Purva Khurana

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Traditional textile crafts are universally found to have been significantly impeded by the uprise of innovative technologies, but sustained human endeavor, in sync with dynamic market nuances, holds key to these otherwise getting fast-extinct marvels. The metamorphosis of such art-forms into niche markets pre-supposes sharp concentration on adaptability. The author has concentrated on the ancient handicraft of Ikat in Andhra Pradesh (India), a manifestation of their cultural heritage and esoteric cottage industry, so very intrinsic to the development and support of local economy and identity. Like any other traditional practice, ikat weaving has been subjected to the challenges of modernization. However, owing to its unique character, personalize production and adaptability, both of material and process, ikat weaving has stood the test of time by way of judiciously embellishing innovation with contemporary taste. To survive as a living craft as also to justify its role as a universal language of aesthetic sensibility, it is imperative that ikat tradition should lend itself continuous process of experiments, change and growth. Besides, the instant paper aims to examine the contours of ikat production process from its pure form, to more fashion and market oriented production, with upgraded process, material and tools. Over the time, it has adapted well to new style-paradigms, duly matching up with the latest fashion trends, in tandem with the market-sensitivities. Apart, it is an effort to investigate how this craft could respond constructively to the pressure of contemporary technical developments in order to be at cutting edge, while preserving its integrity. In order to approach these issues, the methodology adopted is, conceptual analysis of the craft practices, its unique strength and how they could be used to advance the craft in relation to the emergence of technical developments. The paper summarizes the result of the study carried out by the author on the peculiar advantages of suitably- calibrated vat dyes over natural dyes, in terms of its recycling ability and eco-friendly properties, thus holding definite edge, both in terms of socio-economic as well as environmental concerns.

Keywords: craft, eco-friendly dyes, ikat, metamorphosis

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Authors: Kai Zhang, Xi Jiang

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Effect of fuel variabilities on premixed combustion of bio-syngas mixtures is of great importance in bio-syngas utilisation. The uncertainties of concentrations of fuel constituents such as H2, CO and CH4 may lead to unpredictable combustion performances, combustion instabilities and hot spots which may deteriorate and damage the combustion hardware. Numerical modelling and simulations can assist in understanding the behaviour of bio-syngas combustion with pre-defined species concentrations, while the evaluation of variabilities of concentrations is expensive. To be more specific, questions such as ‘what is the burning velocity of bio-syngas at specific equivalence ratio?’ have been answered either experimentally or numerically, while questions such as ‘what is the likelihood of burning velocity when precise concentrations of bio-syngas compositions are unknown, but the concentration ranges are pre-described?’ have not yet been answered. Uncertainty quantification (UQ) methods can be used to tackle such questions and assess the effects of fuel compositions. An efficient probabilistic UQ method based on Polynomial Chaos Expansion (PCE) techniques is employed in this study. The method relies on representing random variables (combustion performances) with orthogonal polynomials such as Legendre or Gaussian polynomials. The constructed PCE via Galerkin Projection provides easy access to global sensitivities such as main, joint and total Sobol indices. In this study, impacts of fuel compositions on combustion (adiabatic flame temperature and laminar flame speed) of bio-syngas fuel mixtures are presented invoking this PCE technique at several equivalence ratios. High-pressure effects on bio-syngas combustion instability are obtained using detailed chemical mechanism - the San Diego Mechanism. Guidance on reducing combustion instability from upstream biomass gasification process is provided by quantifying the significant contributions of composition variations to variance of physicochemical properties of bio-syngas combustion. It was found that flame speed is very sensitive to hydrogen variability in bio-syngas, and reducing hydrogen uncertainty from upstream biomass gasification processes can greatly reduce bio-syngas combustion instability. Variation of methane concentration, although thought to be important, has limited impacts on laminar flame instabilities especially for lean combustion. Further studies on the UQ of percentage concentration of hydrogen in bio-syngas can be conducted to guide the safer use of bio-syngas.

Keywords: bio-syngas combustion, clean energy utilisation, fuel variability, PCE, targeted uncertainty reduction, uncertainty quantification

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Authors: Selvaprakash Ramalingam, Rabi N. Sahoo, Dharmendra Saraswat, A. Kumar, Rajeev Ranjan, Joydeep Mukerjee, Viswanathan Chinnasamy, K. K. Chaturvedi, Sanjeev Kumar

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Rice is one of the most important staple food crops in the world. Among the various diseases that affect rice crops, rice blast is particularly significant, causing crop yield and economic losses. While the plant has defense mechanisms in place, such as chemical indicators (proteins, salicylic acid, jasmonic acid, ethylene, and azelaic acid) and resistance genes in certain varieties that can protect against diseases, susceptible varieties remain vulnerable to these fungal diseases. Early prediction of rice blast (RB) disease is crucial, but conventional techniques for early prediction are time-consuming and labor-intensive. Hyperspectral remote sensing techniques hold the potential to predict RB disease at its asymptomatic stage. In this study, we aimed to demonstrate the prediction of RB disease at the asymptomatic stage using non-imaging hyperspectral ASD spectroradiometer under controlled laboratory conditions. We applied statistical spectral discrimination theory to identify unknown spectra of M. Oryzae, the fungus responsible for rice blast disease. The infrared (IR) region was found to be significantly affected by RB disease. These changes may result in alterations in the absorption, reflection, or emission of infrared radiation by the affected plant tissues. Our research revealed that the protein spectrum in the IR region is impacted by RB disease. In our study, we identified strong correlations in the region (Amide group - I) around X 1064 nm and Y 1300 nm with the Lambda / Lambda derived spectra methods for protein detection. During the stages when the disease is developing, typically from day 3 to day 5, the plant's defense mechanisms are not as effective. This is especially true for the PB-1 variety of rice, which is highly susceptible to rice blast disease. Consequently, the proteins in the plant are adversely affected during this critical time. The spectral contour plot reveals the highly correlated spectral regions 1064 nm and Y 1300 nm associated with RB disease infection. Based on these spectral sensitivities, we developed new spectral disease indices for predicting different stages of disease emergence. The goal of this research is to lay the foundation for future UAV and satellite-based studies aimed at long-term monitoring of RB disease.

Keywords: rice blast, asymptomatic stage, spectral sensitivity, IR

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Authors: Reena Aggarwal

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The use of textile chemicals in the various pre and post-textile manufacturing processes has made the textile industry conscious of its negative contribution to environmental pollution. Popular environmentally friendly fibers such as recycled polyester and organic cotton have been now increasingly used by fabrics and apparel manufacturers. However, after these textiles or the finished apparel are manufactured, they have to be dyed in the same chemical dyes that are harmful and toxic to the environment. Dyeing is a major area of concern for the environment as well as for people who have chemical sensitivities as it may cause nausea, breathing difficulties, seizures, etc. Ayurvastra or herbal medical textiles are one step ahead of the organic lifestyle, which supports the core concept of holistic well-being and also eliminates the impact of harmful chemicals and pesticides. There is a wide range of herbs that can be used not only for dyeing but also for providing medicinal properties to the textiles like antibacterial, antifungal, antiseptic, antidepressant and for treating insomnia, skin diseases, etc. The concept of herbal dyeing of fabric is to manifest herbal essence in every aspect of clothing, i.e., from production to end-use, additionally to eliminate the impact of harmful chemical dyes and chemicals which are known to result in problems like skin rashes, headache, trouble concentrating, nausea, diarrhea, fatigue, muscle and joint pain, dizziness, difficulty breathing, irregular heartbeat and seizures. Herbal dyeing or finishing on textiles will give an extra edge to the textiles as it adds an extra function to the fabric. The herbal extracts can be applied to the textiles by a simple process like the pad dry cure method and mainly acts on the human body through the skin for aiding in the treatment of disease or managing the medical condition through its herbal properties. This paper, therefore, delves into producing Ayurvastra, which is a perfect amalgamation of cloth and wellness. The aim of the paper is to design and create herbal disposable and non-disposable medical textile products acting mainly topically (through the skin) for providing medicinal properties/managing medical conditions. Keeping that in mind, a range of antifungal socks and antibacterial napkins treated with turmeric and aloe vera were developed, which are recommended for the treatment of fungal and bacterial infections, respectively. Both Herbal Antifungal socks and Antibacterial napkins have proved to be efficient enough in managing and treating fungal and bacterial infections of the skin, respectively.

Keywords: ayurvastra, ayurveda, herbal, pandemic, sustainable

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Authors: Neeraj Vij, Christian Leber, Kenneth Schmidt

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Introduction: Total knee arthroplasty is a common procedure. It is well known that the biomechanics of the knee do not fully return to their normal state. Motion analysis has been used to study the biomechanics of the knee after total knee arthroplasty. The purpose of this scoping review is to summarize the current use of gait analysis in total knee arthroplasty and to identify the preoperative motion analysis parameters for which a systematic review aimed at determining the reliability and validity may be warranted. Materials and Methods: This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist strictly. Five search engines were searched for a total of 279 articles. Articles underwent a title and abstract screening process followed by full-text screening. Included articles were placed in the following sections: the role of gait analysis as a research tool for operative decisions, other research applications for motion analysis in total knee arthroplasty, gait analysis as a tool in predicting radiologic outcomes, gait analysis as a tool in predicting clinical outcomes. Results: Eleven articles studied gait analysis as a research tool in studying operative decisions. Motion analysis is currently used to study surgical approaches, surgical techniques, and implant choice. Five articles studied other research applications for motion analysis in total knee arthroplasty. Other research applications for motion analysis currently include studying the role of the unicompartmental knee arthroplasty and novel physical therapy protocols aimed at optimizing post-operative care. Two articles studied motion analysis as a tool for predicting radiographic outcomes. Preoperative gait analysis has identified parameters than can predict postoperative tibial component migration. 15 articles studied motion analysis in conjunction with clinical scores. Conclusions: There is a broad range of applications within the research domain of total knee arthroplasty. The potential application is likely larger. However, the current literature is limited by vague definitions of ‘gait analysis’ or ‘motion analysis’ and a limited number of articles with preoperative and postoperative functional and clinical measures. Knee adduction moment, knee adduction impulse, total knee range of motion, varus angle, cadence, stride length, and velocity have the potential for integration into composite clinical scores. A systematic review aimed at determining the validity, reliability, sensitivities, and specificities of these variables is warranted.

Keywords: motion analysis, joint replacement, patient-reported outcomes, knee surgery

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