Search results for: business model design

Authors: Yusuf Garba Baba

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The construction industry and housing subsector are fraught with risks that have the potential of negatively impacting on the achievement of project objectives. The success or otherwise of most construction projects depends to large extent on how well these risks have been managed. The recent paradigm shift by the subsector to use of formal risk management approach in contrast to hitherto developed rules of thumb means that risks must not only be identified but also properly assessed and responded to in a systematic manner. The study focused on identifying risks associated with housing development projects and prioritisation assessment of the identified risks in order to provide basis for informed decision. The study used a three-step identification framework: review of literature for similar projects, expert consultation and questionnaire based survey to identify potential risk factors. Delphi survey method was employed in carrying out the relative prioritization assessment of the risks factors using computer-based Analytical Hierarchical Process (AHP) software. The results show that 19 out of the 50 risks significantly impact on housing development projects. The study concludes that although significant numbers of risk factors have been identified as having relevance and impacting to housing construction projects, economic risk group and, in particular, ‘changes in demand for houses’ is prioritised by most developers as posing a threat to the achievement of their housing development objectives. Unless these risks are carefully managed, their effects will continue to impede success in these projects. The study recommends the adoption and use of the combination of multi-technique identification framework and AHP prioritization assessment methodology as a suitable model for the assessment of risks in housing development projects.

Keywords: risk management, risk identification, risk analysis, analytic hierarchical process

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Authors: Sapan Bhatnagar

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Micron size particles emitted from different sources and produced by combustion have serious negative effects on human health and environment. They can penetrate deep into our lungs through the respiratory system. Determination of the amount of particulates present in the atmosphere per cubic meter is necessary to monitor, regulate and model atmospheric particulate levels. Cascade impactor is used to collect the atmospheric particulates and by gravimetric analysis, their concentration in the atmosphere of different size ranges can be determined. Cascade impactors have been used for the classification of particles by aerodynamic size. They operate on the principle of inertial impaction. It consists of a number of stages each having an impaction plate and a nozzle. Collection plates are connected in series with smaller and smaller cutoff diameter. Air stream passes through the nozzle and the plates. Particles in the stream having large enough inertia impact upon the plate and smaller particles pass onto the next stage. By designing each successive stage with higher air stream velocity in the nozzle, smaller diameter particles will be collected at each stage. Particles too small to be impacted on the last collection plate will be collected on a backup filter. Impactor consists of 4 stages each made of steel, having its cut-off diameters less than 10 microns. Each stage is having collection plates, soaked with oil to prevent bounce and allows the impactor to function at high mass concentrations. Even after the plate is coated with particles, the incoming particle will still have a wet surface which significantly reduces particle bounce. The particles that are too small to be impacted on the last collection plate are then collected on a backup filter (microglass fiber filter), fibers provide larger surface area to which particles may adhere and voids in filter media aid in reducing particle re-entrainment.

Keywords: aerodynamic diameter, cascade, environment, particulates, re-entrainment

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Authors: Chethika Gunasiri Wadumestrige Dona, Geetha Mohan, Kensuke Fukushi

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Solid waste in urban areas, especially from organic materials like garden waste, food, and degradable sources, can create health and environmental problems if not managed properly. Urban agriculture has emerged as a potential solution in developing countries to mitigate these issues. It offers the possibility of low-carbon economies and knowledge and innovation dissemination. Domestic composting is a significant aspect of urban agriculture, and its success relies on the attitudes of those who practice it. This study examines the perspectives of 402 urban farmers in the Colombo District, Sri Lanka, regarding domestic compost production. It aims to identify the factors that influence these perspectives. The research found that urban farmers are willing to participate in domestic composting because they believe that it facilitates effective recycling of organic waste within their households. The study used an ordinal regression model to determine the factors that shape farmers' perspectives. Age, family size, and crop preferences are significant determinants of the adoption of domestic composting practices among urban farmers in the Colombo District. These findings highlight the importance of understanding and addressing farmers' attitudes in designing effective waste management strategies. In addition, the study also emphasizes the need for tailored interventions that align with farmers' beliefs and preferences to enhance the adoption and implementation of domestic composting practices in urban areas. The insights gained from this study contribute to the academic discourse and offer practical guidance for policymakers and urban planners seeking to promote sustainable waste management practices and support the adoption of urban agriculture in the broader context of urban development.

Keywords: urban agriculture, domestic composting, farmers` perspectives, sustainable urban development

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Authors: Kong Wing Man

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The purpose of this paper is to review the waste generation and management in different parts of the world. It is undeniable that waste generation and management has become an alarming environmental issue. Solid waste generation links inextricably to the degree of industrialization and economic development. Urbanization increases with the economic wealth of the countries. As the income of people and standard of living enhances, so does their consumption of goods and services, leading to a corresponding increase in waste generation. Based on the latest statistics from What A Waste Report published by World Bank (2012), it is estimated that the current global Municipal Solid Waste (MSW) generation levels are about 1.3 billion tonnes per year (1.2 kg per capita per day). By 2050, it is projected that the waste generation will be doubled. Although many waste collection practices have been implemented in various countries, the amount of waste generation keeps increasing. An integrated solid waste management is needed in order to reduce the continuous significant increase in waste generation rates. Although many countries have introduced and implemented the 3Rs strategy and landfill, however, these are only the ways to diverse waste, but cannot reduce the volume. Instead, the advanced thermal treatment technology, incineration, can reduce up to 90% volume of disposed waste prior to dispose at landfills is discussed. Sweden and Tokyo were chosen as case studies, which provide an overview of the municipal solid waste management system. With the condition of escalating amount of wastes generated, it is crucial to build incinerators to relief pressing needs of landfill. Two solutions are proposed to minimize waste generation, including one incineration in one city and several small incinerators in different cities. While taking into consideration of a sustainable model and the perspectives of all stakeholders, building several incinerators at different cities and different sizes would be the best option to reduce waste. Overall, the solution to the global solid waste management should be a holistic approach with the involvement of both government and citizens.

Keywords: Incineration, Municipal Solid Waste, Thermal Treatment, Waste generation

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Authors: Mokgadi Malatji, Tebogo Mothiba, Rambelani Malema

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Absenteeism is a global problem in the working force and this is no exception in the nursing profession. A lot of attention has been drawn to factors that contribute to absenteeism however little attention has been placed on the effects of absenteeism on the remaining workers/nurses being left behind in the workplace by their colleagues. Nurses absent themselves leaving behind their colleagues to do their work. Nurses who are committed to their work often find themselves working under strenuous conditions due to inadequate staff. These may lead to poor patient care provision, nurses feeling overworked and sick due to the increased workload. The purpose of this study was to investigate the effects of absenteeism on nurses that remained at work at Mankweng Hospital in the Capricorn District, Limpopo Province. A descriptive cross-sectional quantitative research design was conducted to determine if there were any effects of absenteeism on nurses remaining at work. Data collection was done using structured questionnaires. The respondents (n=107), consisted of different categories of registered nurses (professional nurses (n=43), auxiliary nurses (n=40) and staff nurses (n=24)) who participated in this study. The findings indicated that most nurses (76, 6%) are demotivated and they struggle with completion of duties when their colleagues are absent. Patient care that nurses provided when their colleagues were absent was of poor quality as set standards and principles were not adhered to. Individualized patient care was not being implemented due to absenteeism. This simply implies that routine work is being done to cover basic duties. Most nurses (74, 8%) believed that favoritism and lack of appreciation of nurse’s skills and capabilities are being displayed by managers and that this contributes to absenteeism. Nurses who are loyal sacrifice their time and work overtime for absent colleagues and this led to fatigue and stress. From the study findings, it is recommended that nurses be trained frequently to upgrade their studies to motivate them to work. The government can provide this training to improve their skills as this will motivate nurses to work harder and be committed to their work. Training can be offered after a stipulated period. For example, after every five years, a nurse can be provided with a new skill. Team building events must be encouraged for the whole hospital to motivate staff. In conclusion, the study revealed that absenteeism poses detrimental effects on nurses, the hospital and patients. More and more nurses end up changing workplace due to these effects.

Keywords: absenteeism, effects, nurses, remaining at work

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Authors: Iman Shabanzadeh

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The economic growth and the special model of development in China have caused sensitivity in the public opinion of the world regarding the nature of this growth and development. In this regard, the Chinese have tried to put an end to such alarming procedures by using all the tools at their disposal and seek to present a peaceful and cooperative image of themselves. In this way, one of the most important diplomatic tools that Beijing has used to reduce the concerns caused by the Threat Theory has been the use of soft power resources and its tools in its development policies. This article begins by analyzing the concept of soft power and examining its foundations in international relations, and continues to examine the components of soft power in its Chinese version. The main purpose of the article is to figure out about the position of West Asia in China's soft power strategy and resources China use to achieve its goals in this region. In response to the main question, the paper's hypothesis is that soft power in its Chinese version had significant differences from Joseph Nye's original idea. In fact, the Chinese have imported the American version of soft power and adjusted, strengthened and, in other words, internalized it with their abilities, capacities and political philosophy. Based on this, China's software presence in West Asia can be traced in three areas. The first source of China's soft power in this region of West Asia is cultural in nature and is realized through strategies such as "use of educational tools and methods", "media methods" and "tourism industry". The second source is related to political soft power, which is applied through the policy of "balance of influence" and the policy of "mediation" and relying on the "ideological foundations of Confucianism". The third source also refers to China's economic soft power and is realized through three tools: "energy exchanges", "foreign investments" and "Belt-Road initiative". The research method of this article is descriptive-analytical.

Keywords: soft power, cooperative power, china, west asia

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Authors: Sultan Ahmad Azizi, Gaurang J. Joshi

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Urban transportation has come to lime light in recent times due to deteriorating travel quality. The economic growth of India has boosted significant rise in private vehicle ownership in cities, whereas public transport systems have largely been ignored in metropolitan cities. Even though there is latent demand for public transport systems like organized bus services, most of the metropolitan cities have unsustainably low share of public transport. Unfortunately, Indian metropolitan cities have failed to maintain balance in mode share of various travel modes in absence of timely introduction of mass transit system of required capacity and quality. As a result, personalized travel modes like two wheelers have become principal modes of travel, which cause significant environmental, safety and health hazard to the citizens. Of late, the policy makers have realized the need to improve public transport system in metro cities for sustaining the development. However, the challenge to the transit planning authorities is to design a transit system for cities that may attract people to switch over from their existing and rather convenient mode of travel to the transit system under the influence of household socio-economic characteristics and the given travel pattern. In this context, the fast-growing industrial city of Surat is taken up as a case for the study of likely shift to bus transit. Deterioration of public transport system of bus after 1998, has led to tremendous growth in two-wheeler traffic on city roads. The inadequate and poor service quality of present bus transit has failed to attract the riders and correct the mode use balance in the city. The disaggregate travel behavior for trip generations and the travel mode choice has been studied for the West Adajan residential sector of city. Mode specific utility functions are calibrated under multi-nominal logit environment for two-wheeler, cars and auto rickshaws with respect to bus transit using SPSS. Estimation of shift to bus transit is carried indicate an average 30% of auto rickshaw users and nearly 5% of 2W users are likely to shift to bus transit if service quality is improved. However, car users are not expected to shift to bus transit system.

Keywords: bus transit, disaggregate travel nehavior, mode choice Behavior, public transport

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Authors: Ádám Vass, István Bakos, Irina Borbáth, Zoltán Pászti, István Sajó, András Tompos

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Important requirements for the anode side electrocatalysts of polymer electrolyte membrane (PEM) fuel cells are CO-tolerance, stability and corrosion resistance. Carbon is still the most common material for electrocatalyst supports due to its low cost, high electrical conductivity and high surface area, which can ensure good dispersion of the Pt. However, carbon becomes degraded at higher potentials and it causes problem during application. Therefore it is important to explore alternative materials with improved stability. Molybdenum-oxide can improve the CO-tolerance of the Pt/C catalysts, but it is prone to leach in acidic electrolyte. The Mo was stabilized by isovalent substitution of molybdenum into the rutile phase titanium-dioxide lattice, achieved by a modified multistep sol-gel synthesis method optimized for preparation of Ti0.7Mo.3O2-C composite. High degree of Mo incorporation into the rutile lattice was developed. The conductivity and corrosion resistance across the anticipated potential/pH window was ensured by mixed oxide – activated carbon composite. Platinum loading was carried out using NaBH4 and ethylene glycol; platinum content was 40 wt%. The electrocatalyst was characterized by both material investigating methods (i.e. XRD, TEM, EDS, XPS techniques) and electrochemical methods (cyclic-voltammetry, COads stripping voltammetry, hydrogen oxidation reaction on rotating disc electrode). The electrochemical activity of the sample was compared to commercial 40 wt% Pt/C (Quintech) and PtRu/C (Quintech, Pt= 20 wt%, Ru= 10 wt%) references. Enhanced CO tolerance of the electrocatalyst prepared using the Ti0.7Mo.3O2-C composite material was evidenced by the appearance of a CO-oxidation related 'pre-peak' and by the pronounced shift of the maximum of the main CO oxidation peak towards less positive potential compared to Pt/C. Fuel cell polarization measurements were also carried out using Bio-Logic and Paxitech FCT-150S test device. All details on the design, preparation, characterization and testing by both electrochemical measurements and fuel cell test device of electrocatalyst supported on Ti0.7Mo.3O2-C composite material will be presented and discussed.

Keywords: anode electrocatalyst, composite material, CO-tolerance, TiMoOx

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Authors: Sajjad Ali Khan Sajjad Ali Khan, Gohar Ayub, Khalil Ur Rahman, Muhammad Sajid, Mumtaz Farooq, Mohammad Irshad, Haider Ali

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A trail was carried out to know the effect of different soil media and planting time on the cuttings of cherry (Prunus avium L.) rootstock Colt at Agriculture Research Institute (ARI) Mingora swat, during winter 2011. The experiment was laid out in Randomized Complete Block Design (RCBD) with split plot arrangement and was replicated three times. Soil media (Silt, Garden soil and Silt+Garden soil+FYM) were assigned to main plots whereas, planting Dates (1st Jan, 11th Jan, 21st Jan, 1st Feb, 11th Feb, 21st Feb and 2nd March) subjected to sub plots. The data recorded on sprouting percentage, shoot diameter cutting-1, number of leaves cutting-1, rootstock height (cm), survival percentage, number of roots, root length (cm), root volume (cm3) and root weight (gm) were significantly affected by different soil media. Maximum sprouting percentage (100%), shoot diameter (1.72 mm), number of leaves cutting-1 (76.74), rootstock height (104.36 cm), survival percentage (41.67%), number of roots (76.35), root length (11.28 cm), root volume (4.43 cm3) and root weight (4.64 gm) were recorded in media M3 (Garden soil+silt+FYM). A significant response to various planting dates were observed for most of vegetative and rooting attributes of cherry rootstock Colt. 1st January plantation showed maximum sprouting percentage (100%), shoot diameter (1.99 mm), number of leaves (81.46), rootstock height (126.24 cm), survival percentage (58.12%), whereas 11th January plantation showed more number of roots (94.43), root length (10.60 cm), root volume (3.68 cm3) and root weight (3.71 gm). Based on the results from the experimental work, it is recommended that cherry cuttings should be planted in early January in soil media (Silt+Garden soil+ FYM) for better growth and development under the agro climatic conditions of temperate region.

Keywords: soil media, cherry rootstock, planting dates, growth parameters

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Authors: Ballout Amor, Yasmina Bouchahm, Lacheheb Dhia Eddine Zakaria

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Several studies all around the world were conducted on the phenomenon of the urban heat island, and referring to the results obtained, one of the most important factors that influence this phenomenon is the mineralization of the cities which means the reducing of evaporative urban surfaces, replacing vegetation and wetlands with concrete and asphalt. The use of vegetation and water can change the urban environment and improve comfort, thus reduce the heat island. The trees act as a mask to the sun, wind, and sound, and also as a source of humidity which reduces air temperature and surrounding surfaces. Water also acts as a buffer to noise; it is also a source of moisture and regulates temperature not to mention the psychological effect on humans. Our main objective in this paper is to determine the impact of vegetation, ponds and fountains on the urban micro climate in general and on the thermal comfort of people along the Independence square in the Algerian city of Sétif, which is a semi-arid climate, in particularly. In order to reach this objective, a comparative study between different scenarios has been done; the use of the Envi-met program enabled us to model the urban environment of the Independence Square and to study the possibility of improving the conditions of comfort by adding an amount of vegetation and water ponds. After studying the results obtained (temperature, relative humidity, wind speed, PMV and PPD indicators), the efficiency of the additions we've made on the square was confirmed and this is what helped us to confirm our assumptions regarding the terms of comfort in the studied site, and in the end we are trying to develop recommendations and solutions which may contribute to improve the conditions for greater comfort in the Independence square.

Keywords: comfort in outer space, urban environment, scenarisation, vegetation, water ponds, public square, simulation

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Authors: G. Yakubova, A. Kavetskiy, S. A. Prior, H. A. Torbert

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In-situ soil carbon determination over large soil surface areas (several hectares) is required in regard to carbon sequestration and carbon credit issues. This capability is important for optimizing modern agricultural practices and enhancing soil science knowledge. Collecting and processing representative field soil cores for traditional laboratory chemical analysis is labor-intensive and time-consuming. The neutron-stimulated gamma analysis method can be used for in-situ measurements of primary elements in agricultural soils (e.g., Si, Al, O, C, Fe, and H). This non-destructive method can assess several elements in large soil volumes with no need for sample preparation. Neutron-gamma soil elemental analysis utilizes gamma rays issued from different neutron-nuclei interactions. This process has become possible due to the availability of commercial portable pulse neutron generators, high-efficiency gamma detectors, reliable electronics, and measurement/data processing software complimented by advances in state-of-the-art nuclear physics methods. In Pulsed Fast Thermal Neutron Analysis (PFTNA), soil irradiation is accomplished using a pulsed neutron flux, and gamma spectra acquisition occurs both during and between pulses. This method allows the inelastic neutron scattering (INS) gamma spectrum to be separated from the thermal neutron capture (TNC) spectrum. Based on PFTNA, a mobile system for field-scale soil elemental determinations (primarily carbon) was developed and constructed. Our scanning methodology acquires data that can be directly used for creating soil elemental distribution maps (based on ArcGIS software) in a reasonable timeframe (~20-30 hectares per working day). Created maps are suitable for both agricultural purposes and carbon sequestration estimates. The measurement system design, spectra acquisition process, strategy for acquiring field-scale carbon content data, and mapping of agricultural fields will be discussed.

Keywords: neutron gamma analysis, soil elemental content, carbon sequestration, carbon credit, soil gamma spectroscopy, portable neutron generators, ArcMap mapping

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Authors: M. Ali Mandegari, S. Farzad, , J. F. Görgens

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Sugar is one of the main agricultural industries in South Africa and approximately livelihoods of one million South Africans are indirectly dependent on sugar industry which is economically struggling with some problems and should re-invent in order to ensure a long-term sustainability. Second generation biorefinery is defined as a process to use waste fibrous for the production of biofuel, chemicals animal food, and electricity. Bioethanol is by far the most widely used biofuel for transportation worldwide and many challenges in front of bioethanol production were solved. Biorefinery annexed to the existing sugar mill for production of bioethanol and electricity is proposed to sugar industry and is addressed in this study. Since flowsheet development is the key element of the bioethanol process, in this work, a biorefinery (bioethanol and electricity production) annexed to a typical South African sugar mill considering 65ton/h dry sugarcane bagasse and tops/trash as feedstock was simulated. Aspen PlusTM V8.6 was applied as simulator and realistic simulation development approach was followed to reflect the practical behaviour of the plant. Latest results of other researches considering pretreatment, hydrolysis, fermentation, enzyme production, bioethanol production and other supplementary units such as evaporation, water treatment, boiler, and steam/electricity generation units were adopted to establish a comprehensive biorefinery simulation. Steam explosion with SO2 was selected for pretreatment due to minimum inhibitor production and simultaneous saccharification and fermentation (SSF) configuration was adopted for enzymatic hydrolysis and fermentation of cellulose and hydrolyze. Bioethanol purification was simulated by two distillation columns with side stream and fuel grade bioethanol (99.5%) was achieved using molecular sieve in order to minimize the capital and operating costs. Also boiler and steam/power generation were completed using industrial design data. Results indicates that the annexed biorefinery can be self-energy sufficient when 35% of feedstock (tops/trash) bypass the biorefinery process and directly be loaded to the boiler to produce sufficient steam and power for sugar mill and biorefinery plant.

Keywords: biorefinery, self-energy sufficiency, tops/trash, bioethanol, electricity

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Authors: Soheir Mohamed Hegazy

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Culture sustainability, which reflects a deep respect for people and history, is a cause of concern in contemporary architecture. Adopting ultramodern architecture styles was initiated in the 20th century by a plurality of states worldwide. Only a few countries, including Oman, realized that fashionable architectural designs ignore cultural values, identity, the context of its environment, economic perspective, and social performance. Stirring the Sultanate of Oman from being a listless and closed community to a modern country started in the year 1970. Despite unprecedented development in all aspects of Omani people's life, the leadership and the public had the capability to adjust to the changing global challenges without compromising social values and identity. This research provides a close analysis of one of the recent examples of contemporary vernacular architecture in the Sultanate of Oman, as a case study, Oman International Airport. The said airport gained an international appreciation for its Omani-themed architecture, distinguished traveler experience, and advanced technology. Accordingly, it was selected by the World Travel Awards as the Best Tourism Development Project in the Middle East only four weeks afterward after starting its operation. This paper aims to transfer this successful design approach of integrating the latest trends in technology, systems, eco-friendly aspects, and materials with the traditional Omani architectural features, which reflects symbiotic harmony of the community, individuals, and environment to other countries, designers, researchers, and students. In addition, the paper aims to encourage architects and teachers to take responsibility for valorizing built heritage as a source of inspiration for modern architecture, which could be considered as an added value. The work depends on reviewing the relevant literature, a case study, interviews with two architects who were involved in the project’s site work, and one current high-ranking employee in the airport besides data analysis and conclusion.

Keywords: contemporary vernacular architecture, culture sustainability, Oman international airport, current Omani architecture type

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Authors: Ghulam Abbas Shah, Maqsood Sadiq, Ahsan Yasin

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Massive global plastic production, combined with poor degradation and recycling, leads to significant environmental pollution from microplastics, whose effects on plants in the soil remain understudied. Besides, effective mitigation strategies and their impact on ammonia (NH₃) emissions under varying fertilizer management practices remains sketchy. Therefore, the objectives of the study were (i) to determine the impact of organic fertilizers on the toxicity of microplastics in sorghum and physicochemical characteristics of microplastics-contaminated soil and (ii) to assess the impacts of these fertilizers on NH₃ emissions from this soil. A field experiment was conducted using sorghum as a test crop. Treatments were: (i) Control (C), (ii) Microplastics (MP), (iii) Inorganic fertilizer (IF), (iv) MPIF, (v) Farmyard manure (FM), (vi) MPFM, (vii) Biochar (BC), and (viii) MPBC, arranged in a randomized complete block design (RCBD) with three replicates. Microplastics of polyvinyl chloride (PVC) were applied at a rate of 1.5 tons ha-¹, and all fertilizers were applied at the recommended dose of 90 kg N ha-¹. Soil sampling was done before sowing and after harvesting the sorghum, with samples analyzed for chemical properties and microbial biomass. Crop growth and yield attributes were measured. In a parallel pot experiment, NH₃ emissions were measured using passive flux samplers over 72 hours following the application of treatments similar to those used in the field experiment. Application of MPFM, MPBC and MPIF reduced soil mineral nitrogen by 8, 20 and 38% compared to their sole treatments, respectively. Microbial biomass carbon (MBC) was reduced by 19, 25 and 59% in MPIF, MPBC and MPFM as compared to their sole application, respectively. Similarly, the respective reduction in microbial biomass nitrogen (MBN) was 10, 27 and 66%. The toxicity of microplastics was mitigated by MPFM and MPBC, each with only a 5% reduction in grain yield of sorghum relative to their sole treatments. The differences in nitrogen uptake between BC vs. MPBC, FM vs. MPFM, and IF vs. MPIF were 8, 10, and 12 kg N ha-¹, respectively, indicating that organic fertilizers mitigate microplastic toxicity in the soil. NH₃ emission was reduced by 5, 11 and 20% after application of MPFM, MPBC and MPIF than their sole treatments, respectively. The study concludes that organic fertilizers such as FM and BC can effectively mitigate the toxicity of microplastics in soil, leading to improved crop growth and yield.

Keywords: microplastics, soil characteristics, crop n uptake, biochar, NH₃ emissions

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Authors: Faith Eweluegim Enahoro-Ofagbe, Alika Eke Joseph

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Information on genetic variation within a population is crucial for utilizing heterozygosity for breeding programs that aim to improve crop species. The study was conducted to ascertain the genotypic similarities among twelve sugarcane (Saccharum officinarum) varieties to group them for purposes of hybridizations for cane yield improvement. The experiment was conducted at the University of Benin, Faculty of Agriculture Teaching and Research Farm, Benin City. Twelve sugarcane varieties obtained from National Cereals Research Institute, Badeggi, Niger State, Nigeria, were planted in three replications in a randomized complete block design. Each variety was planted on a five-row plot of 5.0 m in length. Data were collected on 12 agronomic traits, including; the number of millable cane, cane girth, internode length, number of male and female flowers (fuss), days to flag leaf, days to flowering, brix%, cane yield, and others. There were significant differences, according to the findings among the twelve genotypes for the number of days to flag leaf, number of male and female flowers (fuss), and cane yield. The relationship between the twelve sugarcane varieties was expressed using hierarchical cluster analysis. The twelve genotypes were grouped into three major clusters based on hierarchical classification. Cluster I had five genotypes, cluster II had four, and cluster III had three. Cluster III was dominated by varieties characterized by higher cane yield, number of leaves, internode length, brix%, number of millable stalks, stalk/stool, cane girth, and cane length. Cluster II contained genotypes with early maturity characteristics, such as early flowering, early flag leaf development, growth rate, and the number of female and male flowers (fuss). The maximum inter-cluster distance between clusters III and I indicated higher genetic diversity between the two groups. Hybridization between the two groups could result in transgressive recombinants for agronomically important traits.

Keywords: sugarcane, Saccharum officinarum, genotype, cluster analysis, principal components analysis

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Authors: Hongyun Li, Zhibin Jiang

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The travel of passengers in the urban rail transit network is influenced by changes in network structure and operational status, and the response of individual travel preferences to these changes also varies. Firstly, the influence of the suspension of urban rail transit line sections on passenger travel along the line is analyzed. Secondly, passenger travel trajectories containing multi-dimensional semantics are described based on network UD data. Next, passenger panel data based on spatio-temporal sequences is constructed to achieve frequent passenger clustering. Then, the Graph Convolutional Network (GCN) is used to model and identify the changes in travel modes of different types of frequent passengers. Finally, taking Shanghai Metro Line 11 as an example, the travel behavior patterns of frequent passengers after the Huaqiao section shutdown during the COVID-19 epidemic are analyzed. The results showed that after the section shutdown, most passengers would transfer to the nearest Anting station for boarding, while some passengers would transfer to other stations for boarding or cancel their travels directly. Among the passengers who transferred to Anting station for boarding, most of passengers maintained the original normalized travel mode, a small number of passengers waited for a few days before transferring to Anting station for boarding, and only a few number of passengers stopped traveling at Anting station or transferred to other stations after a few days of boarding on Anting station. The results can provide a basis for understanding urban rail transit passenger travel patterns and improving the accuracy of passenger flow prediction in abnormal operation scenarios.

Keywords: urban rail transit, section shutdown, frequent passenger, travel behavior pattern

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Authors: Rafooneh Mokhtarshahi Sani

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This study explores how the residents of a conserved urban area have used goods and ideas as resources to maintain an enviable architectural identity. Whereas conserved urban quarters are seen as role model for maintaining architectural identity, the article describes how their residents try to give a contemporary modern image to their homes. It is argued that despite the efforts of authorities and decision makers to keep and preserve the traditional architectural identity in conserved urban areas, people have already moved on and have adjusted their homes with their preferred architectural taste. Being through such conflict of interests, have put the future of architectural identity in such places at risk. The thesis is that, on the one hand, such struggle over a desirable symbolic status in identity formation is taking place, and, on the other, it is continuously widening the gap between the real and ideal identity in the built environment. The study then analytically connects the concept of symbolic status to current identity debates. As an empirical research, this study uses systematic social and physical observation methods to describe and categorize the characteristics of settlements in Walled City of Famagusta, which symbolically represent the modern houses. The Walled City is a cultural heritage site, which most of its urban context has been conserved. Traditional houses in this area demonstrate the identity of North Cyprus architecture. The conserved residential buildings, however, either has been abandoned or went through changes by their users to present the ideal image of contemporary life. In the concluding section, the article discusses the differences between the symbolic status of people and authorities in defining a culturally valuable contemporary home. And raises the question of whether we can talk at all about architectural identity in terms of conserving the traditional style, and how we may do so on the basis of dynamic nature of identity and the necessity of its acceptance by the users.

Keywords: symbolic status, architectural identity, conservation, facades, Famagusta walled city

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Authors: Mohammad Ansari, Satinder Mann, Ahmed Ismail

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Primary care patients in Emergency Departments (ED) have been the topic of discussion since 1998 in the United Kingdom. Numerous studies have analysed attendances in EDs retrospectively and suggest that at least one third to fifty percent patients attending ED with problems which could be managed appropriately in General Practice or minor injuries units. The pattern of ED Usage seems to be International. In Australia and many departments in the United States include walk in facilities staffed by physicians on family practice residency programme. It clearly appears in the United Kingdom that EDs have to accept that such patients with primary care problems will attend the ED and facilities will have to be provided to see and treat such patients. Urgent care centres were introduced in the United Kingdom nearly a decade ago to reduce the pressure on EDs. Most of these were situated near pre-existing EDs. Unfortunately these centres failed to have the desired effect of reducing the number of patients visiting EDs, it has been noticed that when more patients were seen in Urgent Care centres there were increased attendances in ED as well. A new model of Urgent Care centre was started in the ED of George Eliot Hospital, Nuneaton, UK. We looked at the working of the centre by looking at the number of patients seen daily against the number of total attendances in the ED. We studied the number and type of patients seen by the Urgent Care Doctor. All the medical records of the patients were seen and the time patients spent in the Urgent Care centre was recorded. The total number of patients seen during this study were 1532. 219 (14.3% ) were seen within our Urgent Care centre. None of the patients waited over four hours to be seen. It has been recognised that primary care patients in the ED are a major part of attendances of the department and unless these patients are seen in Urgent Care centres, overcrowding and long waits cannot been avoided. It has been shown that employing primary care Physicians in Urgent Care centres reduces overall cost because they do not carry out as many investigations as Junior Doctors. In our study over 14% patients were seen by Urgent Care Physicians and none of the patients waited for more than four hours and we feel that care provided to the patients by Urgent Care centre was highly effective and satisfying for the patient.

Keywords: urgent care centres, primary care physicians, overcrowding, cost

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Authors: Keping Zuo, Foad Kabinejadian, Gideon Praveen Kumar Vijayakumar, Fangsen Cui, Pei Ho, Hwa Liang Leo

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Carotid artery stenting (CAS) is the standard procedure for patients with severe carotid stenosis at high risk for carotid endarterectomy (CAE). A major drawback of CAS is the higher incidence of procedure-related stroke compared with traditional open surgical treatment for carotid stenosis - CEA, even with the use of the embolic protection devices (EPD). As the currently available bare metal stents cannot address this problem, our research group developed a novel preferential covered-stent for carotid artery aims to prevent friable fragments of atherosclerotic plaques from flowing into the cerebral circulation, and yet maintaining the flow of the external carotid artery. The preliminary animal studies have demonstrated the potential of this novel covered-stent design for the treatment of carotid atherosclerotic stenosis. The purpose of this study is to evaluate the effect of membrane coating on the stent flexibility in order to improve the clinical performance of our novel covered stents. A total of 21 stents were evaluated in this study: 15 self expanding bare nitinol stents and 6 PTFE-covered stents. 10 of the bare stents were coated with 11%, 16% and 22% Polyurethane(PU), 4%, 6.25% and 11% EE, as well as 22% PU plus 5 μm Parylene. Different laser cutting designs were performed on 4 of the PTFE covert stents. All the stents, with or without the covered membrane, were subjected to a three-point flexural test. The stents were placed on two supports that are 30 mm apart, and the actuator is applying a force in the exact middle of the two supports with a loading pin with radius 2.5 mm. The loading pin displacement change, the force and the variation in stent shape were recorded for analysis. The flexibility of the stents was evaluated by the lumen area preservation at three displacement bending levels: 5mm, 7mm, and 10mm. All the lumen areas in all stents decreased with the increase of the displacement from 0 to 10 mm. The bare stents were able to maintain 0.864 ± 0.015, 0.740 ± 0.025 and 0.597 ± 0.031of original lumen area at 5 mm, 7 mm and 10mm displacement respectively. For covered stents, the stents with EE coating membrane showed the best lumen area preservation (0.839 ± 0.005, 0.7334 ± 0.043 and 0.559 ± 0.014), whereas, the stents with PU and Parylene coating were only 0.662, 0.439 and 0.305. Bending stiffness was also calculated and compared. These results provided optimal material information and it was crucial for enhancing clinical performance of our novel covered stents.

Keywords: carotid artery, covered stent, nonlinear, hyperelastic, stress, strain

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Authors: S. M. Abdul Khader, Anurag Ayachit, Raghuvir Pai, K. A. Ahmed, V. R. K Rao, S. Ganesh Kamath

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The numerical simulation has made tremendous advances in investigating the blood flow phenomenon through elastic arteries. Such study can be useful in demonstrating the disease progression and haemodynamics of cardiovascular diseases such as atherosclerosis. In the present study, patient specific case diagnosed with partially stenosed complete right ICA and normal left carotid bifurcation without any atherosclerotic plaque formation is considered. 3D patient specific carotid bifurcation model is generated based on CT scan data using MIMICS-4.0 and numerical analysis is performed using FSI solver in ANSYS-14.5. The blood flow is assumed to be incompressible, homogenous and Newtonian, while the artery wall is assumed to be linearly elastic. The two-way sequentially-coupled transient FSI analysis is performed using FSI solver for three pulse cycles. The haemodynamic parameters such as flow pattern, Wall Shear Stress, pressure contours and arterial wall deformation are studied at the bifurcation and critical zones such as stenosis. The variation in flow behavior is studied throughout the pulse cycle. Also, the simulation results reveals that there is a considerable increase in the flow behavior in stenosed carotid in contrast to the normal carotid bifurcation system. The investigation also demonstrates the disturbed flow pattern especially at the bifurcation and stenosed zone elevating the haemodynamics, particularly during peak systole and later part of the pulse cycle. The results obtained agree well with the clinical observation and demonstrates the potential of patient specific numerical studies in prognosis of disease progression and plaque rupture.

Keywords: fluid-structure interaction, arterial stenosis, wall shear stress, carotid artery bifurcation

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Authors: M.St. Węglowski, D. Miara, S. Błacha, J. Dworak, J. Rykała, K. Kwieciński, J. Pikuła, G. Ziobro, A. Szafron, P. Zimierska-Nowak, M. Richert, P. Noga

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In the paper the results of welding of car’s air-conditioning elements are presented. These systems based on, mainly, the environmental unfriendly refrigerants. Thus, the producers of cars will have to stop using traditional refrigerant and to change it to carbon dioxide (R744). This refrigerant is environmental friendly. However, it should be noted that the air condition system working with R744 refrigerant operates at high temperature (up to 150 °C) and high pressure (up to 130 bar). These two parameters are much higher than for other refrigerants. Thus new materials, design as well as joining technologies are strongly needed for these systems. AISI 304 and 316L steels as well as aluminium alloys 5xxx are ranked among the prospective materials. As a joining process laser welding, plasma welding, electron beam welding as well as high rotary friction welding can be applied. In the study, the metallographic examination based on light microscopy as well as SEM was applied to estimate the quality of welded joints. The analysis of welding was supported by numerical modelling based on Sysweld software. The results indicated that using laser, plasma and electron beam welding, it is possible to obtain proper quality of welds in stainless steel. Moreover, high rotary friction welding allows to guarantee the metallic continuity in the aluminium welded area. The metallographic examination revealed that the grain growth in the heat affected zone (HAZ) in laser and electron beam welded joints were not observed. It is due to low heat input and short welding time. The grain growth and subgrains can be observed at room temperature when the solidification mode is austenitic. This caused low microstructural changes during solidification. The columnar grain structure was found in the weld metal. Meanwhile, the equiaxed grains were detected in the interface. The numerical modelling of laser welding process allowed to estimate the temperature profile in the welded joint as well as predicts the dimensions of welds. The agreement between FEM analysis and experimental data was achieved.  

Keywords: car’s air–conditioning, microstructure, numerical modelling, welding

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Authors: Kira Gulko Morse

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Choosing one’s primary language may not be as common as choosing an additional foreign language to study or use during travel. In some instances, however, it becomes a matter of internal personal struggle, as language is tied not only to specific circumstances but also to human background and identity. This phenomenological qualitative study focuses on the factors affecting the decision of a person to undergo a language shift. Specifically, it considers how these factors relate to identity negotiation and expression. The data for the study include the analysis of published autobiographical narratives and personal interviews conducted using the Responsive Interviewing model. While research participants come from a variety of geographical locations and have used different reasons for undergoing their individual language shift, the study identifies a number of common features shared by all the participants. Specifically, while all the participants have been able to maintain their first language to varying degrees of proficiency, they have all completed the shift to establish a primary language different from their first. Additionally, the process of self-identification is found to be directly connected to the phenomenon of language choice for each of the participants. The findings of the study further tie the phenomenon of individual language shift to a more comprehensive issue of individual life choices – ethnic revival, immigration, and inter-cultural marriage among others. The study discusses varying language roles and the data indicate that language shift may occur whether it is a symbolic driving force or a secondary means in fulfilling a set life goal. The concept of language addition is suggested as an alternative to the arbitrariness of language shift. Thus, instead of focusing on subtractive bilingualism or language loss, the emphasis becomes the integration of languages within the individual. The study emphasizes the importance of the construct of personal choice in its connection to individual language shift. It places the focus from society onto an individual and the ability of an individual to make decisions in matters of linguistic identification.

Keywords: choice theory, identity negotiation, language shift, psycholinguistics

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Authors: Samia Dahmani

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The research investigated the process and outcomes of an ongoing project “Den Grønne Rute”: a network of recreational rooms to be implemented throughout a former vulnerable neighborhood: Trekanten in the city of Holstebro in Denmark. The aim of the project is to better integrate Trekanten in the city and which initiated reflections upon the (dis)connection and the integration in relation to urban planning and city management, as well as the extent to which the project considers diversity since Holstebro is a growing multicultural city. With this research, it was first verified if Trekanten is splintered from Holstebro city, and secondly if planning for diversity, by engaging people in the process via place-making approaches, can help redress the disconnection between the neighborhood and the rest of the city. More specifically, the paper aims at exploring the role of place-making “Den Grønne Rute” in Trekanten in promoting planning for diversity and reassembling the splintering in the city. The theoretical and conceptual framework served to analyze the relationship between the splintering urbanism concept and the community involvement’s role in an inclusive process. The field study examines the detachment between Trekanten and Holstebro and the extent to which the project can overcome the disconnection. Methodologically a mix-methods approach was adopted where two semi-structured interviews, a focus group, and an online survey were conducted. Contrary to prior assumptions, the results showed that not only is Trekanten splintered from the city, but also the city is greatly disconnected from Trekanten, and hence Holstebro is a splintered city. The surprise was that Trekanten is moreover inner-splintered. The splintering urbanism accordingly has different dimensions. Even though the project’s design seemed to incorporate diverse ages and groups of people, its process lacks an understanding of the diversity’s relevance in promoting inclusiveness. In fact, the analysis revealed socio-cultural and psychological splintering. Since place-making, as a collaborative approach in planning, is itself an expression of diversity (since it brings differences into play), reconsidering diversity within the process by engaging people at the early stages of planning was recommended. Another suggestion was not to limit the project to a destination but more as an experience to remember and a story to tell. Only by bringing people together in re-imagining the place can Trekanten reassemble with Holstebro and vice versa. The aim of the research was to add a new perspective to the splintering urbanism and planning for diversity so to advance place-making as an approach in promoting the latter and redressing the former.

Keywords: the splintering urbanism, place-making, planning for diversity, Den Grønne Rute, Trekanten, Holstebro

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Authors: Sharmin Shahid, Zaher Zain

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The purpose of this study is to explore and examines the theoretical frameworks of ethical leadership style and affective organizational commitment. Additionally, to investigate the extent to which employee orientation and ethical guidance either strengthen or weaken on the relationship between ethical leadership style and affective commitment. The study will also measure the mediating effects of leader’s integrity either influence to inspire and revival employee’s affective commitment or not. The methodology of the study comprised sample of 237 managers, departmental heads, top-level executives, and professors of several financial institutions, banks, and universities in Bangladesh who are directly related with decision making process of respective organization. A cross sectional research design will be used to examine the direct, moderating, and mediating analysis among the research key variables. Data were gathered based on personal administered questionnaire. The findings of the study will be significance because it will provide the real scenario of leadership style which leads to financial and strategic success of any organizations. In addition, the results will be interesting enough to find out either ethical leadership style have positive relationship with affective commitment or not. Employee-orientation and ethical guidance is a moderator to improve leadership style and affective commitment, whereas, leader’s integrity mediates the relationships between leadership style and affective organizational commitment to do the right thing in the right way for the betterment of entire organizational success. Research limitations of the study are the data collected by self administered questionnaire, a method with well-known shortcomings. Second, the study concentrated on financial institutions, banks top executives, and universities professors in Bangladesh. An important implication of the research is that the interesting findings will give some insight to the leadership style and helps management to focus on their management and leadership efficacy, as that could improve their affective organizational commitment. The findings will be original and unique value adding with the existing literature on leadership studies. The study is based on a comprehensive literature review. The results will be based on a sample of financial institutions, banks, and universities in Bangladesh. The research findings are useful to academics and corporate leaders of financial institutions, banks, and universities all over the world.

Keywords: affective organizational commitment, Bangladesh, ethical guidance, ethical leadership style

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Authors: Huda Alyami

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The present study aims to measure the effectiveness of an "Interactive eBook" in order to develop skills of designing and employing webquests for female intern teachers. The study uses descriptive analytical methodology as well as quasi-experimental methodology. The sample of the study consists of (30) female intern teachers from the Department of Special Education (in the tracks of Gifted Education and Learning Difficulties), during the first semester of the academic year 2015, at King Abdul-Aziz University in Jeddah city. The sample is divided into (15) female intern teachers for the experimental group, and (15) female intern teachers for the control group. A set of qualitative and quantitative tools have been prepared and verified for the study, embodied in: a list of the designing webquests' skills, a list of the employing webquests' skills, a webquests' knowledge achievement test, a product rating card, an observation card, and an interactive ebook. The study concludes the following results: 1. After pre-control, there are statistically significant differences, at the significance level of (α ≤ 0.05), between the mean scores of the experimental and the control groups in the post measurement of the webquests' knowledge achievement test, in favor of the experimental group. 2. There are statistically significant differences, at the significance level of (α ≤ 0.05), between the mean scores of experimental and control groups in the post measurement of the product rating card in favor of the experimental group. 3. There are statistically significant differences, at the significance level of (α ≤ 0.05), between the mean scores of experimental and control groups in the post measurement of the observation card for the experimental group. In the light of the previous findings, the study recommends the following: taking advantage of interactive ebooks when teaching all educational courses for various disciplines at the university level, creating educational participative platforms to share educational interactive ebooks for various disciplines at the local and regional levels. The study suggests conducting further qualitative studies on the effectiveness of interactive ebooks, in addition to conducting studies on the use of (Web 2.0) in webquests.

Keywords: interactive eBook, webquest, design, employing, develop skills

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Authors: Rotimi Sunday Ajani, Omowumi Femi-Akinlosotu

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Background: The usually paired human kidneys are retroperitoneal urinary organs with some endocrine functions. Standard text books of anatomy ascribe single value to each of the dimension of length, width and thickness. Research questions: These values do not give consideration to racial and genetic variability in human morphology. They may thus be erroneous to students and clinicians working on Nigerians. Objectives: The study aimed at establishing reference values of the kidney length, width and thickness for Nigerians using the cadaveric model. Methodology: The length, width, thickness and weight of sixty kidneys harvested from cadavers of thirty adult Nigerians (Male: Female; 27: 3) were measured. Respective volume was calculated using the ellipsoid formula. Results: The mean length of the kidney was 9.84±0.89 cm (9.63±0.88 {right}; 10.06±0.86 {left}), width- 5.18±0.70 cm (5.21±0.72 {right}; 5.14±0.70 {left}), thickness-3.45±0.56 cm (3.36±0.58 {right}, 3.53±0.55 {left}), weight-125.06±22.34 g (122.36±21.70 {right}; 127.76 ±24.02 {left}) and volume of 95.45± 24.40 cm3 (91.73± 26.84 {right}; 99.17± 25.75 {left}). Discussion: Though the values of the parameters measured were higher for the left kidney (except for the width), they were not statistically significant. The various parameters obtained by this study differ from those of similar studies from other continents. Conclusion: Stating single value for each of the parameter of length, width and thickness of the kidney as currently obtained in textbooks of anatomy may be incomplete information and hence misleading. Thus, there is the need to emphasize racial differences when stating the normal values of kidney dimensions in textbooks of anatomy. Implication for Research and Innovation: The results of the study showed the dimensions of the kidney (length, width and thickness) have interracial vagaries as they were different from those of similar studies and values stated in standard textbooks of human anatomy. Future direction: This is a preliminary report and the study will continue so that more data will be obtained.

Keywords: kidney dimensions, cadaveric estimation, adult nigerians, racial differences

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Authors: Alex Knighton, Roba Khundkar, Michael Dunn

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Neo-colonialism is defined as the use of economic, political, cultural, or other pressures to control or influence other countries, especially former dependencies, and concerns have been raised about its presence in surgical missions. Surgical missions aim to rectify the huge disparity in surgical access worldwide, but their ethics must be carefully considered. This is especially in light of colonial history which affects international relations and global health today, to ensure that colonial attitudes are not influencing efforts to promote equity. This review examines the history of colonial global health, demonstrating that global health initiatives have consistently been used to benefit those providing them, and then asks whether elements of colonialism are still pervasive in surgical missions today. Data was collected from the literature using specified search terms and snowball searching, as well as from international expert web-based conferences on global surgery ethics. A thematic analysis was then conducted on this data, resulting in the identification of six themes which are identifiable in both past and present global health initiatives. These six themes are power, lack of understanding or respect, feelings of superiority, exploitation, enabling of dependency, and acceptance of poorer standards of care. An ethical analysis follows, concluding that the concerns of power and neo-colonialism in global surgery would be addressed by adopting a framework of procedural justice that promotes a refined governance process in which stakeholders are able to propose and reject decisions that affect them. The paper argues that adopting this model would address concerns of the power disparity in the field directly, as well as promoting an ethical framework to enable the other concerns of power disparity and neo-colonialism identified in the present analysis to be addressed.

Keywords: medical ethics, global surgery, global health, neocolonialism, surgical missions

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Authors: Yahia Massinissa, Afaf Benhouda, Mouloud Yahia

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Objective: The aim of this study was to investigate the toxicity; analgesic and anti-pyretic properties of standardized HA methanolic extract (HAMeOH) in vivo. Methods: The acute toxicity study was performed on rats while adopting the OECD-420 Guidelines (fixed dose procedure). Assessment of analgesic activity was performed in rats with two analgesic models. One was acetic acid induced writhing response and the other formalin-induced paw licking. The anti-pyretic effect was tested by Brewer’s yeast induced fever in rats. Results: For the acute toxicity test, the higher dose administration of 2000 mg/kg bw. of H.albus did not produce any toxic signs or deaths in rats. There were no significant differences (p>0.05) in the body and organ weights between control and treated groups. The (LD50) of 'H. albus' was higher than 2000 g/kg bw. In subacute toxicity study, no mortality and toxic signs were observed with the doses of 100 and 200 mg/kg bw. of extracts of for 28 consecutive days. These analgesic experimental results indicated that HAMeOH (100 mg/kg and 200 mg/kg) decreased the acetic acid-induced writhing responses and HAMeOH (100 mg/kg and 200 mg/kg) decreased the licking time in the second phase of the formalin test. Moreover, in the model of yeast-induced elevation of the body temperature HAMeOH showed dose-dependent lowering of the body temperature up to 3h at both the doses these results obtained, were comparable to that of paracetamol. Conclusion: The present findings indicate that the leaves of Hyoscyamus albus L. possess potent analgesic and antipyretic activity.

Keywords: Hyoscyamus albus, Umbilicus rupestris, secondary metabolites, NMR with protons, pharmacobiologic activities, methanolic extract

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Authors: Fasil Wagnew, Kefyalew Addis Alene, Setegn Eshetie, Tom Wingfield, Matthew Kelly, Darren Gray

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Introduction: Undernutrition is a major and under-appreciated risk factor for TB, which is estimated to be responsible for 1.9 million TB cases per year globally. The effectiveness of micronutrient supplementation on TB treatment outcomes and its prognostic markers such as sputum conversion and serum zinc, retinol, and hemoglobin levels has been poorly understood. This systematic review and meta-analysis aimed to determine the association between zinc and vitamin A supplementation and TB treatment outcomes and its prognostic markers. Methods: A systematic literature search for randomized controlled trials (RCTs) was performed in PubMed, Embase, and Scopus databases. Meta-analysis with a random effect model was performed to estimate risk ratio (RR) and mean difference (MD), with a 95% confidence interval (CI), for dichotomous and continuous outcomes, respectively. Results: Our search identified 2,195 records. Of these, nine RCTs consisting of 1,375 participants were included in the final analyses. Among adults with pulmonary TB, zinc (RR: 0.94, 95%CI: 0.86, 1.03), vitamin A (RR: 0.90, 95%CI: 0.80, 1.01), and combined zinc and vitamin A (RR: 0.98, 95%CI: 0.89, 1.08) supplementation were not significantly associated with TB treatment success. Combined zinc and vitamin A supplementation was significantly associated with increased sputum smear conversion at 2 months (RR: 1.16, 95%CI: 1.03, 1.32), serum zinc levels at 2 months (MD of 0.86umol/l, 95% CI: 0.14, 1.57), serum retinol levels at 2 months (MD: 0.06umol/l, 95 % CI: 0.04, 0.08) and 6 months (MD: 0.12umol/l, 95 % CI: 0.10, 0.14), and serum hemoglobin level at 6 months (MD: 0.29 ug/dl, 95% CI: 0.08 to 0.51), among adults with TB. Conclusions: Providing zinc and vitamin A supplementation to adults with pulmonary TB during treatment may increase early sputum smear conversion, serum zinc, retinol, and hemoglobin levels. However, the use of zinc, vitamin A, or both were not associated with TB treatment success.

Keywords: zinc and vitamin A supplementation, tuberculosis, treatment outcomes, meta-analysis, RCT

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Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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