Search results for: disease index

Authors: Nana Katsia

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This paper explores the ways both medieval and medievalist conceptions of ugliness might be linked to the physical and spiritual transformation of the protagonists and how it is realised through specific musical rhythm, such as the dochmiac rhythm in the opera. As Eco and Henderson note, only one kind of ugliness could be represented in conformity with nature in the Middle Ages without destroying all aesthetic pleasure and, in turn, artistic beauty: namely, a form of ugliness which arouses disgust. Moreover, Eco explores the fact that the enemies of Christ who condemn, martyr, and crucify him are represented as wicked inside. In turn, the representation of inner wickedness and hostility toward God brings with it outward ugliness, coarseness, barbarity, and rage. Ultimately these result in the deformation of the figure. In all these regards, the non-beautiful is represented here as a necessary phase, which is not the case with classical (the ancient Greek) concepts of Beauty. As we can see, the understanding of disfigurement and ugliness in the Middle Ages was both varied and complex. In the Middle Ages, the disfigurement caused by leprosy (and other skin and bodily conditions) was interpreted, in a somewhat contradictory manner, as both a curse and a gift from God. Some saints’ lives even have the saint appealing to be inflicted with the disease as part of their mission toward true humility. We shall explore that this ‘different concept’ of ugliness (non-classical beauty) might be represented in Messiaen’s opera. According to Messiaen, the Leper and Saint François are the principal characters of the third scene, as both of them will be transformed, and a double miracle will take place in the process. Messiaen mirrors the idea of the true humility of Saint’s life and positions Le Baiser au Lépreux as the culmination of the first act. The Leper’s character represents his physical and spiritual disfigurement, which are healed after the miracle. So, the scene can be viewed as an encounter between beauty and ugliness, and that much of it is spent in a study of ugliness. Dochmiac rhythm is one of the most important compositional elements in the opera. It plays a crucial role in the process of creating a dramatic musical narrative and structure in the composition. As such, we shall explore how Messiaen represents the medieval idea of ugliness in the opera through particular musical elements linked to the main protagonists’ spiritual or physical ugliness; why Messiaen makes reference to dochmiac rhythm, and how they create the musical and dramatic context in the opera for the medieval aesthetic category of ugliness.

Keywords: ugliness in music, medieval time, saint françois d’assise, messiaen

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Authors: Seyedahmad Hosseini, Mohammadjavad Sotoudeheian

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Introduction: Allergic asthma is a heterogeneous immuno-inflammatory disease based on Th-2-mediated inflammation. Histopathologic abnormalities of the airways characteristic of asthma include epithelial damage and subepithelial collagen deposition. Objectives: Human bronchial epithelial cell genome expression of TNF‑α, IL‑6, ICAM‑1, VCAM‑1, nuclear factor (NF)‑κB signaling pathways up-regulate during inflammatory cascades. Moreover, immunofluorescence assays confirmed the nuclear translocation of NF‑κB p65 during inflammatory responses. An absolute LDH leakage assays suggestedLPS-inducedcells injury, and the associated mechanisms are co-incident events. LPS-induced phosphorylation of ERKand JNK causes inflammation in epithelial cells through inhibition of ERK and JNK activation and NF-κB signaling pathway. Furthermore, the inhibition of NF-κB mRNA expression and the nuclear translocation of NF-κB lead to anti-inflammatory events. Likewise, activation of SUMF2 which inhibits IL-13 and reduces Th2-cytokines, NF-κB, and IgE levels to ameliorate asthma. On the other hand, TNFα-induced mucus production reduced NF-κB activation through inhibition of the activation status of Rac1 and IκBα phosphorylation. In addition, bradykinin B2 receptor (B2R), which mediates airway remodeling, regulates through NF-κB. Bronchial B2R expression is constitutively elevated in allergic asthma. In addition, certain NF-κB -dependent chemokines function to recruit eosinophils in the airway. Besides, bromodomain containing 4 (BRD4) plays a significant role in mediating innate immune response in human small airway epithelial cells as well as transglutaminase 2 (TG2), which is detectable in saliva. So, the guanine nucleotide-binding regulatory protein α-subunit, Gα16, expresses a κB-driven luciferase reporter. This response was accompanied by phosphorylation of IκBα. Furthermore, expression of Gα16 in saliva markedly enhanced TNF-α-induced κB reporter activity. Methods: The applied method to form NF-κB activation is the electromobility shift assay (EMSA). Also, B2R-BRD4-TG2 complex detection by immunoassay method within saliva with EMSA of NF-κB activation may be a novel biomarker for asthma diagnosis and follow up. Conclusion: This concept introduces NF-κB signaling pathway as potential asthma biomarkers and promising targets for the development of new therapeutic strategies against asthma.

Keywords: NF-κB, asthma, saliva, T-helper

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Authors: Pravina Gurjar, Bothiraja Pour, Vijay Kumbhar, Ganesh Dama

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Andrographolide (AG), a bioactive phytoconstituent, has a wider range of pharmacological action. However, due to the intestinal degradation, shows low oral bioavailability. The aim of the present work was to develop Floating In-situ gelling Gastro retentive System (FISGS) for AG in order to enhance its site specific absorption and minimize pH dependent hydrolysis in alkaline environment. Further to increase its therapeutic efficacy for peptic ulcer disease caused by H. pyroli. Gellan based floating in situ gelling system of AG were prepared by using sodium citrate and calcium carbonate. The 32 factorial designs was used to study the effect of gellan and calcium carbonate concentration (independent variables) on dependent variable such as viscosity, floating lag time and drug release. Developed system was evaluated for drug content, floating lag time, viscosity, and drug release studies. Drug content, viscosity, and floating lag time was found to be 81-99%, 67-117 Cps, and 3-5 sec, respectively. The obtained system showed good in vitro floating ability for more than 12 h using 0.1 N HCl as dissolution medium with initial burst release followed by the controlled zero order drug release up to 24 hrs. In vivo testing of FISGS of AG to rats demonstrated significant antiulcer activity that were evaluated by various parameters like pH, volume, total acidity, millimole equivalent of H+ ions/30 min, and protein content of gastric content. The densities of all the formulation batches were found to be near about 0.9 and floating duration above 12 hr. It was observed that with the increase in conc. of gellan there was increase in the viscosity of formulation but all formulations were in optimum range. The drug content of optimized batch was found to be 99.23. In histopathology study of stomach, the villi at the mucosal surface, the intercellular junction, the intestinal lumen were intact; no destruction of the epithelium, and submucosal gland in formulation treated and control group animals as compared to pure drug AG and standard ranitidine. Gellan-based in situ gastro retentive floating system could be advantageous in terms of increased bioavailability of AG to maintain an effective drug conc. in gastric fluid as well as in serum for longer period of time.

Keywords: andrographolide, floating drug delivery, in situ gelling system, gastroretentive system

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Authors: Erin Hea-Jin Kim

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This study aims to investigate scholarly communication patterns in Korean studies, which focuses on all aspects of Korea, including history, culture, literature, politics, society, economics, religion, and so on. It is called ‘national study or home study’ as the subject of the study is itself, whereas it is called ‘area study’ as the subject of the study is others, i.e., outside of Korea. Understanding of the structure of scholarly communication in Korean studies is important since the motivations, procedures, results, or outcomes of individual studies may be affected by the cooperative relationships that appear in the communication structure. To this end, we collected 1,798 articles with the (author or index) keyword ‘Korean’ published in 2018 from the Scopus database and extracted the institution and country of the authors using a text mining technique. A total of 96 countries, including South Korea, was identified. Then we constructed a co-authorship network based on the countries identified. The indicators of social network analysis (SNA), co-occurrences, and cluster analysis were used to measure the activity and connectivity of participation in collaboration in Korean studies. As a result, the highest frequency of collaboration appears in the following order: S. Korea with the United States (603), S. Korea with Japan (146), S. Korea with China (131), S. Korea with the United Kingdom (83), and China with the United States (65). This means that the most active participants are S. Korea as well as the USA. The highest rank in the role of mediator measured by betweenness centrality appears in the following order: United States (0.165), United Kingdom (0.045), China (0.043), Japan (0.037), Australia (0.026), and South Africa (0.023). These results show that these countries contribute to connecting in Korean studies. We found two major communities among the co-authorship network. Asian countries and America belong to the same community, and the United Kingdom and European countries belong to the other community. Korean studies have a long history, and the study has emerged since Japanese colonization. However, Korean studies have never been investigated by digital content analysis. The contributions of this study are an analysis of co-authorship in Korean studies with a global perspective based on digital content, which has not attempted so far to our knowledge, and to suggest ideas on how to analyze the humanities disciplines such as history, literature, or Korean studies by text mining. The limitation of this study is that the scholarly data we collected did not cover all domestic journals because we only gathered scholarly data from Scopus. There are thousands of domestic journals not indexed in Scopus that we can consider in terms of national studies, but are not possible to collect.

Keywords: co-authorship network, Korean studies, Koreanology, scholarly communication

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Authors: H. C. Ozdamar , O. Kilic-Erkek, H. E. Akkaya, E. Kilic-Toprak, M. Bor-Kucukatay

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Nordic hamstring exercise (NHE) is used to increase hamstring muscle strength, prevent injuries. The aim of this study was to reveal the acute, long-term effects of 10-week NHE, followed by 5, 10-week detraining on anthropometric measurements, flexibility, anaerobic power, muscle architecture, damage, fatigue, oxidative stress, plasma viscosity (PV), blood lactate levels. 40 sedentary, healthy male volunteers underwent 10 weeks of progressive NHE followed by 5, 10 weeks of detraining. Muscle architecture was determined by ultrasonography, stiffness by strain elastography. Anaerobic power was assessed by double-foot standing, long jump, vertical jump, flexibility by sit-lie, hamstring flexibility tests. Creatine kinase activity, oxidant/antioxidant parameters were measured from venous blood by a commercial kit, whereas PV was determined using a cone-plate viscometer. The blood lactate level was measured from the fingertip. NHE allowed subjects to lose weight, this effect was reversed by detraining for 5 weeks. Exercise caused an increase in knee angles measured by a goniometer, which wasn’t affected by detraining. 10-week NHE caused a partially reversed increase in anaerobic performance upon detraining. NHE resulted in increment of biceps femoris long head (BFub) area, pennation angle, which was reversed by detraining of 10-weeks. Blood lactate levels, muscle pain, fatigue were increased after each exercise session. NHE didn’t change oxidant/antioxidant parameters; 5-week detraining resulted in an increase in total oxidant capacity (TOC) and oxidative stress index (OSI). Detraining of 10 weeks caused a reduction of these parameters. Acute exercise caused a reduction in PV at 1 to 10 weeks. Pre-exercise PV measured on the 10th week was lower than the basal value. Detraining caused the increment of PV. The results may guide the selection of the exercise type to increase performance and muscle strength. Knowing how much of the gains will be lost after a period of detraining can contribute to raising awareness of the continuity of the exercise. This work was supported by PAU Scientific Research Projects Coordination Unit (Project number: 2018SABE034)

Keywords: anaerobic power, detraining, Nordic hamstring exercise, oxidative stress, plasma viscosity

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Authors: Sunaitan Al Mutairi

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A perfect start is a key factor for project completion on time. The study examined the effects of delayed mobilization of resources during the initial phases of the project. This paper mainly highlights the identification and categorization of all delays during the initial construction phase and their root cause analysis with corrective/control measures for the Kuwait Oil Company oil and gas projects. A relatively good percentage of the delays identified during the project execution (Contract award to end of defects liability period) attributed to mobilization/preliminary activity delays. Data analysis demonstrated significant increase in average project delay during the last five years compared to the previous period. Contractors had delays/issues during the initial phase, which resulted in slippages and progressively increased, resulting in time and cost overrun. Delays/issues not mitigated on time during the initial phase had very high impact on project completion. Data analysis of the delays for the past five years was carried out using trend chart, scatter plot, process map, box plot, relative importance index and Pareto chart. Construction of any project inside the Gathering Centers involves complex management skills related to work force, materials, plant, machineries, new technologies etc. Delay affects completion of projects and compromises quality, schedule and budget of project deliverables. Works executed as per plan during the initial phase and start-up duration of the project construction activities resulted in minor slippages/delays in project completion. In addition, there was a good working environment between client and contractor resulting in better project execution and management. Mainly, the contractor was on the front foot in the execution of projects, which had minimum/no delays during the initial and construction period. Hence, having a perfect start during the initial construction phase shall have a positive influence on the project success. Our research paper studies each type of delay with some real example supported by statistic results and suggests mitigation measures. Detailed analysis carried out with all stakeholders based on impact and occurrence of delays to have a practical and effective outcome to mitigate the delays. The key to improvement is to have proper control measures and periodic evaluation/audit to ensure implementation of the mitigation measures. The focus of this research is to reduce the delays encountered during the initial construction phase of the project life cycle.

Keywords: construction activities delays, delay analysis for construction projects, mobilization delays, oil & gas projects delays

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Authors: Guler Duru Asiret, Cemile Kutmec Yilmaz, Gulcan Bagcivan, Tugce Turten Kaymaz

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This descriptive study was conducted to determine the relationship between caregiver burden and life satisfaction who give home care to elderly individuals. The sample was recruited from the internal medicine unit and palliative unit of a state hospital located in Turkey on June 2016-2017. The study sample consisted of 231 primary caregiver family member, who met the eligibility criteria and agreed to participate in the study. The inclusion criteria were as follows: inpatient’s caregiver, primary caregiver for at least 3 months, at least 18 years of age, no communication problem or mental disorder. Data were gathered using an Information Form prepared by the researchers based on previous literature, the Zarit Burden Interview (ZBI), and the Satisfaction with Life Scale (SWLS). The data were analyzed using IBM SPSS Statistics software version 20.0 (SPSS, Chicago, IL). The descriptive characteristics of the participant were analyzed using number, percentage, mean and standard deviation. The suitability of normal distribution of scale scores was analyzed using Kolmogorov-Smirnov and Shapiro-Wilk test. Relationships between scales were analyzed using Spearman’s rank-correlation coefficient. P values less than 0.05 were considered to be significant. The average age of the caregivers was 50.11±13.46 (mean±SD) years. Of the caregivers, 76.2% were women, 45% were primary school graduates, 89.2% were married, 38.1% were the daughters of their patients. Among these, 52.4% evaluated their income level to be good. Of them, 53.6% had been giving care less than 2 years. The patients’ average age was 77.1±8.0 years. Of the patients, 55.8% were women, 56.3% were illeterate, 70.6% were married, and 97.4% had at least one chronic disease. The mean Zarit Burden Interview score was 35.4±1.5 and the Satisfaction with Life Scale score was 20.6±6.8. A negative relationship was found between the patients’ score average on the ZBI, and on the SWLS (r= -0.438, p=0.000). The present study determined that the caregivers have a moderate caregiver burden and the life satisfaction. And the life satisfaction of caregivers decreased as their caregiver burden increase. In line with the results obtained from the research, it is recommended that to increase the effectiveness of discharge training, to arrange training and counseling programs for caregivers to cope with the problems they experienced, to monitor the caregivers at regular intervals and to provide necessary institutional support.

Keywords: caregiver burden, family caregivers, nurses, satisfaction

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Authors: Mmamapudi Kubjane, Natacha Berkowitz, Rene Goliath, Naomi S. Levitt, Robert J. Wilkinson, Tolu Oni

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Background: South Africa remains a high tuberculosis (TB) burden country globally and the burden of diabetes – a TB risk factor is growing rapidly. As an infectious disease, TB also induces transient hyperglycaemia. Therefore, screening for diabetes in newly diagnosed tuberculosis patients may result in misclassification of transient hyperglycaemia as diabetes. Objective: The objective of this study was to determine and compare the prevalence of hyperglycaemia (diabetes and impaired glucose regulation (IGR)) in TB patients and to assess the cross-sectional association between TB and hyperglycaemia at enrolment and after three months of follow-up. Methods: Consecutive adult TB and non-TB participants presenting at a TB clinic in Cape Town were enrolled in this cross-sectional study and follow-up between July 2013 and August 2015. Diabetes was defined as self-reported diabetes, fasting plasma glucose (FPG) ≥ 7.0 mmol·L⁻¹ or glycated haemoglobin (HbA1c) ≥ 6.5%. IGR was defined as FPG 5.5– < 7.0 mmol·L⁻¹ or HbA1c 5.7– < 6.5%. TB patients initiated treatment. After three months, all participants were followed up and screened for diabetes again. The association between TB and hyperglycaemia was assessed using logistic regression adjusting for potential confounders including sex, age, income, hypertension, waist circumference, previous prisoner, marital status, work status, HIV status. Results: Diabetes screening was performed in 852 participants (414 TB and 438 non-TB) at enrolment and in 639 (304 TB and 335 non-TB) at three-month follow-up. The prevalence of HIV-1 infection was 69.6% (95% confidence interval (CI), 64.9–73.8 %) among TB patients, and 58.2% (95% CI, 53.5–62.8 %) among the non-TB participants. Glycaemic levels were much higher in TB patients than in the non-TB participants but decreased over time. Among TB patients, the prevalence of IGR was 65.2% (95% CI 60.1 - 69.9) at enrollment and 21.5% (95% CI 17.2-26.5) at follow-up; and was 50% (45.1 - 54.94) and 32% (95% CI 27.9 - 38.0) respectively, among non-TB participants. The prevalence of diabetes in TB patients was 12.5% (95% CI 9.69 – 16.12%) at enrolment and 9.2% (95% CI, 6.43–13.03%) at follow-up; and was 10.04% (95% CI, 7.55–13.24%) and 8.06% (95% CI, 5.58–11.51) respectively, among non-TB participants. The association between TB and IGT was significant at enrolment (adjusted odds ratio (OR) 2.26 (95% CI, 1.55-3.31) but disappeared at follow-up 0.84 (0.53 - 1.36). However, the TB-diabetes association remained positive and significant both at enrolment (2.41 (95% CI, 1.3-4.34)) and follow-up (OR 3.31 (95% CI, 1.5 - 7.25)). Conclusion: Transient hyperglycaemia exists during tuberculosis. This has implications on diabetes screening in TB patients and suggests a need for diabetes confirmation tests during or after TB treatment. Nonetheless, the association between TB and diabetes noted at enrolment persists at 3 months highlighting the importance of diabetes control and prevention for TB control. Further research is required to investigate the impact of hyperglycaemia (transient or otherwise) on TB outcomes to ascertain the clinical significance of hyperglycemia at enrolment.

Keywords: diabetes, impaired glucose regulation, transient hyperglycaemia, tuberculosis

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Authors: Madhusudana S. N., Reeta Mani, Ashwini S. Satishchandra P., Netravati, Udhani V., Fiaz A., Karande S.

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Rabies is an acute encephalitis which is considered 100% fatal despite occasional reports of survivors. However, in recent times more cases of human rabies survivors are being reported. In the last 5 years, there are six laboratories confirmed human rabies survivors in India alone. All cases were children below 15 years and all contracted the disease by dog bites. All of them also had received the full or partial course of rabies vaccination and 4 out of 6 had also received rabies immunoglobulin. All cases were treated in intensive care units in hospitals at Bangalore, Mumbai, Chandigarh, Lucknow and Goa. We report here the results of immunological and virological studies conducted at our laboratory on these patients. The clinical samples that were obtained from these patients were Serum, CSF, nuchal skin biopsy and saliva. Serum and CSF samples were subjected to standard RFFIT for estimation of rabies neutralizing antibodies. Skin biopsy, CSF and saliva were processed by TaqMan real-time PCR for detection of viral RNA. CSF, saliva and skin homogenates were also processed for virus isolation by inoculation of suckling mice. The PBMCs isolated from fresh blood was subjected to ELISPOT assay to determine the type of immune response (Th1/Th2). Both CSF and serum were also investigated for selected cytokines by Luminex assay. The level of antibodies to virus G protein and N protein were determined by ELISA. All survivors had very high titers of RVNA in serum and CSF 100 fold higher than non-survivors and vaccine controls. A five-fold rise in titer could be demonstrated in 4 out of 6 patients. All survivors had a significant increase in antibodies to G protein in both CSF and serum when compared to non-survivors. There was a profound and robust Th1 response in all survivors indicating that interferon gamma could play an important factor in virus clearance. We could isolate viral RNA in only one patient four years after he had developed symptoms. The partial N gene sequencing revealed 99% homology to species I strain prevalent in India. Levels of selected cytokines in CSF and serum did not reveal any difference between survivors and non-survivors. To conclude, survival from rabies is mediated by virus-specific immune responses of the host and clearance of rabies virus from CNS may involve the participation of both Th2 and Th1 immune responses.

Keywords: rabies, rabies treatment, rabies survivors, immune reponse in rabies encephalitis

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Authors: Zavkiddin Mirtoshev, Mirabbos Mirkamalov

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We have analyzed the time series of full disk integrated soft X-ray (SXR) and hard X-ray (HXR) emission from the solar corona during 2004 January 1 to 2009 December 31, covering the descending phase of solar cycle 23. We employed the daily X-ray index (DXI) derived from X-ray observations from the Solar X-ray Spectrometer (SOXS) mission in four different energy bands: 4-5.5; 5.5-7.5 keV (SXR) and 15-20; 20-25 keV (HXR). The application of Lomb-Scargle periodogram technique to the DXI time series observed by the Silicium detector in the energy bands reveals several short and intermediate periodicities of the X-ray corona. The DXI explicitly show the periods of 13.6 days, 26.7 days, 128.5 days, 151 days, 180 days, 220 days, 270 days, 1.24 year and 1.54 year periods in SXR as well as in HXR energy bands. Although all periods are above 70% confidence level in all energy bands, they show strong power in HXR emission in comparison to SXR emission. These periods are distinctly clear in three bands but somehow not unambiguously clear in 5.5-7.5 keV band. This might be due to the presence of Ferrum and Ferrum/Niccolum line features, which frequently vary with small scale flares like micro-flares. The regular 27-day rotation and 13.5 day period of sunspots from the invisible side of the Sun are found stronger in HXR band relative to SXR band. However, flare activity Rieger periods (150 and 180 days) and near Rieger period 220 days are very strong in HXR emission which is very much expected. On the other hand, our current study reveals strong 270 day periodicity in SXR emission which may be connected with tachocline, similar to a fundamental rotation period of the Sun. The 1.24 year and 1.54 year periodicities, represented from the present research work, are well observable in both SXR as well as in HXR channels. These long-term periodicities must also have connection with tachocline and should be regarded as a consequence of variation in rotational modulation over long time scales. The 1.24 year and 1.54 year periods are also found great importance and significance in the life formation and it evolution on the Earth, and therefore they also have great astro-biological importance. We gratefully acknowledge support by the Indian Centre for Space Science and Technology Education in Asia and the Pacific (CSSTEAP, the Centre is affiliated to the United Nations), Physical Research Laboratory (PRL) at Ahmedabad, India. This work has done under the supervision of Prof. Rajmal Jain and paper consist materials of pilot project and research part of the M. Tech program which was made during Space and Atmospheric Science Course.

Keywords: corona, flares, solar activity, X-ray emission

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Authors: Mdluli Fezile, Schmidt Stefan, Thamaga-Chitja Joyce

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In view of the frequently reported foodborne disease outbreaks caused by contaminated fresh produce, consumers have a preference for foods that meet requisite hygiene standards to reduce the risk of foodborne illnesses. Producing good quality fresh produce then becomes critical in improving market access and food security, especially for small-scale farmers. Questions of hygiene and subsequent microbiological quality in the rural small-scale farming sector of South Africa are even more crucial, given the policy drive to develop small-scale farming as a measure for reinforcement of household food security and reduction of poverty. Farming practices and methods, throughout the fresh produce value chain, influence the quality of the final product, which in turn determines its success in the market. This study’s aim was to therefore determine the extent to which training on organic farming methods, including modules such as Importance of Production Hygiene, influenced the hygienic farming practices employed by eTholeni small-scale organic farmers in uMbumbulu, KwaZulu-Natal- South Africa. Questionnaires were administered to 73 uncertified organic farmers and analysis showed that a total of 33 farmers were trained and supplied the local Agri-Hub while 40 had not received training. The questionnaire probed respondents’ attitudes, knowledge of hygiene and composting practices. Data analysis included descriptive statistics such as the Chi-square test and a logistic regression model. Descriptive analysis indicated that a majority of the farmers (60%) were female, most of which (73%) were above the age of 40. The logistic regression indicated that factors such as farmer training and prior experience in the farming sector had a significant influence on hygiene practices both at 5% significance levels. These results emphasize the importance of training, education and farming experience in implementing good hygiene practices in small-scale farming. It is therefore recommended that South African policies should advocate for small-scale farmer training, not only for subsistence purposes, but also with an aim of supplying produce markets with high fresh produce.

Keywords: small-scale farmers, leafy salad vegetables, organic produce, food safety, hygienic practices, food security

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Authors: Takuya Suzuki, Atsushi Shirai, Takashi Seki

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Acupuncture therapy is one of the treatments in traditional Chinese medicine. Recently, some reports have shown the effectiveness of acupuncture. However, its full acceptance has been hindered by the lack of understanding on mechanism of the therapy. Acupuncture applied to Zusanli (ST-36) enhances blood flow volume in superior mesenteric artery (SMA), yielding peripheral vascular resistance – regulated blood flow of SMA dominated by the parasympathetic system and inhibition of sympathetic system. In this study, a lumped-parameter approximation model of blood flow in the systemic arteries was developed. This model was extremely simple, consisting of the aorta, carotid arteries, arteries of the four limbs and SMA, and their peripheral vascular resistances. Here, the individual artery was simplified to a tapered tube and the resistances were modelled by a linear resistance. We numerically investigated contribution of the peripheral vascular resistance of SMA to the systemic blood distribution using this model. In addition to the upstream end of the model, which correlates with the left ventricle, two types of boundary condition were applied; mean left ventricular pressure which correlates with blood pressure (BP) and mean cardiac output which corresponds to cardiac index (CI). We examined it to reproduce the experimentally obtained hemodynamic change, in terms of the ratio of the aforementioned hemodynamic parameters from their initial values before the acupuncture, by regulating the peripheral vascular resistances and the upstream boundary condition. First, only the peripheral vascular resistance of SMA was changed to show contribution of the resistance to the change in blood flow volume in SMA, expecting reproduction of the experimentally obtained change. It was found, however, this was not enough to reproduce the experimental result. Then, we also changed the resistances of the other arteries together with the value given at upstream boundary. Here, the resistances of the other arteries were changed simultaneously in the same amount. Consequently, we successfully reproduced the hemodynamic change to find that regulation of the upstream boundary condition to the value experimentally obtained after the stimulation is necessary for the reproduction, though statistically significant changes in BP and CI were not observed in the experiment. It is generally known that sympathetic and parasympathetic tones take part in regulation of whole the systemic circulation including the cardiac function. The present result indicates that stimulation to ST-36 could induce vasodilation of peripheral circulation of SMA and vasoconstriction of that of other arteries. In addition, it implies that experimentally obtained small changes in BP and CI induced by the acupuncture may be involved in the therapeutic response.

Keywords: acupuncture, hemodynamics, lumped-parameter approximation, modeling, systemic vascular resistance

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Authors: Toshiki Ito, Takahiro Yamane, Yuki Adachi, Yoshiko Kato, Eiji Tsuda, Kousaku Nagasaka, Keigo Yoshida, Yoshiko Kawasaki, Naoki Aizawa, Kyouhei Nishi, Tetsuko Kato

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The epidemic of the coronavirus (COVID-19), first reported in Wuhan at the end of 2019, has drastically changed our daily lives. Under these circumstances, counseling, which provides psychological support to people, was also greatly affected. The structure of counseling, which had generally been implicitly common practice to be conducted in person, was greatly shaken. The author wondered how counseling can be conducted in situations where it is impossible to meet face-to-face. This is where telepsychological support (online counseling) came into use. The authors found that there were the following problems in telepsychological support: (1) anxiety about whether the communication is appropriate, (2) difficulty in understanding the client's situation and condition, (3) inability to perceive what was normally perceived in person, (4) difficulty in adjusting to severely ill clients, (5) difficulty in dealing with emergency situations, etc. In this study, we interviewed psychologists who had been accustomed to telepsychological support for more than two years after the Corona disaster began to clarify how they had or had not overcome the problems of telepsychological support identified in the above studies. We also aim to consider the unique possibilities of how telepsychological support, a new technique of psychological support, can be implemented to provide more effective and meaningful support in society after the end of the Corona disaster (post-Corona society). Thirteen psychologists who are currently providing telepsychological support in the Corona Disaster will be interviewed, and semi-structured interviews will be conducted for one hour per person. In order to empirically examine how the problems in telepsychological support had been overcome or not through the interview survey, the authors asked (1) how they overcame their anxiety about whether they were able to communicate appropriately, (2) how they devised ways to overcome it, (3) how they overcame the difficulty in adapting to heavy clients in terms of the level of the disease, (4) how they overcame the difficulty in dealing with emergency situations. The interviews were analyzed using Thematic Analysis, a qualitative analysis method commonly used in qualitative research overseas. The authors found that some devices and perspectives were newly discovered as a result of two years of practice of telepsychological support and that psychologists in this study considered face-to-face interviews and telepsychological support to be separate and were flexible enough to use them when available and to move to face-to-face interviews when not appropriate.

Keywords: telepsychology, COVID-19, Corona, psychologist

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Authors: Eze Chinwe Catherine, Orji Nkiru Marykate, Anyaegbunam L. C., Igbodika M.C.

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Uterine Leiomyomata (ULs) are the most frequently occurring pelvic and gynaecologic tumors in premenopausal women, occurring globally with a prevalence of 21.4%. UL represents a major public health problem in African women; therefore, this study aimed to reveal public health impact and risk factors associated with uterine leiomyomata among women in Imo state. A convenience sample of 2965 women was studied for gynaecological cases from October 2020 to March 2021 at the selected clinics of study. Eligible women were recruited to participate in a non interventional descriptive cross-sectional study. Data on socio demographic and gynaecological characteristics, BMI, parity, age, age at menarche, knowledge, attitudes, and perception were collected using a structured questionnaire, guided interviews, anthropometrics, and haematological tests. These were analyzed using SPSS Version 23. Associations between continuous variables were analysed appropriately and tested at 95% confidence level and standard error of 5%. A total of 652(22.0%) were diagnosed having uterine Leiomyomata (UL), and the overall prevalence of UF at clinics/Diagnostic centre in Imo State was 22%. A total of 652 women (46.1%) responded. More than half of the women had a parity of zero (1623: 54.8%), 664 (22.4%) had a parity of 1-2, and 491 (16.6%) had a parity of 3-4. Majority (68.6%) indicated that they experience an irregular menstrual cycle, and a similar proportion (67%) number experience pelvic pain. Age was found as a significant associating factor of uterine fibroids in this study (p=0.046, χ2= 6.158), lowest among the women between 16 to 25 years old and highest among the women between 36 – 45 years of age. The rate of UF was found to be 62.1% on the studied women menarche age of 11 years old or less while it was approximately 18% among the women whose age at menarche were at least 14 years old. Education ((p=0.003, χ²= 13.826), residency (p=0.066, χ²= 3.372). BMI (p= 0.000, χ²=102.36) were significantly associated with the risk of UL. Some of the Clinical presentation includes anaemia, abdominal pelvic mass, and infertility. The poor positive perception was obtained on the general perception (16.7%) as well as on treatment seeking behavior (28%). The study concluded that UL had a significant impact on health related quality of life on respondents due to its relatively high prevalence and their probable impact on patient’s quality of life.UL was especially prevalent in women aged between 36 to 45 years, nulliparous women, and women of higher BMI. Community enlightenment to enhance knowledge, attitude, and perception on fibroids and risk factors necessary to ensure early diagnosis and presentation, including patient centered treatment option.

Keywords: fibroids, prevalence, risk factors, body mass index, menarche, anaemia, KAP

Procedia PDF Downloads 141

Authors: Klazina T. Havinga, Hilde R. H. de Geus

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Introduction: Pre-operative coagulation management of Apixaban prescribed patients, a new oral anticoagulant (a factor Xa inhibitor), is difficult, especially when chronic kidney disease (CKD) causes drug overdose. Apixaban is not dialyzable due to its high level of protein binding. An antidote, Andexanet α, is available but expensive and has an unfavorable short half-life. We report the successful extracorporeal removal of Apixaban prior to emergency surgery with the CytoSorb® Hemoadsorption device. Methods: A 89-year-old woman with CKD, with an Apixaban prescription for atrial fibrillation, was presented at the ER with traumatic rib fractures, a flail chest, and an unstable spinal fracture (T12) for which emergency surgery was indicated. However, due to very high Apixaban levels, this surgery had to be postponed. Based on the Apixaban-specific anti-factor Xa activity (AFXaA) measurements at admission and 10 hours later, complete clearance was expected after 48 hours. In order to enhance the Apixaban removal and reduce the time to operation, and therefore reduce pulmonary complications, CRRT with CytoSorb® cartridge was initiated. Apixaban-specific anti-factor Xa activity (AFXaA) was measured frequently as a substitute for Apixaban drug concentrations, pre- and post adsorber, in order to calculate the adsorber-related clearance. Results: The admission AFXaA concentration, as a substitute for Apixaban drug levels, was 218 ng/ml, which decreased to 157 ng/ml after ten hours. Due to sustained anticoagulation effects, surgery was again postponed. However, the AFXaA levels decreased quickly to sub-therapeutic levels after CRRT (Multifiltrate Pro, Fresenius Medical Care, Blood flow 200 ml/min, Dialysate Flow 4000 ml/h, Prescribed renal dose 51 ml-kg-h) with Cytosorb® connected in series into the circuit was initiated (within 5 hours). The adsorber-related (indirect) Apixaban clearance was calculated every half hour (Cl=Qe * (AFXaA pre- AFXaA post/ AFXaA pre) with Qe=plasma flow rate calculated with Ht=0.38 and system blood flow rate 200 ml-min): 100 ml/min, 72 ml/min and 57 ml/min. Although, as expected, the adsorber-related clearance decreased quickly due to saturation of the beads, still the reduction rate achieved resulted in a very rapid decrease in AFXaA levels. Surgery was ordered and possible within 5 hours after Cytosorb initiation. Conclusion: The CytoSorb® Hemoadsorption device enabled rapid correction of Apixaban associated anticoagulation.

Keywords: Apixaban, CytoSorb, emergency surgery, Hemoadsorption

Procedia PDF Downloads 133

Authors: Lalita Khuna, Sugalya Amatachaya, Pipatana Amatachaya, Thiwabhorn Thaweewannakij, Pattra Wattanapan

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The five times sit-to-stand test (FTSST) has been widely used to quantify lower extremity motor strength (LEMS), dynamic balance ability, and risk of falls in many individuals. Recently, it has been used in ambulatory patients with spinal cord injury (SCI) but variously using with or without hands according to patients’ ability. This difference might affect the validity of the test in these individuals. Thus, this study assessed the concurrent validity of the FTSST in ambulatory individuals with SCI, separately for those who could complete the test with or without hands using LEMS and standard functional measures as gold standards. Moreover, the data of the tests from those who completed the FTSST with and without hands were compared. A total of 56 ambulatory participants with SCI who could complete sit-to-stand with or without hands were assessed for the time to complete the FTSST according to their ability. Then they were assessed for their LEMS scores and functional abilities, including the 10-meter walk test (10MWT), the walking index for spinal cord injury II (WISCI II), the timed up and go test (TUGT), and the 6-minute walk test (6MWT). The Mann-Whitney U test was used to compare the different findings between the participants who performed the FTSST with and without hands. The Spearman rank correlation coefficient (ρ) was applied to analyze the levels of correlation between the FTSST and standard tests (LEMS scores and functional measures). There were significant differences in the data between the participants who performed the test with and without hands (p < 0.01). The time to complete the FTSST of the participants who performed the test without hands showed moderate to strong correlation with total LEMS scores and all functional measures (ρ = -0.71 to 0.69, p < 0.001). On the contrary, the FTSST data of those who performed the test with hands were significantly correlated only with the 10MWT, TUGT, and 6MWT (ρ = -0.47 to 0.57, p < 0.01). The present findings confirm the concurrent validity of the FTSST when performed without hands for LEMS and functional mobility necessary for the ability of independence and safety of ambulatory individuals with SCI. However, the test using hands distort the ability of the outcomes to reflect LEMS and WISCI II that reflect lower limb functions. By contrast, the 10MWT, TUGT, and 6MWT allowed upper limb contribution in the tests. Therefore, outcomes of these tests showed a significant correlation to the outcomes of FTSST when assessed using hands. Consequently, the use of FTSST with or without hands needs to consider the clinical application of the outcomes, i.e., to reflect lower limb functions or mobility of the patients.

Keywords: mobility, lower limb muscle strength, clinical test, rehabilitation

Procedia PDF Downloads 127

Authors: Parker Murray, Marci Johnson, Tyson S. Burnham, Alina K. Fong, Mark D. Allen, Bruce McIff

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Purpose: Pathological dysregulation of Neurovascular Coupling (NVC) caused by mild traumatic brain injury (mTBI) is the predominant source of chronic post-concussion syndrome (PCS) symptomology. fNCI has the ability to localize dysregulation in NVC by measuring blood-oxygen-level-dependent (BOLD) signaling during the performance of fMRI-adapted neuropsychological evaluations. With fNCI, 57 brain areas consistently affected by concussion were identified as PCS neural markers, which were validated on large samples of concussion patients and healthy controls. These neuromarkers provide the basis for a computation of PCS severity which is referred to as the Severity Index Score (SIS). The SIS has proven valuable in making pre-treatment decisions, monitoring treatment efficiency, and assessing long-term stability of outcomes. Methods and Materials: After being scanned while performing various cognitive tasks, 476 concussed patients received an SIS score based on the neural dysregulation of the 57 previously identified brain regions. These scans provide an objective measurement of attentional, subcortical, visual processing, language processing, and executive functioning abilities, which were used as biomarkers for post-concussive neural dysregulation. Initial SIS scores were used to develop individualized therapy incorporating cognitive, occupational, and neuromuscular modalities. These scores were also used to establish pre-treatment benchmarks and measure post-treatment improvement. Results: Changes in SIS were calculated in percent change from pre- to post-treatment. Patients showed a mean improvement of 76.5 percent (σ= 23.3), and 75.7 percent of patients showed at least 60 percent improvement. Longitudinal reassessment of 24 of the patients, measured an average of 7.6 months post-treatment, shows that SIS improvement is maintained and improved, with an average of 90.6 percent improvement from their original scan. Conclusions: fNCI provides a reliable measurement of NVC allowing for identification of concussion pathology. Additionally, fNCI derived SIS scores direct tailored therapy to restore NVC, subsequently resolving chronic PCS resulting from mTBI.

Keywords: concussion, functional magnetic resonance imaging (fMRI), neurovascular coupling (NVC), post-concussion syndrome (PCS)

Procedia PDF Downloads 326

Authors: Yori Gidron, Maartje Mol, Norbert Foudraine, Frits Van Osch, Joop Van Den Bergh, Moshe Farchi, Maud Straus

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Background: The worldwide pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-COV2), which began in 2019, also known as Covid-19, has infected over 136 million people and tragically took the lives of over 2.9 million people worldwide. Many of the complications and deaths are predicted by the inflammatory “cytokine storm.” One way to progress in the prevention of death is by finding a predictive and protective factor that inhibits inflammation, on the one hand, and which also increases anti-viral immunity on the other hand. The vagal nerve does precisely both actions. This study examined whether vagal nerve activity, indexed by heart-rate variability (HRV), predicts survival in patients with Covid-19. Method: We performed a pseudo-prospective study, where we retroactively obtained ECGs of 271 Covid-19 patients arriving at a large regional hospital in The Netherlands. HRV was indexed by the standard deviation of the intervals between normal heartbeats (SDNN). We examined patients’ survival at 3 weeks and took into account multiple confounders and known prognostic factors (e.g., age, heart disease, diabetes, hypertension). Results: Patients’ mean age was 68 (range: 25-95) and nearly 22% of the patients had died by 3 weeks. Their mean SDNN (17.47msec) was far below the norm (50msec). Importantly, relatively higher HRV significantly predicted a higher chance of survival, after statistically controlling for patients’ age, cardiac diseases, hypertension and diabetes (relative risk, H.R, and 95% confidence interval (95%CI): H.R = 0.49, 95%CI: 0.26 – 0.95, p < 0.05). However, since HRV declines rapidly with age and since age is a profound predictor in Covid-19, we split the sample by median age (40). Subsequently, we found that higher HRV significantly predicted greater survival in patients older than 70 (H.R = 0.35, 95%CI: 0.16 – 0.78, p = 0.01), but HRV did not predict survival in patients below age 70 years (H.R = 1.11, 95%CI: 0.37 – 3.28, p > 0.05). Conclusions: To the best of our knowledge, this is the first study showing that higher vagal nerve activity, as indexed by HRV, is an independent predictor of higher chances for survival in Covid-19. The results are in line with the protective role of the vagal nerve in diseases and extend this to a severe infectious illness. Studies should replicate these findings and then test in controlled trials whether activating the vagus nerve may prevent mortality in Covid-19.

Keywords: Covid-19, heart-rate Variability, prognosis, survival, vagal nerve

Procedia PDF Downloads 161

Authors: Umamaheswari Shanmugam, Silvia Ronchi, Radu Vornicu

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Software, artificial intelligence, and machine learning can improve healthcare through innovative and advanced technologies that are able to use the large amount and variety of data generated during healthcare services every day. As we read the news, over 500 machine learning or other artificial intelligence medical devices have now received FDA clearance or approval, the first ones even preceding the year 2000. One of the big advantages of these new technologies is the ability to get experience and knowledge from real-world use and to continuously improve their performance. Healthcare systems and institutions can have a great benefit because the use of advanced technologies improves the same time efficiency and efficacy of healthcare. Software-defined as a medical device, is stand-alone software that is intended to be used for patients for one or more of these specific medical intended uses: - diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of a disease, any other health conditions, replacing or modifying any part of a physiological or pathological process–manage the received information from in vitro specimens derived from the human samples (body) and without principal main action of its principal intended use by pharmacological, immunological or metabolic definition. Software qualified as medical devices must comply with the general safety and performance requirements applicable to medical devices. These requirements are necessary to ensure high performance and quality and also to protect patients’ safety. The evolution and the continuous improvement of software used in healthcare must take into consideration the increase in regulatory requirements, which are becoming more complex in each market. The gap between these advanced technologies and the new regulations is the biggest challenge for medical device manufacturers. Regulatory requirements can be considered a market barrier, as they can delay or obstacle the device approval, but they are necessary to ensure performance, quality, and safety, and at the same time, they can be a business opportunity if the manufacturer is able to define in advance the appropriate regulatory strategy. The abstract will provide an overview of the current regulatory framework, the evolution of the international requirements, and the standards applicable to medical device software in the potential market all over the world.

Keywords: artificial intelligence, machine learning, SaMD, regulatory, clinical evaluation, classification, international requirements, MDR, 510k, PMA, IMDRF, cyber security, health care systems.

Procedia PDF Downloads 76

Authors: Anne-Loes K. Warps, Rob A. E. M. Tollenaar, Pieter J. Tanis, Jan Willem T. Dekker

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Anastomotic leakage after colorectal cancer surgery remains a severe complication. Early diagnosis and treatment are essential to prevent further adverse outcomes. In the literature, it has been suggested that earlier reintervention is associated with better survival, but anastomotic leakage can occur with a highly variable time interval to index surgery. This study aims to evaluate the time-interval between rectal cancer resection with primary anastomosis creation and reoperation, in relation to short-term outcomes, stratified for the use of a defunctioning stoma. Methods: Data of all primary rectal cancer patients that underwent elective resection with primary anastomosis during 2013-2019 were extracted from the Dutch ColoRectal Audit. Analyses were stratified for defunctioning stoma. Anastomotic leakage was defined as a defect of the intestinal wall or abscess at the site of the colorectal anastomosis for which a reintervention was required within 30 days. Primary outcomes were new stoma construction, mortality, ICU admission, prolonged hospital stay and readmission. The association between time to reoperation and outcome was evaluated in three ways: Per 2 days, before versus on or after postoperative day 5 and during primary versus readmission. Results: In total 10,772 rectal cancer patients underwent resection with primary anastomosis. A defunctioning stoma was made in 46.6% of patients. These patients had a lower anastomotic leakage rate (8.2% vs. 11.6%, p < 0.001) and less often underwent a reoperation (45.3% vs. 88.7%, p < 0.001). Early reoperations (< 5 days) had the highest complication and mortality rate. Thereafter the distribution of adverse outcomes was more spread over the 30-day postoperative period for patients with a defunctioning stoma. Median time-interval from primary resection to reoperation for defunctioning stoma patients was 7 days (IQR 4-14) versus 5 days (IQR 3-13 days) for no-defunctioning stoma patients. The mortality rate after primary resection and reoperation were comparable (resp. for defunctioning vs. no-defunctioning stoma 1.0% vs. 0.7%, P=0.106 and 5.0% vs. 2.3%, P=0.107). Conclusion: This study demonstrated that early reinterventions after anastomotic leakage are associated with worse outcomes (i.e. mortality). Maybe the combination of a physiological dip in the cellular immune response and release of cytokines following surgery, as well as a release of endotoxins caused by the bacteremia originating from the leakage, leads to a more profound sepsis. Another explanation might be that early leaks are not contained to the pelvis, leading to a more profound sepsis requiring early reoperations. Leakage with or without defunctioning stoma resulted in a different type of reinterventions and time-interval between surgery and reoperation.

Keywords: rectal cancer surgery, defunctioning stoma, anastomotic leakage, time-interval to reoperation

Procedia PDF Downloads 120

Authors: Suganya Chandrababu, Dhundy Bastola

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Like in the gut, the subgingival microbiota plays a crucial role in oral hygiene, health, and cariogenic diseases. Human activities like diet, antibiotics, and periodontal treatments alter the bacterial communities, metabolism, and functions in the oral cavity, leading to a dysbiotic state and changes in the plaques of orthodontic patients. Fixed periodontal appliances hinder oral hygiene and cause changes in the dental plaques influencing the subgingival microbiota. However, the microbial species’ diversity and complexity pose a great challenge in understanding the taxa’s community distribution patterns and their role in oral health. In this research, we analyze the subgingival microbial samples from individuals with fixed dental appliances (metal/clear) using an in silico approach. We employ exploratory hypothesis-driven multivariate and regression analysis to shed light on the microbial community and its functional fluctuations due to dental appliances used and identify risks associated with complex disease phenotypes. Our findings confirm the changes in oral microbiota composition due to the presence and type of fixed orthodontal devices. We identified seven main periodontic pathogens, including Bacteroidetes, Actinobacteria, Proteobacteria, Fusobacteria, and Firmicutes, whose abundances were significantly altered due to the presence and type of fixed appliances used. In the case of metal braces, the abundances of Bacteroidetes, Proteobacteria, Fusobacteria, Candidatus saccharibacteria, and Spirochaetes significantly increased, while the abundance of Firmicutes and Actinobacteria decreased. However, in individuals With clear braces, the abundance of Bacteroidetes and Candidatus saccharibacteria increased. The highest abundance value (P-value=0.004 < 0.05) was observed with Bacteroidetes in individuals with the metal appliance, which is associated with gingivitis, periodontitis, endodontic infections, and odontogenic abscesses. Overall, the bacterial abundances decrease with clear type and increase with metal type of braces. Regression analysis further validated the multivariate analysis of variance (MANOVA) results, supporting the hypothesis that the presence and type of the fixed oral appliances significantly alter the bacterial abundance and composition.

Keywords: oral microbiota, statistical analysis, fixed or-thodontal appliances, bacterial abundance, multivariate analysis, regression analysis

Procedia PDF Downloads 176

Authors: Grmay Kassa Brhane, Hailemariam Siyum Mekonen

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This study was designed to identify the hydrogeochemical and anthropogenic processes controlling the evaluation of groundwater chemistry in the Ellala catchment which covers about 296.5 km2 areal extent. The chemical analysis revealed that the major ions in the groundwater are Ca2+, Mg2+, Na+, and K+ (cations) and HCO3-, PO43-, Cl-, NO3-, and SO42-(anions). Most of the groundwater samples (68.42%) revealed that the groundwater in the catchment is non-alkaline. In addition to the contribution of aquifer material, the solid materials and liquid wastes discharged from different sources can be the main sources of pH and EC in the groundwater. It is observed that the EC of the groundwater is fairly correlated with the DTS. This indicates that high mineralized water is more conductor than water with low concentration. The degree of salinity of the groundwater increases along the groundwater flow path from East to West; then, areas surrounding Mekelle City are highly saline due to the liquid and solid wastes discharged from the city and the industries. The groundwater facies in the catchment are predominated with calcium, magnesium, and bicarbonate which are labeled as Ca-Mg-HCO3 and Mg-Ca-HCO3. The main geochemical process controlling the evolution of the groundwater chemistry in the catchment is rock-water interaction, particularly carbonate dissolution. Due to the clay layer in the aquifer, the reverse is ion exchange. Non-significant silicate weathering and halite dissolution also contribute to the evolution of groundwater chemistry in the catchment. The groundwater in the catchment is dominated by the meteoritic origin although it needs further groundwater chemistry study with isotope dating analysis. The groundwater is under-saturated with calcite, dolomite, and aragonite minerals; hence, the more these minerals encounter the groundwater, the more the minerals dissolve. The main source of calcium and magnesium in groundwater is the dissolution of carbonate minerals (calcite and dolomite) since carbonate rocks are the dominant aquifer materials in the catchment. In addition to this, the weathering of dolerite rock is a possible source of magnesium ions. The relatively higher concentration of sodium over chloride indicates that the source of sodium-ion is reverse ion exchange and/or weathering of sodium-bearing materials, such as shale and dolerite rather than halite dissolution. High concentration of phosphate, nitrate, and chloride in the groundwater is the main anthropogenic source that needs treatment, quality control, and management in the catchment. From the Base Exchange Index Analysis, it is possible to understand that, in the catchment, the groundwater is dominated by the meteoritic origin, although it needs further groundwater chemistry study with isotope dating analysis.

Keywords: Ellala catchment, factor, chemistry, geochemical, groundwater

Procedia PDF Downloads 56

Authors: Magdalena Barbara Kaziuk

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Introduction: In December 2019, the first case of an acute infectious disease of the respiratory system caused by the SARS-CoV-2 virus was recorded in Wuhan in Central China. On March 11, 2020, the World Health Organization restrictions, among others, in the travel industry. Aim: The aim of the study was the assessment of the preparedness of European cultural institutions and catering establishments within the sanitary and epidemiological dimension during the COVID-19 pandemic by Polish tourists and their sense of safety in selected destinations. Material and methods: The study involved 300 Polish tourists (125 females, 175 males, age 46.5+/-12.9 years) who traveled during the COVID-19 pandemic to Southern European countries. 5 most popular travel destinations were selected: Italy, Austria, Greece, Croatia, and Mediterranean islands. The tourists assessed cultural institutions and catering establishments with the use of a proprietary questionnaire which concerned the preparedness regarding the sanitary and epidemiological requirements and the tourists' sense of safety. The number of respondents was deliberate - 60 persons per each country. Results: The more stringent sanitary regimes, the higher the sense of safety in the study group of females aged 45-50 (p<0.005), while the more stringent sanitary and epidemiological issues are implemented, the shorter the stay (p<0.001). Less stringent restrictions resulted in increased sense of freedom and mental rest in the group of studied males (p<0.005). Conclusions: The respondents' opinions revealed that the highest level of safety with regard to sanitary and epidemiological requirements (masks covering mouth and nose worn by both personnel and society, the necessity to present the COVID passport, the possibility to disinfect hands) was observed in Austria and Italy, while shorter length of the stay in these countries resulted from high prices, particularly in catering establishments. According to the respondents, less stringent restrictions, among others lack of the necessity to own the COVID passport, were linked to Croatia and Mediterranean islands. The sense of safety was satisfying, while the sense of freedom and mental rest was high. declared a string of COVID-19 cases a pandemic. Most countries implemented numerous sanitary and epidemiological

Keywords: sanitary and epidemiological regimes, tourist facilities, COVID-19 pandemic, sense of safety

Procedia PDF Downloads 108

Authors: Mohamad Molavi Nojumi, Xiaodong Wang

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In this research fracture behaviour of linear elastic isotropic functionally graded materials (FGMs) are investigated using modified finite element method (FEM). FGMs are advantageous because they enhance the bonding strength of two incompatible materials, and reduce the residual stress and thermal stress. Ceramic/metals are a main type of FGMs. Ceramic materials are brittle. So, there is high possibility of crack existence during fabrication or in-service loading. In addition, damage analysis is necessary for a safe and efficient design. FEM is a strong numerical tool for analyzing complicated problems. Thus, FEM is used to investigate the fracture behaviour of FGMs. Here an accurate 9-node biquadratic quadrilateral graded element is proposed in which the influence of the variation of material properties is considered at the element level. The stiffness matrix of graded elements is obtained using the principle of minimum potential energy. The implementation of graded elements prevents the forced sudden jump of material properties in traditional finite elements for modelling FGMs. Numerical results are verified with existing solutions. Different numerical simulations are carried out to model stationary crack problems in nonhomogeneous plates. In these simulations, material variation is supposed to happen in directions perpendicular and parallel to the crack line. Two special linear and exponential functions have been utilized to model the material gradient as they are mostly discussed in literature. Also, various sizes of the crack length are considered. A major difference in the fracture behaviour of FGMs and homogeneous materials is related to the break of material symmetry. For example, when the material gradation direction is normal to the crack line, even under applying the mode I loading there exists coupled modes I and II of fracture which originates from the induced shear in the model. Therefore, the necessity of the proper modelling of the material variation should be considered in capturing the fracture behaviour of FGMs specially, when the material gradient index is high. Fracture properties such as mode I and mode II stress intensity factors (SIFs), energy release rates, and field variables near the crack tip are investigated and compared with results obtained using conventional homogeneous elements. It is revealed that graded elements provide higher accuracy with less effort in comparison with conventional homogeneous elements.

Keywords: finite element, fracture mechanics, functionally graded materials, graded element

Procedia PDF Downloads 158

Authors: Arto Grasten

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Given the rising trend in obesity in children and youth, age-related decline in moderate- to- vigorous-intensity physical activity (MVPA) in several Western, African, and Asian countries in addition to limited evidence of behavioral, affective, cognitive outcomes in physical education, it is important to clarify the motivational processes in physical education classes behind total MVPA engagement. The present study examined the full sequence of the Hierarchical Model of Motivation in physical education including motivational climate, basic psychological needs, intrinsic motivation, contextual behavior, affect, cognition, total MVPA, and associated links to body mass index (BMI) and gender differences. A cross-sectional data comprised self-reports and objective assessments of 770 middle school students (Mage = 13.99 ± .81 years, 52% of girls) in North-East Finland. In order to test the associations between motivational climate, psychological needs, intrinsic motivation, cognition, behavior, affect, and total MVPA, a path model was implemented. Indirect effects between motivational climate and cognition, behavior, affect and total MVPA were tested by setting basic needs and intrinsic motivation as mediators into the model. The findings showed that direct and indirect paths for girls and boys associated with different contextual outcomes and girls’ indirect paths were not related with total MVPA. Precisely, task-involving climate-mediated by physical competence and intrinsic motivation related to enjoyment, importance, and graded assessments within girls, whereas task-involving climate associated with enjoyment and importance via competence and autonomy, and total MVPA via autonomy, intrinsic motivation, and importance within boys. Physical education assessments appeared to be essential in motivating students to participate in greater total MVPA. BMI was negatively linked with competence and relatedness only among girls. Although, the current and previous empirical findings supported task-involving teaching methods in physical education, in some cases, ego-involving climate should not be totally avoided. This may indicate that girls and boys perceive physical education classes in a different way. Therefore, both task- and ego-involving teaching practices can be useful ways of driving behavior in physical education classes.

Keywords: achievement goal theory, assessment, enjoyment, hierarchical model of motivation, physical activity, self-determination theory

Procedia PDF Downloads 268

Authors: Khairani Omar, Shalinawati Ramli, Nurul Azmawati Mohamed, Zarini Ismail, Nur Syahrina Rahim, Nurul Hayati Chamhuri

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Choosing a career which matches a student’s personality traits is one of the key factors for future work satisfaction. This is because career satisfaction is at the highest when it is in line with one’s personality strength, values and attitudes. Personality traits play a major role in determining the success of a student in the medical course. In the pre-clinical years, medical theories are being emphasized, thus, conscientious students would perform better than those with lower level of this trait. As the emphasis changes in the clinical years during which patient interaction is important, personality traits which involved interpersonal values become more essential for success. The aim of this study was to determine the personality traits of students who had chosen medicine as their career. It was a cross-sectional study conducted at the Islamic Science University of Malaysia. The respondents consisted of 81 students whose age ranged between 20-21 years old. A set of personality assessment inventory index which has been validated for the local context was used to determine the students’ personality traits. The instrument assessed 15 personality traits namely: aggressive, analytical, autonomy, creativity, extrovert, intellectual, motivation, diversity, resiliency, self-criticism, control, helpful, support, structured and achievement. The scores ranged between 1-100%, and they were categorized into low (1-30%), moderate (40-60%) and high scores (70-100%). The respondents were Year 3 pre-clinical medical students and there were more female students (69%) compared to male students (31%). Majority of them were from middle-income families. Approximately 70% of both parents of the respondents had tertiary education. Majority of the students had high scores in autonomy, creativity, diversity, helpful, structured and achievement. In other words, more than 50% of them scored high (70-100%) in these traits. Scoring high in these traits was beneficial for the medical course. For aggressive trait, 54% of them had moderate scores which is compatible for medicine as this indicated an inclination to being assertive. In the analytical and intellectual components, only 40% and 25% had high scores respectively. These results contradicted the usual expectation of medical students whereby they are expected to be highly analytical and intellectual. It would be an added value if the students had high scores in being extrovert as this reflects on good interpersonal values, however, the students had approximately similar scores in all categories of this trait. Being resilient in the medical school is important as the course is difficult and demanding. The students had good scores in this component in which 46% had high scores while 39% had moderate scores. In conclusion, by understanding their personality traits, strengths and weaknesses, the students will have an opportunity to improve themselves in the areas they lack. This will help them to become better doctors in future.

Keywords: career, medical students, medicine, personality traits

Procedia PDF Downloads 279

Authors: M. Warburton

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Background: Case study examining hydrotherapy for a person with DSI. A 46 year-old lady completely deaf and blind post congenital rubella syndrome. Touch becomes the primary information gathering sense to optimise function in life. Communication is achieved via tactile finger spelling and signals onto her hand and skin. Hydrotherapy may provide a suitable mobility environment and somato-sensory input to people, and especially DSI persons. Buoyancy, warmth, hydrostatic pressure, viscosity and turbulence are elements of hydrotherapy that may offer a DSI person somato-sensory input to stimulate the mechanoreceptors, thermoreceptors and proprioceptors and offer a unique hydro-therapeutic environment. Purpose: The purpose of this case study was to establish what measurable benefits could be achieved from hydrotherapy with a DSI person. Methods: Hydrotherapy was provided for 8-weeks, 2 x week, 35-minute session duration. Pool temperature 32.5 degrees centigrade. Pool length 25-metres. Each session consisted of mobility encouragement and supervision, and activities to stimulate the somato-sensory system utilising aquatic properties of buoyancy, turbulence, viscosity, warmth and hydrostatic pressure. Somato-sensory activities focused on stimulating touch and tactile exploration including objects of various shape, size, weight, contour, texture, elasticity, pliability, softness and hardness. Outcomes were measured by the Goal Attainment Scale (GAS) and included mobility distance, attendance, and timed tactile responsiveness to varying objects. Results: Mobility distance and attendance exceeded baseline expectations. Timed tactile responsiveness to varying objects also changed positively from baseline. Average scale scores were 1.00 with an overall GAS t-score of 63.69. Conclusions: Hydrotherapy can be a quantifiable physio-therapeutic option for persons with DSI. It provides a relatively safe environment for mobility and allows the somato-sensory system to be fully engaged - important for the DSI population. Implications: Hydrotherapy can be a measurable therapeutic option for a DSI person. Physiotherapists should consider hydrotherapy for DSI people. Hydrotherapy can offer unique physical properties for the DSI population not available on land.

Keywords: chronic, disability, disease, rehabilitation

Procedia PDF Downloads 334

Authors: William E. Bauta, Jennifer Rebeles, Reggie Jacob

Abstract:

Porphyrins are noteworthy in biomedical science for their cancer tissue accumulation and photophysical properties. The preferential accumulation of some porphyrins in cancerous tissue has been known for many years. This, combined with their characteristic photophysical and photochemical properties, including their strong fluorescence and their ability to generate reactive oxygen species in vivo upon laser irradiation, has led to much research into the application of porphyrins as cancer diagnostic and therapeutic agents. Porphyrins have been used as dyes to detect cancer cells both in vivo and, less commonly, in vitro. In one example, human sputum samples from lung cancer patients and patients without the disease were dissociated and stained with the porphyrin TCPP (5,10,15,20-tetrakis-(4-carboxyphenyl)-porphine). Cells were analyzed by flow cytometry. Cancer samples were identified by their higher TCPP fluorescence intensity relative to the no-cancer controls. However, quantitative analysis of fluorescence in cell suspensions stained with multiple fluorophores requires particles stained with each of the individual fluorophores as controls. Fluorescent control particles must be compatible in size with flow cytometer fluidics and have favorable hydrodynamic properties in suspension. They must also display fluorescence comparable to the cells of interest and be stable upon storage amine-functionalized spherical polystyrene beads in the 5 to 20-micron diameter range that was reacted with TCPP and EDC in aqueous pH six buffer overnight to form amide bonds. Beads were isolated by centrifugation and tested by flow cytometry. The 10-micron amine-functionalized beads displayed the best combination of fluorescence intensity and hydrodynamic properties, such as lack of clumping and remaining in suspension during the experiment. These beads were further optimized by varying the stoichiometry of EDC and TCPP relative to the amine. The reaction was accompanied by the formation of a TCPP-related particulate, which was removed, after bead centrifugation, using a microfiltration process. The resultant TCPP-functionalized beads were compatible with flow cytometry conditions and displayed a fluorescence comparable to that of stained cells, which allowed their use as fluorescence standards. The beads were stable in refrigerated storage in the dark for more than eight months. This work demonstrates the first preparation of porphyrin-functionalized flow cytometry control beads.

Keywords: tetraaryl porphyrin, polystyrene beads, flow cytometry, peptide coupling

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Authors: Alberto A. Escobar Puentes, G. Adriana García, Luis F. Cuevas G., Alejandro P. Zepeda, Fernando B. Martínez, Susana A. Rincón

Abstract:

Snack foods are usually classified as ‘junk food’ because have little nutritional value. However, due to the increase on the demand and third generation (3G) snacks market, low price and easy to prepare, can be considered as carriers of compounds with certain nutritional value. Resistant starch (RS) is classified as a prebiotic fiber it helps to control metabolic problems and has anti-cancer colon properties. The active compound can be developed by chemical cross-linking of starch with phosphate salts to obtain a type 4 resistant starch (RS4). The chemical reaction can be achieved by extrusion, a process widely used to produce snack foods, since it's versatile and a low-cost procedure. Starch is the major ingredient for snacks 3G manufacture, and the seeds of sorghum contain high levels of starch (70%), the most drought-tolerant gluten-free cereal. Due to this, the aim of this research was to develop a snack (3G), with RS4 in optimal conditions extrusion (previously determined) from sorghum starch, and carry on a sensory, chemically and structural characterization. A sample (200 g) of sorghum starch was conditioned with 4% sodium trimetaphosphate/ sodium tripolyphosphate (99:1) and set to 28.5% of moisture content. Then, the sample was processed in a single screw extruder equipped with rectangular die. The inlet, transport and output temperatures were 60°C, 134°C and 70°C, respectively. The resulting pellets were expanded in a microwave oven. The expansion index (EI), penetration force (PF) and sensory analysis were evaluated in the expanded pellets. The pellets were milled to obtain flour and RS content, degree of substitution (DS), and percentage of phosphorus (% P) were measured. Spectroscopy [Fourier Transform Infrared (FTIR)], X-ray diffraction, differential scanning calorimetry (DSC) and scanning electron microscopy (SEM) analysis were performed in order to determine structural changes after the process. The results in 3G were as follows: RS, 17.14 ± 0.29%; EI, 5.66 ± 0.35 and PF, 5.73 ± 0.15 (N). Groups of phosphate were identified in the starch molecule by FTIR: DS, 0.024 ± 0.003 and %P, 0.35±0.15 [values permitted as food additives (<4 %P)]. In this work an increase of the gelatinization temperature after the crosslinking of starch was detected; the loss of granular and vapor bubbles after expansion were observed by SEM; By using X-ray diffraction, loss of crystallinity was observed after extrusion process. Finally, a snack (3G) was obtained with RS4 developed by extrusion technology. The sorghum starch was efficient for snack 3G production.

Keywords: extrusion, resistant starch, snack (3G), Sorghum

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Authors: Ana Bermudez de Castro Muela, Xiomara Santos Salas, Silvia Cayon Somacarrera

Abstract:

The aim of this review is to explain what is the intracranial hypotension and its main causes, and also to approach to the diagnostic management in the different clinical situations, understanding radiological findings, and physiopathological substrate. An approach to the diagnostic management is presented: what are the guidelines to follow, the different tests available, and the typical findings. We review the myelo-CT and myelo-RM studies in patients with suspected CSF fistula or hypotension of unknown cause during the last 10 years in three centers. Signs of intracranial hypotension (subdural hygromas/hematomas, pachymeningeal enhancement, venous sinus engorgement, pituitary hyperemia, and lowering of the brain) that are evident in baseline CT and MRI are also sought. The intracranial hypotension is defined as a lower opening pressure of 6 cmH₂O. It is a relatively rare disorder with an annual incidence of 5 per 100.000, with a female to male ratio 2:1. The clinical features it’s an orthostatic headache, which is defined as development or aggravation of headache when patients move from a supine to an upright position and disappear or typically relieve after lay down. The etiology is a decrease in the amount of cerebrospinal fluid (CSF), usually by loss of it, either spontaneous or secondary (post-traumatic, post-surgical, systemic disease, post-lumbar puncture etc.) and rhinorrhea and/or otorrhea may exist. The pathophysiological mechanisms of hypotension and CSF hypertension are interrelated, as a situation of hypertension may lead to hypotension secondary to spontaneous CSF leakage. The diagnostic management of intracranial hypotension in our center includes, in the case of being spontaneous and without rhinorrhea and/or otorrhea and according to necessity, a range of available tests, which will be performed from less to more complex: cerebral CT, cerebral MRI and spine without contrast and CT/MRI with intrathecal contrast. If we are in a situation of intracranial hypotension with the presence of rhinorrhea/otorrhea, a sample can be obtained for the detection of b2-transferrin, which is found in the CSF physiologically, as well as sinus CT and cerebral MRI including constructive interference steady state (CISS) sequences. If necessary, cisternography studies are performed to locate the exact point of leakage. It is important to emphasize the significance of myelo-CT / MRI to establish the diagnosis and location of CSF leak, which is indispensable for therapeutic planning (whether surgical or not) in patients with more than one lesion or doubts in the baseline tests.

Keywords: cerebrospinal fluid, neuroradiology brain, magnetic resonance imaging, fistula

Procedia PDF Downloads 115