Search results for: Abbas Shah

Authors: Sidra Suleman, Maliha Suleman, Jinesh Shah

Abstract:

Maxillary canines play a crucial role in occlusion and aesthetics. Successful management of impacted canines requires early identification and intervention to prevent complications such as resorption of adjacent teeth and cystic changes. Although removal of the deciduous canine can encourage normal eruption of its successor, this is not always successful. Some patients may require surgical exposure and bonding of a gold chain to mobilise and align the canine, which can take up to 3 years. As this procedure has various risks, patients need to be appropriately consented to. Failure of such treatment commonly occurs due to inadequate anchorage or failure of the gold chain attachment, but in some cases, this is due to ankylosis. Aim: The aim of this study was to determine the incidence of ankylosis of unerupted maxillary ectopic canines following surgical exposure and orthodontic alignment at the Maxillofacial and Orthodontic Department, Royal Stoke University Hospital (RSUH), United Kingdom. Methodology: Patients treated from January 1, 2017, to December 31, 2019, were retrospectively studied. Electronic records with post-treatment follow-up at 3-6 months and 12-15 months were extracted and analysed. Patients were excluded based on three criteria, non-compliance with orthodontic treatment post-surgery, presence of canine transposition, and external orthodontic treatment. Sample: Overall, 159 suitable patients were selected from the 171 patients identified. Surgical exposure and gold chain bonding was carried out for a total of 206 maxillary canines, with the pattern of impaction being 159 (77.2 %) palatal, 46 (22.3%) buccal, and 1 (0.49%) in line of the arch. The sample consisted of 57 (35.8%) males and 102 (64.2%) females between the age range of 10 to 32 years, with the mean age being 15 years. The procedures were carried out under general anaesthesia for all but three patients, with two cases being repeats. Closed exposure was carried out for 189 (91.7%) canines. Results: The incidence of ankylosis from this study was 0.97%. In total, two patients had upper left canine ankylosis, which was identified at their 12-15 months orthodontic follow-up. Both patients were males, one having closed exposure at age 15 and the other having open exposure at age 19. Conclusions: Although this data shows that there is a low risk of ankylosis (0.97%), it highlights the difficulty in predicting which patients may be affected, and thus, a thorough pre-treatment assessment and careful observation during treatment is necessary. Future studies involving larger cohorts are warranted to further analyse factors affecting outcomes.

Keywords: ankylosis, ectopic, maxillary canines, orthodontics

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Authors: Joshi Rajiv, Shah Priyank, Thavkar Amit, Rohira Poonam, Mehta Suyog

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Topical formulation containing minoxidil and finasteride helps hair growth in the treatment of male androgenetic alopecia. The objective of this study is to compare the irritation potential of three conventional formulations of minoxidil 5% + finasteride 0.1% topical solution of in human patch test. The study was a single centre, double blind, non-randomized controlled study in 53 healthy adult Indian subjects. Occlusive patch test for 24 hours was performed with three formulations of minoxidil 5% + finasteride 0.1% topical solution. Products tested included aqueous based minoxidil 5% + finasteride 0.1% (AnasureTM-F, Sun Pharma, India – Brand A), lipid based minoxidil 5% + finasteride 0.1% (Brand B) and aqueous based minoxidil 5% + finasteride 0.1% (Brand C). Isotonic saline 0.9% and 1% w/w sodium lauryl sulphate were included as negative control and positive control respectively. Patches were applied and removed after 24 hours. The skin reaction was assessed and clinically scored 24 hours after the removal of the patches under constant artificial daylight source using the Draize scale (0-4 points scale for erythema/dryness//wrinkles and for oedema). Follow-up was scheduled after one week to confirm recovery for any reaction. A combined mean score up to 2.0/8.0 indicates a product is “non-irritant” and a score between 2.0/8.0 and 4.0/8.0 indicates “mildly irritant” and a score above 4.0/8.0 indicates “irritant”. The procedure of the patch test followed the principles outlined by the Bureau of Indian Standards (BIS) (IS 4011:2018; Methods of Test for safety evaluation of Cosmetics-3rd revision). Fifty three subjects with mean age 31.9 years (25 males and 28 females) participated in the study. The combined mean score ± standard deviation were: 0.06 ± 0.23 (Brand A), 0.81 ± 0.59 (Brand B), 0.38 ± 0.49 (Brand C), 2.92 ± 0.47 (positive control) and 0.0 ± 0.0 (Negative control). This means the score of Brand A (Sun Pharma product) was significantly lower than that of Brand B (p=0.001) and that of Brand C (p=0.001). The combined mean erythema score ± standard deviation were: 0.06 ± 0.23 (Brand A), 0.81 ± 0.59 (Brand B), 0.38 ± 0.49 (Brand C), 2.09 ± 0.4 (Positive control) and 0.0 ± 0.0 (Negative control). The mean erythema score of Brand A was significantly lower than Brand B (p=0.001) and that of Brand C (p=0.001). Any reaction observed at 24hours after patch removal subsided in a week. All the three topical formulations of minoxidil 5% + finasteride 0.1% were non-irritant. Brand A of minoxidil 5% + finasteride 0.1% (Sun Pharma) was found to be the least irritant than Brand B and Brand C based on the combined mean score and mean erythema score in the human patch test as per the BIS, IS 4011:2018

Keywords: erythema, finasteride, irritation, minoxidil, patch test

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Authors: Sule Pallavi, Shah Priyank, Thavkar Amit, Rohira Poonam, Mehta Suyog

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Introduction: Minoxidil has been used topically for a long time to assist hair growth in the management of male androgenetic alopecia. The aim of this study was a comparative assessment of the irritation potential of three commercial formulations of minoxidil 2% topical solution in a human patch test. Methodology: The study was a non-randomized, double-blind, controlled, single-center study of 56 healthy adult Indian subjects. A 24-hour occlusive patch test was conducted with three formulations of minoxidil 2% topical solution. Products tested were aqueous-based minoxidil 2% (AnasureTM 2%, Sun Pharma, India – Brand A), alcohol-based minoxidil 2% (Brand B) and aqueous-based minoxidil 2% (Brand C). Isotonic saline 0.9% and 1% w/w sodium lauryl sulphate as a negative and positive control, respectively, were included. Patches were applied on the back, followed by removal after 24 hours. The Draize scale (0-4 points scale for erythema/dryness/wrinkles and for oedema) was used to evaluate and clinically score the skin reaction under constant artificial daylight 24 hours after the removal of the patches. The patch test was based on the principles outlined by Bureau of Indian Standards (BIS) (IS 4011:2018; Methods of Test for safety evaluation of Cosmetics-3rd revision). A mean combined score up to 2.0/8.0 indicates that a product is “non-irritant,” and a score between 2.0/8.0 and 4.0/8.0 indicates “mildly irritant” and a score above 4.0/8.0 indicates “irritant”. In case of any skin reaction that was observed, a follow-up was planned after one week to confirm recovery. Results: The 56 subjects who participated in the study had a mean age of 28.7 years (28 males and 28 females). The combined mean score ± standard deviation was: 0.09 ± 0.29 (Brand A), 0.29± 0.53 (Brand B), 0.30 ± 0.46 (Brand C), 3.25 ± 0.77 (positive control) and 0.02 ± 0.13 (negative control). This mean score of Brand A (Sun Pharma) was significantly lower than that of Brand B (p=0.016) and that of Brand C (p=0.004). The mean erythema score ± standard deviation was: 0.09 ± 0.29 (Brand A), 0.27 ± 0.49 (Brand B), 0.30 ± 0.46 (Brand C), 2.5 ± 0.66 (positive control) and 0.02 ± 0.13 (negative control). The mean erythema score of Brand A (Sun Pharma) was significantly lower than that of Brand B (p=0.019) and that of Brand C (p=0.004). Reactions that were observed 24 hours after patch removal subsided in a week’s time. Conclusion: Based on the human patch test as per the BIS, IS 4011:2018, all the three topical formulations of minoxidil 2% were found to be non-irritant. Brand A of 2% minoxidil (Sun Pharma) was found to be the least irritant than Brand B and Brand C based on the combined mean score and mean erythema score.

Keywords: erythema, irritation, minoxidil, patch test

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Authors: Joseph Fitoussi, Mohammadali Shirinbayan, Abbas Tcharkhtchi

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Due to material flow during processing, short fiber reinforced composites structures obtained by injection or compression molding generally present strong spatial microstructure variation. On the other hand, quasi-static, dynamic, and fatigue behavior of these materials are highly dependent on microstructure parameters such as fiber orientation distribution. Indeed, because of complex damage mechanisms, SFRC structures design is a key challenge for safety and reliability. In this paper, we propose a micromechanical model allowing prediction of damage behavior of real structures as a function of microstructure spatial distribution. To this aim, a statistical damage criterion including strain rate and fatigue effect at the local scale is introduced into a Mori and Tanaka model. A critical local damage state is identified, allowing fatigue life prediction. Moreover, the multi-scale model is coupled with an experimental intrinsic link between damage under monotonic loading and fatigue life in order to build an abacus giving Tsai-Wu failure criterion parameters as a function of microstructure and targeted fatigue life. On the other hand, the micromechanical damage model gives access to the evolution of the anisotropic stiffness tensor of SFRC submitted to complex thermomechanical loading, including quasi-static, dynamic, and cyclic loading with temperature and amplitude variations. Then, the latter is used to fill out microstructure dependent material cards in finite element analysis for design optimization in the case of complex loading history. The proposed methodology is illustrated in the case of a real automotive component made of sheet molding compound (PSA 3008 tailgate). The obtained results emphasize how the proposed micromechanical methodology opens a new path for the automotive industry to lighten vehicle bodies and thereby save energy and reduce gas emission.

Keywords: short fiber reinforced composite, structural design, damage, micromechanical modelling, fatigue, strain rate effect

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Authors: Mende Mensa Sorato, Majid Davari, Abbas Kebriaeezadeh, Nizal Sarrafzadegan, Tamiru Shibru, Behzad Fatemi

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Markov model, like cardiovascular disease (CVD) policy model based simulation, is being used for evaluating the cost-effectiveness of hypertension treatment. Stroke, angina, myocardial infarction (MI), cardiac arrest, and all-cause mortality were included in this model. Hypertension is a risk factor for a number of vascular and cardiac complications and CVD outcomes. Objective: This systematic review was conducted to evaluate the comprehensiveness of this model across different regions globally. Methods: We searched articles written in the English language from PubMed/Medline, Ovid/Medline, Embase, Scopus, Web of Science, and Google scholar with a systematic search query. Results: Thirteen cohort studies involving a total of 2,165,770 (1,666,554 hypertensive adult population and 499,226 adults with treatment-resistant hypertension) were included in this scoping review. Hypertension is clearly associated with coronary heart disease (CHD) and stroke mortality, unstable angina, stable angina, MI, heart failure (HF), sudden cardiac death, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, peripheral arterial disease (PAD), and abdominal aortic aneurism (AAA). Association between HF and hypertension is variable across regions. Treatment resistant hypertension is associated with a higher relative risk of developing major cardiovascular events and all-cause mortality when compared with non-resistant hypertension. However, it is not included in the previous CVD policy model. Conclusion: The CVD policy model used can be used in most regions for the evaluation of the cost-effectiveness of hypertension treatment. However, hypertension is highly associated with HF in Latin America, the Caribbean, Eastern Europe, and Sub-Saharan Africa. Therefore, it is important to consider HF in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment in these regions. We do not suggest the inclusion of PAD and AAA in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment due to a lack of sufficient evidence. Researchers should consider the effect of treatment-resistant hypertension either by including it in the basic model or during setting the model assumptions.

Keywords: cardiovascular disease policy model, cost-effectiveness analysis, hypertension, systematic review, twelve major cardiovascular events

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Authors: Abbas Sheikhtaheri, Nasim Hashemi

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Health information systems have great benefits for clinical and managerial processes of health care organizations. However, identifying and removing constraints and barriers of implementing and using health information systems before any implementation is essential. Physicians are one of the main users of health information systems, therefore, identifying the causes of their resistance and concerns about the barriers of the implementation of these systems is very important. So the purpose of this study was to determine the barriers of the development and implementation of health information systems in terms of the Iranian physicians’ perspectives. In this study conducted in 8 selected hospitals affiliated to Tehran and Iran Universities of Medical Sciences, Tehran, Iran in 2014, physicians (GPs, residents, interns, specialists) in these hospitals were surveyed. In order to collect data, a research made questionnaire was used (Cronbach’s α = 0.95). The instrument included 25 about organizational (9), personal (4), moral and legal (3) and technical barriers (9). Participants were asked to answer the questions using 5 point scale Likert (completely disagree=1 to completely agree=5). By using a simple random sampling method, 200 physicians (from 600) were invited to study that eventually 163 questionnaires were returned. We used mean score and t-test and ANOVA to analyze the data using SPSS software version 17. 52.1% of respondents were female. The mean age was 30.18 ± 7.29. The work experience years for most of them were between 1 to 5 years (80.4 percent). The most important barriers were organizational ones (3.4 ± 0.89), followed by ethical (3.18 ± 0.98), technical (3.06 ± 0.8) and personal (3.04 ± 1.2). Lack of easy access to a fast Internet (3.67±1.91) and the lack of exchanging information (3.61±1.2) were the most important technical barriers. Among organizational barriers, the lack of efficient planning for the development and implementation systems (3.56±1.32) and was the most important ones. Lack of awareness and knowledge of health care providers about the health information systems features (3.33±1.28) and the lack of physician participation in planning phase (3.27±1.2) as well as concerns regarding the security and confidentiality of health information (3.15 ± 1.31) were the most important personal and ethical barriers, respectively. Women (P = 0.02) and those with less experience (P = 0.002) were more concerned about personal barriers. GPs also were more concerned about technical barriers (P = 0.02). According to the study, technical and ethics barriers were considered as the most important barriers however, lack of awareness in target population is also considered as one of the main barriers. Ignoring issues such as personal and ethical barriers, even if the necessary infrastructure and technical requirements were provided, may result in failure. Therefore, along with the creating infrastructure and resolving organizational barriers, special attention to education and awareness of physicians and providing solution for ethics concerns are necessary.

Keywords: barriers, development health information systems, implementation, physicians

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Authors: Abbas Ahmadi, Bijan Raie, Mohammad Reza Neyshabouri, Mohammad Ali Ghorbani, Farrokh Asadzadeh

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In recent years, vast areas of Urmia Lake in Dasht-e-Tabriz has dried up leading to saline sediments exposure on the surface lake coastal areas being highly susceptible to wind erosion. This study was conducted to investigate wind erosion and its relevance to soil physicochemical properties and also modeling of wind erodibility (WE) using artificial intelligence techniques. For this purpose, 96 soil samples were collected from 0-5 cm depth in 414000 hectares using stratified random sampling method. To measure the WE, all samples (<8 mm) were exposed to 5 different wind velocities (9.5, 11, 12.5, 14.1 and 15 m s-1 at the height of 20 cm) in wind tunnel and its relationship with soil physicochemical properties was evaluated. According to the results, WE varied within the range of 76.69-9.98 (g m-2 min-1)/(m s-1) with a mean of 10.21 and coefficient of variation of 94.5% showing a relatively high variation in the studied area. WE was significantly (P<0.01) affected by soil physical properties, including mean weight diameter, erodible fraction (secondary particles smaller than 0.85 mm) and percentage of the secondary particle size classes 2-4.75, 1.7-2 and 0.1-0.25 mm. Results showed that the mean weight diameter, erodible fraction and percentage of size class 0.1-0.25 mm demonstrated stronger relationship with WE (coefficients of determination were 0.69, 0.67 and 0.68, respectively). This study also compared efficiency of multiple linear regression (MLR), gene expression programming (GEP), artificial neural network (MLP), artificial neural network based on genetic algorithm (MLP-GA) and artificial neural network based on whale optimization algorithm (MLP-WOA) in predicting of soil wind erodibility in Dasht-e-Tabriz. Among 32 measured soil variable, percentages of fine sand, size classes of 1.7-2.0 and 0.1-0.25 mm (secondary particles) and organic carbon were selected as the model inputs by step-wise regression. Findings showed MLP-WOA as the most powerful artificial intelligence techniques (R2=0.87, NSE=0.87, ME=0.11 and RMSE=2.9) to predict soil wind erodibility in the study area; followed by MLP-GA, MLP, GEP and MLR and the difference between these methods were significant according to the MGN test. Based on the above finding MLP-WOA may be used as a promising method to predict soil wind erodibility in the study area.

Keywords: wind erosion, erodible fraction, gene expression programming, artificial neural network

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Authors: Deborah Eric, Abbas Ahmad Khan

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Lead halide perovskites quantum dots have attracted immense scientific and technological interest for successful photovoltaic applications because of their remarkable optoelectronic properties. In this paper, we have simulated CsMAPbI3-xBrx based quantum dots to implement their use in intermediate band solar cells (IBSC). These types of materials exhibit optical and electrical properties distinct from their bulk counterparts due to quantum confinement. The conceptual framework provides a route to analyze the electronic properties of quantum dots. This layer of quantum dots optimizes the position and bandwidth of IB that lies in the forbidden region of the conventional bandgap. A three-dimensional MAPbI3 quantum dot (QD) with geometries including spherical, cubic, and conical has been embedded in the CsPbBr3 matrix. Bound energy wavefunction gives rise to miniband, which results in the formation of IB. If there is more than one miniband, then there is a possibility of having more than one IB. The optimization of QD size results in more IBs in the forbidden region. One band time-independent Schrödinger equation using the effective mass approximation with step potential barrier is solved to compute the electronic states. Envelope function approximation with BenDaniel-Duke boundary condition is used in combination with the Schrödinger equation for the calculation of eigen energies and Eigen energies are solved for the quasi-bound states using an eigenvalue study. The transfer matrix method is used to study the quantum tunneling of MAPbI3 QD through neighbor barriers of CsPbI3. Electronic states are computed using Schrödinger equation with effective mass approximation by considering quantum dot and wetting layer assembly. Results have shown the varying the quantum dot size affects the energy pinning of QD. Changes in the ground, first, second state energies have been observed. The QD is non-zero at the center and decays exponentially to zero at boundaries. Quasi-bound states are characterized by envelope functions. It has been observed that conical quantum dots have maximum ground state energy at a small radius. Increasing the wetting layer thickness exhibits energy signatures similar to bulk material for each QD size.

Keywords: perovskite, intermediate bandgap, quantum dots, miniband formation

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Authors: Maryam Hajibaba, Mohsen Soltanpour, Mehrnoosh Abbasian, S. Abbas Haghshenas

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This paper aims to evaluate the main role of mangroves forests on the unique hydrodynamic characteristics of the Khuran Strait (KS) in the Persian Gulf. Investigation of hydrodynamic conditions of KS is vital to predict and estimate sedimentation and erosion all over the protected areas north of Qeshm Island. KS (or Tang-e-Khuran) is located between Qeshm Island and the Iranian mother land and has a minimum width of approximately two kilometers. Hydrodynamics of the strait is dominated by strong tidal currents of up to 2 m/s. The bathymetry of the area is dynamic and complicated as 1) strong currents do exist in the area which lead to seemingly sand dune movements in the middle and southern parts of the strait, and 2) existence a vast area with mangrove coverage next to the narrowest part of the strait. This is why ordinary modeling schemes with normal mesh resolutions are not capable for high accuracy estimations of current fields in the KS. A comprehensive set of measurements were carried out with several components, to investigate the hydrodynamics and morpho-dynamics of the study area, including 1) vertical current profiling at six stations, 2) directional wave measurements at four stations, 3) water level measurements at six stations, 4) wind measurements at one station, and 5) sediment grab sampling at 100 locations. Additionally, a set of periodic hydrographic surveys was included in the program. The numerical simulation was carried out by using Delft3D – Flow Module. Model calibration was done by comparing water levels and depth averaged velocity of currents against available observational data. The results clearly indicate that observed data and simulations only fit together if a realistic perspective of the mangrove area is well captured by the model bathymetry data. Generating unstructured grid by using RGFGRID and QUICKIN, the flow model was driven with water level time-series at open boundaries. Adopting the available field data, the key role of mangrove area on the hydrodynamics of the study area can be studied. The results show that including the accurate geometry of the mangrove area and consideration of its sponge-like behavior are the key aspects through which a realistic current field can be simulated in the KS.

Keywords: Khuran Strait, Persian Gulf, tide, current, Delft3D

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Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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Aims: Lumbar punctures are a common bedside procedure performed in acute medicine. Published guidance exists on the standardised documentation of invasive procedures in order to reduce the risk of complications. The audit aim was to assess current standards of documentation in accordance with both the GMC and the National Standards for Invasive Procedures guidelines. A second cycle was conducted after introducing a standardised sticker created using current guidelines. This would assess whether the sticker improved documentation, aiming for 100% standard in each step of the procedure. Methods: An initial prospective audit of current practice was conducted over a 3-month period. Patients were identified by their presenting complaints and by colleagues assessing acute medical patients. Initial findings were presented locally, and a further prospective audit was conducted following the implementation of a standardised sticker. Results: 19 lumbar punctures were included in the first cycle and 13 procedures in the second. Pre-procedure documentation was collected for each cycle, whereby documentation of ‘Indication’ improved from 5.3% to 84.6%, ‘Consent’ from 84.2% to 100%, ‘Coagulopathy’ from 0% to 61.5%, ‘Drug Chart checked’ from 0% to 100%, ‘Position of patient’ from 26.3% to 100% and use of ‘Aseptic Technique’ from 83.3% to 100% from the first to the second cycle respectively. ‘Level of Doctor’ and ‘Supervision’ decreased from 53% to 31% and 53% to 46%, respectively, in the second cycle. Documentation of the procedure itself also demonstrated improvements, with ‘Level of Insertion’ 15.8% to 100%, ‘Name of Antiseptic Used’ 11.1% to 69.2%, ‘Local Anaesthetic Used’ 26.3% to 53.8%, ‘Needle Gauge’ 42.1% to 76.9%, ‘Number of Attempts’ 78.9% to 100% and ‘Traumatic/Atraumatic’ procedure 26.3% to 92.3%, respectively. A similar number of opening pressures were documented in each cycle at 57.9% and 53.8%, respectively, but its documentation was deemed ‘Not Applicable’ in a higher number of patients in the second cycle. Post-procedure documentation improved, with ‘Number of Samples obtained’ increasing from 52.6% to 92.3% and documentation of ‘Immediate Complications’ increasing from 78.9% to 100%. ‘Dressing Applied’ was poorly documented in the first cycle at 16.7%. This was not included on the standardised sticker, resulting in 0% documentation in the second cycle. Documentation of Clinicians’ Name and Bleep reduced from 63.2% to 15.4%, but when the name only was analysed, this increased to 84.6%. Conclusions: Standardised stickers for lumbar punctures do improve documentation and hence should result in improved patient safety. There is still room for improvement to reach 100% standard in each area, especially with respect to the clinician’s name and contact details being documented. Final adjustments will be made to the sticker before being included in a lumbar puncture kit, which will be made readily available in the acute medical wards. Future audits could be extended to include other common bedside procedures performed in acute medicine to ensure documentation of all these procedures reaches 100% standard.

Keywords: invasive procedure, lumbar puncture, medical record keeping, procedure checklist, procedure documentation, standardised documentation

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Authors: Ibtisam A. Abbas Al-Darkazly

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In this study, the mechanical properties of alginate hydrogel material for self-standing 3D scaffold architecture with proper shape fidelity are investigated. In-lab built 3D bio-printer extrusion-based technology is utilized to fabricate 3D alginate scaffold constructs. The pressure, needle speed and stage speed are varied using a computer-controlled system. The experimental result indicates that the concentration of alginate solution, calcium chloride (CaCl₂) cross-linking concentration and cross-linking ratios lead to the formation of alginate hydrogel with various gelation states. Besides, the gelling conditions, such as cross-linking reaction time and temperature also have a significant effect on the mechanical properties of alginate hydrogel. Various experimental tests such as the material gelation, the material spreading and the printability test for filament collapse as well as the swelling test were conducted to evaluate the fabricated 3D scaffold constructs. The result indicates that the fabricated 3D scaffold from composition of 3.5% wt alginate solution, that is prepared in DI water and 1% wt CaCl₂ solution with cross-linking ratios of 7:3 show good printability and sustain good shape fidelity for more than 20 days, compared to alginate hydrogel that is prepared in a phosphate buffered saline (PBS). The fabricated self-standing 3D scaffold constructs measured 30 mm × 30 mm and consisted of 4 layers (n = 4) show good pore geometry and clear grid structure after printing. In addition, the percentage change of swelling degree exhibits high swelling capability with respect to time. The swelling test shows that the geometry of 3D alginate-scaffold construct and of the macro-pore are rarely changed, which indicates the capability of holding the shape fidelity during the incubation period. This study demonstrated that the mechanical and physical properties of alginate hydrogel could be tuned for a 3D bio-printing extrusion-based system to fabricate self-standing 3D scaffold soft structures. This 3D bioengineered scaffold provides a natural microenvironment present in the extracellular matrix of the tissue, which could be seeded with the biological cells to generate the desired 3D live tissue model for in vitro and in vivo tissue engineering applications.

Keywords: biomaterial, calcium chloride, 3D bio-printing, extrusion, scaffold, sodium alginate, tissue engineering

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Authors: Rubisha Adhikari, Rajani Shah

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Introduction: Aging is a natural, global and inevitable phenomenon every single person has to go through, and nobody can escape the process. One of the emerging challenges to public health is to improve the quality of later years of life as life expectancy continues to increase. Quality of life (QoL) has grown to be a key goal for many public health initiatives. Population aging has become a global phenomenon as they are growing more quickly in emerging nations than they are in industrialized nations, leaving minimal opportunities to regulate the consequences of the demographic shift. Methods: A community-based descriptive analytical approach was used to examine the quality of life and associated factors among elderly people. A mixed method was chosen for the study. For the quantitative data collection, a household survey was conducted using the WHOQOL-OLD tool. In-depth interviews were conducted among twenty participants for qualitative data collection. Data generated through in-depth interviews were transcribed verbatim. In-depth interviews lasted about an hour and were audio recorded. The in-depth interview guide had been developed by the research team and pilot-tested before actual interviews. Results: This study result showed the association between quality of life and socio-demographic variables. Among all the variables under socio-demographic variable of this study, age (ꭓ2=14.445, p=0.001), gender (ꭓ2=14.323, p=<0.001), marital status (ꭓ2=10.816, p=0.001), education status (ꭓ2=23.948, p=<0.001), household income (ꭓ2=13.493, p=0.001), personal income (ꭓ2=14.129, p=0.001), source of personal income (ꭓ2=28.332,p=<0.001), social security allowance (ꭓ2=18.005,p=<0.001), alcohol consumption (ꭓ2=9.397,p=0.002) are significantly associated with quality of life of elderly. In addition, affordability (ꭓ2=12.088, p=0.001), physical activity (ꭓ2=9.314, p=0.002), emotional support (ꭓ2=9.122, p=0.003), and economic support (ꭓ2=8.104, p=0.004) are associated with quality of life of elderly people. Conclusion: In conclusion, this mixed method study provides insight into the attributes of the quality of life of elderly people in Nepal and similar settings. As the geriatric population is growing in full swing, maintaining a high quality of life has become a major challenge. This study showed that determinants such as age, gender, marital status, education status, household income, personal income, source of personal income, social security allowance and alcohol consumption, economic support, emotional support, affordability and physical activity have an association with quality of life of the elderly.

Keywords: ageing, chitwan, elderly, health status, quality of life

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Authors: Salahud Din, Saima Masood, Hafsa Zaneb, Habib Ur Rehman, Saima Ashraf, Imad Khan, Muqader Shah

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The objective of this study was (1) to study gross morphological, osteometric and clinical important landmarks in the skull of adult Chinkara to obtain baseline data and (2) to study sexual dimorphism in male and female adult Chinkara through osteometry. For this purpose, after performing postmortem examination, the carcass of adult Chinkara of known sex and age was buried in the locality of the Manglot Wildlife Park and Ungulate Breeding Centre, Nizampur, Pakistan; after a specific period of time, the bones were unearthed. Gross morphological features and various osteometric parameters of the skull were studied in the University of Veterinary and Animal Sciences, Lahore, Pakistan. The shape of the Chinkara skull was elongated and had thirty-two bones. The skull was comprised of the cranial and the facial part. The facial region of the skull was formed by maxilla, incisive, palatine, vomar, pterygoid, frontal, parietal, nasal, incisive, turbinates, mandible and hyoid apparatus. The bony region of the cranium of Chinkara was comprised of occipital, ethmoid, sphenoid, interparietal, parietal, temporal, and frontal bone. The foramina identified in the facial region of the skull of Chinkara were infraorbital, supraorbital foramen, lacrimal, sphenopalatine, maxillary and caudal palatine foramina. The foramina of the cranium of the skull of the Chinkara were the internal acoustic meatus, external acoustic meatus, hypoglossal canal, transverse canal, sphenorbital fissure, carotid canal, foramen magnum, stylomastoid foramen, foramen rotundum, foramen ovale and jugular foramen, and the rostral and the caudal foramina that formed the pterygoid canal. The measured craniometric parameters did not show statistically significant differences (p > 0.05) between male and female adult Chinkara except Palatine bone, OI, DO, IOCDE, OCT, ICW, IPCW, and PCPL were significantly higher (p > 0.05) in male than female Chinkara and mean values of the mandibular parameters except b and h were significantly (p < 0.5) higher in male Chinkara than female Chinkara. Sexual dimorphism exists in some of the orbital and foramen magnum parameters, while high levels of sexual dimorphism identified in mandible. In conclusion, morphocraniometric studies of Chinkara skull made it possible to identify species-specific skull and use clinical measurements during practical application.

Keywords: Chinkara, skull, morphology, morphometrics, sexual dimorphism

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Authors: Amir Gharavi, Mohamed Hassan, Amjad Shah

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The main characteristics of unconventional reservoirs include low-to ultra low permeability and low-to-moderate porosity. As a result, hydrocarbon production from these reservoirs requires different extraction technologies than from conventional resources. An unconventional reservoir must be stimulated to produce hydrocarbons at an acceptable flow rate to recover commercial quantities of hydrocarbons. Permeability for unconventional reservoirs is mostly below 0.1 mD, and reservoirs with permeability above 0.1 mD are generally considered to be conventional. The hydrocarbon held in these formations naturally will not move towards producing wells at economic rates without aid from hydraulic fracturing which is the only technique to assess these tight reservoir productions. Horizontal well with multi-stage fracking is the key technique to maximize stimulated reservoir volume and achieve commercial production. The main objective of this research paper is to investigate development options for a tight mature oilfield. This includes multistage hydraulic fracturing and spacing by building of reservoir models in the Reveal simulator to model potential development options based on sidetracking the existing vertical well. To simulate potential options, reservoir models have been built in the Reveal. An existing Petrel geological model was used to build the static parts of these models. A FBHP limit of 40bars was assumed to take into account pump operating limits and to maintain the reservoir pressure above the bubble point. 300m, 600m and 900m lateral length wells were modelled, in conjunction with 4, 6 and 8 stages of fracs. Simulation results indicate that higher initial recoveries and peak oil rates are obtained with longer well lengths and also with more fracs and spacing. For a 25year forecast, the ultimate recovery ranging from 0.4% to 2.56% for 300m and 1000m laterals respectively. The 900m lateral with 8 fracs 100m spacing gave the highest peak rate of 120m3/day, with the 600m and 300m cases giving initial peak rates of 110m3/day. Similarly, recovery factor for the 900m lateral with 8 fracs and 100m spacing was the highest at 2.65% after 25 years. The corresponding values for the 300m and 600m laterals were 2.37% and 2.42%. Therefore, the study suggests that longer laterals with 8 fracs and 100m spacing provided the optimal recovery, and this design is recommended as the basis for further study.

Keywords: unconventional, resource, hydraulic, fracturing

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Authors: Preet Shah, Om Shrivastav

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Introduction : In India, Leishmania donovani is the only parasite causing Leishmaniasis. The parasite infects the reticuloendothelial system and is found in the bone marrow, spleen and liver. Treatment of choice is amphotericin-B with sodium stibogluconate being an alternative. Miltefosine is useful in refractory cases. In our case, Leishmaniasis occurred in a person residing in western India (which is quite rare) and it failed to respond to two different drugs (again an uncommon feature) before it finally responded to a third one. Description: A 50 year old lady, a resident of western India, with no history of recent travel, presented with an ulcer on the left side of the nose since 8 months. She was apparently alright 8 months back, when she noticed a small ulcerated lesion on the left ala of the nose which was immediately biopsied. The biopsy revealed amastigotes of Leishmania for which she was administered intra-lesional sodium stibogluconate for 1 month (4 doses every 8 days).Despite this, there was no regression of the ulcer and hence she presented to us for further management. On examination, her vital parameters were normal. Barring an ulcer on the left side of the nose, rest of the examination findings were unremarkable. Complete blood count was normal. Ultrasound abdomen showed hepatomegaly. PET-CT scan showed increased metabolic activity in left ala of nose, hepatosplenomegaly and increased metabolic activity in spleen and bone marrow. Bone marrow biopsy was done which showed hypercellular marrow with erythroid preponderance. Considering a diagnosis of leishmaniasis which had so far been unresponsive to sodium stibogluconate, she was started on liposomal amphotericin-B. At the time of admission, her creatinine level was normal, but it started rising with the administration of liposomal amphotericin-B, hence the dose was reduced. Despite this, creatinine levels did not improve, and she started developing hypokalemia and hypomagnesemia as side effects of the drug, hence further reductions in the dosage were made. Despite a total of 3 weeks of liposomal amphotericin-B, there was no improvement in the ulcer. As had so far failed to respond to sodium stibogluconate and liposomal amphotericin-B, it was decided to start her on miltefosine. She received the miltefosine for a total of 12 weeks. At the end of this duration, there was a marked regression of the cutaneous lesion. Conclusion: Refractoriness to amphotericin-B in leishmaniasis may be seen in up to 5 % cases. Here, an alternative drug such as miltefosine is useful and hence we decided to use it, to which she responded adequately. Furthermore, although leishmaniasis is common in the eastern part of India, it is a relatively unknown entity in the western part of the country with the occurrence being very rare. Because of these 2 reasons, we consider our case to be a unique one.

Keywords: amphotericin-b, leishmaniasis, miltefosine, tropical diseases

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Authors: M. Sulieman, H. Arabiyat, H. Ali, K. Potiszil, I. Abbas, R. English, P. King, I. Brown, P. Drew

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Introduction: The incidence of breast ductal Carcinoma in Situ (DCIS) has been increasing; it currently represents up 20-25% of all breast carcinomas. Some aspects of DCIS management are still controversial, mainly due to the heterogeneity of its clinical presentation and of its biological and pathological characteristics. In DCIS, histological diagnosis obtained preoperatively, carries the risk of sampling error if the presence of invasive cancer is subsequently diagnosed. The mammographic extent over than 4–5 cm and the presence of architectural distortion, focal asymmetric density or mass on mammography are proven important risk factors of preoperative histological under staging. Intracystic papillary cancer (IPC) is a rare form of breast carcinoma. Despite being previously compared to DCIS it has been shown to present histologically with invasion of the basement membrane and even metastasis. SLNB – Carries the risk of associated comorbidity that should be considered when planning surgery for DCIS and IPC. Objectives: The aim of this Audit was to better define a ‘high risk’ group of patients with pre-op diagnosis of non-invasive cancer undergoing breast conserving surgery, who would benefit from sentinel node biopsy. Method: Retrospective data collection of all patients with ductal carcinoma in situ over 5 years. 636 patients identified, and after exclusion criteria applied: 394 patients were included. High risk defined as: Extensive micro-calcification >40mm OR any mass forming DCIS. IPC: Winpath search from for the term ‘papillary carcinoma’ in any breast specimen for 5 years duration;.29 patients were included in this group. Results: DCIS: 188 deemed high risk due to >40mm calcification or a mass forming (radiological or palpable) 61% of those had a mastectomy and 32% BCS. Overall, in that high-risk group - the number with invasive disease was 38%. Of those high-risk DCIS pts 85% had a SLN - 80% at the time of surgery and 5% at a second operation. For the BCS patients - 42% had SLN at time of surgery and 13% (8 patients) at a second operation. 15 (7.9%) pts in the high-risk group had a positive SLNB, 11 having a mastectomy and 4 having BCS. IPC: The provisional diagnosis of encysted papillary carcinoma is upgraded to an invasive carcinoma on final histology in around a third of cases. This has may have implications when deciding whether to offer sentinel node removal at the time of therapeutic surgery. Conclusions: We have defined a ‘high risk’ group of pts with pre-op diagnosis of non-invasive cancer undergoing BCS, who would benefit from SLNB at the time of the surgery. In patients with high-risk features; the risk of invasive disease is up to 40% but the risk of nodal involvement is approximately 8%. The risk of morbidity from SLN is up to about 5% especially the risk of lymphedema.

Keywords: breast ductal carcinoma in Situ (DCIS), intracystic papillary carcinoma (IPC), sentinel node biopsy (SLNB), high-risk, non-invasive, cancer disease

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Authors: Michael Kenomore, Mohamed Hassan, Amjad Shah, Hom Dhakal

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Shale gas reservoirs have been of greater importance compared to shale oil reservoirs since 2009 and with the current nature of the oil market, understanding the technical and economic performance of shale gas reservoirs is of importance. Using the Barnett shale as a case study, an economic model was developed to quantify the effect of finding and development costs and gas prices on the basins in the Barnett shale using net present value as an evaluation parameter. A rate of return of 20% and a payback period of 60 months or less was used as the investment hurdle in the model. The Barnett was split into four basins (Strawn Basin, Ouachita Folded Belt, Forth-worth Syncline and Bend-arch Basin) with analysis conducted on each of the basin to provide a holistic outlook. The dataset consisted of only horizontal wells that started production from 2008 to at most 2015 with 1835 wells coming from the strawn basin, 137 wells from the Ouachita folded belt, 55 wells from the bend-arch basin and 724 wells from the forth-worth syncline. The data was analyzed initially on Microsoft Excel to determine the estimated ultimate recoverable (EUR). The range of EUR from each basin were loaded in the Palisade Risk software and a log normal distribution typical of Barnett shale wells was fitted to the dataset. Monte Carlo simulation was then carried out over a 1000 iterations to obtain a cumulative distribution plot showing the probabilistic distribution of EUR for each basin. From the cumulative distribution plot, the P10, P50 and P90 EUR values for each basin were used in the economic model. Gas production from an individual well with a EUR similar to the calculated EUR was chosen and rescaled to fit the calculated EUR values for each basin at the respective percentiles i.e. P10, P50 and P90. The rescaled production was entered into the economic model to determine the effect of the finding and development cost and gas price on the net present value (10% discount rate/year) as well as also determine the scenario that satisfied the proposed investment hurdle. The finding and development costs used in this paper (assumed to consist only of the drilling and completion costs) were £1 million, £2 million and £4 million while the gas price was varied from $2/MCF-$13/MCF based on Henry Hub spot prices from 2008-2015. One of the major findings in this study was that wells in the bend-arch basin were least economic, higher gas prices are needed in basins containing non-core counties and 90% of the Barnet shale wells were not economic at all finding and development costs irrespective of the gas price in all the basins. This study helps to determine the percentage of wells that are economic at different range of costs and gas prices, determine the basins that are most economic and the wells that satisfy the investment hurdle.

Keywords: shale gas, Barnett shale, unconventional gas, estimated ultimate recoverable

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Authors: Amir Nazemi, Milad Ramezankhani, Marian Kӧrber, Abbas S. Milani

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The excellent strength to weight ratio of woven fabric composites, along with their high formability, is one of the primary design parameters defining their increased use in modern manufacturing processes, including those in aerospace and automotive. However, for emerging automated preform processes under the smart manufacturing paradigm, complex geometries of finished components continue to bring several challenges to the designers to cope with manufacturing defects on site. Wrinklinge. g. is a common defectoccurring during the forming process and handling of semi-finished textile composites. One of the main reasons for this defect is the weak bending stiffness of fibers in unconsolidated state, causing excessive relative motion between them. Further challenges are represented by the automated handling of large-area fiber blanks with specialized gripper systems. For fabric composites forming simulations, the finite element (FE)method is a longstanding tool usedfor prediction and mitigation of manufacturing defects. Such simulations are predominately meant, not only to predict the onset, growth, and shape of wrinkles but also to determine the best processing condition that can yield optimized positioning of the fibers upon forming (or robot handling in the automated processes case). However, the need for use of small-time steps via explicit FE codes, facing numerical instabilities, as well as large computational time, are among notable drawbacks of the current FEtools, hindering their extensive use as fast and yet efficient digital twins in industry. This paper presents a novel woven fabric simulation technique through the application of the material point method (MPM), which enables the use of much larger time steps, facing less numerical instabilities, hence the ability to run significantly faster and efficient simulationsfor fabric materials handling and forming processes. Therefore, this method has the ability to enhance the development of automated fiber handling and preform processes by calculating the physical interactions with the MPM fiber models and rigid tool components. This enables the designers to virtually develop, test, and optimize their processes based on either algorithmicor Machine Learning applications. As a preliminary case study, forming of a hemispherical plain weave is shown, and the results are compared to theFE simulations, as well as experiments.

Keywords: material point method, woven fabric composites, forming, material handling

Procedia PDF Downloads 155

Authors: Muhammad Ather Nadeem, Bilal Ahmad Khan, Hussam F. Najeeb Alawadi, Athar Mahmood, Aneela Nijabat, Tasawer Abbas, Muhammad Habib, Abdullah

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The global prevalence of Avena fatua infestation poses a significant challenge to wheat sustainability. While chemical control stands out as an efficient and rapid way to control weeds, concerns over developing resistance in weeds and environmental pollution have led to criticisms of herbicide use. Consequently, this study was designed to address these challenges through the chemical synthesis, characterization, and optimization of chitosan-based nanoparticles containing clodinofop Propargyl and fenoxaprop-P-ethyl for the effective management of A. fatua. Utilizing the ionic gelification technique, chitosan-based nanoparticles of clodinofop Propargyl and fenoxaprop-P-ethyl were prepared. These nanoparticles were applied at the 3-4 leaf stage of Phalaris minor weed, applying seven altered doses. These nanoparticles were applied at the 3-4 leaf stage of Phalaris minor weed, applying seven altered doses (D0 (Check weeds), D1 (Recommended dose of traditional-herbicide (TH), D2 (Recommended dose of Nano-herbicide (NPs-H)), D3 (NPs-H with 05-fold lower dose), D4 ((NPs-H) with 10-fold lower dose), D5 (NPs-H with 15-fold lower dose), and D6 (NPs-H with 20-fold lower dose)). Characterization of the chitosan-containing herbicide nanoparticles (CHT-NPs) was conducted using FT-IR analysis, demonstrating a perfect match with standard parameters. UV–visible spectrum further revealed absorption peaks at 310 nm for NPs of clodinofop propargyl and at 330 nm for NPs of fenoxaprop-p-ethyl. This research aims to contribute to sustainable weed management practices by addressing the challenges associated with chemical herbicide use. The application of chitosan-based nanoparticles (CHT-NPs) containing fenoxaprop-P-ethyl and clodinofop-propargyl at the recommended dose of the standard herbicide resulted in 100% mortality and visible injury to weeds. Surprisingly, when applied at a lower dose with 5-folds, these chitosan-containing nanoparticles of clodinofop Propargyl and fenoxaprop-P-ethyl demonstrated extreme control efficacy. Furthermore, at a 10-fold lower dose compared to standard herbicides and the recommended dose of clodinofop-propargyl and fenoxaprop-P-ethyl, the chitosan-based nanoparticles exhibited comparable effects on chlorophyll content, visual injury (%), mortality (%), plant height (cm), fresh weight (g), and dry weight (g) of A. fatua. This study indicates that chitosan/tripolyphosphate-loaded nanoparticles containing clodinofop-propargyl and fenoxaprop-P-ethyl can be effectively utilized for the management of A. fatua at a 10-fold lower dose, highlighting their potential for sustainable and efficient weed control.

Keywords: mortality, chitosan-based nanoparticles, visual injury, chlorophyl contents, 5-fold lower dose.

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Authors: Nasim Hashemi, Abbas Sheikhtaheri

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Telemedicine is the use of telecommunication and information technologies to provide health care services that would often not be consistently available in distant rural communities to people at these remote areas. Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Thus, teleophthalmology can overcome geographical barriers and improve quality, access, and affordability of eye health care services. Since teleophthalmology has been widespread applied in recent years, the aim of this study was to determine the different applications of teleophthalmology in the world. To this end, three bibliographic databases (Medline, ScienceDirect, Scopus) were comprehensively searched with these keywords: eye care, eye health care, primary eye care, diagnosis, detection, and screening of different eye diseases in conjunction with telemedicine, telehealth, teleophthalmology, e-services, and information technology. All types of papers were included in the study with no time restriction. We conducted the search strategies until 2015. Finally 70 articles were surveyed. We classified the results based on the’type of eye problems covered’ and ‘the type of telemedicine services’. Based on the review, from the ‘perspective of health care levels’, there are three level for eye health care as primary, secondary and tertiary eye care. From the ‘perspective of eye care services’, the main application of teleophthalmology in primary eye care was related to the diagnosis of different eye diseases such as diabetic retinopathy, macular edema, strabismus and aged related macular degeneration. The main application of teleophthalmology in secondary and tertiary eye care was related to the screening of eye problems i.e. diabetic retinopathy, astigmatism, glaucoma screening. Teleconsultation between health care providers and ophthalmologists and also education and training sessions for patients were other types of teleophthalmology in world. Real time, store–forward and hybrid methods were the main forms of the communication from the perspective of ‘teleophthalmology mode’ which is used based on IT infrastructure between sending and receiving centers. In aspect of specialists, early detection of serious aged-related ophthalmic disease in population, screening of eye disease processes, consultation in an emergency cases and comprehensive eye examination were the most important benefits of teleophthalmology. Cost-effectiveness of teleophthalmology projects resulted from reducing transportation and accommodation cost, access to affordable eye care services and receiving specialist opinions were also the main advantages of teleophthalmology for patients. Teleophthalmology brings valuable secondary and tertiary care to remote areas. So, applying teleophthalmology for detection, treatment and screening purposes and expanding its use in new applications such as eye surgery will be a key tool to promote public health and integrating eye care to primary health care.

Keywords: applications, telehealth, telemedicine, teleophthalmology

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Authors: Jacob Schwartz, Maxim Durach, Aniruddha Mitra, Abbas Rashidi, Glen Sage, Atin Adhikari

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NIOSH (National Institute for Occupational Safety and Health) approved N95 respirators are commonly used by workers in construction sites where there is a large amount of dust being produced from sawing, grinding, blasting, welding, etc., both electrostatically charged and not. A significant portion of airborne particles in construction sites could be nanoparticles created beside coarse particles. The penetration of the particles through the masks may differ depending on the size and charge of the individual particle. In field experiments relevant to this current study, we found that nanoparticles of medium size ranges are penetrating more frequently than nanoparticles of smaller and larger sizes. For example, penetration percentages of nanoparticles of 11.5 – 27.4 nm into a sealed N95 respirator on a manikin head ranged from 0.59 to 6.59%, whereas nanoparticles of 36.5 – 86.6 nm ranged from 7.34 to 16.04%. The possible causes behind this increased penetration of mid-size nanoparticles through mask filters are not yet explored. The objective of this study is to identify causes behind this unusual behavior of mid-size nanoparticles. We have considered such physical factors as Boltzmann distribution of the particles in thermal equilibrium with the air, kinetic energy of the particles at impact on the mask, Stoke’s drag force, and electrostatic forces in the mask stopping the particles. When the particles collide with the mask, only the particles that have enough kinetic energy to overcome the energy loss due to the electrostatic forces and the Stokes’ drag in the mask can pass through the mask. To understand this process, the following assumptions were made: (1) the effect of Stoke’s drag depends on the particles’ velocity at entry into the mask; (2) the electrostatic force is proportional to the charge on the particles, which in turn is proportional to the surface area of the particles; (3) the general dependence on electrostatic charge and thickness means that for stronger electrostatic resistance in the masks and thicker the masks’ fiber layers the penetration of particles is reduced, which is a sensible conclusion. In sampling situations where one mask was soaked in alcohol eliminating electrostatic interaction the penetration was much larger in the mid-range than the same mask with electrostatic interaction. The smaller nanoparticles showed almost zero penetration most likely because of the small kinetic energy, while the larger sized nanoparticles showed almost negligible penetration most likely due to the interaction of the particle with its own drag force. If there is no electrostatic force the fraction for larger particles grows. But if the electrostatic force is added the fraction for larger particles goes down, so diminished penetration for larger particles should be due to increased electrostatic repulsion, may be due to increased surface area and therefore larger charge on average. We have also explored the effect of ambient temperature on nanoparticle penetrations and determined that the dependence of the penetration of particles on the temperature is weak in the range of temperatures in the measurements 37-42°C, since the factor changes in the range from 3.17 10-3K-1 to 3.22 10-3K-1.

Keywords: respiratory protection, industrial hygiene, aerosol, electrostatic force

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Authors: Sunidhi Sood, Drashti Narendrakumar Shah, Aakarsh Sharma, Nirali Harsh Panchal, Maria Karizhenskaia

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Cancer is a global health concern, causing a significant number of deaths, with chemotherapy being a standard treatment method. However, chemotherapy often induces side effects that profoundly impact the physical and emotional well-being of patients, lowering their overall quality of life (QoL). This research aims to investigate the potential of music and art therapy as holistic adjunctive therapy for cancer patients undergoing chemotherapy, offering non-pharmacological support. This is achieved through a comprehensive review of existing literature with a focus on the following themes, including stress and anxiety alleviation, emotional expression and coping skill development, transformative changes, and pain management with mood upliftment. A systematic search was conducted using Medline, Google Scholar, and St. Lawrence College Library, considering original, peer-reviewed research papers published from 2014 to 2023. The review solely incorporated studies focusing on the impact of music and art therapy on the health and overall well-being of cancer patients undergoing chemotherapy in North America. The findings from 16 studies involving pediatric oncology patients, females affected by breast cancer, and general oncology patients show that music and art therapies significantly reduce anxiety (standardized mean difference: -1.10) and improve perceived stress (median change: -4.0) and overall quality of life in cancer patients undergoing chemotherapy. Furthermore, music therapy has demonstrated the potential to decrease anxiety, depression, and pain during infusion treatments (average changes in resilience scale: 3.4 and 4.83 for instrumental and vocal music therapy, respectively). This data calls for consideration of the integration of music and art therapy into supportive care programs for cancer patients undergoing chemotherapy. Moreover, it provides guidance to healthcare professionals and policymakers, facilitating the development of patient-centered strategies for cancer care in Canada. Further research is needed in collaboration with qualified therapists to examine its applicability and explore and evaluate patients' perceptions and expectations in order to optimize the therapeutic benefits and overall patient experience. In conclusion, integrating music and art therapy in cancer care promises to substantially enhance the well-being and psychosocial state of patients undergoing chemotherapy. However, due to the small population size considered in existing studies, further research is needed to bridge the knowledge gap and ensure a comprehensive, patient-centered approach, ultimately enhancing the quality of life (QoL) for individuals facing the challenges of cancer treatment.

Keywords: anxiety, cancer, chemotherapy, depression, music and art therapy, pain management, quality of life

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Authors: Muhammad Qamar Masood, Syed Abbas Raza, Umar Yousaf Raja, Imran Hassan, Bilal Afzal, Muhammad Aleem Zahir, Atika Shaheer

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Background: Cardiovascular disease (CVD) is a major burden among people with type 2 diabetes (T2D) with 1 in 3 reported to have CVD. Therefore, understanding real-world clinical characteristics and prescribing patterns could help in better care. Objective: The CONVERGE (Cardiovascular Outcomes and Value in the Real world with GLP-1RAs) study characterized demographics and medication usage patterns in T2D intensified (add-on to metformin) overall population. The data were further divided into subgroups {dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), insulins, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is)}, according to the latest prescribed antidiabetic agent (ADA) in India/Pakistan/Thailand. Here, we report findings from Pakistan. Methods: A multi-center retrospective study utilized data from medical records between 13-Sep-2008 (post-market approval of GLP-1RAs) and 31-Dec-2017 in adults (≥18-year-old). The data for this study were collected from 05 centers / institutes located in major cities of Pakistan, including Karachi, Lahore, Islamabad, and Multan. These centers included National Hospital, Aga Khan University Hospital, Diabetes Endocrine Clinic Lahore, Shifa International Hospital, Mukhtar A Sheikh Hospital Multan. Data were collected at start of medical record and at 6 or 12-months prior to baseline based on variable type; analyzed descriptively. Results: Overall, 1,010 patients were eligible. At baseline, overall mean age (SD) was 51.6 (11.3) years, T2D duration was 2.4 (2.6) years, HbA1c was 8.3% (1.9) and 35% received ≥1CVD medications in the past 1-year (before baseline). Most frequently prescribed ADAs post-metformin were DPP-4is and SUs (~63%). Only 6.5% received GLP-1RAs and SGLT-2is were not available in Pakistan during the study period. Overall, it took a mean of 4.4 years and 5 years to initiate GLP-1RAs and SGLT-2is, respectively. In comparison to other subgroups, more patients from GLP-1RAs received ≥3 types of ADA (58%), ≥1 CVD medication (64%) and had higher body mass index (37kg/m2). Conclusions: Utilization of GLP-1RAs and SGLT-2is was low, took longer time to initiate and not before trying multiple ADAs. This may be due to lack of evidence for CV benefits for these agents during the study period. The planned phase 2 of the CONVERGE study can provide more insights into utilization and barriers to prescribe GLP-1RAs and SGLT-2is post 2018 in Pakistan.

Keywords: type 2 diabetes, GLP-1RA, treatment intensification, cardiovascular disease

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Authors: Rahul Patel, S. P. Dave, M. V Shah

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Ahmedabad is a rapidly growing city in western India that is experiencing significant urbanization and industrialization. With projections indicating that it will become a metropolitan city in the near future, various construction activities are taking place, making soil testing a crucial requirement before construction can commence. To achieve this, construction companies and contractors need to periodically conduct soil testing. This study focuses on the process of creating a spatial database that is digitally formatted and integrated with geotechnical data and a Geographic Information System (GIS). Building a comprehensive geotechnical Geo-database involves three essential steps. Firstly, borehole data is collected from reputable sources. Secondly, the accuracy and redundancy of the data are verified. Finally, the geotechnical information is standardized and organized for integration into the database. Once the Geo-database is complete, it is integrated with GIS. This integration allows users to visualize, analyze, and interpret geotechnical information spatially. Using a Topographic to Raster interpolation process in GIS, estimated values are assigned to all locations based on sampled geotechnical data values. The study area was contoured for SPT N-Values, Soil Classification, Φ-Values, and Bearing Capacity (T/m2). Various interpolation techniques were cross-validated to ensure information accuracy. The GIS map generated by this study enables the calculation of SPT N-Values, Φ-Values, and bearing capacities for different footing widths and various depths. This approach highlights the potential of GIS in providing an efficient solution to complex phenomena that would otherwise be tedious to achieve through other means. Not only does GIS offer greater accuracy, but it also generates valuable information that can be used as input for correlation analysis. Furthermore, this system serves as a decision support tool for geotechnical engineers. The information generated by this study can be utilized by engineers to make informed decisions during construction activities. For instance, they can use the data to optimize foundation designs and improve site selection. In conclusion, the rapid growth experienced by Ahmedabad requires extensive construction activities, necessitating soil testing. This study focused on the process of creating a comprehensive geotechnical database integrated with GIS. The database was developed by collecting borehole data from reputable sources, verifying its accuracy and redundancy, and organizing the information for integration. The GIS map generated by this study is an efficient solution that offers greater accuracy and generates valuable information that can be used as input for correlation analysis. It also serves as a decision support tool for geotechnical engineers, allowing them to make informed decisions during construction activities.

Keywords: arcGIS, borehole data, geographic information system (GIS), geo-database, interpolation, SPT N-value, soil classification, φ-value, bearing capacity

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Authors: Aakriti Chetan Shah, Elle Sein

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Background/purpose: Group B Streptococcus(GBS) is the leading cause of severe early onset infection in newborns, with the incidence of Early Onset Group B Streptococcus (EOGBS) in the UK and Ireland rising from 0.48 to 0.57 per 1000 births from 2000 to 2015. A WHO study conducted in 2017, has shown that 38.5% of cases can result in stillbirth and infant deaths. This is an important problem to consider as 20% of women worldwide have GBS colonisation and can suffer from these detrimental effects. Current Royal College of Obstetricians and Midwives (RCOG) guidelines do not recommend bacteriological screening for pregnant women due to its low sensitivity in antenatal screening correlating with the neonate having GBS but advise a patient information leaflet be given to pregnant women. However, a Healthcare Safety Investigation Branch (HSIB) 2019 learning report found that only 50% of trusts and health boards reported giving GBS information leaflets to all pregnant mothers. Therefore, this audit aimed to assess current practices of information dissemination about GBS at Chelsea & Westminster (C&W) Hospital. Methodology: A quantitative cross-sectional study was carried out using a questionnaire based on the RCOG GBS guidelines and the HSIB Learning report. The study was conducted in antenatal clinics at Chelsea & Westminster Hospital, from 29th January 2021 to 14th February 2021, with twenty-two practicing obstetricians and midwives participating in the survey. The main outcome measure was the proportion of obstetricians and midwives who disseminate information about GBS to pregnant women, and the reasons behind why they do or do not. Results: 22 obstetricians and midwives responded with 18 complete responses. Of which 12 were obstetricians and 6 were midwives. Only 17% of clinical staff routinely inform all pregnant women about GBS, and do so at varying timeframes of the pregnancy, with an equal split in the first, second and third trimester. The primary reason for not informing women about GBS was influenced by three key factors: Deemed relevant only for patients at high risk of GBS, lack of time in clinic appointments and no routine NHS screening available. Interestingly 58% of staff in the antenatal clinic believe it is necessary to inform all women about GBS and its importance. Conclusion: It is vital for obstetricians and midwives to inform all pregnant women about GBS due to the high prevalence of incidental carriers in the population, and the harmful effects it can cause for neonates. Even though most clinicians believe it is important to inform all pregnant women about GBS, most do not. To ensure that RCOG and HSIB recommendations are followed, we recommend that women should be given this information at 28 weeks gestation in the antenatal clinic. Proposed implementations include an information leaflet to be incorporated into the Mum and Baby app, an informative video and end-to-end digital clinic documentation to include this information sharing prompt.

Keywords: group B Streptococcus, early onset sepsis, Antenatal care, Neonatal morbidity, GBS

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Authors: Alireza Barari, Ahmad Abdi

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Regular body trainings cause adaption in various system in body. One of the important effect of body training is its effect on immune system. It seems that cytokines usually release after long period exercises or some exercises which cause skeletal muscular damages. If some of the cytokines which cause responses such as inflammation of cells in skeletal muscles, with manipulating of training program, it can be avoided or limited from those exercises which induct cytokines release. Ginger plant is a kind of medicinal plants which is known as a anti inflammation plant. This plant is as most precedence medicinal plants in medicine science especially in inflammation cure. The aim of the present study was the effect of selected resistance training and consumption of ginger extract on IL-1α and TNFα untrained young women. The population includes young women interested in participating in the study with the average of 30±2 years old from Abbas Abad city among which 32 participants were chosen randomly and divided into 4 four groups, resistance training (R), resistance training and ginger consumption(RG), Ginger consumption(G)and Control group(C). The training groups performed circuit resistance training at the intensity of 65-75% one repeat maximum, 3 days a week for 6 weeks. Besides resistance training, subjects were given either ginseng (5 mg/kg per day) or placebo. Prior to and 48 hours after interventions body composition was measured and blood samples were taken in order to assess serum levels of IL-1α and TNFα. Plasma levels of cytokines were measured with commercially available ELISA Kits.IL-1α kit and TNFα kit were used in this research. To demonstrate the effectiveness of the independent variable and the comparison between groups, t-test and ANOVA were used. To determine differences between the groups, the Scheffe test was used that showed significant changes in any of the variables. we observed that circuit resistance training in R and RG groups can significant decreased in weight and body mass index in untrained females (p<0.05). The results showed a significant decreased in the mean level of IL-1α levels before and after the training period in G group (p=0.046) and RG group (p=0.022). Comparison between groups also showed there was significant difference between groups R-RG and RG-C. Intergroup comparison results showed that the mean levels of TNFα before and after the training in group G (p=0.044) and RG (p=0.037), significantly decreased. Comparison between groups also showed there was significant difference between groups R–RG , R-G ,RG-C and G-C. The research shows that circuit resistance training with reducing overload method results in systemic inflammation had significant effect on IL-1α levels and TNFα. Of course, Ginger can counteract the negative effects of resistance training exercise on immune function and stability of the mast cell membrane. Considerable evidence supported the anti-inflammatory properties of ginger for several constituents, especially gingerols, shogaols, paradols, and zingerones, through decreased cytokine gene TNF α and IL-1Α expression and inhibition of cyclooxygenase 1 and 2. These established biological actions suggest that ingested ginger could block the increase in IL-1α.

Keywords: resistance training, ginger, IL-1α , TNFα

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Authors: M. K. Sheikh, Y. M. Laghari., P. K. Lashari., N. T. Narejo

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The Indus River is one of the longest important rivers of the world in Asia that flows southward through Pakistan, merges into the Arabian Sea near the port city of Karachi in Sindh Province, and forms the Indus Delta. Fish are an important resource for humans worldwide, especially as food. In fish, healthy nutriments are present which are not found in any other meat source because it have a huge quantity of omega- 3 fatty acids, which are very essential for the human body. Ichthyologic surveys were conducted to explore the diversity of freshwater fishes, distribution, abundance and current status of the fishes at different spatial scale of the downstream, Indus River. Total eight stations were selected namely Railo Miyan (RM), Karokho (Kk), Khanpur (Kp), Mullakatiyar (Mk), Wasi Malook Shah (WMS), Branch Morie (BM), Sujawal (Sj) and Jangseer (JS). The study was carried in the period of January 2016 to December 2019 to identify River and biodiversity threats and to suggest recommendations for conservation. The data were analysed by different population diversity index. Altogether, 124 species were recorded belonging to 12 Orders and 43 Families from the downstream of Indus River. Among 124 species, 29% belong to high commercial value and 35% were trash fishes. 31% of fishes were identified as marine/estuarine origin (migratory) and 05% were exotic fish species. Perciformes is the most predominated order, contributing to 41% of families. Among 43 families, the family Cyprinidae was the richest family from all localities of downstream, represented by 24% of fish species demonstrating a significant dominance in the number of species. A significant difference was observed for species abundance in between all sites, the maximum abundance species were found at first location RM having 115 species and minimum observed at the last station JS 56 genera. In the recorded Ichthyofauna, seven groups were found according to the International Union for Conservation of Nature status (IUCN), where a high species ratio was collected, in Least Concern (LC) having 94 species, 11 were found as not evaluated (NE), whereas 8 was identified as near threatened (NT), 1 was recorded as critically endangered (CR), 11 were collected as data deficient (DD), and while 8 was observed as vulnerable (VU) and 3 endangered (EN) species. Different diversity index has been used extensively in environmental studies to estimate the species richness and abundance of ecosystems outputs of their wellness; a positive environment (biodiversity rich) with species at RM had an environmental wellness and biodiversity levels of 4.566% while a negative control environment (biodiversity poor) on last station JS had an environmental wellness and biodiversity levels of 3.931%. The status of fish biodiversity and river has been found under serious threat. Due to the lower diversity of fishes, it became not only venerable for fish but also risky for fishermen. Necessary steps are recommended to protect the biodiversity by conducting further conservative research in this area.

Keywords: ichthyofaunal biodiversity, threatened species, diversity index, Indus River downstream

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Authors: Aboli Gore, Aritra Das, Sunil Sonthalia, Tanmay Mahapatra, Sridhar Srikantiah, Hemant Shah

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AMANAT is an initiative, taken in collaboration with the Government of Bihar, aimed at improving the Quality of Maternal and Neonatal care services at Bihar’s public health facilities – those offering either the Basic Emergency Obstetric and Neonatal care (BEmONC) or Comprehensive Emergency Obstetric and Neonatal care (CEmONC) services. The effectiveness of this program is evaluated by conducting cross-sectional assessments at the concerned facilities prior to (baseline) and following completion (endline) of intervention. Direct Observation of Delivery (DOD) methodology is employed for carrying out the baseline and endline assessments – through which key obstetric and neonatal care practices among the Health Care Providers (especially the nurses) are assessed quantitatively by specially trained nursing professionals. Assessment of vitals prior to delivery improved during all three phases of BEmONC and all four phases of CEmONC training with statistically significant improvement noted in: i) pulse measurement in BEmONC phase 2 (9% to 68%), 3 (4% to 57%) & 4 (14% to 59%) and CEmONC phase 2 (7% to 72%) and 3 (0% to 64%); ii) blood pressure measurement in BEmONC phase 2 (27% to 84%), 3 (21% to 76%) & 4 (36% to 71%) and CEmONC phase 2 (23% to 76%) and 3 (2% to 70%); iii) fetal heart rate measurement in BEmONC phase 2 (10% to 72%), 3 (11% to 77%) & 4 (13% to 64%) and CEmONC phase 1 (24% to 38%), 2 (14% to 82%) and 3 (1% to 73%); and iv) abdominal examination in BEmONC phase 2 (14% to 59%), 3 (3% to 59%) & 4 (6% to 56%) and CEmONC phase 1 (0% to 24%), 2 (7% to 62%) & 3 (0% to 62%). Regarding infection control, wearing of apron, mask and cap by the delivery conductors improved significantly in all BEmONC phases. Similarly, the practice of handwashing improved in all BEmONC and CEmONC phases. Even on disaggregation, the handwashing showed significant improvement in all phases but CEmONC phase-4. Not only the positive practices related to handwashing improved but also negative practices such as turning off the tap with bare hands declined significantly in the aforementioned phases. Significant decline was also noted in negative maternal care practices such as application of fundal pressure for hastening the delivery process and administration of oxytocin prior to delivery. One of the notable achievement of AMANAT is an improvement in active management of the third stage of labor (AMTSL). The overall AMTSL (including administration of oxytocin or other uterotonics uterotonic in proper dose, route and time along with controlled cord traction and uterine massage) improved in all phases of BEmONC and CEmONC mentoring. Another key area of improvement, across phases, was in proper cutting/clamping of the umbilical cord. AMANAT mentoring also led to improvement in important immediate newborn care practices such as initiation of skin-to-skin care and timely initiation of breastfeeding. The next phase of the mentoring program seeks to institutionalize mentoring across the state that could potentially perpetuate improvement with minimal external intervention.

Keywords: capacity building, nurse-mentoring, quality of care, pregnancy, newborn care

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Authors: Afsheen Aman, Zainab Bibi, Shah Ali Ul Qader

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Introduction: Xylan is a heteropolysaccharide composed of xylose monomers linked together through 1,4 linkages within a complex xylan network. Owing to wide applications of xylan hydrolytic products (xylose, xylobiose and xylooligosaccharide) the researchers are focusing towards the development of various strategies for efficient xylan degradation. One of the most important strategies focused is the use of heat tolerant biocatalysts which acts as strong and specific cleaving agents. Therefore, the exploration of microbial pool from extremely diversified ecosystem is considerably vital. Microbial populations from extreme habitats are keenly explored for the isolation of thermophilic entities. These thermozymes usually demonstrate fast hydrolytic rate, can produce high yields of product and are less prone to microbial contamination. Another possibility of degrading xylan continuously is the use of immobilization technique. The current work is an effort to merge both the positive aspects of thermozyme and immobilization technique. Methodology: Geobacillus stearothermophilus was isolated from soil sample collected near the blast furnace site. This thermophile is capable of producing thermostable endo-β-1,4-xylanase which cleaves xylan effectively. In the current study, this thermozyme was immobilized within a synthetic and a non-synthetic matrice for continuous production of metabolites using entrapment technique. The kinetic parameters of the free and immobilized enzyme were studied. For this purpose calcium alginate and polyacrylamide beads were prepared. Results: For the synthesis of immobilized beads, sodium alginate (40.0 gL-1) and calcium chloride (0.4 M) was used amalgamated. The temperature (50°C) and pH (7.0) optima of immobilized enzyme remained same for xylan hydrolysis however, the enzyme-substrate catalytic reaction time raised from 5.0 to 30.0 minutes as compared to free counterpart. Diffusion limit of high molecular weight xylan (corncob) caused a decline in Vmax of immobilized enzyme from 4773 to 203.7 U min-1 whereas, Km value increased from 0.5074 to 0.5722 mg ml-1 with reference to free enzyme. Immobilized endo-β-1,4-xylanase showed its stability at high temperatures as compared to free enzyme. It retained 18% and 9% residual activity at 70°C and 80°C, respectively whereas; free enzyme completely lost its activity at both temperatures. The Immobilized thermozyme displayed sufficient recycling efficiency and can be reused up to five reaction cycles, indicating that this enzyme can be a plausible candidate in paper processing industry. Conclusion: This thermozyme showed better immobilization yield and operational stability with the purpose of hydrolyzing the high molecular weight xylan. However, the enzyme immobilization properties can be improved further by immobilizing it on different supports for industrial purpose.

Keywords: immobilization, reusability, thermozymes, xylanase

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Authors: Krupali Mukeshkumar, Jinesh Shah

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Background: Bilateral Sagittal Split Osteotomy (BSSO), used for the correction of mandibular deformities, is a common oral and maxillofacial surgical procedure. Inferior alveolar nerve dysfunction is commonly reported post-operatively by patients as paresthesia or anesthesia. The current literature lacks a consensus on the incidence of inferior alveolar nerve dysfunction as patients are not routinely assessed pre and post-operatively with an objective assessment. The range of incidence varies from 9% to 85% of patients, with some authors arguing that 100% of patients experience nerve dysfunction immediately post-surgery. Systematic reviews have shown a difference between incidence rates at different follow-up periods using objective and subjective methods. Aim: To identify the incidence of inferior alveolar nerve dysfunction following BSSO. Gold standard: Nerve dysfunction incidence rates similar or lower than current literature of 83% day one post-operatively and 18.4% at one year follow up. Setting: A retrospective cross-sectional audit of patients treated between 2017-2019 at the Royal Stoke University Hospital, Maxillofacial and Orthodontic departments. Sample: All patients who underwent a BSSO (with or without le fort one osteotomy) between 2017–2019 were identified from the database. Patients with pre-existing neurosensory disturbance, those who had a genioplasty at the same time and those with no follow-up were excluded. The sample consisted of 121 patients, 37 males and 84 females between the ages of 17-50 years at the time of surgery. Methods: Clinical records of 121 cases were reviewed to assess the age, sex, type of mandibular osteotomy, status of the nerve during the surgical procedure, type of bony split and incidence of nerve dysfunction at follow-up appointments. The surgical procedure was carried out by three Maxillo-facial surgeons and follow-up appointments were carried out in the Orthodontic and Oral and Maxillo-facial departments. Results: 120 patients were treated to correct the mandibular facial deformity and 1 patient was treated for sleep apnoea. Seventeen patients had a mandibular setback and 104 patients had mandibular advancement. 68 patients reported inferior alveolar nerve dysfunction at one week following their surgery. Seventy-six patients had temporary paresthesia present between 2 weeks and 12 months post-surgery. 13 patients had persistent nerve dysfunction at 12 months, of which 1 had a bad bony split during the BSSO. The incidence of nerve dysfunction postoperatively was 6.6% after 1 day, 56.1% at 1 week, 62.8% at 2 weeks, 59.5% between 3-6 weeks, 43.0% between 8-16 weeks and 10.7% at 1 year. Conclusions: The results of this audit show a similar incidence rate to the research gold standard at the one-year follow-up. Future Recommendations: No changes to surgical procedure or technique are indicated, but a need for improved documentation and a standardized approach for assessment of post-operative nerve dysfunction would be beneficial.

Keywords: bilateral sagittal split osteotomy, inferior alveolar nerve, mandible, nerve dysfunction

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