Search results for: diagnosis and treatment
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9345

Search results for: diagnosis and treatment

2445 Libido and Semen Quality Characteristics of Post-Pubertal Rabbit Bucks Fed Ginger Rhizome Meal Based Diets

Authors: I. P. Ogbuewu, I. F. Etuk, V. U. Odoemelam, I. C. Okoli, M. U. Iloeje

Abstract:

The effect of dietary ginger rhizome meal on libido and semen characteristics of post-pubertal rabbit bucks was investigated in an experiment that lasted for 12 weeks. Thirty-six post-pubertal bucks were randomly assigned to 4 dietary groups of 9 rabbits each in a completely randomized design. Four experimental diets were formulated to contain ginger rhizome meal at 0 g/kg feed (BT0), 5g/kg feed (BT5), 10 g/kg feed (BT10), and 15g/kg feed (BT15) were fed ad libitum to the experimental animals. Results revealed that semen colour changed from cream milky to milky. Data on semen pH and sperm concentration were similar (p>0.05) among the dietary groups. Semen volume for the bucks in BT0 (0.64 mL) and BT5 (0.60 mL) groups were significantly (p<0.05) higher than those in BT10 (0.44 mL) and BT15 (0.46 mL) groups. Total spermatozoa concentration value was significantly (p<0.05) higher in BT0 and BT5 groups than those in BT10 and BT15 groups. Sperm motility and percent live sperm declined (p<0.05) progressively among the treatment groups. Percent dead sperm were significantly (p<0.05) lower for bucks in BT0 group than in BT10 and BT15 groups. Reaction time had a dose-dependent increase; however, the observed difference was not significant (p>0.05). These results indicate that the inclusion of ginger rhizome meal at 5-15g per kg feed in ration for post-pubertal rabbit bucks could cause mild depressive effect on semen production and quality.

Keywords: rabbits, semen, libido, ginger

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2444 Ab-initio Calculations on the Mechanism of Action of Platinum and Ruthenium Complexes in Phototherapy

Authors: Eslam Dabbish, Fortuna Ponte, Stefano Scoditti, Emilia Sicilia, Gloria Mazzone

Abstract:

The medical techniques based on the use of light for activating the drug are occupying a prominent place in the cancer treatment due to their selectivity that contributes to reduce undesirable side effects of conventional chemotherapy. Among these therapeutic treatments, photodynamic therapy (PDT) and photoactivated chemotherapy (PACT) are emerging as complementary approaches for selective destruction of neoplastic tissue through direct cellular damage. Both techniques rely on the employment of a molecule, photosensitizer (PS), able to absorb within the so-called therapeutic window. Thus, the exposure to light of otherwise inert molecules promotes the population of excited states of the drug, that in PDT are able to produce the cytotoxic species, such as 1O2 and other ROS, in PACT can be responsible of the active species release or formation. Following the success of cisplatin in conventional treatments, many other transition metal complexes were explored as anticancer agents for applications in different medical approaches, including PDT and PACT, in order to improve their chemical, biological and photophysical properties. In this field, several crucial characteristics of candidate PSs can be accurately predicted from first principle calculations, especially in the framework of density functional theory and its time-dependent formulation, contributing to the understanding of the entire photochemical pathways involved which can ultimately help in improving the efficiency of a drug. A brief overview of the outcomes on some platinum and ruthenium-based PSs proposed for the application in the two phototherapies will be provided.

Keywords: TDDFT, metal complexes, PACT, PDT

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2443 Evaluation of a Mindfulness and Self-Care-Based Intervention for Teachers to Enhance Mental Health

Authors: T. Noichl, M. Cramer, G. E. Dlugosch, I. Hosenfeld

Abstract:

Teachers are exposed to a variety of stresses in their work context. These can have a negative impact on physical and psychological well-being. The online training ‘Better Living! Self-care for teachers’ is based on the training ‘Better Living! Self-care for mental health professionals’, which has been proven to be effective over a period of 3 years. The training for teachers is being evaluated for its effectiveness between October 2021 and March 2023 in a study funded by the German Federal Ministry of Education and Research. The aim of the training is to promote self-care and mindfulness among participants and thereby to foster well-being. The concept of self-care was already mentioned in antiquity and was also named as an imperative by philosophers such as Socrates and Epictetus. In the absence of a universal understanding of self-care today, the following definition was developed within the research group: Self-care is 1) facing oneself in a loving and appreciative way, 2) taking one's own needs seriously, and 3) actively contributing to one's own well-being. The study is designed as a randomized wait-control group repeated-measures design with 4 (treatment group) resp. 6 (wait-control group) measurement points. Central dependent variables are self-care, mindfulness, stress, and well-being. To assess the long-term effectiveness of training participation, these constructs are surveyed at the beginning and the end of the training as well as five weeks and one year later. Based on the results of the evaluation with mental health professionals, it is expected that participation will lead to an increase in subjective well-being, self-care, and mindfulness. The first results of the evaluation study are presented and discussed with regard to the effectiveness of the training among teachers.

Keywords: longitudinal intervention study, mindfulness, self-care, teachers’ mental health, well-being

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2442 A Comparative Study of the Athlete Health Records' Minimum Data Set in Selected Countries and Presenting a Model for Iran

Authors: Robab Abdolkhani, Farzin Halabchi, Reza Safdari, Goli Arji

Abstract:

Background and purpose: The quality of health record depends on the quality of its content and proper documentation. Minimum data set makes a standard method for collecting key data elements that make them easy to understand and enable comparison. The aim of this study was to determine the minimum data set for Iranian athletes’ health records. Methods: This study is an applied research of a descriptive comparative type which was carried out in 2013. By using internal and external forms of documentation, a checklist was created that included data elements of athletes health record and was subjected to debate in Delphi method by experts in the field of sports medicine and health information management. Results: From 97 elements which were subjected to discussion, 85 elements by more than 75 percent of the participants (as the main elements) and 12 elements by 50 to 75 percent of the participants (as the proposed elements) were agreed upon. In about 97 elements of the case, there was no significant difference between responses of alumni groups of sport pathology and sports medicine specialists with medical record, medical informatics and information management professionals. Conclusion: Minimum data set of Iranian athletes’ health record with four information categories including demographic information, health history, assessment and treatment plan was presented. The proposed model is available for manual and electronic medical records.

Keywords: Documentation, Health record, Minimum data set, Sports medicine

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2441 Prediction Factor of Recurrence Supraventricular Tachycardia After Adenosine Treatment in the Emergency Department

Authors: Welawat Tienpratarn, Chaiyaporn Yuksen, Rungrawin Promkul, Chetsadakon Jenpanitpong, Pajit Bunta, Suthap Jaiboon

Abstract:

Supraventricular tachycardia (SVT) is an abnormally fast atrial tachycardia characterized by narrow (≤ 120 ms) and constant QRS. Adenosine was the drug of choice; the first dose was 6 mg. It can be repeated with the second and third doses of 12 mg, with greater than 90% success. The study found that patients observed at 4 hours after normal sinus rhythm was no recurrence within 24 hours. The objective of this study was to investigate the factors that influence the recurrence of SVT after adenosine in the emergency department (ED). The study was conducted retrospectively exploratory model, prognostic study at the Emergency Department (ED) in Faculty of Medicine, Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study was conducted for ten years period between 2010 and 2020. The inclusion criteria were age > 15 years, visiting the ED with SVT, and treating with adenosine. Those patients were recorded with the recurrence SVT in ED. The multivariable logistic regression model developed the predictive model and prediction score for recurrence PSVT. 264 patients met the study criteria. Of those, 24 patients (10%) had recurrence PSVT. Five independent factors were predictive of recurrence PSVT. There was age>65 years, heart rate (after adenosine) > 100 per min, structural heart disease, and dose of adenosine. The clinical risk score to predict recurrence PSVT is developed accuracy 74.41%. The score of >6 had the likelihood ratio of recurrence PSVT by 5.71 times. The clinical predictive score of > 6 was associated with recurrence PSVT in ED.

Keywords: supraventricular tachycardia, recurrance, emergency department, adenosine

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2440 Functionalized Carbon-Base Fluorescent Nanoparticles for Emerging Contaminants Targeted Analysis

Authors: Alexander Rodríguez-Hernández, Arnulfo Rojas-Perez, Liz Diaz-Vazquez

Abstract:

The rise in consumerism over the past century has resulted in the creation of higher amounts of plasticizers, personal care products and other chemical substances, which enter and accumulate in water systems. Other sources of pollutants in Neotropical regions experience large inputs of nutrients with these pollutants resulting in eutrophication of water which consume large quantities of oxygen, resulting in high fish mortality. This dilemma has created a need for the development of targeted detection in complex matrices and remediation of emerging contaminants. We have synthesized carbon nanoparticles from macro algae (Ulva fasciata) by oxidizing the graphitic carbon network under extreme acidic conditions. The resulting material was characterized by STEM, yielding a spherical 12 nm average diameter nanoparticles, which can be fixed into a polysaccharide aerogel synthesized from the same macro algae. Spectrophotometer analyses show a pH dependent fluorescent behavior varying from 450-620 nm in aqueous media. Heavily oxidized edges provide for easy functionalization with enzymes for a more targeted analysis and remediation technique. Given the optical properties of the carbon base nanoparticles and the numerous possibilities of functionalization, we have developed a selective and robust targeted bio-detection and bioremediation technique for the treatment of emerging contaminants in complex matrices like estuarine embayment.

Keywords: aerogels, carbon nanoparticles, fluorescent, targeted analysis

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2439 Fusion Neutron Generator Dosimetry and Applications for Medical, Security, and Industry

Authors: Kaouther Bergaui, Nafaa Reguigui, Charles Gary

Abstract:

Characterization and the applications of deuterium-deuterium (DD) neutron generator developed by Adelphie technology and acquired by the National Centre of Nuclear Science and Technology (NCNST) were presented in this work. We study the performance of the neutron generator in terms of neutron yield, production efficiency, and the ionic current as a function of the acceleration voltage at various RF powers. We provide the design and optimization of the PGNAA chamber and thus give insight into the capabilities of the planned PGNAA facility. Additional non-destructive techniques were studied employing the DD neutron generator, such as PGNAA and neutron radiography: The PGNAA is used for determining the concentration of 10B in Si and SiO2 matrices by using a germanium detector HPGe and the results obtained are compared with PGNAA system using a Sodium Iodide detector (NaI (Tl)); Neutron radiography facility was tested and simulated, using a camera device CCD and simulated by the Monte Carlo code; and the explosive detection system (EDS) also simulated using the Monte Carlo code. The study allows us to show that the new models of DD neutron generators are feasible and that superior-quality neutron beams could be produced and used for various applications. The feasibility of Boron neutron capture therapy (BNCT) for cancer treatment using a neutron generator was assessed by optimizing Beam Shaping Assembly (BSA) on a phantom using Monte-Carlo (MCNP6) simulations.

Keywords: neutron generator deuterium-deuterium, Monte Carlo method, radiation, neutron flux, neutron activation analysis, born, neutron radiography, explosive detection, BNCT

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2438 Music Training as an Innovative Approach to the Treatment of Language Disabilities

Authors: Jonathan Bolduc

Abstract:

Studies have demonstrated the effectiveness of music training approaches to help children with language disabilities. Because music is closely associated with a number of cognitive functions, including language, it has been hypothesized that musical skills transfer to other domains. Research suggests that music training strengthens basic auditory processing skills in dyslexic children and may ameliorate phonological deficits. Furthermore, music instruction has the particular advantage of being non-literacy-based, thus removing the frustrations that can be associated with reading and writing activities among children with specific learning disabilities. In this study, we assessed the effect of implementing an intensive music program on the development of language skills (phonological and reading) in 4- to 9-year-old children. Seventeen children (N=17) participated in the study. The experiment took place over 6 weeks in a controlled environment. Eighteen lessons of 40 minutes were offered during this period by two music specialists. The Dalcroze, Orff, and Kodaly approaches were used. A series of qualitative measures were implemented to document the contribution of music training to this population. Currently, the data is being analyzed. The first results show that learning music seems to significantly improve verbal memory. We already know that language disabilities are considered one of the main causes of school dropout as well as later professional and social failure. We aim to corroborate that an integrated music education program can provide children with language disabilities with the same opportunities to develop and succeed in school as their classmates. Scientifically, the results will contribute to advance the knowledge by identifying the more effective music education strategies to improve the overall development of children worldwide.

Keywords: music education, music, art education, language diasabilities

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2437 Comparative Scanning Electron Microscopic Observations of Anthelminthic Effect of Trigonella foenum-graecum on Paramphistomum cervi in Buffalo

Authors: Kiran Roat, Bhanupriya Sanger, Gayatri Swarnakar

Abstract:

Amphistomiasis disease is the main health problem throughout of the world and responsible for great economic losses to cattle industries, mostly to poor cattle farmers in developing countries. Among the rumen parasites, the Paramphistomum cervi were collected from the rumen of freshly slaughtered buffalo for the further treatment process. Trigonella foenum-graecum is commonly known as methi and fenugreek and their seeds are known for their therapeutic value. The present study was considered to evaluate in vitro efficacy of aqueous extract of Trigonella foenum-graecum on P. cervi. 130 mg/ml concentration of aqueous extract shows total mortality of P. cervi at 5 hours. The ultrastructural surface topography of untreated animal was compared with a treated animal by scanning electron microscope (SEM). The body of untreated P. cervi in conical shape, tegumental surface is highly ridged with transverse folds and present abundance number of papillaes. Observations demonstrated that the body of treated P. cervi become shrunken & elongated. Treated parasite shows the deep breakage in tegument and the disappearance of tegumental folds & papillae. Severe blebs formations have been found. Above findings, it can be concluded that the seeds of Trigonella foenum-graecum can be used as an anthelminthic agent to eliminate P. cervi from the body of buffalo.

Keywords: Paramphistomum cervi, Trigonella foenum-graecum, scanning electron microscope, buffalo

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2436 Periodontal Disease or Cement Disease: New Frontier in the Treatment of Periodontal Disease in Dogs

Authors: C. Gallottini, W. Di Mari, A. Amaddeo, K. Barbaro, A. Dolci, G. Dolci, L. Gallottini, G. Barraco, S. Eramo

Abstract:

A group of 10 dogs (group A) with Periodontal Disease in the third stage, were subjected to regenerative therapy of periodontal tissues, by use of nano hydroxy apatite (NHA). These animals induced by general anesthesia, where treated by ultrasonic scaling, root planning, and at the end by a mucogingival flap in which it was applied NHA. The flap was closed and sutured with simple steps. Another group of 10 dogs (group B), control group, was treated only by scaling and root planning. No patient was subjected to antibiotic therapy. After three months, a check was made by inspection of the oral cavity, radiography and bone biopsy at the alveolar level. Group A showed a total restitutio ad integrum of the periodontal structures, and in group B still mild gingivitis in 70% of cases and 30% of the state remains unchanged. Numerous experimental studies both in animals and humans have documented that the grafts of porous hydroxyapatite are rapidly invaded by fibrovascular tissue which is subsequently converted into mature lamellar bone tissue by activating osteoblast. Since we acted on the removal of necrotic cementum and rehabilitating the root tissue by polishing without intervention in the ligament but only on anatomical functional interface of cement-blasts, we can connect the positive evolution of the clinical-only component of the cement that could represent this perspective, the only reason that Periodontal Disease become a Cement Disease, while all other clinical elements as nothing more than a clinical pathological accompanying.

Keywords: nanoidroxiaphatite, parodontal disease, cement disease, regenerative therapy

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2435 Production of Biotechnological Chondroitin from Recombinant E, Coli K4 Strains on Renewable Substrates

Authors: Donatella Cimini, Sergio D’ambrosio, Saba Sadiq, Chiara Schiraldi

Abstract:

Chondroitin sulfate (CS), as well as modified CS, and unsulfated chondroitin, are largely applied in research today. CS is a linear glycosaminoglycan normally present in cartilage-rich tissues and bones in the form of proteoglycans decorated with sulfate groups in different positions. CS is used as an effective non-pharmacological alternative for the treatment of osteoarthritis, and other potential applications in the biomedical field are being investigated. Some bacteria, such as E. coli K4, produce a polysaccharide that is a precursor of CS (unsulfated chondroitin). This work focused on the construction of integrative E. coli K4 recombinant strains overexpressing genes (kfoA, kfoF, pgm and galU in different combinations) involved in the biosynthesis of the nucleotide sugars necessary for polysaccharide synthesis. Strain growth and polymer production were evaluated using renewable waste materials as substrates in shake flasks and small-scale batch fermentation processes. Results demonstrated the potential to replace pure sugars with cheaper medium components to establish environmentally sustainable and cost-effective production routes for potential industrial development. In fact, although excellent fermentation results have been described so far by employing strains that naturally produce chondroitin-like polysaccharides on semi-defined media, there is still the need to reduce manufacturing costs by providing a cost-effective biotechnological alternative to currently used animal-based extraction procedures.

Keywords: E. coli K4, chondroitin, microbial cell factories, glycosaminoglycans, renewable resources

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2434 New Active Dioxin Response Element Sites in Regulatory Region of Human and Viral Genes

Authors: Ilya B. Tsyrlov, Dmitry Y. Oshchepkov

Abstract:

A computational search for dioxin response elements (DREs) in genes of proteins comprising the Ah receptor (AhR) cytosolic core complex was performed by highly efficient tool SITECON. Eventually, the following number of new DREs in 5’flanking region was detected by SITECON: one in AHR gene, five in XAP2, eight in HSP90AA1, and three in HSP90AB1 genes. Numerous DREs found in genes of AhR and AhR cytosolic complex members would shed a light on potential mechanisms of expression, the stoichiometry of unliganded AhR core complex, and its degradation vs biosynthesis dynamics resulted from treatment of target cells with the AhR most potent ligand, 2,3,7,8-TCDD. With human viruses, reduced susceptibility to TCDD of geneencoding HIV-1 P247 was justified by the only potential DRE determined in gag gene encoding HIV-1 P24 protein, whereas the regulatory region of CMV genes encoding IE gp/UL37 has five potent DRE, 1.65 kb/UL36 – six DRE, pp65 and pp71 – each has seven DRE, and pp150 – ten DRE. Also, from six to eight DRE were determined with SITECON in the regulatory region of HSV-1 IE genes encoding tegument proteins, UL36 and UL37, and of UL19 gene encoding bindingglycoprotein C (gC). So, TCDD in the low picomolar range may activate in human cells AhR: Arnt transcription pathway that triggers CMV and HSV-1 reactivation by binding to numerous promoter DRE within immediate-early (IE) genes UL37 and UL36, thus committing virus to the lytic cycle.

Keywords: dioxin response elements, Ah receptor, AhR: Arnt transcription pathway, human and viral genes

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2433 Concentration of Waste Waters by Enzyme-Assisted Low-Temperature Evaporation

Authors: Ahokas Mikko, Taskila Sanna, Varrio Kalle, Tanskanen Juha

Abstract:

The present research aimed at the development of an energy efficient process for the concentration of starchy waste waters. The selected principle is mechanical vapor recompression evaporation (MVR) which leads to concentrated solid material and evaporated water phase. Evaporation removes water until a certain viscosity limit is reached. Materials with high viscosity cannot be concentrated using standard evaporators due to limitations of pumps and other constraints, such as wetting. Control of viscosity is thus essential for efficient evaporation. This applies especially to fluids in which due starch or other compounds the viscosity tends to increase via removal of water. In the present research, the effect of enzymes on evaporation of highly viscous starch industry waste waters was investigated. Wastewater samples were received from starch industry at pH of 4.8. Response surface methodology (RSM) was applied for the investigation of factor effects on the behaviour of concentrate during evaporation. The RSM was prepared using quadratic face-centered central composite design (CCF). The evaporation performance was evaluated by monitoring the viscosity of fluid during processing. Based on viscosity curves, the addition of glucoamylase reduced the viscosity during evaporation. This assumption was confirmed by CCF, suggesting that the use of starch decomposing glucoamylase allowed evaporation of the starchy wastewater to a relatively high total solid concentration without a detrimental increase in the viscosity. The results suggest that use of enzymes for reduction of viscosity during the evaporation allows more effective concentration of the wastewater and thereby recovery of potable water.

Keywords: viscous, wastewater, treatment, evaporation, concentration

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2432 Hydrofracturing for Low Temperature Waxy Reservoirs: Problems and Solutions

Authors: Megh Patel, Arjun Chauhan, Jay Thakkar

Abstract:

Hydrofracturing is the most prominent but at the same time expensive, highly skilled and time consuming well stimulation technique. Due to high cost and skilled labor involved, it is generally carried out as the consummate solution among other well stimulation techniques. Considering today’s global petroleum market, no gaffe or complications could be entertained during fracturing, as it would further hamper the current dwindling economy. The literature would be dealing with the challenges encountered during fracturing low temperature waxy reservoirs and the prominent solutions to overcome such teething troubles. During fracturing treatment for, shallow and high freezing point waxy oil reservoirs, the first line problems are to overcome uncompleted breakdown, uncompleted cleanup of fracturing fluids and cold damages to the formations by injecting cold fluid (fluid at ambient conditions). Injecting fracturing fluids at ambient conditions have the tendency to decrease the near wellbore reservoir temperature below the freezing point of oil reservoir and hence leading to wax deposition around the wellbore thereby hampering the fluid production as well as fracture propagation. To overcome such problems, solutions such as hot fracturing fluid injection, encapsulated heat generating hydraulic fracturing fluid system, and injection of wax inhibitor techniques would be discussed. The paper would also be throwing light on changes in rheological properties occurred during heating fracturing fluids and solutions to deal with it taking economic considerations into account.

Keywords: hydrofracturing, waxy reservoirs, low temperature, viscosity, crosslinkers

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2431 Effect of Phosphorus and Potassium Nutrition on Growth, Yield and Minerals Accumulation of Two Soybean Cultivars Differing in Phytate Contents

Authors: Taliman Nisar Ahmad, Hirofume Saneoka

Abstract:

A pot experiment was conducted to investigate the effect of phosphorus (P) and potassium (K) nutrition on grain yield, phytic acid and grain quality of high-phytate (Akimaro) and low-phytate line. Phosphorus and potassium were applied as; P₁ (20 kg ha⁻¹) and P₂ (100 kg ha⁻¹), same as K₁ (20 kg ha⁻¹) and K₂ (100 kg ha⁻¹), respectively. Low-phytate soybean had the highest grain yield, and 75% increase was observed compared to the high-phytate under same treatments. Highly significant differences of seed phytate P were observed in both cultivars, and the phytate P in high-phytate was found 39% higher than low-phytate, whereas no significant differences observed in response to P and K treatment. Percentage of phytate P from total P in seeds was 28 to 35% in low-phytate and 72 to 81% in high-phytate in different treatments. The lipid content in low-phytate was found lowered compared to that of high-phytate. Crude protein in grains was also found significantly higher in PK combined. No significant difference was observed in seed calcium (Ca), magnesium (Mg), and Zinc (Zn) in different treatments, but high-phytate showed 87% increase in seed Ca and 76% of Mg compared to low-phytate; however, low-phytate showed 82% increase in Zn content over high-phytate. The result illustrates that low-phytate soybean achieved higher grain yield and grain Pi in response to increased P and K nutrition. To achieve higher yield and quality seeds from the low-phytate soybean, it is recommended that proper phosphorus and potassium nutrition to be applied suggested in this study.

Keywords: phytic acid, low-phytate soybean, high-phytate soybean, P and K nutrition, protein content, soybean

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2430 A Genetic Identification of Candida Species Causing Intravenous Catheter-Associated Candidemia in Heart Failure Patients

Authors: Seyed Reza Aghili, Tahereh Shokohi, Shirin Sadat Hashemi Fesharaki, Mohammad Ali Boroumand, Bahar Salmanian

Abstract:

Introduction: Intravenous catheter-associated fungal infection as nosocomial infection continue to be a deep problem among hospitalized patients, decreasing quality of life and adding healthcare costs. The capacity of catheters in the spread of candidemia in heart failure patients is obvious. The aim of this study was to evaluate the prevalence and genetic identification of Candida species in heart disorder patients. Material and Methods: This study was conducted in Tehran Hospital of Cardiology Center (Tehran, Iran, 2014) during 1.5 years on the patients hospitalized for at least 7 days and who had central or peripheral vein catheter. Culture of catheters, blood and skin of the location of catheter insertion were applied for detecting Candida colonies in 223 patients. Identification of Candida species was made on the basis of a combination of various phenotypic methods and confirmed by sequencing the ITS1-5.8S-ITS2 region amplified from the genomic DNA using PCR and the NCBI BLAST. Results: Of the 223 patients samples tested, we identified totally 15 Candida isolates obtained from 9 (4.04%) catheter cultures, 3 (1.35%) blood cultures and 2 (0.90%) skin cultures of the catheter insertion areas. On the base of ITS region sequencing, out of nine Candida isolates from catheter, 5(55.6%) C. albicans, 2(22.2%) C. glabrata, 1(11.1%) C. membranifiaciens and 1 (11.1%) C. tropicalis were identified. Among three Candida isolates from blood culture, C. tropicalis, C. carpophila and C. membranifiaciens were identified. Non-candida yeast isolated from one blood culture was Cryptococcus albidus. One case of C. glabrata and one case of Candida albicans were isolated from skin culture of the catheter insertion areas in patients with positive catheter culture. In these patients, ITS region of rDNA sequence showed a similarity between Candida isolated from the skin and catheter. However, the blood samples of these patients were negative for fungal growth. We report two cases of catheter-related candidemia caused by C. membranifiaciens and C. tropicalis on the base of genetic similarity of species isolated from blood and catheter which were treated successfully with intravenous fluconazole and catheter removal. In phenotypic identification methods, we could only identify C. albicans and C. tropicalis and other yeast isolates were diagnosed as Candida sp. Discussion: Although more than 200 species of Candida have been identified, only a few cause diseases in humans. There is some evidence that non-albicans infections are increasing. Many risk factors, including prior antibiotic therapy, use of a central venous catheter, surgery, and parenteral nutrition are considered to be associated with candidemia in hospitalized heart failure patients. Identifying the route of infection in candidemia is difficult. Non-albicans candida as the cause of candidemia is increasing dramatically. By using conventional method, many non-albicans isolates remain unidentified. So, using more sensitive and specific molecular genetic sequencing to clarify the aspects of epidemiology of the unknown candida species infections is essential. The positive blood and catheter cultures for candida isolates and high percentage of similarity of their ITS region of rDNA sequence in these two patients confirmed the diagnosis of intravenous catheter-associated candidemia.

Keywords: catheter-associated infections, heart failure patient, molecular genetic sequencing, ITS region of rDNA, Candidemia

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2429 Comparative Evaluation of Pharmacologically Guided Approaches (PGA) to Determine Maximum Recommended Starting Dose (MRSD) of Monoclonal Antibodies for First Clinical Trial

Authors: Ibraheem Husain, Abul Kalam Najmi, Karishma Chester

Abstract:

First-in-human (FIH) studies are a critical step in clinical development of any molecule that has shown therapeutic promise in preclinical evaluations, since preclinical research and safety studies into clinical development is a crucial step for successful development of monoclonal antibodies for guidance in pharmaceutical industry for the treatment of human diseases. Therefore, comparison between USFDA and nine pharmacologically guided approaches (PGA) (simple allometry, maximum life span potential, brain weight, rule of exponent (ROE), two species methods and one species methods) were made to determine maximum recommended starting dose (MRSD) for first in human clinical trials using four drugs namely Denosumab, Bevacizumab, Anakinra and Omalizumab. In our study, the predicted pharmacokinetic (pk) parameters and the estimated first-in-human dose of antibodies were compared with the observed human values. The study indicated that the clearance and volume of distribution of antibodies can be predicted with reasonable accuracy in human and a good estimate of first human dose can be obtained from the predicted human clearance and volume of distribution. A pictorial method evaluation chart was also developed based on fold errors for simultaneous evaluation of various methods.

Keywords: clinical pharmacology (CPH), clinical research (CRE), clinical trials (CTR), maximum recommended starting dose (MRSD), clearance and volume of distribution

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2428 Batch Adsorption Studies for the Removal of Textile Dyes from Aqueous Solution on Three Different Pine Bark

Authors: B. Cheknane, F. Zermane

Abstract:

The main objective of the present study is the valorization of natural raw materials of plant origin for the treatment of textile industry wastewater. Selected bark was: maritime (MP), pinyon (PP) and Aleppo pine (AP) bark. The efficiency of these barks were tested for the removal of three dye; rhodamine B (RhB), Green Malachite (GM) and X Methyl Orange (MO). At the first time we focus to study the different parameters which can influence the adsorption processes such as: nature of the adsorbents, nature of the pollutants (dyes) and the effect of pH. Obtained results reveals that the speed adsorption is strongly influencing by the pH medium and the comparative study show that adsorption is favorable in the acidic medium with amount adsorbed of (Q=40mg/g) for rhodamine B and (Q=46mg/g) for orange methyl. Results of adsorption kinetics reveals that the molecules of GM are adsorbed better (Q=48mg/g) than the molecules of RhB (Q=46mg/g) and methyl orange (Q=18mg/g), with equilibrium time of 6 hours. The results of adsorption isotherms show clearly that the maritime pine bark is the most effective adsorbents with adsorbed amount of (QRhB=200mg/g) and (QMO=88mg/g) followed by pinyon pine (PP) with (QRhB=184mg/g) and (QMO=56mg/g) and finally Aleppo pine (AP) bark with (QRhB=131mg/g) and (QMO= 46mg/g). The different obtained isotherms were modeled using the Langmuir and Freundlich models and according to the adjustment coefficient values R2, the obtained isotherms are well represented by Freundlich model.

Keywords: maritime pine bark (MP), pinyon pine bark (PP), Aleppo pine (AP) bark, adsorption, dyes

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2427 Management and Evaluation of Developing Medical Device Software in Compliance with Rules

Authors: Arash Sepehri bonab

Abstract:

One of the regions of critical development in medical devices has been the part of the software - as an indispensable component of a therapeutic device, as a standalone device, and more as of late, as applications on portable gadgets. The chance related to a breakdown of the standalone computer program utilized inside healthcare is in itself not a model for its capability or not as a medical device. It is, subsequently, fundamental to clarify a few criteria for the capability of a stand-alone computer program as a medical device. The number of computer program items and therapeutic apps is persistently expanding and so as well is used in wellbeing education (e. g., in clinics and doctors' surgeries) for determination and treatment. Within the last decade, the use of information innovation in healthcare has taken a developing part. In reality, the appropriation of an expanding number of computer devices has driven several benefits related to the method of quiet care and permitted simpler get to social and health care assets. At the same time, this drift gave rise to modern challenges related to the usage of these modern innovations. The program utilized in healthcare can be classified as therapeutic gadgets depending on the way they are utilized and on their useful characteristics. In the event that they are classified as therapeutic gadgets, they must fulfill particular directions. The point of this work is to show a computer program improvement system that can permit the generation of secure and tall, quality restorative gadget computer programs and to highlight the correspondence between each program advancement stage and the fitting standard and/or regulation.

Keywords: medical devices, regulation, software, development, healthcare

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2426 Prevalence of Occupational Asthma Diagnosed by Specific Challenge Test in 5 Different Working Environments in Thailand

Authors: Sawang Saenghirunvattana, Chao Saenghirunvattana, Maria Christina Gonzales, Wilai Srimuk, Chitchamai Siangpro, Kritsana Sutthisri

Abstract:

Introduction: Thailand is one of the fastest growing countries in Asia. It has emerged from agricultural to industrialized economy. Work places have shifted from farms to factories, offices and streets were employees are exposed to certain chemicals and pollutants causing occupational diseases particularly asthma. Work-related diseases are major concern and many studies have been published to demonstrate certain professions and their exposures that elevate the risk of asthma. Workers who exhibit coughing, wheezing and difficulty of breathing are brought to a health care setting where Pulmonary Function Test (PFT) is performed and based from results, they are then diagnosed of asthma. These patients, known to have occupational asthma eventually get well when removed from the exposure of the environment. Our study, focused on performing PFT or specific challenge test in diagnosing workers of occupational asthma with them executing the test within their workplace, maintaining the environment and their daily exposure to certain levels of chemicals and pollutants. This has provided us with an understanding and reliable diagnosis of occupational asthma. Objective: To identify the prevalence of Thai workers who develop asthma caused by exposure to pollutants and chemicals from their working environment by conducting interview and performing PFT or specific challenge test in their work places. Materials and Methods: This study was performed from January-March 2015 in Bangkok, Thailand. The percentage of abnormal symptoms of 940 workers in 5 different areas (factories of plastic, fertilizer, animal food, office and streets) were collected through a questionnaire. The demographic information, occupational history, and the state of health were determined using a questionnaire and checklists. PFT was executed in their work places and results were measured and evaluated. Results: Pulmonary Function test was performed by 940 participants. The specific challenge test was done in factories of plastic, fertilizer, animal food, office environment and on the streets of Thailand. Of the 100 participants working in the plastic industry, 65% complained of having respiratory symptoms. None of them had an abnormal PFT. From the participants who worked with fertilizers and are exposed to sulfur dioxide, out of 200 participants, 20% complained of having symptoms and 8% had abnormal PFT. The 300 subjects working with animal food reported that 45% complained of respiratory symptoms and 15% had abnormal PFT results. From the office environment where there is indoor pollution, Out of 140 subjects, 7% had symptoms and 4% had abnormal PFT. The 200 workers exposed to traffic pollution, 24% reported respiratory symptoms and 12% had abnormal PFT. Conclusion: We were able to identify and diagnose participants of occupational asthma through their abnormal lung function test done at their work places. The chemical agents and exposures were determined therefore effective management of workers with occupational asthma were advised to avoid further exposure for better chances of recovery. Further studies identifying the risk factors and causative agents of asthma in workplaces should be developed to encourage interventional strategies and programs that will prevent occupation related diseases particularly asthma.

Keywords: occupational asthma, pulmonary function test, specific challenge test, Thailand

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2425 Sexual Cognitive Behavioral Therapy: Psychological Performance and Openness to Experience

Authors: Alireza Monzavi Chaleshtari, Mahnaz Aliakbari Dehkordi, Amin Asadi Hieh, Majid Kazemnezhad

Abstract:

This research was conducted with the aim of determining the effectiveness of sexual cognitive behavioral therapy on psychological performance and openness to experience in women. The type of research was experimental in the form of pre-test-post-test. The statistical population of this research was made up of all working and married women with membership in the researcher's Instagram social network who had problems in marital-sexual relationships (N=900). From the statistical community, which includes working and married women who are members of the researcher's Instagram social network who have problems in marital-sexual relationships, there are 30 people including two groups (15 people in the experimental group and 15 people in the control group) as available sampling and selected randomly. They were placed in two experimental and control groups. The anxiety, stress, and depression scale (DASS) and the Costa and McCree personality questionnaire were used to collect data, and the cognitive behavioral therapy protocol of Dr. Mehrnaz Ali Akbari was used for the treatment sessions. To analyze the data, the covariance test was used in the SPSS22 software environment. The results showed that sexual cognitive behavioral therapy has a positive and significant effect on psychological performance and openness to experience in women. Conclusion: It can be concluded that interventions such as cognitive-behavioral sex can be used to treat marital problems.

Keywords: sexual cognitive behavioral therapy, psychological function, openness to experience, women

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2424 A Method for Evaluating the Mechanical Stress on Mandibular Advancement Devices

Authors: Tsung-yin Lin, Yi-yu Lee, Ching-hua Hung

Abstract:

Snoring, the lay term for obstructive breathing during sleep, is one of the most prevalent of obnoxious human habits. Loud snoring usually makes others feel noisy and uncomfortable. Snoring also influences the sleep quality of snorers’ bed partners, because of the noise they do not get to sleep easily. Snoring causes the reduce of sleep quality leading to several medical problems, such as excessive daytime sleepiness, high blood pressure, increased risk for cardiovascular disease and cerebral vascular accident, and etc. There are many non-prescription devices offered for sale on the market, but very limited data are available to support a beneficial effect of these devices on snoring and use in treating obstructive sleep apnea (OSA). Mandibular advancement devices (MADs), also termed as the Mandibular reposition devices (MRDs) are removable devices which are worn at night during sleep. Most devices require dental impression, bite registration, and fabrication by a dental laboratory. Those devices are fixed to upper and lower teeth and are adjusted to advance the mandible. The amount of protrusion is adjusted to meet the therapeutic requirements, comfort, and tolerance. Many devices have a fixed degree of advancement. Some are adjustable in a limited degree. This study focuses on the stress analysis of Mandibular Advancement Devices (MADs), which are considered as a standard treatment of snoring that promoted by American Academy of Sleep Medicine (AASM). This paper proposes a new MAD design, and the finite element analysis (FEA) is introduced to precede the stress simulation for this MAD.

Keywords: finite element analysis, mandibular advancement devices, mechanical stress, snoring

Procedia PDF Downloads 347
2423 Evaluation of the Pain of Patients with Chronic Renal Disease in Hemodialysis

Authors: Fabiana Souza Orlandi, Izabel Cristina Chavez Gomes, Barbara Isabela De Paula Morais, Ana Carolina Ottaviani

Abstract:

Chronic Kidney Disease (CKD) is considered a public health problem. Patients who present CKD in their more advanced stages usually present several biopsychosocial changes, which may include pain. Pain can be considered subjective and personal, and its perception is characterized as a multidimensional experience. The objective of this study was to evaluate the level and descriptors of pain of adults and elderly patients with chronic kidney disease, through the Multidimensional Pain Evaluation Scale (EMADOR). This is a descriptive cross-sectional study with a quantitative approach. The sample consisted of 100 subjects with CKD in hemodialysis treatment at a Renal Replacement Therapy Service in the interior of the state of São Paulo. Data were collected through an individual interview, using a Sociodemographic Characterization and Multidimensional Pain Evaluation Scale (EMADOR). All ethical precepts were respected. The majority of the respondents were men (61.0%), white (56.0%) and with a high school education (34.0%). Regarding the pain of the individuals, 89 patients reported pain, with Chronic Pain predominating (50.0%, n = 50), followed by Acute Pain (39.0%, n = 39). Of the subjects who presented acute pain most of the 89.0% described the pain felt as unbearable, and of those who presented chronic pain, 35.0% described the pain felt as painful, unbearable and uncomfortable. It was concluded that there was a significant presence of pain, being the chronic pain dominant in the studied population. Faced with such factors, the present study motivates researches in this population, in order to establish interventions with the objective of improving the quality of life of these individuals.

Keywords: pain, chronic kidney disease, dialysis, evaluation

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2422 Using Thinking Blocks to Encourage the Use of Higher Order Thinking Skills among Students When Solving Problems on Fractions

Authors: Abdul Halim Abdullah, Nur Liyana Zainal Abidin, Mahani Mokhtar

Abstract:

Problem-solving is an activity which can encourage students to use Higher Order Thinking Skills (HOTS). Learning fractions can be challenging for students since empirical evidence shows that students experience difficulties in solving the fraction problems. However, visual methods can help students to overcome the difficulties since the methods help students to make meaningful visual representations and link abstract concepts in Mathematics. Therefore, the purpose of this study was to investigate whether there were any changes in students’ HOTS at the four highest levels when learning the fractions by using Thinking Blocks. 54 students participated in a quasi-experiment using pre-tests and post-tests. Students were divided into two groups. The experimental group (n=32) received a treatment to improve the students’ HOTS and the other group acted as the control group (n=22) which used a traditional method. Data were analysed by using Mann-Whitney test. The results indicated that during post-test, students who used Thinking Blocks showed significant improvement in their HOTS level (p=0.000). In addition, the results of post-test also showed that the students’ performance improved significantly at the four highest levels of HOTS; namely, application (p=0.001), analyse (p=0.000), evaluate (p=0.000), and create (p=0.000). Therefore, it can be concluded that Thinking Blocks can effectively encourage students to use the four highest levels of HOTS which consequently enable them to solve fractions problems successfully.

Keywords: Thinking Blocks, Higher Order Thinking Skills (HOTS), fractions, problem solving

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2421 Carcass Characteristics and Qualities of Philippine White Mallard (Anas boschas L.) and Pekin (Anas platyrhynchos L.) Duck

Authors: Jerico M. Consolacion, Maria Cynthia R. Oliveros

Abstract:

The Philippine White Mallard duck was compared with Pekin duck for potential meat production. A total of 50 ducklings were randomly assigned to five (5) pens per treatment after one month of brooding. Each pen containing five (5) ducks was considered as a replicate. The ducks were raised until 12 weeks of age and slaughtered at the end of the growing period. Meat from both breeds was analyzed. The data were subjected to the Independent-Sample T-test at 5% level of confidence. Results showed that post-mortem pH (0, 20 minutes, 50 minutes, 1 hour and 20 minutes, 1 hour and 50 minutes, and 24 hours ) did not differ significantly (P>0.05) between breeds. However, Pekin ducks (89.84±0.71) had a significantly higher water-holding capacity than Philippine White Mallard ducks (87.93±0.63) (P<0.05). Also, meat color (CIE L, a, b) revealed that no significant differences among the lightness, redness, and yellowness of the skin (breast) in both breeds (P>0.05) except for the yellowness of the lean muscles of the Pekin duck breast. Pekin duck meat (1.15±0.04) had significantly higher crude fat content than Philippine White Mallard (0.47±0.58). The study clearly showed that breed is a factor and provided some pronounced effects among the parameters. However, these results are considered as preliminary information on the meat quality of Philippine White Mallard duck. Hence, further studies are needed to understand and fully utilize it for meat production and develop different meat products from this breed.

Keywords: crude fat, meat color, meat pH, water-holding capacity

Procedia PDF Downloads 259
2420 Evaluation of a Potential Metabolism-Mediated Drug-Drug Interaction between Carvedilol and Fluvoxamine in Rats

Authors: Ana-Maria Gheldiu, Bianca M. Abrudan, Maria A. Neag, Laurian Vlase, Dana M. Muntean

Abstract:

Background information: The objective of this study was to investigate the effect of multiple-dose fluvoxamine on the pharmacokinetic profile of single-dose carvedilol in rats, in order to evaluate this possible drug-drug pharmacokinetic interaction. Methods: A preclinical study, in 28 white male Wistar rats, was conducted. Each rat was cannulated on the femoral vein, prior to being connected to BASi Culex ABC®. Carvedilol was orally administrated in rats (3.57 mg/kg body mass (b.m.)) in the absence of fluvoxamine or after a pre-treatment with multiple oral doses of fluvoxamine (14.28 mg/kg b.m.). The plasma concentrations of carvedilol were estimated by high performance liquid chromatography-tandem mass spectrometry. The pharmacokinetic parameters of carvedilol were analyzed by non-compartmental method. Results: After carvediol co-administration with fluvoxamine, an approximately 2-fold increase in the exposure of carvedilol was observed, considering the significantly elevated value of the total area under the concentration versus time curve (AUC₀₋∞). Moreover, an increase by approximately 145% of the peak plasma concentration was found, as well as an augmentation by approximately 230% of the half life time of carvedilol was observed. Conclusion: Fluvoxamine co-administration led to a significant alteration of carvedilol’s pharmacokinetic profile in rats, these effects could be explained by the existence of a drug-drug interaction mediated by CYP2D6 inhibition. Acknowledgement: This work was supported by CNCS Romania – project PNII-RU-TE-2014-4-0242.

Keywords: carvedilol, fluvoxamine, drug-drug pharmacokinetic interaction, rats

Procedia PDF Downloads 259
2419 Thermal Insulating Silicate Materials Suitable for Thermal Insulation and Rehabilitation Structures

Authors: Jitka Hroudová, Martin Sedlmajer, Jiří Zach

Abstract:

Problems insulation of building structures is often closely connected with the problem of moisture remediation. In the case of historic buildings or if only part of the redevelopment of envelope of structures, it is not possible to apply the classical external thermal insulation composite systems. This application is mostly effective thermal insulation plasters with high porosity and controlled capillary properties which assures improvement of thermal properties construction, its diffusion openness towards the external environment and suitable treatment capillary properties of preventing the penetration of liquid moisture and salts thereof toward the outer surface of the structure. With respect to the current trend of reducing the energy consumption of building structures and reduce the production of CO2 is necessary to develop capillary-active materials characterized by their low density, low thermal conductivity while maintaining good mechanical properties. The aim of researchers at the Faculty of Civil Engineering, Brno University of Technology is the development and study of hygrothermal behaviour of optimal materials for thermal insulation and rehabilitation of building structures with the possible use of alternative, less energy demanding binders in comparison with conventional, frequently used binder, which represents cement. The paper describes the evaluation of research activities aimed at the development of thermal insulation and repair materials using lightweight aggregate and alternative binders such as metakaolin and finely ground fly ash.

Keywords: thermal insulating plasters, rehabilitation materials, thermal conductivity, lightweight aggregate, alternative binders.

Procedia PDF Downloads 289
2418 The Cell Viability Study of Extracts of Bark, Flowers, Leaves and Seeds of Indian Dhak Tree, Flame of Forest

Authors: Madhavi S. Apte, Milind Bhitre

Abstract:

In pharmaceutical research and new drug development, medicinal plants have important roles. Similarly, Indian dhak tree belonging to family Fabaceae has been widely used in the traditional Indian medical system of ‘Ayurveda’ for the treatment of a variety of ailments. Hence the cell viability study was undertaken to evaluate and compare the activity of extracts of various parts like flower, bark, leaf, seed by conducting MTT assay method along with other pharmacognostical studies. The methanolic extracts of bark, flowers, leaves, and seeds were used for the study. The cell viability MTT assay was performed using the standard operating procedures. The extracts were dissolved in DMSO and serially diluted with complete medium to get the concentrations range of test concentration. DMSO concentration was kept < 0.1% in all the samples. HUVEC cells maintained in appropriate conditions were seeded in 96 well plates and treated with different concentrations of the test samples and incubated at 37°C, 5% CO₂ for 96 hours. MTT reagent was added to the wells and incubated for 4 hours; the dark blue formazan product formed by the cells was dissolved in DMSO under a safety cabinet and read at 550nm. Percentage inhibitions were calculated and plotted with the concentrations used to calculate the IC50 values. The bark, flower, leaves and seed extracts have shown the cytotoxicity activity and can be further studied for antiangiogenesis activity.

Keywords: pharmacognosy, Cell viability, MTT assay, anti-angiogenesis

Procedia PDF Downloads 277
2417 Lipidomic Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer

Authors: Patricia O. Carvalho, Marcia C. F. Messias, Salvador Sanchez Vinces, Caroline F. A. Gatinoni, Vitor P. Iordanu, Carlos A. R. Martinez

Abstract:

Lipidomics methods are widely used in the identification and validation of disease-specific biomarkers and therapy response evaluation. The present study aimed to identify a panel of potential lipid biomarkers to evaluate response to neoadjuvant chemoradiotherapy in rectal adenocarcinoma (RAC). Liquid chromatography–mass spectrometry (LC-MS)-based untargeted lipidomic was used to profile human serum samples from patients with clinical stage T2 or T3 resectable RAC, after and before chemoradiotherapy treatment. A total of 28 blood plasma samples were collected from 14 patients with RAC who recruited at the São Francisco University Hospital (HUSF/USF). The study was approved by the ethics committee (CAAE 14958819.8.0000.5514). Univariate and multivariate statistical analyses were applied to explore dysregulated metabolic pathways using untargeted lipidic profiling and data mining approaches. A total of 36 statistically significant altered lipids were identified and the subsequent partial least-squares discriminant analysis model was both cross validated (R2, Q2) and permutated. Lisophosphatidyl-choline (LPC) plasmalogens containing palmitoleic and oleic acids, with high variable importance in projection score, showed a tendency to be lower after completion of chemoradiotherapy. Chemoradiotherapy seems to change plasmanyl-phospholipids levels, indicating that these lipids play an important role in the RAC pathogenesis.

Keywords: lipidomics, neoadjuvant chemoradiotherapy, plasmalogens, rectal adenocarcinoma

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2416 Effect of Seed Soaking and Drying Methods on Coffee Seed and Seedling Quality

Authors: Taju Mohammednur, Tesfaye Megersa, Karta Kaske, Tekeste Kifle

Abstract:

Coffee is economically important in Ethiopia. However, the conditions under which coffee seeds are dried and processed significantly affect the seedling quality and productivity. The objective of this study was to evaluate the effect of pre-sowing treatments and drying methods on the physiological quality of coffee seeds and seedlings. The study was conducted at the Jimma Agricultural Research Center seed laboratory and nursery site. Two coffee varieties, 74110 and 75227, were used. Fully ripe red cherries were harvested, and the seeds were dried under two conditions: a shade drying room and direct open sun. Pre-sowing seed soaking treatments of 6, 8, 18, and 24 hours, including a control, were applied. A factorial design in a Complete Randomized Design was used. The highest germination percentage (91.48%), emergence rate (90.19%), and seedling vigor index (2236.30) were recorded for seeds dried in the shade drying room. In contrast, the lowest values (70.47%, 68.36%, and 1378.22, respectively) were observed for seeds dried in direct sunlight. There was a significant difference in seed germination based on soaking time, with the highest germination percentage (83.25%) recorded for seeds soaked for 6 hours, followed by 24 hours (83.13%), while the lowest (76.88%) was recorded for un-soaked seeds. The results indicated that drying seeds under shade is better for seed quality. Moreover, further investigation into seed treatment methods and preservation techniques is necessary to improve coffee seed quality.

Keywords: coffee, seed drying, germination, seed, seed longevity, seed priming

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