Closing the loop: What is the delay in Reversal of Hartmann's procedure?

Reversal of Hartmann's procedure is performed to restore intestinal continuity. There is conflicting literature on the best time for reversal, with little evidence suggesting waiting longer than a year is beneficial. We assessed the experience of our patients. Patients were identified from the local Enhanced Recovery After Surgery (ERAS) database over a 9-year period (2012-2021) at a University Hospital. Data was collected from digitalised hospital notes on patient demographics;timings to reversal of Hartmann's;defunctioning stoma;reasons for delay;length of stay;and complications. Forty-three patients underwent reversal of Hartmann's procedure. Median age was 57 (38-83) years;19 (44%) of patients were female. Surgery was performed laparoscopically in 18 (42%);laparoscopic converted to open 6 (14 %);open in 19 (44%) patients. Average length of stay was 6 days. Indications for primary Hartmann's procedure were diverticular disease (67%), malignancy (21%), and other causes (14%). Median time from the index operation to reversal of Hartmann's was 85.2 weeks (range 19.9-312.4 weeks). Only 9 (21%) patients underwent reversal Hartmann's within 1 year of primary surgery. Of the reasons known for the delay in reversal;15 (35%) were due to patient complications, 6 (14%) were due to administrative reasons, 2 (5%) were due to COVID-19 associated delays and 1 (2%) patient choice. This retrospective analysis highlights the varied patient experience within just one centre, further research incorporating detailed patient experience is needed. It also highlights a paucity of national evidence-based consensus on optimal timing for challenging revisional surgery.

Air Pollution Trend and Variation during a Mega Festival of Firecrackers (Diwali) in Context to COVID-19 Pandemic

The present study was conducted in Lucknow city to assess the impact of firecracker burning during Diwali, from 2 November 2021-6 November 2021 including the pre and post-Diwali days. The concentrations of PM10, PM2.5, SO2, NO2, CO, O3, benzene and toluene, were monitored from the Central Pollution Control Board site on an hourly basis. The Air Quality Index was also recorded for PM10, PM2.5, SO2 and NO2. A questionnaire survey was done with 51 doctors to know the reported complaints post-Diwali. On Diwali night the PM2.5 value reached 262 μg m-3 around 22:00 hours and the maximum value (900 μg m-3) was obtained on 5 November, reported from the Central School monitoring station. From Gomti Nagar highest PM2.5 value obtained on Diwali day was 538 μg m-3 at 23:00 hours reaching 519 μg m-3 post-Diwali. Areas belonging to the old part of the city witnessed higher variations as PM2.5 crossed 900 μg m-3, in Lalbagh and Talkatora areas. The multivariate analysis showed that on Diwali night there was an increase of 204, 386, 344 and 341 in the PM2.5 concentration reported from Gomtinagar, Central School, Talkatora and Lalbagh stations, showing that firecracker burning resulted in a significant increase in air pollution. The Toluene/Benzene ratio was mostly more than 1 indicating that toluene and benzene may be emitted from other sources as well including the mobile sources. Around 50-75% rise was seen in the number of patients post-Diwali. 57.1% of the reported cases had respiratory issues, followed by allergic reactions. The data obtained from Lalbagh, Talkatora and Central School showed that although the values remained high, a decreasing trend was seen in the AQI compared to previous years which is a good sign and may be attributed to public awareness and the ongoing pandemic making people conscious © 2022 by Asian Association for Atmospheric Environment

Buying Happiness: The Emergence of Consumer Consciousness in English Canada

Shifting ways of thinking, she says, were described in moral and aesthetic terms by social critics, statisticians, politicians, policy makers, academics, writers, and artists;and it is these cultural reflections of underlying social change that she addresses in the text. Chapter Seven is particularly effective in demonstrating change over time: a case study of case studies, it examines homemaking magazines' presentation of family budgets and women as buying agents in the post-war period. Here, Liverant gathers the threads, including gendered division of labour, consumption as a kind of skilled practice distinct from remunerative work, and the meaning of family and home.

Pivoting Open? Pandemic Pedagogy and the Search for Openness in the viral Learning Environment

This paper is based on the authors' experiences and reflections working in educational technology and design support roles in higher education during the COVID-19 pandemic. We retrace our lived experience from the beginning of the pandemic in the spring (from our vantage points in the UK and Canada) and the associated 'pivot online' enacted in education around the world, through to the autumn of 2020, when we appeared to be transitioning into a so-called 'new normal' of the mid-pandemic. As digital education practitioners, who are also educators. researchers, and also simply as humans and friends living through a global pandemic, we had turned to each other initially for support in terms of work, wellness, and sharing news, information and sense-making, during which we began to consider researching under-examined dimensions of the evolving situation. The experiences and issues we reference are drawn from our own work, as well as from our responses to popular narratives advanced by key voices who have encouraged certain interpretations of the pandemic and its educational effects. Using Schon's (1983) reflection-in-action lens, we examine these experiences and narratives of pandemic pedagogy through the frame of our multiple identities. In particular, from our perspective as researchers and advocates of open education, we noted calls for openness (such as the use of open educational resources) in response to the online pivot, which did not appear to be cutting through the noise of the sudden deluge of information, advice and broadly negative coverage of online teaching. However, through our reflective narrative and synthesis, we offer an alternative interpretation, which is that openness was nonetheless flourishing, but that the 'pivot open' was to practices rather than resources. Open exchange, community building and support amongst educators were apparent in multiple contexts. While pandemic profiteering has highlighted the need for open resources and infrastructures, and we anticipate this case continuing to be made more strongly as we emerge from the emergency, it is the turn to open practices which has met the immediate needs of educators and learners through community, interactions. sharing and care.