Search results for: Paul V. Thomas

Authors: Emily S. M. Chow

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The word ‘utopia’ was coined by Thomas More in Utopia (1516). Its Greek roots ‘ou’ means ‘not’ and ‘topos’ means ‘place.’ In other words, it literally refers to ‘no-place.’ However, the possibility of having an alternative and better future society has always been appealing. In fact, at the core of every utopianism is the search for a future alternative state with the anticipation of a better life. Nonetheless, the practicalities of such ideas have never ceased to be questioned. At times, building a utopia presents itself as a divisive act. In addition to the violence that must be employed to sweep away the old regime in order to make space for the new, all utopias carry within them the potential for bringing catastrophic consequences to human life. After all, every utopia seeks to remodel the individual in a very particular way for the benefit of the masses. In this sense, utopian thinking has the potential both to create and destroy the future. While writing during a traumatic transitional period in Zimbabwe’s history, Dambudzo Marechera witnessed an age of upheavals in which different parties battled for power over Zimbabwe. Being aware of the fact that all institutionalized narratives, be they originated from the governance of the UK, Ian Smith’s white minority regime or Zimbabwe’s revolutionary parties, revealed themselves to be nothing more than fiction, Marechera realized the impossibility of determining reality absolutely. As such, this thesis concerns the writing of the Zimbabwean maverick, Dambudzo Marechera. It argues that Marechera writes a unique vision of utopia. In short, for Marechera utopia is not a static entity but a moment of perpetual change. He rethinks utopia in the sense that he phrases it as an event that ceaselessly contests institutionalized and naturalized narratives of a post-colonial self and its relationship to society. Marechera writes towards a vision of an alternative future of the country. Yet, it is a vision that does not constitute a fully rounded sense of utopia. Being cautious about the world and the operation of power upon the people, rather than imposing his own utopian ideals, Marechera chooses to instead peeling away the narrative constitution of the self in relation to society in order to turn towards a truly radical utopian thinking that empowers the individual.

Keywords: African literature, Marechera, post-colonial literature, utopian studies

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Authors: Isabela Thomas Mkude

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This research was done to assess how the community is involved in waste management activities and their willingness to pay for services. Mnadani and Madukani are among the old wards in Dodoma urban. These two areas are similar and face numerous environmental problems, poor solid waste management practices being among them. People realize problems because they live with them daily but the study advice that the only way to stay off problems is to find appropriate measures. The findings recognized some problems that led to poor community involvement solid waste management the study areas. Lack of community education on how to deal with solid wastes, poor responsibility of ward leaders in issues concerning the environment and in active participation of communities in environmental meeting are among other major problems found during the research. The research also revealed that there is low willingness to pay for waste collection among communities and financial problems that make environmental committee inactive; that leading to a poor disposal and unavailable collection facilities in urban area. Although the municipal improves disposal activities by increasing amount of waste to be disposed off by 11% in three years, the amount of waste that collected is also increasing by 41% each day. It is advised that some corrective measures need to be put in place so that the communities are well involved in managing solid wastes as the best way to attain achievement in keeping the urban free from solid waste. Environmental education dissemination to the communities is needed so that they become responsible and dedicated citizen on the environment. There should be some incentives from government to the wards local government and CBOs so that they can practically implement solid waste management programs and to attract formation of more groups and motivate the present groups. Capacity building programs to the ward leaders need to be given priority so that leaders are well organized and able to plan, coordinate and cooperate with various governmental institutions, and NGOs responsible for development and environmental management.

Keywords: solid waste, waste management, public involvement, rapid urbanized region

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Authors: Shilu Deepa Thomas, P. Jayaprakash, Dorota Łazewska, Katarzyna Kieć-Kononowicz, B. Sadek

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A large body of evidence suggests the involvement of cognitive impairment, increased levels of inflammation and oxidative stress in the pathogenesis of autism spectrum disorder (ASD). ASD commonly coexists with psychiatric conditions like anxiety and cognitive challenges, and individuals with ASD exhibit significant levels of inflammation and immune system dysregulation. Previous Studies have identified elevated levels of pro-inflammatory markers such as IL-1β, IL-6, IL-2 and TNF-α, particularly in young children with ASD. The current therapeutic options for ASD show limited effectiveness, signifying the importance of exploring an efficient drugs to address the core symptoms. The role of histamine H3 receptors (H3Rs) in memory and the prospective role of H3R antagonists in pharmacological control of neurodegenerative disorders, e.g., ASD, is well-accepted. Hence, the effects of chronic systemic administration of H3R antagonist E159 on autistic-like repetitive behaviors, social deficits, memory and anxiety parameters, as well as neuroinflammation in Black and Tan BRachyury (BTBR) mice, were evaluated using Y maze, Barnes maze, self-grooming, open field and three chamber social test. E159 (2.5, 5 and 10 mg/kg, i.p.) dose-dependently ameliorated repetitive and compulsive behaviors by reducing the increased time spent in self-grooming and improved reduced spontaneous alternation in BTBR mice. Moreover, treatment with E159 attenuated disturbed anxiety levels and social deficits in tested male BTBR mice. Furthermore, E159 attenuated oxidative stress by significantly increasing GSH, CAT, and SOD and decreasing the increased levels of MDA in the cerebellum as well as the hippocampus. In addition, E159 decreased the elevated levels of proinflammatory cytokines (tumor necrosis factor (TNF-α), interleukin-1β (IL-1β), and IL-6). The observed results show that H3R antagonists like E159 may represent a promising novel pharmacological strategy for the future treatment of ASD.

Keywords: histamine H3 receptors, antagonist E159, autism, behaviors, mice

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Authors: Thomas Meier

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One of the major challenges for sustainable smart building systems is to support device interoperability, i.e. connecting sensor or actuator devices from different vendors, and present their functionality to the external applications. Furthermore, smart building systems are supposed to connect with devices that are not available yet, i.e. devices that become available on the market sometime later. It is of vital importance that a sustainable smart building platform provides an appropriate external interface that can be leveraged by external applications and smart services. An external platform interface must be stable and independent of specific devices and should support flexible and scalable usage scenarios. A typical approach applied in smart home systems is based on a generic device interface used within the smart building platform. Device functions, even of rather complex devices, are mapped to that generic base type interface by means of specific device drivers. Our new approach, presented in this work, extends that approach by using the smart building system’s rule engine to create complex virtual devices that can represent the most diverse properties of real devices. We examined and evaluated both approaches by means of a practical case study using a smart building system that we have developed. We show that the solution we present allows the highest degree of flexibility without affecting external application interface stability and scalability. In contrast to other systems our approach supports complex virtual device configuration on application layer (e.g. by administration users) instead of device configuration at platform layer (e.g. platform operators). Based on our work, we can show that our approach supports almost arbitrarily flexible use case scenarios without affecting the external application interface stability. However, the cost of this approach is additional appropriate configuration overhead and additional resource consumption at the IoT platform level that must be considered by platform operators. We conclude that the concept of complex virtual devices presented in this work can be applied to improve the usability and device interoperability of sustainable intelligent building systems significantly.

Keywords: Internet of Things, smart building, device interoperability, device integration, smart home

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Authors: Paul Lam, Chi Him Chan, Alan Tse

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Language laboratories have been widely used in language learning, starting in the middle of the last century as one of the earliest forms of educational technology. They are designed to assist students’ language learning with technological innovations. Traditional language laboratories provide individual workstations that allow students to access multimedia language resources. In this type of facility, students can train their listening and speaking abilities, and teachers can also assess the performance of an individual student. Although such a setting promotes a student-centered pedagogy by encouraging students to work at their own pace and according to their own needs, it still favours a traditional, behaviourist language learning pedagogy which focuses on repetitive drilling. The change of pedagogies poses challenges to both the teachers and the facilities. The peer-learning pedagogy advocates that language learning should focus on the social aspect, which emphasizes the importance of everyday communication in language learning. The self-access, individual workstation language laboratories may not be able to provide the flexibility for interaction in the new pedagogies. Modern advancement in technology is another factor that drove our language laboratory renovation. In particular, mobile and wireless technology enabled the use of smaller and more flexible devices, making possible much clever use of space. The Chinese University of Hong Kong (CUHK) renovated nine existing language laboratories to provide lighter and more advanced equipment, movable tables, and round desks. These facilities allow more flexibility and encourage students’ interaction. It is believed that the renovated language laboratories can serve different peer learning activities and thus support peer-learning pedagogies in language teaching and learning. A survey has been conducted to collect comments from the teachers who have used the renovated language laboratories and received forty-four response. The teachers’ comments reveal that they experienced different challenges in using the renovated language laboratories, and there is a need to provide guidance to teachers during the technological and pedagogical transition. For example, teachers need instruction on using the newly installed devices such as touch-monitor and visualizer. They also need advice on planning new teaching and learning activities. Nevertheless, teachers appreciated that the renovated language laboratories are flexible and provide more spaces for different learning activities.

Keywords: language laboratories, language learning, peer-learning, student interaction

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Authors: Danielle A. Walker, Kyle L. Johnson, Tara B. Thomas, Sandor Dorgo, Jacen S. Moore

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Approximately 37 million people worldwide are infected with the Human Immunodeficiency Virus (HIV), with the majority located in sub-Saharan Africa. The relationship existing between HIV incidence and socioeconomic inequity confirms the critical need for programs promoting HIV education, prevention and treatment access. This literature review analyzed 36 sources with a specific focus on the Democratic Republic of Congo, whose critically low socioeconomic status and education rate have resulted in a drastically high HIV rates. Relationships between HIV testing and treatment and barriers to care were explored. Cultural and religious considerations were found to be vital when creating and implementing HIV education and testing programs. Partnerships encouraging active support from community-based spiritual leaders to implement HIV educational programs were also key mechanisms to reach communities and individuals. Gender roles were highlighted as a key component for implementation of effective community trust-building and successful HIV education programs. The efficacy of added support by hospitals and clinics in rural areas to facilitate access to HIV testing and care for people living with HIV/AIDS (PLWHA) was discussed. This review highlighted the need for healthcare providers to provide a network of continued education for PLWHA in clinical settings during disclosure and throughout the course of treatment to increase retention in care and promote medication adherence for viral load suppression. Implementation of culturally sensitive models that rely on community familiarity with HIV educators such as ‘train-the-trainer’ were also proposed as efficacious tools for educating rural communities about HIV. Further research is needed to promote community partnerships for HIV education, understand the cultural context of gender roles as barriers to care, and empower local health care providers to be successful within the HIV Continuum of Care.

Keywords: cultural sensitivity, Democratic Republic of the Congo, education, HIV

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Authors: Narash Narasimman, Calvin Leong Jia Jun, Raksha Karthik, Paul Englert

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Background: Project Grit, a 12-week youth resilience program implemented by Impart and Spartans Boxing Club, aimed to help at-risk adolescents develop resilience through psychoeducation and mental health techniques for dealing with everyday stressors and adversity. The programme consists of two parts-1.5 hours of group therapy followed by 1 hour of boxing. Due to the novelty of the study, 6 male participants, aged 13 to 18, were recruited to participate in the study. Aim: This case study aims to examine the effectiveness of Project Grit in building resilience among at-risk adolescents. Methods: A case study design was employed to capture the complexity and uniqueness of the intervention, without oversimplifying or generalizing it. A 15-year-old male participant with a history of behavioural challenges, delinquency and gang involvement was selected for the study. Teacher, parent and child versions of the Strengths and Difficulties Questionnaire (SDQ) were administered to the facilitators, parents and participants respectively before and after the programme. Relevant themes from the qualitative interviews will be discussed. Results: Scores from all raters revealed improvements in most domains of the SDQ. Total difficulties scores across all raters improved from “very high” to “close to average”. High interrater reliability was observed (κ= .81). The participant reported learning methods to effectively deal with his everyday concerns using healthy coping strategies, developing a supportive social network, and building on his self efficacy. Themes from the subject’s report concurred with the improvement in SDQ scores. Conclusions: The findings suggest that Project Grit is a promising intervention for promoting resilience among at-risk adolescents. The teleological behaviourism framework and the combination of sports engagement and future orientation may be particularly effective in fostering resilience among this population. Further studies need to be conducted with a larger sample size to further validate the effectiveness of Project Grit.

Keywords: resilience, project grit, adolescents, at-risk, boxing, future orientation

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Authors: Jovian Cheung, Thomas Kwok, Victor Wong

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Buildings are entwined with smart city developments. Building performance relies heavily on electrical and mechanical (E&M) systems and services accounting for about 40 percent of global energy use. By cohering the advancement of technology as well as energy and operation-efficient initiatives into the buildings, people are enabled to raise building performance and enhance the sustainability of the built environment in their daily lives. Digital transformation in the buildings is the profound development of the city to leverage the changes and opportunities of digital technologies To optimize the building performance, intelligent power quality and energy management system is developed for transforming data into actions. The system is formed by interfacing and integrating legacy metering and internet of things technologies in the building and applying big data techniques. It provides operation and energy profile and actionable insights of a building, which enables to optimize the building performance through raising people awareness on E&M services and energy consumption, predicting the operation of E&M systems, benchmarking the building performance, and prioritizing assets and energy management opportunities. The intelligent power quality and energy management system comprises four elements, namely the Integrated Building Performance Map, Building Performance Dashboard, Power Quality Analysis, and Energy Performance Analysis. It provides predictive operation sequence of E&M systems response to the built environment and building activities. The system collects the live operating conditions of E&M systems over time to identify abnormal system performance, predict failure trends and alert users before anticipating system failure. The actionable insights collected can also be used for system design enhancement in future. This paper will illustrate how intelligent power quality and energy management system provides operation and energy profile to optimize the building performance and actionable insights to revitalize an existing building into a smart building. The system is driving building performance optimization and supporting in developing Hong Kong into a suitable smart city to be admired.

Keywords: intelligent buildings, internet of things technologies, big data analytics, predictive operation and maintenance, building performance

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Authors: Sabir Hussain, Muhammad Naeem, Yousif Aldryhim, Susan E. Halbert, Qingjun Wu

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Plant viruses annually cause severe economic losses in crop production and globally, different aphid species are responsible for the transmission of such viruses. Additionally, aphids are also serious pests of trees, and agricultural crops. Al Bahah Province, Kingdom of Saudi Arabia (KSA) has a high native and introduced plant species with a temperate climate that provides ample habitats for aphids. In this study, we surveyed virus-transmitting aphids from the Province to highlight their spatial distributions and hot spot areas for their target control strategies. During our fifteen month's survey in Al Bahah Province, three hundred and seventy samples of aphids were collected using both beating sheets and yellow water pan traps. Consequently, fifty-four aphid species representing 30 genera belonging to four families were recorded from Al Bahah Province. Alarmingly, 35 aphid species from our records are virus transmitting species. The most common virus transmitting aphid species based on number of collecting samples, were Macrosiphum euphorbiae (Thomas, 1878), Brachycaudus rumexicolens (Patch, 1917), Uroleucon sonchi (Linnaeus, 1767), Brachycaudus helichrysi (Kaltenbach, 1843), and Myzus persicae (Sulzer, 1776). The numbers of samples for the forementioned species were 66, 24, 23, 22, and 20, respectively. The widest range of plant hosts were found for M. euphorbiae (39 plant species), B. helichrysi (12 plant species), M. persicae (12 plant species), B. rumexicolens (10 plant species), and U. sonchi (9 plant species). The hottest spot areas were found in Al-Baha, Al Mekhwah and Biljarashi cities of the province on the basis of their abundance. This study indicated that Al Bahah Province has relatively rich aphid diversity due to the relatively high plant diversity in a favorable climatic condition. ArcGIS tools can be helpful for biologists to implement the target control strategies against these pests in the integrated pest management, and ultimately to save money and time.

Keywords: Al Bahah province, aphid-virus interaction, biodiversity, global information system

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Authors: Paul Koffitse Agobia

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In 2020 the Ministry of Education in Ghana and the National Council for Curriculum and Assessment (NaCCA) rolled out a new curriculum, Common Core Programme (CCP) for Basic 7 to 10, that lays emphasis on character building and values which are important to the Ghanaian society by providing education that will produce character–minded learners, with problem solving skills, who can play active roles in dealing with the increasing challenges facing Ghana and the global society. Therefore, learning and teaching approaches that prioritise the use of digital learning resources and active learning are recommended. The new challenge facing Ghanaian teachers is the ability to use new technologies together with the appropriate content pedagogical knowledge to help learners develop, aside the communication skills in French, the essential 21st century skills as recommended in the new curriculum. This article focusses on the pedagogical approaches that are recommended by NaCCA. The study seeks to examine French language teachers’ understanding of the recommended pedagogical approaches and how they use digital learning resources in class to foster the development of these essential skills and values. 54 respondents, comprised 30 teachers and 24 head teachers, were selected in 6 Junior High schools in rural districts (both private and public) and 6 from Junior High schools in an urban setting. The schools were selected in three regions: Volta, Central and Western regions. A class observation checklist and an interview guide were used to collect data for the study. The study reveals that some teachers adopt teaching techniques that do not promote active learning. They demonstrate little understanding of the core competences and values, therefore, fail to integrate them in their lessons. However, some other teachers, despite their lack of understanding of learning and teaching philosophies, adopted techniques that can help learners develop some of the core competences and values. In most schools, digital learning resources are not utilized, though teachers have smartphones or laptops.

Keywords: active learning, core competences, digital learning resources, pedagogical approach, values.

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Authors: William Thomas Worster

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This paper will highlight the failure of international adjudication to prevent a state from evading an order of provisional measures by simply issuing a diplomatic assurance to the court. This practice changes the positions of the litigants as equals before a court, prevents the court from inquiring into the reliability of the political pledge as it would with assurances from a state to an individual, and diminishes the court’s ability to control its own proceedings in the face of concerns over sovereignty. Both the European Court of Human Rights (ECtHR) and International Court of Justice (ICJ) will entertain these kinds of unilateral pledges, but they consider them differently when the declaration is made between states or between a state and an individual, and when made directly to the court. In short, diplomatic assurances issued between states or to individuals are usually considered not to be legally binding and are essentially questions of fact, but unilateral assurances issued directly to an international court are questions of law, and usually legally binding. At the same time, orders for provisional measures are now understood also to be legally binding, yet international courts will sometimes permit a state to substitute an assurance in place of an order for provisional measures. This emerging practice has brought the nature of a state as a sovereign capable of creating legal obligations into the forum of adjudication where the parties should have equality of arms and permitted states to create legal obligations that escape inquiry into the reliability of the outcome. While most recent practice has occurred at the ICJ in state-to-state litigation, there is some practice potentially extending the practice to human rights courts. Especially where the litigants are factually unequal – a state and an individual – this practice is problematic since states could more easily overcome factual failings in their pledges and evade the control of the court. Consider, for example, the potential for evading non-refoulement obligations by extending the current diplomatic assurances practice from the state-to-state context to the state-to-court context. The dual nature of assurances, as both legal and factual instruments, should be considered as addressed to distinct questions, each with its own considerations, and that we need to be more demanding about their precise legal and factual effects.

Keywords: unilateral, diplomacy, assurances, undertakings, provisional measures, interim measures

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Authors: Julius K. Gane, Mohamad N. Nahil, Paul T. Williams

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In today’s world of rapid population growth and a changing climate, one way to mitigate various negative effects is via renewable energy solutions. Energy and power as basic requirements in almost all human endeavours are also the banes of the changing climate and the impacts thereof. Thus it is crucial to develop innovative and environmentally friendly energy options to ameliorate various negative repercussions. Upgrading of fast pyrolysis bio-oil via hydro-treatment offers such opportunities, as quality renewable liquid transportation fuels can be produced. The process, however, is typically accompanied by bio-char formation as a by-product. The goal of this work was to study the yield and some properties of bio-chars formed from a hydrotreatment process, with an overall aim to promote the valuable utilization of wastes or by-products from renewable energy technologies. It is assumed that bio-chars that have comparable energy contents with coals will be more desirable as solid energy materials due to renewability and environmental friendliness. Therefore, the analytical work in this study focused mainly on determining the higher heating value (HHV) of the chars. The method involved the reaction of bio-oil in an autoclave supplied by the Parr Instrument Company, IL, USA. Two main parameters (different temperatures and resident times) were investigated. The chars were characterized using a Thermo EA2000 CHNS analyser, then oxygen contents and HHVs computed based on the literature. From the results, these bio-chars can readily serve as feedstocks for the production of renewable solid fuels. Their HHVs ranged between 29.26-39.18 MJ/kg, affected by different temperatures and retention times. There was an inverse relationship between the oxygen content and the HHVs of the chars. It can, therefore, be concluded that it is possible to optimize the process efficiency of the hydrotreatment process used through the production of renewable energy materials from the 'waste’ char by-products. Future work should consider developing a suitable balance between the primary objective of bio-oil upgrading processes (which is to improve the quality of the liquid fuels) and the conversion of its solid wastes into value-added products such as smokeless briquettes.

Keywords: bio-char, renewable solid biofuels, valorisation, waste-to-energy

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Authors: Lukas Vierus, Thomas Schuster

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A general framework is examined for dynamic tensor field tomography within an inhomogeneous medium characterized by refraction and absorption, treated as an inverse source problem concerning the associated transport equation. Guided by Fermat’s principle, the Riemannian metric within the specified domain is determined by the medium's refractive index. While considerable literature exists on the inverse problem of reconstructing a tensor field from its longitudinal ray transform within a static Euclidean environment, limited inversion formulas and algorithms are available for general Riemannian metrics and time-varying tensor fields. It is established that tensor field tomography, akin to an inverse source problem for a transport equation, persists in dynamic scenarios. Framing dynamic tensor tomography as an inverse source problem embodies a comprehensive perspective within this domain. Ensuring well-defined forward mappings necessitates establishing existence and uniqueness for the underlying transport equations. However, the bilinear forms of the associated weak formulations fail to meet the coercivity condition. Consequently, recourse to viscosity solutions is taken, demonstrating their unique existence within suitable Sobolev spaces (in the static case) and Sobolev-Bochner spaces (in the dynamic case), under a specific assumption restricting variations in the refractive index. Notably, the adjoint problem can also be reformulated as a transport equation, with analogous results regarding uniqueness. Analytical solutions are expressed as integrals over geodesics, facilitating more efficient evaluation of forward and adjoint operators compared to solving partial differential equations. Certainly, here's the revised sentence in English: Numerical experiments are conducted using a Nesterov-accelerated Landweber method, encompassing various fields, absorption coefficients, and refractive indices, thereby illustrating the enhanced reconstruction achieved through this holistic modeling approach.

Keywords: attenuated refractive dynamic ray transform of tensor fields, geodesics, transport equation, viscosity solutions

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Authors: Thomas Ruppert, Shana Jones, J. Scott Pippin

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State and federal government agencies within the United States have recently invested substantial resources into studies of future flood risk conditions associated with climate change and sea-level rise. A review of numerous case studies has uncovered several key themes that speak to an overall incoherence within current flood risk assessment procedures in the U.S. context. First, there are substantial local differences in the quality of available information about basic infrastructure, particularly with regard to local stormwater features and essential facilities that are fundamental components of effective flood hazard planning and mitigation. Second, there can be substantial mismatch between regulatory Flood Insurance Rate Maps (FIRMs) as produced by the National Flood Insurance Program (NFIP) and other 'current condition' flood assessment approaches. This is of particular concern in areas where FIRMs already seem to underestimate extant flood risk, which can only be expected to become a greater concern if future FIRMs do not appropriately account for changing climate conditions. Moreover, while there are incentives within the NFIP’s Community Rating System (CRS) to develop enhanced assessments that include future flood risk projections from climate change, the incentive structures seem to have counterintuitive implications that would tend to promote moral hazard. In particular, a technical finding of higher future risk seems to make it easier for a community to qualify for flood insurance savings, with much of these prospective savings applied to individual properties that have the most physical risk of flooding. However, there is at least some case study evidence to indicate that recognition of these issues is prompting broader discussion about the need to move beyond FIRMs as a standalone local flood planning standard. The paper concludes with approaches for developing climate adaptation and flood resilience strategies in the U.S. that move away from the social welfare model being applied through NFIP and toward more of an informed risk approach that transfers much of the investment responsibility over to individual private property owners.

Keywords: climate change adaptation, flood risk, moral hazard, sea-level rise

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Authors: Jonathan Soliman, Thomas Cavasino, Virginie Pommelet, Lahouari Amor, Pierre Mornand, Simon Escoda, Nina Droz, Soraya Matczak, Julie Toubiana, François Angoulvant, Etienne Carbonnelle, Albert Faye, Loic de Pontual, Luu-Ly Pham

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Background: Typhoid and paratyphoid fever are systemic infections caused by Salmonella enterica serovar Typhi or paratyphi (A, B, C). Children traveling to tropical areas are at risk to contract these diseases which can be complicated. Methods: Clinical, biological and bacteriological data were collected from 78 pediatric cases reported between 2000 and 2017 in six Parisian hospitals. Children aged 0 to 18 years old, with a diagnosis of typhoid or paratyphoid fever confirmed by bacteriological exams, were included. Epidemiologic, clinical, biological features and presence of multidrug-resistant (MDR) bacteria or intermediate susceptibility to ciprofloxacin (nalidixic acid resistant) were examined by univariate analysis and by logistic regression analysis to identify risk factors of severe typhoid in children. Results: 84,6% of the children were imported cases of typhoid fever (n=66/78) and 15,4% were autochthonous cases (n=12/78). 89,7% were caused by S.typhi (n=70/78) and 12,8% by S.paratyphi (n=10/78) including 2 co-infections. 19,2% were intrafamilial cases (n=15/78). Median age at diagnosis was 6,4 years-old [6 months-17,9 years]. 28,2% of the cases were complicated forms (n=22/78): digestive (n=8; 10,3%), neurological (n=7; 9%), pulmonary complications (n=4; 5,1%) and hemophagocytic syndrome (n=4; 5,1%). Only 5% of the children had prior immunization with typhoid non-conjugated vaccine (n=4/78). 28% of the cases (n=22/78) were caused by resistant bacteria. Thrombocytopenia and diagnosis delay was significantly associated with severe infection (p= 0.029 and p=0,01). Complicated forms were more common with MDR (p=0,1) and not statistically associated with a young age or sex in this study. Conclusions: Typhoid and paratyphoid fever are not rare in children back from tropical areas. This multicentric pediatric study seems to show that thrombocytopenia, diagnosis delay, and multidrug resistant bacteria are associated with severe typhoid fever and complicated forms in children.

Keywords: antimicrobial resistance, children, Salmonella enterica typhi and paratyphi, severe typhoid

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Authors: Javier Muro, Anja Linstadter, Florian Manner, Lisa Schwarz, Stephan Wollauer, Paul Magdon, Gohar Ghazaryan, Olena Dubovyk

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Monitoring the trade-off between biomass production and biodiversity in grasslands is critical to evaluate the effects of management practices across environmental gradients. New generations of remote sensing sensors and machine learning approaches can model grasslands’ characteristics with varying accuracies. However, studies often fail to cover a sufficiently broad range of environmental conditions, and evidence suggests that prediction models might be case specific. In this study, biomass production and biodiversity indices (species richness and Fishers’ α) are modeled in 150 grassland plots for three sites across Germany. These sites represent a North-South gradient and are characterized by distinct soil types, topographic properties, climatic conditions, and management intensities. Predictors used are derived from Sentinel-1 & 2 and a set of topoedaphic variables. The transferability of the models is tested by training and validating at different sites. The performance of feed-forward deep neural networks (DNN) is compared to a random forest algorithm. While biomass predictions across gradients and sites were acceptable (r2 0.5), predictions of biodiversity indices were poor (r2 0.14). DNN showed higher generalization capacity than random forest when predicting biomass across gradients and sites (relative root mean squared error of 0.5 for DNN vs. 0.85 for random forest). DNN also achieved high performance when using the Sentinel-2 surface reflectance data rather than different combinations of spectral indices, Sentinel-1 data, or topoedaphic variables, simplifying dimensionality. This study demonstrates the necessity of training biomass and biodiversity models using a broad range of environmental conditions and ensuring spatial independence to have realistic and transferable models where plot level information can be upscaled to landscape scale.

Keywords: ecosystem services, grassland management, machine learning, remote sensing

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Authors: Ian Campbell, Gillian Mitchell, Paul James, Na Li, Ella Thompson

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The genetic cause of the majority of multiple-case breast cancer families remains unresolved. Next generation sequencing has emerged as an efficient strategy for identifying predisposing mutations in individuals with inherited cancer. We are conducting whole exome sequence analysis of germ line DNA from multiple affected relatives from breast cancer families, with the aim of identifying rare protein truncating and non-synonymous variants that are likely to include novel cancer predisposing mutations. Data from more than 200 exomes show that on average each individual carries 30-50 protein truncating mutations and 300-400 rare non-synonymous variants. Heterogeneity among our exome data strongly suggest that numerous moderate penetrance genes remain to be discovered, with each gene individually accounting for only a small fraction of families (~0.5%). This scenario marks validation of candidate breast cancer predisposing genes in large case-control studies as the rate-limiting step in resolving the missing heritability of breast cancer. The aim of this study is to screen genes that are recurrently mutated among our exome data in a larger cohort of cases and controls to assess the prevalence of inactivating mutations that may be associated with breast cancer risk. We are using the Agilent HaloPlex Target Enrichment System to screen the coding regions of 168 genes in 1,000 BRCA1/2 mutation-negative familial breast cancer cases and 1,000 cancer-naive controls. To date, our interim analysis has identified 21 genes which carry an excess of truncating mutations in multiple breast cancer families versus controls. Established breast cancer susceptibility gene PALB2 is the most frequently mutated gene (13/998 cases versus 0/1009 controls), but other interesting candidates include NPSR1, GSN, POLD2, and TOX3. These and other genes are being validated in a second cohort of 1,000 cases and controls. Our experience demonstrates that beyond PALB2, the prevalence of mutations in the remaining breast cancer predisposition genes is likely to be very low making definitive validation exceptionally challenging.

Keywords: predisposition, familial, exome sequencing, breast cancer

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Authors: Percy Galvez, Anatoly Petukhin, Paul Somerville, Ken Miyakoshi, Kojiro Irikura, Daniel Peter

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Physics-based dynamic rupture modelling is necessary for estimating parameters such as rupture velocity and slip rate function that are important for ground motion simulation, but poorly resolved by observations, e.g. by seismic source inversion. In order to generate a large number of physically self-consistent rupture models, whose rupture process is consistent with the spatio-temporal heterogeneity of past earthquakes, we use multicycle simulations under the heterogeneous rate-and-state (RS) friction law for a 45deg dip-slip fault. We performed a parametrization study by fully dynamic rupture modeling, and then, a set of spontaneous source models was generated in a large magnitude range (Mw > 7.0). In order to validate rupture models, we compare the source scaling relations vs. seismic moment Mo for the modeled rupture area S, as well as average slip Dave and the slip asperity area Sa, with similar scaling relations from the source inversions. Ground motions were also computed from our models. Their peak ground velocities (PGV) agree well with the GMPE values. We obtained good agreement of the permanent surface offset values with empirical relations. From the heterogeneous rupture models, we analyzed parameters, which are critical for ground motion simulations, i.e. distributions of slip, slip rate, rupture initiation points, rupture velocities, and source time functions. We studied cross-correlations between them and with the friction weakening distance Dc value, the only initial heterogeneity parameter in our modeling. The main findings are: (1) high slip-rate areas coincide with or are located on an outer edge of the large slip areas, (2) ruptures have a tendency to initiate in small Dc areas, and (3) high slip-rate areas correlate with areas of small Dc, large rupture velocity and short rise-time.

Keywords: earthquake dynamics, strong ground motion prediction, seismic engineering, source characterization

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Authors: Rehin Sulay, Anandhu Krishna, Jintumol Mathew, Vibin Ipe Thomas

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N-Nitrosodimethyl amine, the simplest member of the N-Nitrosoamine family, is a carcinogenic and mutagenic agent that has gained considerable research interest owing to its toxic nature. Ozonation of industrially important hydrazines such as unsymmetrical dimethylhydrazine (UDMH) or monomethylhydrazine (MMH) has been associated with NDMA formation and accumulation in the environment. UDMH/MMH - ozonation also leads to several other transformation products such as acetaldehyde dimethyl hydrazone (ADMH), tetramethyl tetra azene (TMT), diazomethane, methyl diazene, etc, which can be either precursors or competitors for NDMA formation.In this work, we explored the formation mechanism of ADMH and TMT from UDMH-ozonation and their further oxidation to NDMA using the second-order Moller Plesset perturbation theory employing the 6-311G(d) basis set. We have also investigated how MMH selectively forms methyl diazene and diazomethane under normal conditions and NDMA in the presence of excess ozone. Our calculations indicate that the reactions proceed via an initial H abstraction from the hydrazine –NH2 group followed by the oxidation of the generated N-radical species. The formation of ADMH from the UDMH-ozone reaction involves an acetaldehyde intermediate, which then reacts with a second UDMH molecule to generate ADMH. The preferable attack of ozone molecule on N=C bond of ADMH generates DMAN intermediate, which subsequently undergoes oxidation to form NDMA. Unlike other transformation products, TMT formation occurs via the dimerization of DMAN. Though there exist a N=N bonds in the TMT, which are preferable attacking sites for ozone, experimental studies show the lower yields of NDMA formation, which corroborates with the high activation barrier required for the process(42kcal/mol).Overall, our calculated results agree well with the experimental observations and rate constants. Computational calculations bring insights into the electronic nature and kinetics of the elementary reactions of this pathway, enabled by computed energies of structures that are not possible to access experimentally.

Keywords: reaction mechanism, ozonation, substituted hydrazine, transition state

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Authors: Timmis W., Simms M., Thomas C.

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This case discusses the management of two floors of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk and second primary cancer development.

Keywords: alcohol dependence, biopsy, oral carcinoma, tobacco

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Authors: Fadia Gafri, Kathryn Mckintosh, Louise Young, Alan Harvey, Simon Mackay, Andrew Paul, Robin Plevin

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Nuclear factor-kappa B (NF-κB) is a ubiquitous transcription factor found originally to play a key role in regulating inflammation. However considerable evidence links this pathway to the suppression of apoptosis, cellular transformation, proliferation and invasion (Aggarwal et al., 2006). Moreover, recent studies have also linked inflammation to cancer progression making NF-κB overall a promising therapeutic target for drug discovery (Dobrovolskaia & Kozlov, 2005). In this study we examined the effect of the natural product canthin-6-one (SU182) as part of a CRUK small molecule drug discovery programme for effects upon the NF-κB pathway. Initial studies demonstrated that SU182 was found to have good potency against the inhibitory kappa B kinases (IKKs) at 30M in vitro. However, at concentrations up to 30M, SU182 had no effect upon TNFα stimulated loss in cellular IκBα or p65 phosphorylation in the keratinocyte cell line NCTC2544. Nevertheless, 30M SU182 reduced TNF-α / PMA-induced NF-κB-linked luciferase reporter activity to (22.9 ± 5%) and (34.6± 3 %, P<0.001) respectively, suggesting an action downstream of IKK signalling. Indeed, SU182 neither decreased NF-κB-DNA binding as assayed by EMSA nor prevented the translocation of p65 (NF-κB) to the nucleus assessed by immunofluorescence and subcellular fractionation. In addition to the inhibition of transcriptional activity of TNFα-induced NF-κB reporter activity SU182 significantly reduced PMA-induced AP-1-linked luciferase reporter activity to about (48± 9% at 30M, P<0.001) . This mode of inhibition was not sufficient to prevent the activation of NF-κB dependent induction of other proteins such as COX-2 and iNOS, or activated MAP kinases (p38, JNK and ERK1/2) in LPS stimulated RAW 264.7 macrophages. Taken together these data indicate the potential for SU182 to interfere with the transcription factors NF-κB and AP-1 at transcriptional level. However, no potential anti-inflammatory effect was indicated, further investigation for other NF-κB dependent proteins linked to survival are also required to identify the exact mechanism of action.

Keywords: Canthin-6-one, NF-κB, AP-1, phosphorylation, Nuclear translocation, DNA-binding activity, inflammatory proteins.

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Authors: Elizabeth Behrens, Anne Timmermann, Alexander Yerkan, Joshua Thomas, Deborah Katz, Agne Paner, Melissa Larson, Shivi Jain, Seo-Hyun Kim, Celalettin Ustun, Ankur Varma, Parameswaran Venugopal, Jamile Shammo

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Coronavirus Disease-2019 (COVID-19) causes persistent concern for poor outcomes in vulnerable populations. Patients with hematologic malignancies (HM) have been found to have higher COVID-19 case fatality rates compared to those without malignancy. While cytopenias are common in patients with HM, especially in those undergoing chemotherapy treatment, hemoglobin (Hgb) and platelet count have not yet been studied, to our best knowledge, as potential prognostic indicators for patients with HM and COVID-19. The goal of this study is to identify factors that may increase the risk of mortality in patients with HM and COVID-19. In this single-center, retrospective, observational study, 65 patients with HM and laboratory confirmed COVID-19 were identified between March 2020 and January 2021. Information on demographics, laboratory data the day of COVID-19 diagnosis, and prognosis was extracted from the electronic medical record (EMR), chart reviewed, and analyzed using the statistical software SAS version 9.4. Chi-square testing was used for categorical variable analyses. Risk factors associated with mortality were established by logistic regression models. Non-Hodgkin lymphoma (37%), chronic lymphocytic leukemia (20%), and plasma cell dyscrasia (15%) were the most common HM. Higher Hgb level upon COVID-19 diagnosis was related to decreased mortality, odd ratio=0.704 (95% confidence interval [CI]: 0.511-0.969; P = .0263). Platelet count the day of COVID-19 diagnosis was lower in patients who ultimately died (mean 127 ± 72K/uL, n=10) compared to patients who survived (mean 197 ±92K/uL, n=55) (P=.0258). Female sex was related to decreased mortality, odd ratio=0.143 (95% confidence interval [CI]: 0.026-0.785; P = .0353). There was no mortality difference between the patients who were on treatment for HM the day of COVID-19 diagnosis compared to those who were not (P=1.000). Lower Hgb and male sex are independent risk factors associated with increased mortality of HM patients with COVID-19. Clinicians should be especially attentive to patients with HM and COVID-19 who present with cytopenias. Larger multi-center studies are urgently needed to further investigate the impact of anemia, thrombocytopenia, and demographics on outcomes of patients with hematologic malignancies diagnosed with COVID-19.

Keywords: anemia, COVID-19, hematologic malignancy, prognosis

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Authors: Christina Williams, Mehari Weldemariam, Ann M. Farese, Thomas J. MacVittie, Maureen A. Kane

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Radiation exposure results in dose-dependent and time-dependent multi-organ damage. Drug development of medical countermeasures (MCM) for radiation-induced injury occurs under the FDA Animal Rule because human efficacy studies are not ethical or feasible. The FDA Animal Rule requires the representation of both sexes and describes several uses for biomarkers in MCM drug development studies. Currently, MCMs are limited and there is no FDA-approved biomarker for any radiation injury. Sex as a variable is essential to identifying biomarkers and developing effective MCMs for acute radiation exposure (ARS) and delayed effects of acute radiation exposure (DEARE). These studies aim to address the death of information on sex differences that have not been determined by studies that included only male, single-sex cohorts. Studies have reported differences in radiosensitivity according to sex. As such, biomarker discovery for radiation-induced damage must consider sex as a variable. This study evaluated the plasma proteomic profile of Rhesus macaque non-human primates after different exposures and doses, as well as time points after radiation. Exposures and doses included total body irradiation between 5-7.5 Gy and partial body irradiation with 5% bone marrow sparing at 9, 9.5 and 10 Gy. Timepoints after irradiation included days 1, 3, 60, and 180, which encompassed both acute radiation syndromes and delayed effects of acute radiation exposure. Bottom-up proteomic analyses of plasma included equal numbers of males and females. In the control animals, few proteomic differences are observed between the sexes. In the irradiated animals, there are a few sex differences, with changes mostly consisting of proteins upregulated in the female animals. Multiple canonical pathways were upregulated in irradiated animals relative to the control animals when subjected to pathway analysis, but differential responses between the sexes are limited. These data provide critical baseline differences according to sex and establish sex differences in non-human primate models relevant to drug development of MCM under the FDA Animal Rule.

Keywords: ionizing radiation, sex differences, plasma proteomics, biomarker discovery

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Authors: Alice Brites, Gerd Sparovek, Jean Paul Metzger, Ricardo Rodrigues

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The segregation between science and policy in decision making process hinders nature conservation efforts worldwide. Scientists have been criticized for not producing information that leads to effective solutions for environmental problems. In an attempt to bridge this gap between science and practice, we conducted a project aimed at supporting the implementation of the Brazilian Native Vegetation Protection Law (NVPL) implementation in São Paulo State (SP), Brazil. To do so, we conducted multiple open meetings with the stakeholders involved in this discussion. Throughout this process, we raised stakeholders' demands for scientific information and brought feedbacks about our findings. However, our main scientific advice was not taken into account during the NVPL implementation in SP. The NVPL has a mechanism that exempts landholders who converted native vegetation without offending the legislation in place at the time of the conversion from restoration requirements. We found out that there were no accurate spatialized data for native vegetation cover before the 1960s. Thus, the initial benchmark for the mechanism application should be the 1965 Brazilian Forest Act. Even so, SP kept the 1934 Brazilian Forest Act as the initial legal benchmark for the law application. This decision implies the use of a probabilistic native vegetation map that has uncertainty and subjectivity as its intrinsic characteristics, thus its use can lead to legal queries, corruption, and an unfair benefit application. But why this decision was made even after the scientific advice was vastly divulgated? We raised some possible reasons to explain it. First, the decision was made during a government transition, showing that circumstantial political events can overshadow scientific arguments. Second, the debate about the NVPL in SP was not pacified and powerful stakeholders could benefit from the confusion created by this decision. Finally, the native vegetation protection mechanism is a complex issue, with many technical aspects that can be hard to understand for a non-specialized courtroom, such as the one that made the final decision at SP. This example shows that science and decision-makers still have a long way ahead to improve their way to interact and that science needs to find its way to be heard above the political buzz.

Keywords: Brazil, forest act, science-based dialogue, science-policy interface

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Authors: Henda J Thomas, Cornelia PJ Harmse, Cecile Schultz

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Wearables are one of the technologies that will flourish within the fourth industrial revolution and digital transformation arenas, allowing employers to integrate collected data into organisational information systems. The study aimed to investigate whether wearable technology readiness can predict employees’ acceptance to wear wearables in the workplace. The factors of technology readiness predisposition that predict acceptance and positive attitudes towards wearable use in the workplace were examined. A quantitative research approach was used. The population consisted of 8 081 South African Department of Employment and Labour employees (DEL). Census sampling was used, and questionnaires to collect data were sent electronically to all 8 081 employees, 351 questionnaires were received back. The measuring instrument called the Technology Readiness and Acceptance Model (TRAM) was used in this study. Four hypotheses were formulated to investigate the relationship between readiness and acceptance of wearables in the workplace. The results found consistent predictions of technology acceptance (TA) by eagerness, optimism, and discomfort in the technology readiness (TR) scales. The TR scales of optimism and eagerness were consistent positive predictors of the TA scales, while discomfort proved to be a negative predictor for two of the three TA scales. Insecurity was found not to be a predictor of TA. It was recommended that the digital transformation policy of the DEL should be revised. Wearables in the workplace should be embraced from the viewpoint of convenience, automation, and seamless integration with the DEL information systems. The empirical contribution of this study can be seen in the fact that positive attitude emerged as a factor that extends the TRAM. In this study, positive attitude is identified as a new dimension to the TRAM not found in the original TA model and subsequent studies of the TRAM. Furthermore, this study found that Perceived Usefulness (PU) and Behavioural Intention to Use and (BIU) could not be separated but formed one factor. The methodological contribution of this study can lead to the development of a Wearable Readiness and Acceptance Model (WRAM). To the best of our knowledge, no author has yet introduced the WRAM into the body of knowledge.

Keywords: technology acceptance model, technology readiness index, technology readiness and acceptance model, wearable devices, wearable technology, fourth industrial revolution

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Authors: K. Appasamy, P. Paul

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Mauritius, a developing small-island-state, is facing a recession which is having a considerable economic impact particularly on its construction sector. Further, the presence of foreign entities, both as companies and workers, within this sector is creating a very competitive environment for local firms. This study investigates the key drivers that allow foreign firms to participate in this sector, in particular looking at the international and local tender processes, and the capacity of local industry to participate. This study also looks at how the current set up may hinder the latter’s involvement. The methodology used included qualitative semi-structured interviews conducted with established foreign companies, local companies, and public bodies. Study findings indicate: there is an adequate availability of professional skills and expertise within the Mauritian construction industry but a lack of skilled labour especially at the operative level; projects awarded to foreign firms are either due to their uniqueness and hence lack of local knowledge, or due to foreign firms having lower tender bids; tendering systems and processes are weak, including monitoring and enforcement, which encourages corruption and favouritism; a high level of ignorance of this sector’s characteristics and opportunities exists amongst the local population; local entities are very profit oriented and have short term strategies that discourage long term investment in workforce training and development; but most importantly, stakeholders do not grasp the importance of encouraging youngsters to join this sector, they have no long term vision, and there is a lack of mutual involvement and collaboration between them. Although local industry is highly competent, qualified and experienced, the tendering and procurement systems in Mauritius are not conducive enough to allow for effective strategic planning and an equitable allocation of projects during an economic downturn so that the broadest spread of stakeholders’ benefit. It is of utmost importance that all sector and government entities collaborate to formulate strategies and reforms on tender processes and capacity building to ensure fairness and continuous growth of this sector in Mauritius.

Keywords: construction industry, tender process, international firms, local capacity, Mauritius

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Authors: Thomas Vlasak, Tanja Dujlociv, Alfred Barth

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Shift work is an essential element of modern labor, ensuring ideal conditions of service for today’s economy and society. Despite the beneficial properties, its impact on the neurobehavioral performance of exposed subjects remains controversial. This meta-analysis aims to provide first summarizing the effects regarding the association between shift work exposure and different cognitive functions. A literature search was performed via the databases PubMed, PsyINFO, PsyARTICLES, MedLine, PsycNET and Scopus including eligible studies until December 2020 that compared shift workers with non-shift workers regarding neurobehavioral performance tests. A random-effects model was carried out using Hedge’s g as a meta-analytical effect size with a restricted likelihood estimator to summarize the mean differences between the exposure group and controls. The heterogeneity of effect sizes was addressed by a sensitivity analysis using funnel plots, egger’s tests, p-curve analysis, meta-regressions, and subgroup analysis. The meta-analysis included 18 studies resulting in a total sample of 18,802 participants and 37 effect sizes concerning six different neurobehavioral outcomes. The results showed significantly worse performance in shift workers compared to non-shift workers in the following cognitive functions with g (95% CI): processing speed 0.16 (0.02 - 0.30), working memory 0.28 (0.51 - 0.50), psychomotor vigilance 0.21 (0.05 - 0.37), cognitive control 0.86 (0.45 - 1.27) and visual attention 0.19 (0.11 - 0.26). Neither significant moderating effects of publication year or study quality nor significant subgroup differences regarding type of shift or type of profession were indicated for the cognitive outcomes. These are the first meta-analytical findings that associate shift work with decreased cognitive performance in processing speed, working memory, psychomotor vigilance, cognitive control, and visual attention. Further studies should focus on a more homogenous measurement of cognitive functions, a precise assessment of experience of shift work and occupation types which are underrepresented in the current literature (e.g., law enforcement). In occupations where shift work is fundamental (e.g., healthcare, industries, law enforcement), protective countermeasures should be promoted for workers.

Keywords: meta-analysis, neurobehavioral performance, occupational psychology, shift work

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Authors: Sameer A. Pathan, Biswadev Mitra, Salman Mirza, Umais Momin, Zahoor Ahmed, Lubna G. Andraous, Dharmesh Shukla, Mohammed Y. Shariff, Magid M. Makki, Tinsy T. George, Saad S. Khan, Stephen H. Thomas, Peter A. Cameron

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Study objective: Emergency physician’s (EP) ability to identify hydronephrosis on point-of-care ultrasound (POCUS) has been assessed in the past using CT scan as the reference standard. We aimed to assess EP interpretation of POCUS to identify and grade the hydronephrosis in a direct comparison with the consensus-interpretation of POCUS by radiologists, and also to compare the EP and radiologist performance using CT scan as the criterion standard. Methods: Using data from a POCUS databank, a prospective interpretation study was conducted at an urban academic emergency department. All POCUS exams were performed on patients presenting with renal colic to the ED. Institutional approval was obtained for conducting this study. All the analyses were performed using Stata MP 14.0 (Stata Corp, College Station, Texas). Results: A total of 651 patients were included, with paired sets of renal POCUS video clips and the CT scan performed at the same ED visit. Hydronephrosis was reported in 69.6% of POCUS exams by radiologists and 72.7% of CT scans (p=0.22). The κ for consensus interpretation of POCUS between the radiologists to detect hydronephrosis was 0.77 (0.72 to 0.82) and weighted κ for grading the hydronephrosis was 0.82 (0.72 to 0.90), interpreted as good to very good. Using CT scan findings as the criterion standard, Eps had an overall sensitivity of 81.1% (95% CI: 79.6% to 82.5%), specificity of 59.4% (95% CI: 56.4% to 62.5%), PPV of 84.3% (95% CI: 82.9% to 85.7%), and NPV of 53.8% (95% CI: 50.8% to 56.7%); compared to radiologist sensitivity of 85.0% (95% CI: 82.5% to 87.2%), specificity of 79.7% (95% CI: 75.1% to 83.7%), PPV of 91.8% (95% CI: 89.8% to 93.5%), and NPV of 66.5% (95% CI: 61.8% to 71.0%). Testing for a report of moderate or high degree of hydronephrosis, specificity of EP was 94.6% (95% CI: 93.7% to 95.4%) and to 99.2% (95% CI: 98.9% to 99.5%) for identifying severe hydronephrosis alone. Conclusion: EP POCUS interpretations were comparable to the radiologists for identifying moderate to severe hydronephrosis using CT scan results as the criterion standard. Among patients with moderate or high pre-test probability of ureteric calculi, as calculated by the STONE-score, the presence of moderate to severe (+LR 6.3 and –LR 0.69) or severe hydronephrosis (+LR 54.4 and –LR 0.57) was highly diagnostic of the stone disease. Low dose CT is indicated in such patients for evaluation of stone size and location.

Keywords: renal colic, point-of-care, ultrasound, bedside, emergency physician

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Authors: Thomas Abraham, Garcia de la Vega Felipe, Lubna Nishath, Nzekwe Nduka, Powell Anne-Marie

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Introduction: The purpose of this paper is to discuss the effectiveness of a peer support network created to provide medical education, pastoral support, and reliable resources to registrars to help them pass the MRCGP exams. This paper will include a description of the network and its purpose, discuss how it has been used by trainees since its creation, and explain how this methodology can be applied to other areas of medical education and primary care. Background: The peer support network was created in February 2021, using Facebook, Telegram, and WhatsApp platforms to facilitate discussion of cases and answer queries about the exams, share resources, and offer peer support from qualified GPs and specialists. The network was created and is maintained by the authors of this paper and is open to anyone who is registered with the General Medical Council (GMC) and is studying for the MRCGP exams. Purpose: The purpose of the network is to provide medical education, pastoral support, and reliable resources to registrars to help them pass the exams. The network is free to use and is designed to take the onus away from a single medical educator and collate a vast amount of information from multiple medical educators/trainers; thereby creating a digital library of information for all trainees - exam related or otherwise. Methodology The network is managed by a team of moderators who respond to queries and facilitate discussion. Smaller study groups are created from the main group and provide a platform for trainees to work together, share resources, and provide peer support. The network has had thousands of trainees using it since February 2021, with positive feedback from all trainees. Results: The feedback from trainees has been overwhelmingly positive. Word of mouth has spread rapidly, growing the groups exponentially. Trainees add colleagues to the groups and often stay after they pass their exams to 'give back' to their fellow trainees. To date, thousands of trainees have passed the MRCGP exams using the resources and support provided by the network. Conclusion The success of this peer support network demonstrates the effectiveness of creating a network of thousands of doctors to provide medical education and support.

Keywords: peer support, medical education, pastoral support, MRCGP exams

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Authors: Filiz Celik, Rachel Harrad, Rob Keasley, Paul Bennett

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The COVID-19 pandemic has posed a significant challenge to many, with some groups with particular vulnerability to adverse psychological impacts. These include those disadvantaged by mental ill health, either pre-existing or occurring during pregnancy or post-partum. Using a qualitative approach, the research aimed to identify the challenges posed by COVID-19 to women, their infants and families during the perinatal period and to suggest what further support can help alleviate the adverse mental health impact of COVID-19. 21 expectant and new mothers who were currently receiving support via a peri-natal mental health service participated in semi-structured interviews. In these interviews, participants explored the impact of changes in social circumstances and healthcare providers as a result of COVID-19 restrictions, with the resultant audio recordings transcribed and analyzed using Reflexive Thematic Analysis (RTA). Based on these accounts, it was concluded that women, their partners and potentially their infants experienced heightened peri-natal distress, and their experience at this time increased their risk for future mental health problems. Women described emerging as more vulnerable, owing to their role as primary caregivers during the perinatal period and also explained how social isolation and limited access to services meant protective buffers against mental health deterioration were reduced and the resources they needed in order to develop resilience were weakened. Although partners were invited to take part in the research, a sizeable volume of data could not be generated to fully assess the impact of the pandemic on a partner’s mental well-being. However, women expressed concerns about the paternal mental health of partners and husbands which invites us to be further vigilant to paternal mental health and associated experiences. Overall, these interviews serve to highlight and provide a voice to these women and their families who describe experiencing disadvantage at an already vulnerable time in their lives, as well as illustrating the need for services to prioritize the needs of this population when acute events strike, be those future pandemics or other disasters.

Keywords: patient experience, perinatal mental health, covid-19 pandemic, heightened anxiety, birth trauma, post-natal well-being

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