Search results for: Coastal Vulnerability Index
240 Real-world Characterization of Treatment Intensified (Add-on to Metformin) Adults with Type 2 Diabetes in Pakistan: A Multi-center Retrospective Study (Converge)
Authors: Muhammad Qamar Masood, Syed Abbas Raza, Umar Yousaf Raja, Imran Hassan, Bilal Afzal, Muhammad Aleem Zahir, Atika Shaheer
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Background: Cardiovascular disease (CVD) is a major burden among people with type 2 diabetes (T2D) with 1 in 3 reported to have CVD. Therefore, understanding real-world clinical characteristics and prescribing patterns could help in better care. Objective: The CONVERGE (Cardiovascular Outcomes and Value in the Real world with GLP-1RAs) study characterized demographics and medication usage patterns in T2D intensified (add-on to metformin) overall population. The data were further divided into subgroups {dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), insulins, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is)}, according to the latest prescribed antidiabetic agent (ADA) in India/Pakistan/Thailand. Here, we report findings from Pakistan. Methods: A multi-center retrospective study utilized data from medical records between 13-Sep-2008 (post-market approval of GLP-1RAs) and 31-Dec-2017 in adults (≥18-year-old). The data for this study were collected from 05 centers / institutes located in major cities of Pakistan, including Karachi, Lahore, Islamabad, and Multan. These centers included National Hospital, Aga Khan University Hospital, Diabetes Endocrine Clinic Lahore, Shifa International Hospital, Mukhtar A Sheikh Hospital Multan. Data were collected at start of medical record and at 6 or 12-months prior to baseline based on variable type; analyzed descriptively. Results: Overall, 1,010 patients were eligible. At baseline, overall mean age (SD) was 51.6 (11.3) years, T2D duration was 2.4 (2.6) years, HbA1c was 8.3% (1.9) and 35% received ≥1CVD medications in the past 1-year (before baseline). Most frequently prescribed ADAs post-metformin were DPP-4is and SUs (~63%). Only 6.5% received GLP-1RAs and SGLT-2is were not available in Pakistan during the study period. Overall, it took a mean of 4.4 years and 5 years to initiate GLP-1RAs and SGLT-2is, respectively. In comparison to other subgroups, more patients from GLP-1RAs received ≥3 types of ADA (58%), ≥1 CVD medication (64%) and had higher body mass index (37kg/m2). Conclusions: Utilization of GLP-1RAs and SGLT-2is was low, took longer time to initiate and not before trying multiple ADAs. This may be due to lack of evidence for CV benefits for these agents during the study period. The planned phase 2 of the CONVERGE study can provide more insights into utilization and barriers to prescribe GLP-1RAs and SGLT-2is post 2018 in Pakistan.Keywords: type 2 diabetes, GLP-1RA, treatment intensification, cardiovascular disease
Procedia PDF Downloads 49239 Institutional and Economic Determinants of Foreign Direct Investment: Comparative Analysis of Three Clusters of Countries
Authors: Ismatilla Mardanov
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There are three types of countries, the first of which is willing to attract foreign direct investment (FDI) in enormous amounts and do whatever it takes to make this happen. Therefore, FDI pours into such countries. In the second cluster of countries, even if the country is suffering tremendously from the shortage of investments, the governments are hesitant to attract investments because they are at the hands of local oligarchs/cartels. Therefore, FDI inflows are moderate to low in such countries. The third type is countries whose companies prefer investing in the most efficient locations globally and are hesitant to invest in the homeland. Sorting countries into such clusters, the present study examines the essential institutions and economic factors that make these countries different. Past literature has discussed various determinants of FDI in all kinds of countries. However, it did not classify countries based on government motivation, institutional setup, and economic factors. A specific approach to each target country is vital for corporate foreign direct investment risk analysis and decisions. The research questions are 1. What specific institutional and economic factors paint the pictures of the three clusters; 2. What specific institutional and economic factors are determinants of FDI; 3. Which of the determinants are endogenous and exogenous variables? 4. How can institutions and economic and political variables impact corporate investment decisions Hypothesis 1: In the first type, country institutions and economic factors will be favorable for FDI. Hypothesis 2: In the second type, even if country economic factors favor FDI, institutions will not. Hypothesis 3: In the third type, even if country institutions favorFDI, economic factors will not favor domestic investments. Therefore, FDI outflows occur in large amounts. Methods: Data come from open sources of the World Bank, the Fraser Institute, the Heritage Foundation, and other reliable sources. The dependent variable is FDI inflows. The independent variables are institutions (economic and political freedom indices) and economic factors (natural, material, and labor resources, government consumption, infrastructure, minimum wage, education, unemployment, tax rates, consumer price index, inflation, and others), the endogeneity or exogeneity of which are tested in the instrumental variable estimation. Political rights and civil liberties are used as instrumental variables. Results indicate that in the first type, both country institutions and economic factors, specifically labor and logistics/infrastructure/energy intensity, are favorable for potential investors. In the second category of countries, the risk of loss of assets is very high due to governmentshijacked by local oligarchs/cartels/special interest groups. In the third category of countries, the local economic factors are unfavorable for domestic investment even if the institutions are well acceptable. Cluster analysis and instrumental variable estimation were used to reveal cause-effect patterns in each of the clusters.Keywords: foreign direct investment, economy, institutions, instrumental variable estimation
Procedia PDF Downloads 152238 Mirna Expression Profile is Different in Human Amniotic Mesenchymal Stem Cells Isolated from Obese Respect to Normal Weight Women
Authors: Carmela Nardelli, Laura Iaffaldano, Valentina Capobianco, Antonietta Tafuto, Maddalena Ferrigno, Angela Capone, Giuseppe Maria Maruotti, Maddalena Raia, Rosa Di Noto, Luigi Del Vecchio, Pasquale Martinelli, Lucio Pastore, Lucia Sacchetti
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Maternal obesity and nutrient excess in utero increase the risk of future metabolic diseases in the adult life. The mechanisms underlying this process are probably based on genetic, epigenetic alterations and changes in foetal nutrient supply. In mammals, the placenta is the main interface between foetus and mother, it regulates intrauterine development, modulates adaptive responses to sub optimal in uterus conditions and it is also an important source of human amniotic mesenchymal stem cells (hA-MSCs). We previously highlighted a specific microRNA (miRNA) profiling in amnion from obese (Ob) pregnant women, here we compared the miRNA expression profile of hA-MSCs isolated from (Ob) and control (Co) women, aimed to search for any alterations in metabolic pathways that could predispose the new-born to the obese phenotype. Methods: We isolated, at delivery, hA-MSCs from amnion of 16 Ob- and 7 Co-women with pre-pregnancy body mass index (mean/SEM) 40.3/1.8 and 22.4/1.0 kg/m2, respectively. hA-MSCs were phenotyped by flow cytometry. Globally, 384 miRNAs were evaluated by the TaqMan Array Human MicroRNA Panel v 1.0 (Applied Biosystems). By the TargetScan program we selected the target genes of the miRNAs differently expressed in Ob- vs Co-hA-MSCs; further, by KEGG database, we selected the statistical significant biological pathways. Results: The immunophenotype characterization confirmed the mesenchymal origin of the isolated hA-MSCs. A large percentage of the tested miRNAs, about 61.4% (232/378), was expressed in hA-MSCs, whereas 38.6% (146/378) was not. Most of the expressed miRNAs (89.2%, 207/232) did not differ between Ob- and Co-hA-MSCs and were not further investigated. Conversely, 4.8% of miRNAs (11/232) was higher and 6.0% (14/232) was lower in Ob- vs Co-hA-MSCs. Interestingly, 7/232 miRNAs were obesity-specific, being expressed only in hA-MSCs isolated from obese women. Bioinformatics showed that these miRNAs significantly regulated (P<0.001) genes belonging to several metabolic pathways, i.e. MAPK signalling, actin cytoskeleton, focal adhesion, axon guidance, insulin signaling, etc. Conclusions: Our preliminary data highlight an altered miRNA profile in Ob- vs Co-hA-MSCs and suggest that an epigenetic miRNA-based mechanism of gene regulation could affect pathways involved in placental growth and function, thereby potentially increasing the newborn’s risk of metabolic diseases in the adult life.Keywords: hA-MSCs, obesity, miRNA, biosystem
Procedia PDF Downloads 521237 Controllable Modification of Glass-Crystal Composites with Ion-Exchange Technique
Authors: Andrey A. Lipovskii, Alexey V. Redkov, Vyacheslav V. Rusan, Dmitry K. Tagantsev, Valentina V. Zhurikhina
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The presented research is related to the development of recently proposed technique of the formation of composite materials, like optical glass-ceramics, with predetermined structure and properties of the crystalline component. The technique is based on the control of the size and concentration of the crystalline grains using the phenomenon of glass-ceramics decrystallization (vitrification) induced by ion-exchange. This phenomenon was discovered and explained in the beginning of the 2000s, while related theoretical description was given in 2016 only. In general, the developed theory enables one to model the process and optimize the conditions of ion-exchange processing of glass-ceramics, which provide given properties of crystalline component, in particular, profile of the average size of the crystalline grains. The optimization is possible if one knows two dimensionless parameters of the theoretical model. One of them (β) is the value which is directly related to the solubility of crystalline component of the glass-ceramics in the glass matrix, and another (γ) is equal to the ratio of characteristic times of ion-exchange diffusion and crystalline grain dissolution. The presented study is dedicated to the development of experimental technique and simulation which allow determining these parameters. It is shown that these parameters can be deduced from the data on the space distributions of diffusant concentrations and average size of crystalline grains in the glass-ceramics samples subjected to ion-exchange treatment. Measurements at least at two temperatures and two processing times at each temperature are necessary. The composite material used was a silica-based glass-ceramics with crystalline grains of Li2OSiO2. Cubical samples of the glass-ceramics (6x6x6 mm3) underwent the ion exchange process in NaNO3 salt melt at 520 oC (for 16 and 48 h), 540 oC (for 8 and 24 h), 560 oC (for 4 and 12 h), and 580 oC (for 2 and 8 h). The ion exchange processing resulted in the glass-ceramics vitrification in the subsurface layers where ion-exchange diffusion took place. Slabs about 1 mm thick were cut from the central part of the samples and their big facets were polished. These slabs were used to find profiles of diffusant concentrations and average size of the crystalline grains. The concentration profiles were determined from refractive index profiles measured with Max-Zender interferometer, and profiles of the average size of the crystalline grains were determined with micro-Raman spectroscopy. Numerical simulation were based on the developed theoretical model of the glass-ceramics decrystallization induced by ion exchange. The simulation of the processes was carried out for different values of β and γ parameters under all above-mentioned ion exchange conditions. As a result, the temperature dependences of the parameters, which provided a reliable coincidence of the simulation and experimental data, were found. This ensured the adequate modeling of the process of the glass-ceramics decrystallization in 520-580 oC temperature interval. Developed approach provides a powerful tool for fine tuning of the glass-ceramics structure, namely, concentration and average size of crystalline grains.Keywords: diffusion, glass-ceramics, ion exchange, vitrification
Procedia PDF Downloads 264236 Understanding Feminization of Indian Agriculture and the Dynamics of Intrahousehold Bargaining Power at a Household Level
Authors: Arpit Sachan, Nilanshu Kumar
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This paper tries to understand the nuances of feminisation of agriculture in the Indian context and how that is associated with better intrahousehold bargaining power for women. The economic survey of India indicates a constant increase in the share of the female workforce in Indian agriculture in the past few decades. This can be accounted for by many factors like the migration of male workers to urban areas and, therefore, the complete burden of agriculture shifting on the female counterparts. Therefore this study is an attempt to study that how this increase in the female workforce corresponds to a better decision-making ability for women in rural farm households. This paper is an attempt to carefully evaluate this aspect of the feminisation of Indian agriculture. The paper tries to study how various factors that improve the status of women in agriculture change with things like resource ownership. This paper uses both the macro-level and micro-level data to study the dynamics of the proportion of the workforce in agriculture across different states in India and how that has translated into better indicators for women in rural areas. The fall in India’s rank in the global gender wage gap index is alarming in such a context, and this creates a puzzle with increasing female workforce participation. The paper will consider if the condition of women improved over time with the increased share of employment or not? Using field survey data, this paper tries to understand if there exists any digression for some of the indicators both at the macro and micro level. The paper also tries to integrate the economic understanding of gender aspects of the workforce and the sociological stance prevailing in the existing literature. Therefore, this paper takes a mixed-method approach to better understand the role that social structure plays in the improved status of women within and across various households. Therefore, this paper will finally help us understanding if at all there is a feminisation of Indian agriculture or it's just exploitation of a different kind. This study intends to create a distinction between the gendered labour force in Indian agriculture and the complete democratization of Indian agriculture. The study is primarily focused on areas where the exodus of male migrants pushes women to work on agricultural farms. The question posits is whether it is the willingness of women to work in agriculture or is it urbanisation and development-induced conditions that make women work in agriculture as farm labourers? The motive is to understand if factors like resource ownership and the ability to autonomous decision-making are interlinked with an increased proportion of the female workforce or not? Based on this framework, we finally provide a brief comment on policy implications of government intervention in improving Indian agriculture and the gender aspects associated with it.Keywords: feminisation, intrahousehold bargaining, farm households, migration, agriculture, decision-making
Procedia PDF Downloads 125235 The Cooperation among Insulin, Cortisol and Thyroid Hormones in Morbid Obese Children and Metabolic Syndrome
Authors: Orkide Donma, Mustafa M. Donma
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Obesity, a disease associated with a low-grade inflammation, is a risk factor for the development of metabolic syndrome (MetS). So far, MetS risk factors such as parameters related to glucose and lipid metabolisms as well as blood pressure were considered for the evaluation of this disease. There are still some ambiguities related to the characteristic features of MetS observed particularly in pediatric population. Hormonal imbalance is also important, and quite a lot information exists about the behaviour of some hormones in adults. However, the hormonal profiles in pediatric metabolism have not been cleared yet. The aim of this study is to investigate the profiles of cortisol, insulin, and thyroid hormones in children with MetS. The study population was composed of morbid obese (MO) children without (Group 1) and with (Group 2) MetS components. WHO BMI-for age and sex percentiles were used for the classification of obesity. The values above 99 percentile were defined as morbid obesity. Components of MetS (central obesity, glucose intolerance, high blood pressure, high triacylglycerol levels, low levels of high density lipoprotein cholesterol) were determined. Anthropometric measurements were performed. Ratios as well as obesity indices were calculated. Insulin, cortisol, thyroid stimulating hormone (TSH), free T3 and free T4 analyses were performed by electrochemiluminescence immunoassay. Data were evaluated by statistical package for social sciences program. p<0.05 was accepted as the degree for statistical significance. The mean ages±SD values of Group 1 and Group 2 were 9.9±3.1 years and 10.8±3.2 years, respectively. Body mass index (BMI) values were calculated as 27.4±5.9 kg/m2 and 30.6±8.1 kg/m2, successively. There were no statistically significant differences between the ages and BMI values of the groups. Insulin levels were statistically significantly increased in MetS in comparison with the levels measured in MO children. There was not any difference between MO children and those with MetS in terms of cortisol, T3, T4 and TSH. However, T4 levels were positively correlated with cortisol and negatively correlated with insulin. None of these correlations were observed in MO children. Cortisol levels in both MO as well as MetS group were significantly correlated. Cortisol, insulin, and thyroid hormones are essential for life. Cortisol, called the control system for hormones, orchestrates the performance of other key hormones. It seems to establish a connection between hormone imbalance and inflammation. During an inflammatory state, more cortisol is produced to fight inflammation. High cortisol levels prevent the conversion of the inactive form of the thyroid hormone T4 into active form T3. Insulin is reduced due to low thyroid hormone. T3, which is essential for blood sugar control- requires cortisol levels within the normal range. Positive association of T4 with cortisol and negative association of it with insulin are the indicators of such a delicate balance among these hormones also in children with MetS.Keywords: children, cortisol, insulin, metabolic syndrome, thyroid hormones
Procedia PDF Downloads 137234 Development and Characterization of Topical 5-Fluorouracil Solid Lipid Nanoparticles for the Effective Treatment of Non-Melanoma Skin Cancer
Authors: Sudhir Kumar, V. R. Sinha
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Background: The topical and systemic toxicity associated with present nonmelanoma skin cancer (NMSC) treatment therapy using 5-Fluorouracil (5-FU) make it necessary to develop a novel delivery system having lesser toxicity and better control over drug release. Solid lipid nanoparticles offer many advantages like: controlled and localized release of entrapped actives, nontoxicity, and better tolerance. Aim:-To investigate safety and efficacy of 5-FU loaded solid lipid nanoparticles as a topical delivery system for the treatment of nonmelanoma skin cancer. Method: Topical solid lipid nanoparticles of 5-FU were prepared using Compritol 888 ATO (Glyceryl behenate) as lipid component and pluronic F68 (Poloxamer 188), Tween 80 (Polysorbate 80), Tyloxapol (4-(1,1,3,3-Tetramethylbutyl) phenol polymer with formaldehyde and oxirane) as surfactants. The SLNs were prepared with emulsification method. Different formulation parameters viz. type and ratio of surfactant, ratio of lipid and ratio of surfactant:lipid were investigated on particle size and drug entrapment efficiency. Results: Characterization of SLNs like–Transmission Electron Microscopy (TEM), Differential Scannig calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), Particle size determination, Polydispersity index, Entrapment efficiency, Drug loading, ex vivo skin permeation and skin retention studies, skin irritation and histopathology studies were performed. TEM results showed that shape of SLNs was spherical with size range 200-500nm. Higher encapsulation efficiency was obtained for batches having higher concentration of surfactant and lipid. It was found maximum 64.3% for SLN-6 batch with size of 400.1±9.22 nm and PDI 0.221±0.031. Optimized SLN batches and marketed 5-FU cream were compared for flux across rat skin and skin drug retention. The lesser flux and higher skin retention was obtained for SLN formulation in comparison to topical 5-FU cream, which ensures less systemic toxicity and better control of drug release across skin. Chronic skin irritation studies lacks serious erythema or inflammation and histopathology studies showed no significant change in physiology of epidermal layers of rat skin. So, these studies suggest that the optimized SLN formulation is efficient then marketed cream and safer for long term NMSC treatment regimens. Conclusion: Topical and systemic toxicity associated with long-term use of 5-FU, in the treatment of NMSC, can be minimized with its controlled release with significant drug retention with minimal flux across skin. The study may provide a better alternate for effective NMSC treatment.Keywords: 5-FU, topical formulation, solid lipid nanoparticles, non melanoma skin cancer
Procedia PDF Downloads 507233 The Effect of Technology on Skin Development and Progress
Authors: Haidy Weliam Megaly Gouda
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Dermatology is often a neglected specialty in low-resource settings despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV-positive patients. African countries have the highest HIV infection rates, and skin conditions are frequently misdiagnosed and mismanaged because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve the diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV-positive patients. A literature search within Embassy, Medline and Google Scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff, a list of 15 skin conditions was included, and a booklet was created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.Keywords: prevalence and pattern of skin diseases, impact on quality of life, rural Nepal, interventions, quality switched ruby laser, skin color river blindness, clinical signs, circularity index, grey level run length matrix, grey level co-occurrence matrix, local binary pattern, object detection, ring detection, shape identification
Procedia PDF Downloads 47232 Structural Balance and Creative Tensions in New Product Development Teams
Authors: Shankaran Sitarama
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New Product Development involves team members coming together and working in teams to come up with innovative solutions to problems, resulting in new products. Thus, a core attribute of a successful NPD team is their creativity and innovation. They need to be creative as a group, generating a breadth of ideas and innovative solutions that solve or address the problem they are targeting and meet the user’s needs. They also need to be very efficient in their teamwork as they work through the various stages of the development of these ideas, resulting in a POC (proof-of-concept) implementation or a prototype of the product. There are two distinctive traits that the teams need to have, one is ideational creativity, and the other is effective and efficient teamworking. There are multiple types of tensions that each of these traits cause in the teams, and these tensions reflect in the team dynamics. Ideational conflicts arising out of debates and deliberations increase the collective knowledge and affect the team creativity positively. However, the same trait of challenging each other’s viewpoints might lead the team members to be disruptive, resulting in interpersonal tensions, which in turn lead to less than efficient teamwork. Teams that foster and effectively manage these creative tensions are successful, and teams that are not able to manage these tensions show poor team performance. In this paper, it explore these tensions as they result in the team communication social network and propose a Creative Tension Balance index along the lines of Degree of Balance in social networks that has the potential to highlight the successful (and unsuccessful) NPD teams. Team communication reflects the team dynamics among team members and is the data set for analysis. The emails between the members of the NPD teams are processed through a semantic analysis algorithm (LSA) to analyze the content of communication and a semantic similarity analysis to arrive at a social network graph that depicts the communication amongst team members based on the content of communication. This social network is subjected to traditional social network analysis methods to arrive at some established metrics and structural balance analysis metrics. Traditional structural balance is extended to include team interaction pattern metrics to arrive at a creative tension balance metric that effectively captures the creative tensions and tension balance in teams. This CTB (Creative Tension Balance) metric truly captures the signatures of successful and unsuccessful (dissonant) NPD teams. The dataset for this research study includes 23 NPD teams spread out over multiple semesters and computes this CTB metric and uses it to identify the most successful and unsuccessful teams by classifying these teams into low, high and medium performing teams. The results are correlated to the team reflections (for team dynamics and interaction patterns), the team self-evaluation feedback surveys (for teamwork metrics) and team performance through a comprehensive team grade (for high and low performing team signatures).Keywords: team dynamics, social network analysis, new product development teamwork, structural balance, NPD teams
Procedia PDF Downloads 68231 Evaluation Method for Fouling Risk Using Quartz Crystal Microbalance
Authors: Natsuki Kishizawa, Keiko Nakano, Hussam Organji, Amer Shaiban, Mohammad Albeirutty
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One of the most important tasks in operating desalination plants using a reverse osmosis (RO) method is preventing RO membrane fouling caused by foulants found in seawater. Optimal design of the pre-treatment process of RO process for plants enables the reduction of foulants. Therefore, a quantitative evaluation of the fouling risk in pre-treated water, which is fed to RO, is required for optimal design. Some measurement methods for water quality such as silt density index (SDI) and total organic carbon (TOC) have been conservatively applied for evaluations. However, these methods have not been effective in some situations for evaluating the fouling risk of RO feed water. Furthermore, stable management of plants will be possible by alerts and appropriate control of the pre-treatment process by using the method if it can be applied to the inline monitoring system for the fouling risk of RO feed water. The purpose of this study is to develop a method to evaluate the fouling risk of RO feed water. We applied a quartz crystal microbalance (QCM) to measure the amount of foulants found in seawater using a sensor whose surface is coated with polyamide thin film, which is the main material of a RO membrane. The increase of the weight of the sensor after a certain length of time in which the sample water passes indicates the fouling risk of the sample directly. We classified the values as “FP: Fouling Potential”. The characteristics of the method are to measure the very small amount of substances in seawater in a short time: < 2h, and from a small volume of the sample water: < 50mL. Using some RO cell filtration units, a higher correlation between the pressure increase given by RO fouling and the FP from the method than SDI and TOC was confirmed in the laboratory-scale test. Then, to establish the correlation in the actual bench-scale RO membrane module, and to confirm the feasibility of the monitoring system as a control tool for the pre-treatment process, we have started a long-term test at an experimental desalination site by the Red Sea in Jeddah, Kingdom of Saudi Arabia. Implementing inline equipment for the method made it possible to measure FP intermittently (4 times per day) and automatically. Moreover, for two 3-month long operations, the RO operation pressure among feed water samples of different qualities was compared. The pressure increase through a RO membrane module was observed at a high FP RO unit in which feed water was treated by a cartridge filter only. On the other hand, the pressure increase was not observed at a low FP RO unit in which feed water was treated by an ultra-filter during the operation. Therefore, the correlation in an actual scale RO membrane was established in two runs of two types of feed water. The result suggested that the FP method enables the evaluation of the fouling risk of RO feed water.Keywords: fouling, monitoring, QCM, water quality
Procedia PDF Downloads 205230 Domestic Trade, Misallocation and Relative Prices
Authors: Maria Amaia Iza Padilla, Ibai Ostolozaga
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The objective of this paper is to analyze how transportation costs between regions within a country can affect not only domestic trade but also the allocation of resources in a given region, aggregate productivity, and relative domestic prices (tradable versus non-tradable). On the one hand, there is a vast literature that analyzes the transportation costs faced by countries when trading with the rest of the world. However, this paper focuses on the effect of transportation costs on domestic trade. Countries differ in their domestic road infrastructure and transport quality. There is also some literature that focuses on the effect of road infrastructure on the price difference between regions but not on relative prices at the aggregate level. On the other hand, this work is also related to the literature on resource misallocation. Finally, the paper is also related to the literature analyzing the effect of trade on the development of the manufacturing sector. Using the World Bank Enterprise Survey database, it is observed cross-country differences in the proportion of firms that consider transportation as an obstacle. From the International Comparison Program, we obtain a significant negative correlation between GDP per worker and relative prices (manufacturing sector prices relative to the service sector). Furthermore, there is a significant negative correlation between a country’s transportation quality and the relative price of manufactured goods with respect to the price of services in that country. This is consistent with the empirical evidence of a negative correlation between transportation quality and GDP per worker, on the one hand, and the negative correlation between GDP per worker and domestic relative prices, on the other. It is also shown that in a country, the share of manufacturing firms whose main market is at the local (regional) level is negatively related to the quality of the transportation infrastructure within the country. Similarly, this index is positively related to the share of manufacturing firms whose main market is national or international. The data also shows that those countries with a higher proportion of manufacturing firms operating locally have higher relative prices. With this information in hand, the paper attempts to quantify the effects of the allocation of resources between and within sectors. The higher the trade barriers caused by transportation costs, the less efficient allocation, which causes lower aggregate productivity. Second, it is built a two-sector model where regions within a country trade with each other. On the one hand, it is found that with respect to the manufacturing sector, those countries with less trade between their regions will be characterized by a smaller variety of goods, less productive manufacturing firms on average, and higher relative prices for manufactured goods relative to service sector prices. Thus, the decline in the relative price of manufactured goods in more advanced countries could also be explained by the degree of trade between regions. This trade allows for efficient intra-industry allocation (traders are more productive, and resources are allocated more efficiently)).Keywords: misallocation, relative prices, TFP, transportation cost
Procedia PDF Downloads 78229 A Clinical Cutoff to Identify Metabolically Unhealthy Obese and Normal-Weight Phenotype in Young Adults
Authors: Lívia Pinheiro Carvalho, Luciana Di Thommazo-Luporini, Rafael Luís Luporini, José Carlos Bonjorno Junior, Renata Pedrolongo Basso Vanelli, Manoel Carneiro de Oliveira Junior, Rodolfo de Paula Vieira, Renata Trimer, Renata G. Mendes, Mylène Aubertin-Leheudre, Audrey Borghi-Silva
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Rationale: Cardiorespiratory fitness (CRF) and functional capacity in young obese and normal-weight people are associated with metabolic and cardiovascular diseases and mortality. However, it remains unclear whether their metabolically healthy (MH) or at risk (AR) phenotype influences cardiorespiratory fitness in this vulnerable population such as obese adults but also in normal-weight people. HOMA insulin resistance index (HI) and leptin-adiponectin ratio (LA) are strong markers for characterizing those phenotypes that we hypothesized to be associated with physical fitness. We also hypothesized that an easy and feasible exercise test could identify a subpopulation at risk to develop metabolic and related disorders. Methods: Thirty-nine sedentary men and women (20-45y; 18.5Keywords: aerobic capacity, exercise, fitness, metabolism, obesity, 6MST
Procedia PDF Downloads 339228 Degradation of the Cu-DOM Complex by Bacteria: A Way to Increase Phytoextraction of Copper in a Vineyard Soil
Authors: Justine Garraud, Hervé Capiaux, Cécile Le Guern, Pierre Gaudin, Clémentine Lapie, Samuel Chaffron, Erwan Delage, Thierry Lebeau
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The repeated use of Bordeaux mixture (copper sulphate) and other chemical forms of copper (Cu) has led to its accumulation in wine-growing soils for more than a century, to the point of modifying the ecosystem of these soils. Phytoextraction of copper could progressively reduce the Cu load in these soils, and even to recycle copper (e.g. as a micronutrient in animal nutrition) by cultivating the extracting plants in the inter-row of the vineyards. Soil cleaning up usually requires several years because the chemical speciation of Cu in solution is mainly based on forms complexed with dissolved organic matter (DOM) that are not phytoavailable, unlike the "free" forms (Cu2+). Indeed, more than 98% of Cu in the solution is bound to DOM. The selection and inoculation of invineyardsoils in vineyard soils ofbacteria(bioaugmentation) able to degrade Cu-DOM complexes could increase the phytoavailable pool of Cu2+ in the soil solution (in addition to bacteria which first mobilize Cu in solution from the soil bearing phases) in order to increase phytoextraction performance. In this study, sevenCu-accumulating plants potentially usable in inter-row were tested for their Cu phytoextraction capacity in hydroponics (ray-grass, brown mustard, buckwheat, hemp, sunflower, oats, and chicory). Also, a bacterial consortium was tested: Pseudomonas sp. previously studied for its ability to mobilize Cu through the pyoverdine siderophore (complexing agent) and potentially to degrade Cu-DOM complexes, and a second bacterium (to be selected) able to promote the survival of Pseudomonas sp. following its inoculation in soil. Interaction network method was used based on the notions of co-occurrence and, therefore, of bacterial abundance found in the same soils. Bacteria from the EcoVitiSol project (Alsace, France) were targeted. The final step consisted of incoupling the bacterial consortium with the chosen plant in soil pots. The degradation of Cu-DOMcomplexes is measured on the basis of the absorption index at 254nm, which gives insight on the aromaticity of the DOM. The“free” Cu in solution (from the mobilization of Cu and/or the degradation of Cu-MOD complexes) is assessed by measuring pCu. Eventually, Cu accumulation in plants is measured by ICP-AES. The selection of the plant is currently being finalized. The interaction network method targeted the best positive interactions ofFlavobacterium sp. with Pseudomonassp. These bacteria are both PGPR (plant growth promoting rhizobacteria) with the ability to improve the plant growth and to mobilize Cu from the soil bearing phases (siderophores). Also, these bacteria are known to degrade phenolic groups, which are highly present in DOM. They could therefore contribute to the degradation of DOM-Cu. The results of the upcoming bacteria-plant coupling tests in pots will be also presented.Keywords: complexes Cu-DOM, bioaugmentation, phytoavailability, phytoextraction
Procedia PDF Downloads 73227 Conditional Relation between Migration, Demographic Shift and Human Development in India
Authors: Rakesh Mishra, Rajni Singh, Mukunda Upadhyay
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Since the last few decades, the prima facie of development has shifted towards the working population in India. There has been a paradigm shift in the development approach with the realization that the present demographic dividend has to be harnessed for sustainable development. Rapid urbanization and improved socioeconomic characteristics experienced within its territory has catalyzed various forms of migration into it, resulting in massive transference of workforce between its states. Workforce in any country plays a very crucial role in deciding development of both the places, from where they have out-migrated and the place they are residing currently. In India, people are found to be migrating from relatively less developed states to a well urbanized and developed state for satisfying their neediness. Linking migration to HDI at place of destination, the regression coefficient (β ̂) shows affirmative association between them, because higher the HDI of the place would be, higher would be chance of earning and hence likeliness of the migrants would be more to choose that place as a new destination and vice versa. So the push factor is compromised by the cost of rearing and provides negative impulse on the in migrants letting down their numbers to metro cities or megacities of the states but increasing their mobility to the suburban areas and vice versa. The main objective of the study is to check the role of migration in deciding the dividend of the place of destination as well as people at the place of their usual residence with special focus to highly urban states in India. Idealized scenario of Indian migrants refers to some new theories in making. On analyzing the demographic dividend of the places we got to know that Uttar Pradesh provides maximum dividend to Maharashtra, West Bengal and Delhi, and the demographic divided of migrants are quite comparable to the native’s shares in the demographic dividend in these places. On analyzing the data from National Sample Survey 64th round and Census of India-2001, we have observed that for males in rural areas, the share of unemployed person declined by 9 percentage points (from 45% before migration to 36 % after migration) and for females in rural areas the decline was nearly 12 percentage points (from 79% before migration to 67% after migration. It has been observed that the shares of unemployed males in both rural and urban areas, which were significant before migration, got reduced after migration while the share of unemployed females in the rural as well as in the urban areas remained almost negligible both for before and after migration. So increase in the number of employed after migration provides an indication of changes in the associated cofactors like health and education of the place of destination and arithmetically to the place from where they have migrated out. This paper presents the evidence on the patterns of prevailing migration dynamics and corresponding demographic benefits in India and its states, examines trends and effects, and discusses plausible explanations.Keywords: migration, demographic shift, human development index, multilevel analysis
Procedia PDF Downloads 380226 The Comparison of Physical Fitness across Age and Gender in the Lithuanian Primary School Students: Population-Based Cross-Sectional Study
Authors: Arunas Emeljanovas, Brigita Mieziene, Vida Cesnaitiene, Ingunn Fjortoft, Lise Kjonniksen
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Background: Gender differences in physical fitness were tracked in many studies with lower effect in preschool children and increasing difference among genders across age. In Lithuania, on a population level, secular trends in physical fitness were regularly observed each ten years for the last two decades for 11-18 years old students. However, there is apparently a lack of such epidemiological studies among primary school students. Assessing and monitoring physical fitness from an early age is of particular importance seeking to develop and strengthen physical abilities of youths for future health benefits. The goal of the current study was to indicate age and gender differences in anthropometric measures, musculoskeletal, motor and cardiorespiratory fitness in Lithuanian primary school children. Methods: The study included 3456 1-4th grade students from 6 to 10 years. The data reliably represents the population of primary school children in Lithuania. Among them, 1721 (49.8 percent) were boys. Physical fitness was measured by the 9-item test battery, developed by Fjørtoft and colleagues (2011). Height and weight were measured and body mass index was calculated. Student t test evaluated differences in physical fitness between boys and girls, ANOVA was performed to indicate differences across age. Results: All anthropometric and fitness means that were identified as significantly different were better in boys than in girls and in older than younger students (p < .05). Among anthropometric measures, height was higher in boys aged 7 through 9 years. Weight and BMI differed among boys and girls only at 8 years old. Means of height and weight increased significantly across all ages. Among musculoskeletal fitness tests, means of standing broad jump, throwing a tennis ball and pushing a medicine ball were different between genders within each age group and across all ages. Differences between genders were less likely in motor fitness than in musculoskeletal or cardiorespiratory fitness. Differences in means of shuttle run 10 x 5 test between genders occurred at age 6, 9 and 10 years; running 20 m at age 6 and 9 years, and climbing wall bars at age 9 and 10. Means of Reduced Cooper test representing cardiorespiratory fitness were different between genders within each age group but did not differ among age 6 and 8 as well as 7 and 8 years in boys, and among age 7 and 8 years in girls. Conclusion: In general, the current study confirms gender differences in musculoskeletal, motor and cardiorespiratory fitness found in other studies across the world in primary school and older children. Observed gender differences might be explained by higher physical activity in boys rather than girls. As it is explained by previous literature, older boys and girls had better performances than younger ones, because of the components of fitness change as a function of growth, maturation, development, and interactions among the three processes.Keywords: primary school children, motor fitness, musculoskeletal fitness, cardiovascular fitness
Procedia PDF Downloads 199225 The Effect of Positional Release Technique versus Kinesio Tape on Iliocostalis lumborum in Back Myofascial Pain Syndrome
Authors: Shams Khaled Abdelrahman Abdallah Elbaz, Alaa Aldeen Abd Al Hakeem Balbaa
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Purpose: The purpose of this study was to compare the effects of Positional Release Technique versus Kinesio Tape on pain level, pressure pain threshold level and functional disability in patients with back myofascial pain syndrome at iliocostalis lumborum. Backgrounds/significance: Myofascial Pain Syndrome is a common muscular pain syndrome that arises from trigger points which are hyperirritable, painful and tender points within a taut band of skeletal muscle. In more recent literature, about 75% of patients with musculoskeletal pain presenting to a community medical centres suffer from myofascial pain syndrome.Iliocostalis lumborum are most likely to develop active trigger points. Subjects: Thirty patients diagnosed as back myofascial pain syndrome with active trigger points in iliocostalis lumborum muscle bilaterally had participated in this study. Methods and materials: Patients were randomly distributed into two groups. The first group consisted of 15 patients (8 males and 7 females) with mean age 30.6 (±3.08) years, they received positional release technique which was applied 3 times per session, 3/week every other day for 2 weeks. The second group consisted of 15 patients(5 males, 10 females) with a mean age 30.4 (±3.35) years, they received kinesio tape which was applied and changed every 3 days with one day off for a total 3 times in 2 weeks. Both techniques were applied over trigger points of the iliocostalis lumborum bilaterally. Patients were evaluated pretreatment and posttreatment program for Pain intensity (Visual analogue scale), pressure pain threshold (digital pressure algometry), and functional disability (The Oswestry Disability Index). Analyses: Repeated measures MANOVA was used to detect differences within and between groups pre and post treatment. Then the univariate ANOVA test was conducted for the analysis of each dependant variable within and between groups. All statistical analyses were done using SPSS. with significance level set at p<0.05 throughout all analyses. Results: The results revealed that there was no significant difference between positional release technique and kinesio tape technique on pain level, pressure pain threshold and functional activities (p > 0.05). Both groups of patients showed significant improvement in all the measured variables (p < 0.05) evident by significant reduction of both pain intensity and functional disability as well as significant increase of pressure pain threshold Conclusions : Both positional release technique and kinesio taping technique are effective in reducing pain level, improving pressure pain threshold and improving function in treating patients who suffering from back myofascial pain syndrome at iliocostalis lumborum. As there was no statistically significant difference was proven between both of them.Keywords: positional release technique, kinesio tape, myofascial pain syndrome, Iliocostalis lumborum
Procedia PDF Downloads 226224 The Coaching on Lifestyle Intervention (CooL): Preliminary Results and Implementation Process
Authors: Celeste E. van Rinsum, Sanne M. P. L. Gerards, Geert M. Rutten, Ien A. M. van de Goor, Stef P. J. Kremers
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Combined lifestyle interventions have shown to be effective in changing and maintaining behavioral lifestyle changes and reducing overweight and obesity. A lifestyle coach is expected to promote lifestyle changes in adults related to physical activity and diet. The present Coaching on Lifestyle (CooL) study examined participants’ physical activity level, dietary behavioral, and motivational changes immediately after the intervention and at 1.5 years after baseline. In CooL intervention a lifestyle coach coaches individuals from eighteen years and older with (a high risk of) obesity in group and individual sessions. In addition a process evaluation was conducted in order to examine the implementation process and to be able to interpret the changes within the participants. This action-oriented research has a pre-post design. Participants of the CooL intervention (N = 200) completed three questionnaires: at baseline, immediately after the intervention (on average after 44 weeks), and at 1.5 years after baseline. T-tests and linear regressions were conducted to test self-reported changes in physical activity (IPAQ), dietary behaviors, their quality of motivation for physical activity (BREQ-3) and for diet (REBS), body mass index (BMI), and quality of life (EQ-5D-3L). For the process evaluation, we used individual and group interviews, observations and document analyses to gain insight in the implementation process (e.g. the recruitment) and how the intervention was valued by the participants, lifestyle coaches, and referrers. The study is currently ongoing and therefore the results presented here are preliminary. On average, the participants that finished the intervention and those that have completed the long-term measurement improved their level of vigorous-intense physical activity, sedentary behavior, sugar-sweetened beverage consumption and BMI. Mixed results were observed in motivational regulation for physical activity and nutrition. Moreover, an improvement on the quality of life dimension anxiety/depression was found, also in the long-term. All the other constructs did not show significant change over time. The results of the process evaluation have shown that recruitment of clients was difficult. Participants evaluated the intervention positively and the lifestyle coaches have continuously adapted the structure and contents of the intervention throughout the study period, based on their experiences and feedback from research. Preliminary results indicate that the CooL-intervention may have beneficial effects on overweight and obese participants in terms of energy balance-related behaviors, weight reduction, and quality of life. Recruitment of participants and embedding the position of the lifestyle coach in traditional care structures is challenging.Keywords: combined lifestyle intervention, effect evaluation, lifestyle coaching, process evaluation, overweight, the Netherlands
Procedia PDF Downloads 224223 Cobalamin, Folate and Metabolic Syndrome Parameters in Pediatric Morbid Obesity and Metabolic Syndrome
Authors: Mustafa M. Donma, Orkide Donma
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Obesity is known to be associated with many clinically important diseases including metabolic syndrome (MetS). Vitamin B12 plays essential roles in fat and protein metabolisms and its cooperation with vitamin B9 is well-known. The aim of this study is to investigate the possible contributions as well as associations of these micronutrients upon obesity and MetS during childhood. A total of 128 children admitted to Namik Kemal University, Medical Faculty, Department of Pediatrics Outpatient Clinics were included into the scope of this study. The mean age±SEM of 92 morbid obese (MO) children and 36 with MetS were 118.3±3.8 months and 129.5±6.4 months, respectively (p > 0.05). The study was approved by Namık Kemal University, Medical Faculty Ethics Committee. Written informed consent forms were obtained from the parents. Demographic features and anthropometric measurements were recorded. WHO BMI-for age percentiles were used. The values above 99 percentile were defined as MO. Components of MetS [waist circumference (WC), fasting blood glucose (FBG), triacylglycerol (TRG), high density lipoprotein cholesterol (HDL-Chol), systolic pressure (SP), diastolic pressure (DP)] were determined. Routine laboratory tests were performed. Serum vitamin B12 concentrations were measured using electrochemiluminescence immunoassay. Vitamin B9 was analyzed by an immunoassay analyzer. Values for vitamin B12 < 148 pmol/L, 148-221 pmol/L, > 221 pmol/L were accepted as low, borderline and normal, respectively. Vitamin B9 levels ≤ 4 mcg/L defined deficiency state. Statistical evaluations were performed by SPSSx Version 16.0. p≤0.05 was accepted as statistical significance level. Statistically higher body mass index (BMI), WC, hip circumference (C) and neck C were calculated in MetS group compared to children with MO. No difference was noted for head C. All MetS components differed between the groups (SP, DP p < 0.001; WC, FBG, TRG p < 0.01; HDL-Chol p < 0.05). Significantly decreased vitamin B9 and vitamin B12 levels were detected (p < 0.05) in children with MetS. In both groups percentage of folate deficiency was 5.5%. No cases were below < 148 pmol/L. However, in MO group 14.3% and in MetS group 22.2% of the cases were of borderline status. In MO group B12 levels were negatively correlated with BMI, WC, hip C and head C, but not with neck C. WC, hip C, head C and neck C were all negatively correlated with HDL-Chol. None of these correlations were observed in the group of children with MetS. Strong positive correlation between FBG and insulin as well as strong negative correlation between TRG and HDL-Chol detected in MO children were lost in MetS group. Deficiency state end-products of both B9 and B12 may interfere with the expected profiles of MetS components. In this study, the alterations in MetS components affected vitamin B12 metabolism and also its associations with anthropometric body measurements. Further increases in vitamin B12 and vitamin B9 deficiency in MetS associated with the increased vitamin B12 as well as vitamin B9 deficiency metabolites may add to MetS parameters.Keywords: children, cobalamin, folate, metabolic syndrome, obesity
Procedia PDF Downloads 180222 Pattern of Deliberate Self-Harm Repetition in Rural Sri Lanka
Authors: P. H. G. J. Pushpakumara, Andrew Dawson
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Introduction: Deliberate self harm (DSH) is a major public health problem globally. Suicide rates of Sri Lanka are being among the highest national rates in the world, since 1950. Previous DSH is the most important independent predictor of repetition. The estimated 1 year non-fatal repeat self-harm rate was 16.3%. Asian countries had considerably lower rate, 10.0%. Objectives: To calculate incidence of deliberate self-poisoning (DSP) and suicides, repetition rate of DSP in Kurunegala District (KD). To determine the pattern of repeated DSP in KD. Methods: Study had two components. In the first component, demographic and event related details of, DSP admission in 46 hospitals and suicides in 28 police stations of KD were collected for 3 years from January 2011. Demographic details of cohort of DSP patients admitted to above hospitals in 2011 were linked with hospital admissions and police records of next two years period from the index admission. Records were screened for links with high sensitivity using the computer then did manual matching which would have been much more specific. In the second component, randomly selected DSP patients (n=438), who admitted to main referral centre which receives 60% of DSP cases of the district, were interviewed to assess life-time repetition. Results: There were 16,993 DSP admissions and 1078 suicides for the three year period. Suicide incidences in KD were, 21.6, 20.7 and 24.3 per 100,000 population in 2011, 2012 and 2013. Average male to female ratio for suicide incidences was 5.5. DSP incidences were 205.4, 248.3 and 202.5 per 100,000 population. Male incidences were slightly greater than the female incidences, male: female ratio was 1.1:1. Highest age standardized male and female incidence was reported in 20-24 years age group, 769.6/100,000, and 15-19 years age group 1304.0/100,000. Male to female ratio of the incidence increased with the age. There were 318 (179 male and 139 female) patients attempted DSH within two years. Female repetitive patients were ounger compared to the males, p < 0.0001, median age: males 28 and females 19 years. 290 (91.2%) had only one repetitive attempt, 24 (7.5%) had two, 3 (0.9%) had three and one (0.3%) had four in that period. One year repetition rate was 5.6 and two year repetition rate was 7.9%. Average intervals between indexed events and first repetitive DSP events were 246.8 (SD:223.4) and 238.5 (SD:207.0) days among males and females. One fifth of first repetitive events occurred within first two weeks in both males and females. Around 50% of males and females had the second event within 28 weeks. Within the first year of the indexed event, around 70% had the second event. First repetitive event was fatal for 28 (8.8%) individuals. Ages of those who died, mean 49.7 years (SD:15.3), were significantly higher compared to those who had non-fatal outcome, p<0.0001. 9.5% had life time history of DSH attempts. Conclusions: Both, DSP and suicide incidences were very high in KD. However, repetition rates were lesser compared regional values. Prevention of repetition alone may not produce significant impact on prevention of DSH.Keywords: deliberate self-harm, incidence, repetition, Sri Lanka, suicide
Procedia PDF Downloads 210221 Effects of Long-Term Exposure of Cadmium to the Ovary of Lithobius forficatus (Myriapoda, Chilopoda)
Authors: Izabela Poprawa, Alina Chachulska-Zymelka, Lukasz Chajec, Grazyna Wilczek, Piotr Wilczek, Sebastian Student, Magdalena Rost-Roszkowska
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Heavy metals polluting the environment, especially soil, have a harmful effect on organisms, because they can damage the organ structure, disturb their function and cause developmental disorders. They can affect not only the somatic tissues but also the germinal tissues. In the natural environment, plants and animals are exposed to short- and long-term exposure to these stressors, which have a major influence on the functioning of these organisms. Numerous animals have been treated as the bioindicators of the environment. Therefore, studies on any alterations caused by, e.g., heavy metals are in the center of interests of not only environmental but also medical and biological science. Myriapods are invertebrates which are bioindicators of the environment. One of the species which lives in the upper layers of soil, particularly under stones and rocks is Lithobius forficatus (Chilopoda), commonly known as the brown centipede or stone centipede. It is a European species of the family Lithobiidae. This centipede living in the soil is exposed to, e.g., heavy metals such as cadmium, lead, arsenic. The main goal of our project was to analyze the impact of long-term exposure to cadmium on the structure of ovary with the emphasis on the course of oogenesis. As the material for analysis of cadmium exposure to ovaries, we chose the centipede species, L. forficatus. Animals were divided into two experimental groups: C – the control group, the animals cultured in laboratory conditions in a horticultural soil; Cd2 – the animals cultured in a horticultural soil supplemented with 80 mg/kg (dry weight) of CdCl2 for 45 days – long-term exposure. Animals were fed with Acheta and Chironomus larvae maintained in tap water. The analyzes were carried out using transmission electron microscopy (TEM), flow cytometry and laser scanning (confocal) microscopy. Here we present the results of long-term exposure to cadmium concentration in soil on the organ responsible for female germ cell formation. Analysis with the use of the transmission electron microscope showed changes in the ultrastructure of both somatic and germ cells in the ovary. Moreover, quantitative analysis revealed the decrease in the percentage of cells viability, the increase in the percentage of cells with depolarized mitochondria and increasing the number of early apoptotic cells. All these changes were statistically significant compared to the control. Additionally, an increase in the ADP/ATP index was recorded. However, changes were not statistically significant to the control. Acknowledgment: The study has been financed by the National Science Centre, Poland, grant no 2017/25/B/NZ4/00420.Keywords: cadmium, centipede, ovary, ultrastructure
Procedia PDF Downloads 106220 The Impact of the Global Financial Crisis on the Performance of Czech Industrial Enterprises
Authors: Maria Reznakova, Michala Strnadova, Lukas Reznak
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The global financial crisis that erupted in 2008 is associated mainly with the debt crisis. It quickly spread globally through financial markets, international banks and trade links, and affected many economic sectors. Measured by the index of the year-on-year change in GDP and industrial production, the consequences of the global financial crisis manifested themselves with some delay also in the Czech economy. This can be considered a result of the overwhelming export orientation of Czech industrial enterprises. These events offer an important opportunity to study how financial and macroeconomic instability affects corporate performance. Corporate performance factors have long been given considerable attention. It is therefore reasonable to ask whether the findings published in the past are also valid in the times of economic instability and subsequent recession. The decisive factor in effective corporate performance measurement is the existence of an appropriate system of indicators that are able to assess progress in achieving corporate goals. Performance measures may be based on non-financial as well as on financial information. In this paper, financial indicators are used in combination with other characteristics, such as the firm size and ownership structure. Financial performance is evaluated based on traditional performance indicators, namely, return on equity and return on assets, supplemented with indebtedness and current liquidity indices. As investments are a very important factor in corporate performance, their trends and importance were also investigated by looking at the ratio of investments to previous year’s sales and the rate of reinvested earnings. In addition to traditional financial performance indicators, the Economic Value Added was also used. Data used in the research were obtained from a questionnaire survey administered in industrial enterprises in the Czech Republic and from AMADEUS (Analyse Major Database from European Sources), from which accounting data of companies were obtained. Respondents were members of the companies’ senior management. Research results unequivocally confirmed that corporate performance dropped significantly in the 2010-2012 period, which can be considered a result of the global financial crisis and a subsequent economic recession. It was reflected mainly in the decreasing values of profitability indicators and the Economic Value Added. Although the total year-on-year indebtedness declined, intercompany indebtedness increased. This can be considered a result of impeded access of companies to bank loans due to the credit crunch. Comparison of the results obtained with the conclusions of previous research on a similar topic showed that the assumption that firms under foreign control achieved higher performance during the period investigated was not confirmed.Keywords: corporate performance, foreign control, intercompany indebtedness, ratio of investment
Procedia PDF Downloads 322219 Pakistan Nuclear Security: Threats from Non-State Actors
Authors: Jennifer Wright
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The recent rise of powerful terrorist groups such as ISIS and Al-Qaeda brings up concerns about nuclear terrorism as well as a focus on nuclear security, specifically the physical security of nuclear weapons and fissile material storage sites in countries where powerful nonstate actors are present. Particularly because these non-state actors, who lack their own sovereign territory, cannot be ‘deterred’ in the traditional sense. In light of the current threat environment, it’s necessary to now rethink these strategies in the 21st century – a multipolar world with the presence of powerful non-state actors. As a country in the spotlight for its low ranking on the Nuclear Threat Initiative’s (NTI) Nuclear Security Index, Pakistan is a relevant example to explore the question of whether the presence of non-state actors poses a real risk to nuclear security today. It’s necessary to take a look at their nuclear security policies to determine if they’re robust enough to deal with political instability and violence in the country. After carrying out interviews with experts in May 2017 in Islamabad on nuclear security and nuclear terrorism, this paper aims to highlight findings by providing a Pakistan-centric view on the subject and give experts there a chance to counter criticism. Western media would have us fearful of nuclear security mechanisms in Pakistan after reports that areas such as cybersecurity and accounting and control of materials are weak, as well as sensitive nuclear material being transported in unmarked, unguarded vehicles. Also reported are cases where terrorist groups carried out targeted attacks against Pakistani military bases or secure sites where nuclear material is stored. One specific question asked of each interviewee in Islamabad was Do you feel the threat of nuclear terrorism calls into question the reliance on deterrence? Their responses will be elaborated on in the longer paper, but overall they demonstrate views that deterrence still serves a purpose for state-to-state security strategy, but not for a state in countering nonstate threats. If nuclear security is lax enough for these non-state actors to get their hands on either an intact nuclear weapon or enough military-grade fissile material to build a nuclear weapon, then what would stop them from launching a nuclear attack? As deterrence is a state-centric strategy, it doesn’t work to deter non-state actors from carrying out an attack on another state, as they lack their own territory, and as such, are not fearful of a reprisal attack. Deterrence will need to be addressed, and its relevance analyzed to determine its utility in the current security environment. The aim of this research is to demonstrate the real risk of nuclear terrorism by pointing to weaknesses in global nuclear security, particularly in Pakistan. The research also aims to provoke thought on the weaknesses of deterrence as a whole. Original thinking is needed as we attempt to adequately respond to the 21st century’s current threat environment.Keywords: deterrence, non-proliferation, nuclear security, nuclear terrorism
Procedia PDF Downloads 215218 Numerical Simulation of the Heat Transfer Process in a Double Pipe Heat Exchanger
Authors: J. I. Corcoles, J. D. Moya-Rico, A. Molina, J. F. Belmonte, J. A. Almendros-Ibanez
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One of the most common heat exchangers technology in engineering processes is the use of double-pipe heat exchangers (DPHx), mainly in the food industry. To improve the heat transfer performance, several passive geometrical devices can be used, such as the wall corrugation of tubes, which increases the wet perimeter maintaining a constant cross-section area, increasing consequently the convective surface area. It contributes to enhance heat transfer in forced convection, promoting secondary recirculating flows. One of the most extended tools to analyse heat exchangers' efficiency is the use of computational fluid dynamic techniques (CFD), a complementary activity to the experimental studies as well as a previous step for the design of heat exchangers. In this study, a double pipe heat exchanger behaviour with two different inner tubes, smooth and spirally corrugated tube, have been analysed. Hence, experimental analysis and steady 3-D numerical simulations using the commercial code ANSYS Workbench v. 17.0 are carried out to analyse the influence of geometrical parameters for spirally corrugated tubes at turbulent flow. To validate the numerical results, an experimental setup has been used. To heat up or cool down the cold fluid as it passes through the heat exchanger, the installation includes heating and cooling loops served by an electric boiler with a heating capacity of 72 kW and a chiller, with a cooling capacity of 48 kW. Two tests have been carried out for the smooth tube and for the corrugated one. In all the tests, the hot fluid has a constant flowrate of 50 l/min and inlet temperature of 59.5°C. For the cold fluid, the flowrate range from 25 l/min (Test 1) and 30 l/min (Test 2) with an inlet temperature of 22.1°C. The heat exchanger is made of stainless steel, with an external diameter of 35 mm and wall thickness of 1.5 mm. Both inner tubes have an external diameter of 24 mm and 1 mm thickness of stainless steel with a length of 2.8 m. The corrugated tube has a corrugation height (H) of 1.1 mm and helical pitch (P) of 25 mm. It is characterized using three non-dimensional parameters, the ratio of the corrugation shape and the diameter (H/D), the helical pitch (P/D) and the severity index (SI = H²/P x D). The results showed good agreement between the numerical and the experimental results. Hence, the lowest differences were shown for the fluid temperatures. In all the analysed tests and for both analysed tubes, the temperature obtained numerically was slightly higher than the experimental results, with values ranged between 0.1% and 0.7%. Regarding the pressure drop, the maximum differences between the values obtained numerically, and the experimental values were close to 16%. Based on the experimental and the numerical results, for the corrugated tube, it can be highlighted that the temperature difference between the inlet and the outlet of the cold fluid is 42%, higher than the smooth tube.Keywords: corrugated tube, heat exchanger, heat transfer, numerical simulation
Procedia PDF Downloads 136217 Spatial Heterogeneity of Urban Land Use in the Yangtze River Economic Belt Based on DMSP/OLS Data
Authors: Liang Zhou, Qinke Sun
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Taking the Yangtze River Economic Belt as an example, using long-term nighttime lighting data from DMSP/OLS from 1992 to 2012, support vector machine classification (SVM) was used to quantitatively extract urban built-up areas of economic belts, and spatial analysis of expansion intensity index, standard deviation ellipse, etc. was introduced. The model conducts detailed and in-depth discussions on the strength, direction, and type of the expansion of the middle and lower reaches of the economic belt and the key node cities. The results show that: (1) From 1992 to 2012, the built-up areas of the major cities in the Yangtze River Valley showed a rapid expansion trend. The built-up area expanded by 60,392 km², and the average annual expansion rate was 31%, that is, from 9615 km² in 1992 to 70007 km² in 2012. The spatial gradient analysis of the watershed shows that the expansion of urban built-up areas in the middle and lower reaches of the river basin takes Shanghai as the leading force, and the 'bottom-up' model shows an expanding pattern of 'upstream-downstream-middle-range' declines. The average annual rate of expansion is 36% and 35%, respectively. 17% of which the midstream expansion rate is about 50% of the upstream and downstream. (2) The analysis of expansion intensity shows that the urban expansion intensity in the Yangtze River Basin has generally shown an upward trend, the downstream region has continued to rise, and the upper and middle reaches have experienced different amplitude fluctuations. To further analyze the strength of urban expansion at key nodes, Chengdu, Chongqing, and Wuhan in the upper and middle reaches maintain a high degree of consistency with the intensity of regional expansion. Node cities with Shanghai as the core downstream continue to maintain a high level of expansion. (3) The standard deviation ellipse analysis shows that the overall center of gravity of the Yangtze River basin city is located in Anqing City, Anhui Province, and it showed a phenomenon of reciprocating movement from 1992 to 2012. The nighttime standard deviation ellipse distribution range increased from 61.96 km² to 76.52 km². The growth of the major axis of the ellipse was significantly larger than that of the minor axis. It had obvious east-west axiality, in which the nighttime lights in the downstream area occupied in the entire luminosity scale urban system leading position.Keywords: urban space, support vector machine, spatial characteristics, night lights, Yangtze River Economic Belt
Procedia PDF Downloads 109216 The Effect of Mindfulness Meditation on Pain, Sleep Quality, and Self-Esteem in Patients Receiving Hemodialysis in Jordan
Authors: Hossam N. Alhawatmeh, Areen I. Albustanji
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Hemodialysis negatively affects physical and psychological health. Pain, poor sleep quality, and low self-esteem are highly prevalent among patients with end-stage renal disease (ESRD) who receive hemodialysis, significantly increasing mortality and morbidity of those patients. Mind-body interventions (MBI), such as mindfulness meditation, have been recently gaining popularity that improved pain, sleep quality, and self-esteem in different populations. However, to our best knowledge, its effects on these health problems in patients receiving hemodialysis have not been studied in Jordan. Thus, the purpose of the study was to examine the effect of mindfulness meditation on pain, sleep quality, and self-esteem in patients with ESR receiving hemodialysis in Jordan. An experimental repeated-measures, randomized, parallel control design was conducted on (n =60) end-stage renal disease patients undergoing hemodialysis between March and June 2023 in the dialysis center at a public hospital in Jordan. Participants were randomly assigned to the experimental (n =30) and control groups (n =30) using a simple random assignment method. The experimental group practiced mindfulness meditation for 30 minutes three times per week for five weeks during their hemodialysis treatments. The control group's patients continued to receive hemodialysis treatment as usual for five weeks during hemodialysis sessions. The study variables for both groups were measured at baseline (Time 0), two weeks after intervention (Time 1), and at the end of intervention (Time 3). The numerical rating scale (NRS), the Rosenberg Self-Esteem Scale (RSES-M), and the Pittsburgh Sleep Quality Index (PSQI) were used to measure pain, self-esteem, and sleep quality, respectively. SPSS version 25 was used to analyze the study data. The sample was described by frequency, mean, and standard deviation as an appropriate. The repeated measures analysis of variance (ANOVA) tests were run to test the study hypotheses. The results of repeated measures ANOVA (within-subject) revealed that mindfulness meditation significantly decrease pain by the end of the intervention in the experimental group. Additionally, mindfulness meditation improved sleep quality and self-esteem in the experimental group, and these improvements occurred significantly after two weeks of the intervention and at the end of the intervention. The results of repeated measures ANOVA (within and between-subject) revealed that the experimental group, compared to the control group, experienced lower levels of pain and higher levels of sleep quality and self-esteem over time. In conclusion, the results provided substantial evidence supporting the positive impacts of mindfulness meditation on pain, sleep quality, and self-esteem in patients with ESRD undergoing hemodialysis. These results highlight the potential of mindfulness meditation as an adjunctive therapy in the comprehensive care of this patient population. Incorporating mindfulness meditation into the treatment plan for patients receiving hemodialysis may contribute to improved well-being and overall quality of life.Keywords: hemodialysis, pain, sleep quality, self-esteem, mindfulness
Procedia PDF Downloads 75215 Roads and Agriculture: Impacts of Connectivity in Peru
Authors: Julio Aguirre, Yohnny Campana, Elmer Guerrero, Daniel De La Torre Ugarte
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A well-developed transportation network is a necessary condition for a country to derive full benefits from good trade and macroeconomic policies. Road infrastructure plays a key role in the economic development of rural areas of developing countries; where agriculture is the main economic activity. The ability to move agricultural production from the place of production to the market, and then to the place of consumption, greatly influence the economic value of farming activities, and of the resources involved in the production process, i.e., labor and land. Consequently, investment in transportation networks contributes to enhance or overcome the natural advantages or disadvantages that topography and location have imposed over the agricultural sector. This is of particular importance when dealing with countries, like Peru, with a great topographic diversity. The objective of this research is to estimate the impacts of road infrastructure on the performance of the agricultural sector. Specific variables of interest are changes in travel time, shifts of production for self-consumption to production for the market, changes in farmers income, and impacts on the diversification of the agricultural sector. In the study, a cross-section model with instrumental variables is the central methodological instrument. The data is obtained from agricultural and transport geo-referenced databases, and the instrumental variable specification utilized is based on the Kruskal algorithm. The results show that the expansion of road connectivity reduced farmers' travel time by an average of 3.1 hours and the proportion of output sold in the market increases by up to 40 percentage points. The increase in connectivity has an unexpected increase in the districts index of diversification of agricultural production. The results are robust to the inclusion of year and region fixed-effects, and to control for geography (i.e., slope and altitude), population variables, and mining activity. Other results are also very eloquent. For example, a clear positive impact can be seen in access to local markets, but this does not necessarily correlate with an increase in the production of the sector. This can be explained by the fact that agricultural development not only requires provision of roads but additional complementary infrastructure and investments intended to provide the necessary conditions so that producers can offer quality products (improved management practices, timely maintenance of irrigation infrastructure, transparent management of water rights, among other factors). Therefore, complementary public goods are needed to enhance the effects of roads on the welfare of the population, beyond enabling them to increase their access to markets.Keywords: agriculture devolepment, market access, road connectivity, regional development
Procedia PDF Downloads 194214 Development of Method for Detecting Low Concentration of Organophosphate Pesticides in Vegetables Using near Infrared Spectroscopy
Authors: Atchara Sankom, Warapa Mahakarnchanakul, Ronnarit Rittiron, Tanaboon Sajjaanantakul, Thammasak Thongket
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Vegetables are frequently contaminated with pesticides residues resulting in the most food safety concern among agricultural products. The objective of this work was to develop a method to detect the organophosphate (OP) pesticides residues in vegetables using Near Infrared (NIR) spectroscopy technique. Low concentration (ppm) of OP pesticides in vegetables were investigated. The experiment was divided into 2 sections. In the first section, Chinese kale spiked with different concentrations of chlorpyrifos pesticide residues (0.5-100 ppm) was chosen as the sample model to demonstrate the appropriate conditions of sample preparation, both for a solution or solid sample. The spiked samples were extracted with acetone. The sample extracts were applied as solution samples, while the solid samples were prepared by the dry-extract system for infrared (DESIR) technique. The DESIR technique was performed by embedding the solution sample on filter paper (GF/A) and then drying. The NIR spectra were measured with the transflectance mode over wavenumber regions of 12,500-4000 cm⁻¹. The QuEChERS method followed by gas chromatography-mass spectrometry (GC-MS) was performed as the standard method. The results from the first section showed that the DESIR technique with NIR spectroscopy demonstrated good accurate calibration result with R² of 0.93 and RMSEP of 8.23 ppm. However, in the case of solution samples, the prediction regarding the NIR-PLSR (partial least squares regression) equation showed poor performance (R² = 0.16 and RMSEP = 23.70 ppm). In the second section, the DESIR technique coupled with NIR spectroscopy was applied to the detection of OP pesticides in vegetables. Vegetables (Chinese kale, cabbage and hot chili) were spiked with OP pesticides (chlorpyrifos ethion and profenofos) at different concentrations ranging from 0.5 to 100 ppm. Solid samples were prepared (based on the DESIR technique), then samples were scanned by NIR spectrophotometer at ambient temperature (25+2°C). The NIR spectra were measured as in the first section. The NIR- PLSR showed the best calibration equation for detecting low concentrations of chlorpyrifos residues in vegetables (Chinese kale, cabbage and hot chili) according to the prediction set of R2 and RMSEP of 0.85-0.93 and 8.23-11.20 ppm, respectively. For ethion residues, the best calibration equation of NIR-PLSR showed good indexes of R² and RMSEP of 0.88-0.94 and 7.68-11.20 ppm, respectively. As well as the results for profenofos pesticide, the NIR-PLSR also showed the best calibration equation for detecting the profenofos residues in vegetables according to the good index of R² and RMSEP of 0.88-0.97 and 5.25-11.00 ppm, respectively. Moreover, the calibration equation developed in this work could rapidly predict the concentrations of OP pesticides residues (0.5-100 ppm) in vegetables, and there was no significant difference between NIR-predicted values and actual values (data from GC-MS) at a confidence interval of 95%. In this work, the proposed method using NIR spectroscopy involving the DESIR technique has proved to be an efficient method for the screening detection of OP pesticides residues at low concentrations, and thus increases the food safety potential of vegetables for domestic and export markets.Keywords: NIR spectroscopy, organophosphate pesticide, vegetable, food safety
Procedia PDF Downloads 143213 A Therapeutic Approach for Bromhidrosis with Glycopyrrolate 2% Cream: Clinical Study of 20 Patients
Authors: Vasiliki Markantoni, Eftychia Platsidaki, Georgios Chaidemenos, Georgios Kontochristopoulos
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Introduction: Bromhidrosis, also known as osmidrosis, is a common distressing condition with a significant negative effect on patient’s quality of life. Its etiology is multifactorial. It usually affects axilla, genital skin, breasts and soles, areas where apocrine glands are mostly distributed. Therapeutic treatments include topical antibacterial agents, antiperspirants and neuromuscular blocker agents-toxins. In this study, we aimed to evaluate the efficacy and possible complications of topical glycopyrrolate, an anticholinergic agent, for treatment of bromhidrosis. Glycopyrrolate, applied topically as a cream, solution or spray at concentrations between 0,5% and 4%, has been successfully used to treat different forms of focal hyperhidrosis. Materials and Methods: Twenty patients, six males and fourteen females, meeting the criteria for bromhidrosis were treated with topical glycopyrrolate for two months. The average age was 36. Eleven patients had bromhidrosis located to the axillae, four to the soles, four to both axillae and soles and one to the genital folds. Glycopyrrolate was applied topically as a cream at concentration 2%, formulated in Fitalite. During the first month, patients were using the cream every night and thereafter twice daily. The degree of malodor was assessed subjectively by patients and scaled averagely as ‘none’, ‘mild’, ‘moderate’, and ‘severe’ with corresponding scores of 0, 1, 2, and 3, respectively. The modified Dermatology Life Quality Index (DLQI) was used to assess the quality of life. The clinical efficacy was graded by the patient scale of excellent, good, fair and poor. In the end, patients were given the power to evaluate whether they were totally satisfied with, partially satisfied or unsatisfied and possible side effects during the treatment were recorded. Results: All patients were satisfied at the end of the treatment. No patient defined the response as no improvement. The subjectively assessed score level of bromhidrosis was remarkably improved after the first month of treatment and improved slightly more after the second month. DLQI score was also improved to all patients. Adverse effects were reported in 2 patients. In the first case, topical irritation was reported. This was classed as mild (erythema and desquamation), appeared during the second month of treatment and was treated with low-potency topical corticosteroids. In the second case, mydriasis was reported, that recovered without specific treatment, as soon as we insisted to the importance of careful hygiene after cream application so as not to contaminate the periocular skin or ocular surface. Conclusions: Dermatologists often encounter patients with bromhidrosis, therefore should be aware of treatment options. To the best of our knowledge, this is the first study to evaluate the use of topical glycopyrrolate as a therapeutic approach for bromhidrosis. Our findings suggest that topical glycopyrrolate has an excellent safety profile and demonstrate encouraging results for the management of this distressful condition.Keywords: Bromhidrosis, glycopyrrolate, topical treatment, osmidrosis
Procedia PDF Downloads 158212 Resistance Training and Ginger Consumption on Cytokines Levels
Authors: Alireza Barari, Ahmad Abdi
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Regular body trainings cause adaption in various system in body. One of the important effect of body training is its effect on immune system. It seems that cytokines usually release after long period exercises or some exercises which cause skeletal muscular damages. If some of the cytokines which cause responses such as inflammation of cells in skeletal muscles, with manipulating of training program, it can be avoided or limited from those exercises which induct cytokines release. Ginger plant is a kind of medicinal plants which is known as a anti inflammation plant. This plant is as most precedence medicinal plants in medicine science especially in inflammation cure. The aim of the present study was the effect of selected resistance training and consumption of ginger extract on IL-1α and TNFα untrained young women. The population includes young women interested in participating in the study with the average of 30±2 years old from Abbas Abad city among which 32 participants were chosen randomly and divided into 4 four groups, resistance training (R), resistance training and ginger consumption(RG), Ginger consumption(G)and Control group(C). The training groups performed circuit resistance training at the intensity of 65-75% one repeat maximum, 3 days a week for 6 weeks. Besides resistance training, subjects were given either ginseng (5 mg/kg per day) or placebo. Prior to and 48 hours after interventions body composition was measured and blood samples were taken in order to assess serum levels of IL-1α and TNFα. Plasma levels of cytokines were measured with commercially available ELISA Kits.IL-1α kit and TNFα kit were used in this research. To demonstrate the effectiveness of the independent variable and the comparison between groups, t-test and ANOVA were used. To determine differences between the groups, the Scheffe test was used that showed significant changes in any of the variables. we observed that circuit resistance training in R and RG groups can significant decreased in weight and body mass index in untrained females (p<0.05). The results showed a significant decreased in the mean level of IL-1α levels before and after the training period in G group (p=0.046) and RG group (p=0.022). Comparison between groups also showed there was significant difference between groups R-RG and RG-C. Intergroup comparison results showed that the mean levels of TNFα before and after the training in group G (p=0.044) and RG (p=0.037), significantly decreased. Comparison between groups also showed there was significant difference between groups R–RG , R-G ,RG-C and G-C. The research shows that circuit resistance training with reducing overload method results in systemic inflammation had significant effect on IL-1α levels and TNFα. Of course, Ginger can counteract the negative effects of resistance training exercise on immune function and stability of the mast cell membrane. Considerable evidence supported the anti-inflammatory properties of ginger for several constituents, especially gingerols, shogaols, paradols, and zingerones, through decreased cytokine gene TNF α and IL-1Α expression and inhibition of cyclooxygenase 1 and 2. These established biological actions suggest that ingested ginger could block the increase in IL-1α.Keywords: resistance training, ginger, IL-1α , TNFα
Procedia PDF Downloads 416211 Comparative Study on Efficacy and Clinical Outcomes in Minimally Invasive Surgery Transforaminal Interbody Fusion vs Minimally Invasive Surgery Lateral Interbody Fusion
Authors: Sundaresan Soundararajan, George Ezekiel Silvananthan, Chor Ngee Tan
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Introduction: Transforaminal Interbody Fusion (TLIF) has been adopted for many decades now, however, XLIF, still in relative infancy, has grown to be accepted as a new Minimally Invasive Surgery (MIS) option. There is a paucity of reports directly comparing lateral approach surgery to other MIS options such as TLIF in the treatment of lumbar degenerative disc diseases. Aims/Objectives: The objective of this study was to compare the efficacy and clinical outcomes between Minimally Invasive Transforaminal Interbody Fusion (TLIF) and Minimally Invasive Lateral Interbody Fusion (XLIF) in the treatment of patients with degenerative disc disease of the lumbar spine. Methods: A single center, retrospective cohort study involving a total of 38 patients undergoing surgical intervention between 2010 and 2013 for degenerative disc disease of lumbar spine at single L4/L5 level. 18 patients were treated with MIS TLIF, and 20 patients were treated with XLIF. Results: The XLIF group showed shorter duration of surgery compared to the TLIF group (176 mins vs. 208.3 mins, P = 0.03). Length of hospital stay was also significantly shorter in XLIF group (5.9 days vs. 9 days, p = 0.03). Intraoperative blood loss was favouring XLIF as 85% patients had blood loss less than 100cc compared to 58% in the TLIF group (P = 0.03). Radiologically, disc height was significantly improved post operatively in the XLIF group compared to the TLIF group (0.56mm vs. 0.39mm, P = 0.01). Foraminal height increment was also higher in the XLIF group (0.58mm vs. 0.45mm , P = 0.06). Clinically, back pain and leg pain improved in 85% of patients in the XLIF group and 78% in the TLIF group. Post op hip flexion weakness was more common in the XLIF group (40%) than in the TLIF group (0%). However, this weakness resolved within 6 months post operatively. There was one case of dural tear and surgical site infection in the TLIF group respectively and none in the XLIF group. Visual Analog Scale (VAS) score 6 months post operatively showed comparable reduction in both groups. TLIF group had Owsterty Disability Index (ODI) improvement on 67% while XLIF group showed improvement of 70% of its patients. Conclusions: Lateral approach surgery shows comparable clinical outcomes in resolution of back pain and radiculopathy to conventional MIS techniques such as TLIF. With significantly shorter duration of surgical time, minimal blood loss and shorter hospital stay, XLIF seems to be a reasonable MIS option compared to other MIS techniques in treating degenerative lumbar disc diseases.Keywords: extreme lateral interbody fusion, lateral approach, minimally invasive, XLIF
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