Search results for: development health information systems

Authors: Chukwuka Justus Iwegbu

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Background: A major concern facing the world is providing senior citizens, individuals with disabilities, and other vulnerable groups with high-quality care. This issue is more serious in Nigeria's North Eastern area, where the burden of disease and disability is heavy, and access to care is constrained. This study aims to fill this gap by exploring the roles, challenges and support needs of caregivers, care home management, funding and administration in challenged communities in North Eastern Nigeria. The study will also provide a comprehensive understanding of the current situation and identify opportunities for improving the quality of care and support for caregivers and care recipients in these communities. Methods: A mixed-methods design, including both quantitative and qualitative data collection methods, will be used, and it will be guided by the stress process model of caregiving. The qualitative stage approach will comprise a survey, In-depth interviews, observations, and focus group discussion and the quantitative analysis will be used in order to comprehend the variations between caregiver's roles and care home management. A review of relevant documents, such as care home policies and funding reports, would be used to gather quantitative data on the administrative and financial aspects of care. The data collected will be analyzed using both descriptive statistics and thematic analysis. A sample size of around 200-300 participants, including caregivers, care recipients, care home managers and administrators, policymakers and health care providers, would be recruited. Findings: The study revealed that caregivers in challenged communities in North Eastern Nigeria face significant challenges, including lack of training and support, limited access to funding and resources, and high levels of burnout. Care home management and administration were also found to be inadequate, with a lack of clear policies and procedures and limited oversight and accountability. Conclusion: There is a need for increased investment in training and support for caregivers, as well as a need for improved care home management and administration in challenged communities in North Eastern Nigeria. It also highlights the importance of involving community members in decision-making and planning processes related to care homes and services. The study would contribute to the existing body of knowledge by providing a detailed understanding of the challenges faced by caregivers, care home managers and administrators.

Keywords: caregivers, care home management, funding, administration, challenge communities, North Eastern Nigeria

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Authors: Yasmeen Jamal Alabdallat, Almutazballlah Bassam Qablan, Obada Ahmad Al Jayyousi, Ihdaa Mahmoud Bani Khalaf, Eman E. Alshial

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Background: Bipolar disorder, formerly known as manic depression, is a mental health status that leads to extreme mood swings that include emotional lows (depression) and highs (mania or hypomania). This systematic review and meta-analysis aimed to assess the safety and efficacy of lithium versus valproate among bipolar patients. Methods: A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until June 2022. Studies comparing lithium versus valproate among bipolar patients were selected for the analysis, and all relevant outcomes were pooled in the meta-analysis using Review Manager Software. Results: 11 Randomized Clinical Trials were included in this meta-analysis with a total of 4159 patients. Our meta showed that lithium was superior to valproate in terms of Young Mania Rating Scale (YMRS) (MD = 0.00 with 95% CI, (-0.55 – 0.55; I2 = 0%), P = 1.00). The results of the Hamilton Depression Rating Scale (HDRS) showed that the overall effect favored the valproate treated group (MD = 1.41 with 95% CI, (-0.15 – 2.67; I2 = 0%), P = 0.03). Concerning the results of the Montgomery-Asberg Depression Rating Scale (MADRS), the results showed that the lithium was superior to valproate (MD = 0.03 with 95% CI, (-0.80 to 0.87; I2 = 40%), P = 0.94). In terms of the sexual side effect, we found that the valproate was superior to lithium (RR 1.19 with 95% CI, (0.74 to 1.91; I2 = 0%), P = 0.47). The lithium-treated group was superior in comparison to valproate treated group in terms of Abnormal Involuntary Movement Scale (AIMS) (MD = -0.03 with 95% CI (-0.38 to 0.32; I2 = 0%), P = 0.87). The lithium was more favorable in terms of Simpson-Agnes scale (MD = -0.40 with 95% CI, (-0.86 to 0.06; I2 = 0%), P = 0.09). The results of the Barnes akathisia scale showed that the overall effect of the valproate was more favorable in comparison to lithium (MD = 0.05 with 95% CI, (-0.12 to 0.22; I2 = 0%), P = 0.57). Conclusion: Our study revealed that on the scales of efficacy Lithium treated group surpassed Valproate treated group in terms of Young Mania Rating Scale (YMRS), Abnormal Involuntary Movement Scale (AIMS) and Simpson-Agnes scale, but valproate surpassed it in Barnes Akathisia scale. Furthermore, on the scales of depression Hamilton Depression Rating Scale (HDRS) showed that the overall effect favored Valproate treated group, but Lithium surpassed valproate in terms of Montgomery-Asberg Depression Rating Scale (MADRS). Valproate surpassed Lithium in terms of sexual side effects.

Keywords: bipolar, mania, bipolar-depression, sexual dysfunction, sexual side effects, treatment

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Authors: Rob Schindler

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Industry-standard methods of mitigating erosion of seabed sediments rely on ‘hard engineering’ approaches which have numerous environmental shortcomings: (1) direct loss of habitat by smothering of benthic species, (2) disruption of sediment transport processes, damaging geomorphic and ecosystem functionality (3) generation of secondary erosion problems, (4) introduction of material that may propagate non-local species, and (5) provision of pathways for the spread of invasive species. Recent studies have also revealed the importance of biological cohesion, the result of naturally occurring extra-cellular polymeric substances (EPS), in stabilizing natural sediments. Mimicking the strong bonding kinetics through the deliberate addition of EPS to sediments – henceforth termed ‘biostabilisation’ - offers a means in which to mitigate against erosion induced by structures or episodic increases in hydrodynamic forcing (e.g. storms and floods) whilst avoiding, or reducing, hard engineering. Here we present unique experiments that systematically examine how biostabilisation reduces scour around a monopile in a current, a first step to realizing the potential of this new method of scouring reduction for a wide range of engineering purposes in aquatic substrates. Experiments were performed in Plymouth University’s recirculating sediment flume which includes a recessed scour pit. The model monopile was 0.048 m in diameter, D. Assuming a prototype monopile diameter of 2.0 m yields a geometric ratio of 41.67. When applied to a 10 m prototype water depth this yields a model depth, d, of 0.24 m. The sediment pit containing the monopile was filled with different biostabilised substrata prepared using a mixture of fine sand (D50 = 230 μm) and EPS (Xanthan gum). Nine sand-EPS mixtures were examined spanning EPS contents of 0.0% < b0 < 0.50%. Scour development was measured using a laser point gauge along a 530 mm centreline at 10 mm increments at regular periods over 5 h. Maximum scour depth and excavated area were determined at different time steps and plotted against time to yield equilibrium values. After 5 hours the current was stopped and a detailed scan of the final scour morphology was taken. Results show that increasing EPS content causes a progressive reduction in the equilibrium depth and lateral extent of scour, and hence excavated material. Very small amounts equating to natural communities (< 0.1% by mass) reduce scour rate, depth and extent of scour around monopiles. Furthermore, the strong linear relationships between EPS content, equilibrium scour depth, excavation area and timescales of scouring offer a simple index on which to modify existing scour prediction methods. We conclude that the biostabilisation of sediments with EPS may offer a simple, cost-effective and ecologically sensitive means of reducing scour in a range of contexts including OWFs, bridge piers, pipeline installation, and void filling in rock armour. Biostabilisation may also reduce economic costs through (1) Use of existing site sediments, or waste dredged sediments (2) Reduced fabrication of materials, (3) Lower transport costs, (4) Less dependence on specialist vessels and precise sub-sea assembly. Further, its potential environmental credentials may allow sensitive use of the seabed in marine protection zones across the globe.

Keywords: biostabilisation, EPS, marine, scour

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Authors: Louise Penzenstadler, Tiphaine Robet, Radu Iuga, Daniele Zullino

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Context: The outpatient clinic of the psychiatric addiction service of Geneva University Hospital has been providing support to individuals affected by various narcotics for 30 years. However, the increasing consumption of crack cocaine in Geneva has presented a new challenge for the healthcare system. Research Aim: The aim of this research is to evaluate the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder. Methodology: The research utilizes a combination of quantitative and qualitative retrospective data analysis to evaluate the effectiveness of the outreach intervention. Findings: The data collected from October 2023 to December 2023 show that the outreach program successfully made 1,071 contacts with drug users and led to 15 new requests for care and enrollment in treatment. Patients expressed high satisfaction with the intervention, citing easy and rapid access to treatment and social support. Theoretical Importance: This research contributes to the understanding of the challenges and specific needs of a complex group of drug users who face severe health problems. It highlights the importance of outreach interventions in establishing trust, connecting users with care, and facilitating medication-assisted treatment for opioid addiction. Data Collection: Data was collected through the outreach program's interactions with drug users, including street outreach interventions and presence at locations frequented by users. Patient satisfaction surveys were also utilized. Analysis Procedures: The collected data was analyzed using both quantitative and qualitative methods. The quantitative analysis involved examining the number of contacts made, new requests for care, and treatment enrollment. The qualitative analysis focused on patient satisfaction and their perceptions of the intervention. Questions Addressed: The research addresses the following questions: What is the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder? How effective is the outreach program in connecting drug users with care and initiating medication-assisted treatment? Conclusion: The outreach program has proven to be an effective intervention in establishing trust with crack users, connecting them with care, and initiating medication-assisted treatment for opioid addiction. It has also highlighted the importance of addressing the specific challenges faced by this group of drug users.

Keywords: crack addiction, outreach treatment, peer intervention, polydrug use

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Authors: Gizaw Mamo Gebeyehu, Marianna Pap, Geza Makkai, Tibor Z. Janosi, Shima Rashidian, Tibor A. Rauch

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Sepsis poses a significant global health threat, necessitating extensive exploration of indicators tied to its pathological mechanisms and multi-organ dysfunction. While murine studies have shed light on sepsis, the intricate cellular and molecular landscape in human sepsis remains enigmatic. Exploring the influence of activated monocyte-derived exosomes in sepsis sheds light on a promising pathway for understanding the intricate cellular and molecular mechanisms involved in this condition in humans. In sepsis, exosome-borne mRNA and miRNA orchestrate immune response gene expression in recipient cells. Yet, the specifics of exosome-mediated cell-to-cell communication, especially how mRNA cargoes modulate gene expression in recipient cells, remain poorly understood. This study aims to elucidate the precise molecular pathways through which exosomal mRNA cargo, particularly MAFB, contributes to the developing sepsis-induced molecular aberrations in liver tissues, employing rigorously defined cell culture conditions. THP-1 cells were treated with LPS to induce changes in exosomal RNA profiles. Exosomes were isolated and characterized using microscopy and mass spectrometry. RNA was extracted from exosomes and sequenced. The most abundant exosomal mRNAs were subjected to GO analysis for functional annotation analysis and KEGG database analysis to identify the involved enriched pathways. PCR (Polymerase Chain Reaction), RNA sequencing, and Western blotting were involved to analyze changes in gene expression, protein levels, and signaling pathways within the liver cells( HepG2) after exposure to exosomal MAFB. This study pinpoints exosomal MAFB as a potential key regulator linked to liver cell damage during sepsis, along with associated genes (miR155HG, H3F3A, and possibly JARD2) forming a crucial molecular pathway contributing to liver cell injury, Together, these elements indicate a vital molecular pathway that plays a significant role in the emergence of liver cell injury during sepsis.. These findings suggest the importance of further research on these components for potential therapeutic interventions in managing acute liver damage in sepsis.

Keywords: sepsis, exososome, exosomal MAFB, LPS-induced THP-1 cells, RNA profiles, sepsis-triggered liver injury

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Authors: Mia Schneeweiss, Joseph Merola

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Atopic dermatitis (AD) is a chronic inflammatory skin condition with a prevalence of 9.6 million in children under the age of 18 in the US, 3.2 million of those suffer severe AD. AD has significant effects on the quality of life and psychiatric comorbidity in affected patients. We sought to quantify the use of psychotropic medications and mental health services in children. We used longitudinal claims data form commercially insured patients in the US between 2003 and 2016 to identify children aged 18 or younger with a diagnosis of AD associated with an outpatient or inpatient encounter. A 180-day enrollment period was required before the first diagnosis of AD. Among those diagnosed, we computed the use of psychiatric services and dispensing of psychotropic medications during the following 6 months. Among 1.6 million children <18 years with a diagnosis of AD, most were infants (0-1 years: 17.6%), babies (1-2 years: 12.2%) and young children (2-4 years: 15.4). 5.1% were in age group 16-18 years. Among younger children 50% of patients were female, after the age of 14 about 60% were female. In 16-18 years olds 6.4% had at least one claim with a recorded psychopathology during the 6-month baseline period; 4.6% had depression, 3.3% anxiety, 0.3% panic disorder, 0.6% psychotic disorder, 0.1% anorexia. During the 6 months following the physician diagnosis of AD, 66% used high-potency topical corticosteroids, 3.5% used an SSRI, 0.3% used an SNRI, 1.2% used a tricyclic antidepressant, 1.4% used an antipsychotic medication, and 5.2% used an anxiolytic agent. 4.4% had an outpatient visit with a psychiatrist and 0.1% had been hospitalized with a psychiatric diagnosis. In 14-16 years olds, 4.7% had at least one claim with a recorded psychopathology during the 6-month baseline period; 3.3% had depression, 2.5% anxiety, 0.2% panic disorder, 0.5% psychotic disorder, 0.1% anorexia. During the 6 months following the physician diagnosis of AD, 68% used high-potency topical corticosteroids, 4.6% used an SSRI, 0.6% used an SNRI, 1.5% used a tricyclic antidepressant, 1.4% used an antipsychotic medication, and 4.6% used an anxiolytic agent. 4.7% had an outpatient visit with a psychiatrist and 0.1% had been hospitalized with a psychiatric diagnosis. In 12-14 years olds, 3.3% had at least one claim with a recorded psychopathology during the 6-month baseline period; 1.9% had depression, 2.2% anxiety, 0.1% panic disorder, 0.7% psychotic disorder, 0.0% anorexia. During the 6 months following the physician diagnosis of AD, 67% used high-potency topical corticosteroids, 2.1% used an SSRI, 0.1% used an SNRI, 0.7% used a tricyclic antidepressant, 0.9 % used an antipsychotic medication, and 4.1% used an anxiolytic agent. 3.8% had an outpatient visit with a psychiatrist and 0.05% had been hospitalized with a psychiatric diagnosis. In younger children psychopathologies were decreasingly common: 10-12: 2.8%; 8-10: 2.3%; 6-8: 1.3%; 4-6: 0.6%. In conclusion, there is substantial psychiatric comorbidity among children, <18 years old, with diagnosed atopic dermatitis in a US commercially insured population. Meaningful psychiatric medication use (>3%) starts as early as 12 years old.

Keywords: pediatric atopic dermatitis, phychotropic medication use, psychiatric comorbidity, claims database

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Authors: Patience Manjengwa-Hungwe, Carmen White

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Background: Odyssean malaria refers to malaria acquired by infected mosquito bites from malaria endemic to non-endemic regions by mechanical modes of transport, such as airplanes, water vessels, trains and vehicles. Odyssean Malaria is rare and is characterised by absence of travel history to malaria endemic areas. As not anticipated in non-endemic areas, late diagnosis and treatment lead to a high case fatality rate. On 26 September 2014, the Outbreak Response Unit at the National Institute of Communicable Diseases was notified of a suspected death from Odyssean Malaria in Johannesburg, Gauteng Province, a non-endemic area. The main objective of this investigation was to identify the etiological agent's mode and source of transmission. Methods: Epidemiological surveys were conducted with the deceased’s family and clinical details were obtained from doctors who treated the victim in Southrand, Johannesburg. Blood samples were collected prior to death and sent to the National Health Laboratory Services, Johannesburg laboratory for a full blood count, urea electrolytes, creatinine, and C-reactive protein. Environmental assessments and entomological investigations, including collection of mosquito and larvae, were conducted at the deceased’s home and surrounding areas and sent to the laboratory for analysis. Results: Epidemiological surveys revealed no travel history, no mechanical transmission through blood transfusion and no previous possible exposure of the victim to malaria mosquitoes. Laboratory findings indicated that the platelet count was low. A further smear revealed that the malaria parasite was present and malaria antigen for P. falciparum was positive. Entomological findings revealed that none of the six adult or larval mosquitoes collected on site were malaria vectors. Dumping sites found at the back of the house were identified as possible sites where mosquitoes from endemic places could possibly breed. Conclusion: Given that there was no travel history or the possibility of mechanical transmission (blood transfusion or needle), the research team concluded that it is highly probable that the infection was acquired through an infective Anopheles mosquito inadvertently translocated from a Malaria endemic area by mechanical modes of transport. We recommend that clinicians in non-endemic malaria areas be aware of this type of malaria and test for malaria in patients showing malaria-like symptoms.

Keywords: Odyssean Malaria, vector Bourne, malaria, epidemiological surveys

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Authors: L. D. Upegui, Isabel Alvarez-Solorza, Karina Garduno-Ulloa, Maren Boecker

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Introduction: The increasing prevalence rate of resistant and multiresistant bacterial strains to antibiotics is a threat to public health and requires a rapid multifunctional answer. Individuals that are affected by resistant strains present a higher morbidity and mortality than individuals that are infected with the same species of bacteria but with sensitive strains. There have been identified risk factors that are related to the misuse and overuse of antibiotics, like socio-demographic characteristics and psychological aspects of the individuals that have not been explored objectively due to a lack of valid and reliable instruments for their measurement. Objective: To validate a questionnaire for the evaluation of the levels of knowledge related to the use of antibiotics in a Mexican population. Materials and Methods: Analytical cross-sectional observational study. The questionnaire consists of 12 items to evaluated knowledge (1=no, 2=not sure, 3=yes) regarding the use of antibiotics, with higher scores corresponding to a higher level of knowledge. Data are collected in a sample of students. Data collection is still ongoing. In this abstract preliminary results of 30 respondents are reported which were collected during pilot-testing. The validation of the instrument was done using the Rasch model. Fit to the Rasch model was tested checking overall fit to the model, unidimensionality, local independence and evaluating the presence of Differential Item Functioning (DIF) by age and gender. The software Rumm2030 and the SPSS were used for the analyses. Results: The participants of the pilot-testing presented an average age of 32 years ± 12.6 and 53% were women. The preliminary results indicated that the items showed good fit to the Rasch model (chi-squared=12.8 p=0.3795). Unidimensionality (number of significant t-tests of 3%) could be proven, the items were locally independent, and no DIF was observed. Knowledge was the smallest regarding statements on the role of antibiotics in treating infections, e.g., most of the respondents did not know that antibiotics would not work against viral infections (70%) and that they could also cause side effects (87%). The knowledge score ranged from 0 to 100 points with a transformed measurement (mean of knowledge 27.1 ± 4.8). Conclusions: The instrument showed good psychometric proprieties. The low scores of knowledge about antibiotics suggest that misinterpretations on the use of these medicaments were prevalent, which could influence the production of antibiotic resistance. The application of this questionnaire will allow the objective identification of 'Hight risk groups', which will be the target population for future educational campaigns, to reduce the knowledge gaps on the general population as an effort against antibiotic resistance.

Keywords: antibiotics, knowledge, misuse, overuse, questionnaire, Rasch model, validation

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Authors: Emma Plante, Charles Ekwunwa, Diego Illanes

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Introduction: Serum Sickness-Like Reaction (SSLR) is an inflammatory immune response characterized by a rash, polyarthralgias, and fever. SSLR usually occurs in response to a new medication (most commonly antibiotics, anticonvulsants, or antiinflammatory agents) and is believed to involve the formation of drug-specific immune complexes. Here we present a case of a 16-year-old female patient who developed an SSLR in response to the D-mannose-containing over-the-counter supplement, Uqora, used to promote bladder health. Methodology: The methodology for this study included a thorough literature search for other cases of SSLR associated with D-Mannose containing products. Data collection was performed through a review of the patient’s medical record, including history, physical examination, relevant laboratory results, and treatment plan. Findings: A 16-year-old female with a history of overactive bladder and anemia presented with a diffuse urticarial rash, headaches, joint pain, and swelling for three days. Her medications included oral contraceptive pills, iron, mirabegron, UQora, and a probiotic. Physical examination revealed a diffuse urticarial rash, and her musculoskeletal exam revealed swelling and tenderness in her wrists. Her CBC, basic metabolic panel, liver function panel, lyme titers, and urinalysis were all within normal limits. The patient was referred to an allergist, who diagnosed her with SSLR. All medications were discontinued, and she was treated with a 7-day course of prednisone and cetirizine. Her symptoms resolved, and her medications were slowly resumed sequentially over several months. However, UQora triggered a recurrence of her symptoms, and it was identified as the culprit medication. Consequently, UQora was permanently discontinued, and the patient has remained symptom-free. Conclusion: This case report describes the first documented case of SSLR caused by UQora (active ingredient D-mannose). D-Mannose is a monosaccharide found in many plants and fruits, and it is commonly used to prevent urinary tract infections. While the clinical features and timeline, in this case, were typical of SSLR, UQora as the trigger was highly unusual. Clinicians should be aware of the diverse triggers of SSLR and the importance of prompt identification and management to enhance patient safety. It is possible D-mannose was not the trigger, and further research is necessary to better understand the potential therapeutic applications of D-mannose, as well as the potential risks and interactions.

Keywords: serum sickness-like reaction, d-mannose, hypersensitivity reaction, urticaria

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Authors: Mustafa Metin Donma, Orkide Donma

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Obesity in children particularly draws attention because it may threaten the individual’s future life due to many chronic diseases it may lead to. Most of these diseases, including obesity itself altogether are related to inflammation. For this reason, inflammation-related parameters gain importance. Within this context, complete blood cell counts, ratios or indices derived from these counts have recently found some platform to be used as inflammatory markers. So far, mostly adipokines were investigated within the field of obesity. The liver is at the center of the metabolic pathways network. Metabolic inflammation is closely associated with cellular dysfunction. In this study, hematologic inflammatory markers and two major hepatokines, cytokines produced predominantly by the liver, fibroblast growth factor-21 (FGF-21) and fetuin A were investigated in pediatric obesity. Two groups were constituted from seventy-six obese children based on World Health Organization criteria. Group 1 was composed of children whose age- and sex-adjusted body mass index (BMI) percentiles were between 95 and 99. Group 2 consists of children who are above the 99ᵗʰ percentile. The first and the latter groups were defined as obese (OB) and morbid obese (MO). Anthropometric measurements of the children were performed. Informed consent forms and the approval of the institutional ethics committee were obtained. Blood cell counts and ratios were determined by an automated hematology analyzer. The related ratios and indexes were calculated. Statistical evaluation of the data was performed by the SPSS program. There was no statistically significant difference in terms of neutrophil-to lymphocyte ratio, monocyte-to-high density lipoprotein cholesterol ratio and the platelet-to-lymphocyte ratio between the groups. Mean platelet volume and platelet distribution width values were decreased (p<0.05), total platelet count, red cell distribution width (RDW) and systemic immune inflammation index values were increased (p<0.01) in MO group. Both hepatokines were increased in the same group; however, increases were not statistically significant. In this group, also a strong correlation was calculated between FGF-21 and RDW when controlled by age, hematocrit, iron and ferritin (r=0.425; p<0.01). In conclusion, the association between RDW, a hematologic inflammatory marker, and FGF-21, an inflammation-related hepatokine, found in MO group is an important finding discriminating between OB and MO children. This association is even more powerful when controlled by age and iron-related parameters.

Keywords: childhood obesity, fetuin A , fibroblast growth factor-21, hematologic markers, red cell distribution width

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Authors: Asim Abbasi, Muhammad Sufyan, Iqra, Hafiza Javaria Ashraf

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The share of vector-borne diseases (VBDs) in the global burden of infectious diseases is almost 17%. The advent of new drugs and latest research in medical science helped mankind to compete with these lethal diseases but still diseases transmitted by different mosquito species, including filariasis, malaria, viral encephalitis and dengue are serious threats for people living in disease endemic areas. Injudicious and repeated use of pesticides posed selection pressure on mosquitoes leading to development of resistance. Hence biological control agents are under serious consideration of scientific community to be used in vector control programmes. Fish have a history of predating immature stages of different aquatic insects including mosquitoes. The noteworthy examples in Africa and Asia includes, Aphanius discolour and a fish in the Panchax group. Moreover, common mosquito fish, Gambusia affinis predates mostly on temporary water mosquitoes like anopheline as compared to permanent water breeders like culicines. Mosquitoes belonging to genus Toxorhynchites have a worldwide distribution and are mostly associated with the predation of other mosquito larvae habituating with them in natural and artificial water containers. These species are harmless to humans as their adults do not suck human blood but feeds on floral nectar. However, their activity is mostly temperature dependent as Toxorhynchites brevipalpis consume 359 Aedes aegypti larvae at 30-32 ºC in contrast to 154 larvae at 20-26 ºC. Although many bacterial species were isolated from mosquito cadavers but those belonging to genus Bacillus are found highly pathogenic against them. The successful species of this genus include Bacillus thuringiensis and Bacillus sphaericus. The prime targets of B. thuringiensis are mostly the immatures of genus Aedes, Culex, Anopheles and Psorophora while B. sphaericus is specifically toxic against species of Culex, Psorophora and Culiseta. The entomopathogenic nematodes belonging to family, mermithidae are also pathogenic to different mosquito species. Eighty different species of mosquitoes including Anopheles, Aedes and Culex proved to be highly vulnerable to the attack of two mermithid species, Romanomermis culicivorax and R. iyengari. Cytoplasmic polyhedrosis virus was the first described pathogenic virus, isolated from the cadavers of mosquito specie, Culex tarsalis. Other viruses which are pathogenic to culicine includes, iridoviruses, cytopolyhedrosis viruses, entomopoxviruses and parvoviruses. Protozoa species belonging to division microsporidia are the common pathogenic protozoans in mosquito populations which kill their host by the chronic effects of parasitism. Moreover, due to their wide prevalence in anopheline mosquitoes and transversal and horizontal transmission from infected to healthy host, microsporidia of the genera Nosema and Amblyospora have received much attention in various mosquito control programmes. Fungal based mycopesticides are used in biological control of insect pests with 47 species reported virulent against different stages of mosquitoes. These include both aquatic fungi i.e. species of Coelomomyces, Lagenidium giganteum and Culicinomyces clavosporus, and the terrestrial fungi Metarhizium anisopliae and Beauveria bassiana. Hence, it was concluded that the integrated use of all these biological control agents can be a healthy contribution in mosquito control programmes and become a dire need of the time to avoid repeated use of pesticides.

Keywords: entomopathogenic nematodes, protozoa, Toxorhynchites, vector-borne

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Authors: Julie Anne Braun, Leonardo D. da Fonseca, Gerson C. Parreira, Ricardo J. E. Andrade

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Polyurethanes (PU) are multifunctional polymers used across various industries. In construction, thermosetting polyurethanes are applied as coatings for flooring, paints, and waterproofing. They are widely specified in Brazil for waterproofing concrete structures like roof slabs and parking decks. Applied to concrete, they form a fully adhered membrane, providing a protective barrier with low water absorption, high chemical resistance, impermeability to liquids, and low vapor permeability. Their mechanical properties, including tensile strength (1 to 35 MPa) and Shore A hardness (83 to 88), depend on resin molecular weight and functionality, often using Methylene diphenyl diisocyanate. PU production, reliant on fossil-derived isocyanates and polyols, contributes significantly to carbon emissions. Sustainable alternatives, such as biopolyurethanes from renewable sources, are needed. Castor oil is a viable option for synthesizing sustainable polyurethanes. As a bio-based feedstock, castor oil is extensively cultivated in Brazil, making it a feasible option for the national market and ranking third internationally. This study aims to develop and characterize castor oil-based biopolyurethane for high-performance waterproofing and coating applications. A comparative analysis between castor oil-based PU and polyether polyol-based PU was conducted. Mechanical tests (tensile strength, Shore A hardness, abrasion resistance) and surface properties (contact angle, water absorption) were evaluated. Thermal, chemical, and morphological properties were assessed using thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). The results demonstrated that both polyurethanes exhibited high mechanical strength. Specifically, the tensile strength for castor oil-based PU was 19.18 MPa, compared to 12.94 MPa for polyether polyol-based PU. Similarly, the elongation values were 146.90% for castor oil-based PU and 135.50% for polyether polyol-based PU. Both materials exhibited satisfactory performance in terms of abrasion resistance, with mass loss of 0.067% for castor oil PU and 0.043% for polyether polyol PU and Shore A hardness values of 89 and 86, respectively, indicating high surface hardness. The results of the water absorption and contact angle tests confirmed the hydrophilic nature of polyether polyol PU, with a contact angle of 58.73° and water absorption of 2.53%. Conversely, the castor oil-based PU exhibited hydrophobic properties, with a contact angle of 81.05° and water absorption of 0.45%. The results of the FTIR analysis indicated the absence of a peak around 2275 cm-1, which suggests that all of the NCO groups were consumed in the stoichiometric reaction. This conclusion is supported by the high mechanical test results. The TGA results indicated that polyether polyol PU demonstrated superior thermal stability, exhibiting a mass loss of 13% at the initial transition (around 310°C), in comparison to castor oil-based PU, which experienced a higher initial mass loss of 25% at 335°C. In summary, castor oil-based PU demonstrated mechanical properties comparable to polyether polyol PU, making it suitable for applications such as trafficable coatings. However, its higher hydrophobicity makes it more promising for watertightness. Increasing environmental concerns necessitate reducing reliance on non-renewable resources and mitigating the environmental impacts of polyurethane production. Castor oil is a viable option for sustainable polyurethanes, aligning with emission reduction goals and responsible use of natural resources.

Keywords: polyurethane, castor oil, sustainable, waterproofing, construction industry

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Authors: Negar Vkilbashi, Hassan Kabiri

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Modern diplomacy, in its general form, refers to the people and not the governments, and diplomacy tactics are more addressed to the people than to the governments. Media diplomacy and cyber diplomacy are also one of the sub-branches of public diplomacy and, in fact, the role of media in the process of influencing public opinion and directing foreign policy. Mass media, including written, radio and television, theater, satellite, internet, and news agencies, transmit information and demands. What the Qatari government tried to implement in the countries of the region during the Arab Spring and after was through its important media, Al Jazeera. The embargo on Qatar began in 2017, when Saudi Arabia, the United Arab Emirates, Bahrain, and Egypt imposed a land, sea, and air blockade against the country. The media tool constitutes the cornerstone of soft power in the field of foreign policy, which Qatari leaders have consistently resorted to over the past two decades. Undoubtedly, the role it played in covering the events of the Arab Spring has created geopolitical tensions. The United Arab Emirates and other neighboring countries sometimes criticize Al Jazeera for providing a platform for the Muslim Brotherhood, Hamas, and other Islamists to promote their ideology. In 2011, at the same time as the Arab Spring, Al Jazeera reached the peak of its popularity. Al Jazeera's live coverage of protests in Tunisia, Egypt, Yemen, Libya, and Syria helped create a unified narrative of the Arab Spring, with audiences tuning in every Friday to watch simultaneous protests across the Middle East. Al Jazeera operates in three groups: First, it is a powerful base in the hands of the government so that it can direct and influence Arab public opinion. Therefore, this network has been able to benefit from the unlimited financial support of the Qatar government to promote its desired policies and culture. Second, it has provided an attractive platform for politicians and scientific and intellectual elites, thus attracting their support and defense from the government and its rulers. Third, during the last years of Prince Hamad's reign, the Al Jazeera network formed a deterrent weapon to counter the media and political struggle campaigns. The importance of the research is that this network covers a wide range of people in the Middle East and, therefore, has a high influence on the decision-making of countries. On the other hand, Al Jazeera is influential as a tool of public diplomacy and soft power in Qatar's foreign policy, and by studying it, the results of its effectiveness in the past years can be examined. Using a qualitative method, this research analyzes the impact of the media on the implementation of Qatar's foreign policy on the public opinion of the people of the Middle East. Data collection has been done by the secondary method, that is, reading related books, magazine articles, newspaper reports and articles, and analytical reports of think tanks. The most important findings of the research are that Al Jazeera plays an important role in Qatar's foreign policy in Qatar's public diplomacy. So that, in 2011, 2017 and 2023, it played an important role in Qatar's foreign policy in various crises. Also, the people of Arab countries use Al-Jazeera as their first reference.

Keywords: Al Jazeera, Qatar, media, diplomacy

Procedia PDF Downloads 57

Authors: Stefan K. Behfar

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The rapid growth of the Ethereum network has brought forth the urgent need for scalable analysis methods to handle the increasing volume of blockchain data. In this research, we propose efficient methodologies for making Ethereum network analysis scalable. Our approach leverages a combination of graph-based data representation, probabilistic sampling, and parallel processing techniques to achieve unprecedented scalability while preserving critical network insights. Data Representation: We develop a graph-based data representation that captures the underlying structure of the Ethereum network. Each block transaction is represented as a node in the graph, while the edges signify temporal relationships. This representation ensures efficient querying and traversal of the blockchain data. Probabilistic Sampling: To cope with the vastness of the Ethereum blockchain, we introduce a probabilistic sampling technique. This method strategically selects a representative subset of transactions and blocks, allowing for concise yet statistically significant analysis. The sampling approach maintains the integrity of the network properties while significantly reducing the computational burden. Graph Convolutional Networks (GCNs): We incorporate GCNs to process the graph-based data representation efficiently. The GCN architecture enables the extraction of complex spatial and temporal patterns from the sampled data. This combination of graph representation and GCNs facilitates parallel processing and scalable analysis. Distributed Computing: To further enhance scalability, we adopt distributed computing frameworks such as Apache Hadoop and Apache Spark. By distributing computation across multiple nodes, we achieve a significant reduction in processing time and enhanced memory utilization. Our methodology harnesses the power of parallelism, making it well-suited for large-scale Ethereum network analysis. Evaluation and Results: We extensively evaluate our methodology on real-world Ethereum datasets covering diverse time periods and transaction volumes. The results demonstrate its superior scalability, outperforming traditional analysis methods. Our approach successfully handles the ever-growing Ethereum data, empowering researchers and developers with actionable insights from the blockchain. Case Studies: We apply our methodology to real-world Ethereum use cases, including detecting transaction patterns, analyzing smart contract interactions, and predicting network congestion. The results showcase the accuracy and efficiency of our approach, emphasizing its practical applicability in real-world scenarios. Security and Robustness: To ensure the reliability of our methodology, we conduct thorough security and robustness evaluations. Our approach demonstrates high resilience against adversarial attacks and perturbations, reaffirming its suitability for security-critical blockchain applications. Conclusion: By integrating graph-based data representation, GCNs, probabilistic sampling, and distributed computing, we achieve network scalability without compromising analytical precision. This approach addresses the pressing challenges posed by the expanding Ethereum network, opening new avenues for research and enabling real-time insights into decentralized ecosystems. Our work contributes to the development of scalable blockchain analytics, laying the foundation for sustainable growth and advancement in the domain of blockchain research and application.

Keywords: Ethereum, scalable network, GCN, probabilistic sampling, distributed computing

Procedia PDF Downloads 44

Authors: Alberto Azevedo, Ricardo Martins, André B. Fortunato, Anabela Oliveira

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Water is under severe threat today because of the rising population, increased agricultural and industrial needs, and the intensifying effects of climate change. Due to sea-level rise, erosion, and demographic pressure, the coastal regions are of significant concern to the scientific community. The Water Monitoring Sentinel Cloud platform (WORSICA) service is focused on providing new tools for monitoring water in coastal and inland areas, taking advantage of remote sensing, in situ and tidal modeling data. WORSICA is a service that can be used to determine the coastline, coastal inundation areas, and the limits of inland water bodies using remote sensing (satellite and Unmanned Aerial Vehicles - UAVs) and in situ data (from field surveys). It applies to various purposes, from determining flooded areas (from rainfall, storms, hurricanes, or tsunamis) to detecting large water leaks in major water distribution networks. This service was built on components developed in national and European projects, integrated to provide a one-stop-shop service for remote sensing information, integrating data from the Copernicus satellite and drone/unmanned aerial vehicles, validated by existing online in-situ data. Since WORSICA is operational using the European Open Science Cloud (EOSC) computational infrastructures, the service can be accessed via a web browser and is freely available to all European public research groups without additional costs. In addition, the private sector will be able to use the service, but some usage costs may be applied, depending on the type of computational resources needed by each application/user. Although the service has three main sub-services i) coastline detection; ii) inland water detection; iii) water leak detection in irrigation networks, in the present study, an application of the service to Óbidos lagoon in Portugal is shown, where the user can monitor the evolution of the lagoon inlet and estimate the topography of the intertidal areas without any additional costs. The service has several distinct methodologies implemented based on the computations of the water indexes (e.g., NDWI, MNDWI, AWEI, and AWEIsh) retrieved from the satellite image processing. In conjunction with the tidal data obtained from the FES model, the system can estimate a coastline with the corresponding level or even topography of the inter-tidal areas based on the Flood2Topo methodology. The outcomes of the WORSICA service can be helpful for several intervention areas such as i) emergency by providing fast access to inundated areas to support emergency rescue operations; ii) support of management decisions on hydraulic infrastructures operation to minimize damage downstream; iii) climate change mitigation by minimizing water losses and reduce water mains operation costs; iv) early detection of water leakages in difficult-to-access water irrigation networks, promoting their fast repair.

Keywords: remote sensing, coastline detection, water detection, satellite data, sentinel, Copernicus, EOSC

Procedia PDF Downloads 104

Authors: Atabaev I. G., Fayziev Sh. A., Irmatova Sh. K.

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Raw materials with high content of Kalium oxide widely used in ceramic technology for prevention or decreasing of deformation of ceramic goods during drying process and under thermal annealing. Becouse to low melting temperature it is also used to decreasing of the temperature of thermal annealing during fabrication of ceramic goods [1,2]. So called “Porceline or China stones” - quartz-sericite (muscovite) minerals is also can be used for prevention of deformation as the content of Kalium oxide in muscovite is rather high (SiO2, + KAl2[AlSi3O10](OH)2). [3] . To estimation of possibility of use of this mineral for ceramic manufacture, in the presented article the influence of thermal processing on phase and a chemical content of this raw material is investigated. As well as to other ceramic raw materials (kaoline, white burning clays) the basic requirements of the industry to quality of "a porcelain stone» are following: small size of particles, relative high uniformity of disrtribution of components and phase, white color after burning, small content of colorant oxides or chromophores (Fe2O3, FeO, TiO2, etc) [4,5]. In the presented work natural minerale from the Boynaksay deposit (Uzbekistan) is investigated. The samples was mechanically polished for investigation by Scanning Electron Microscope. Powder with size of particle up to 63 μm was used to X-ray diffractometry and chemical analysis. The annealing of samples was performed at 900, 1120, 1350oC during 1 hour. Chemical composition of Boynaksay raw material according to chemical analysis presented in the table 1. For comparison the composition of raw materials from Russia and USA are also presented. In the Boynaksay quartz – sericite the average parity of quartz and sericite makes 55-60 and 30-35 % accordingly. The distribution of quartz and sericite phases in raw material was investigated using electron probe scanning electronic microscope «JEOL» JXA-8800R. In the figure 1 the scanning electron microscope (SEM) micrograps of the surface and the distributions of Al, Si and K atoms in the sample are presented. As it seen small granular, white and dense mineral includes quartz, sericite and small content of impurity minerals. Basically, crystals of quartz have the sizes from 80 up to 500 μm. Between quartz crystals the sericite inclusions having a tablet form with radiant structure are located. The size of sericite crystals is ~ 40-250 μm. Using data on interplanar distance [6,7] and ASTM Powder X-ray Diffraction Data it is shown that natural «a porcelain stone» quartz – sericite consists the quartz SiO2, sericite (muscovite type) KAl2[AlSi3O10](OH)2 and kaolinite Al203SiO22Н2О (See Figure 2 and Table 2). As it seen in the figure 3 and table 3a after annealing at 900oC the quartz – sericite contains quartz – SiO2 and muscovite - KAl2[AlSi3O10](OH)2, the peaks related with Kaolinite are absent. After annealing at 1120oC the full disintegration of muscovite and formation of mullite phase Al203 SiO2 is observed (the weak peaks of mullite appears in fig 3b and table 3b). After annealing at 1350oC the samples contains crystal phase of quartz and mullite (figure 3c and table 3с). Well known Mullite gives to ceramics high density, abrasive and chemical stability. Thus the obtained experimental data on formation of various phases during thermal annealing can be used for development of fabrication technology of advanced materials. Conclusion: The influence of thermal annealing in the interval 900-1350oC on phase composition and structure of quartz-sericite minerale is investigated. It is shown that during annealing the phase content of raw material is changed. After annealing at 1350oC the samples contains crystal phase of quartz and mullite (which gives gives to ceramics high density, abrasive and chemical stability).

Keywords: quartz-sericite, kaolinite, mullite, thermal processing

Procedia PDF Downloads 388

Authors: M. Kadela

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The load caused by the traffic movement should be transferred in the road constructions in a harmless way to the pavement as follows: − on the stiff upper layers of the structure (e.g. layers of asphalt: abrading and binding), and − through the layers of principal and secondary substructure, − on the subsoil, directly or through an improved subsoil layer. Reliable description of the interaction proceeding in a system “road construction – subsoil” should be in such case one of the basic requirements of the assessment of the size of internal forces of structure and its durability. Analyses of road constructions are based on: − elements of mechanics, which allows to create computational models, and − results of the experiments included in the criteria of fatigue life analyses. Above approach is a fundamental feature of commonly used mechanistic methods. They allow to use in the conducted evaluations of the fatigue life of structures arbitrarily complex numerical computational models. Considering the work of the system “road construction – subsoil”, it is commonly accepted that, as a result of repetitive loads on the subsoil under pavement, the growth of relatively small deformation in the initial phase is recognized, then this increase disappears, and the deformation takes the character completely reversible. The reliability of calculation model is combined with appropriate use (for a given type of analysis) of constitutive relationships. Phenomena occurring in the initial stage of the system “road construction – subsoil” is unfortunately difficult to interpret in the modeling process. The classic interpretation of the behavior of the material in the elastic-plastic model (e-p) is that elastic phase of the work (e) is undergoing to phase (e-p) by increasing the load (or growth of deformation in the damaging structure). The paper presents the essence of the calibration process of cooperating subsystem in the calculation model of the system “road construction – subsoil”, created for the mechanistic analysis. Calibration process was directed to show the impact of applied constitutive models on its deformation and stress response. The proper comparative base for assessing the reliability of created. This work was supported by the on-going research project “Stabilization of weak soil by application of layer of foamed concrete used in contact with subsoil” (LIDER/022/537/L-4/NCBR/2013) financed by The National Centre for Research and Development within the LIDER Programme. M. Kadela is with the Department of Building Construction Elements and Building Structures on Mining Areas, Building Research Institute, Silesian Branch, Katowice, Poland (phone: +48 32 730 29 47; fax: +48 32 730 25 22; e-mail: m.kadela@ itb.pl). models should be, however, the actual, monitored system “road construction – subsoil”. The paper presents too behavior of subsoil under cyclic load transmitted by pavement layers. The response of subsoil to cyclic load is recorded in situ by the observation system (sensors) installed on the testing ground prepared for this purpose, being a part of the test road near Katowice, in Poland. A different behavior of the homogeneous subsoil under pavement is observed for different seasons of the year, when pavement construction works as a flexible structure in summer, and as a rigid plate in winter. Albeit the observed character of subsoil response is the same regardless of the applied load and area values, this response can be divided into: - zone of indirect action of the applied load; this zone extends to the depth of 1,0 m under the pavement, - zone of a small strain, extending to about 2,0 m.

Keywords: road structure, constitutive model, calculation model, pavement, soil, FEA, response of soil, monitored system

Procedia PDF Downloads 329

Authors: Anisah Ari

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Effects of organized crime permeate all facets of life, including public health, socio-economic endeavors, and human security. If any element of this is affected, it impacts large-scale national and global interest. Seeking to address terrorist networks through technical thinking is like trying to kill a weed by just cutting off its branches. It will re-develop and expand in proportions beyond one’s imagination, even in horrific ways that threaten human security. The continent of Africa has been bedeviled by this menace, with little or no solution to the problem. Nigeria is dealing with a protracted insurgency that is perpetrated by a sect against any form of westernization. Reimagining approaches to dealing with pressing issues like terrorism may require engaging the right set of people in the conversation for any sustainable change. These are people who have lived through the daily effects of the violence that ensues from the activities of terrorist activities. Effective leadership is required for an inclusive process, where spaces are created for diverse voices to be heard, and multiple perspectives are listened to, and not just heard, that supports a determination of the realistic outcome. Addressing insurgency in Nigeria has experienced a lot of disinformation and uncertainty. This may be in part due to poor leadership or an iteration of technical solutions to adaptive challenge peacemaking efforts in Nigeria has focused on behaviors, attitudes and practices that contribute to violence. However, it is important to consider the underlying issues that build-up, ignite and fan the flames of violence—looking at conflict as a complex system, issues like climate change, low employment rates, corruption and the impunity of discrimination due to ethnicity and religion. This article will be looking at an option of the more relational way of addressing insurgency through adaptive approaches that embody engagement and solutions with the people rather than for the people. The construction of a local turn in peacebuilding is informed by the need to create a locally driven and sustained peace process that embodies the culture and practices of the people in enacting an everyday peace beyond just a perennial and universalist outlook. A critical analysis that explores the socially identified individuals and situations will be made, considering the more adaptive approach to a complex existential challenge rather than a universalist frame. Case Study and Ethnographic research approach to understand what other scholars have documented on the matter and also a first-hand understanding of the experiences and viewpoints of the participants.

Keywords: terrorism, adaptive, peace, culture

Procedia PDF Downloads 81

Authors: Virendra Nath, Vipin Kumar

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Background: TypeII Diabetes mellitus is a foremost health problem worldwide, predisposing to increased mortality and morbidity. Undesirable effects of the current medications have prompted the researcher to develop more potential drug(s) against the disease. The peroxisome proliferator-activated receptors (PPARs) are members of the nuclear receptors family and take part in a vital role in the regulation of metabolic equilibrium. They can induce or repress genes associated with adipogenesis, lipid, and glucose metabolism. Aims: Investigation of PPARα/γ agonistic hits were screened by hierarchical virtual screening followed by molecular dynamics simulation and knowledge-based structure-activity relation (SAR) analysis using approved PPAR α/γ dual agonist. Methods: The PPARα/γ agonistic activity of compounds was searched by using Maestro through structure-based virtual screening and molecular dynamics (MD) simulation application. Virtual screening of nuclear-receptor ligands was done, and the binding modes with protein-ligand interactions of newer entity(s) were investigated. Further, binding energy prediction, Stability studies using molecular dynamics (MD) simulation of PPARα and γ complex was performed with the most promising hit along with the structural comparative analysis of approved PPARα/γ agonists with screened hit was done for knowledge-based SAR. Results and Discussion: The silicone chip-based approach recognized the most capable nine hits and had better predictive binding energy as compared to the reference drug compound (Tesaglitazar). In this study, the key amino acid residues of binding pockets of both targets PPARα/γ were acknowledged as essential and were found to be associated in the key interactions with the most potential dual hit (ChemDiv-3269-0443). Stability studies using molecular dynamics (MD) simulation of PPARα and γ complex was performed with the most promising hit and found root mean square deviation (RMSD) stabile around 2Å and 2.1Å, respectively. Frequency distribution data also revealed that the key residues of both proteins showed maximum contacts with a potent hit during the MD simulation of 20 nanoseconds (ns). The knowledge-based SAR studies of PPARα/γ agonists were studied using 2D structures of approved drugs like aleglitazar, tesaglitazar, etc. for successful designing and synthesis of compounds PPARγ agonistic candidates with anti-hyperlipidimic potential.

Keywords: computational, diabetes, PPAR, simulation

Procedia PDF Downloads 75

Authors: Bollu Mounica

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Background: Nowadays drug related problems were seen very commonly within the health care practice. These could result in the medication errors, adverse events, drug interactions and harm to patients. Pharmacist has an identified role in minimizing and preventing such type of problems. Objectives: To detect the incidence of drug related problems for the hospitalized patient, and to analyze the clinical pharmacist interventions performed during the review of prescription orders of the general medicine, psychiatry, surgery, pediatrics, gynaecology units of a large tertiary care teaching hospital. Methods: It was a retrospective, observational and interventional study. The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions. For a period starting November 2012 until December 2014, the inpatient medication charts and orders were identified and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services in a tertiary care teaching hospital on routine daily activities. Data was collected and evaluated. The causes of this problem were identified. Results: A total of 360 patients were followed. Male (71.66%) predominance was noted over females (28.33%). Drug related problems were more commonly seen in patients aged in between 31-60. Most of the DRP observed in the study resulted from the dispensing errors (26.11%), improper drug selection (17.22%), followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing (26.11%), and drug change (18.05%). Minor significance of DRPs were noted high (41.11 %), whereas (35.27 %) were moderate and (23.61 %) were major. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Conclusion: Our study showed that the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes needed in the prescriptions. In this context, routine participation of clinical pharmacists in clinical medical rounds facilitates the identification of DRPs and may prevent their occurrence.

Keywords: drug related problems, clinical pharmacist, drug prescriptions, drug related problems, intervention

Procedia PDF Downloads 286

Authors: Ayoti Banerjee, Meenakshi Banerjee

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The study of metamorphic reaction textures is important in contributing to our understanding of the evolution of metamorphic terranes. Where preserved, they provide information on changes in the P-T conditions during the metamorphic history of the rock, and thus allow us to speculate on the P-T-t evolution of the terrane. Mafic dykes have attracted the attention of petrologists because they act as window to mantle. This rock represents a mafic dyke of doleritic composition. It is fine to medium grained in which clinopyroxene are enclosed by the lath shaped plagioclase grains to form spectacular ophitic texture. At places, sub ophitic texture was also observed. Grains of pyroxene and plagioclase show very less deformation typically plagioclase showing deformed lamella along with plagioclase-clinopyroxene-phyric granoblastic fabric within a groundmass of feldspar microphenocrysts and Fe–Ti oxides. Both normal and reverse zoning were noted in the plagioclase laths. The clinopyroxene grains contain exsolved phases such as orthopyroxene, plagioclase, magnetite, ilmenite along the cleavage traces and the orthopyroxene lamella form granules in the periphery of the clinopyroxene grains. Garnet corona also develops preferentially around plagioclase at the contact of clinopyroxene, ilmenite or magnetite. Tiny quartz and K-fs grains showed symplectic intergrowth with garnet at a few places. The product quartz formed along with garnet rims the coronal garnet and the reacting clinopyroxene. Thin amphibole corona formed along the periphery of deformed plagioclase and clinopyroxene occur as patches over the magmatic minerals. The amphibole coronas cannot be assigned to a late magmatic stage and are interpreted as reactive being restricted to the contact between clinopyroxene and plagioclase, thus postdating the crystallization of both. The amphibole and garnet do not share grain boundary in the entire rock and is thus pointing towards simultaneous crystallization. Olivine is absent. Spectacular myrmekitic growth of orthoclase and quartz rimming the plagioclase is consistent with the potash metasomatic effects that is also found in other rocks of this region. These textural features are consistent with a phase of fluid induced metamorphism (retrogression). But the appearance of coronal garnet and amphibole exclusive of each other reflects the participation if Ti as the prime reason. Presence of Ti as a reactant phase is a must for amphibole forming reactions whereas it is not so in case of garnet forming reactions although the reactants are the same plagioclase and clinopyroxene in both cases. These findings are well validated by petrographical and textural analysis. In order to obtain balanced chemical reactions that explain formation of amphibole and garnet in the mafic dyke rocks a matrix operation technique called Singular Value Decomposition (SVD) was adopted utilizing the measured chemical compositions of the minerals. The computer program C-Space was used for this purpose and the required compositional matrix. Data fed to C-Space was after doing cation-calculation of the oxide percentages obtained from EPMA analysis. The Garnet-Clinopyroxene geothermometer yielded a temperature of 650 degrees Celsius. The Garnet-Clinopyroxene-Plagioclase geobarometer and Al-in amphibole yielded roughly 7.5 kbar pressure.

Keywords: corona, dolerite, geothermometer, metasomatism, metamorphic reaction texture, retrogression

Procedia PDF Downloads 251

Authors: Suikinai Nobre Santos, Ranko Gacesa, Paul F. Long, Itamar Soares de Melo

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Extremophilic microorganism are adapted to biotopes combining several stress factors (temperature, pressure, radiation, salinity and pH), which indicate the richness valuable resource for the exploitation of novel biotechnological processes and constitute unique models for investigations their biomolecules (1, 2). The above information encourages us investigate bioprospecting synthesized compounds by a noval actinomycete, designated thermotolerant Streptomyces caatingaensis CMAA 1322, isolated from sample soil tropical dry forest (Caatinga) in the Brazilian semiarid region (3-17°S and 35-45°W). This set of constrating physical and climatic factores provide the unique conditions and a diversity of well adapted species, interesting site for biotechnological purposes. Preliminary studies have shown the great potential in the production of cytotoxic, pesticidal and antimicrobial molecules (3). Thus, to extend knowledge of the genes clusters responsible for producing biosynthetic pathways of natural products in strain CMAA1322, whole-genome shotgun (WGS) DNA sequencing was performed using paired-end long sequencing with PacBio RS (Pacific Biosciences). Genomic DNA was extracted from a pure culture grown overnight on LB medium using the PureLink genomic DNA kit (Life Technologies). An approximately 3- to 20-kb-insert PacBio library was constructed and sequenced on an 8 single-molecule real-time (SMRT) cell, yielding 116,269 reads (average length, 7,446 bp), which were allocated into 18 contigs, with 142.11x coverage and N50 value of 20.548 bp (BioProject number PRJNA288757). The assembled data were analyzed by Rapid Annotations using Subsystems Technology (RAST) (4) the genome size was found to be 7.055.077 bp, comprising 6167 open reading frames (ORFs) and 413 subsystems. The G+C content was estimated to be 72 mol%. The closest-neighbors tool, available in RAST through functional comparison of the genome, revealed that strain CMAA1322 is more closely related to Streptomyces hygroscopicus ATCC 53653 (similarity score value, 537), S. violaceusniger Tu 4113 (score value, 483), S. avermitilis MA-4680 (score value, 475), S. albus J1074 (score value, 447). The Streptomyces sp. CMAA1322 genome contains 98 tRNA genes and 135 genes copies related to stress response, mainly osmotic stress (14), heat shock (16), oxidative stress (49). Functional annotation by antiSMASH version 3.0 (5) identified 41 clusters for secondary metabolites (including two clusters for lanthipeptides, ten clusters for nonribosomal peptide synthetases [NRPS], three clusters for siderophores, fourteen for polyketide synthetase [PKS], six clusters encoding a terpene, two clusters encoding a bacteriocin, and one cluster encoding a phenazine). Our work provide in comparative analyse of genome and extract produced (data no published) by lineage CMAA1322, revealing the potential of microorganisms accessed from extreme environments as Caatinga” to produce a wide range of biotechnological relevant compounds.

Keywords: caatinga, streptomyces, environmental stresses, biosynthetic pathways

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Authors: Hayden R Schott, John M Felder III

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Introduction: Chronic lower extremity wounds in the diabetic and vasculopathic populations are associated with a high degree of morbidity.When wounds require more extensive treatment than can be offered by wound care centers, more aggressive solutions involve local tissue transfer and microsurgical free tissue transfer for achieving definitive soft tissue coverage. These procedures of autologous tissue transfer (ATT) offer resilient, soft tissue coverage of limb-threatening wounds and confer promising limb salvage rates. However, chronic osteomyelitis and recalcitrant soft tissue infections are common in severe diabetic foot wounds and serve to significantly complicate ATT procedures. Stimulan is a resorbable calcium sulfate antibiotic carrier. The use of stimulan antibiotic beads to treat chronic osteomyelitis is well established in the orthopedic and plastic surgery literature. In these procedures, the beads are placed beneath the skin flap to directly deliver antibiotics to the infection site. The purpose of this study was to quantify the success of Stimulan antibiotic beads in treating recalcitrant infections in patients with diabetic foot wounds receiving ATT. Methods: A retrospective review of clinical and demographic information was performed on patients who underwent ATT with the placement of Stimulan antibiotic beads for attempted limb salvage from 2018-21. Patients were analyzed for preoperative wound characteristics, demographics, infection recurrence, and adverse outcomes as a result of product use. The primary endpoint was 90 day infection recurrence, with secondary endpoints including 90 day complications. Outcomes were compared using basic statistics and Fisher’s exact tests. Results: In this time span, 14 patients were identified. At the time of surgery, all patients exhibited clinical signs of active infection, including positive cultures and erythema. 57% of patients (n=8) exhibited chronic osteomyelitis prior to surgery, and 71% (n=10) had exposed bone at the wound base. In 57% of patients (n=8), Stimulan beads were placed beneath a free tissue flap and beneath a pedicle tissue flap in 42% of patients (n=6). In all patients, Stimulan beads were only applied once. Recurrent infections were observed in 28% of patients (n=4) at 90 days post-op, and flap nonadherence was observed in 7% (n=1). These were the only Stimulan related complications observed. Ultimately, lower limb salvage was successful in 85% of patients (n=12). Notably, there was no significant association between the preoperative presence of osteomyelitis and recurrent infections. Conclusions: The use of Stimulanantiobiotic beads to treat recalcitrant infections in patients receiving definitive skin coverage of diabetic foot wounds does not appear to demonstrate unnecessary risk. Furthermore, the lack of significance between the preoperative presence of osteomyelitis and recurrent infections indicates the successful use of Stimulan to dampen infection in patients with osteomyelitis, as is consistent with the literature. Further research is needed to identify Stimulan as the significant contributor to infection treatment using future cohort and case control studies with more patients. Nonetheless, the use of Stimulan antibiotic beads in patients with diabetic foot wounds demonstrates successful infection suppression and maintenance of definitive soft tissue coverage.

Keywords: wound care, stimulan antibiotic beads, free tissue transfer, plastic surgery, wound, infection

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Authors: A. Bentley, A. Prost, N. Daruwalla, D. Osrin

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Background: This study aims to investigate the relationship between experiences of violence against women in the family, and levels of self-esteem in women residing in informal settlement (slum) areas of Mumbai, India. The authors hypothesise that violence against women in Indian households extends beyond that of intimate partner violence (IPV), to include other members of the family and that experiences of violence are associated with lower levels of self-esteem. Methods: Experiences of violence were assessed through a cross-sectional survey of 598 women, including questions about specific acts of emotional, economic, physical and sexual violence across different time points, and the main perpetrator of each. Self-esteem was assessed using the Rosenberg self-esteem questionnaire. A global score for self-esteem was calculated and the relationship between violence in the past year and Rosenberg self-esteem score was assessed using multivariable linear regression models, adjusted for years of education completed, and clustering using robust standard errors. Results: 482 (81%) women consented to interview. On average, they were 28.5 years old, had completed 6 years of education and had been married 9.5 years. 88% were Muslim and 46% lived in joint families. 44% of women had experienced at least one act of violence in their lifetime (33% emotional, 22% economic, 24% physical, 12% sexual). Of the women who experienced violence after marriage, 70% cited a perpetrator other than the husband for at least one of the acts. 5% had low self-esteem (Rosenberg score < 15). For women who experienced emotional violence in the past year, the Rosenberg score was 2.6 points lower (p < 0.001). It was 1.2 points lower (p = 0.03) for women who experienced economic violence. For physical or sexual violence in the past year, no statistically significant relationship with Rosenberg score was seen. However, for a one-unit increase in the number of different acts of each type of violence experienced in the past year, a decrease in Rosenberg score was seen (-0.62 for emotional, -0.76 for economic, -0.53 for physical and -0.47 for sexual; p < 0.05 for all). Discussion: The high prevalence of violence experiences across the lifetime was likely due to the detailed assessment of violence and the inclusion of perpetrators within the family other than the husband. Experiences of emotional or economic violence in the past year were associated with lower Rosenberg scores and therefore lower self-esteem, but no relationship was seen between experiences of physical or sexual violence and Rosenberg score overall. For all types of violence in the past year, a greater number of different acts were associated with a decrease in Rosenberg score. Emotional violence showed the strongest relationship with self-esteem, but for all types of violence the more complex the pattern of perpetration with different methods used, the lower the levels of self-esteem. Due to the cross-sectional nature of the study causal directionality cannot be attributed. Further work to investigate the relationship between severity of violence and self-esteem and whether self-esteem mediates relationships between violence and poorer mental health would be beneficial.

Keywords: family violence, India, informal settlements, Rosenberg self-esteem scale, self-esteem, violence against women

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Authors: Ambika Roy Bardhan

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Kolkata, the City of Joy, is a greying metropolis not only in respect of its concrete jungle but also because of the largest population of 60-plus residents that it shelters among all other cities in India. Declining birth and death rates and a negative growth of population indicate that the city has reached the last stage of demographic transition. Thus, the obvious consequence has been the ageing of its population. With this background, the present paper attempts to study the demographic and socio-economic status of the elderly population in Kolkata. Analysis and findings have been based on secondary data obtained from Census of India of various years, Sample Registration System Reports and reports by HelpAge India. Findings show that the elderly population is increasing continuously. With respect to gender, the male elderly outnumbers the female elderly population. The percentage of households having one elderly member is more in the city due to the emergence of the nuclear families and erosion of joint family system. With respect to socio-economic status, those elderly who are the heads of the family are lower in percentages than those in the other age groups. Also, male elderly as head of the family are greater in percentage than female elderly. Elderly in the category of currently married records the highest percentage followed by widowed, never married and lastly, separated or divorced. Male elderly outnumber the female elderly as currently married, while female elderly outnumbers the male elderly in the category of widowed. In terms of living status, the percentage of elderly who are living alone is highest in Kolkata and the reason for staying alone as no support from children also happens to be highest in this city. The literacy rate and higher level of education is higher among the male than female elderly. Higher percentages of female elderly have been found to be with disability. Disability in movement and multiple disabilities have been found to be more common among the elderly population in Kolkata. Percentages of male literate pensioners are highest than other categories. Also, in terms of levels of education male elderly who are graduate and above other than technical degree are the highest receivers of pension. Also, in terms of working status, elderly as non-workers are higher in percentages with the population of elderly females outnumbering the males. The old age dependency ratio in the city is increasing continuously and the ratio is higher among females than male. Thus, it can be stated that Kolkata is witnessing continuous and rapid ageing of its population. Increasing dependency ratio is likely to create pressure on the working population, available civic, social and health amenities. This requires intervention in the form of planning, formulation and implementation of laws, policies, programs and measures to safeguard and improve the conditions of the elderly in Kolkata.

Keywords: demographic, elderly, population, socio-economic

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Authors: Yuan-Hao Lee, Chia-Wei Lee, Ming-Fang Lin, Tzu-Huei Wu, Chih-Hsiang Ko, Wing P. Chan

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Computed tomography (CT) scan of the head is a good method for investigating cranial lesions. However, radiation-induced oxidative stress can be accumulated in the eyes and promote carcinogenesis and cataract. In this regard, we aimed to protect the eyes with barium sulfate shield(s) during CT scans and investigate the resultant image quality and radiation dose to the eye. Patients who underwent health examinations were selectively enrolled in this study in compliance with the protocol approved by the Ethics Committee of the Joint Institutional Review Board at Taipei Medical University. Participants’ brains were scanned with a water-based marker simultaneously by a multislice CT scanner (SOMATON Definition Flash) under a fixed tube current-time setting or automatic tube current modulation (TCM). The lens dose was measured by Gafchromic films, whose dose response curve was previously fitted using thermoluminescent dosimeters, with or without barium sulfate or bismuth-antimony shield laid above. For the assessment of image quality CT images at slice planes that exhibit the interested regions on the zygomatic, orbital and nasal bones of the head phantom as well as the water-based marker were used for calculating the signal-to-noise and contrast-to-noise ratios. The application of barium sulfate and bismuth-antimony shields decreased 24% and 47% of the lens dose on average, respectively. Under topogram-based TCM, the dose saving power of bismuth-antimony shield was mitigated whereas that of barium sulfate shield was enhanced. On the other hand, the signal-to-noise and contrast-to-noise ratios of DSCT images were decreased separately by barium sulfate and bismuth-antimony shield, resulting in an overall reduction of the CNR. In contrast, the integration of topogram-based TCM elevated signal difference between the ROIs on the zygomatic bones and eyeballs while preferentially decreasing the signal-to-noise ratios upon the use of barium sulfate shield. The results of this study indicate that the balance between eye exposure and image quality can be optimized by combining eye shields with topogram-based TCM on the multislice scanner. Eye shielding could change the photon attenuation characteristics of tissues that are close to the shield. The application of both shields on eye protection hence is not recommended for seeking intraorbital lesions.

Keywords: computed tomography, barium sulfate shield, dose saving, image quality

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Authors: Steven W. Carruthers

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The purpose of the present research is to equate two test forms as part of a study to evaluate the educational effectiveness of the ARTé: Mecenas art history learning game. The researcher applied Item Response Theory (IRT) procedures to calculate item, test, and mean-sigma equating parameters. With the sample size n=134, test parameters indicated “good” model fit but low Test Information Functions and more acute than expected equating parameters. Therefore, the researcher applied equipercentile equating and linear equating to raw scores and compared the equated form parameters and effect sizes from each method. Item scaling in IRT enables the researcher to select a subset of well-discriminating items. The mean-sigma step produces a mean-slope adjustment from the anchor items, which was used to scale the score on the new form (Form R) to the reference form (Form Q) scale. In equipercentile equating, scores are adjusted to align the proportion of scores in each quintile segment. Linear equating produces a mean-slope adjustment, which was applied to all core items on the new form. The study followed a quasi-experimental design with purposeful sampling of students enrolled in a college level art history course (n=134) and counterbalancing design to distribute both forms on the pre- and posttests. The Experimental Group (n=82) was asked to play ARTé: Mecenas online and complete Level 4 of the game within a two-week period; 37 participants completed Level 4. Over the same period, the Control Group (n=52) did not play the game. The researcher examined between group differences from post-test scores on test Form Q and Form R by full-factorial Two-Way ANOVA. The raw score analysis indicated a 1.29% direct effect of form, which was statistically non-significant but may be practically significant. The researcher repeated the between group differences analysis with all three equating methods. For the IRT mean-sigma adjusted scores, form had a direct effect of 8.39%. Mean-sigma equating with a small sample may have resulted in inaccurate equating parameters. Equipercentile equating aligned test means and standard deviations, but resultant skewness and kurtosis worsened compared to raw score parameters. Form had a 3.18% direct effect. Linear equating produced the lowest Form effect, approaching 0%. Using linearly equated scores, the researcher conducted an ANCOVA to examine the effect size in terms of prior knowledge. The between group effect size for the Control Group versus Experimental Group participants who completed the game was 14.39% with a 4.77% effect size attributed to pre-test score. Playing and completing the game increased art history knowledge, and individuals with low prior knowledge tended to gain more from pre- to post test. Ultimately, researchers should approach test equating based on their theoretical stance on Classical Test Theory and IRT and the respective  assumptions. Regardless of the approach or method, test equating requires a representative sample of sufficient size. With small sample sizes, the application of a range of equating approaches can expose item and test features for review, inform interpretation, and identify paths for improving instruments for future study.

Keywords: effectiveness, equipercentile equating, IRT, learning games, linear equating, mean-sigma equating

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Authors: Smriti Rastogi, Narsingh Verma

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Background: A vast body of research exists on the use of oral hypoglycaemic drugs, insulin injections and the like in managing diabetes but no such research exists that has taken into consideration the parameter of time restricted meal intake and its positive effects in managing diabetes. The utility of this project is immense as it offers a solution to the woes of diabetics based on circadian rhythm and normal physiology of the human body. Method: 80 Diabetics, enrolled from the Out Patient Department of Endocrinology, KGMU (King George's Medical University) were randomly divided based on consent to early dinner TRM(time restricted meal) group or not (control group). Follow up was done at six months and 12 months for anthropometric measurement, height, weight, waist-hip ratio, neck size, fasting, postprandial blood sugar, HbA1c, serum urea, serum creatinine, and lipid profile. The patient was given a clear understanding of chronomedicine and how it affects their health. A single intervention was done - the timing of dinner was at or around 7 pm for TRM group. Result: 65% of TRM group and 40 %(non- TRM) had normal HbA1c after 12 months. HbA1c in TRM Group (first visit to second follow up) had a significant p value=0.017. A p value of <0.0001 was observed on comparing the values of blood sugar (fasting) in TRM Group from the first visit and second follow up. The values of blood sugar (postprandial) in TRM Group (first visit and second follow up) showed a p-value <0.0001 (highly significant). Values of the three parameters were non- significant in the control group. Hip size(First Visit to Second Follow Up) TRM Group showed a p-value = 0.0344 (Significant) (Difference between means=2.762 ± 1.261)Detailed results of the above parameters and a few newer ones will be presented at the conference. Conclusion: Time restricted meal intake in diabetics shows promise and is worth exploring further. Time Restricted Meal intake in Type 2 diabetics has a significant effect in controlling and maintaining HbA1c as the reduction in HbA1c value was very significant in the TRM group vs. the control group. Similar highly significant results were obtained in the case of fasting and postprandial values of blood sugar in the TRM group when compared to the control group. The effects of time restricted meal intake in diabetics show promise and are worth exploring further. It is one of the first studies which have been undertaken in Indian diabetics, although the initial data obtained is encouraging yet further research and study are required to corroborate results.

Keywords: chronomedicine, diabetes, endocrinology, time restricted meal intake

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Authors: Ingrid Van Der Heijden, Naeemah Abrahams, Jane Harries

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Background: Commonly, womanhood is defined as the qualities considered to be natural to or characteristic of a woman. However, womanhood is not a static concept; it is contextual and negotiable. For women with disabilities, gender roles or ‘qualities’ of womanhood are often overstated or contradicted because of assumptions of weakness, passivity, asexuality and infertility. Currently, little is known about how disability stigma intersects with notions of womanhood to make women with disabilities vulnerable to violence, or how women navigate this intersection to prevent or protect themselves from violence. Objective: To describe how the stigmatized constructions of womanhood and disability promote women with physical disabilities’ exposure to or protection from violence. Methods: Qualitative data for this paper comes from a doctoral study involving women with disabilities living in Cape Town, South Africa. It presents data from repeat in-depth interviews with 30 women with a range of physical impairments. Women attending protective workshops, rehabilitative centers and residential care facilities for people living with disabilities were invited to participate. Consent procedures and interviews were conducted by the first author (who is herself a woman living with a physical disability), and a female research assistant/translator who is a qualified occupational therapist. Reasonable accommodation is central to the methodology and the study as a whole. Findings: Descriptive and thematic analyses reveal how stigma and local constructions around womanhood, as well as women’s self-image and physical limitations, promotes women’s exposure to psychological, physical and sexual violence. It reveals how disabled women feel they are presumed incapable of living up to expectations of a ‘proper’ woman. This plays out as psychological violence, with women reporting that they feel ‘devalued,' ‘rejected’ and deprived of lasting intimate relationships. Furthermore, forms of psychological violence perpetuate physical and sexual violence. Women also discuss using strategies to prevent violence; by refusing to date, avoiding certain places or avoiding isolation, creating awareness, hiding their physical impairments, and exaggerating their ‘femininity.' Implications: Service providers need to be made aware of women’s violence experiences, and provide a range of accessible psychological and mental health services to women living with disabilities, as well as raising awareness around disability, and violence prevention, among caregivers, men, and women. Violence awareness and prevention interventions need to involve disability experts, researchers and people with disabilities.

Keywords: disability, gender, stigma, violence awareness and prevention interventions

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Authors: Brock Liden, Eric Janowitz

Abstract:

Introduction: Diabetic peripheral neuropathy (DPN) affects 70% of individuals with diabetes1. DPN causes a loss of protective sensation, which can lead to tissue damage and diabetic foot ulcer (DFU) formation2. These ulcers can result in infections and lower-extremity amputations of toes, the entire foot, and the lower leg. Even after a DFU is healed, recurrence is common, with 49% of DFU patients developing another ulcer within a year and 68% within 5 years3. This case series examines the use of sensory insoles and newly available plantar data (pressure, temperature, step count, adherence) and remote patient monitoring in patients at risk of DFU. Methods: Participants were provided with custom-made sensory insoles to monitor plantar pressure, temperature, step count, and daily use and were provided with real-time cues for pressure offloading as they went about their daily activities. The sensory insoles were used to track subject compliance, ulceration, and response to feedback from real-time alerts. Patients were remotely monitored by a qualified healthcare professional and were contacted when areas of concern were seen and provided coaching on reducing risk factors and overall support to improve foot health. Results: Of the 40 participants provided with the sensory insole system, 4 presented with a DFU. Based on flags generated from the available plantar data, patients were contacted by the remote monitor to address potential concerns. A standard clinical escalation protocol detailed when and how concerns should be escalated to the provider by the remote monitor. Upon escalation to the provider, patients were brought into the clinic as needed, allowing for any issues to be addressed before more serious complications might arise. Conclusion: This case series explores the use of innovative sensory technology to collect plantar data (pressure, temperature, step count, and adherence) for DFU detection and early intervention. The results from this case series suggest the importance of sensory technology and remote patient monitoring in providing proactive, preventative care for patients at risk of DFU. This robust plantar data, with the addition of remote patient monitoring, allow for patients to be seen in the clinic when concerns arise, giving providers the opportunity to intervene early and prevent more serious complications, such as wounds, from occurring.

Keywords: diabetic foot ulcer, DFU prevention, digital therapeutics, remote patient monitoring

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