Search results for: adverse reactions
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2146

Search results for: adverse reactions

1726 Cannabis for the Treatment of Drug Resistant Epilepsy in Children

Authors: Sarah E. Casey

Abstract:

Epilepsy is the most common neurological disorder in children and approximately one-third of children with epilepsy have seizures that are uncontrolled on anticonvulsants alone. Cannabidiol is shown to be an effective treatment at reducing the amount of breakthrough seizures experienced by children with drug resistant epilepsy. Improvements in quality of life and overall condition were noted during cannabidiol treatment. Adverse side effects were experienced and were generally mild to moderate in nature. Additional double-blind, controlled studies with a more diverse sample population and standardized dosing are needed to ensure the efficacy and safety of cannabidiol use in children with drug resistant epilepsy.

Keywords: cannabis, drug resistant epilepsy, children, epilepsy

Procedia PDF Downloads 218
1725 Clusterization Probability in 14N Nuclei

Authors: N. Burtebayev, Sh. Hamada, Zh. Kerimkulov, D. K. Alimov, A. V. Yushkov, N. Amangeldi, A. N. Bakhtibaev

Abstract:

The main aim of the current work is to examine if 14N is candidate to be clusterized nuclei or not. In order to check this attendance, we have measured the angular distributions for 14N ion beam elastically scattered on 12C target nuclei at different low energies; 17.5, 21, and 24.5MeV which are close to the Coulomb barrier energy for 14N+12C nuclear system. Study of various transfer reactions could provide us with useful information about the attendance of nuclei to be in a composite form (core + valence). The experimental data were analyzed using two approaches; Phenomenological (Optical Potential) and semi-microscopic (Double Folding Potential). The agreement between the experimental data and the theoretical predictions is fairly good in the whole angular range.

Keywords: deuteron transfer, elastic scattering, optical model, double folding, density distribution

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1724 Synthesis, Physicochemical Characterization and Study of the Antimicrobial Activity of Chlorobutanol

Authors: N. Hadhoum, B. Guerfi, T. M. Sider, Z. Yassa, T. Djerboua, M. Boursouti, M. Mamou, F. Z. Hadjadj Aoul, L. R. Mekacher

Abstract:

Introduction and objectives: Chlorobutanol is a raw material, mainly used as an antiseptic and antimicrobial preservative in injectable and ophthalmic preparations. The main objective of our study was the synthesis and evaluation of the antimicrobial activity of chlorobutanol hemihydrates. Material and methods: Chlorobutanol was synthesized according to the nucleophilic addition reaction of chloroform to acetone, identified by an infrared absorption using Spectrum One FTIR spectrometer, melting point, Scanning electron microscopy and colorimetric reactions. The dosage of carvedilol active substance was carried out by assaying the degradation products of chlorobutanol in a basic solution. The chlorobutanol obtained was subjected to bacteriological tests in order to study its antimicrobial activity. The antibacterial activity was evaluated against strains such as Escherichia coli (ATCC 25 922), Staphylococcus aureus (ATCC 25 923) and Pseudomonas aeroginosa (ATCC = American type culture collection). The antifungal activity was evaluated against human pathogenic fungal strains, such as Candida albicans and Aspergillus niger provided by the parasitology laboratory of the Hospital of Tizi-Ouzou, Algeria. Results and discussion: Chlorobutanol was obtained in an acceptable yield. The characterization tests of the product obtained showed a white and crystalline appearance (confirmed by scanning electron microscopy), solubilities (in water, ethanol and glycerol), and a melting temperature in accordance with the requirements of the European pharmacopoeia. The colorimetric reactions were directed towards the presence of a trihalogenated carbon and an alcohol function. The spectral identification (IR) showed the presence of characteristic chlorobutanol peaks and confirmed the structure of the latter. The microbiological study revealed an antimicrobial effect on all strains tested (Sataphylococcus aureus (MIC = 1250 µg/ml), E. coli (MIC = 1250 µg/ml), Pseudomonas aeroginosa (MIC = 1250 µg/ml), Candida albicans (MIC =2500 µg/ml), Aspergillus niger (MIC =2500 µg/ml)) with MIC values close to literature data. Conclusion: Thus, on the whole, the synthesized chlorobutanol satisfied the requirements of the European Pharmacopoeia, and possesses antibacterial and antifungal activity; nevertheless, it is necessary to insist on the purification step of the product in order to eliminate the maximum impurities.

Keywords: antimicrobial agent, bacterial and fungal strains, chlorobutanol, MIC, minimum inhibitory concentration

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1723 Efficacy and Safety of Sublingual Sufentanil for the Management of Acute Pain

Authors: Neil Singla, Derek Muse, Karen DiDonato, Pamela Palmer

Abstract:

Introduction: Pain is the most common reason people visit emergency rooms. Studies indicate however, that Emergency Department (ED) physicians often do not provide adequate analgesia to their patients as a result of gender and age bias, opiophobia and insufficient knowledge of and formal training in acute pain management. Novel classes of analgesics have recently been introduced, but many patients suffer from acute pain in settings where the availability of intravenous (IV) access may be limited, so there remains a clinical need for rapid-acting, potent analgesics that do not require an invasive route of delivery. A sublingual sufentanil tablet (SST), dispensed using a single-dose applicator, is in development for treatment of moderate-to-severe acute pain in a medically-supervised setting. Objective: The primary objective of this study was to demonstrate the repeat-dose efficacy, safety and tolerability of sufentanil 20 mcg and 30 mcg sublingual tablets compared to placebo for the management of acute pain as determined by the time-weighted sum of pain intensity differences (SPID) to baseline over the 12-hour study period (SPID12). Key secondary efficacy variables included SPID over the first hour (SPID1), Total pain relief over the 12-hour study period (TOTPAR12), time to perceived pain relief (PR) and time to meaningful PR. Safety variables consisted of adverse events (AE), vital signs, oxygen saturation and early termination. Methods: In this Phase 2, double-blind, dose-finding study, an equal number of male and female patients were randomly assigned in a 2:2:1 ratio to SST 20 mcg, SS 30 mcg or placebo, respectively, following bunionectomy. Study drug was dosed as needed, but not more frequently than hourly. Rescue medication was available as needed. The primary endpoint was the Summed Pain Intensity Difference to baseline over 12h (SPIDI2). Safety was assessed by continuous oxygen saturation monitoring and adverse event reporting. Results: 101 patients (51 Male/50 Female) were randomized, 100 received study treatment (intent-to-treat [ITT] population), and 91 completed the study. Reasons for early discontinuation were lack of efficacy (6), adverse events (2) and drug-dosing error (1). Mean age was 42.5 years. For the ITT population, SST 30 mcg was superior to placebo (p=0.003) for the SPID12. SPID12 scores in the active groups were superior for both male (ANOVA overall p-value =0.038) and female (ANOVA overall p-value=0.005) patients. Statistically significant differences in favour of sublingual sufentanil were also observed between the SST 30mcg and placebo group for SPID1(p<0.001), TOTPAR12(p=0.002), time to perceived PR (p=0.023) and time to meaningful PR (p=0.010). Nausea, vomiting and somnolence were more frequent in the sufentanil groups but there were no significant differences between treatment arms for the proportion of patients who prematurely terminated due to AE or inadequate analgesia. Conclusions: Sufentanil tablets dispensed sublingually using a single-dose applicator is in development for treatment of patients with moderate-to-severe acute pain in a medically-supervised setting where immediate IV access is limited. When administered sublingually, sufentanil’s pharmacokinetic profile and non-invasive delivery makes it a useful alternative to IM or IV dosing.

Keywords: acute pain, pain management, sublingual, sufentanil

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1722 Status of Hazardous Waste Generation and Its Impacts on Environment and Human Health: A Study in West Bengal

Authors: Sk Ajim Ali

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The present study is an attempt to overview on the major environmental and health impacts due to hazardous waste generation and poor management. In present scenario, not only hazardous waste, but as a common term ‘Waste’ is one of the acceptable and thinkable environmental issues. With excessive increasing population, industrialization and standardization of human’s life style heap in extra waste generation which is directly or indirectly related with hazardous waste generation. Urbanization and population growth are solely responsible for establishing industrial sector and generating various Hazardous Waste (HW) and concomitantly poor management practice arising adverse effect on environment and human health. As compare to other Indian state, West Bengal is not too much former in HW generation. West Bengal makes a rank of 7th in HW generation followed by Maharashtra, Gujarat, Tamil Nadu, U.P, Punjab and Andhra Pradesh. During the last 30 years, the industrial sectors in W.B have quadrupled in size, during 1995 there were only 440 HW generating Units in West Bengal which produced 129826 MTA hazardous waste but in 2011, it rose up into 609 units and it produced about 259777 MTA hazardous waste. So, the notable thing is that during a 15 year interval there increased 169 waste generating units but it produced about 129951 MTA of hazardous waste. Major chemical industries are the main sources of HW and causes of adverse effect on the environment and human health. HW from industrial sectors contains heavy metals, cyanides, pesticides, complex aromatic compounds (i.e. PCB) and other chemical which are toxic, flammable, reactive, and corrosive and have explosive properties which highly affect the surrounding environment and human health in and around he disposal sites. The main objective of present study is to highlight on the sources and components of hazardous waste in West Bengal and impacts of improper HW management on health and environment. This study is carried out based on a secondary source of data and qualitative method of research. The secondary data has been collected annual report of WBPCB, WHO’s report, research paper, article, books and so on. It has been found that excessive HW generation from various sources and communities has serious health hazards that lead to the spreading of infectious disease and environmental change.

Keywords: environmental impacts, existing HW generation and management practice, hazardous waste (HW), health impacts, recommendation and planning

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1721 Assessment of Urban Immunization Practices among Urban Mother's in Sri Lanka

Authors: Kasun U. G. Palihakkara

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Although vaccine coverage in Sri Lanka is close to 100%, with the widely spreading vaccine rejection trend reaching South Asian regions, it is essential to catch on whether Sri Lankans are being misinformed from the common misconceptions regarding vaccines. As the rates of target diseases decrease, parents become less accepting of even minor common adverse events. It is essential to preserve the integrity of immunization programs and protect public health by finding out the prevalence of anti-immunization trends. The primary objective of this study was to assess the immunization practices and prevalence of trends related to anti-immunization among urban community in Sri Lanka. A descriptive cross-sectional quantitative study on 323 participants using convenient sampling with 213 self-administered questionnaires. Additionally, 110 online questionnaires were distributed. 31% of the study population does not maintain immunization records for their children. While majority seek information regarding immunization from reliable sources such as the family physician or specialist pediatricians, 30% also refer to unreliable sources such as online communities for their opinion. 31% of study population had not vaccinated for Japanese encephalitis. 73% of the study population had encountered with side effects of vaccination such as fever & 47% believed that such side effects are rare. 52% of the population had hostile attitude regarding the administration of several doses multiple vaccines within a child’s first year. Diseases like polio had been successfully eradicated from Sri Lanka with the help of vigorous vaccination programs. However, majority of the study population believe that there’s no need to keep vaccinating the children for those eradicated diseases and exposing the child for adverse effects of such vaccines. Majority of the population were aware of the existing misconceptions regarding immunization. The most popular misconceptions about vaccines popular among the study population were the MMR (Measles, Mumps, and Rubella) vaccine being a possible cause leading to autism and bowel disease and children getting infected with the disease even after they get vaccinated, may be due to the inactivated vaccine. Disturbingly 22% of the study population believed that vaccines are useless in preventing diseases nowadays. These data obtained from the urban study population reveals that even though statistically Sri Lankan immunization coverage is 100%, there is a possibility of anti-vaccination trend arising in Sri Lanka due to the prevalence of various misconceptions and rumors related to it. Therefore these data recommend the need for thorough awareness among the mothers.

Keywords: anti-vaccination, immunization, infectious diseases, pediatric health

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1720 The Association Between Different Body Mass Index Levels And Midterm Surgical Revascularization Outcomes

Authors: Farzad Masoud Kabir, Jamshid Bagheri, Khosro Barkhordari

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This historical cohort study included 17,751 patients patients who underwent isolated CABG at our center between 2007 and 2016. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs.

Keywords: body mass index, surgical outcomes, midterm, cardiac surgery patients

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1719 Textile Waste Management: A Comprehensive Approach to Sustainable Solutions

Authors: Parastoo Ahmadpoor

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Textile waste has become a significant environmental concern in recent years due to its adverse effects on ecosystems and human health. This manuscript presents a comprehensive overview of textile waste management, focusing on sustainable solutions for minimizing waste generation, promoting recycling and upcycling, and adopting circular economy principles. The manuscript explores the challenges and opportunities in textile waste management and highlights the importance of collaboration between stakeholders to achieve a more sustainable and responsible textile industry.

Keywords: textile waste, waste management, recycling, upcycling, circular economy, sustainability, environmental impact

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1718 Nitrogen Fixation of Soybean Approaches for Enhancing under Saline and Water Stress Conditions

Authors: Ayman El Sabagh, AbdElhamid Omar, Dekoum Assaha, Khair Mohammad Youldash, Akihiro Ueda, Celaleddin Barutçular, Hirofumi Saneoka

Abstract:

Drought and salinity stress are a worldwide problem, constraining global crop production seriously. Hence, soybean is susceptible to yield loss from water deficit and salinity stress. Therefore, different approaches have been suggested to solve these issues. Osmoprotectants play an important role in protection the plants from various environmental stresses. Moreover, organic fertilization has several beneficial effects on agricultural fields. Presently, efforts to maximize nitrogen fixation in soybean are critical because of widespread increase in soil degradation in Egypt. Therefore, a greenhouse research was conducted at plant nutritional physiology laboratory, Hiroshima University, Japan for assessing the impact of exogenous osmoregulators and compost application in alleviating the adverse effects of salinity and water stress on soybean. Treatments was included (i) water stress treatments (different soil moisture levels consisting of (100%, 75%, and 50% of field water holding capacity), (ii) salinity concentrations (0 and 15 mM) were applied in fully developed trifoliolate leaf node (V1), (iii) compost treatments (0 and 24 t ha-1) and (iv) the exogenous, proline and glycine betaine concentrations (0 mM and 25 mM) for each, was applied at two growth stages (V1 and R1). The seeds of soybean cultivar Giza 111, was sown into basin from wood (length10 meter, width 50cm, height 50cm and depth 350cm) containing a soil mixture of granite regosol soil and perlite (2:1 v/v). The nitrogen-fixing activity was estimated by using gas chromatography and all measurements were made in three replicates. The results showed that water deficit and salinity stress reduced biological nitrogen fixation and specific nodule activity than normal irrigation conditions. Exogenous osmoprotectants were improved biological nitrogen fixation and specific nodule activity as well as, applying of compost led to improving many of biological nitrogen fixation and specific nodule activity with superiority than stress conditions. The combined application compost fertilizer and exogenous osmoprotectants were more effective in alleviating the adverse effect of stress to improve biological nitrogen fixation and specific nodule activity of Soybean.

Keywords: a biotic stress, biological nitrogen fixation, compost, osmoprotectants, specific nodule activity, soybean

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1717 Numerical Modelling of Surface Waves Generated by Low Frequency Electromagnetic Field for Silicon Refinement Process

Authors: V. Geza, J. Vencels, G. Zageris, S. Pavlovs

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One of the most perspective methods to produce SoG-Si is refinement via metallurgical route. The most critical part of this route is refinement from boron and phosphorus. Therefore, a new approach could address this problem. We propose an approach of creating surface waves on silicon melt’s surface in order to enlarge its area and accelerate removal of boron via chemical reactions and evaporation of phosphorus. A two dimensional numerical model is created which includes coupling of electromagnetic and fluid dynamic simulations with free surface dynamics. First results show behaviour similar to experimental results from literature.

Keywords: numerical modelling, silicon refinement, surface waves, VOF method

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1716 Eco-Benign and Highly Efficient Procedures for the Synthesis of Amides Catalyzed by Heteropolyanion-Based Ionic Liquids under Solvent-Free Conditions

Authors: Zhikai Chena, Renzhong Fu, Wen Chaib, Rongxin Yuanb

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Two eco-benign and highly efficient routes for the synthesis of amides have been developed by treating amines with corresponding carboxylic acids or carboxamides in the presence of heteropolyanion-based ionic liquids (HPAILs) as catalysts. These practical reactions can tolerate a wide range of substrates. Thus, various amides were obtained in good to excellent yields under solvent-free conditions at heating. Moreover, recycling studies revealed that HPAILs are easily reusable for this two procedures. These methods provide green and much improved protocols over the existing methods.

Keywords: synthesis, amide, ıonic liquid, catalyst

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1715 Alleviation of Adverse Effects of Salt Stress on Soybean (Glycine max. L.) by Using Osmoprotectants and Compost Application

Authors: Ayman El Sabagh, SobhySorour, AbdElhamid Omar, Adel Ragab, Mohammad Sohidul Islam, Celaleddin Barutçular, Akihiro Ueda, Hirofumi Saneoka

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Salinity is one of the major factors limiting crop production in an arid environment. What adds to the concern is that all the legume crops are sensitive to increasing soil salinity. So it is implacable to either search for salinity enhancement of legume plants. The exogenous of osmoprotectants has been found effective in reducing the adverse effects of salinity stress on plant growth. Despite its global importance soybean production suffer the problems of salinity stress causing damages at plant development. Therefore, in the current study we try to clarify the mechanism that might be involved in the ameliorating effects of osmo-protectants such as proline and glycine betaine and compost application on soybean plants grown under salinity stress. Experiments were carried out in the greenhouse of the experimental station, plant nutritional physiology, Hiroshima University, Japan in 2011- 2012. The experiment was arranged in a factorial design with 4 replications at NaCl concentrations (0 and 15 mM). The exogenous, proline and glycine betaine concentrations (0 mM and 25 mM) for each. Compost treatments (0 and 24 t ha-1). Results indicated that salinity stress induced reduction in all growth and physiological parameters (dry weights plant-1, chlorophyll content, N and K+ content) likewise, seed and quality traits of soybean plant compared with those of the unstressed plants. In contrast, salinity stress led to increases in the electrolyte leakage ratio, Na and proline contents. Thus tolerance against salt stress was observed, the improvement of salt tolerance resulted from proline, glycine betaine and compost were accompanied with improved membrane stability, K+, and proline accumulation on contrary, decreased Na+ content. These results clearly demonstrate that could be used to reduce the harmful effect of salinity on both physiological aspects and growth parameters of soybean. They are capable of restoring yield potential and quality of seed and may be useful in agronomic situations where saline conditions are diagnosed as a problem. Consequently, exogenous osmo-protectants combine with compost will effectively solve seasonal salinity stress problem and are a good strategy to increase salinity resistance in the drylands.

Keywords: compost, glycine betaine, proline, salinity tolerance, soybean

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1714 CO₂ Conversion by Low-Temperature Fischer-Tropsch

Authors: Pauline Bredy, Yves Schuurman, David Farrusseng

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To fulfill climate objectives, the production of synthetic e-fuels using CO₂ as a raw material appears as part of the solution. In particular, Power-to-Liquid (PtL) concept combines CO₂ with hydrogen supplied from water electrolysis, powered by renewable sources, which is currently gaining interest as it allows the production of sustainable fossil-free liquid fuels. The proposed process discussed here is an upgrading of the well-known Fischer-Tropsch synthesis. The concept deals with two cascade reactions in one pot, with first the conversion of CO₂ into CO via the reverse water gas shift (RWGS) reaction, which is then followed by the Fischer-Tropsch Synthesis (FTS). Instead of using a Fe-based catalyst, which can carry out both reactions, we have chosen the strategy to decouple the two functions (RWGS and FT) on two different catalysts within the same reactor. The FTS shall shift the equilibrium of the RWGS reaction (which alone would be limited to 15-20% of conversion at 250°C) by converting the CO into hydrocarbons. This strategy shall enable optimization of the catalyst pair and thus lower the temperature of the reaction thanks to the equilibrium shift to gain selectivity in the liquid fraction. The challenge lies in maximizing the activity of the RWGS catalyst but also in the ability of the FT catalyst to be highly selective. Methane production is the main concern as the energetic barrier of CH₄ formation is generally lower than that of the RWGS reaction, so the goal will be to minimize methane selectivity. Here we report the study of different combinations of copper-based RWGS catalysts with different cobalt-based FTS catalysts. We investigated their behaviors under mild process conditions by the use of high-throughput experimentation. Our results show that at 250°C and 20 bars, Cobalt catalysts mainly act as methanation catalysts. Indeed, CH₄ selectivity never drops under 80% despite the addition of various protomers (Nb, K, Pt, Cu) on the catalyst and its coupling with active RWGS catalysts. However, we show that the activity of the RWGS catalyst has an impact and can lead to longer hydrocarbons chains selectivities (C₂⁺) of about 10%. We studied the influence of the reduction temperature on the activity and selectivity of the tandem catalyst system. Similar selectivity and conversion were obtained at reduction temperatures between 250-400°C. This leads to the question of the active phase of the cobalt catalysts, which is currently investigated by magnetic measurements and DRIFTS. Thus, in coupling it with a more selective FT catalyst, better results are expected. This was achieved using a cobalt/iron FTS catalyst. The CH₄ selectivity dropped to 62% at 265°C, 20 bars, and a GHSV of 2500ml/h/gcat. We propose that the conditions used for the cobalt catalysts could have generated this methanation because these catalysts are known to have their best performance around 210°C in classical FTS, whereas the iron catalysts are more flexible but are also known to have an RWGS activity.

Keywords: cobalt-copper catalytic systems, CO₂-hydrogenation, Fischer-Tropsch synthesis, hydrocarbons, low-temperature process

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1713 Optimizing Hydrogen Production from Biomass Pyro-Gasification in a Multi-Staged Fluidized Bed Reactor

Authors: Chetna Mohabeer, Luis Reyes, Lokmane Abdelouahed, Bechara Taouk

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In the transition to sustainability and the increasing use of renewable energy, hydrogen will play a key role as an energy carrier. Biomass has the potential to accelerate the realization of hydrogen as a major fuel of the future. Pyro-gasification allows the conversion of organic matter mainly into synthesis gas, or “syngas”, majorly constituted by CO, H2, CH4, and CO2. A second, condensable fraction of biomass pyro-gasification products are “tars”. Under certain conditions, tars may decompose into hydrogen and other light hydrocarbons. These conditions include two types of cracking: homogeneous cracking, where tars decompose under the effect of temperature ( > 1000 °C), and heterogeneous cracking, where catalysts such as olivine, dolomite or biochar are used. The latter process favors cracking of tars at temperatures close to pyro-gasification temperatures (~ 850 °C). Pyro-gasification of biomass coupled with water-gas shift is the most widely practiced process route for biomass to hydrogen today. In this work, an innovating solution will be proposed for this conversion route, in that all the pyro-gasification products, not only methane, will undergo processes that aim to optimize hydrogen production. First, a heterogeneous cracking step was included in the reaction scheme, using biochar (remaining solid from the pyro-gasification reaction) as catalyst and CO2 and H2O as gasifying agents. This process was followed by a catalytic steam methane reforming (SMR) step. For this, a Ni-based catalyst was tested under different reaction conditions to optimize H2 yield. Finally, a water-gas shift (WGS) reaction step with a Fe-based catalyst was added to optimize the H2 yield from CO. The reactor used for cracking was a fluidized bed reactor, and the one used for SMR and WGS was a fixed bed reactor. The gaseous products were analyzed continuously using a µ-GC (Fusion PN 074-594-P1F). With biochar as bed material, it was seen that more H2 was obtained with steam as a gasifying agent (32 mol. % vs. 15 mol. % with CO2 at 900 °C). CO and CH4 productions were also higher with steam than with CO2. Steam as gasifying agent and biochar as bed material were hence deemed efficient parameters for the first step. Among all parameters tested, CH4 conversions approaching 100 % were obtained from SMR reactions using Ni/γ-Al2O3 as a catalyst, 800 °C, and a steam/methane ratio of 5. This gave rise to about 45 mol % H2. Experiments about WGS reaction are currently being conducted. At the end of this phase, the four reactions are performed consecutively, and the results analyzed. The final aim is the development of a global kinetic model of the whole system in a multi-stage fluidized bed reactor that can be transferred on ASPEN PlusTM.

Keywords: multi-staged fluidized bed reactor, pyro-gasification, steam methane reforming, water-gas shift

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1712 Copper Oxide Doped Carbon Catalyst for Anodic Half-Cell of Vanadium Redox Flow Battery

Authors: Irshad U. Khan, Tanmay Paul, Murali Mohan Seepana

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This paper presents a study on synthesizing and characterizing a Copper oxide doped Carbon (CuO-C) electrocatalyst for the negative half-cell reactions of Vanadium Redox Flow Battery (VRFB). The CuO was synthesized using a microreactor. The electrocatalyst was characterized using X-ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), and Field Emission Scanning Electron Microscopy (SEM). The electrochemical performance was assessed by linear sweep voltammetry (LSV). The findings suggest that the synthesized CuO exhibited favorable crystallinity, morphology, and surface area, which reflects improved cell performance.

Keywords: ECSA, electrocatalyst, energy storage, Tafel

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1711 Coupling of Microfluidic Droplet Systems with ESI-MS Detection for Reaction Optimization

Authors: Julia R. Beulig, Stefan Ohla, Detlev Belder

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In contrast to off-line analytical methods, lab-on-a-chip technology delivers direct information about the observed reaction. Therefore, microfluidic devices make an important scientific contribution, e.g. in the field of synthetic chemistry. Herein, the rapid generation of analytical data can be applied for the optimization of chemical reactions. These microfluidic devices enable a fast change of reaction conditions as well as a resource saving method of operation. In the presented work, we focus on the investigation of multiphase regimes, more specifically on a biphasic microfluidic droplet systems. Here, every single droplet is a reaction container with customized conditions. The biggest challenge is the rapid qualitative and quantitative readout of information as most detection techniques for droplet systems are non-specific, time-consuming or too slow. An exception is the electrospray mass spectrometry (ESI-MS). The combination of a reaction screening platform with a rapid and specific detection method is an important step in droplet-based microfluidics. In this work, we present a novel approach for synthesis optimization on the nanoliter scale with direct ESI-MS detection. The development of a droplet-based microfluidic device, which enables the modification of different parameters while simultaneously monitoring the effect on the reaction within a single run, is shown. By common soft- and photolithographic techniques a polydimethylsiloxane (PDMS) microfluidic chip with different functionalities is developed. As an interface for the MS detection, we use a steel capillary for ESI and improve the spray stability with a Teflon siphon tubing, which is inserted underneath the steel capillary. By optimizing the flow rates, it is possible to screen parameters of various reactions, this is exemplarity shown by a Domino Knoevenagel Hetero-Diels-Alder reaction. Different starting materials, catalyst concentrations and solvent compositions are investigated. Due to the high repetition rate of the droplet production, each set of reaction condition is examined hundreds of times. As a result, of the investigation, we receive possible reagents, the ideal water-methanol ratio of the solvent and the most effective catalyst concentration. The developed system can help to determine important information about the optimal parameters of a reaction within a short time. With this novel tool, we make an important step on the field of combining droplet-based microfluidics with organic reaction screening.

Keywords: droplet, mass spectrometry, microfluidics, organic reaction, screening

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1710 The Role of a Biphasic Implant Based on a Bioactive Silk Fibroin for Osteochondral Tissue Regeneration

Authors: Lizeth Fuentes-Mera, Vanessa Perez-Silos, Nidia K. Moncada-Saucedo, Alejandro Garcia-Ruiz, Alberto Camacho, Jorge Lara-Arias, Ivan Marino-Martinez, Victor Romero-Diaz, Adolfo Soto-Dominguez, Humberto Rodriguez-Rocha, Hang Lin, Victor Pena-Martinez

Abstract:

Biphasic scaffolds in cartilage tissue engineering have been designed to influence not only the recapitulation of the osteochondral architecture but also to take advantage of the healing ability of bone to promote the implant integration with the surrounding tissue and then bone restoration and cartilage regeneration. This study reports the development and characterization of a biphasic scaffold based on the assembly of a cartilage phase constituted by fibroin biofunctionalized with bovine cartilage matrix; cellularized with differentiated pre-chondrocytes from adipose tissue stem cells (autologous) and well attached to a bone phase (bone bovine decellularized) to mimic the structure of the nature of native tissue and to promote the cartilage regeneration in a model of joint damage in pigs. Biphasic scaffolds were assembled by fibroin crystallization with methanol. The histological and ultrastructural architectures were evaluated by optical and scanning electron microscopy respectively. Mechanical tests were conducted to evaluate Young's modulus of the implant. For the biological evaluation, pre-chondrocytes were loaded onto the scaffolds and cellular adhesion, proliferation, and gene expression analysis of cartilage extracellular matrix components was performed. The scaffolds that were cellularized and matured for 10 days were implanted into critical 3 mm in diameter and 9-mm in depth osteochondral defects in a porcine model (n=4). Three treatments were applied per knee: Group 1: monophasic cellular scaffold (MS) (single chondral phase), group 2: biphasic scaffold, cellularized only in the chondral phase (BS1), group 3: BS cellularized in both bone and chondral phases (BS2). Simultaneously, a control without treatment was evaluated. After 4 weeks of surgery, integration and regeneration tissues were analyzed by x-rays, histology and immunohistochemistry evaluation. The mechanical assessment showed that the acellular biphasic composites exhibited Young's modulus of 805.01 kPa similar to native cartilage (400-800 kPa). In vitro biological studies revealed the chondroinductive ability of the biphasic implant, evidenced by an increase in sulfated glycosaminoglycan (GAGs) and type II collagen, both secreted by the chondrocytes cultured on the scaffold during 28 days. No evidence of adverse or inflammatory reactions was observed in the in vivo trial; however, In group 1, the defects were not reconstructed. In group 2 and 3 a good integration of the implant with the surrounding tissue was observed. Defects in group 2 were fulfilled by hyaline cartilage and normal bone. Group 3 defects showed fibrous repair tissue. In conclusion; our findings demonstrated the efficacy of biphasic and bioactive scaffold based on silk fibroin, which entwined chondroinductive features and biomechanical capability with appropriate integration with the surrounding tissue, representing a promising alternative for osteochondral tissue-engineering applications.

Keywords: biphasic scaffold, extracellular cartilage matrix, silk fibroin, osteochondral tissue engineering

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1709 Using Nature-Based Solutions to Decarbonize Buildings in Canadian Cities

Authors: Zahra Jandaghian, Mehdi Ghobadi, Michal Bartko, Alex Hayes, Marianne Armstrong, Alexandra Thompson, Michael Lacasse

Abstract:

The Intergovernmental Panel on Climate Change (IPCC) report stated the urgent need to cut greenhouse gas emissions to avoid the adverse impacts of climatic changes. The United Nations has forecasted that nearly 70 percent of people will live in urban areas by 2050 resulting in a doubling of the global building stock. Given that buildings are currently recognised as emitting 40 percent of global carbon emissions, there is thus an urgent incentive to decarbonize existing buildings and to build net-zero carbon buildings. To attain net zero carbon emissions in communities in the future requires action in two directions: I) reduction of emissions; and II) removal of on-going emissions from the atmosphere once de-carbonization measures have been implemented. Nature-based solutions (NBS) have a significant role to play in achieving net zero carbon communities, spanning both emission reductions and removal of on-going emissions. NBS for the decarbonisation of buildings can be achieved by using green roofs and green walls – increasing vertical and horizontal vegetation on the building envelopes – and using nature-based materials that either emit less heat to the atmosphere thus decreasing photochemical reaction rates, or store substantial amount of carbon during the whole building service life within their structure. The NBS approach can also mitigate urban flooding and overheating, improve urban climate and air quality, and provide better living conditions for the urban population. For existing buildings, de-carbonization mostly requires retrofitting existing envelopes efficiently to use NBS techniques whereas for future construction, de-carbonization involves designing new buildings with low carbon materials as well as having the integrity and system capacity to effectively employ NBS. This paper presents the opportunities and challenges in respect to the de-carbonization of buildings using NBS for both building retrofits and new construction. This review documents the effectiveness of NBS to de-carbonize Canadian buildings, identifies the missing links to implement these techniques in cold climatic conditions, and determine a road map and immediate approaches to mitigate the adverse impacts of climate change such as urban heat islanding. Recommendations are drafted for possible inclusion in the Canadian building and energy codes.

Keywords: decarbonization, nature-based solutions, GHG emissions, greenery enhancement, buildings

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1708 Traffic Congestion: Causes, Consequences, and Planning Solutions

Authors: Raj Kumar Kama, Rajshree Kamat

Abstract:

Traffic congestion is a serious problem that is to be considered, and it is increasing day-by-day in urban areas that is seriously affecting the urban society. From the study, it is understood that increased urbanization and growth of population are the principal causes of congestion. It has adverse effects on society, economy, environment, and health. This study mainly focussed on studying and understanding the causes of congestion, consequences faced by urban society, and planning solutions to mitigate congestion. Techniques like transit oriented development (TOD) and integrated transport systems are more effective in mitigating traffic congestion.

Keywords: traffic congestion, transit oriented development, integrated transport system, urbanization

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1707 Assessment of Fermentative Activity in Heavy Metal Polluted Soils in Alaverdi Region, Armenia

Authors: V. M. Varagyan, G. A. Gevorgyan, K. V. Grigoryan, A. L. Varagyan

Abstract:

Alaverdi region is situated in the northern part of the Republic of Armenia. Previous studies (1989) in Alaverdi region showed that due to soil irrigation with the highly polluted waters of the Debed and Shnogh rivers, the content of heavy metals in the brown forest steppe soils was significantly higher than the maximum permissible concentration as a result of which the fermentative activity in all the layers of the soils was stressed. Compared to the non-polluted soils, the activity of ferments in the plough layers of the highly polluted soils decreased by 44 - 68% (invertase – 60%, phosphatase – 44%, urease – 66%, catalase – 68%). In case of the soil irrigation with the polluted waters, a decrease in the intensity of fermentative reactions was conditioned by the high content of heavy metals in the soils and changes in chemical composition, physical and physicochemical properties. 20-year changes in the fermentative activity in the brown forest steppe soils in Alaverdi region were investigated. The activity of extracellular ferments in the soils was determined by the unification methods. The study has confirmed that self-recovery process occurs in soils previously polluted with heavy metals which can be revealed by fermentative activity. The investigations revealed that during 1989 – 2009, the activity of ferments in the plough layers of the medium and highly polluted soils increased by 31.2 – 52.6% (invertase – 31.2%, urease – 52.6%, phosphatase – 33.3%, catalase – 41.8%) and 24.1 – 87.0% (invertase – 40.4%, urease – 76.9%, phosphatase – 24.1%, catalase – 87.0%) respectively which indicated that the dynamic properties of the soils, which had been broken due to heavy metal pollution, were improved. In 1989, the activity of the Alaverdi copper smelting plant was temporarily stopped due to financial problems caused by the economic crisis and the absence of market, and the factory again started operation in 1997 and isn’t currently running at full capacity. As a result, the Debed river water has obtained a new chemical composition and comparatively good irrigation properties. Due to irrigation with this water, the gradually recovery of the soil dynamic properties, which had been broken due to irrigation with the waters polluted with heavy metals, was occurred. This is also explained by the fact that in case of irrigation with the partially cleaned water, the soil protective function against pollutants rose due to a content increase in humus and silt fractions. It is supposed that in case of the soil irrigation with the partially cleaned water, the intensity of fermentative reactions wasn’t directly affected by heavy metals.

Keywords: alaverdi region, heavy metal pollution, self-recovery, soil fermentative activity

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1706 Impact of Solar Radiation Effects on the Physicochemical Properties of Unformulated Polyethylene (PE) Plastic Film

Authors: A. Adelhafidhi, I. M. Babaghayou, S. F. Chabira, M. Sebaa

Abstract:

This study deals with the photodegradation of unformulated polyethylene films for greenhouse covering. The UV range of solar light appears as the most deleterious factor of plastic degradation in outdoor exposure. The reasons of this photosensitivity are structural defects which are light-absorbing. The use of FTIR as an investigation tool has revealed that the material reacts with surrounding oxygen via a photooxidation process. Although the photochemical process is quite complex, it appears through this study than crosslinking and chain scissions are the most important events taking place during aging These two key reactions change irremediably the average molecular weight affecting thus drastically the mechanical properties and reducing, in the same way, the service lifetime of the films.

Keywords: polyethylene, films, unformulated, FTIR, ageing

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1705 Use of Indian Food Mascot Design as an Advertising Tool in Maintaining and Growing the Brand Name

Authors: Preeti Yadav, Dandeswar Bisoyi, Debkumar Chakrabarti

Abstract:

Mascots provide memories to viewers, and numerous promotional campaigns with different appearances, continue to trigger viewers and capture their interest. This study investigates the effect of Indian food mascot designs and influence on enhancing communication; thereby, building long-term brand recognition by the consumers. This paper presents a descriptive approach to Indian food mascot design as an advertising tool, and its research adopts a quantitative methodology. The study confirms that mascots have an ability to communicate a message in an effective manner; all though they are simple in terms of design and fashion trend, they have the capability to build positive reactions.

Keywords: food mascot, brand recognitions, advertising, humour

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1704 Butene Catalytic Cracking to Propylene over Iron and Phosphorus Modified HZSM-5

Authors: Jianwen Li, Hongfang Ma, Haitao Zhang, Qiwen Sun, Weiyong Ying

Abstract:

HZSM-5 zeolites modified by iron and phosphorus were applied in catalytic cracking of butene. N2 adsorption and NH3-TPD were employed to measure the structure and acidity of catalysts. The results indicate that increasing phosphorus loading decreased surface area, pore volume and strong acidity of catalysts. The introduction of phosphorus significantly decreased butene conversion and promoted propylene selectivity. The catalytic performance of catalyst was strongly dependent on the reaction conditions. Appropriate reaction conditions could suppress side reactions and enhance propylene selectivity.

Keywords: butene catalytic cracking, HZSM-5, modification, reaction conditions

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1703 Frequency of Problem Drinking and Depression in Males with a History of Alcohol Consumption Admitted to a Tertiary Care Setting in Southern Sri Lanka

Authors: N. H. D. P. Fonseka, I. H. Rajapakse, A. S. Dissanayake

Abstract:

Background: Problem drinking, namely alcohol dependence (AD) and alcohol abuse (AA) are associated with major medical, social and economic adverse consequences. Problem drinking behavior is noted among those admitted to hospitals due to alcohol-related medical/surgical complaints as well as those with unrelated complaints. Literature shows an association between alcohol consumption and depression. Aims of this study were to determine the frequency of problem drinking and depression among males with a history of alcohol consumption tertiary care setting in Southern Sri Lanka. Method: Two-hundred male patients who consumed alcohol, receiving care in medical and surgical wards in Teaching Hospital Galle, were assessed. A validated J12 questionnaire of the Mini International Neuropsychiatric Interview was administered to determine frequency AA and AD. A validated PHQ 9 questionnaire to determine the prevalence and severity of depression. Results: Sixty-three participants (31%) had problem drinking. Of them, 61% had AD, and 39% had AA. Depression was noted in 39 (19%) subjects. In those who reported alcohol consumption not amounting to problem drinking, depression was noted in 23 (16%) participants. Mild depression was seen in 17, moderate in five and moderately severe in one. Among those who had problem drinking, 16 (25%) had depression. Mild depression was seen in four, moderate in seven, moderately severe in three and severe in two. Conclusions: A high proportion alcohol users had problem drinking. Adverse consequences associated with problem drinking places a major strain on the health system especially in a low resource setting where healthcare spending is limited and alcohol cessation support services are not well organised. Thus alcohol consumption and problem drinking behaviour need to be inquired into all medical consultations. Community prevalence of depression in Sri Lanka is approximately 10%. Depression among those consuming alcohol was two times higher compared to the general population. The rates of depression among those with problem drinking were especially high being 2.5 times more common than in the general population. A substantial proportion of these patients with depression had moderately severe or severe depression. When depression coexists with problem drinking, it may increase the tendency to consume alcohol as well as act as a barrier to the success of alcohol cessation interventions. Thus screening all patients who consume alcohol for depression, especially those who are problem drinkers becomes an important step in their clinical evaluation. In addition, in view of the high prevalence of problem drinking and coexistent depression, the need to organize a structured alcohol cessation support service in Sri Lanka as well as the need for increasing access to psychological evaluation and treatment of those with problem drinking are highlighted.

Keywords: alcohol abuse, alcohol, depression, problem drinking

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1702 Prospects of Regenerative Medicine with Human Allogeneic Adipose Tissue-Derived Mesenchymal Stem Cell Sheets: Achievements and Future Outlook in Clinical Trials for Myopic Chorioretinal Atrophy

Authors: Norimichi Nagano, Yoshio Hirano, Tsutomu Yasukawa

Abstract:

Mesenchymal stem cells are thought to confer neuroprotection, facilitate tissue regeneration and exert their effects on retinal degenerative diseases, however, adverse events such as proliferative vitreoretinopathy and preretinal membrane disease associated with cell suspension transplantation have also been reported. We have recently developed human (allogeneic) adipose tissue-derived mesenchymal stem cell (adMSC) sheets through our proprietary sheet transformation technique, which could potentially mitigate these adverse events. To clarify the properties of our adMSC sheets named PAL-222, we performed in vitro studies such as viability testing, cytokine secretions by ELISA, immunohistochemical study, and migration assay. The viability of the cells exceeded 70%. Vascular Endothelial Growth Factor (VEGF) and Pigment Epithelium-Derived Factor (PEDF), which are quite important cytokines for the retinal area, were observed. PAL-222 expressed type I collagen, a strength marker, type IV collagen, a marker of the basement membrane, and elastin, an elasticity marker. Finally, the migration assay was performed and showed negative, which means that PAL-222 is stably kept in the topical area and does not come to pieces. Next, to evaluate the efficacy in vivo, we transplanted PAL-222 into the subretinal space of the eye of Royal College of Surgeons rats with congenital retinal degeneration and assessed it for three weeks after transplantation. We confirmed that PAL-222 suppressed the decrease in the thickness of the outer nuclear layer, which means that the photoreceptor protective effect treated with PAL-222 was significantly higher than that in the sham group. (p < 0.01). This finding demonstrates that PAL-222 showed their retinoprotective effect in a model of congenital retinal degeneration. As the study suggested the efficacy of PAL-222 in both in vitro and in vivo studies, we are presently engaged in clinical trials of PAL-222 for myopic chorioretinal atrophy, which is one of the retinal degenerative diseases, for the purpose of regenerative medicine.

Keywords: cell sheet, clinical trial, mesenchymal stem cell, myopic chorioretinal atrophy

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1701 Evaluated Nuclear Data Based Photon Induced Nuclear Reaction Model of GEANT4

Authors: Jae Won Shin

Abstract:

We develop an evaluated nuclear data based photonuclear reaction model of GEANT4 for a more accurate simulation of photon-induced neutron production. The evaluated photonuclear data libraries from the ENDF/B-VII.1 are taken as input. Incident photon energies up to 140 MeV which is the threshold energy for the pion production are considered. For checking the validity of the use of the data-based model, we calculate the photoneutron production cross-sections and yields and compared them with experimental data. The results obtained from the developed model are found to be in good agreement with the experimental data for (γ,xn) reactions.

Keywords: ENDF/B-VII.1, GEANT4, photoneutron, photonuclear reaction

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1700 A Qualitative Analysis of Audience Interpretations of the Saudi Youtube Soap Opera Takki

Authors: Noor Attar

Abstract:

This paper proposes a qualitative study to examine the roles of the female characters in the Saudi YouTube soap opera Takki and audience reactions to them. It draws on concepts from Western feminist media studies and information about current portrayals of Saudi women in Saudi TV. The study will identify the themes that Takki presents related to new professional and personal opportunities for Saudi women and investigate Saudi women’s views of those themes. And finally, it will demonstrate how those themes may relate to the evolving positions and aspirations of Saudi women.

Keywords: a qualitative analysis, female characters, Saudi Arabia, Western feminist media

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1699 Improving Alkaline Water Electrolysis by Using an Asymmetrical Electrode Cell Design

Authors: Gabriel Wosiak, Felipe Staciaki, Eryka Nobrega, Ernesto Pereira

Abstract:

Hydrogen is an energy carrier with potential applications in various industries. Alkaline electrolysis is a commonly used method for hydrogen production; however, its energy cost remains relatively high compared to other methods. This is due in part to interfacial pH changes that occur during the electrolysis process. Interfacial pH changes refer to the changes in pH that occur at the interface between the cathode electrode and the electrolyte solution. These changes are caused by the electrochemical reactions at both electrodes, which consume or produces hydroxide ions (OH-) from the electrolyte solution. This results in an important change in the local pH at the electrode surface, which can have several impacts on the energy consumption and durability of electrolysers. One impact of interfacial pH changes is an increase in the overpotential required for hydrogen production. Overpotential is the difference between the theoretical potential required for a reaction to occur and the actual potential that is applied to the electrodes. In the case of water electrolysis, the overpotential is caused by a number of factors, including the mass transport of reactants and products to and from the electrodes, the kinetics of the electrochemical reactions, and the interfacial pH. An increase in the interfacial pH at the anode surface in alkaline conditions can lead to an increase in the overpotential for hydrogen production. This is because the lower local pH makes it more difficult for the hydroxide ions to be oxidized. As a result, there is an increase in the required energy to the process occur. In addition to increasing the overpotential, interfacial pH changes can also lead to the degradation of the electrodes. This is because the lower pH can make the electrode more susceptible to corrosion. As a result, the electrodes may need to be replaced more frequently, which can increase the overall cost of water electrolysis. The method presented in the paper addresses the issue of interfacial pH changes by using a cell design with a different cell design, introducing the electrode asymmetry. This design helps to mitigate the pH gradient at the anode/electrolyte interface, which reduces the overpotential and improves the energy efficiency of the electrolyser. The method was tested using a multivariate approach in both laboratory and industrial current density conditions and validated the results with numerical simulations. The results demonstrated a clear improvement (11.6%) in energy efficiency, providing an important contribution to the field of sustainable energy production. The findings of the paper have important implications for the development of cost-effective and sustainable hydrogen production methods. By mitigating interfacial pH changes, it is possible to improve the energy efficiency of alkaline electrolysis and make it a more competitive option for hydrogen production.

Keywords: electrolyser, interfacial pH, numerical simulation, optimization, asymmetric cell

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1698 Yield, Economics and ICBR of Different IPM Modules in Bt Cotton in Maharashtra

Authors: N. K. Bhute, B. B. Bhosle, D. G. More, B. V. Bhede

Abstract:

The field experiments were conducted during kharif season of the year 2007-08 at the experimental farm of the Department of Agricultural Entomology, Vasantrao Naik Marathwada Krishi Vidyapeeth, Studies on evaluation of different IPM modules for Bt cotton in relation to yield economics and ICBR revealed that MAU and CICR IPM modules proved superior. It was, however, on par with chemical control. Considering the ICBR and safety to natural enemies, an inference can be drawn that Bt cotton with IPM module is the most ideal combination. Besides reduction in insecticide use, it is also expected to ensure favourable ecological and economic returns in contrast to the adverse effects due to conventional insecticides. The IPM approach, which takes care of varying pest situation, appears to be essential for gaining higher advantage from Bt cotton.

Keywords: yield, economics, ICBR, IPM Modules, Bt cotton

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1697 Cost-Conscious Treatment of Basal Cell Carcinoma

Authors: Palak V. Patel, Jessica Pixley, Steven R. Feldman

Abstract:

Introduction: Basal cell carcinoma (BCC) is the most common skin cancer worldwide and requires substantial resources to treat. When choosing between indicated therapies, providers consider their associated adverse effects, efficacy, cosmesis, and function preservation. The patient’s tumor burden, infiltrative risk, and risk of tumor recurrence are also considered. Treatment cost is often left out of these discussions. This can lead to financial toxicity, which describes the harm and quality of life reductions inflicted by high care costs. Methods: We studied the guidelines set forth by the American Academy of Dermatology for the treatment of BCC. A PubMed literature search was conducted to identify the costs of each recommended therapy. We discuss costs alongside treatment efficacy and side-effect profile. Results: Surgical treatment for BCC can be cost-effective if the appropriate treatment is selected for the presenting tumor. Curettage and electrodesiccation can be used in low-grade, low-recurrence tumors in aesthetically unimportant areas. The benefits of cost-conscious care are not likely to be outweighed by the risks of poor cosmesis or tumor return ($471 BCC of the cheek). When tumor burden is limited, MMS offers better cure rates and lower recurrence rates than surgical excision, and with comparable costs (MMS $1263; SE $949). Surgical excision with permanent sections may be indicated when tumor burden is more extensive or if molecular testing is necessary. The utility of surgical excision with frozen sections, which costs substantially more than MMS without comparable outcomes, is less clear (SE with frozen sections $2334-$3085). Less data exists on non-surgical treatments for BCC. These techniques cost less, but recurrence-risk is high. Side-effects of nonsurgical treatment are limited to local skin reactions, and cosmesis is good. Cryotherapy, 5-FU, and MAL-PDT are all more affordable than surgery, but high recurrence rates increase risk of secondary financial and psychosocial burden (recurrence rates 21-39%; cost $100-270). Radiation therapy offers better clearance rates than other nonsurgical treatments but is associated with similar recurrence rates and a significantly larger financial burden ($2591-$3460 BCC of the cheek). Treatments for advanced or metastatic BCC are extremely costly, but few patients require their use, and the societal cost burden remains low. Vismodegib and sonidegib have good response rates but substantial side effects, and therapy should be combined with multidisciplinary care and palliative measures. Expert-review has found sonidegib to be the less expensive and more efficacious option (vismodegib $128,358; sonidegib $122,579). Platinum therapy, while not FDA-approved, is also effective but expensive (~91,435). Immunotherapy offers a new line of treatment in patients intolerant of hedgehog inhibitors ($683,061). Conclusion: Dermatologists working within resource-compressed practices and with resource-limited patients must prudently manage the healthcare dollar. Surgical therapies for BCC offer the lowest risk of recurrence at the most reasonable cost. Non-surgical therapies are more affordable, but high recurrence rates increase the risk of secondary financial and psychosocial burdens. Treatments for advanced BCC are incredibly costly, but the low incidence means the overall cost to the system is low.

Keywords: nonmelanoma skin cancer, basal cell skin cancer, squamous cell skin cancer, cost of care

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