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INTRODUCTION: Pediatric testicular torsion (TT) is a urologic emergency that may result in testicular loss if left untreated. Testicular salvage is dependent on prompt intervention, and thus delays in diagnosis and management may threaten testicular viability. Knowledge of real-world Canadian practice patterns for pediatric TT will allow optimization of practices based on resource availability and geographic limitations to improve care. METHODS: An electronic survey on pediatric TT management was distributed to Canadian urologists. Descriptive statistics were performed on respondent demographic factors, hospital policies and barriers to care, surgical approaches, and transfer practices. Respondent practice patterns were analyzed based on geographic location and training. RESULTS: Thirty-four urologists responded, with most respondents operating a community practice. Ultrasonography (US) was frequently used to support TT diagnosis. Despite this, poor US access was often cited as a barrier to care, with particular impact on rural urologists. Neonatal patients and <10 years old were commonly transferred to a pediatric hospital for definitive management due to surgeon discomfort and hospital policies. Reported transport methods commonly included use of the patient's own vehicle or ambulance based on availability and timing. CONCLUSIONS: Neonatal patients and patients under 10 years old are most commonly reported to be transferred to pediatric hospitals for TT management. Patients located in rural locations and at centers with limited US access may be at risk for delayed diagnosis and treatment. Pathways for prompt management of suspected TT may better serve these younger pediatric patients. [ABSTRACT FROM AUTHOR]

Purpose: We performed a systematic review and meta-analysis of the literature to evaluate the efficacy of the routine use of tranexamic acid (TXA) during percutaneous nephrolithotomy (PCNL). Methods: This systematic review was conducted following the updated reporting guidelines from PRISMA 2020. Results: In total, 275 titles and abstracts were reviewed, of which 20 were screened to be eligible for full text review. Of these 20 articles, 11 were selected for inclusion after full article evaluations. Seven of these 11 studies were seen as having a low risk of bias with a Jadad score of ≥3. These studies were included for data extraction. Once data were extracted, 964 patients were included. The primary outcome, blood transfusion rate, showed significant reduction with a ratio for transfusion rate of 0.34 [95% confidence interval (CI) (0.19 to 0.61), z = 3.61, p = 0.0003]. Mean hemoglobin (Hgb) drop and operative time were both shown to be reduced with the use of TXA. The mean difference for Hgb drop was −0.86 [95% CI (−1.26 to −0.46), z = 4.23, p < 0.0001]. Reduction in operative time showed a mean difference of −8.45 minutes [95% CI (−15.04 to −1.86), z = 2.51, p = 0.01]. Stone clearance was not shown to differ significantly between experimental and control groups, with a risk ratio of 1.28 [95% CI (0.89 to 1.84), z = 1.31, p = 0.19]. Conclusions: This meta-analysis revealed that the routine use of TXA at time of PCNL reduces the rates of blood transfusion, mean Hgb drop, and operative time. With the low cost of TXA and strong safety profile, stronger consideration should be given to the routine use of TXA during PCNL by endoscopic surgeons. [ABSTRACT FROM AUTHOR]

This article presents a modified water poverty index that captures several waterscape attributes to better understand complex issues surrounding water. Household surveys (n= 300), water quality tests (n= 375) and qualitative methods were deployed to examine 14 post-tsunami settlements in Nagapattinam and Karaikal Districts (India) through the lens of water. Data were used to develop a contextualized, participant-driven water poverty index to measure water poverty at several scales. Statistical tests revealed significant differences between the two districts (p≤ .0001) and between rural and urban areas within each district (p≤ .0001). Three weight schemes (one dictated entirely by research participants) produced analogous outcomes though predicated on different indicator arrangements. [ABSTRACT FROM PUBLISHER]

Point-of-use water treatment has received widespread application in the developing world to help mitigate waterborne infectious disease. This study examines the efficacy of a combined filter and chemical disinfection technology in removing bacterial contaminants, and more specifically changes in its performance resulting from seasonal weather variability. During a 12-month field trial in Chennai, India, mean log-reductions were 1.51 forE. coliand 1.67 for total coliforms, and the highest concentration of indicator bacteria in treated water samples were found during the monsoon season. Analysis of variance revealed significant differences in the microbial load of indicator organisms (coliforms andE. coli) between seasons, storage time since treatment (TST), and samples with and without chlorine residuals. Findings indicate that the bacteriological quality of drinking water treated in the home is determined by a complex interaction of environmental and sociological conditions. Moreover, while the effect of disinfection was independent of season, the impact of storage TST on water quality was found to be seasonally dependent. [ABSTRACT FROM AUTHOR]

This article scrutinizes the boiling of water in Tamil Nadu and Puducherry, India. Boiling, as it is commonly practiced, improves water quality, but its full potential is not being realized. Thus, the objective is to refine the method in practice, promote acceptability, and foster the scalability of boiling and household water treatment (HWT) writ large. The study is based on bacteriological samples from 300 households and 80 public standposts, 14 focus group discussions (FGDs), and 74 household interviews. Collectively, the data fashion both an empirical and ethnographic understanding of boiling. The rate and efficacy of boiling, barriers to and caveats of its adoption, and recommendations for augmenting its practice are detailed. While boiling is scientifically proven to eliminate bacteria, data demonstrate that pragmatics inhibit their total destruction. Furthermore, data and the literature indicate that a range of cultural, economic, and ancillary health factors challenge the uptake of boiling. Fieldwork and resultant knowledge arrive at strategies for overcoming these impediments. The article concludes with recommendations for selecting, introducing, and scaling up HWT mechanisms. A place-based approach that can be sustained over the long-term is espoused, and prolonged exposure by the interveners coupled with meaningful participation of the target population is essential. [ABSTRACT FROM AUTHOR]

The appropriateness of any development technology depends on its suitability to meet the needs, circumstances and capacities of the people in a unique and challenging environment. This paper focuses on the importance of collaborative innovation that harmonizes technical ingenuity with user satisfaction while working within social and environmental constraints. The people of Mylai Balaji Nagar (MBN), a low-income, peri-urban community on the fringe of Chennai, India, were recruited to participate in the design of an alternative safe water system with researchers from the University of Guelph and the Indian Institute of Technology Madras. The community obtains its drinking water from a nearby lake known to contain dangerously high concentrations of faecal indicator bacteria, implicated in diarrhoeal disease. This study employed a participatory design framework for the development of a safe water system capable of removing or rendering inactive bacterial pathogens and making the water safe for human consumption. Researchers undertook a five stage participatory design process modeled after participatory action research, to develop a household water filtration system. Following laboratory assessment to assess bacteriological and organics control efficacy, four treatment prototypes were presented to, and critiqued by, community representatives for their appropriateness to context. [ABSTRACT FROM AUTHOR]

The article offers information on the applicable provisions of the International Covenant on Civil and Political Rights (ICCPR) and their relevance to criminal disenfranchisement. It considers the supplementary ways of interpretation of the ICCPR to decide what conceptualization of criminal disenfranchisement law is allowable under ICCPR Article 25(b). It assigns the criminal disenfranchisement law of the countries into four groups according to factors including the crimes committed and the length of sentence.

Adaptation to drought is particularly challenging on remote island atolls, such as those found in the Republic of the Marshall Islands (RMI), a nation of 58,000 populating 29 low-lying coral atolls spread over >2 million km2. Exposure to consecutive atmospheric hazards, such as meteorological floods and droughts diminish scarce water resources and erode the resilience of island communities. Drought impact mitigation measures must supply emergency drinking water to stricken communities, while simultaneously conserving natural sources in order to reduce their vulnerability to subsequent events. Household surveys (n = 298) and focus group discussions (n = 16) in eight RMI communities revealed that 86% of households have experienced drought and 88% reported using multiple water sources to meet normal household needs. With no surface water and a thin freshwater lens (FWL), rainwater collected from rooftops is the most common household water source. The traditional use of carved hollows in the base of coconut trees to collect rainwater ("Mammaks") appears to have been displaced by large rainwater tanks. However, rationing of rainwater for consumption only during drought was widely reported, with private wells supporting non-consumptive uses. Reverse osmosis (RO) desalination units have provided relief during drought emergencies but concerns have been raised around dependency, maintenance challenges, and loss of traditional water practices. Most notably, RO use has the potential to change the anthroposhpere by adversely affecting the FWL; 86% of RO units were installed at island-centre where excessive pumping can cause upconing, making the FWL brackish. Balancing the introduction of desalination technology to mitigate water shortages with maintenance of traditional water conservation practices to preserve the quantity and quality of the FWL is a promising strategy on island atolls that requires further investigation. Unlabelled Image • Small island states are among the most vulnerable to drought and climate change. • Cycling of multiple household water sources increases resilience to drought. • Austere usage behaviors conserve rainwater for drinking during drought. • Emergency water created using reverse osmosis presents a hazard to groundwater. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Routine measurements of serum hemoglobin (sHgb) are common after abdominal surgery; however, prolonged measurements may be associated with patient anxiety, increased costs, and longer hospitalization without clinical benefit. The objective of this study was to determine the utility of routine sHgb measurements after radical cystectomy (RC) and factors associated with transfusion of packed red blood cell (pRBC) beyond postoperative day (POD) 2. METHODS: We retrospectively reviewed patients who underwent RC between 2009 and 2019 at a single academic tertiary care center. The number of sHgb measurements for each patient was examined and pRBC transfusion rates were calculated. Multivariable logistic regression was used to determine factors associated with transfusion beyond POD 2. RESULTS: The median number of sHgb measurements per patient during admission was nine (interquartile range [IQR] 7, 25). Overall, 69/240 (28.7%) patients received a postoperative transfusion, including 46/240 (19.2%) patients receiving a transfusion beyond POD 2. Among patients with a sHgb >100 g/L on POD 2, 7/85 (8.2%) went on to receive a transfusion beyond this day compared with 39/155 (25.2%) patients with sHgb <100 g/L. On multivariable analysis, risk factors associated with pRBC transfusion beyond POD 2 included older age, lower sHgb on POD 2, and longer length of stay in hospital. CONCLUSIONS: Transfusion of pRBCs beyond POD 2 was found to be common; however, patients with sHgb >100 g/L on POD 2 were at low risk of requiring subsequent transfusion. Discontinuing further routine sHgb checks in these patients may serve to decrease patient anxiety, healthcare costs, and delays in hospital discharge. [ABSTRACT FROM AUTHOR]

This study advances methods of measuring access to water by providing a framework that can be operationalized by practitioners to inform decision and policy making. A modified WPI was developed and deployed in India, with results indicating significant differences between WPI and many indicator scores both between and within administrative territories. Spatial analyses identified significant clustering of WPI and indicator scores, indicating that scores are not randomly distributed. Three weight schemes were applied, two of which were informed by local stakeholders. The weight schemes highlighted the subjectivity of weighting and importance of including local populations in water development and management. [ABSTRACT FROM AUTHOR]