Search results for: onset of symptom

Authors: Boce Zhang, Yaguang Luo

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Ripening of climacteric fruits, such as bananas and avocados, are usually initiated days prior to the retail marketing. However, upon the onset of irreversible ripening, they undergo rapid spoilage if not consumed within a narrow climacteric time window. Controlled ripening of climacteric fruits is a critical step to provide consumers with high-quality products while reducing postharvest losses and food waste. There is a high demand for technologies that can retard the ripening process or enable accelerated ripening immediately before consumption. In this work, metal−organic framework (MOF) was developed as a solid porous matrix to encapsulate gaseous hormone, including ethylene, for subsequent application. The feasibility of the on-demand stimulated ripening of bananas and avocados is also evaluated. MOF was synthesized and loaded with ethylene gas. The MOF−ethylene was placed inside sealed containers with preclimacteric bananas and avocados and stored at 16 °C. The fruits were treated for 24-48 hours, and evaluated for ripening progress. Results indicate that MOF−ethylene treatment significantly accelerated the ripening-related changes of color and textural properties in treated bananas and avocados. The average ripening period for both avocados and bananas were reduced in half by using this method. No significant differences of quality characteristics at respective ripening stages were observed between produce ripened via MOF-ethylene versus exogenously supplied ethylene gas or endogenously produced ethylene. Solid MOF matrices could have multiple advantages compared to existing systems, including easy to transport and safe to use by minimally trained produce handlers and consumers. We envision that this technology can help tackle food waste challenges at the critical retail and consumer stages in the food supply chain.

Keywords: climacteric produce, controllable ripening, food waste challenge, metal organic framework

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Authors: Shivani Thakur, Jasmin Dominguez Cervantes, Ahmed Zabiba, Fatima Zabiba, Sandhini Agarwal, Kamalpreet Kaur, Hussein Maatouk, Shae Chand, Omar Madriz, Tiffany Huang, Saloni Bansal

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The prevalence of lymphedema in women in rural communities highlights the importance of developing effective treatment and prevention methods. Subjects with secondary lymphedema in California’s Central Valley were surveyed at 6 surgical clinics to assess demographics and symptoms of lymphedema. Additionally, subjects on semaglutide treatment for obesity and/or T2DM were monitored for their diabetes management, weight loss progress, and lymphedema symptoms compared to subjects who were not treated with semaglutide. The subjects were followed for 12 months. Subjects who were treated with semaglutide completed pre-treatment questionnaires and follow-up post-treatment questionnaires at 3, 6, 9, 12 months, along with medical assessment. The untreated subjects completed similar questionnaires. The questionnaires investigated subjective feelings regarding lymphedema symptoms and management using a Likert-scale; quantitative leg measurements were collected, and blood work reviewed at these appointments. Paired difference t-tests, chi-squared tests, and independent sample t-tests were performed. 50 subjects, aged 18-75 years, completed the surveys evaluating secondary lymphedema: 90% female, 69% Hispanic, 45% Spanish speaking, 42% disabled, 57 % employed, 54% income range below 30 thousand dollars, and average BMI of 40. Both treatment and non-treatment groups noted the most common symptoms were leg swelling (x̄=3.2, ▁d= 1.3), leg pain (x̄=3.2, ▁d=1.6 ), loss of daily function (x̄=3, ▁d=1.4 ), and negative body image (x̄=4.4, ▁d=0.54). Subjects in the semaglutide treatment group >3 months of treatment compared to the untreated group demonstrated: 55% subject in the treated group had a 10% weight loss vs 3% in the untreated group (average BMI reduction by 11% vs untreated by 2.5%, p<0.05) and improved subjective feelings about their lymphedema symptoms: leg swelling (x̄=2.4, ▁d=0.45 vs x̄=3.2, ▁d=1.3, p<0.05), leg pain (x̄=2.2, ▁d=0.45 vs x̄= 3.2, ▁d= 1.6, p<0.05), and heaviness (x̄=2.2, ▁d=0.45 vs x̄=3, ▁d=1.56, p<0.05). Improvement in diabetes management was demonstrated by an average of 0.9 % decrease in A1C values compared to untreated 0.1 %, p<0.05. In comparison to untreated subjects, treatment subjects on semaglutide noted 6 cm decrease in the circumference of the leg, knee, calf, and ankle compared to 2 cm in untreated subjects, p<0.05. Semaglutide was shown to significantly improve weight loss, T2DM management, leg circumference, and secondary lymphedema functional, physical and psychosocial symptoms.

Keywords: diabetes, secondary lymphedema, semaglutide, obesity

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Authors: Tracey Lion-Cachet

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Eating disorders typically manifest in adolescence and are notoriously difficult to treat. There are two notable reasons for this. Firstly, research consistently demonstrates that early intervention is a critical mediator of prognosis, with early intervention leading to a better prognosis. However, because eating disorders do not originate as full-syndrome diagnoses but rather as prodromal cases, they often go undetected; by the time symptoms meet diagnostic criteria, they have become recalcitrant. Another interrelated issue is motivation to change. Research demonstrates that in the early stages of an eating disorder, adolescents are highly resistant to change, and motivation increases only once symptoms have shifted from egosyntonic to egodystonic in nature. The purpose of this project was to design a prevention model based on the social psychology paradigm of Entertainment-Education, which embeds messages within the genre of film as a means of affecting change. The resulting project was a narrative screenplay targeting teenagers/young adults from diverse backgrounds. The goals of the project were to create a film script that, if ultimately made into a film, could serve to: 1) interrupt symptom progression and improve prognosis through early intervention; 2) incorporate techniques from third-wave cognitive behavioral treatment models, acceptance and commitment therapy (ACT) and rational recovery (RR), with a focus on the effects of mindfulness as a means of informing recovery; 3) target issues to do with motivation to change by shifting the perception of eating disorders from culturally specific psychiatric illnesses to habit-based brain wiring issues. Nine licensed clinicians were asked to evaluate two excerpts taken from the final script. They subsequently provided feedback on a Likert-scale, which assessed whether the script had achieved its goals. Overall, evaluators agreed that the project’s etiological and intervention models have the potential to inspire change and serve as an effective means of prevention and treatment of eating disorders. However, one-third of the evaluators did not find the content developmentally appropriate. This is a notable limitation to the study and will need to be addressed in the larger script before the final project can potentially be targeted to a teenage and young adult audience.

Keywords: adolescents, eating disorders, pediatrics, entertainment-education, mindfulness-based intervention, prevention

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Authors: Juan C. Reyes, Linnette Rodríguez, Héctor Villanueva, Jorge Vázquez, Ivonne Rivera

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On July 2020, a private non-profit community health center (HealthProMed) that serves people without a medical insurance plan or with limited resources in one of the most populated areas in San Juan, Puerto Rico, implemented a COVID-19 case investigation and contact-tracing surveillance system. Nursing personnel at the health center completed a computerized case investigation form that was translated, adapted, and modified from CDC’s Patient Under Investigation (PUI) Form. Between July 13, 2020, and March 17, 2022, a total of 9,233 SARS-CoV-2 tests were conducted at the health center, 16.9% of which were classified as confirmed cases (positive molecular test) and 27.7% as probable cases (positive serologic test). Most of the confirmed cases were females (60.0%), under 20 years old (29.1%), and living in their homes (59.1%). In the 14 days before the onset of symptoms, 26.3% of confirmed cases reported going to the supermarket, 22.4% had contact with a known COVID-19 case, and 20.7% went to work. The symptoms most commonly reported were sore throat (33.4%), runny nose (33.3%), cough (24.9%), and headache (23.2%). The most common preexisting medical conditions among confirmed cases were hypertension (19.3%), chronic lung disease including asthma, emphysema, COPD (13.3%), and diabetes mellitus (12.8). Multiple logistic regression analysis revealed that patients who used alcohol frequently during the last two weeks (OR=1.43; 95%CI: 1.15-1.77), those who were in contact with a positive case (OR=1.58; 95%CI: 1.33-1.88) and those who were obese (OR=1.82; 95%CI: 1.24-2.69) were significantly more likely to be a confirmed case after controlling for sociodemographic variables. Implementing a case investigation and contact-tracing component at community health centers can be of great value in the prevention and control of COVID-19 at the community level and could be used in future outbreaks.

Keywords: community health center, Puerto Rico, risk factors, SARS-CoV-2

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Authors: Obasa Joshua Ifeoluwa

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Phonetics is the foundation and most important part of language learning. This article, through an acoustic experiment as well as using Praat software, uses Yoruba students’ Chinese consonants, vowels, and tones pronunciation to carry out a visual comparison with that of native Chinese speakers. This article is aimed at Yoruba native speakers learning Chinese phonetics; therefore, Yoruba students are selected. The students surveyed are required to be at an elementary level and have learned Chinese for less than six months. The students selected are all undergraduates majoring in Chinese Studies at the University of Lagos. These students have already learned Chinese Pinyin and are all familiar with the pinyin used in the provided questionnaire. The Chinese students selected are those that have passed the level two Mandarin proficiency examination, which serves as an assurance that their pronunciation is standard. It is discovered in this work that in terms of Mandarin’s consonants pronunciation, Yoruba students cannot distinguish between the voiced and voiceless as well as the aspirated and non-aspirated phonetics features. For instance, while pronouncing [ph] it is clearly shown in the spectrogram that the Voice Onset Time (VOT) of a Chinese speaker is higher than that of a Yoruba native speaker, which means that the Yoruba speaker is pronouncing the unaspirated counterpart [p]. Another difficulty is to pronounce some affricates like [tʂ]、[tʂʰ]、[ʂ]、[ʐ]、 [tɕ]、[tɕʰ]、[ɕ]. This is because these sounds are not in the phonetic system of the Yoruba language. In terms of vowels, some students find it difficult to pronounce some allophonic high vowels such as [ɿ] and [ʅ], therefore pronouncing them as their phoneme [i]; another pronunciation error is pronouncing [y] as [u], also as shown in the spectrogram, a student pronounced [y] as [iu]. In terms of tone, it is most difficult for students to differentiate between the second (rising) and third (falling and rising) tones because these tones’ emphasis is on the rising pitch. This work concludes that the major error made by Yoruba students while pronouncing Chinese sounds is caused by the interference of their first language (LI) and sometimes by their lingua franca.

Keywords: Chinese, Yoruba, error analysis, experimental phonetics, consonant, vowel, tone

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Authors: Monika Malik, Pooja Arora, Ruchi Sachdeva, Vishnampettai G. Ramachandran, Rahul Pal

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Apoptotic debris is believed to be the antigenic trigger in lupus. Whether such debris and autoantibodies induced in lupus-prone mice which specifically recognize its constituents can mediate differential effects on innate and humoral responses in such mice was assessed. The influence of apoptotic blebs and apoptotic cell-reactive monoclonal antibodies on phenotypic markers expressed on bone marrow-derived dendritic cells (BMDCs) and secreted cytokines were evaluated. Sera from lupus-prone and healthy mice immunized with the antibodies were analyzed for anti-self reactivity. Apoptotic blebs, as well as somatically-mutated IgG and non-mutated IgM apoptotic-cell reactive monoclonal antibodies, induced the preferential maturation of BMDCs derived from lupus-prone mice relative to BMDCs derived from healthy mice; antibody specificity and cell genotype both influenced the secretion of inflammatory cytokines. Immunization of lupus-prone mice with IgM and IgG antibodies led to hypergammaglobulinemia; elicited antibodies were self-reactive, and exhibited enhanced recognition of lupus-associated autoantigens (dsDNA, Ro60, RNP68, and Sm) in comparison with adjuvant-induced sera. While ‘natural’ IgM antibodies are believed to contribute to immune homeostasis, this study reveals that apoptotic cell-reactive IgM antibodies can promote inflammation and drive anti-self responses in lupus. Only in lupus-prone mice did immunization with IgG auto-antibodies enhance the kinetics of humoral anti-self responses, resulting in advanced-onset glomerulosclerosis. This study reveals that preferential innate and humoral recognition of the products of cell death in an autoimmune milieu influences the indices associated with lupus pathology.

Keywords: antigen spreading, apoptotic cell-reactive pathogenic IgG, and IgM autoantibodies, glomerulosclerosis, lupus

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Authors: Nidia Thalia Alva Rangel, Ferran Padros Blazquez, Ma. Ines Gomez Del Campo Del Paso

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Happiness has been since antiquity a concept of interest around the world. Positive psychology is the science that begins to study happiness in a more precise and controlled way, obtaining wide amount of research which can be applied. One of the central constructs of Positive Psychology is Carol Ryff’s psychological well-being model as eudaimonic happiness, which comprehends six dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Humanistic psychology is a clear precedent of Positive Psychology, which has studied human development topics and it features a great variety of intervention techniques nevertheless has little evidence with controlled research. Therefore, the present research had the aim to evaluate the efficacy of a humanistic intervention program to increase psychological well-being in healthy adults through a mixed methods study. Before and after the intervention, it was applied Carol Ryff’s psychological well-being scale (PWBS) and the Symptom Check List 90 as pretest and posttest. In addition, a questionnaire of five open questions was applied after each session. The intervention program was designed in experiential workshop format, based on the foundational attitudes defined by Carl Rogers: congruence, unconditional positive regard and empathy, integrating humanistic intervention strategies from gestalt, psychodrama, logotherapy and psychological body therapy, with the aim to strengthen skills in the six dimensions of psychological well-being model. The workshop was applied to six volunteer adults in 12 sessions of 2 hours each. Finally, quantitative data were analyzed with Wilcoxon statistic test through the SPSS program, obtaining as results differences statistically significant in pathology symptoms between prettest and postest, also levels of dimensions of psychological well-being were increased, on the other hand for qualitative strand, by open questionnaires it showed how the participants were experiencing the techniques and changing through the sessions. Thus, the humanistic psychology program was effective to increase psychological well-being. Working to promote well-being prompts to be an effective way to reduce pathological symptoms as a secondary gain. Experiential workshops are a useful tool for small groups. There exists the need for research to count with more evidence of humanistic psychology interventions in different contexts and impulse the application of Positive Psychology knowledge.

Keywords: happiness, humanistic psychology, positive psychology, psychological well-being, workshop

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Authors: Muhammad Rasyid Angkotasan

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The soil is a dense granules and arrangement of the pores that are related to each other, so that the water can flow from one point which has higher energy to a point that has lower energy. The flow of water through the pores of the porous ground is urgently needed in water seepage estimates in ground water pumping problems, investigate for underground construction, as well as analyzing the stability of the construction of Weirs. Climate change resulted in long-term changes in the distribution of weather patterns are statistically throughout the period start time of decades to millions of years. In other words, changes in the average weather circumstances or a change in the distribution of weather events, on average, for example, the number of extreme weather events that increasingly a lot or a little. Climate change is limited to a particular regional or can occur in all regions of the Earth. Geographical location between two continents and two oceans and is located around the equator is klimatologis factor is the cause of flooding and drought in Indonesia. This caused Indonesia' geographical position is on a hemisphere with a tropical monsoon climate is very sensitive to climatic anomaly El Nino Southern Oscillation (ENSO). ENSO causes drought occurrence in sea surface temperature conditions in the Pacific Equator warms up to the middle part of the East (El Nino). Based on the analysis of the climate of the last 30 years show that there is a tendency, the formation of a new pattern of climate causes the onset of climate change. The impact of climate change on the occurrence of the agricultural sector is the bergesernya beginning of the dry season which led to the above-mentioned pattern planting due to drought. The impact of climate change (drought) which is very extreme in Indonesia affect the shrinkage dimensions grain land and reduced the value of a percentage of the soil Plasticity Index caused by climate change.

Keywords: climate change, soil shrinkage, plasticity index, shrinking dimensions

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Authors: Rory Brown, Jessica Daniels, Babatunde Oremule, William Tsang, Sadie Khwaja

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Introduction: Dentures are common and are an intervention for both physical and psychological symptoms associated with tooth loss. However, the humble denture can cause morbidity and mortality if swallowed or aspirated. Numerous case reports document complications including hollow viscus perforation, fistula formation and airway compromise. The purpose of this review was to examine the literature documenting cases of swallowed or aspirated dentures over the past ten years to investigate factors that contribute to developing complications. Methods: A Medline literature search was performed to identify cases of denture ingestion or aspiration for over ten years. Data was collected to include patient, appliance and temporal factors that may contribute to developing complications including hollow viscus perforation, fistula formation, abscess, bowel obstruction, necrosis, hemorrhage and airway obstruction. The data was analyzed using observational and inferential statistics in the form of Chi-Squared and Pearson correlation tests. Results: Eighty-five cases of ingested or aspirated dentures were identified from 77 articles published between 1/10/2009 and 31/10/2019. Fourteen articles were excluded because they did not provide sufficient information on individual cases. Complications were documented in 37.6% of patients, and 2 cases resulted in death. There was no significant difference in complication risk based on patient age, hooked appliance, level of impaction, or radiolucency. However, symptoms of greater than 1-day duration are associated with an increased risk of complication (p=0.005). Increased time from ingestion or aspiration to removal is associated with an increased risk of complications, and the p-value remains significant up to and including day 4 (p=0.017). Conclusions: With denture use predicted to rise complications from the denture, ingestion and aspiration may become more frequent. We have demonstrated that increased symptom duration significantly increases the risk of developing complications. Additionally, we established the risk of developing complications is significantly reduced if the denture is removed with four days of aspiration or ingestion. By actively intervening early when presented with a case of swallowed or aspirated dentures, we may be able to reduce the morbidity associated with this unassuming device.

Keywords: aspiration, denture, ingestion, endoscopic foreign, body removal, foreign body impaction

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Authors: Pranee Suecharoen, Ratchadaporn Soontornpas, Jaturat Kanpittaya

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Background: Contrast media has an important role for disease diagnosis through detection of pathologies. Contrast media can, however, cause adverse reactions after administration of its agents. Although non-ionic contrast media are commonly used, the incidence of adverse events is relatively low. The most common reactions found (10.5%) were mild and manageable and/or preventable. Pharmacists can play an important role in evaluating adverse reactions, including awareness of the specific preparation and the type of adverse reaction. As most common types of adverse reactions are idiosyncratic or pseudo-allergic reactions, common standards need to be established to prevent and control adverse reactions promptly and effectively. Objective: To measure the effect of using tools for symptom evaluation in order to reduce the severity, or prevent the occurrence, of adverse reactions from contrast media. Methods: Retrospective review descriptive research with data collected on adverse reactions assessment and Naranjo’s algorithm between June 2015 and May 2016. Results: 158 patients (10.53%) had adverse reactions. Of the 1,500 participants with an adverse event evaluation, 137 (9.13%) had a mild adverse reaction, including hives, nausea, vomiting, dizziness, and headache. These types of symptoms can be treated (i.e., with antihistamines, anti-emetics) and the patient recovers completely within one day. The group with moderate adverse reactions, numbering 18 cases (1.2%), had hypertension or hypotension, and shortness of breath. Severe adverse reactions numbered 3 cases (0.2%) and included swelling of the larynx, cardiac arrest, and loss of consciousness, requiring immediate treatment. No other complications under close medical supervision were recorded (i.e., corticosteroids use, epinephrine, dopamine, atropine, or life-saving devices). Using the guideline, therapies are divided into general and specific and are performed according to the severity, risk factors and ingestion of contrast media agents. Patients who have high-risk factors were screened and treated (i.e., prophylactic premedication) for prevention of severe adverse reactions, especially those with renal failure. Thus, awareness for the need for prescreening of different risk factors is necessary for early recognition and prompt treatment. Conclusion: Studying adverse reactions can be used to develop a model for reducing the level of severity and setting a guideline for a standardized, multidisciplinary approach to adverse reactions.

Keywords: role of pharmacist, management of adverse reactions, guideline for contrast media, non-ionic contrast media

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Authors: Surachart Koyadun

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Currently, Plasmodium knowlesi malaria has spread to almost all countries in Southeast Asia. This research aimed to 1) describe the epidemiology of Plasmodium knowlesi malaria, 2) examine the clinical symptoms of P. knowlesi malaria patients 3) analyze the ecology, animal reservoir and entomology of P. knowlesi malaria. 4) summarize the diagnosis, blood parasites, and treatment of P. knowlesi malaria. The study design was a case report combined with retrospective descriptive survey research. A total of 34 study subjects were patients with a confirmed diagnosis of P. knowlesi malaria who received treatment at hospitals and vector-borne disease control units in Songkhla Province during 2021 – 2022. The results of the epidemiological study unveiled the majority of the samples were male, had a history of staying overnight in the forest before becoming sick, the source of the infection was in the forest, and the season during which they were sick was mostly summer. The average length of time from the onset of illness until receiving a blood test was 3.8 days. The average length of hospital stay was 4 days. Patients were treated with Chloroquine Phosphate, Primaquine, Artesunate, Quinine, and Dihydroartemisinin-piperaquine (40 mg DHA-320 mg PPQ). One death was seen in 34 P. knowlesi malaria patients. All remaining patients recovered and responded to treatment. All symptoms improved after drug administration. No treatment failures were found. Analyses of ecological, zoonotic and entomological data revealed an association between infected patients and forested, monkey-hosted and mosquito-transmitted areas. The recommendation from this study was that the Polymerase Chain Reaction (PCR) method should be used in conjunction with the Thick/Thin Film test and blood parasite test (Parasitaemia) for the specificity of the infection, accuracy of diagnosis, leading to treatment of disease in a timely manner and be effective in disease control.

Keywords: human malaria, Plasmodium knowlesi, zoonotic disease, diagnosis and treatment, epidemiology, ecology

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Authors: Ali Kamal M. Sami, Safa Almukhtar, Alaa Al-Krush, Ismael Hama-Amin Akha Weas, Ruqaya Ahmed Alqais

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Introduction and Objectives Lower urinary tract symptoms (LUTS) are common among men with benign prostatic hyperplasia (BPH). The combination of 5 alpha-reductase inhibitors and alpha-blockers has been used as a conservative treatment of male LUTS secondary to BPH. Nanotechnology structured water magnalife is a type of water that is produced by modulators and specific frequency and energy fields that transform ordinary water into this Nanowater. In this study, we evaluated the use of Nano-water with the conservative treatment and to see if it improves the outcome and gives better results in those patients with LUTS/BPH. Material and methods For a period of 3 months, 200 men with International Prostate Symptom Score (IPSS)≥13, maximum flow rate (Qmax)≤ 15ml/s, and prostate volume > 30 and <80 ccs were randomly divided into two groups. Group A 100 men were given Nano-water with the (tamsulosindutasteride) and group B 100 men were given ordinary bottled water with the (tamsulosindutasteride). The water bottles were unlabeled and were given in a daily dose of 20ml/kg body weight. Dutasteride 0.5mg and tamsulosin 0.4 mg daily doses. Both groups were evaluated for the IPSS, Qmax, Residual Urine (RU), International Index of Erectile Function–Erectile Function (IIEF-EF) domain at the beginning (baseline data), and at the end of the 3 months. Results Of the 200 men with LUTS who were included in this study, 193 men were followed, and 7 men dropped out of the study for different reasons. In group A which included 97 men with LUTS, IPSS decreased by 16.82 (from 20.47 to 6.65) (P<0.00001) and Qmax increased by 5.73 ml/s (from 11.71 to 17.44) (P<0.00001) and RU <50 ml in 88% of patients (P<0.00001) and IIEF-EF increased to 26.65 (from 16.85) (P<0.00001). While in group B, 96 men with LUTS, IPSS decreased by 8.74(from 19.59 to 10.85)(P<0.00001) and Qmax increased by 4.67 ml/s(from 10.74 to 15.41)(P<0.00001), RU<50 ml in 75% of patients (P<0.00001), and IIEF-EF increased to 21(from 15.87)(P<0.00001). Group A had better results than group B. IPSS in group A decreased to 6.65 vs 10.85 in group B(P<0.00001), also Qmax increased to 17.44 in group A vs 15.41 in group B(P<0.00001), group A had RU <50 ml in 88% of patients vs 75% of patients in group B(P<0.00001).Group A had better IIEF-EF which increased to 26.65 vs 21 in group B(P<0.00001). While the differences between the baseline data of both groups were statistically not significant. Conclusion The use of nanotechnology structured water magnalife gives a better result in terms of LUTS and scores in patients with BPH. This combination is showing improvements in IPSS and even in erectile function in those men after 3 months.

Keywords: nano water, lower urinary tract symptoms, benign prostatic hypertrophy, erectile dysfunction

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Authors: Salimah Hasnah, Namratha Radhakrishnan

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Communities play a vital role in mobilizing people and resources for the benefit of all. Since time immemorial, communities have been spear heading different activities ranging from disaster management, palliative care, local economic development and many more with laudable success. Urban agriculture is one such activity where communities can prove to make a real difference. Farming activities in cities across different developed countries have proved to have favorable outcomes in the form of increased food security, neighborhood revitalization, health benefits and local economic growth. However, urban agriculture in the developing nations have never been prioritized as an important planning tool to cater to the basic needs of the public. Urban agricultural practices are being carried out in a fragmented fashion without a formal backing. The urban dwellers rely heavily on their far-off rural counterparts for daily food requirements. With the onset of the pandemic and the recurring lockdowns, the significance of geographic proximity and its impact on the availability of food to the public are gradually being realized around the globe. This warrants a need for localized food systems by shortening the distance between production and consumption of food. The significance of communities in realizing these urban farming benefits is explored in this paper. A case-study approach is adopted to understand how different communities have overcome barriers to urban farming in cities. The applicability of these practices is validated against the state of Kerala in India wherein different community centered approaches have been successful in the past. The existing barriers are assessed and way forward to achieve a self-sufficient localized food systems is formulated with the key lessons from the case studies. These recommendations will be helpful to successfully establish and sustain farming activities in urban areas by leveraging the power of communities.

Keywords: community-centric, COVID-19, drivers and barriers, local food system, urban agriculture

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Authors: Shweta Hoyani, Charlie Oommen

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HAN-based liquid propellants are perceived as potential substitute for hydrazine in space propulsion. Storage stability for long service life in orbit is one of the key concerns for HAN-based monopropellants because of its reactivity with metallic and non-metallic impurities which could entrain from the surface of fuel tanks and the tubes. The end result of this reactivity directly affects the handling, performance and storability of the liquid propellant. Gaseous products resulting from the decomposition of the propellant can lead to deleterious pressure build up in storage vessels. The partial loss of an energetic component can change the ignition and the combustion behavior and alter the performance of the thruster. The effect of largely plausible metals- iron, copper, chromium, nickel, manganese, molybdenum, zinc, titanium and cadmium on the thermal decomposition mechanism of HAN has been investigated in this context. Studies involving different concentrations of metal ions and HAN at different preheat temperatures have been carried out. Effect of metal ions on the decomposition behavior of HAN has been studied earlier in the context of use of HAN as gun propellant. However the current investigation pertains to the decomposition mechanism of HAN in the context of use of HAN as monopropellant for space propulsion. Decomposition onset temperature, rate of weight loss, heat of reaction were studied using DTA- TGA and total pressure rise and rate of pressure rise during decomposition were evaluated using an in-house built constant volume batch reactor. Besides, reaction mechanism and product profile were studied using TGA-FTIR setup. Iron and copper displayed the maximum reaction. Initial results indicate that iron and copper shows sensitizing effect at concentrations as low as 50 ppm with 60% HAN solution at 80°C. On the other hand 50 ppm zinc does not display any effect on the thermal decomposition of even 90% HAN solution at 80°C.

Keywords: hydroxylammonium nitrate, monopropellant, reaction mechanism, thermal stability

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Authors: Yu-Tzu Hsu, Alice Wu, Hsiang-Kuang Tseng

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Introduction: Hepatitis A virus causes acute hepatitis and is usually transmitted by a fecal-oral route of food contamination, which is more prevalent in areas with poor hygienic practices. However, we described a hepatitis A outbreak associated with a fecal-oral route of sexual behavior in men who has sex with men (MSM) in Northern Taiwan. Methods: We retrospectively collected patients with acute HAV infection in MacKay Memorial Hospital, Taipei, Taiwan between July 2015 and November 2016. Demographic data (age, gender, onset time and infection risk), laboratory data (GOT, GPT, bilirubin, HIV status, HBsAg, HCV antibody and syphilis), clinical symptoms and travel history with a foreign tour were analyzed. We compared variables between HIV and non-HIV group. Unless otherwise stated, continuous variables were expressed as mean ± SD, and categorical variables were expressed as number (percentage) for each item. The t test for continuous variables was applied for the comparison between two groups and chi-square for categorical variables were applied for measures of association. Results: We collected 80 cases during the study period. Among them, 54 (67.5%) cases were MSM and 43 (53.8%) cases were HIV positive. The average age was 32.6±7.59 years-old. The average value of initial liver function was 1324 IU/L for AST (GOT), 2100 IU/L for ALT (GPT), and 5.82 mg/dL for bilirubin. We found seven (8.6%) cases were in the status of HBV carrier, five (6.3%) cases were positive for HCV antibody, and 15 (18.6%) cases were co-infected with syphilis. With regards to associated symptoms, 32 (40%) had fever, 46 (57.5%) had nausea, 34 (42.5%) had abdominal discomfort and 46 (57.5%) had general malaise. To compare the non-HIV patients with HIV patients, HIV patients were more likely to be male (p=0.008), MSM (p=0.000), co-infected syphilis (p=0.000) and slowly improving liver function of transaminases (p=0.033, 0.027). Conclusion: The HAV outbreak in Northern Taiwan was mainly occurred in MSM population. Hereafter, our cohort data support a policy in Taiwan to provide one dose of free HAV vaccine shot in this population. Hopefully, the outbreak could be stop by the free vaccine policy and public education.

Keywords: acute hepatitis A, men who has sex with men, human immunodeficiency virus, vaccine

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Authors: Justin P. Pool, Haruyo Yoshida

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This research focuses on the effects of creating an English as a foreign language curriculum that combines online learning and classroom teaching in a complementary manner. Through pre- and post-test results, teacher observation, and learner reflection, it will be shown that learners can benefit from online programs focusing on receptive skills if combined with a communicative classroom environment that encourages learners to develop their productive skills. Much research has lamented the fact that many modern mobile assisted language learning apps do not take advantage of the affordances of modern technology by focusing only on receptive skills rather than inviting learners to interact with one another and develop communities of practice. This research takes into account the realities of the state of such apps and focuses on how to best create a curriculum that complements apps which focus on receptive skills. The research involved 15 adult learners working for a business in Japan simultaneously engaging in 1) a commercial online English language learning application that focused on reading, listening, grammar, and vocabulary and 2) a 15-week class focused on communicative language teaching, presentation skills, and mitigation of error aversion tendencies. Participants of the study experienced large gains on a standardized test, increased motivation and willingness to communicate, and asserted that they felt more confident regarding English communication. Moreover, learners continued to study independently at higher rates after the study than they had before the onset of the program. This paper will include the details of the program, reveal the improvement in test scores, share learner reflections, and critically view current evaluation models for mobile assisted language learning applications.

Keywords: adult learners, communicative language teaching, mobile assisted language learning, motivation

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Authors: Sharique Ahmed, Khushtar Anwar Salman

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Alpha-1-antitrypsin (AAT) is a major plasma serine protease inhibitor (SERPIN). Hereditary AAT deficiency is one of the common diseases in some part of the world. AAT is mainly produced in the liver and functions to protect the lung against proteolytic damage (e.g., from neutrophil elastase) acting as the major inhibitor for neutrophil elastase. α (1)-Antitrypsin (AAT) deficiency is an under recognized genetic condition that affects approximately 1 in 2,000 to 1 in 5,000 individuals and predisposes to liver disease and early-onset emphysema. Not only does α-1-antitrypsin deficiency lead to disabling syndrome of pulmonary emphysema, there are other disorders too which include ANCA (antineutrophilic cytoplasmic antibody) positive Wegener's granulomatosis, diffuse bronchiectasis, necrotizing panniculitis in α-1-antitrypsin phenotype (S), idiopathic pulmonary fibrosis and steroid dependent asthma. Augmentation therapy with alpha-1 antitrypsin (AAT) from human plasma has been available for specific treatment of emphysema due to AAT deficiency. Apart from this several observations have also suggested a role for endogenous suppressors of HIV-1, alpha-1 antitrypsin (AAT) has been identified to be one of those. In view of its varied important role in humans, serum from a mammalian source was chosen for the isolation and purification. Studies were performed on the homogeneous fraction. This study suggests that the buffalo serum α-1-antritrypsin has characteristics close to ovine, dog, horse and more importantly to human α-1-antritrypsin in terms of its hydrodynamic properties such as molecular weight, carbohydrate content, etc. The similarities in the hydrodynamic properties of buffalo serum α-1-antitrypsin with other sources of mammalian α-1-antitrypsin mean that it can be further studied and be a potential source for "augmentation therapy", as well as a source of AAT replacement therapy to raise serum levels above the protective threshold. Other parameters like the amino acid sequence, the effect of denaturants, and the thermolability or thermostability of the inhibitor will be the interesting basis of future studies on buffalo serum alpha-1 antitrypsin (AAT).

Keywords: α-1-antitrypsin, augmentation therapy , hydrodynamic properties, serine protease inhibitor

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Authors: Hemalatha Jain, M. Vasantha

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Patteda Anchu is one of the first variety of sari woven centuries ago in Gajendragarh village from Gadag district of north Karnataka. The sari played a significant role in bringing together the socio-cultural aspect in ancient days. It was used as wedding sari for bride and also to adorn goddess Yellamma Saundatti by the devotees. Indian traditional art and crafts were rich in culture and diversity, however with the onset of liberalisation and end of the license raj lot of traditional Indian artwork are on the verge of extinction today. Patteda Anchu is one of the examples of traditional art lost to globalisation. The main aim of the study was to document the ancient weaving tradition of the Patteda Anchu and revive by exploring the weaving possibility as yardage with different product layout. To accomplish the formulated objectives a exploratory cum diagnostic study was planned. Data was collected through observations and interviews schedule during the field visits in Gajendragarh village. There are very few weavers weaving on traditional looms and many weavers who have moved to weaving other sari's or construction work were interviewed to understand the downfall of the sari. The discussions and interviews conducted with the local weavers, shop keepers, sales agents, weaving society, NGOs and Self help groups helped in unearthing the new opportunities to develop products for the local and national market and help start weaving of Patteda Anchu and expand its market. The handloom art details in terms of raw materials, loom set up, dyeing, types of Patteda Anchu, weaving process and colors were documented through photographs, video recordings and supplemented with notes. Based on the analysis of the feedback gathered it was recommended to develop products on the handloom without changing the width frame or design of the traditional weaving methods. The weavers, weavers society and other cooperatives centres also were in consent with the new product development which will help sustain the Patteda Anchu.

Keywords: Gajendragarh, patteda Anchu sari, revival of traditional art, weaving, handloom

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Authors: Ying-Lun Tseng Chiu-Ying Chen

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Taiwan's Mental Health Act was amended at the end of 2022; they added regulations regarding refusing compulsory treatment by patients with mental illnesses. In addition, not only by an examination committee, the judge must also assess the patient's need for compulsory treatment. Additionally, the maximum of compulsory hospitalization has been reduced from an unlimited period to a maximum of 60 days. They aim to promote the healthcare autonomy of individuals with mental illnesses in Taiwan and prevent their silenced voice in medical decision-making while they still possess rationality. Furthermore, they plan to use community support and social care networks to replace the current practice of compulsory treatment in Taiwan. This study uses qualitative research methodology, utilizing interview guidelines to inquire about the experiences of Taiwanese who have undergone compulsory hospitalization, compulsory community treatment, and compulsory medical care. The interviews aimed to explore their feelings when they were subjected to compulsory medical intervention, the inside of their illness, their opinions after treatments, and whether alternative medical interventions proposed by them were considered. Additionally, participants also asked about their personal life history and their support networks in their lives. We collected 12 Taiwanese who had experienced compulsory medical interventions and were interviewed 14 times. The findings indicated that participants still possessed rationality during the onset of their illness. However, when they have other treatments to replace compulsory medical, they sometimes diverge from those of the doctors and their families. Finally, doctors prefer their professional judgment and patients' families' option. Therefore, Taiwanese mental health patients' power of decision-making still needs to improve. Because this research uses qualitative research, so difficult to find participants, and the sample size rate was smaller than Taiwan's population, it may have biases in the analysis. So, Taiwan still has significant progress in enhancing the decision-making rights of participants in the study.

Keywords: medical decision making, compulsory treatment, medical ethics, mental health act

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Authors: SHWETA SRIKUMAR

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Winter stratospheric dynamics is a highly variable and spectacular field of research in middle atmosphere. It is well believed that the interaction of energetic planetary waves with mean flow causes the temperature to increase in the stratosphere and associated circulation reversal. This wave driven sudden disturbances in the polar stratosphere is defined as Sudden Stratospheric Warming. The main objective of the present work is to investigate the mid-winter major stratospheric warming events on equatorial dynamics over Peninsular India. To explore the effect of mid-winter stratospheric warming on Indian region (60oE -100oE), we have selected the winters 2003/04, 2005/06, 2008/09, 2012/13 and 2018/19. This study utilized the data from ERA-Interim Reanalysis, Outgoing Longwave Radiation (OLR) from NOAA and TRMM satellite data from NASA mission. It is observed that a sudden drop in OLR (averaged over Indian Region) occurs during the course of warming for the winters 2005/06, 2008/09 and 2018/19. But in winters 2003/04 and 2012/13, drop in OLR happens prior to the onset of major warming. Significant amplitude of planetary wave activity is observed in equatorial lower stratosphere which indicates the propagation of extra-tropical planetary waves from high latitude to equator. During the course of warming, a strong downward propagation of EP flux convergence is observed from polar to equator region. The polar westward wind reaches upto 20oN and the weak eastward wind dominates the equator during the winters 2003/04, 2005/06 and 2018/19. But in 2012/13 winter, polar westward wind reaches upto equator. The equatorial wind at 2008/09 is dominated by strong westward wind. Further detailed results will be presented in the conference.

Keywords: Equatorial dynamics, Outgoing Longwave Radiation, Sudden Stratospheric Warming, Planetary Waves

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Authors: Mohammed Tahir, Jonas Lagergren

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Vancron 40, a nitrided powder metallurgical tool Steel, is used in cold work applications where the predominant failure mechanisms are adhesive wear or galling. Typical applications of Vancron 40 are among others fine blanking, cold extrusion, deep drawing and cold work rolls for cluster mills. Vancron 40 positive results for cold work rolls for cluster mills and as a tool for some severe metal forming process makes it competitive compared to other type of work rolls that require higher precision, among others in cold rolling of thin stainless steel, which required high surface finish quality. In this project, three roll materials for cold rolling of stainless steel strip was examined, Vancron 40, Narva 12B (a high-carbon, high-chromium tool steel alloyed with tungsten) and Supra 3 (a Chromium-molybdenum tungsten-vanadium alloyed high speed steel). The purpose of this project was to study the depth profiles of the ironed stainless steel strips, emergence of galling and to study the lubrication performance used by steel industries. Laboratory experiments were conducted to examine scratch of the strip, galling and surface roughness of the roll materials under severe tribological conditions. The critical sliding length for onset of galling was estimated for stainless steel with four different lubricants. Laboratory experiments result of performance evaluation of resistance capability of rolls toward adhesive wear under severe conditions for low and high reductions. Vancron 40 in combination with cold rolling lubricant gave good surface quality, prevents galling of metal surfaces and good bearing capacity.

Keywords: Vancron 40, cold rolling, adhesive wear, galling, surface finish, lubricant, stainless steel

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Authors: M. Borgie, Z. Dagher, F. Ledoux, A. Verdin, F. Cazier, H. Greige, P. Shirali, D. Courcot

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In October 2013, the International Agency for Research on Cancer (IARC) classified outdoor air pollution and fine particulate matter (PM2.5) as carcinogenic to humans. Despite the clearly relationship established by epidemiological studies between PM exposure and the onset of respiratory and cardiovascular diseases, uncertainties remain about the physiopathological mechanisms responsible for these diseases. The aim of this work was to evaluate the toxicological effects of two samples of atmospheric PM2.5 collected at urban and rural sites on human bronchial epithelial cells, BEAS-2B, especially to investigate the metabolic activation of organic compounds, the alteration of epigenetic mechanisms (i.e. microRNAs genes expression), the phosphorylation of H2AX and the telomerase activity. Our results showed a significant increase in CYP1A1, CYP1B1, and AhRR genes expression, miR-21 gene expression, H2AX phosphorylation and telomerase activity in BEAS-2B cells after their exposure to PM2.5, both in a dose and site-dependent manner. These results showed that PM2.5, especially urban PM, are able to induce the expression of metabolizing enzymes which can provide metabolic biotransformation of organic compounds into more toxic and carcinogenic metabolites, and to induce the expression of the oncomiR miR-21 which promotes cell growth and enhances tumor invasion and metastasis in lung cancer. In addition, our results have highlighted the role of PM2.5 in the activation of telomerase, which can maintain the telomeres length and subsequently preventing cell death, and have also demonstrated the ability of PM2.5 to induce DNA breaks and thus to increase the risk of mutations or chromosomal translocations that lead to genomic instability. All these factors may contribute to cell abnormalities, and thus the development of cancer.

Keywords: BEAS-2B cells, carcinogenesis, epigenetic alterations and genotoxicity, PM2.5

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Authors: Sawyer Spurry

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Problem: Palliative care providers at an academic medical center in Maryland stated medical intensive care unit (MICU) patients are often referred late in their hospital stay. The MICU has performed well below the hospital quality performance metric of 80% of patients who expire with expected outcomes should have received a palliative care consult within 48 hours of admission. Purpose: The purpose of this quality improvement (QI) project is to increase palliative care utilization in the MICU through the implementation of a Nurse-Driven PalliativeTriggerTool to prompt the need for specialty palliative care consult. Methods: MICU nursing staff and providers received education concerning the implications of underused palliative care services and the literature data supporting the use of nurse-driven palliative care tools as a means of increasing utilization of palliative care. A MICU population specific criteria of palliative triggers (Palliative Care Trigger Tool) was formulated by the QI implementation team, palliative care team, and patient care services department. Nursing staff were asked to assess patients daily for the presence of palliative triggers using the Palliative Care Trigger Tool and present findings during bedside rounds. MICU providers were asked to consult palliative medicinegiven the presence of palliative triggers; following interdisciplinary rounds. Rates of palliative consult, given the presence of triggers, were collected via electronic medical record e-data pull, de-identified, and recorded in the data collection tool. Preliminary Results: Over 140 MICU registered nurses were educated on the palliative trigger initiative along with 8 nurse practitioners, 4 intensivists, 2 pulmonary critical care fellows, and 2 palliative medicine physicians. Over 200 patients were admitted to the MICU and screened for palliative triggers during the 15-week implementation period. Primary outcomes showed an increase in palliative care consult rates to those patients presenting with triggers, a decreased mean time from admission to palliative consult, and increased recognition of unmet palliative care needs by MICU nurses and providers. Conclusions: Anticipatory findings of this QI project would suggest a positive correlation between utilizing palliative care trigger criteria and decreased time to palliative care consult. The direct outcomes of effective palliative care results in decreased length of stay, healthcare costs, and moral distress, as well as improved symptom management and quality of life (QOL).

Keywords: palliative care, nursing, quality improvement, trigger tool

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Authors: Maurício N. Kleinberg, Ana P. R. N. Barroso, Frederico R. Silva, Natasha l. Gomes, Rodrigo F. Guimarães, Marcelo M. V. Parente, Jackson Q. Malveira

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Increased production of biofuels, especially biodiesel, as an option to replace the diesel derived from oil is already a reality in countries seeking a renewable and environmentally friendly fuel, as is the case in Brazil. However, it is known that the use of fuels, renewable or not, implies that it is in contact with various metallic materials which may cause corrosion. In the search for more corrosion resistant materials has been experimentally observed that the addition of molybdenum in ferritic steels increases their protective character without significantly burdening the cost of production. In order to evaluate the effect of adding molybdenum, samples of commercial steel (austenitic, ferritic and carbon steel) and the experimental ferritic alloy with a high molybdenum content (5.3%) were immersed separately into biodiesel derived from transesterification of soy oil to monitor the corrosion process of these metal samples, and in parallel to analyze the oxidative degradation of biodiesel itself. During the immersion time of 258 days, biodiesel samples were taken for analysis of acidity, kinematic viscosity, density and refraction. Likewise, the metal samples were taken from the biodiesel to be weighed and microstructurally analyzed by light microscopy. The results obtained at the end of 258 days shown that biodiesel presented a considerable increase on the values of the studied parameters for all the samples. However, this increase was not able to produce significant mass loss in metallic samples. As regards the microstructural analysis, it showed the onset of surface oxidation on the carbon steel sample. As for the other samples, no significant surface changes were shown. These results are consistent with literature for short immersion times. It is concluded that the increase in the values of the studied parameters is not significant yet, probably due to the low time of immersion and exposure of the samples. Thus, it is necessary to continue the tests so that the objectives of this work are achieved.

Keywords: biodiesel, corrosion, immersion, experimental alloy

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Authors: Asal Pournaghshband

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This paper presents the development of a finite element model to study the large deflection behavior of restrained stainless steel cellular beams at elevated temperature. Cellular beams are widely used for efficient utilization of raw materials to facilitate long spans with faster construction resulting sustainable design solution that can enhance the performance and merit of any construction project. However, their load carrying capacity is less than the equivalent beams without opening due to developing shear-moment interaction at the openings. In structural frames due to elements continuity, such beams are restrained by their adjoining members which has a substantial effect on beams behavior in fire. Stainless steel has also become integral part of the build environment due to its excellent corrosion resistance, whole life-cycle costs, and sustainability. This paper reports the numerical investigations into the effect of structural continuity on the thermo-mechanical performance of restrained steel beams with circle and elongated circle shapes of web opening in fire. The numerical model is firstly validated using existing numerical results from the literature, and then employed to perform a parametric study. The structural continuity is evaluated through the application of different levels of axial restraints on the response of carbon steel and stainless steel cellular beam in fire. The transit temperature for stainless steel cellular beam is shown to be less affected by the level of axial stiffness than the equivalent carbon steel cellular beam. Overall, it was established that whereas stainless steel cellular beams show similar stages of behavior of carbon steel cellular beams in fire, they are capable of withstanding higher temperatures prior to the onset of catenary action in large deflection, despite the higher thermal expansion of stainless steel material.

Keywords: axial restraint, catenary action, cellular beam, fire, numerical modeling, stainless steel, transit temperature

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Authors: Melissa K. Hord, Stephen P. Whiteside

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Impairment in functioning is a requirement for diagnosing psychopathology, identifying individuals in need of treatment, and documenting improvement with treatment. Further, identifying different types of functional impairment can guide educators and treatment providers. However, most assessment tools focus on symptom severity and few measures assess impairment associated with childhood anxiety disorders. The child- and parent-report versions of the Child Sheehan Disability Scale (CSDS) are measures that may provide useful information regarding impairment. The purpose of the present study is to examine whether children diagnosed with different anxiety disorders have greater impairment in school or home functioning based on self or parent report. The sample consisted of 844 children ages 5 to 19 years of age (mean 13.43, 61% female, 90.9% Caucasian), including 281 children diagnosed with obsessive compulsive disorder (OCD), 200 with generalized anxiety disorder (GAD), 176 with social phobia, 83 with separation anxiety, 61 with anxiety not otherwise specified (NOS), 30 with panic disorder, and 13 with panic with agoraphobia. To assess whether children and parents reported greater impairment in school or home functioning, a multivariate analysis of variance was conducted. (The assumptions of independence and homogeneity of variance were checked and met). A significant difference was found, Pillai's trace = .143, F (4, 28) = 4.19, p < .001, partial eta squared = .04. Post hoc comparisons using the Tukey HSD test indicated that children report significantly greater impairment in school with panic disorder (M=5.18, SD=3.28), social phobia (M=4.95, SD=3.20), and OCD (M=4.62, SD=3.32) compared to other diagnoses; whereas parents endorse significantly greater school impairment when their child has a social phobia (M=5.70, SD=3.39) diagnosis. Interestingly, both children and parents reported greater impairment in family functioning for an OCD (child report M=5.37, SD=3.20; parent report M=5.59, SD=3.38) diagnosis compared to other anxiety diagnoses. (Additional findings for the anxiety disorders associated with less impairment will also be presented). The results of the current study have important implications for educators and treatment providers who are working with anxious children. First, understanding that differences exist in how children and parents view impairment related to childhood anxiety can help those working with these families to be more sensitive during interactions. Second, evidence suggests that difficulties in one environment do not necessarily translate to another environment, thus caregivers may benefit from careful explanation of observations obtained by educators. Third, results support the use of the CSDS measure by treatment providers to identify impairment across environments in order to more effectively target interventions.

Keywords: anxiety, childhood, impairment, school functioning

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Authors: Aarti Agarwal, Ajmal Khan

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Background and Objective: Breathing difficulty is most distressing symptom for the patient and their caregivers providing palliative care to individuals with advanced malignancy. It needs to be tackled effectively and sometimes preemptively to provide relief from respiratory obstruction. Interventional procedures like tracheal stenting are becoming increasingly popular as a part of palliation for respiratory symptoms. We present a case of esophageal tumor earlier stented by Gastroenterologist to maintain esophageal patency, but the tumor outgrew to produce tracheal infiltration and thereby causing airway obstruction. Method and Result: 62-year-old man presented with unresectable Carcinoma oesophagus with inability to swallow. A metallic stent was placed by the gastroenterologist, to maintain esophageal patency and enable patient to swallow. Two months later, the patient returned to hospital in emergency with respiratory distress. CT neck and thorax revealed tumor infiltration through posterior tracheal wall. Lower extent of the tumor was till 1 cm above the carina. Airway stenting with Tracheo bronchial stent with Y configuration was planned under general anaesthesia with airway blocks. Superior Laryngeal Nerve Block, Glossopharyngeal block and Trans tracheal infiltration of local anaesthetics were performed. The patient was sedated with Fentanyl, Midazolam and propofol infusion but was breathing spontaneously. Once the rigid bronchoscope was placed inside trachea, breathing was supported with oxygen and sevoflurane. Initially, the trachea was cleared of tumor by coring. After creating space, tracheal stent was positioned and deployed. After stent placement patient was awakened, suctioned and nebulized. His respiratory stridor relieved instantaneously and was shifted to recovery. Conclusion: Airway blocks help in decreasing the incidence and severity of coughing during airway instrumentation thereby help in proper stent placement. They also reduce the requirement of general anaesthetics and hasten the post stenting recovery. Airway stent provided immediate relief to patient from symptoms of respiratory difficulty. Decision for early tracheal stenting may be taken for a select group of patients with high propensity for local spread, thereby avoiding respiratory complications and providing better quality of life in patients with inoperable malignancy.

Keywords: tracheal stent, respiratory difficulty, esophageal tumor, anaesthetic management

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Authors: Nagwa E. Abd Elazim, Maha S. El-naggar, Rania H. Mohamed, Sara M. Awad

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Background: Radiodermatitis is a common side effect of radiation therapy for breast cancer. However, there is no current consensus about effective standard therapy for the prevention and management of radiation dermatitis. Topical ectoine has demonstrated efficacy in the treatment of atopic dermatitis owing to its anti-inflammatory activity. Objective: To evaluate the efficacy of topical ectoine in comparison to traditional topical dexpanthenol treatment in the management of acute radiodermatitis in breast cancer patients undergoing adjuvant radiotherapy. Methods: Fifty patients were randomized to use either dexpanthenol 0.5% cream (25 patients), or ectoin 7% cream (25 patients), applied twice daily to the irradiated area during the radiation period and continued for 2 weeks after cessation of radiotherapy. Assessment of radiation skin toxicity using Common Terminology Criteria of Adverse Events (CTCAE) v4.0, radiation-associated symptoms, and adverse events were undertaken weekly during radiotherapy and 2 weeks after the end of radiotherapy. Results: Topical ectoine showed some clinical benefit over dexpanthenol, as shown by delayed time to onset (at week 3 versus week 2, respectively) and larger number of patients who reached grade 0 at the end of treatment (64% vs. 48%, respectively). The clinical symptoms of pain (p = 0.003) and itching (p = 0.001) attributable to radiation were less pronounced with ectoine than with dexpanthenol. Burning and hyperpigmentation were the most common side effects with ectoine. However, no significant difference between dexpanthenol and ectoine treatments was found in any of the side effects (p = 0.1). Conclusion: Ectoin was overall more effective in improving radiation dermatitis than topical dexpanthenol in breast cancer patients. Ectoin could be proposed as a preventive or curative treatment for patients undergoing postoperative irradiation for breast cancer. Further clinical studies with a larger number of patients are recommended for the confirmation of these preliminary results.

Keywords: breast cancer, dexapanthenol, ectoin, radiation dermatitis

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Authors: Nikolai Bertelsen, Robert A. Alphinas, Klaus B. Orskov

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The shortest possible tool stickout has been the traditional go-to approach with expectations of increased stability and productivity. However, experimental studies at Danish Advanced Manufacturing Research Center (DAMRC) have proven that for some tool stickout lengths, there exist local productivity optimums when utilizing the Stability Lobe Diagrams for chatter avoidance. This contradicts with traditional logic and the best practices taught to machinists. This paper explores the vibrational characteristics and behaviour of a milling system over the tool stickout length. The experimental investigation has been conducted by tap testing multiple endmills where the tool stickout length has been varied. For each length, the modal parameters have been recorded and mapped to visualize behavioural tendencies. Furthermore, the paper explores the correlation between the modal parameters and the Stability Lobe Diagram to outline the influence and importance of each parameter in a multi-mode system. The insights are conceptualized into a tool tuning approximation solution. It builds on an almost linear change in the natural frequencies when amending tool stickout, which results in changed positions of the Chatter-free Stability Lobes. Furthermore, if the natural frequency of two modes become too close, it will onset of the dynamic absorber effect phenomenon. This phenomenon increases the critical stable depth of cut, allowing for a more stable milling process. Validation tests on the tool tuning approximation solution have shown varying success of the solution. This outlines the need for further research on the boundary conditions of the solution to understand at which conditions the tool tuning approximation solution is applicable. If the conditions get defined, the conceptualized tool tuning approximation solution outlines an approach for quick and roughly approximating tool stickouts with the potential for increased stiffness and optimized productivity.

Keywords: milling, modal parameters, stability lobes, tap testing, tool tuning

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Authors: M. S. Aparna, Pushparaj Shetty D.

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Nowadays social networking sites have become so popular that the producers or the sellers look for these sites as one of the best options to target the right audience to market their products. There are several tools available to monitor or analyze the social networks. Our task is to identify the right community web pages and find out the behavior analysis of the members by using these tools and formulate an appropriate strategy to market the products or services to achieve the set goals. The advertising becomes more effective when the information of the product/ services come from a known source. The strategy explores great buying influence in the audience on referral marketing. Our methodology proceeds with critical budget analysis and promotes viral influence propagation. In this context, we encompass the vital bits of budget evaluation such as the number of optimal seed nodes or primary influential users activated onset, an estimate coverage spread of nodes and maximum influence propagating distance from an initial seed to an end node. Our proposal for Buyer Prediction mathematical model arises from the urge to perform complex analysis when the probability density estimates of reliable factors are not known or difficult to calculate. Order Statistics and Buyer Prediction mapping function guarantee the selection of optimal influential users at each level. We exercise an efficient tactics of practicing community pages and user behavior to determine the product enthusiasts on social networks. Our approach is promising and should be an elementary choice when there is little or no prior knowledge on the distribution of potential buyers on social networks. In this strategy, product news propagates to influential users on or surrounding networks. By applying the same technique, a user can search friends who are capable to advise better or give referrals, if a product interests him.

Keywords: viral marketing, social network analysis, community web pages, buyer prediction, influence propagation, budget constraints

Procedia PDF Downloads 257