Search results for: generalised

Authors: T. S. Almutairi, Paul May, Neil Allan

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The geometrical, electronic and magnetic properties of the neutral Mg center and MgN₃ cluster in diamond have been studied theoretically in detail by means of an HSE06 Hamiltonian that includes a fraction of the exact exchange term; this is important for a satisfactory picture of the electronic states of open-shell systems. Another batch of the calculations by GGA functionals have also been included for comparison, and these support the results from HSE06. The local perturbations in the lattice by introduced Mg defect are restricted in the first and second shell of atoms before eliminated. The formation energy calculated with HSE06 and GGA of single Mg agrees with the previous result. We found the triplet state with C₃ᵥ is the ground state of Mg center with energy lower than the singlet with C₂ᵥ by ~ 0.1 eV. The recent experimental ZPL (557.4 nm) of Mg center in diamond has been discussed in the view of present work. The analysis of the band-structure of the MgN₃ cluster confirms that the MgN₃ defect introduces a shallow donor level in the gap lying within the conduction band edge. This observation is supported by the EMM that produces n-type levels shallower than the P donor level. The formation energy of MgN₂ calculated from a 2NV defect (~ 3.6 eV) is a promising value from which to engineer MgN₃ defects inside the diamond. Ion-implantation followed by heating to about 1200-1600°C might induce migration of N related defects to the localized Mg center. Temperature control is needed for this process to restore the damage and ensure the mobilities of V and N, which demands a more precise experimental study.

Keywords: empirical marker method, generalised gradient approximation, Heyd–Scuseria–Ernzerhof screened hybrid functional, zero phono line

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Authors: Matthew Holland, Jason Everett, Martin Cox, Iain Suthers

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High spatial-resolution distribution of planktivorous reef fish can reveal behavioural adaptations to optimise the balance between feeding success and predator avoidance. We used a multi-beam echosounder to record bathymetry and the three-dimensional distribution of fish schools associated with natural and artificial reefs. We utilised generalised linear models to assess the distribution, orientation, and aggregation of fish schools relative to the structure, vertical relief, and currents. At artificial reefs, fish schooled more closely to the structure and demonstrated a preference for the windward side, particularly when exposed to strong currents. Similarly, at natural reefs fish demonstrated a preference for windward aspects of bathymetry, particularly when associated with high vertical relief. Our findings suggest that under conditions with stronger current velocity, fish can exercise their preference to remain close to structure for predator avoidance, while still receiving an adequate supply of zooplankton delivered by the current. Similarly, when current velocity is low, fish tend to disperse for better access to zooplankton. As artificial reefs are generally deployed with the goal of creating productivity rather than simply attracting fish from elsewhere, we advise that future artificial reefs be designed as semi-linear arrays perpendicular to the prevailing current, with multiple tall towers. This will facilitate the conversion of dispersed zooplankton into energy for higher trophic levels, enhancing reef productivity and fisheries.

Keywords: artificial reef, current, forage fish, multi-beam, planktivorous fish, reef fish, schooling

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Authors: Ziyue Zeng

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Bacteriophages are viruses which infect bacteria specifically. Over the past decades, phage λ has been extensively studied, especially its interaction with the Escherichia coli LamB (EcLamB) protein receptor. Nonetheless, despite the enormous numbers and near-ubiquity of environmental phages, aside from phage λ, there is a paucity of information on other phages which target EcLamB as a receptor. In this study, to answer the question of whether there are other EcLamB-targeting phages in the natural environment, a simple and convenient method was developed and used for isolating environmental phages which target a particular surface structure of a particular bacterium; in this case, the EcLamB outer membrane protein. From the enrichments with the engineered bacterial hosts, a collection of EcLamB-targeting phages (ΦZZ phages) were easily isolated. Intriguingly, unlike phage λ, an obligate EcLamB-dependent phage in the Siphoviridae family, the newly isolated ΦZZ phages alternatively recognised EcLamB or E. coli OmpC (EcOmpC) as a receptor when infecting E. coli. Furthermore, ΦZZ phages were suggested to represent new species in the Tequatrovirus genus in the Myoviridae family, based on phage morphology and genomic sequences. Most phages are thought to have a narrow host range due to their exquisite specificity in receptor recognition. With the ability to optionally recognise two receptors, ΦZZ phages were considered relatively promiscuous. Via the heterologous expression of EcLamB on the bacterial cell surface, the host range of ΦZZ phages was further extended to three different enterobacterial genera. Besides, an interesting selection of evolved phage mutants with a broader host range was isolated, and the key mutations involved in their evolution to adapt to new hosts were investigated by genomic analysis. Finally, and importantly, two ΦZZ phages were found to be putative generalised transducers, which could be exploited as tools for DNA manipulations.

Keywords: environmental microbiology, phage, microbe-host interactions, microbial ecology

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Authors: Getiye Dejenu Kibret, Daniel Demant, Andrew Hayen

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Introduction: In Ethiopia, more than half of newborn babies do not have access to Emergency Obstetric and Neonatal Care (EmONC) services. Understanding the effect of distance to health facilities on service use and neonatal survival is crucial to recommend policymakers and improve resource distribution. We aimed to investigate the effect of distance to health services on maternal service use and neonatal mortality. Methods: We implemented a data linkage method based on geographic coordinates and calculated straight-line (Euclidean) distances from the Ethiopian 2016 demographic and health survey clusters to the closest health facility. We computed the distance in ESRI ArcGIS Version 10.3 using the geographic coordinates of DHS clusters and health facilities. Generalised Structural Equation Modelling (GSEM) was used to estimate the effect of distance on neonatal mortality. Results: Poor geographic accessibility to health facilities affects maternal service usage and increases the risk of newborn mortality. For every ten kilometres (km) increase in distance to a health facility, the odds of neonatal mortality increased by 1.33% (95% CI: 1.06% to 1.67%). Distance also negatively affected antenatal care, facility delivery and postnatal counselling service use. Conclusions: A lack of geographical access to health facilities decreases the likelihood of newborns surviving their first month of life and affects health services use during pregnancy and immediately after birth. The study also showed that antenatal care use was positively associated with facility delivery service use and that both positively influenced postnatal care use, demonstrating the interconnectedness of the continuum of care for maternal and neonatal care services. Policymakers can leverage the findings from this study to improve accessibility barriers to health services.

Keywords: acessibility, distance, maternal health service, neonatal mortality

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Authors: Halimatus Sakdiah Minhat, Hamizah Sulaiman

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Introduction: Old age is commonly link with menopause among women. The main purpose of this study is to explore the views of middle-aged women and its association with menopause. Methods: Qualitative interviews in the form of focus group discussions (FGD) were conducted among women aged between 35 and 59 years old living in urban localities in two different states in Malaysia. Selection of respondents were conducted using the maximum variation sampling, focussing on five age categories which are between 35 to 39, 40 to 44, 45 to 49, 50 to 54 and 55 to 59 years old. Each FGD involved 5 to 7 respondents and lasted for 1 to 2 hours each. The content of the interviews were recorded, transcribed verbatim after each interview before the next focus group discussion is conducted. Field notes of reflexive observations were recorded by the rapporteur. Individual transcripts were analysed using standard methods of qualitative thematic analysis. The material was read through twice and later coded. The codes were further collapsed into several key themes related to perceptions towards menopause among the respondents. Results: A total number of 36 middle-aged women were consented for the interviews. The contents of the interviews revealed that younger women tend to associate menopause with being old, which were dominated by the younger aged categories of less than 50 years old. Majority of the respondents linked menopause with end of woman’s reproductive capacity or inability to give birth, lethargic or endless feeling of tiredness and insomnia, emotional instability or having more sensitive feelings and also the beginning of many health problems such as osteoarthritis which they perceived very synonyms with being old. Conclusion: The findings of this study indirectly reflect the negative views towards menopause among the middle-aged women in Malaysia. Being residents in the urban areas equipped with advanced technology and health information, do not exclude them from having negative views about menopause. However, this is a qualitative study which only focussing on age ranges, regardless of their socioeconomic and demographic background, which make further studies on related issues are necessaries. The fact that it was a qualitative interview, the findings could not be generalised and only specific to the targeted population.

Keywords: Menopause, Middle-aged women, old, Malaysia

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Authors: B. Hammouti, H. Oudda, A. Benabdellah, A. Benayada, A. Aouniti

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Corrosion behaviour of carbon steel was studied in various concentrated HClO4 solutions. To explain the acid attack in relation of H+ activity, new sensor was realised: two carbon paste electrodes (CPE) were constructed by incorporating ferrocene (Fc) and orthoquinone into the carbon paste matrix and crossed by weak current to stabilize potential difference. The potentiometric method at imposed weak current between these two electrodes permits the in situ determination of both concentration and acidity level of various concentrated HClO4 solutions. The different factors affecting the potential at imposed current as current intensity, temperature and H+ ion concentration are studied. The potentials measured between ferrocene and chloranil electrodes are directly linked to the acid concentration. The acidity Ri(H) function defined represents the determination of the H+ activity and constitutes the extend of pH is concentrated acid solutions. Ri(H) has been determined and compared to Strehlow Ro(H), Janata HGF and Hammett Ho functions. The collected data permit to give a scale of strength of mineral concentrated acids at a given concentration. Ri(H) is numerically equal to the thermodynamic Ro(H), but deviated from Hammett functions based on indicator determination. The CPE electrode with inserted ferrocene in presence of ferricinium (Fc+) ion in concentrated HClO4 at various concentrations is realized without junction potential and may plays the role of a practical reference electrode (FRE) in concentrated acids. Fc+ was easily prepared in biphasic medium HClO4-acid by the quantitative oxidation of ferrocene by the ortho-chloranil (oQ). Potential of FRE is stable with time. The variation of equilibrium potential of the interface Fc/ Fc+ at various concentrations of Fc+ (10-4 - 2 10-2 M) obeyed to the Nernst equation with a slope 0.059 Volt per decade. Corrosion rates obtained by weight loss and electrochemical techniques were then easily linked to acidity level.

Keywords: ferrocene, strehlow, concentrated acid, corrosion, Generalised pH, sensor carbon paste electrode

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Authors: Aamna Tufail, Kajal Kotecha, Iordanis Toursounidis, Ravinder Pabla

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Introduction/Aims: Acute Myeloid Leukaemia (AML) is a part of leukaemic group of hematopoietic disorders with a varying range of presentations, including oro-facial manifestations. Early recognition and management are essential for favourable outcomes. Materials and Methods: We present our experience, clinical presentation, and clinical photographs of a patient with previously undiagnosed AML who presented with oral symptoms to the emergency department of our hospital. An analysis of clinical characteristics, diagnostic investigations, and management modalities was performed. Results/Statistics: A 58-year-old man presented to A&E reporting an 11-day history of right sided facial swelling, acute TMJ symptoms, and oral discomfort. A dentist ruled out acute dental causes one day post onset of symptoms. Initial assessment was anatomically inconsistent and did not reveal a routine oral or maxillofacial etiology. Detailed clinical examination demonstrated fever, generalised pallor, swelling and erythema of right nasolabial region, bilateral masseteric tenderness, intraoral palatal ecchymosis, palatal ulceration, buccal and labial petechiae, cervical lymphadenopathy, and haematoma on dorsum of right hand overlying right 2nd metacarpal joint. Suspecting a systemic medical cause, we requested haematological investigations, which revealed neutropenia, thrombocytopenia, and anaemia. Flow cytometry confirmed CD34 + AML. Oral discomfort was managed symptomatically. The patient was referred to a tertiary care centre for acute haematologic care, where he was treated with IV antibiotics and continuing cycles of chemotherapy. Conclusions/Clinical Relevance: Oro-facial manifestations may be the first clinical sign of AML. Awareness of its features is vital in early diagnosis. In this context, dentists and oral medicine specialists can play an important role in detecting clinical signs of haematological disorders such as AML.

Keywords: acute myeloid leukaemia, oral symptoms, ulceration, diagnosis, management

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Authors: Bharati Mehta, Manish Parakh, Bharti Bhandari, Sneha Ambwani

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Speech and language delay (SLD) is seen commonly as a co-morbidity in children having severe resistant focal and generalized, syndromic and symptomatic epilepsies. It is however not clear whether epilepsy contributes to or is a mere association in the pathogenesis of SLD. Also, it is acknowledged that Auditory Brainstem Evoked Responses (ABER), besides used for evaluating hearing threshold, also aid in prognostication of neurological disorders and abnormalities in the hearing pathway in the brainstem. There is no circumscribed or surrogate neurophysiologic laboratory marker to adjudge the extent of SLD. The current study was designed to evaluate the abnormalities in Electroencephalography (EEG) and ABER in children with SLD who do not have an overt hearing deficit or autism. 94 children of age group 2-8 years with predominant SLD and without any gross motor developmental delay, head injury, gross hearing disorder, cleft lip/palate and autism were selected. Standard video Electroencephalography using the 10:20 international system and ABER after click stimulus with intensities 110 db until 40 db was performed in all children. EEG was abnormal in 47.9% (n= 45; 36 boys and 9 girls) children. In the children with abnormal EEG, 64.5% (n=29) had an abnormal background, 57.8% (n=27) had presence of generalized interictal epileptiform discharges (IEDs), 20% (n=9) had focal epileptiform discharges exclusively from left side and 33.3% (n=15) had multifocal IEDs occurring both in isolation or associated with generalised abnormalities. In ABER, surprisingly, the peak latencies for waves I, III & V, inter-peak latencies I-III & I-V, III-V and wave amplitude ratio V/I, were found within normal limits in both ears of all the children. Thus in the current study it is certain that presence of generalized IEDs in EEG are seen in higher frequency with SLD and focal IEDs are seen exclusively in left hemisphere in these children. It may be possible that even with generalized EEG abnormalities present in these children, left hemispheric abnormalities as a part of this generalized dysfunction may be responsible for the speech and language dysfunction. The current study also emphasizes that ABER may not be routinely recommended as diagnostic or prognostic tool in children with SLD without frank hearing deficit or autism, thus reducing the burden on electro physiologists, laboratories and saving time and financial resources.

Keywords: ABER, EEG, speech, language delay

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Authors: Tamas Molnar

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Electronic government systems are currently in the same development stage as e-commerce applications were about in the late 1990s. Wide adoption by the majority of population is near, as such services are not only more and more desired by the users, but also strongly advocated and pushed by the state, as a means to increase effectiveness and cut expenses at the same time. Diffusion is however hampered by the low motivation caused by usability issues which will cause more and more frustration as the general population ages. Usability centred design is essential when creating such services. Elderly users, who have statistically the least experience, have the most problems, and therefore reject unusable systems first. The goal of our research was to find a way to map the needs of the elderly and create guidelines for the design of electronic government systems which are usable for the whole population. The first phase of our research, started mid-2009, was centred on the idea to gather information about the needs of the target group, in both Germany and Hungary with over 70 participants. This was done with the help of scenarios, interviews and questionnaires. The supplied data enabled to choose an eGovernment system for tests on the target group. Tests conducted in Germany and Hungary were based on the design and functions of the German electronic ID card, in the native languages. Scenarios mirroring common, every day transactions requiring an identification procedure were used. The obtained results allowed us to develop a generalised solution, the IGUAN guideline. This guideline makes a standardised approach to the usability improvement process possible. It contains the special requirements of elderly users, and a catalogue of criteria, which helps to develop an application in line with the set requirements. The third phase of our research was used a proof of concept for the IGUAN. The guideline was evaluated and tested with an iterative prototyping. The successful completion of this phase indicates that the IGUAN can be used to measurably increase the acceptance of e-government systems by elderly users. We could therefore demonstrate that improvements in the interface make e-government application possible which are perceived useful and easy to use by elderly users. These improvements will measurably increase the user motivation and experience. This can however only be achieved with a structured design process, and requires a framework which takes the requirements of the elderly users into account.

Keywords: e-Government, usability, acceptance, guidelines

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Authors: Peeyush Verma, Anil Kumar, Anju Rawlley, Chanchal Mehra

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India's school-going population is largely served by an educational system that is, in most rural parts, stuck with methods that emphasize rote learning, endless examinations, and monotonous classroom activities. Rural government schools are generally seen as having poor infrastructure, poor support system and low motivation for teaching as well as learning. It was experienced during the survey of this project that there is lesser motivation of rural boys and girls to attend their schools and still less likely chances to study science, tabooed as “difficult”. An experiment was conducted with the help of Rural Knowledge Network Project through Department of Science and Technology, Govt of India in five remote villages of Sehore District in Madhya Pradesh (India) during 2012-2015. These schools are located about 50-70 Km away from Bhopal, the capital of Madhya Pradesh and can distinctively qualify as average rural schools. Three tier methodology was adapted to unfold the experiment. In first tier randomly selected boys and girls from these schools were taken to a daylong visit to the Regional Science Centre located in Bhopal. In second tier, randomly selected half of those who visited earlier were again taken to the Science Centre to make models of Science. And in third tier, all the boys and girls studying science were exposed to video lectures and study material through web. The results have shown an interesting face towards learning science among youths in rural schools through peer learning or incremental learning. The students who had little or no interest in learning science became good learners and queries started pouring in from the neighbourhood village as well as a few parents requested to take their wards in the project to learn science. The paper presented is a case study of the experiment conducted in five rural schools of Sehore District. It reflects upon the methodology of developing awareness and interest among students and finally engaging them in popularising science through peer-to-peer learning using incremental learning elements. The students, who had a poor perception about science initially, had changed their attitude towards learning science during the project period. The results of this case, however, cannot be generalised unless replicated in the same setting elsewhere.

Keywords: popularisation of science, science temper, incremental learning, peer-to-peer learning

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Authors: Konrad Steyn, Jacques Laubscher

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South African urban design solutions are mostly aligned with European and North American models that are often not appropriate in addressing some of this country’s challenges such as multiculturalism and decaying urban areas. Sustainable urban redevelopment in South Africa should be comprehensive in nature, sensitive in its manifestation, and should be robust and inclusive in order to achieve social relevance. This paper argues that the success of an urban design intervention is largely dependent on the public’s perceptions and expectations, and the way people participate in shaping their environments. The concept of sustainable urbanism is thus more comprehensive than – yet should undoubtedly include – methods of construction, material usage and climate control principles. The case study is a central element of this research paper. 725 Arcadia Street in Pretoria, was originally commissioned as a food market structure. A starkly contrasting existing modernist adjacent building forms the morphological background. Built in 1969, it is a valuable part of Pretoria’s modernist fabric. It was realised early on that the project should not be a mere localised architectural intervention, but rather an occasion to revitalise the neighbourhood through urban regeneration. Because of the complex and comprehensive nature of the site and rich cultural diversity of the area, a multi-faceted approach seemed the most appropriate response. The methodology for collating data consisted of a combination of literature reviews (regarding the historic original fauna and flora and current plants, observation (frequent site visits) and physical surveying on the neighbourhood level (physical location, connectivity to surrounding landmarks as well as movement systems and pedestrian flows). This was followed by an exploratory design phase, culminating in the present redevelopment proposal. Since built environment interventions are increasingly based on generalised normative guidelines, an approach focusing of urban acupuncture could serve as an alternative. Celebrating the specific urban condition, urban acupuncture offers an opportunity to influence the surrounding urban fabric and achieve urban renewal through physical, social and cultural mediation.

Keywords: neighbourhood, urban renewal, South African urban design solutions, sustainable urban redevelopment

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Authors: Benoît Leclercq, Ilse Depraetere

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The goal of this presentation is to shed new light on the semantics and pragmatics of be able to. It presents the results of a corpus analysis based on data from the BNC (British National Corpus), and discusses these results in light of a specific stance on the semantics-pragmatics interface taking into account recent developments. Be able to is often discussed in relation to can and could, all of which can be used to express ability. Such an onomasiological approach often results in the identification of usage constraints for each expression. In the case of be able to, it is the formal properties of the modal expression (unlike can and could, be able to has non-finite forms) that are in the foreground, and the modal expression is described as the verb that conveys future ability. Be able to is also argued to expressed actualised ability in the past (I was able/could to open the door). This presentation aims to provide a more accurate pragmatic-semantic profile of be able to, based on extensive data analysis and one that is embedded in a very explicit view on the semantics-pragmatics interface. A random sample of 3000 examples (1000 for each modal verb) extracted from the BNC was analysed to account for the following issues. First, the challenge is to identify the exact semantic range of be able to. The results show that, contrary to general assumption, be able to does not only express ability but it shares most of the root meanings usually associated with the possibility modals can and could. The data reveal that what is called opportunity is, in fact, the most frequent meaning of be able to. Second, attention will be given to the notion of actualisation. It is commonly argued that be able to is the preferred form when the residue actualises: (1) The only reason he was able to do that was because of the restriction (BNC, spoken) (2) It is only through my imaginative shuffling of the aces that we are able to stay ahead of the pack. (BNC, written) Although this notion has been studied in detail within formal semantic approaches, empirical data is crucially lacking and it is unclear whether actualisation constitutes a conventional (and distinguishing) property of be able to. The empirical analysis provides solid evidence that actualisation is indeed a conventional feature of the modal. Furthermore, the dataset reveals that be able to expresses actualised 'opportunities' and not actualised 'abilities'. In the final part of this paper, attention will be given to the theoretical implications of the empirical findings, and in particular to the following paradox: how can the same expression encode both modal meaning (non-factual) and actualisation (factual)? It will be argued that this largely depends on one's conception of the semantics-pragmatics interface, and that this need not be an issue when actualisation (unlike modality) is analysed as a generalised conversational implicature and thus is considered part of the conventional pragmatic layer of be able to.

Keywords: Actualisation, Modality, Pragmatics, Semantics

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Authors: Martín Pratto Burgos

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The Engineering School of the University of the Republic in Uruguay offers an Introductory Mathematical Course from the second semester of 2019. This course has been designed to assist students in preparing themselves for math courses that are essential for Engineering Degrees, namely Math1, Math2, and Math3 in this research. The research proposes to build a model that can accurately predict the student's activity and academic progress based on their performance in the three essential Mathematical courses. Additionally, there is a need for a model that can forecast the incidence of the Introductory Mathematical Course in the three essential courses approval during the first academic year. The techniques used are Principal Component Analysis and predictive modelling using the Generalised Linear Model. The dataset includes information from 5135 engineering students and 12 different characteristics based on activity and course performance. Two models are created for a type of data that follows a binomial distribution using the R programming language. Model 1 is based on a variable's p-value being less than 0.05, and Model 2 uses the stepAIC function to remove variables and get the lowest AIC score. After using Principal Component Analysis, the main components represented in the y-axis are the approval of the Introductory Mathematical Course, and the x-axis is the approval of Math1 and Math2 courses as well as student activity three years after taking the Introductory Mathematical Course. Model 2, which considered student’s activity, performed the best with an AUC of 0.81 and an accuracy of 84%. According to Model 2, the student's engagement in school activities will continue for three years after the approval of the Introductory Mathematical Course. This is because they have successfully completed the Math1 and Math2 courses. Passing the Math3 course does not have any effect on the student’s activity. Concerning academic progress, the best fit is Model 1. It has an AUC of 0.56 and an accuracy rate of 91%. The model says that if the student passes the three first-year courses, they will progress according to the timeline set by the curriculum. Both models show that the Introductory Mathematical Course does not directly affect the student’s activity and academic progress. The best model to explain the impact of the Introductory Mathematical Course on the three first-year courses was Model 1. It has an AUC of 0.76 and 98% accuracy. The model shows that if students pass the Introductory Mathematical Course, it will help them to pass Math1 and Math2 courses without affecting their performance on the Math3 course. Matching the three predictive models, if students pass Math1 and Math2 courses, they will stay active for three years after taking the Introductory Mathematical Course, and also, they will continue following the recommended engineering curriculum. Additionally, the Introductory Mathematical Course helps students to pass Math1 and Math2 when they start Engineering School. Models obtained in the research don't consider the time students took to pass the three Math courses, but they can successfully assess courses in the university curriculum.

Keywords: machine-learning, engineering, university, education, computational models

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Authors: Robin Devillers, Chantal van Dijk

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Children face ambiguities in everyday language use. Particularly ambiguity in pronoun resolution can be challenging, whereas adults can rapidly identify the antecedent of the mentioned pronoun. Two main factors underlie this process, namely the accessibility of the referent and the syntactic cues of the pronoun. After 200ms, adults have converged the accessibility and the syntactic constraints, while relieving cognitive effort by considering contextual cues. As children are still developing their cognitive capacity, they are not able yet to simultaneously assess and integrate accessibility, contextual cues and syntactic information. As such, they fail to identify the correct referent and possibly fixate more on the competitor in comparison to adults. In this study, Dutch while-clauses were used to investigate the interpretation of pronouns by children. The aim is to a) examine the extent to which 7-10 year old children are able to utilise discourse and syntactic information during online and offline sentence processing and b) analyse the contribution of individual factors, including age, working memory, condition and vocabulary. Adult and child participants are presented with filler-items and while-clauses, and the latter follows a particular structure: ‘Anna and Sophie are sitting in the library. While Anna is reading a book, she is taking a sip of water.’ This sentence illustrates the ambiguous situation, as it is unclear whether ‘she’ refers to Anna or Sophie. In the unambiguous situation, either Anna or Sophie would be substituted by a boy, such as ‘Peter’. The pronoun in the second sentence will unambiguously refer to one of the characters due to the syntactic constraints of the pronoun. Children’s and adults’ responses were measured by means of a visual world paradigm. This paradigm consisted of two characters, of which one was the referent (the target) and the other was the competitor. A sentence was presented and followed by a question, which required the participant to choose which character was the referent. Subsequently, this paradigm yields an online (fixations) and offline (accuracy) score. These findings will be analysed using Generalised Additive Mixed Models, which allow for a thorough estimation of the individual variables. These findings will contribute to the scientific literature in several ways; firstly, the use of while-clauses has not been studied much and it’s processing has not yet been identified. Moreover, online pronoun resolution has not been investigated much in both children and adults, and therefore, this study will contribute to adults and child’s pronoun resolution literature. Lastly, pronoun resolution has not been studied yet in Dutch and as such, this study adds to the languages

Keywords: pronouns, online language processing, Dutch, eye-tracking, first language acquisition, language development

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Authors: Saifalarab A. Mohmmed, Morgana E. Vianna, Jonathan C. Knowles

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The issue of apical periodontitis has received considerable critical attention. Bacteria is integrated into communities, attached to surfaces and consequently form biofilm. The biofilm structure provides bacteria with a series protection skills against, antimicrobial agents and enhances pathogenicity (e.g. apical periodontitis). Sodium hypochlorite (NaOCl) has become the irrigant of choice for elimination of bacteria from the root canal system based on its antimicrobial findings. The aim of the study was to investigate the effect of different agitation techniques on the efficacy of 2.5% NaOCl to eliminate the biofilm from the surface of the lateral canal using the residual biofilm, and removal rate of biofilm as outcome measures. The effect of canal complexity (lateral canal) on the efficacy of the irrigation procedure was also assessed. Forty root canal models (n = 10 per group) were manufactured using 3D printing and resin materials. Each model consisted of two halves of an 18 mm length root canal with apical size 30 and taper 0.06, and a lateral canal of 3 mm length, 0.3 mm diameter located at 3 mm from the apical terminus. E. faecalis biofilms were grown on the apical 3 mm and lateral canal of the models for 10 days in Brain Heart Infusion broth. Biofilms were stained using crystal violet for visualisation. The model halves were reassembled, attached to an apparatus and tested under a fluorescence microscope. Syringe and needle irrigation protocol was performed using 9 mL of 2.5% NaOCl irrigant for 60 seconds. The irrigant was either left stagnant in the canal or activated for 30 seconds using manual (gutta-percha), sonic and ultrasonic methods. Images were then captured every second using an external camera. The percentages of residual biofilm were measured using image analysis software. The data were analysed using generalised linear mixed models. The greatest removal was associated with the ultrasonic group (66.76%) followed by sonic (45.49%), manual (43.97%), and passive irrigation group (control) (38.67%) respectively. No marked reduction in the efficiency of NaOCl to remove biofilm was found between the simple and complex anatomy models (p = 0.098). The removal efficacy of NaOCl on the biofilm was limited to the 1 mm level of the lateral canal. The agitation of NaOCl results in better penetration of the irrigant into the lateral canals. Ultrasonic agitation of NaOCl improved the removal of bacterial biofilm.

Keywords: 3D printing, biofilm, root canal irrigation, sodium hypochlorite

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Authors: Kanogkan Leerojanaprapa

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Textile and garment industry is used to a major exporting industry of Thailand. According to lacking of the nation's price-competitiveness by stopping the EU's GSP (Generalised Scheme of Preferences) and ‘Nationwide Minimum Wage Policy’ that Thailand’s employers must pay all employees at least 300 baht (about $10) a day, the supply chains of the Thai textile and garment industry is affected and need to be reformed. Therefore, either Thai textile or garment industry will be existed or not would be concerned. This is also challenged for the government to decide which industries should be promoted the future industries of Thailand. Recently Thai government launch The Cluster-based Special Economic Development Zones Policy for promoting business cluster (effect on September 16, 2015). They define a cluster as the concentration of interconnected businesses and related institutions that operate within the same geographic areas and textiles and garment is one of target industrial clusters and 9 provinces are targeted (Bangkok, Kanchanaburi, Nakhon Pathom, Ratchaburi, Samut Sakhon, Chonburi, Chachoengsao, Prachinburi, and Sa Kaeo). The cluster zone are defined to link west-east corridor connected to manufacturing source in Cambodia and Mynmar to Bangkok where are promoted to be design, sourcing, and trading hub. The Thai government will provide tax and non-tax incentives for targeted industries within the clusters and expects these businesses are scattered to where they can get the most benefit which will identify future industrial cluster. This research will show the difference between the current cluster and future cluster following the target provinces of the textile and garment. The current cluster is analysed from secondary data. The four characteristics of the numbers of plants in Spinning, weaving and finishing of textiles, Manufacture of made-up textile articles, except apparel, Manufacture of knitted and crocheted fabrics, and Manufacture of other textiles, not elsewhere classified in particular 77 provinces (in total) are clustered by K-means cluster analysis and Hierarchical Cluster Analysis. In addition, the cluster can be confirmed and showed which variables contribute the most to defined cluster solution with ANOVA test. The results of analysis can identify 22 provinces (which the textile or garment plants are located) into 3 clusters. Plants in cluster 1 tend to be large numbers of plants which is only Bangkok, Next plants in cluster 2 tend to be moderate numbers of plants which are Samut Prakan, Samut Sakhon and Nakhon Pathom. Finally plants in cluster 3 tend to be little numbers of plants which are other 18 provinces. The same methodology can be implemented in other industries for future study.

Keywords: ANOVA, hierarchical cluster analysis, industrial clusters, K -means cluster analysis, textile and garment industry

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Authors: Ciwang Teyra, A. H. Y. Lai

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Introduction: Indigenous LGBTQ individuals face with significant life stress such as racial and gender discrimination and microaggressions, which may lead to negative impacts of their mental health. Although studies relevant to Taiwanese indigenous LGBTQpeople gradually increase, most of them are primarily conceptual or qualitative in nature. This research aims to fulfill the gap by offering empirical quantitative evidence, especially investigating the impact of racial and gender microaggressions on mental health among Taiwanese indigenous LGBTQindividuals with an intersectional perspective, as well as examine whether social support can help them to cope with microaggressions. Methods: Participants were (n=200; mean age=29.51; Female=31%, Male=61%, Others=8%). A cross-sectional quantitative design was implemented using data collected in the year 2020. Standardised measurements was used, including Racial Microaggression Scale (10 items), Gender Microaggression Scale (9 items), Social Support Questionnaire-SF(6 items); Patient Health Questionnaire(9-item); and Generalised Anxiety Disorder(7-item). Covariates were age, gender, and perceived economic hardships. Structural equation modelling (SEM) was employed using Mplus 8.0 with the latent variables of depression and anxiety as outcomes. A main effect SEM model was first established (Model1).To test the moderation effects of perceived social support, an interaction effect model (Model 2) was created with interaction terms entered into Model1. Numerical integration was used with maximum likelihood estimation to estimate the interaction model. Results: Model fit statistics of the Model 1:X2(df)=1308.1 (795), p<.05; CFI/TLI=0.92/0.91; RMSEA=0.06; SRMR=0.06. For Model, the AIC and BIC values of Model 2 improved slightly compared to Model 1(AIC =15631 (Model1) vs. 15629 (Model2); BIC=16098 (Model1) vs. 16103 (Model2)). Model 2 was adopted as the final model. In main effect model 1, racialmicroaggressionand perceived social support were associated with depression and anxiety, but not sexual orientation microaggression(Indigenous microaggression: b = 0.27 for depression; b=0.38 for anxiety; Social support: b=-0.37 for depression; b=-0.34 for anxiety). Thus, an interaction term between social support and indigenous microaggression was added in Model 2. In the final Model 2, indigenous microaggression and perceived social support continues to be statistically significant predictors of both depression and anxiety. Social support moderated the effect of indigenous microaggression of depression (b=-0.22), but not anxiety. All covariates were not statistically significant. Implications: Results indicated that racial microaggressions have a significant impact on indigenous LGBTQ people’s mental health. Social support plays as a crucial role to buffer the negative impact of racial microaggression. To promote indigenous LGBTQ people’s wellbeing, it is important to consider how to support them to develop social support network systems.

Keywords: microaggressions, intersectionality, indigenous population, mental health, social support

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Authors: Łukasz Ambroziak

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Although the impact of the production fragmentation on trade flows has been examined many times since the 1990s, the research was not comprehensive because of the limitations in traditional trade statistics. Early 2010s the complex databases containing world input-output tables (or indicators calculated on their basis) has made available. It increased the possibilities of examining the production sharing in the world. The trade statistic in value-added terms enables us better to estimate trade changes resulted from the internationalisation and globalisation as well as benefits of the countries from international trade. In the literature, there are many research studies on this topic. Unfortunately, trade in value added of the Central and Eastern European Countries (CEECs) has been so far insufficiently studied. Thus, the aim of the paper is to present changes in value added trade of the CEECs (Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia) in the period of 1995-2011. The concept 'trade in value added' or 'value added trade' is defined as the value added of a country which is directly and indirectly embodied in final consumption of another country. The typical question would be: 'How much value added is created in a country due to final consumption in the other countries?' The data will be downloaded from the World Input-Output Database (WIOD). The structure of this paper is as follows. First, theoretical and methodological aspects related to the application of the input-output tables in the trade analysis will be studied. Second, a brief survey of the empirical literature on this topic will be presented. Third, changes in exports and imports in value added of the CEECs will be analysed. A special attention will be paid to the differences in bilateral trade balances using traditional trade statistics (in gross terms) on one side, and value added statistics on the other. Next, in order to identify factors influencing value added exports and value added imports of the CEECs the generalised gravity model, based on panel data, will be used. The dependent variables will be value added exports and imports. The independent variables will be, among others, the level of GDP of trading partners, the level of GDP per capita of trading partners, the differences in GDP per capita, the level of the FDI inward stock, the geographical distance, the existence (or non-existence) of common border, the membership (or not) in preferential trade agreements or in the EU. For comparison, an estimation will also be made based on exports and imports in gross terms. The initial research results show that the gravity model better explained determinants of trade in value added than gross trade (R2 in the former is higher). The independent variables had the same direction of impact both on value added exports/imports and gross exports/imports. Only value of coefficients differs. The most difference concerned geographical distance. It had smaller impact on trade in value added than gross trade.

Keywords: central and eastern European countries, gravity model, input-output tables, trade in value added

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Authors: T. Lydon, A. McNabola, P. Coughlan

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Energy consumption in the water distribution network (WDN) is a well established problem equating to the industry contributing heavily to carbon emissions, with 0.9 kg CO2 emitted per m3 of water supplied. It is indicated that 85% of energy wasted in the WDN can be recovered by installing turbines. Existing potential in networks is present at small capacity sites (5-10 kW), numerous and dispersed across networks. However, traditional turbine technology cannot be scaled down to this size in an economically viable fashion, thus alternative approaches are needed. This research aims to enable energy recovery potential within the WDN by exploring the potential of pumps-as-turbines (PATs), to realise this potential. PATs are estimated to be ten times cheaper than traditional micro-hydro turbines, presenting potential to contribute to an economically viable solution. However, a number of technical constraints currently prohibit their widespread use, including the inability of a PAT to control pressure, difficulty in the selection of PATs due to lack of performance data and a lack of understanding on how PATs can cater for fluctuations as extreme as +/- 50% of the average daily flow, characteristic of the WDN. A PAT prototype is undergoing testing in order to identify the capabilities of the technology. Results of preliminary testing, which involved testing the efficiency and power potential of the PAT for varying flow and pressure conditions, in order to develop characteristic and efficiency curves for the PAT and a baseline understanding of the technologies capabilities, are presented here: •The limitations of existing selection methods which convert BEP from pump operation to BEP in turbine operation was highlighted by the failure of such methods to reflect the conditions of maximum efficiency of the PAT. A generalised selection method for the WDN may need to be informed by an understanding of impact of flow variations and pressure control on system power potential capital cost, maintenance costs, payback period. •A clear relationship between flow and efficiency rate of the PAT has been established. The rate of efficiency reductions for flows +/- 50% BEP is significant and more extreme for deviations in flow above the BEP than below, but not dissimilar to the reaction of efficiency of other turbines. •PAT alone is not sufficient to regulate pressure, yet the relationship of pressure across the PAT is foundational in exploring ways which PAT energy recovery systems can maintain required pressure level within the WDN. Efficiencies of systems of PAT energy recovery systems operating conditions of pressure regulation, which have been conceptualise in current literature, need to be established. Initial results guide the focus of forthcoming testing and exploration of PAT technology towards how PATs can form part of an efficiency energy recovery system.

Keywords: energy recovery, pump-as-turbine, water distribution network, water distribution network

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Authors: Elisavet Kechagia

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Due to the interplay of different genetic and environmental risk factors and its heterogeneous nature, the concept of attention deficit hyperactivity disorder (ADHD) has shaped controversy and conflicts, which have been, in turn, reflected in the controversial arguments about its treatment. Taking into account recent well evidence-based researches suggesting that ADHD is a condition, in which biopsychosocial factors are all weaved together, the current paper explores the multiple risk-factors that are likely to influence ADHD, with a particular focus on adolescents with ADHD who might experience comorbid social, emotional and behavioural disorders (SEBD). In the first section of this paper, the primary objective was to investigate the conflicting ideas regarding the definition, diagnosis and treatment of ADHD at an international level as well as to critically examine and identify the limitations of the two most prevailing sets of diagnostic criteria that inform current diagnosis, the American Psychiatric Association’s (APA) diagnostic scheme, DSM-V, and the World Health Organisation’s (WHO) classification of diseases, ICD-10. Taking into consideration the findings of current longitudinal studies on ADHD association with high rates of comorbid conditions and social dysfunction, in the second section the author moves towards an investigation of the transitional points −physical, psychological and social ones− that students with ADHD might experience during early adolescence, as informed by neuroscience and developmental contextualism theory. The third section is an exploration of the different perspectives of ADHD as reflected in individuals’ with ADHD self-reports and the KENT project’s findings on school staff’s attitudes and practices. In the last section, given the high rates of SEBDs in adolescents with ADHD, it is examined how cognitive behavioural therapy (CBT), coupled with other interventions, could be effective in ameliorating anti-social behaviours and/or other emotional and behavioral difficulties of students with ADHD. The findings of a range of randomised control studies indicate that CBT might have positive outcomes in adolescents with multiple behavioural problems, hence it is suggested to be considered both in schools and other community settings. Finally, taking into account the heterogeneous nature of ADHD, the different biopsychosocial and environmental risk factors that take place during adolescence and the discourse and practices concerning ADHD and SEBD, it is suggested how it might be possible to make sense of and meaningful improvements to the education of adolescents with ADHD within a multi-modal and multi-disciplinary whole-school approach that addresses the multiple problems that not only students with ADHD but also their peers might experience. Further research that would be based on more large-scale controls and would investigate the effectiveness of various interventions, as well as the profiles of those students who have benefited from particular approaches and those who have not, will generate further evidence concerning the psychoeducation of adolescents with ADHD allowing for generalised conclusions to be drawn.

Keywords: adolescence, attention deficit hyperctivity disorder, cognitive behavioural theory, comorbid social emotional behavioural disorders, treatment

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Authors: Neha Joshi, Srikanth Jois, Hector J. Peughero, Poornima Jayakrishna, Moulya R., Purnima Madivanan, Kiran Kumar K. Salagame

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Transgenders are a marginalized section of the community, who are at high risk of mental health problems due to their stigmatization, abandonment by family, prejudice, discrimination by society at large, and the physical, emotional, and sexual abuse from both within and outside their community. Their mental healthcare needs remain largely unaddressed due to lack of access, discrimination by healthcare professions, and lack of resources, including time and money, to seek conventional medical and psychotherapeutic treatments. Meditation is increasingly receiving acceptance as a tool for managing stress and anxiety by the patients as well as mental healthcare professionals. “Meditation on Twin Hearts” is a no cost, self-administered intervention that a person can practice anywhere and at any time of the day. This pilot study evaluates the need for alternate traditional and ingenious interventions like “Meditation of Twin Hearts” to address the mental healthcare needs of the transgender community and acceptance of such an intervention by the community. Thirteen individuals identifying themselves as transgender were invited to participate in one (Hunsur Taluk) of the five scheduled free meditation camps in Mysore. After obtaining informed consent for participation in the study, their mental health status is captured using an anonymous survey using standard, validated, self-reported questionnaires Generalised Anxiety Disorders (GAD)-7 for anxiety, Patient Health Questionnaire (PHQ-9) for depression, and Suicidal Behavior Questionnaire-Revised for suicidality. Then, they were requested to attend a session on “Meditation on Twin Hearts.” After the session, their feedback on willingness to further explore the meditation technique for managing their mental healthcare need was assessed through another survey form. Out of the 13 participants, 92% scored for anxiety (4 mild, and 8 moderate anxiety). In the depression scale, 5 scored for mild and 5 for moderate depression, with a total of 77% (10/13) scoring positively on depression scale. Nearly 70% of participants (9/13), scored greater than the clinical cutoff for the need for clinical intervention. The proportion of individuals at risk for suicide was particularly high in this group, with 8/ 13 (61.5%) participants scoring the clinical cutoff score of ≥ 7. Surprisingly, none of the participants had ever consulted a mental healthcare professional. All the participants (13/13; 100%) responded in affirmative to the question, “Will you be willing to continue meditation for management of your anxiety?” Six out of 13 participants described their experience of meditation as “happy” and 3 described it as “peaceful”. None of the participants reported any negative beliefs or experience regarding the meditation. The study provides evidence for the urgent yet unmet mental healthcare need of the transgender community. The findings of the study also supports the rationale of conducting future systematic research to evaluate and explore ingenious and traditional practices, such as meditation, to meet the healthcare needs, especially in marginalized populations in a low income setting such as Lower and Middle Income countries. Based on these preliminary findings, the Principal Investigator (PI) is planning to cover 4 more areas of Mysore district.

Keywords: anxiety, depression, meditation on twin heart, suicidality, transgender

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Authors: A.H.Y. Lai, C. Teyra

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In Taiwan, there are 16 official indigenous groups, accounting for 2.3% of the total population. Like other indigenous populations worldwide, indigenous peoples in Taiwan have poorer mental health because of their history of oppression and colonisation. Amid the negative narratives, the ethnic identity of cultural minorities is their unique psychological and cultural asset. Moreover, positive socialisation is found to be related to strong ethnic identity. Based on Phinney’s theory on ethnic identity development and social support theory, this study adopted a strength-based approach conceptualising ethnic identity as the central organising principle that linked perceived social support and mental health among indigenous adults in Taiwan. Aims. Overall aim is to examine the effect of ethnic identity and social support on mental health. Specific aims were to examine : (1) the association between ethnic identity and mental health; (2) the association between perceived social support and mental health ; (3) the indirect effect of ethnic identity linking perceived social support and mental health. Methods. Participants were indigenous adults in Taiwan (n=200; mean age=29.51; Female=31%, Male=61%, Others=8%). A cross-sectional quantitative design was implemented using data collected in the year 2020. Respondent-driven sampling was used. Standardised measurements were: Ethnic Identity Scale(6-item); Social Support Questionnaire-SF(6 items); Patient Health Questionnaire(9-item); and Generalised Anxiety Disorder(7-item). Covariates were age, gender and economic satisfaction. A four-stage structural equation modelling (SEM) with robust maximin likelihood estimation was employed using Mplus8.0. Step 1: A measurement model was built and tested using confirmatory factor analysis (CFA). Step 2: Factor covariates were re-specified as direct effects in the SEM. Covariates were added. The direct effects of (1) ethnic identity and social support on depression and anxiety and (2) social support on ethnic identity were tested. The indirect effect of ethnic identity was examined with the bootstrapping technique. Results. The CFA model showed satisfactory fit statistics: x^2(df)=869.69(608), p<.05; Comparative ft index (CFI)/ Tucker-Lewis fit index (TLI)=0.95/0.94; root mean square error of approximation (RMSEA)=0.05; Standardized Root Mean Squared Residual (SRMR)=0.05. Ethnic identity is represented by two latent factors: ethnic identity-commitment and ethnic identity-exploration. Depression, anxiety and social support are single-factor latent variables. For the SEM, model fit statistics were: x^2(df)=779.26(527), p<.05; CFI/TLI=0.94/0.93; RMSEA=0.05; SRMR=0.05. Ethnic identity-commitment (b=-0.30) and social support (b=-0.33) had direct negative effects on depression, but ethnic identity-exploration did not. Ethnic identity-commitment (b=-0.43) and social support (b=-0.31) had direct negative effects on anxiety, while identity-exploration (b=0.24) demonstrated a positive effect. Social support had direct positive effects on ethnic identity-exploration (b=0.26) and ethnic identity-commitment (b=0.31). Mediation analysis demonstrated the indirect effect of ethnic identity-commitment linking social support and depression (b=0.22). Implications: Results underscore the role of social support in preventing depression via ethnic identity commitment among indigenous adults in Taiwan. Adopting the strength-based approach, mental health practitioners can mobilise indigenous peoples’ commitment to their group to promote their well-being.

Keywords: ethnic identity, indigenous population, mental health, perceived social support

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Authors: Martina Curtin, Rosalind Herman

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Background: Deaf children can experience difficulties with understanding how social interaction works, particularly when communicating with unfamiliar hearing people. Deaf children often struggle with integrating into a mainstream, hearing environments. These negative experiences can lead to social isolation, depression and other mental health difficulties later in life. smiLE Therapy (Schamroth, 2015) is a video-based social communication intervention that aims to teach deaf children skills to confidently communicate with unfamiliar hearing people. Although two previous studies have reported improvements in communication skills immediately post intervention, evidence for maintenance of gains or generalisation of skills (i.e., the transfer of newly learnt skills to untrained situations) has not to date been demonstrated. Parental involvement has been shown to support deaf children’s therapy outcomes. Therefore, this study added parent training to the therapy children received to investigate the benefits to generalisation of children’s skills. Parents were also invited to present their perspective on the training they received. Aims: (1) To assess pupils’ progress from pre- to post-intervention in trained and untrained tasks, (2) to investigate if training parents improved their (a) understanding of their child’s needs and (b) their skills in supporting their child appropriately in smiLE Therapy tasks, (3) to assess if parent training had an impact on the pupil’s ability to (a) maintain their skills in trained tasks post-therapy, and (b) generalise their skills in untrained, community tasks. Methods: This was a mixed-methods, repeated measures study. 31 deaf pupils (aged between 7 and 14) received an hour of smiLE Therapy per week, for 6 weeks. Communication skills were assessed pre-, post- and 3-months post-intervention using the Communication Skills Checklist. Parents were then invited to attend two training sessions and asked to bring a video of their child communicating in a shop or café. These videos were used to assess whether, after parent training, the child was able to generalise their skills to a new situation. Finally, parents attended a focus group to discuss the effectiveness of the therapy, particularly the wider impact, i.e., more child participation within the hearing community. Results: All children significantly improved their scores following smiLE therapy and maintained these skills to high level. Children generalised a high percentage of their newly learnt skills to an untrained situation. Parents reported improved understanding of their child’s needs, their child’s potential and in how to support them in real-life situations. Parents observed that their children were more confident and independent when carrying out communication tasks with unfamiliar hearing people. Parents realised they needed to ‘let go’ and embrace their child’s independence and provide more opportunities for them to participate in their community. Conclusions: This study adds to the evidence base on smiLE Therapy; it is an effective intervention that develops deaf children’s ability to interact competently with unfamiliar, hearing, communication partners. It also provides preliminary evidence of the benefits of parent training in helping children to generalise their skills to other situations. These findings will be of value to therapists wishing to develop deaf children’s communication skills beyond the therapy setting.

Keywords: deaf children, generalisation, parent involvement, social communication

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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