Spontaneous ureteral stone passage: a novel and comprehensive nomogram.

BACKGROUND: Ureteral stones pose a high economic and medical burden among Emergency Department (ED) admissions. Management strategies vary from expectant therapy to surgical interventions. Since predictors of ureteral spontaneous stone passage (SSP) are still not well understood, we sought to create a novel nomogram to guide management decisions. METHODS: Charts were retrospectively reviewed for patients who presented to our institution's ED with non-febrile renal colic and received a radiological diagnosis of ureteral stone ≤10 mm. Demographic, clinical, laboratory, and non-contrast CT data were collected. This novel nomogram incorporates the serum neutrophil-to-lymphocyte ratio (NLR) as a potential predictor of SSP. The model was derived from a multivariate logistic regression and was validated on a different cohort. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed. RESULTS: A total of 1186 patients presented to our ED between January 2010 and October 2018. We randomly divided our population into a derivation and validation cohort in one to five ratio. A stone size ≥7 mm was the strongest predictor of SSP failure; OR=9.47; 95% CI: 6.03-14.88. Similarly, a NLR≥3.14 had 2.17; (1.58-2.98) the odds of retained stone. SSP failure was also correlated with proximal position, severe hydronephrosis, and leukocyte esterase ≥75, P=0.02, P=0.05, and P=0.006, respectively. The model had an AUC of 0.804 (0.776-0.832). The nomogram was also used to compute the risk of SSP failure (AUC 0.769 [0.709-0.829]). CONCLUSIONS: Our novel nomogram can be used as a predictor for SSP and can be used clinically in decision making.

Transdisciplinary interventions for environmental sustainability.

This paper presents a case study of a transdisciplinary research based on an ex-post assessment of the environmental and socio-behavioral contexts of solid waste management in Lebanese peri-urban communities. Lessons learned are compiled into the Transdisciplinary Interventions for Environmental Sustainability conceptual framework. The approach starts with building a team of researchers and non-academic partners, continues with co-creating solution-oriented knowledge, and ends by integrating and applying the produced knowledge. The co-created knowledge includes the environmental and socio-behavioral ex-post assessment's results. The former reveals low air pollution levels, evidence of waste-related water contamination, and higher self-reported frequencies of ill-health symptoms and diseases closer to the landfill. The latter indicates that the community's perception about waste production differs from the real accounting of generated waste. Nine lessons are identified: (1) inherent common interest between the researchers and the community, (2) flexible interdisciplinary research team, (3) representative citizen committee, (4) contextually-informed outreach coordinator, (5) iterative research process accounting for the shifting socio-political context, (6) common expectations of the research process, (7) boundary objects leading to spin-off activities in the same setting, (8) effective communication strategy, and (9) ex-post assessment of subsequent societal and scientific impacts. The non-phased framework links all nine pointers in a logical order to ease scalability. The study answers a global need for a unified, clear, broadly adopted framework for transdisciplinarity and a deeper understanding of factors ensuring full-circle knowledge co-creation in waste-related contexts in the global South. The study offers managerial and research implications and suggests avenues for further research.

Identification and prioritization of areas with high environmental risk in Mediterranean coastal areas: A flexible approach.

Interdisciplinarity and transdisciplinarity are the cornerstone for the future management of coastal ecosystems with many vulnerability and hazard indexes developed for this purpose, especially in the engineering literature, but with limited studies that considered ecological implications within a risk assessment. Similarly, the concept of prioritization of sites has been widely examined in biodiversity conservation studies, but only recently as an instrument for territory management. Considering coastal plant diversity at the species and community levels, and their vulnerability to three main potential hazards threatening coastal areas (oil spills, Hazardous and Noxious Substances pollution, fragmentation of natural habitats), the objective of this paper is to define an easy-to-use approach to locate and prioritize the areas more susceptible to those stressors, in order to have a practical instrument for risk management in the ordinary and extra-ordinary management of the coastline. The procedure has been applied at pilot areas in four Mediterranean countries (Italy, France, Lebanon and Tunisia). This approach can provide policy planners, decision makers and local communities an easy-to-use instrument able to facilitate the implementation of the ICZM (Integrated Coastal Zone Management) process in their territory.