Boryeong Dam Emergency Water Diversion Facility: Ensuring Operational Flexibility and Resilient Response to Climate Change

The Boryeong district, Chungnam western region, is well known as a chronic water-deficiency area; it is thus necessary to ensure that the operational system for the Boryeong Dam emergency facilities is sufficiently resilient to withstand the potential impacts of climate change, in particular irregular droughts with resultant low water inflows and low storage. This study was undertaken to determine the operational flexibility of the Boryeong Dam emergency diversion facilities and their ability to respond to water resources demand, even if the facilities have been operating on a simple open-close release rule, depending on dam storage levels. The precipitation and inflow in Boryeong district were forecasted according to the modelling of RCP (Representative Concentration Pathways) in combination with SSP (Shared Socio-economic Pathways) scenarios. This has led to recommendations for the flexible operation of the Dam’s diversion facilities in order to ensure a stable water supply based especially on SSP1-2.6 and SSP5-8.5; i.e., steady growth and dramatic growth scenarios were simulated. The result from these two scenarios was an average diversion rate of 39,600 m³/day and 39,900 m³/day, respectively. This was evaluated as reasonable water resource use because water deficit days were fewer, and the average diversion rate was less than the RCP scenarios.

Mucosa plication reinforced colorectal anastomosis and trans-anal vacuum drainage: a pilot study with preliminary results

Dehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019–October 2020. The mean age of patients was 61 years (lower–upper quartiles 54–69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower–upper quartiles 3.00–4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien–Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

Municipal Solid Waste Characteristics: Recycling Potential and Waste Diversion Rate in Bali Province, Indonesia

This research was conducted to evaluate waste management in Bali Province through the waste recycling potential and waste diversion rate. These values describe how much waste can be recycled and diverted from landfills. Based on observations and data analysis, Bali’s total waste amounts to 2,253,542.03 kg d-1 or equivalent to 822,542.84 tonnes yr-1 from 9 (nine) cities/regencies with a population of 4,183,072 in 2019. Bali Province’s waste at the source is dominated by organic waste with 65% wet weight (ww) of the total waste generated, consisting of food waste and wood/leaf waste. It is also dominated by plastic waste with 15.70% ww and paper waste with 8.92% ww. The material flow analysis results in 53.02% ww of waste, or equivalent to 436,137.41 tonnes yr-1, which ended up in the landfill. Meanwhile, 13.36% ww or equivalent to 109,896.80 tonnes yr-1 is sold outside Bali, while 26.94% or equivalent to 221,583.37 tonnes yr-1 is unmanaged. Waste reduction by recycling in Bali’s landfill only reaches 20.38% of its potential; in comparison, the waste that can be diverted from landfills only reached 11.79% ww of the total generated waste. The reality is still very far from the 2025 government target of 30% reduction waste target and its diversion rate potential of 77.35% ww of the total waste generation.

Highly selective diversion with proactive leakage management after low anterior resection for rectal cancer

In this single center case series with nine percent primary diversion, 86 of 94 patients alive and with complete follow-up at one year had a functioning anastomosis. Seventy-five of the initial 99 patients never had a stoma. Meaning: Highly selective fecal diversion in combination with proactive leakage management, low anastomoses can be preserved safely, and the majority of patients will be spared all disadvantages of a diverting stoma. In this single-centre case series, with a primary diversion rate of 9 per cent, 86 of 94 patients who were alive and had complete follow-up at 1 year had a functioning anastomosis. Seventy-five of the initial 99 patients never had a stoma. The results indicate that, with highly selective faecal diversion in combination with proactive leakage management, low anastomoses can be preserved safely, and the majority of patients will be spared the disadvantages of a diverting stoma.

Issues and Challenges Confronting the Achievement of Zero Plastic Waste in Victoria, Australia

Despite the increase in popularity of the zero waste (ZW) concept, the successful implementation of this concept in waste management is still facing many challenges. The plastic recycling rate in Australia is at only about 9.4% (in 2017–2018). The state of Victoria (in Australia) has proposed an ambitious 10-year plan to upgrade its waste and recycling system and to divert about 80% of waste from landfills by 2030. The aim of this research is to study this currently proposed waste management plan and to develop a simulation model to assess the feasibility of achieving 80% diversion rate by 2030. The feasibility of achieving zero plastic waste by 2035 has also been assessed. In this direction, the existing knowledge of global ZW implementation has been reviewed to gain understanding of the challenges, obstacles, and uncertainties in achieving the ZW target. A simulation model is established using a method called double baselines. This method was developed to address the limitation of data availability for the model development. The model was run in 4 scenarios including one for Victoria’s current 10-year plan. Outcomes from the model are produced using six key considerations, including the rate of plastic consumption, waste to landfill, diversion rate, recycling rate, relative accumulative effort, and cost. The findings of this study point out that Victoria’s current plan for achieving an 80% diversion rate by 2030 is possible. On the other hand, the study results also suggest that achieving zero plastic waste by 2035 is less likely to happen. Hence, opportunities for improvement especially towards achieving the zero plastic waste are also presented.

DIPG-28. REPEATED LOW DOSE RT FOR PEDIATRIC DIPG – LESS DISEASE BURDEN WITH COMPARABLE OUTCOMES

PURPOSE Pediatric diffuse intrinsic pontine glioma (DIPG) is the most dismal prognosis pediatric brain tumor. Six weeks radiation therapy (RT) remains the mainstay of treatment. The aim of the current study was to compare the results of firstly reported repeated low dose RT (rLRT) with conventional RT (CRT). METHODS AND MATERIALS: This retrospective review included 24 children with DIPG, aged 3 -18 years, underwent CRT (52- 60.0 Gy in 1.8- 2.0 Gy, n = 16) or rLRT (18 - 30 Gy in 1.5–2.0 Gy per cycle for 1–3 cycles, n = 8). All children had typical symptoms and MRI features of DIPG, or biopsy-proven DIPG. RESULTS The median overall survival (OS) was 12.6 months in rLRT group and 11.4 months in CRT group (p =0.347), progression-free survival (PFS) was 3.6 months in rLRT group and 6.5 months in CRT group (p = 0.821), no significant survival difference was observed between two groups. Temporary discontinuation or tapering of steroids rate was significantly higher in rLRT group (100% vs 60%, p = 0.028). Although not statistically significant, mean non-hospitalized days were longer in the rLRT group, 403 days versus 305 days in the CRT group, as were mean cumulative progression-free days, 276 days versus 163 days and 1-year free from CSF diversion rate was higher, 100% versus 64.9%. CONCLUSIONS For patients with newly diagnosed DIPG, repeated low dose RT, given over 3 to 4 weeks per cycle for 1 to 3 cycles, offers comparable survival outcome with less disease burden compared with conventional RT.

Reducing Repeat Offending Through Less Prosecution in Victoria, Australia: Opportunities for Increased Diversion of Offenders

Research Question How did the use of diversion from prosecution and criminal sentencing change in Victoria, Australia, in the 10 years to 2016/2017, with what estimated effects on repeat offending? Data We tracked 1,163,113 criminal cases brought against both juveniles and adults by police in the state of Victoria, Australia, including 181,836 diversions, during the 10-year time period from the fiscal year of 2007/2008 through 2016/2017. Methods Taking the percentage of all cases diverted in the first year (25.6%), we calculated for each of the study years how many more cases would have been diverted from prosecution across the subsequent 9 years if the diversion rate had stayed the same (“missed opportunities”). We multiplied the estimated number of these “missed opportunities” by the reduced frequency of repeat offences that the prosecuted offenders were likely to have committed, after adjusting for the time at risk by the number of years left in the study period. Then, based on a systematic review of diversion experiments (Petrosino et al. 2010), we applied the standardised effect size of diversion in those studies to Farrington’s (1992) annualised crime frequency per 100 offenders aged 25, multiplying that effect across all of the person-years after a case was prosecuted rather than diverted, using both population-based rates and rates based only on detected offenders at that age. Findings The diversion rate in Victoria dropped in half over 10 years, from 25.6% to 12.5%. The total missed opportunities for diversion, compared to the counterfactual of applying diversion at a constant rate of 25% over that time period, totalled 115,885 cases over the 10 years. Taking an average effect size (d = − 0.232) across seven experiments with a mean follow-up time of 12–13 months, as derived from a systematic review of diversion experiment outcomes, our illustrative estimate is that at least 8 crimes per year per 100 offenders could have been prevented among the missed opportunity cases. Using a population rate of offending, the estimate equals 1474 crimes that could have been prevented. Using the offending population rate, we estimate that 37,050 offences could have been prevented. Conclusions While the exact amount of crime prevented remains speculative, the application of best evidence to the missed opportunity cases suggests that more diversion could have resulted in substantially less repeat offending, and hence less total crime.