Search results for: alternative of antibiotics
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4041

Search results for: alternative of antibiotics

3621 Informal Self-Governance: The Formation of an Alternative Urban Framework in a Cairo Region

Authors: Noor Abdelhamid

Abstract:

Almost half of Cairo’s growing population is housed in self-built, self-governed informal settlements serving as an alternative in the absence of government-provided public housing. These settlements emerged as the spatial expression of informal practices or activities operating outside regulated, formal frameworks. A comprehensive narrative of political events, administrative decisions, and urban policies set the stage for the growth of informal expression in Egypt. The purpose of this qualitative inquiry is to portray informal self-governance practiced by residents in the Cairo region. This research argues that informal spatial practices offer an alternative urban framework for bottom-up development in the absence of government provisions. In the context of this study, informal self-governance is defined as the residents’ autonomous control and use of public urban space in informal settlements. The case study for this research is Ard al-Liwa, a semi-formal settlement representing the majority of informal settlement typologies in Egypt, which consist of the formal occupation of land through an uncontrolled land subdivision, zoning, and construction. An inductive methodological approach is adopted to first study informal practices as singular activities and then as components of a larger environment. The collected set of empirical data consists of audiovisual material and observations obtained during regular site visits and interviews with residents native to the settlement. Methods of analysis are synthesized to identify themes in the data: the static and dynamic use of sidewalks, the urban traces of informal building allocation and construction, the de facto right to urban space, and the resultant spatial patterns. The paper concludes by positioning the research in the context of the current architectural practice, questioning the role, and responsibility, of designers in these self-governed urban regions.

Keywords: Egypt, informal settlements, self-governance, urban framework

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3620 Using a Strength Based Approach to Teaching Children with Special Needs

Authors: Eunice Tan

Abstract:

The purpose of this presentation is to look at an alternative to the approach and methodologies of working with a child with special needs. The strength-based approach to education embodies a paradigm shift. It is a strategy to move away from a deficit-based methodology which inadvertently may lead to an extensive list of things that the child cannot do or is unable to do. Today, many parents of individuals with special needs are focused on the individual’s deficits rather than on his or her strengths. Even when parents recognise and identify their child’s savant strengths to be valuable and wish to develop their abilities, they face the challenge that there are insufficient programs committed to supporting the development and improvement of such abilities. What is a strength-based approach in education? A strength-based approach in education focuses on students' positive qualities and contributions to class instead of the skills and abilities they may not have. Many schools are focused on the child’s special educational needs rather than the whole child. Parents interviewed have said that they have to engage external tutors to help hone in on their child’s interests and strengths. The strength-based approach to writing statements encourages educators to find out: • What a child can do • What a child can do when he or she is given educational support • Learning more about children with special needs and their strengths and talents will broaden our understanding of how we can help them with language acquisition, social skills, as well as self-help and independence skills.

Keywords: special needs, strengths, and talents, alternative educational approach, strength based approach

Procedia PDF Downloads 259
3619 Decision Tree Model for the Recommendation of Digital and Alternate Payment Methods for SMEs

Authors: Arturo J. Anci Alméstar, Jose D. Fernandez Huapaya, David Mauricio

Abstract:

Companies make erroneous decisions by not evaluating the inherent difficulties of entering electronic commerce without a prior review of current digital and alternate means of payment. For this reason, it is very important for businesses to have reliable, complete and integrated information on the means of current digital and alternate payments that allow decisions to be made about which of these to use. However, there is no such consolidated information or criteria that companies use to make decisions about the means of payment according to their needs. In this paper, we propose a decision tree model based on a taxonomy that presents us with a categorization of digital and alternative means of payment, as well as the visualization of the flow of information at a high level from the company to obtain a recommendation. This will allow the company to make the most appropriate decision about the implementation of the digital means of payment or alternative ideal for their needs, which allows a reduction in costs and complexity of the payment process. Likewise, the efficiency of the proposed model was evaluated through a satisfaction survey presented to company personnel, confirming the satisfactory quality level of the recommendations obtained by the model.

Keywords: digital payment medium, decision tree, decision making, digital payments taxonomy

Procedia PDF Downloads 159
3618 Bacteriophage Is a Novel Solution of Therapy Against S. aureus Having Multiple Drug Resistance

Authors: Sanjay Shukla, A. Nayak, R. K. Sharma, A. P. Singh, S. P. Tiwari

Abstract:

Excessive use of antibiotics is a major problem in the treatment of wounds and other chronic infections, and antibiotic treatment is frequently non-curative, thus alternative treatment is necessary. Phage therapy is considered one of the most promising approaches to treat multi-drug resistant bacterial pathogens. Infections caused by Staphylococcus aureus are very efficiently controlled with phage cocktails, containing a different individual phages lysate infecting a majority of known pathogenic S. aureus strains. The aim of the present study was to evaluate the efficacy of a purified phage cocktail for prophylactic as well as therapeutic application in mouse model and in large animals with chronic septic infection of wounds. A total of 150 sewage samples were collected from various livestock farms. These samples were subjected for the isolation of bacteriophage by the double agar layer method. A total of 27 sewage samples showed plaque formation by producing lytic activity against S. aureus in the double agar overlay method out of 150 sewage samples. In TEM, recovered isolates of bacteriophages showed hexagonal structure with tail fiber. In the bacteriophage (ØVS) had an icosahedral symmetry with the head size 52.20 nm in diameter and long tail of 109 nm. Head and tail were held together by connector and can be classified as a member of the Myoviridae family under the order of Caudovirale. Recovered bacteriophage had shown the antibacterial activity against the S. aureus in vitro. Cocktail (ØVS1, ØVS5, ØVS9, and ØVS 27) of phage lysate were tested to know in vivo antibacterial activity as well as the safety profile. Result of mice experiment indicated that the bacteriophage lysate were very safe, did not show any appearance of abscess formation, which indicates its safety in living system. The mice were also prophylactically protected against S. aureus when administered with cocktail of bacteriophage lysate just before the administration of S. aureuswhich indicates that they are good prophylactic agent. The S. aureusinoculated mice were completely recovered by bacteriophage administration with 100% recovery, which was very good as compere to conventional therapy. In the present study, ten chronic cases of the wound were treated with phage lysate, and follow up of these cases was done regularly up to ten days (at 0, 5, and 10 d). The result indicated that the six cases out of ten showed complete recovery of wounds within 10 d. The efficacy of bacteriophage therapy was found to be 60% which was very good as compared to the conventional antibiotic therapy in chronic septic wounds infections. Thus, the application of lytic phage in single dose proved to be innovative and effective therapy for the treatment of septic chronic wounds.

Keywords: phage therapy, S aureus, antimicrobial resistance, lytic phage, and bacteriophage

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3617 Effect of Hydrogen on the Performance of a Methanol SI-Engine at City Driving Conditions

Authors: Junaid Bin Aamir, Ma Fanhua

Abstract:

Methanol is one of the most suitable alternative fuels for replacing gasoline in present and future spark-ignited engines. However, for pure methanol engines, cold start problems and misfires are observed under certain operating conditions. Hydrogen provides a solution for such problems. This paper experimentally investigated the effect of hydrogen on the performance of a pure methanol SI-engine at city driving conditions (1500 rpm speed and 1.18 excess air ratio). Hydrogen was used as a part of methanol reformed syngas (67% hydrogen by volume). 4% by mass of the total methanol converted to hydrogen and other constituent gases, was used in each cycle. Port fuel injection was used to inject methanol and hydrogen-rich syngas into the 4-cylinder engine. The results indicated an increase in brake thermal efficiency up to 5% with the addition of hydrogen, a decrease in brake specific fuel consumption up to 200 g/kWh, and a decrease in exhaust gas temperature by 100°C for all mean effective pressures. Hydrogen addition also decreased harmful exhaust emissions significantly. There was a reduction in THC emissions up to 95% and CO emissions up to 50%. NOx emissions were slightly increased (up to 15%), but they can be reduced to zero by lean burn strategy.

Keywords: alternative fuels, hydrogen, methanol, performance, spark ignition engines

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3616 A Design for Supply Chain Model by Integrated Evaluation of Design Value and Supply Chain Cost

Authors: Yuan-Jye Tseng, Jia-Shu Li

Abstract:

To design a product with the given product requirement and design objective, there can be alternative ways to propose the detailed design specifications of the product. In the design modeling stage, alternative design cases with detailed specifications can be modeled to fulfill the product requirement and design objective. Therefore, in the design evaluation stage, it is required to perform an evaluation of the alternative design cases for deciding the final design. The purpose of this research is to develop a product evaluation model for evaluating the alternative design cases by integrated evaluating the criteria of functional design, Kansei design, and design for supply chain. The criteria in the functional design group include primary function, expansion function, improved function, and new function. The criteria in the Kansei group include geometric shape, dimension, surface finish, and layout. The criteria in the design for supply chain group include material, manufacturing process, assembly, and supply chain operation. From the point of view of value and cost, the criteria in the functional design group and Kansei design group represent the design value of the product. The criteria in the design for supply chain group represent the supply chain and manufacturing cost of the product. It is required to evaluate the design value and the supply chain cost to determine the final design. For the purpose of evaluating the criteria in the three criteria groups, a fuzzy analytic network process (FANP) method is presented to evaluate a weighted index by calculating the total relational values among the three groups. A method using the technique for order preference by similarity to ideal solution (TOPSIS) is used to compare and rank the design alternative cases according to the weighted index using the total relational values of the criteria. The final decision of a design case can be determined by using the ordered ranking. For example, the design case with the top ranking can be selected as the final design case. Based on the criteria in the evaluation, the design objective can be achieved with a combined and weighted effect of the design value and manufacturing cost. An example product is demonstrated and illustrated in the presentation. It shows that the design evaluation model is useful for integrated evaluation of functional design, Kansei design, and design for supply chain to determine the best design case and achieve the design objective.

Keywords: design for supply chain, design evaluation, functional design, Kansei design, fuzzy analytic network process, technique for order preference by similarity to ideal solution

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3615 A Plan of Smart Management for Groundwater Resources

Authors: Jennifer Chen, Pei Y. Hsu, Yu W. Chen

Abstract:

Groundwater resources play a vital role in regional water supply because over 1/3 of total demand is satisfied by groundwater resources. Because over-pumpage might cause environmental impact such as land subsidence, a sustainable management of groundwater resource is required. In this study, a blueprint of smart management for groundwater resource is proposed and planned. The framework of the smart management can be divided into two major parts, hardware and software parts. First, an internet of groundwater (IoG) which is inspired by the internet of thing (IoT) is proposed to observe the migration of groundwater usage and the associated response, groundwater levels. Second, algorithms based on data mining and signal analysis are proposed to achieve the goal of providing highly efficient management of groundwater. The entire blueprint is a 4-year plan and this year is the first year. We have finished the installation of 50 flow meters and 17 observation wells. An underground hydrological model is proposed to determine the associated drawdown caused by the measured pumpages. Besides, an alternative to the flow meter is also proposed to decrease the installation cost of IoG. An accelerometer and 3G remote transmission are proposed to detect the on and off of groundwater pumpage.

Keywords: groundwater management, internet of groundwater, underground hydrological model, alternative of flow meter

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3614 An Examination of the Effectiveness of iPad-Based Augmentative and Alternative Intervention on Acquisition, Generalization and Maintenance of the Requesting Information Skills of Children with Autism

Authors: Amaal Almigal

Abstract:

Technology has been argued to offer distinct advantages and benefits for teaching children with autism spectrum disorder (ASD) to communicate. One aspect of this technology is augmentative and alternative communication (AAC) systems such as picture exchange or speech generation devices. Whilst there has been significant progress in teaching these children to request their wants and needs with AAC, there remains a need for developing technologies that can really make a difference in teaching them to ask questions. iPad-based AAC can be effective for communication. However, the effectiveness of this type of AAC in teaching children to ask questions needs to be examined. Thus, in order to examine the effectiveness of iPad-based AAC in teaching children with ASD to ask questions, This research will test whether iPad leads to more learning than a traditional approach picture and text cards does. Two groups of children who use AAC will be taught to ask ‘What is it?’ questions. With the first group, low-tech AAC picture and text cards will be used, while an iPad-based AAC application called Proloquo2Go will be used with the second group. Interviews with teachers and parents will be conducted before and after the experiment. The children’s perspectives will also be considered. The initial outcomes of this research indicate that iPad can be an effective tool to help children with autism to ask questions.

Keywords: autism, communication, information, iPad, pictures, requesting

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3613 The Prevalence and Profile of Extended Spectrum B-Lactamase (ESBL) Producing Enterobacteriaceae Species in the Intensive Care Unit (ICU) Setting of a Tertiary Care Hospital of North India

Authors: Harmeet Pal Singh Dhooria, Deepinder Chinna, UPS Sidhu, Alok Jain

Abstract:

Serious infections caused by gram-negative bacteria are a significant cause of mortality and morbidity in the hospital setting. In acute care facilities like in intensive care units (ICUs), the intensity of antimicrobial use together with a population highly susceptible to infection, creates an environment, which facilitates both emergence and transmission of Extended Spectrum -lactamase (ESBL) producing Enterobacteriaceae species. The study was conducted in the Medical Intensive Care Unit (MICU) and the Pulmonary Critical Care Unit (PCCU) of the Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Out of a total of 1108 samples of urine, blood and respiratory tract secretions received for culture and sensitivity analysis from Medical Intensive Care Unit and Pulmonary Critical Care Unit, a total of 170 isolates of Enterobacteriaceae species were obtained which were then included in our study. Out of these 170 isolates, confirmed ESBL production was seen in 116 (68.24%) cases. E.coli was the most common species isolated (56.47%) followed by Klebsiella (32.94%), Enterobacter (5.88%), Citrobacter (3.53%), Enterobacter (0.59%) and Morganella (0.59%) among the total isolates. The rate of ESBL production was more in Klebsiella (78.57%) as compared to E.coli (60.42%). ESBL producers were found to be significantly more common in patients with prior history of hospitalization, antibiotic use, and prolonged ICU stay. Also significantly increased the prevalence of ESBL related infections was observed in patients with a history of catheterization or central line insertion but not in patients with the history of intubation. Patients who had an underlying malignancy had significantly higher prevalence of ESBL related infections as compared to other co-morbid illnesses. A slightly significant difference in the rate of mortality/LAMA was observed in the ESBL producer versus the non-ESBL producer group. The rate of mortality/LAMA was significantly higher in the ESBL related UTI but not in the ESBL related respiratory tract and bloodstream infections. ESBL producing isolates had significantly higher rates of resistance to Cefepime and Piperacillin/Tazobactum, and to non β-lactum antibiotics like Amikacin and Ciprofloxacin. The level of resistance to Imipenem was lower as compared to other antibiotics. However, it was noted that ESBL producing isolates had higher levels of resistance to Imipenem as compared to non-ESBL producing isolates. Conclusion- The prevalence of ESBL producing organisms was found to be very high (68.24%) among Enterobacteriaceae isolates in our ICU setting as among other ICU care settings around the world.

Keywords: enterobacteriaceae, extended spectrum B-lactamase (ESBL), ICU, antibiotic resistance

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3612 Energy Potential of Turkey and Evaluation of Solar Energy Technology as an Alternative Energy

Authors: Naci Büyükkaracığan, Murat Ahmet Ökmen

Abstract:

Emerging demand for energy in developing countries rapid population growth and industrialization are causing a rapid increase, such as Turkey. Energy is an important and indispensable factor in the industry. At the same time, energy is one of the main indicators that reflect a country's economic and social development potential. There is a linear relationship between the energy consumption and social development, and in parallel this situation, it is seen that energy consumption increase with economic growth and prosperity. In recent year’s, energy sources consumption is increasingly continuing, because of population growth and economy in Turkey. 80% of the energy used in Turkey is supplied from abroad. At the same time, while almost all of the energy obtained from our country is met by hydropower. Alternatively, studies of determining and using potential renewable energy sources such as solar energy have been realized for recent years. In this study, first of all, the situation of energy sources was examined in Turkey. Information of reserve/capacity, production and consumption values of energy sources were emphasized. For this purpose, energy production and consumption, CO2 emission and electricity energy consumption of countries were investigated. Energy consumption and electricity energy consumption per capita were comparatively analyzed.

Keywords: energy potential, alternative energy sources, solar energy, Turkey

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3611 Enhancement of Mechanical Properties and Thermal Conductivity of Oil Palm Shell Lightweight Concrete Reinforced with High Performance Polypropylene Fibres

Authors: Leong Tatt Loh, Ming Kun Yew, Ming Chian Yew, Lip Huat Saw, Jing Han Beh, Siong Kang Lim, Foo Wei Lee

Abstract:

Oil palm shell (OPS) is the solid waste product from the palm oil sector of the agricultural industry and can be used as alternative coarse aggregates to substitute depleting conventional raw materials. This research aims to investigate the incorporation of various high-performance polypropylene (HPP) fibres with different geometry to enhance the mechanical properties and thermal conductivity of OPS lightweight concrete. The effect of different volume fractions (Vf) (0.05%, 0.10% and 0.15%) were studied for each fibre. The results reveal that the effectiveness of HPP fibres to increase the compressive strength at later ages was more pronounced than at early age. It is found that the use of HPP fibres reinforced OPS lightweight concrete (LWC) induced the advantageous of improving mechanical properties (compressive strength, flexural strength and splitting tensile strength) and thermal conductivity. Hence, this HPP fibres is a promising alternative solution to compensate lower mechanical properties as well as contribute to energy efficiency building material in the construction industry.

Keywords: oil palm shell, high performance polypropylene fibre, lightweight concrete, mechanical properties, thermal conductivity

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3610 An Alternative Stratified Cox Model for Correlated Variables in Infant Mortality

Authors: K. A. Adeleke

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Often in epidemiological research, introducing stratified Cox model can account for the existence of interactions of some inherent factors with some major/noticeable factors. This research work aimed at modelling correlated variables in infant mortality with the existence of some inherent factors affecting the infant survival function. An alternative semiparametric Stratified Cox model is proposed with a view to take care of multilevel factors that have interactions with others. This, however, was used as a tool to model infant mortality data from Nigeria Demographic and Health Survey (NDHS) with some multilevel factors (Tetanus, Polio, and Breastfeeding) having correlation with main factors (Sex, Size, and Mode of Delivery). Asymptotic properties of the estimators are also studied via simulation. The tested model via data showed good fit and performed differently depending on the levels of the interaction of the strata variable Z*. An evidence that the baseline hazard functions and regression coefficients are not the same from stratum to stratum provides a gain in information as against the usage of Cox model. Simulation result showed that the present method produced better estimates in terms of bias, lower standard errors, and or mean square errors.

Keywords: stratified Cox, semiparametric model, infant mortality, multilevel factors, cofounding variables

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3609 The Effect of the Weld Current Types on Microstructure and Hardness in Tungsten Inert Gas Welding of the AZ31 Magnesium Alloy Sheet

Authors: Bilge Demir, Ahmet Durgutlu, Mustafa Acarer

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In this study, the butt welding of the commercial AZ31 magnesium alloy sheets have been carried out by using Tungsten Inert Gas (TIG) welding process with alternative and pulsed current. Welded samples were examined with regards to hardness and microstructure. Despite some recent developments in welding of magnesium alloys, they have some problems such as porosity, hot cracking, oxide formation and so on. Samples of the welded parts have undergone metallographic and mechanical examination. Porosities and homogeneous micron grain oxides were rarely observed. Orientations of the weld microstructure in terms of heat transfer also were rarely observed and equiaxed grain morphology was dominant grain structure as in the base metal. As results, fusion zone and few locations of the HAZ of the welded samples have shown twin’s grains. Hot cracking was not observed for any samples. Weld bead geometry of the welded samples were evaluated as normal according to welding parameters. In the results, conditions of alternative and pulsed current and the samples were compared to each other with regards to microstructure and hardness.

Keywords: AZ31 magnesium alloy, microstructures, micro hardness TIG welding

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3608 The Effect of Hydrogen on Performance and Emissions of a Methanol Si-Engine at Part Load

Authors: Junaid Bin Aamir, Ma Fanhua

Abstract:

Methanol and hydrogen are the most suitable alternative fuel resources for the existing and future internal combustion engines. This paper experimentally examined the effects of hydrogen addition on the performance and emission characteristics of a spark-ignition engine fueled with methanol at part load conditions. The experiments were carried out for various engine speeds and loads. Hydrogen-rich syngas was used to enhance the performance of the test engine. It was formed by catalytic dissociation of methanol itself, and volumetric hydrogen fraction in syngas was about 67%. A certain amount of syngas dissociated from methanol was injected into the intake manifold in each engine cycle, and the low heating value (LHV) of hydrogen-rich syngas used was 4% of methanol in each cycle. Both the fuels were injected separately using port fuel injectors. The results showed that brake thermal efficiency of the engine was enhanced by 3-5% with hydrogen addition, while brake specific fuel consumption and exhaust gas temperature were reduced. There was a significant reduction (90-95%) in THC and (35-50%) in CO emissions at the exhaust. NOx emissions from hydrogen blended methanol increased slightly (10-15%), but they can be reduced by using lean fuel-air mixture to keep the cylinder temperature low.

Keywords: hydrogen, methanol, alternative fuel, emissions, spark ignition engines

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3607 Development of Paper Based Analytical Devices for Analysis of Iron (III) in Natural Water Samples

Authors: Sakchai Satienperakul, Manoch Thanomwat, Jutiporn Seedasama

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A paper based analytical devices (PADs) for the analysis of Fe (III) ion in natural water samples is developed, using reagent from guava leaf extract. The extraction is simply performed in deionized water pH 7, where tannin extract is obtained and used as an alternative natural reagent. The PADs are fabricated by ink-jet printing using alkenyl ketene dimer (AKD) wax. The quantitation of Fe (III) is carried out using reagent from guava leaf extract prepared in acetate buffer at the ratio of 1:1. A color change to gray-purple is observed by naked eye when dropping sample contained Fe (III) ion on PADs channel. The reflective absorption measurement is performed for creating a standard curve. The linear calibration range is observed over the concentration range of 2-10 mg L-1. Detection limited of Fe (III) is observed at 2 mg L-1. In its optimum form, the PADs is stable for up to 30 days under oxygen free conditions. The small dimensions, low volume requirement and alternative natural reagent make the proposed PADs attractive for on-site environmental monitoring and analysis.

Keywords: green chemical analysis, guava leaf extract, lab on a chip, paper based analytical device

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3606 Creation of Greenhouses by Students, Using the Own Installations of the University and Increasing the Growth of Plants

Authors: Espinosa-Garza G., Loera-Hernandez I., Antonyan N.

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To innovate, it is necessary to perform projects directed towards the search of improvement. The agricultural technique and the design of greenhouses have been studied by undergraduate engineering students from the Tecnológico de Monterrey using the campus areas. The purpose of this project was to incite students to create innovations and help rural populations of the state to solve one of the problems that they are dealing with nowadays. The main objective of the project was to search for an alternative technique that will allow the planting of the “chile piquín” plant, also known as Capsicum annuum, to grow quicker as it germinates. The “chile piquín” is one of the original crops of Mexico and forms the basis of the Mesoamerican cultures’ diet since the pre-hispanic era. To fulfill with today’s demand, it is required to implement new alternative methods to increase the “chile piquín’s” growth. The project lasted one semester with the participation of engineering students from multiple majors. The most important results from this academic experience were that, from the proposed goal, the students could analyze the needs of their town and were capable of introducing new and innovative ideas with the aim of resolving them. In the present article the pedagogic methodologies that allowed to carry out this project will be discussed.

Keywords: academic experience, chile piquín, engineering education, greenhouse design, innovation

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3605 Analysis of Resistance and Virulence Genes of Gram-Positive Bacteria Detected in Calf Colostrums

Authors: C. Miranda, S. Cunha, R. Soares, M. Maia, G. Igrejas, F. Silva, P. Poeta

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The worldwide inappropriate use of antibiotics has increased the emergence of antimicrobial-resistant microorganisms isolated from animals, humans, food, and the environment. To combat this complex and multifaceted problem is essential to know the prevalence in livestock animals and possible ways of transmission among animals and between these and humans. Enterococci species, in particular E. faecalis and E. faecium, are the most common nosocomial bacteria, causing infections in animals and humans. Thus, the aim of this study was to characterize resistance and virulence factors genes among two enterococci species isolated from calf colostrums in Portuguese dairy farms. The 55 enterococci isolates (44 E. faecalis and 11 E. faecium) were tested for the presence of the resistance genes for the following antibiotics: erythromicyn (ermA, ermB, and ermC), tetracycline (tetL, tetM, tetK, and tetO), quinupristin/dalfopristin (vatD and vatE) and vancomycin (vanB). Of which, 25 isolates (15 E. faecalis and 10 E. faecium) were tested until now for 8 virulence factors genes (esp, ace, gelE, agg, cpd, cylA, cylB, and cylLL). The resistance and virulence genes were performed by PCR, using specific primers and conditions. Negative and positive controls were used in all PCR assays. All enterococci isolates showed resistance to erythromicyn and tetracycline through the presence of the genes: ermB (n=29, 53%), ermC (n=10, 18%), tetL (n=49, 89%), tetM (n=39, 71%) and tetK (n=33, 60%). Only two (4%) E. faecalis isolates showed the presence of tetO gene. No resistance genes for vancomycin were found. The virulence genes detected in both species were cpd (n=17, 68%), agg (n=16, 64%), ace (n=15, 60%), esp (n=13, 52%), gelE (n=13, 52%) and cylLL (n=8, 32%). In general, each isolate showed at least three virulence genes. In three E. faecalis isolates was not found virulence genes and only E. faecalis isolates showed virulence genes for cylA (n=4, 16%) and cylB (n=6, 24%). In conclusion, these colostrum samples that were consumed by calves demonstrated the presence of antibiotic-resistant enterococci harbored virulence genes. This genotypic characterization is crucial to control the antibiotic-resistant bacteria through the implementation of restricts measures safeguarding public health. Acknowledgements: This work was funded by the R&D Project CAREBIO2 (Comparative assessment of antimicrobial resistance in environmental biofilms through proteomics - towards innovative theragnostic biomarkers), with reference NORTE-01-0145-FEDER-030101 and PTDC/SAU-INF/30101/2017, financed by the European Regional Development Fund (ERDF) through the Northern Regional Operational Program (NORTE 2020) and the Foundation for Science and Technology (FCT). This work was supported by the Associate Laboratory for Green Chemistry - LAQV which is financed by national funds from FCT/MCTES (UIDB/50006/2020 and UIDP/50006/2020).

Keywords: antimicrobial resistance, calf, colostrums, enterococci

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3604 Novel Aminoglycosides to Target Resistant Pathogens

Authors: Nihar Ranjan, Derrick Watkins, Dev P. Arya

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Current methods in the study of antibiotic activity of ribosome targeted antibiotics are dependent on cell based bacterial inhibition assays or various forms of ribosomal binding assays. These assays are typically independent of each other and little direct correlation between the ribosomal binding and bacterial inhibition is established with the complementary assay. We have developed novel high-throughput capable assays for ribosome targeted drug discovery. One such assay examines the compounds ability to bind to a model ribosomal RNA A-site. We have also coupled this assay to other functional orthogonal assays. Such analysis can provide valuable understanding of the relationships between two complementary drug screening methods and could be used as standard analysis to correlate the affinity of a compound for its target and the effect the compound has on a cell.

Keywords: bacterial resistance, aminoglycosides, screening, drugs

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3603 Therapeutic Challenges in Treatment of Adults Bacterial Meningitis Cases

Authors: Sadie Namani, Lindita Ajazaj, Arjeta Zogaj, Vera Berisha, Bahrije Halili, Luljeta Hasani, Ajete Aliu

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Background: The outcome of bacterial meningitis is strongly related to the resistance of bacterial pathogens to the initial antimicrobial therapy. The objective of the study was to analyze the initial antimicrobial therapy, the resistance of meningeal pathogens and the outcome of adults bacterial meningitis cases. Materials/methods: This prospective study enrolled 46 adults older than 16 years of age, treated for bacterial meningitis during the years 2009 and 2010 at the infectious diseases clinic in Prishtinë. Patients are categorized into specific age groups: > 16-26 years of age (10 patients), > 26-60 years of age (25 patients) and > 60 years of age (11 patients). All p-values < 0.05 were considered statistically significant. Data were analyzed using Stata 7.1 and SPSS 13. Results: During the two year study period 46 patients (28 males) were treated for bacterial meningitis. 33 patients (72%) had a confirmed bacterial etiology; 13 meningococci, 11 pneumococci, 7 gram-negative bacilli (Ps. aeruginosa 2, Proteus sp. 2, Acinetobacter sp. 2 and Klebsiella sp. 1 case) and 2 staphylococci isolates were found. Neurological complications developed in 17 patients (37%) and the overall mortality rate was 13% (6 deaths). Neurological complications observed were: cerebral abscess (7/46; 15.2%), cerebral edema (4/46; 8.7%); haemiparesis (3/46; 6.5%); recurrent seizures (2/46; 4.3%), and single cases of thrombosis sinus cavernosus, facial nerve palsy and decerebration (1/46; 2.1%). The most common meningeal pathogens were meningococcus in the youngest age group, gram negative-bacilli in second age group and pneumococcus in eldery age group. Initial single-agent antibiotic therapy (ceftriaxone) was used in 17 patients (37%): in 60% of patients in the youngest age group and in 44% of cases in the second age group. 29 patients (63%) were treated with initial dual-agent antibiotic therapy; ceftriaxone in combination with vancomycin or ampicillin. Ceftriaxone and ampicillin were the most commonly used antibiotics for the initial empirical therapy in adults > 50 years of age. All adults > 60 years of age were treated with the initial dual-agent antibiotic therapy as in this age group was recorded the highest mortality rate (M=27%) and adverse outcome (64%). Resistance of pathogens to antimicrobics was recorded in cases caused by gram-negative bacilli and was associated with greater risk for developing neurological complications (p=0.09). None of the gram-negative bacilli were resistant to carbapenems; all were resistant to ampicillin while 5/7 isolates were resistant to cefalosporins. Resistance of meningococci and pneumococci to beta-lactams was not recorded. There were no statistical differences in the occurrence of neurological complications (p > 0.05), resistance of meningeal pathogens to antimicrobics (p > 0.05) and the inital antimicrobial therapy (one vs. two antibiotics) concerning group-ages in adults. Conclusions: The initial antibiotic therapy with ceftriaxone alone or in combination with vancomycin or ampicillin did not cover cases caused by gram-negative bacilli.

Keywords: adults, bacterial meningitis, outcomes, therapy

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3602 Deproteination and Demineralization of Shrimp Waste Using Lactic Acid Bacteria for the Production of Crude Chitin and Chitosan

Authors: Farramae Francisco, Rhoda Mae Simora, Sharon Nunal

Abstract:

Deproteination and demineralization efficiencies of shrimp waste using two Lactobacillus species treated with different carbohydrate sources for chitin production, its chemical conversion to chitosan and the quality of chitin and chitosan produced were determined. Using 5% glucose and 5% cassava starch as carbohydrate sources, pH slightly increased from the initial pH of 6.0 to 6.8 and 7.2, respectively after 24 h and maintained their pH at 6.7 to 7.3 throughout the treatment period. Demineralization (%) in 5 % glucose and 5 % cassava was highest during the first day of treatment which was 82% and 83%, respectively. Deproteination (%) was highest in 5% cassava starch on the 3rd day of treatment at 84.4%. The obtained chitin from 5% cassava and 5% glucose had a residual ash and protein below 1% and solubility of 59% and 44.3%, respectively. Chitosan produced from 5% cassava and 5% glucose had protein content below 0.05%; residual ash was 1.1% and 0.8%, respectively. Chitosan solubility and degree of deacetylation were 56% and 33% in 5% glucose and 48% and 29% in 5% cassava, respectively. The advantage this alternative technology offers over that of chemical extraction is large reduction in chemicals needed thus less effluent production and generation of a protein-rich liquor, although the demineralization process should be improved to achieve greater degree of deacetylation.

Keywords: alternative carbon source, bioprocessing, lactic acid bacteria, waste utilization

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3601 Pathogenic Escherichia Coli Strains and Their Antibiotic Susceptibility Profiles in Cases of Child Diarrhea at Addis Ababa University, College of Health Sciences, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Authors: Benyam Zenebe, Tesfaye Sisay, Gurja Belay, Workabeba Abebe

Abstract:

Background: The prevalence and antibiogram of pathogenic E. coli strains, which cause diarrhea vary from region to region, and even within countries in the same geographical area. In Ethiopia, diagnostic approaches to E. coli induced diarrhea in children less than five years of age are not standardized. The aim of this study was to determine the involvement of pathogenic E. coli strains in child diarrhea and determine the antibiograms of the isolates in children less than 5 years of age with diarrhea at Addis Ababa University College of Health Sciences TikurAnbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: A purposive study that included 98 diarrheic children less than five years of age was conducted at Addis Ababa University College of Health Sciences, TikurAnbessa Specialized Hospital, Addis Ababa, Ethiopia to detect pathogenic E. coli biotypes. Stool culture was used to identify presumptive E. coliisolates. Presumptive isolates were confirmed by biochemical tests, and antimicrobial susceptibility tests were performed on confirmed E. coli isolates by the disk diffusion method. DNA was extracted from confirmed isolates by a heating method and subjected to Polymerase Chain Reaction or the presence of virulence genes. Amplified PCR products were analyzed by agarose gel electrophoresis. Data were collected on child demographics and clinical conditions using administered questionnaires. The prevalence of E. coli strains from the total diarrheic children, and the prevalence of pathogenic strains from total E. coli isolates along with their susceptibility profiles; the distribution of pathogenic E.coli biotypes among different age groups and between the sexes were determined by using descriptive statistics. Result: Out of 98 stool specimens collected from diarrheic children less than 5 years of age, 75 presumptive E. coli isolates were identified by culture; further confirmation by biochemical tests showed that only 56 of the isolates were E. coli; 29 of the isolates were found in male children and 27 of them in female children. Out of the 58 isolates of E. coli, 25 pathotypes belonging to different classes of pathogenic strains: STEC, EPEC, EHEC, EAEC were detected by using the PCR technique. Pathogenic E. coli exhibited high rates of antibiotic resistance to many of the antibiotics tested. Moreover, they exhibited multiple drug resistance. Conclusion: This study found that the isolation rate of E. coli and the involvement of antibiotic-resistant pathogenic E. coli in diarrheic children is prominent, and hence focus should be given on the diagnosis and antimicrobial sensitivity testing of pathogenic E. coli at Addis Ababa University College of Health Sciences TikurAnbessa Specialized Hospital. Among antibiotics tested, Cefotitan could be a drug of choice to treat E. coli.

Keywords: antibiotic susceptibility profile, children, diarrhea, E. coli, pathogenic

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3600 “A Built-In, Shockproof, Shit Detector”: Major Challenges and Peculiarities of Translating Ernest Hemingway’s Short Stories Into Georgian

Authors: Natia Kvachakidze

Abstract:

Translating fiction is a complicated and multidimensional issue. However, studying and analyzing literary translations is not less challenging. This becomes even more complex due to the existence of several alternative translations of one and the same literary work. However, this also makes the research process more interesting at the same time. The aim of the given work is to distinguish major obstacles and challenges translators come across while working on Ernest Hemingway’s short fiction, as well as to analyze certain peculiarities and characteristic features of some existing Georgian translations of the writer’s work (especially in the context of various alternative versions of some well-known short stories). Consequently, the focus is on studying how close these translations come to the form and the context of the original text in order to see if the linguistic and stylistic characteristics of the original author are preserved. Moreover, it is interesting not only to study the relevance of each translation to the original text but also to present a comparative analysis of some major peculiarities of the given translations, which are naturally characterized by certain strengths and weaknesses. The latter is at times inevitable, but in certain cases, there is room for improvement. The given work also attempts to humbly suggest certain ways of possible improvements of some translation inadequacies, as this can provide even more opportunities for deeper and detailed studies in the future.

Keywords: Hemingway, short fiction, translation, Georgian

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3599 Dwelling in the Built Environment: The Resilience by Design in Modular Thinking toward an Adaptive Alternatives

Authors: Tzen-Ying Ling

Abstract:

Recently, the resilience of dwellings in urban areas has been deliberated, as to accommodate the growing demand for changing the demography and rapid urbanization. The need to incorporate sustainability and cleaner production thinking have intensified to mitigate climate risks and satisfy the demand for housing. The modular thinking satisfies both the pressing call for fast-tracked housing stocks; while meeting the goal of more sustainable production. In the other side, the importance of the dwelling as a podium for well-being and social connectedness are sought to explore the key human/environment design thinking for the modular system in dwelling. We argue the best practice incorporates the concept of systemic components thinking. The fieldwork reported in this paper illustrates the process of the case study in a modular dwelling unit prototype development; focusing on the systemic frame system design process and adjustment recommendation hereafter. Using a case study method, the study identified that: (1) inclusive human dimensional factoring through systemic design thinking results in affordable implementations possibilities. (2) The environmental dimension encourages the place-based solution suited for the locality and the increasing demand for dwelling in the urban system. (3) Prototype design consideration avails module system component as dwelling construction alternative. (4) Building code often acts as an inhibitor for such dwelling units by the restriction in lot sizes and units placement. The demand for fast-track dwelling construction and cleaner production decisively outweighs the code inhibition; we further underscored the sustainability implication of the alternative prototype as the core of this study. The research suggests that modular thinking results in a resilient solution suited for the locality and the increasing demand for dwelling in the urban system.

Keywords: system prototype, urban resilience, human/environment dimension, modular thinking, dwelling alternative

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3598 Metal-Organic Chemical Vapor Deposition (MOCVD) Process Investigation for Co Thin Film as a TSV Alternative Seed Layer

Authors: Sajjad Esmaeili, Robert Krause, Lukas Gerlich, Alireza Mohammadian Kia, Benjamin Uhlig

Abstract:

This investigation aims to develop the feasible and qualitative process parameters for the thin films fabrication into ultra-large through-silicon-vias (TSVs) as vertical interconnections. The focus of the study is on TSV metallization and its challenges employing new materials for the purpose of rapid signal propagation in the microsystems technology. Cobalt metal-organic chemical vapor deposition (Co-MOCVD) process enables manufacturing an adhesive and excellent conformal ultra-thin film all the way through TSVs in comparison with the conventional non-conformal physical vapor deposition (PVD) process of copper (Cu) seed layer. Therefore, this process provides a Cu seed-free layer which is capable of direct Cu electrochemical deposition (Cu-ECD) on top of it. The main challenge of this metallization module is to achieve the proper alternative seed layer with less roughness, sheet resistance and granular organic contamination (e.g. carbon) which intensify the Co corrosion under the influence of Cu electrolyte.

Keywords: Cobalt MOCVD, direct Cu electrochemical deposition (ECD), metallization technology, through-silicon-via (TSV)

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3597 Biodiesel Is an Alternative Fuel for CI Engines

Authors: Sanat Kumar, Rahul Kumar Tiwari

Abstract:

At this time when society is becoming increasingly aware of the declining reserves of fossil, it has become apparent that biodiesel is destined to make a substantial contribution to the future energy demands of the domestic and industrial economies. In this regard, the significance of biodiesel is technically and commercially viable alternative to fossil-diesel. There are different potential feed stocks for biodiesel production. This paper analyses the performance, combustion and emission characteristics of biodiesel from different feed stocks. Biodiesel fuel is considered as offering many benefits like reduction of greenhouse gas emissions and many harmful pollutants (PM, HC, CO etc.). This paper critically reviews the effect of injection timing on combustion and emission characteristics. An attempt has been carried out to discuss the effect of biodiesel in terms of combustion, emission and performance based up on composition and properties. The results of the study show that different chemical composition leads to variation in its combustion, performance and emission characteristics. Biodiesel produced from different aspired feed stocks reduces the pollutant emission and resistive to oxidation but exhibit poor atomization. As a conclusion many research needs to be carried out to understand the relationship between the types of biodiesel feed stock, performance conclusion and emission.

Keywords: atomization, biodiesel, greenhouse gas, oxidation

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3596 Chitin Nanocrystals as Sustainable Surfactant Alternative for Enhancing Oil-in-Water Emulsions Stability in Oil and Gas Fields

Authors: A. Altomi, A. Alhebshi, M. Rasm, B. Osman

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This study explored the application of chitin nanocrystals (ChiNCs), derived from a renewable and environmentally friendly material, as stabilizers for oil-in-water (O/W) emulsions. O/W emulsions are commonly used in various applications but are prone to instability and degradation over time. Instability can occur due to factors such as flocculation, coalescence, and gravitational separation, including creaming and sedimentation, either independently or simultaneously. To produce ChiNCs, chitin powder underwent acid hydrolysis. Transmission electron microscopy (TEM) analysis revealed that ChiNCs exhibited a needle-like morphology, with lengths ranging from 200 to 800 nm and widths ranging from 20 to 80 nm. The surface charge of ChiNCs was negative at pH values above 7 and positive at pH values below 7. The rheological properties of O/W emulsions stabilized by ChiNCs were compared to those stabilized by synthetic surfactants, namely Tween 80 and CTAB. The emulsions stabilized by ChiNCs demonstrated higher yield stress and lower shear viscosity compared to those stabilized by synthetic surfactants. This indicates that ChiNC-stabilized emulsions are more stable and less prone to breakdown. Based on these findings, ChiNCs show promise as an alternative to synthetic surfactants for stabilizing O/W emulsions.

Keywords: chitin nanocrystals, colloidal pickering, emulsion rheology, oil-in-water, synthetic surfactant

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3595 Heteroscedastic Parametric and Semiparametric Smooth Coefficient Stochastic Frontier Application to Technical Efficiency Measurement

Authors: Rebecca Owusu Coffie, Atakelty Hailu

Abstract:

Variants of production frontier models have emerged, however, only a limited number of them are applied in empirical research. Hence the effects of these alternative frontier models are not well understood, particularly within sub-Saharan Africa. In this paper, we apply recent advances in the production frontier to examine levels of technical efficiency and efficiency drivers. Specifically, we compare the heteroscedastic parametric and the semiparametric stochastic smooth coefficient (SPSC) models. Using rice production data from Ghana, our empirical estimates reveal that alternative specification of efficiency estimators results in either downward or upward bias in the technical efficiency estimates. Methodologically, we find that the SPSC model is more suitable and generates high-efficiency estimates. Within the parametric framework, we find that parameterization of both the mean and variance of the pre-truncated function is the best model. For the drivers of technical efficiency, we observed that longer farm distances increase inefficiency through a reduction in labor productivity. High soil quality, however, increases productivity through increased land productivity.

Keywords: pre-truncated, rice production, smooth coefficient, technical efficiency

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3594 Sustainability in the Purchase of Airline Tickets: Analysis of Digital Communication from the Perspective of Neuroscience

Authors: Rodríguez Sánchez Carla, Sancho-Esper Franco, Guillen-Davo Marina

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Tourism is one of the most important sectors worldwide since it is an important economic engine for today's society. It is also one of the sectors that most negatively affect the environment in terms of CO₂ emissions due to this expansion. In light of this, airlines are developing Voluntary Carbon Offset (VCO). There is important evidence focused on analyzing the features of these VCO programs and their efficacy in reducing CO₂ emissions, and findings are mixed without a clear consensus. Different research approaches have centered on analyzing factors and consequences of VCO programs, such as economic modelling based on panel data, survey research based on traveler responses or experimental research analyzing customer decisions in a simulated context. This study belongs to the latter group because it tries to understand how different characteristics of an online ticket purchase website affect the willingness of a traveler to choose a sustainable one. The proposed behavioral model is based on several theories, such as the nudge theory, the dual processing ELM and the cognitive dissonance theory. This randomized experiment aims at overcoming previous studies based on self-reported measures that mainly study sustainable behavioral intention rather than actual decision-making. It also complements traditional self-reported independent variables by gathering objective information from an eye-tracking device. This experiment analyzes the influence of two characteristics of the online purchase website: i) the type of information regarding flight CO₂ emissions (quantitative vs. qualitative) and the comparison framework related to the sustainable purchase decision (negative: alternative with more emissions than the average flight of the route vs. positive: alternative with less emissions than the average flight of the route), therefore it is a 2x2 experiment with four alternative scenarios. A pretest was run before the actual experiment to refine the experiment features and to check the manipulations. Afterward, a different sample of students answered the pre-test questionnaire aimed at recruiting the cases and measuring several pre-stimulus measures. One week later, students came to the neurolab at the University setting to be part of the experiment, made their decision regarding online purchases and answered the post-test survey. A final sample of 21 students was gathered. The committee of ethics of the institution approved the experiment. The results show that qualitative information generates more sustainable decisions (less contaminant alternative) than quantitative information. Moreover, evidence shows that subjects are more willing to choose the sustainable decision to be more ecological (comparison of the average with the less contaminant alternative) rather than to be less contaminant (comparison of the average with the more contaminant alternative). There are also interesting differences in the information processing variables from the eye tracker. Both the total time to make the choice and the specific times by area of interest (AOI) differ depending on the assigned scenario. These results allow for a better understanding of the factors that condition the decision of a traveler to be part of a VCO program and provide useful information for airline managers to promote these programs to reduce environmental impact.

Keywords: voluntary carbon offset, airline, online purchase, carbon emission, sustainability, randomized experiment

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3593 Comparison of Two Methods of Cryopreservation of Testicular Tissue from Prepubertal Lambs

Authors: Rensson Homero Celiz Ygnacio, Marco Aurélio Schiavo Novaes, Lucy Vanessa Sulca Ñaupas, Ana Paula Ribeiro Rodrigues

Abstract:

The cryopreservation of testicular tissue emerges as an alternative for the preservation of the reproductive potential of individuals who still cannot produce sperm; however, they will undergo treatments that may affect their fertility (e.g., chemotherapy). Therefore, the present work aims to compare two cryopreservation methods (slow freezing and vitrification) in testicular tissue of prepubertal lambs. For that, to obtain the testicular tissue, the animals were castrated and the testicles were collected immediately in a physiological solution supplemented with antibiotics. In the laboratory, the testis was split into small pieces. The total size of the testicular fragments was 3×3x1 mm³ and was placed in a dish contained in Minimum Essential Medium (MEM-HEPES). The fragments were distributed randomly into non-cryopreserved (fresh control), slow freezing (SF), and vitrified. To SF procedures, two fragments from a given male were then placed in a 2,0 mL cryogenic vial containing 1,0 mL MEM-HEPES supplemented with 20% fetal bovine serum (FBS) and 20% dimethylsulfoxide (DMSO). Tubes were placed into a Mr. Frosty™ Freezing container with isopropyl alcohol and transferred to a -80°C freezer for overnight storage. On the next day, each tube was plunged into liquid nitrogen (NL). For vitrification, the ovarian tissue cryosystem (OTC) device was used. Testicular fragments were placed in the OTC device and exposed to the first vitrification solution composed of MEM-HEPES supplemented with 10 mg/mL Bovine Serum Albumin (BSA), 0.25 M sucrose, 10% Ethylene glycol (EG), 10% DMSO and 150 μM alpha-lipoic acid for four min. The VS1 was discarded and then the fragments were submerged into a second vitrification solution (VS2) containing the same composition of VS1 but 20% EG and 20% DMSO. VS2 was then discarded and each OTC device containing up to four testicular fragments was closed and immersed in NL. After the storage period, the fragments were removed from the NL, kept at room temperature for one min and then immersed at 37 °C in a water bath for 30 s. Samples were warmed by sequentially immersing in solutions of MEM-HEPES supplemented with 3 mg/mL BSA and decreasing concentrations of sucrose. Hematoxylin-eosin staining to analyze the tissue architecture was used. The score scale used was from 0 to 3, classified with a score 0 representing normal morphologically, and 3 were considered a lot of alteration. The histomorphological evaluation of the testicular tissue shows that when evaluating the nuclear alteration (distinction of nucleoli and condensation of nuclei), there are no differences when using slow freezing with respect to the control. However, vitrification presents greater damage (p <0.05). On the other hand, when evaluating the epithelial alteration, we observed that the freezing showed scores statistically equal to the control in variables such as retraction of the basement membrane, formation of gaps and organization of the peritubular cells. The results of the study demonstrated that cryopreservation using the slow freezing method is an excellent tool for the preservation of pubertal testicular tissue.

Keywords: cryopreservation, slow freezing, vitrification, testicular tissue, lambs

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3592 Acupuncture for Major Depressive Disorders: A Systematic Review of the Randomized Clinical Trials

Authors: Derick Shi-Chen Ou, Liang-Yu Chen

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Background: Acupuncture, a potential alternative, and complementary therapy revealed insufficient evidence in depression treatment. The efficacy of acupuncture treatment was still uncertainty. To evaluate the effect of acupuncture in treating depression, the randomized controlled trials (RCTs) were examined. Methods: RCTs of the acupuncture therapy in treating major depression were searched from MEDLINE from 2007 to 2017. Keywords used for searching strategy included acupuncture, acupoint, and major depressive disorder. Results: Among the nine RCTs, four studies demonstrated great improvement in acupuncture treatment and five studies revealed the effectiveness of acupuncture intervention in medication. General trends suggest that acupuncture treatment is as effective as antidepressants with minimal side effects. Conclusion: Despite the promising results from the RCTs, there are still a variety of limitations, including small sample size, imprecise enrollment criteria, difficulties with blinding, randomization, short duration of study and lack of longitudinal follow-up. Therefore, the evidence that acupuncture as an alternative therapy for depression is inconclusive. More rigorously designed RCTs should be conducted in the future.

Keywords: acupuncture, major depressive disorders, randomized clinical trials, antidepressants

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