Do pre-operative urine cultures correlate with intraoperative renal cultures and final blood cultures in obstructive pyelonephritis?

INTRODUCTION AND OBJECTIVES: Following surgical decompression of the infected, obstructed collecting system, culture directed antibiotic therapy maximizes therapeutic efficacy. Initially, patients are empirically placed on broad-spectrum antibiotics pending speciation of pre-operatively obtained urine cultures. Voided urine cultures may not always correlate with renal urine cultures obtained at the time of surgical decompression, which may result in suboptimal antibiotic coverage. The purpose of this study is to compare the correlation between pre-operative voided urine cultures, intraoperative renal cultures and ultimate blood cultures in patients with obstructing, infected ureteral stones. METHODS: A retrospective review of 100 consecutive patients presenting to a single academic institution with obstructed, infected ureteral stones between July 2014 and August 2018 was performed. Data regarding patient demographics, pre-operative voided urine cultures, intraoperatively collected renal cultures and final blood cultures were correlated with length of hospital stay. Mann-Whitney U test and Spearman′s rank correlation coefficient were performed, with p\u3c0.05 considered significant. RESULTS: In the 100 obstructed, infected patients, 47 had intraoperatively collected renal cultures available. The mean patient age was 51.3 (16-88) and mean BMI was 30.6 (15.0- 65.6). Renal cultures correlated with pre-operative urine cultures in 69.2% of cases (r=0.52, p\u3c0.01) but were discordant in 30.8% of cases. In comparison, blood cultures did not correlate with pre-operative urine cultures in 36.4% of cases (r=0.18, p=0.26). Patients had a significantly longer hospital stay when pre-operative urine cultures were discordant with renal cultures (7.3 vs. 4.6 days; p=0.05) or when pre-op cultures did not correlate with final blood cultures (9.3 vs 4.6 days; p=0.02). In addition, patients with positive intrarenal urine cultures had a significantly longer hospital stay than patients with negative intrarenal urine cultures (6.6 vs 3.5 days; p=0.008). CONCLUSIONS: Pre-operatively collected urine cultures do not always correlate with renal or blood cultures in obstructive pyelonephritis, and hospital stays were significantly longer when cultures did not correlate or when intrarenal cultures were positive. This study highlights the significant discordance between cultures obtained proximal to obstruction compared to distal to obstruction and the importance of collecting intraoperative renal urine cultures at the time of surgical decompression

The Interplay between the Secular and the Sacred in The Canterbury Tales and Old English Poetry

The writings of Geoffrey Chaucer (1343-1400) are greatly influenced by former literary works, especially those by the Roman poets Boethius, Ovid and Cicero. His poetry treats contemporary themes within a framework that draws upon plots and subjects from preceding literature. However, Chaucer's later work The Canterbury Tales (1387-1400) tackles subjects and employs characters that reflect the spirit of England's Middle Ages. The General Prologue, among other tales that form Chaucer's The Canterbury Tales, treats the themes of the age through a context that creates an amalgamation of the mundane and the divine. The work deals with both religious and secular questions. A similar amalgamation is also evident in major earlier Old English poems as Beowulf (ca. 700-1000), The Dream of the Rood (ca. 700-9000), The Battle of Maldon (ca. 991), The Wanderer (ca. 597) and The Seafarer (ca. 900). This paper aims to examine the impact of employing secular and sacred aspects on English Medieval literature, particularly Chaucer's The Canterbury Tales and the major Old English poems. Keywords: The Canterbury Tales, Beowulf, Old English Poetry, Medieval Poetr

Shelley’s Adonais: a Fryean Archetypal Perspective

This research attempts at approaching Shelley’s poem, Adonais, using Frye’s archetypal criticism. This offers a different reading of Shelley whose poetry has been frequently approached as part of the Romantic literary tradition exhausted by an overemphasis on the conventional Romantic features supposed to be found in Romantic poetry. The Fryean approach to Romantic poetry frees it from the restrictions traditional approaches to literature impose on Romantic literature. From a Fryean perspective, works of literature are treated as part of a universal literary body – a quality that allows a comprehensive reading and treatment of literature. The research concludes with an emphasis on the significance of the Fryean perspective in approaching literature, and in highlighting its role in emphasizing the universality of Shelley’s poetry.Keywords: Frye, Archetypal Criticism, Adonais, Natural Cycles, Vegetation Myths

HEGEMONIC MASCULINITY IN ARCHETYPAL AFRICAN NOVELS

The study attempts to examine the concept of hegemonic masculinity in Tayeb Salih's Season of Migration to the North (1966) and Chinua Achebe’s Things Fall Apart (1958). To achieve that it deals with two concerns. First, it tackles the process of development of masculinity attempting to identify hegemonic masculinity among other stages within this process.  Secondly, it investigates hegemonic masculinity as a concept occasionally occurs in popular African fiction with emphasis placed on its presence in Salih's Season of Migration to the North and Achebe’s Things Fall Apart. The research concludes with a recommendation to focus more research efforts on literature that deals with hypermasculinity, the stage succeeding hegemonic masculinity, as it needs immediate consideration due to its critical impact on contemporary world and audience. HEGEMONI MASKULINITAS DALAM NOVEL-NOVEL ARCHETYPAL AFRICAN Penelitian yang bertujuan untuk mengkaji konsep mengenai hegemoni maskulinitas di Tayeb Salih’s Season of Migration to The North (1996) dan Chinua Achebe’s Things Fall Apart (1958) ini berfokus pada dua hal. Pertama, mengkaji proses perkembangan maskulinitas untuk mengidentifikasi hegemoni maskulinitas. Kedua, menginvestigasi hegemoni maskulinitas sebagai sebuah konsep yang selalu muncul dalam karya-karya fiksi afrika dengan penekanan pada Salih’s Season of Migration to The North and Achebe’s Things Fall Apart. Penelitian ini memberikan simpulan dan rekomendasi pada fokus penelitian selanjutnya yang berkaitan dengan hipermaskulinitas, seperti suksesnya hegemoni maskulinitas yang perlu dipertimbangkan penelitiannya karena dampak yang kritis dari dunia dan audiens saat ini

Shelley’s Adonais: a Fryean Archetypal Perspective

This research attempts at approaching Shelley’s poem, Adonais, using Frye’s archetypal criticism. This offers a different reading of Shelley whose poetry has been frequently approached as part of the Romantic literary tradition exhausted by an overemphasis on the conventional Romantic features supposed to be found in Romantic poetry. The Fryean approach to Romantic poetry frees it from the restrictions traditional approaches to literature impose on Romantic literature. From a Fryean perspective, works of literature are treated as part of a universal literary body – a quality that allows a comprehensive reading and treatment of literature. The research concludes with an emphasis on the significance of the Fryean perspective in approaching literature, and in highlighting its role in emphasizing the universality of Shelley’s poetry

Experimental Validation of Shared Inverter Topology to Drive Multi AC-Loads

Many reduced-switch-count (RSC) inverter topologies have been proposed in the literature. As the number of switches required to produce a set of voltages in RSC inverters are less than that in conventional inverter, as a result utilizing RSC inverters in a certain system reduces its size and cost. In this paper, a novel RSC shared inverter topology consisting of fifteen switches and capable of driving four three-phase AC-loads independently is proposed and experimentally verified. A carrier-based pulse width modulation (PWM) technique that employs the zero-sequence-signal injection principle is developed to drive the proposed inverter along with adequate DC voltage bus utilization between the shared loads for common frequency (CF) as well as different frequency (DF) modes. The structure and the principle of operation of the proposed inverter are introduced and intensively verified using simulation and field-programmable-gate-array (FPGA)-in-the-loop simulation under linear and nonlinear loads. Then, Inverter prototype was built and the proposed inverter has been verified experimentally. The experimental results verify the applicability of the proposed inverter and the employed PWM

Jordan as a Medical Hotspot: Views on Medical Tourism

Purpose:  This study focuses on the concept of medical tourism, its significance, and its implications for the Jordanian health sector. Patients travel to Jordan to seek elective, less expensive medical procedures while having a vacation. Other factors that promote medical tourism include better quality of care, shorter queues, exotic locations, and culture. The Medical Liability Law passed not long ago, further encouraged more patients to seek treatment in Jordan. Medical tourism's contribution to Jordanian GDP is noteworthy; providing economic growth and employment opportunities. Though medical tourism received great recognition, little is said about specific concerns like the brain drain of health workers and incurring high costs on Jordanian citizens. This issue needs further attention.   Design/methodology/approach: This research employed qualitative analysis by conducting semi-structured, in-person interviews with ten Jordanian professionals who have an interest in the field of medical tourism. The interviewees included a health marketer, private hospital directors, a health policymaker, a health accreditation expert, a quality assurance manager, and health care professionals. The key participants responded to the same open-ended interview questions. The selected participants represent a diversity of facilitators involved in the medical tourism industry. Interviews were transcribed and correlated with the literature.   Findings: The competitive edge of Jordan in medical tourism arises from cost-effective health services, its renowned reputation in healthcare, and the diversity of touristic attractions. Most foreign patients that come to Jordan are from Arab countries. Jordan offers no language barrier and similar culture. The importance of medical tourism to Jordan is reflected in its contribution to the GDP by 3.5 percent or $1 billion. Little attention is drawn to some issues such as brain drain, high-incurring costs, promotional campaigns, medical inequality, and other pitfalls.   Practical implications: Health policymakers and health services providers around the globe with similar health systems have expressed interest in facilitating the growth of the medical tourism industry. They should encourage what reduces operational and medical risks that may accompany the medical tourism industry. This paper could provide a better understanding of medical tourism in Jordan as a hot spot in the world for medical tourism.   Social implications: Medical tourism can drive a robust social multiplier effect on a nation in terms of enhancing employment generation as well as fostering a culture of innovation and advancement in the field of healthcare and medicine.   Originality/value: The interviews and other secondary data sources help shed some insight into the current status and ramifications of medical tourism in Jordan.

Understanding EHRs continuance intention to use from the perspectives of UTAUT: practice environment moderating effect and top management support as predictor variables

This study attempts to comprehend factors influencing nurses' continuance intention to use electronic health records (EHR) system in Jordan since they as the key service providers in healthcare services are main users of the system. Their acceptance and usage of the system are imperative to evaluate the system's implementation success. A cross-sectional survey is conducted on the fully implemented EHR system public hospitals. Study framework is based on the extended model of the unified theory of acceptance and use of technology (UTAUT) and top management support (TMS). Results reveal effort expectancy, performance expectancy and facilitating conditions positively influence nurses' continuance intention to use and top management support as significant and negatively related to nurses' continuance intention to use. Results also disclose relationship between social influence and continuance intention to use as not significant. Multi-group analysis result indicates stronger relationship between effort expectancy and continuance intention to use is evident to ward nurses than special unit nurses. Findings confirm on the necessity to support new technologies specifically EHR system in hospitals and contributes to UTAUT theory through revealing the impact of top management support on continuance intention to use and establishing relevant measurement accuracy of study framework in Jordanian context

Managing University of Sharjah Setting and Infrastructure Towards a Sustainable and Livable Campus

This paper describes the setting and infrastructure management at the University of Sharjah (UoS) as a continuous effort towards a livable and sustainable campus. The UoS has been participating in the UI GreenMetric World Universities Ranking (UIGWUR) since 2017 to measure its performance in the field of sustainability for continuous improvement. During the last three years, the UoS has succeeded in being among the best 150 universities in the SI category by achieving 70% of the score. However, the UoS managed to get 75% of the total score in this KPI and 100% in the open space per person KPI ratio. To become one of the leading universities, the Landscape and Building Management Sustainability Circle (LBMSC) at the Sustainability Office has analyzed the KPIs and suggested an action plan for continuous improvement. Two KPIs can be improved: sustainability efforts and the total area covered in plants. The UoS shall increase the sustainability efforts and budget and increase the internal and external planting in the coming years. For some KPIs, it cannot be applied to desert regions. It is recommended that the UIGWUR revisit its KPIs and make them more flexible and applicable worldwide. Furthermore, for the open space ratio to the total area KPI, it is recommended to revisit the distribution of the points to have fair comparison. Action plans to improve the sustainability and livability of the campus have also been addressed.Keyword: Setting and infrastructure, LBMSC, livable campus, open area, forest, water absorption, green area, sustainability efforts/budget, and GreenMetri

Comprehensive quantity discount model for dynamic green supplier selection and order allocation

We model and solve a deterministic multi-period single-product green supplier selection and order allocation problem in which the considered suppliers’ availability, cost, and green performance change from one period to another in the planning horizon. Moreover, the available suppliers may offer an all-unit or an incremental quantity discount (QD) scheme, resulting in three problem configurations. In one configuration, all suppliers offer all-unit QD. In the second, all suppliers offer incremental QD. In the third, some suppliers offer all-unit QD, and others offer incremental QD. The problem is modelled using a bi-objective integer linear programming formulation that maximizes the total green value of the purchased items from all the suppliers and minimizes their total corresponding cost, including the fixed cost, variable cost, inventory holding cost, and shortage cost. The proposed bi-objective model is scalarized and solved using the branch-and-cut algorithm and a population-based heuristic. A numerical analysis is conducted, which allows first to validate the heuristic approach using small-size instances by comparing its results with those of the exact approach. Moreover, an extensive comparison between the exact and heuristic solution approaches is carried out. The results reveal different findings. First, the economic and environmental solutions of an instance are different, and the environmental solution is independent of the suppliers’ pricing schemes. Second, the maximum difference between the heuristic approach and the exact approach in terms of the bi-objective function value is 4.72%, which makes the proposed heuristic recommended for large-size instances due to its short computation time and good accuracy. Third, there is no difference in terms of the heuristic performance between the combined model and the models with a single type of discount. Fourth, the all-unit discount scheme seems to be generally better in terms of the trade-off between the green value of purchasing and cost