A Conversational Analysis of a Lesson in the School

The interaction between the teachers and the students determines the success of the teaching learning process. Teaching dose not only involve the transmission or reception of information as well as it is a chance for conversation and discussion. The aim of this study is that to analyze how teacher-student interaction is expressed conversationally, i.e., how it is started and closed. It is also intended to describe the discoursal structure of verbal interaction as reflected in the classroom. The study hypothesises that  the teacher- student discourse structure is complex, and the main speaker is the teacher. As well as the students are not passive listeners. Finally , the study has come up with that the teacher and the student have an effective role in the classroom

Assessing Accuracy of the Vertical Component of Airborne Laser Scanner for 3D Urban Infrastructural Mapping.

This study presents two methods used to measure the accuracy of the height component of Airborne Laser Scanning (ALS) data.The objectives are: to assess the accuracy of LiDAR data, to find correlation between the actual and sensor recorded height, and to explore the effectiveness of linear regression model for accuracy assessment. Field observation was carried out with Total Station as reference data and the corresponding data obtained from normalized digital surface model (n-DSM). First, statistical method was used to obtained a Root Mean Square Error (RMSE) value of 0.607 and linear accuracy of 1.18948 at 95% confidence level. Similarly, linear regression function was used to obtained RMSE value of 0.5073 and linear accuracy of 1.10999. The study shows that ALS recorded height is reliable for 3D urban mapping. A resulting correlation coefficient of 0.9919 indicates a very good agreement between the sensor recorded height and the actual height of the object (R2= 0.9839; p less than 2.2e-16). The study indicates that linear regression model is effective for assessing the accuracy of ASL data

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Suggested Strategies for Writing Narrative Essay

Learning strategies are many, varied, and very important, especially when it comes to expressing and narrating events. Learning to write a narrative essay in the second language is essential, and writing articles by following special strategies develops the second language for the learner and opens new horizons for him in the field of language learning. Using methods and strategies while teaching pupils makes students more intelligent and aware and not make mistakes that they may make while writing articles or narrating on any topic. The study aims at helping students to start writing and ultimately to produce more writing and Encourage fluency in generating ideas for writing on any topic. Moreover, this work will help students begin organizing ideas. The research also includes the study of writing the narrative essay, how to write it, its patterns, and knowledge. The study ends with a conclusion that summarizes the current study

A Novel ZnO Nanoparticles Enhanced Surfactant Based Viscoelastic Fluid Systems for Fracturing under High Temperature and High Shear Rate Conditions: Synthesis, Rheometric Analysis, and Fluid Model Derivation

Surfactant-based viscoelastic (SBVE) fluids are innovative nonpolymeric non-newtonian fluid compositions that have recently gained much attention from the oil industry. SBVE can replace traditional polymeric fracturing fluid composition by mitigating problems arising during and after hydraulic fracturing operations are performed. In this study, SBVE fluid systems which are entangled with worm-like micellar solutions of cationic surfactant: cetrimonium bromide or CTAB and counterion inorganic sodium nitrate salt are synthesized. The salt reagent concentration is optimized by comparing the rheological characteristics of different concentration fluids at 25 &deg;C. The study aims to mitigate the primary issue concerning these SBVE fluids: significant drop in viscosity at high temperature and high shear rate (HTHS) conditions. Hence, the authors synthesized a modified viscoelastic fluid system using ZnO nanoparticle (NPs) additives with a hypothesis of getting fluids with improved rheology. The rheology of optimum fluids of both categories: with (0.6 M NaNO3 concentration fluid) and without (0.8 M NaNO3 concentration fluid) ZnO NPs additives were compared for a range of shear rates from 1 to 500 Sec&minus;1 at different temperatures from 25 &deg;C to 75 &deg;C to visualize modifications in viscosity values after the addition of NPs additives. The rheology in terms of viscosity was higher for the fluid with 1% dispersed ZnO NPs additives at all temperatures for the entire range of shear rate values. Additionally, rheological correlation function models were derived for the synthesized fluids using statistical analysis methods. Subsequently, Herschel&ndash;Bulkley models were developed for optimum fluids depending on rheological correlation models. In the last section of the study, the pressure-drop estimation method is described using given group equations for laminar flow in a pipe depending on Herschel&ndash;Bulkley-model parameters have been identified for optimum fluids are consistency, flow index and yield stress values

Decontamination of Metronidazole Antibiotic: A Novel Nanocomposite-Based Strategy

In this study, the synthesis of magnetic nanoparticles (MNPs) employing leaf extract from Alocasia macrorrhiza was investigated as a reducing agent. CuFe2O4, CuFe2O4/CuO, and CuFe2O4@ CuO/CdS made constituted the core-shell of these MNPs, which were stabilized on naturally Ninevite rocks (NRs) to provide a more cost-effective support. Analytical techniques of various methods were used to characterize the MNPs/NR nanocomposite that was produced utilizing eco-friendly methods. Among the methods used were infrared spectroscopy, X-ray diffraction, scanning electron microscopy, and vibrating sample magnetometry (VSM). The antibiotic Metronidazole (MET) was broken down using a potent nanocatalyst made of MNPs in a solar-irradiated batch system. A solar-photocatalytic system was used to investigate the effects of the initial MET concentration, irradiation time, H2O2 concentration, catalyst nanocomposite concentration, and pH solution on MET photodegradation. Artificial neural networks (ANNs) were also used in data modeling to determine which oxidation technique performed the best in certain conditions. This investigation showed that the CuFe2O4@CuO-CdS magnetic catalyst had the greatest MET removal efficiency of 97% among all MNPs. Moreover, ANN were used to examine data from the photocatalytic oxidation of MET utilizing a CuFe2O4@CuO-CdS/NRs catalyst. The results revealed that the MNP dose had the highest influence on the photodegradation of MET. The correlation coefficients (R2) for the training regressions, validation, testing, and total data were all 0.999, 0.996, 0.993, and 0.998, respectively