Search results for: pathogen exclusion

Authors: Zatovska T. V., Nesterova N. V., Baranova G. V., Zagorodnya S. D.

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In recent years, biosensor technologies based on the phenomenon of surface plasmon resonance (SPR) are becoming increasingly used in biology and medicine. Their application facilitates exploration in real time progress of binding of biomolecules and identification of agents that specifically interact with biologically active substances immobilized on the biosensor surface (biochips). Special attention is paid to the use of Biosensor analysis in determining the antibody-antigen interaction in the diagnostics of diseases caused by viruses and bacteria. According to WHO, the diseases that are caused by the herpes simplex virus (HSV), take second place (15.8%) after influenza as a cause of death from viral infections. Current diagnostics of HSV infection include PCR and ELISA assays. The latter allows determination the degree of immune response to viral infection and respective stages of its progress. In this regard, the searches for new and available diagnostic methods are very important. This work was aimed to develop Biosensor chip for detection of specific antibodies to HSV-1 in the human blood serum. The proteins of HSV1 (strain US) were used as antigens. The viral particles were accumulated in cell culture MDBK and purified by differential centrifugation in cesium chloride density gradient. Analysis of the HSV1 proteins was performed by polyacrylamide gel electrophoresis and ELISA. The protein concentration was measured using De Novix DS-11 spectrophotometer. The device for detection of antigen-antibody interactions was an optoelectronic two-channel spectrometer ‘Plasmon-6’, using the SPR phenomenon in the Krechman optical configuration. It was developed at the Lashkarev Institute of Semiconductor Physics of NASU. The used carrier was a glass plate covered with 45 nm gold film. Screening of human blood serums was performed using the test system ‘HSV-1 IgG ELISA’ (GenWay, USA). Development of Biosensor chip included optimization of conditions of viral antigen sorption and analysis steps. For immobilization of viral proteins 0.2% solution of Dextran 17, 200 (Sigma, USA) was used. Sorption of antigen took place at 4-8°C within 18-24 hours. After washing of chip, three times with citrate buffer (pH 5,0) 1% solution of BSA was applied to block the sites not occupied by viral antigen. It was found direct dependence between the amount of immobilized HSV1 antigen and SPR response. Using obtained biochips, panels of 25 positive and 10 negative for the content of antibodies to HSV-1 human sera were analyzed. The average value of SPR response was 185 a.s. for negative sera and from 312 to. 1264 a.s. for positive sera. It was shown that SPR data were agreed with ELISA results in 96% of samples proving the great potential of SPR in such researches. It was investigated the possibility of biochip regeneration and it was shown that application of 10 mM NaOH solution leads to rupture of intermolecular bonds. This allows reuse the chip several times. Thus, in this study biosensor chip for detection of specific antibodies to HSV1 was successfully developed expanding a range of diagnostic methods for this pathogen.

Keywords: biochip, herpes virus, SPR

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Authors: Hasan Demiroğlu, Uğur Avcıbaşı, Serhan Sakarya, Perihan Ünak

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Implanted devices are progressively practiced in innovative medicine to relieve pain or improve a compromised function. Implant-associated infections represent an emerging complication, caused by organisms which adhere to the implant surface and grow embedded in a protective extracellular polymeric matrix, known as a biofilm. In addition, the microorganisms within biofilms enter a stationary growth phase and become phenotypically resistant to most antimicrobials, frequently causing treatment failure. In such cases, surgical removal of the implant is often required, causing high morbidity and substantial healthcare costs. Staphylococcus aureus is the most common pathogen causing implant-associated infections. Successful treatment of these infections includes early surgical intervention and antimicrobial treatment with bactericidal drugs that also act on the surface-adhering microorganisms. Linezolid is a promising anti-microbial with ant-staphylococcal activity, used for the treatment of MRSA infections. Linezolid is a synthetic antimicrobial and member of oxazolidinoni group, with a bacteriostatic or bactericidal dose-dependent antimicrobial mechanism against gram-positive bacteria. Intensive use of antibiotics, have emerged multi-resistant organisms over the years and major problems have begun to be experienced in the treatment of infections occurred with them. While new drugs have been developed worldwide, on the other hand infections formed with microorganisms which gained resistance against these drugs were reported and the scale of the problem increases gradually. Scientific studies about the production of bacterial biofilm increased in recent years. For this purpose, we investigated the activity of Lin, Lin radiolabeled with 131I (131I-Lin) and cold iodinated Lin (127I-Lin) against clinical strains of Staphylococcus aureus DSM 4910 in biofilm. In the first stage, radio and cold labeling studies were performed. Quality-control studies of Lin and iodo (radio and cold) Lin derivatives were carried out by using TLC (Thin Layer Radiochromatography) and HPLC (High Pressure Liquid Chromatography). In this context, it was found that the binding yield was obtained to be about 86±2 % for 131I-Lin. The minimal inhibitory concentration (MIC) of Lin, 127I-Lin and 131I-Lin for Staphylococcus aureus DSM 4910 strain were found to be 1µg/mL. In time-kill studies of Lin, 127I-Lin and 131I-Lin were producing ≥ 3 log10 decreases in viable counts (cfu/ml) within 6 h at 2 and 4 fold of MIC respectively. No viable bacteria were observed within the 24 h of the experiments. Biofilm eradication of S. aureus started with 64 µg/mL of Lin, 127I-Lin and 131I-Lin, and OD630 was 0.507±0.0.092, 0.589±0.058 and 0.266±0.047, respectively. The media control of biofilm producing Staphylococcus was 1.675±0,01 (OD630). 131I and 127I did not have any effects on biofilms. Lin and 127I-Lin were found less effectively than 131I-Lin at killing cells in biofilm and biofilm eradication. Our results demonstrate that the 131I-Lin have potent anti-biofilm activity against S. aureus compare to Lin, 127I-Lin and media control. This is suggested that, 131I may have harmful effect on biofilm structure.

Keywords: iodine-131, linezolid, radiolabeling, slime layer, Staphylococcus

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Authors: Mary Jane Suarez

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A massive educational overhaul has taken place at the onset of the 21st century addressing the mismatches of employability skills with that of scholastic skills taught in schools. For a community to thrive in an ever-developing economy, the teaching of the necessary skills for job competencies should be realized by every educational institution. However, in harnessing 21st-century skills amongst learners, teachers, who often lack familiarity and thorough insights into the emerging 21st-century skills, are chained with the restraint of the need to comprehend the physiognomies of 21st-century skills learning and the requisite to implement the tenets of 21st-century skills teaching. With the endeavor to espouse 21st-century skills learning and teaching, a United States-based national coalition called Partnership 21st Century Skills (P21) has identified the four most important skills in 21st-century learning: critical thinking, communication, collaboration, and creativity and innovation with an established framework for 21st-century skills standards. Assessment of skills is the lifeblood of every teaching and learning encounter. It is correspondingly crucial to look at the 21st century standards and the assessment guides recognized by P21 to ensure that learners are 21st century ready. This mixed-method study sought to discover and describe what classroom assessments were used by English teachers in a public secondary school in the Philippines with course offerings on science, technology, engineering, and mathematics (STEM). The research evaluated the assessment tools implemented by English teachers and how these assessment tools were congruent to the 21st assessment standards of P21. A convergent parallel design was used to analyze assessment tools and practices in four phases. In the data-gathering phase, survey questionnaires, document reviews, interviews, and classroom observations were used to gather quantitative and qualitative data simultaneously, and how assessment tools and practices were consistent with the P21 framework with the four Cs as its foci. In the analysis phase, the data were treated using mean, frequency, and percentage. In the merging and interpretation phases, a side-by-side comparison was used to identify convergent and divergent aspects of the results. In conclusion, the results yielded assessments tools and practices that were inconsistent, if not at all, used by teachers. Findings showed that there were inconsistencies in implementing authentic assessments, there was a scarcity of using a rubric to critically assess 21st skills in both language and literature subjects, there were incongruencies in using portfolio and self-reflective assessments, there was an exclusion of intercultural aspects in assessing the four Cs and the lack of integrating collaboration in formative and summative assessments. As a recommendation, a harmonized assessment scheme of P21 skills was fashioned for teachers to plan, implement, and monitor classroom assessments of 21st-century skills, ensuring the alignment of such assessments to P21 standards for the furtherance of the institution’s thrust to effectively integrate 21st-century skills assessment standards to its curricula.

Keywords: 21st-century skills, 21st-century skills assessments, assessment standards, congruency, four Cs

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Authors: Itee Chowdhury, Shikha Modi

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Introduction: Cancer is beginning to outpace cardiovascular disease as a cause of death affecting every major organ system with profound implications for perioperative management. Breast cancer is the most common cancer in women in India, accounting for 27% of all cancers. The small changes in analgesic management of cancer patients can greatly improve prognosis and reduce the risk of postsurgical cancer recurrence as opioid-based analgesia has a deleterious effect on cancer outcomes. Shortened postsurgical recovery time facilitates earlier return to intended oncological therapy maximising the chance of successful treatment. Literature reveals that the role of BIS since FDA approval has been assessed in various types of surgeries, but clinical data on its use in oncosurgical patients are scanty. Our study focuses on the role of BIS-guided anaesthesia for breast cancer surgery patients. Methods: A prospective randomized controlled study in patients aged 36-55years scheduled for modified radical mastectomy was conducted in 51 patients in each group who met the inclusion and exclusion criteria, and randomization was done by sealed envelope technique. In BIS guided anaesthesia group (B), sevoflurane was titrated to keep the BIS value 45-60, and thereafter if the patient showed hypertension/tachycardia, an opioid was given. In standard anaesthesia care (group C), sevoflurane was titrated to keep MAC in the range of 0.8-1, and fentanyl was given if the patient showed hypertension/tachycardia. Intraoperative opioid consumption was calculated. Postsurgery recovery characteristics, including Aldrete score, were assessed. Patients were questioned for pain, PONV, and recall of the intraoperative event. A comparison of age, BMI, ASA, recovery characteristics, opioid, and VAS score was made using the non-parametric Mann-Whitney U test. Categorical data like intraoperative awareness of surgery and PONV was studied using the Chi-square test. A comparison of heart rate and MAP was made by an independent sample t-test. #ggplot2 package was used to show the trend of the BIS index for all intraoperative time points for each patient. For a statistical test of significance, the cut-off p-value was set as <0.05. Conclusions: BIS monitoring led to reduced opioid consumption and early recovery from anaesthesia in breast cancer patients undergoing MRM resulting in less postoperative nausea and vomiting and less pain intensity in the immediate postoperative period without any recall of the intraoperative event. Thus, the use of a Bispectral index monitor allows for tailoring of anaesthesia administration with a good outcome.

Keywords: bispectral index, depth of anaesthesia, recovery, opioid consumption

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Authors: Gaston Bacquet

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The purpose of this research is to explore how language and culture shape a learner’s identity as they immerse themselves in the world of second language learning and how teachers can assist in the process of identity construction within a classroom setting. The study will be conducted as an in-classroom ethnography, using a qualitative methods approach and analyzing students’ experiences as language learners, their degree of investment, inclusion/exclusion, and attitudes, both towards themselves and their social context; the research question the study will attempt to answer is: What kind of pedagogical interventions are needed to help language learners in the process of identity construction so they can offset unequal conditions of power and gain further social inclusion? The following methods will be used for data collection: i) Questionnaires to investigate learners’ attitudes and feelings in different areas divided into four strands: themselves, their classroom, learning English and their social context. ii) Participant observations, conducted in a naturalistic manner. iii) Journals, which will be used in two different ways: on the one hand, learners will keep semi-structured, solicited diaries to record specific events as requested by the researcher (event-contingent). On the other, the researcher will keep his journal to maintain a record of events and situations as they happen to reduce the risk of inaccuracies. iv) Person-centered interviews, which will be conducted at the end of the study to unearth data that might have been occluded or be unclear from the methods above. The interviews will aim at gaining further data on experiences, behaviors, values, opinions, feelings, knowledge and sensory, background and demographic information. This research seeks to understand issues of socio-cultural identities and thus make a significant contribution to knowledge in this area by investigating the type of pedagogical interventions needed to assist language learners in the process of identity construction to achieve further social inclusion. It will also have applied relevance for those working with diverse student groups, especially taking our present social context into consideration: we live in a highly mobile world, with migrants relocating to wealthier, more developed countries that pose their own particular set of challenges for these communities. This point is relevant because an individual’s insight and understanding of their own identity shape their relationship with the world and their ability to continue constructing this relationship. At the same time, because a relationship is influenced by power, the goal of this study is to help learners feel and become more empowered by increasing their linguistic capital, which we hope might result in a greater ability to integrate themselves socially. Exactly how this help will be provided will vary as data is unearthed through questionnaires, focus groups and the actual participant observations being carried out.

Keywords: identity construction, second-language learning, investment, second-language culture, social inclusion

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Authors: Manuel Branco

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This paper argues that mainstream economics is one of the reasons that can explain the difficulty in fully realizing human rights because its logic is intrinsically contradictory to human rights, most especially economic, social and cultural rights. First, its utilitarianism, both in its cardinal and ordinal understanding, contradicts human rights principles. Maximizing aggregate utility along the lines of cardinal utility is a theoretical exercise that consists in ensuring as much as possible that gains outweigh losses in society. In this process an individual may get worse off, though. If mainstream logic is comfortable with this, human rights' logic does not. Indeed, universality is a key principle in human rights and for this reason the maximization exercise should aim at satisfying all citizens’ requests when goods and services necessary to secure human rights are at stake. The ordinal version of utilitarianism, in turn, contradicts the human rights principle of indivisibility. Contrary to ordinal utility theory that ranks baskets of goods, human rights do not accept ranking when these goods and services are necessary to secure human rights. Second, by relying preferably on market logic to allocate goods and services, mainstream economics contradicts human rights because the intermediation of money prices and the purpose of profit may cause exclusion, thus compromising the principle of universality. Finally, mainstream economics sees human rights mainly as constraints to the development of its logic. According to this view securing human rights would, then, be considered a cost weighing on economic efficiency and, therefore, something to be minimized. Fully realizing human rights needs, therefore, a different approach. This paper discusses a human rights-based political economy. This political economy, among other characteristics should give up mainstream economics narrow utilitarian approach, give up its belief that market logic should guide all exchanges of goods and services between human beings, and finally give up its view of human rights as constraints on rational choice and consequently on good economic performance. Giving up mainstream’s narrow utilitarian approach means, first embracing procedural utility and human rights-aimed consequentialism. Second, a more radical break can be imagined; non-utilitarian, or even anti-utilitarian, approaches may emerge, then, as alternatives, these two standpoints being not necessarily mutually exclusive, though. Giving up market exclusivity means embracing decommodification. More specifically, this means an approach that takes into consideration the value produced outside the market and an allocation process no longer necessarily centered on money prices. Giving up the view of human rights as constraints means, finally, to consider human rights as an expression of wellbeing and a manifestation of choice. This means, in turn, an approach that uses indicators of economic performance other than growth at the macro level and profit at the micro level, because what we measure affects what we do.

Keywords: economic and social rights, political economy, economic theory, markets

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Authors: Parul Kulshreshtha, Subrata Sinha, Rakesh Bhatnagar

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This study was conducted by taking B. anthracis as a model pathogen. On infecting a host, B. anthracis secretes three proteins, namely, protective antigen (PA, 83kDa), edema factor (EF, 89 kDa) and lethal factor (LF, 90 kDa). These three proteins are the components of two anthrax toxins. PA binds to the cell surface receptors, namely, tumor endothelial marker (TEM) 8 and capillary morphogenesis protein (CMG) 2. TEM8 and CMG2 interact with LDL-receptor related protein (LRP) 6 for endocytosis of EF and LF. On entering the cell, EF acts as a calmodulin-dependent adenylate cyclase that causes a prolonged increase of cytosolic cyclic adenosine monophosphate (cAMP). LF is a metalloprotease that cleaves most isoforms of mitogen-activated protein kinase kinases (MAPKK/MEK) close to their N-terminus. By secreting these two toxins, B.anthracis ascertains death of the host. Once the systemic levels of the toxins rise, antibiotics alone cannot save the host. Therefore, toxin-specific inhibitors have to be developed. In this wake, monoclonal antibodies have been developed for the neutralization of toxic effects of anthrax toxins. We created hybridomas by using spleen of mice that were actively immunized with rLFn (recombinant N-terminal domain of lethal factor of B. anthracis) to obtain anti-toxin antibodies. Later on, separate group of mice were immunized with rLFn to obtain a polyclonal control for passive immunization studies of monoclonal antibodies. This led to the identification of one cohort of rLFn-immunized mice that harboured disease-enhancing polyclonal antibodies. At the same time, the monoclonal antibodies from all the hybridomas were being tested. Two hybridomas secreted monoclonal antibodies (H8 and H10) that were cross-reactive with EF (edema factor) and LF (lethal factor), while the other two hybridomas secreted LF-specific antibodies (H7 and H11). The protective efficacy of H7, H8, H10 and H11 was investigated. H7, H8 and H10 were found to be protective. H11 was found to have disease enhancing characteristics in-vitro and in mouse model of challenge with B. anthracis. In this study the disease enhancing character of H11 monoclonal antibody and anti-rLFn polyclonal sera was investigated. Combination of H11 with protective monoclonal antibodies (H8 and H10) reduced its disease enhancing nature both in-vitro and in-vivo. But combination of H11 with LETscFv (an scFv with VH and VL identical to H10 but lacking Fc region) could not abrogate the disease-enhancing character of H11 mAb. Therefore it was concluded that for suppression of disease enhancement, Fc portion was absolutely essential for interaction of H10 with H11. Our study indicates that the protective potential of an antibody depends equally on its idiotype/ antigen specificity and its isotype. A number of monoclonal and engineered antibodies are being explored as immunotherapeutics but it is absolutely essential to characterize each one for their individual and combined protective potential. Although new in the sphere of toxin-based diseases, it is extremely important to characterize the disease-enhancing nature of polyclonal as well as monoclonal antibodies. This is because several anti-viral therapeutics and vaccines have failed in the face of this phenomenon. The passive –immunotherapy thus needs to be well formulated to avoid any contraindications.

Keywords: immunotherapy, polyclonal, monoclonal, antibody-dependent disease enhancement

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Authors: Eleonora Di Salvo, Antonio Panebianco, Graziella Ziino

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Background: Vibrio parahaemolyticus is a human pathogen that is widely distributed in marine environments. It is frequently isolated from raw seafood, particularly shellfish. Consumption of raw or undercooked seafood contaminated with V. parahaemolyticus may lead to acute gastroenteritis. Vibrio spp. has excellent resistance to low temperatures so it can be found in frozen products for a long time. Recently, the viable but non-culturable state (VBNC) of bacteria has attracted great attention, and more than 85 species of bacteria have been demonstrated to be capable of entering this state. VBNC cells cannot grow in conventional culture medium but are viable and maintain metabolic activity, which may constitute an unrecognized source of food contamination and infection. Also V. parahaemolyticus could exist in VBNC state under nutrient starvation or low-temperature conditions. Aim: The aim of the present study was to optimize methods and investigate V. parahaemolyticus VBNC cells and their presence in frozen bivalve molluscs, regularly marketed. Materials and Methods: propidium monoazide (PMA) was integrated with real-time polymerase chain reaction (qPCR) targeting the tl gene to detect and quantify V. parahaemolyticus in the VBNC state. PMA-qPCR resulted highly specific to V. parahaemolyticus with a limit of detection (LOD) of 10-1 log CFU/mL in pure bacterial culture. A standard curve for V. parahaemolyticus cell concentrations was established with the correlation coefficient of 0.9999 at the linear range of 1.0 to 8.0 log CFU/mL. A total of 77 samples of frozen bivalve molluscs (35 mussels; 42 clams) were subsequently subjected to the qualitative (on alkaline phosphate buffer solution) and quantitative research of V. parahaemolyticus on thiosulfate-citrate-bile salts-sucrose (TCBS) agar (DIFCO) NaCl 2.5%, and incubation at 30°C for 24-48 hours. Real-time PCR was conducted on homogenate samples, in duplicate, with and without propidium monoazide (PMA) dye, and exposed for 45 min under halogen lights (650 W). Total DNA was extracted from cell suspension in homogenate samples according to bolliture protocol. The Real-time PCR was conducted with species-specific primers for V. parahaemolitycus. The RT-PCR was performed in a final volume of 20 µL, containing 10 µL of SYBR Green Mixture (Applied Biosystems), 2 µL of template DNA, 2 µL of each primer (final concentration 0.6 mM), and H2O 4 µL. The qPCR was carried out on CFX96 TouchTM (Bio-Rad, USA). Results: All samples were negative both to the quantitative and qualitative detection of V. parahaemolyticus by the classical culturing technique. The PMA-qPCR let us individuating VBNC V. parahaemolyticus in the 20,78% of the samples evaluated with a value between the Log 10-1 and Log 10-3 CFU/g. Only clams samples were positive for PMA-qPCR detection. Conclusion: The present research is the first evaluating PMA-qPCR assay for detection of VBNC V. parahaemolyticus in bivalve molluscs samples, and the used method was applicable to the rapid control of marketed bivalve molluscs. We strongly recommend to use of PMA-qPCR in order to identify VBNC forms, undetectable by the classic microbiological methods. A precise knowledge of the V.parahaemolyticus in a VBNC form is fundamental for the correct risk assessment not only in bivalve molluscs but also in other seafood.

Keywords: food safety, frozen bivalve molluscs, PMA dye, Real-time PCR, VBNC state, Vibrio parahaemolyticus

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Authors: Odirachukwu S. Mwim, Tana Pistorius

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Since the early 1990s political and economic pressures have been mounted on policy and law makers to increase patent protection by raising the protection standards. The perception of the relation between patent protection and development, particularly economic development, has evolved significantly in the past few years. Debate on patent protection in the international arena has been significantly influenced by the perception that there is a strong link between patent protection and economic development. The level of patent protection determines the extent of development that can be achieved. Recently there has been a paradigm shift with a lot of emphasis on extending patent protection to method of doing business generally referred to as Business Method Patenting (BMP). The general perception among international organizations and the private sectors also indicates that there is a strong correlation between BMP protection and economic growth. There are two diametrically opposing views as regards the relation between Intellectual Property (IP) protection and development and innovation. One school of thought promotes the view that IP protection improves economic development through stimulation of innovation and creativity. The other school advances the view that IP protection is unnecessary for stimulation of innovation and creativity and is in fact a hindrance to open access to resources and information required for innovative and creative modalities. Therefore, different theories and policies attach different levels of protection to BMP which have specific implications for economic growth. This study examines the impact of BMP protection on development by focusing on the challenges confronting economic growth in African communities as a result of the new paradigm in patent law. (Africa is used as a single unit in this study but this should not be construed as African homogeneity. Rather, the views advanced in this study are used to address the common challenges facing many communities in Africa). The study reviews (from the point of views of legal philosophers, policy makers and decisions of competent courts) the relevant literature, patent legislation particularly the International Treaty, policies and legal judgments. Findings from this study suggest that over and above the various criticisms levelled against the extreme liberal approach to the recognition of business methods as patentable subject matter, there are other specific implications that are associated with such approach. The most critical implication of extending patent protection to business methods is the locking-up of knowledge which may hamper human development in general and economic development in particular. Locking up knowledge necessary for economic advancement and competitiveness may have a negative effect on economic growth by promoting economic exclusion, particularly in African communities. This study suggests that knowledge of BMP within the African context and the extent of protection linked to it is crucial in achieving a sustainable economic growth in Africa. It also suggests that a balance is struck between the two diametrically opposing views.

Keywords: Africa, business method patenting, economic growth, intellectual property, patent protection

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Authors: Allya Koesoema, Arni Ariani

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While religion is only a very minor factor contributing to financial exclusion in most countries, the World Bank 2014 Global Financial Development Report highlighted it as a significant barrier for having a financial account in some Muslim majority countries. This is in part due to the perceived incompatibility between traditional financial institutions practices and Islamic finance principles. In these cases, the development of financial institutions and products that are compatible with the principles of Islamic finance may act as an important lever to increasing formal account ownership. However, there is significant diversity in the relationship between a country’s proportion of Muslim population and its level of financial inclusion. This paper combines data taken from the Global Findex Database, World Development Indicators, and the Pew Research Center to quantitatively explore the relationship between individual and country level religious and socioeconomic factor to financial inclusion. Results from regression analyses show a complex relationship between financial inclusion and religion-related factors in the population both on the individual and country level. Consistent with prior literature, on average the percentage of Islamic population positively correlates with the proportion of unbanked populations who cites religious reasons as a barrier to getting an account. However, its impact varies across several variables. First, a deeper look into countries’ religious composition reveals that the average negative impact of a large Muslim population is not as strong in more religiously diverse countries and less religious countries. Second, on the individual level, among the unbanked, the poorest quintile, least educated, older and the female populations are comparatively more likely to not have an account because of religious reason. Results also show indications that in this case, informal mechanisms partially substitute formal financial inclusion, as indicated by the propensity to borrow from family and friends. The individual level findings are important because the demographic groups that are more likely to cite religious reasons as barriers to formal financial inclusion are also generally perceived to be more vulnerable socially and economically and may need targeted attention. Finally, the number of Islamic financial institutions in a particular country is negatively correlated to the propensity of religious reasons as a barrier to financial inclusion. Importantly, the number of financial institutions in a country also mitigates the negative impact of the proportion of Muslim population, low education and individual age to formal financial inclusion. These results point to the potential importance of Islamic Finance Institutions in increasing global financial inclusion, and highlight the potential importance of looking beyond the proportion of Muslim population to other underlying institutional and socioeconomic factor in maximizing its impact.

Keywords: cross country comparison, financial inclusion, Islamic banking and finance, quantitative methods, socioeconomic factors

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Authors: Rebecca Pryce, Nijole Bernaitis, Andrew K. Davey, Shailendra Anoopkumar-Dukie

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Background: Warfarin is an oral anticoagulant widely used in the prevention of strokes in patients with atrial fibrillation (AF) and in the treatment and prevention of deep vein thrombosis (DVT). Regular monitoring of Internationalised Normalised Ratio (INR) is required to ensure therapeutic benefit with time in therapeutic range (TTR) used to measure warfarin control. A number of factors influence TTR including diet, concurrent illness, and drug interactions. Extensive literature exists regarding the effect of conventional medicines on warfarin control, but documented interactions relating to complementary medicines are limited. It has been postulated that fish oil and krill oil supplementation may affect warfarin due to their association with bleeding events. However, to date little is known as to whether fish and krill oil significantly alter the incidence of bleeding with warfarin or impact on warfarin control. Aim:To assess the influence of fish oil and krill oil supplementation on warfarin control in AF and DVT patients by determining the influence of these supplements on TTR and bleeding events. Methods:A retrospective cohort analysis was conducted utilising patient information from a large private pathology practice in Queensland. AF and DVT patients receiving warfarin management by the pathology practice were identified and their TTR calculated using the Rosendaal method. Concurrent medications were analysed and patients taking no other interacting medicines were identified and divided according to users of fish oil and krill oil supplements and those taking no supplements. Study variables included TTR and the incidence of bleeding with exclusion criteria being less than 30 days of treatment with warfarin. Subject characteristics were reported as the mean and standard deviation for continuous data and number and percentages for nominal or categorical data. Data was analysed using GraphPad InStat Version 3 with a p value of <0.05 considered to be statistically significant. Results:Of the 2081 patients assessed for inclusion into this study, a total of 573 warfarin users met the inclusion criteria. Of these, 416 (72.6%) patients were AF patients and 157 (27.4%) DVT patients and overall there were 316 (55.1%) male and 257 (44.9%) female patients. 145 patients were included in the fish oil/krill oil group (supplement) and 428 were included in the control group. The mean TTR of supplement users was 86.9% and for the control group 84.7% with no significant difference between these groups. Control patients experienced 1.6 times the number of minor bleeds per person compared to supplement patients and 1.2 times the number of major bleeds per person. However, this was not statistically significant nor was the comparison between thrombotic events. Conclusion: No significant difference was found between supplement and control patients in terms of mean TTR, the number of bleeds and thrombotic events. Fish oil and krill oil supplements when used concurrently with warfarin do not significantly affect warfarin control as measured by TTR and bleeding incidence.

Keywords: atrial fibrillation, deep vein thormbosis, fish oil, krill oil, warfarin

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Authors: Dana R. Thomson, Catherine Linard, Sabine Vanhuysse, Jessica E. Steele, Michal Shimoni, Jose Siri, Waleska Caiaffa, Megumi Rosenberg, Eleonore Wolff, Tais Grippa, Stefanos Georganos, Helen Elsey

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The Sustainable Development Goals (SDGs) and Urban Health Equity Assessment and Response Tool (Urban HEART) identify dozens of key indicators to help local decision-makers prioritize and track inequalities in health outcomes. However, presentations and discussions at the International Conference on Urban Health (ICUH) 2017 suggested that additional indicators are needed to make decisions and policies. A local decision-maker may realize that malaria or road accidents are a top priority. However, s/he needs additional health determinant indicators, for example about standing water or traffic, to address the priority and reduce inequalities. Health determinants reflect the physical and social environments that influence health outcomes often at community- and societal-levels and include such indicators as access to quality health facilities, access to safe parks, traffic density, location of slum areas, air pollution, social exclusion, and social networks. Indicator identification and disaggregation are necessarily constrained by available datasets – typically collected about households and individuals in surveys, censuses, and administrative records. Continued advancements in earth observation, data storage, computing and mobile technologies mean that new sources of health determinants indicators derived from 'big data' are becoming available at fine geographic scale. Big data includes high-resolution satellite imagery and aggregated, anonymized mobile phone data. While big data are themselves not representative of the population (e.g., satellite images depict the physical environment), they can provide information about population density, wealth, mobility, and social environments with tremendous detail and accuracy when combined with population-representative survey, census, administrative and health system data. The aim of this paper is to (1) flag to data scientists important indicators needed by health decision-makers at the city and sub-city scale - ideally free and publicly available, and (2) summarize for local decision-makers new datasets that can be generated from big data, with layperson descriptions of difficulties in generating them. We include SDGs and Urban HEART indicators, as well as indicators mentioned by decision-makers attending ICUH 2017.

Keywords: health determinant, health outcome, mobile phone, remote sensing, satellite imagery, SDG, urban HEART

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Authors: Rahimi-Movaghar Vafa, Mansouri Pejman, Chardoli Mojtaba, Rezvani Samina

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Introduction: Blunt abdominal trauma is one of the leading causes of morbidity and mortality in all age groups, but diagnosis of serious intra-abdominal pathology is difficult and most of the damages are obscure in the initial investigation. There is still controversy about which patients should undergo abdomen/pelvis CT, which patients needs more observation and which patients can be discharged safely The aim of this study was to determine that is it safe to discharge patients with blunt abdominal trauma with normal initial findings. Methods: This non-randomized cross-sectional study was conducted from September 2013 to September 2014 at two levels I trauma centers, Sina hospital and Rasoul-e-Akram hospital (Tehran, Iran). Our inclusion criteria were all patients were admitted for suspicious BAT and our exclusion criteria were patients that have serious head and neck, chest, spine and limb injuries which need surgical intervention, those who have unstable vital signs, pregnant women with a gestational age over 3 months and homeless or without exact home address. 390 patients with blunt trauma abdomen examined and the necessary data, including demographic data, the abdominal examination, FAST result, patients’ lab test results (hematocrit, base deficit, urine analysis) on admission and at 6 and 12 hours after admission were recorded. Patients with normal physical examination, laboratory tests and FAST were discharged from the ED during 12 hours with the explanation of the alarm signs and were followed up after 24 hours and 1 week by a telephone call. Patients with abnormal findings in physical examination, laboratory tests, and FAST underwent abdomino-pelvic CT scan. Results: The study included 390 patients with blunt abdominal trauma between 12 and 80 years of age (mean age, 37.0 ± 13.7 years) and the mean duration of hospitalization in patients was 7.4 ± 4.1 hours. 88.6% of the patients were discharged from hospital before 12 hours. Odds ratio (OR) for having any symptoms for discharge after 6 hours was 0.160 and after 12 hours was 0.117 hours, which is statistically significant. Among the variables age, systolic and diastolic blood pressure, heart rate, respiratory rate, hematocrit and base deficit at admission, 6 hours and 12 hours after admission showed no significant statistical relationship with discharge time. From our 390 patients, 190 patients have normal initial physical examination, lab data and FAST findings that didn’t show any signs or symptoms in their next assessment and in their follow up by the phone call. Conclusion: It is recommended that patients with no symptoms at admission (completely normal physical examination, ultrasound, normal hematocrit and normal base deficit and lack of microscopic hematuria) and good family and social status can be safely discharged from the emergency department.

Keywords: blunt abdominal trauma, patient discharge, emergency department, FAST

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Authors: Bibha Kumari, Nigel P. Brunton, Dilip K. Rai, Brijesh K. Tiwari

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Edible mushrooms possess numerous functional components like homo- and hetero- β-glucans [β(1→3), β(1→4) and β(1→6) glucosidic linkages], chitins, ergosterols, bioactive polysaccharides and peptides imparting health beneficial properties to mushrooms. Some of the proven biological activities of mushroom extracts are antioxidant, antimicrobial, immunomodulatory, cholesterol lowering activity by inhibiting a key cholesterol metabolism enzyme i.e. 3-hydroxy-3-methyl-glutaryl CoA reductase (HMGCR), angiotensin I-converting enzyme (ACE) inhibition. Application of novel extraction technologies like pulsed electric field (PEF) and high power ultrasound offers clean, green, faster and efficient extraction alternatives with enhanced and good quality extracts. Sequential PEF followed by ultrasound assisted extraction (UAE) were applied to recover bioactive enriched fractions from industrial white button mushroom (Agaricus bisporus) stalk waste using environmentally friendly and GRAS solvents i.e. water and water/ethanol combinations. The PEF treatment was carried out at 60% output voltage, 2 Hz frequency for 500 pulses of 20 microseconds pulse width, using KCl salt solution of 0.6 mS/cm conductivity by the placing 35g of chopped fresh mushroom stalks and 25g of salt solution in the 4x4x4cm3 treatment chamber. Sequential UAE was carried out on the PEF pre-treated samples using ultrasonic-water-bath (USB) of three frequencies (25 KHz, 35 KHz and 45 KHz) for various treatment times (15-120 min) at 80°C. Individual treatment using either PEF or UAE were also investigation to compare the effect of each treatment along with the combined effect on the recovery and bioactivity of the crude extracts. The freeze dried mushroom stalk powder was characterised for proximate compositional parameters (dry weight basis) showing 64.11% total carbohydrate, 19.12% total protein, 7.21% total fat, 31.2% total dietary fiber, 7.9% chitin (as glucosamine equivalent) and 1.02% β-glucan content. The total phenolic contents (TPC) were determined by the Folin-Ciocalteu procedure and expressed as gallic-acid-equivalents (GAE). The antioxidant properties were ascertained using DPPH and FRAP assays and expressed as trolox-equivalents (TE). HMGCR activity and molecular mass of β-glucans will be measured using the commercial HMG-CoA Reductase Assay kit (Sigma-Aldrich) and size exclusion chromatography (HPLC-SEC), respectively. Effects of PEF, UAE and their combination on the antioxidant capacity, HMGCR inhibition and β-glucans content will be presented.

Keywords: β-glucan, mushroom stalks, pulsed electric field (PEF), ultrasound assisted extraction (UAE)

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Authors: Anteneh Dagnachew Sewenet, Paola Pisano

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The concept of circular economy, circularity, and sustainability are interconnected and promote a more sustainable future. However, previous studies have mainly focused on each concept individually, neglecting the relationships and gaps in the existing literature. This study aims to integrate and link these concepts to expand the theoretical and practical methods of scholars and professionals in pursuit of sustainability. The aim of this systematic literature review is to comprehensively analyze and summarize the interconnections between circular economy, circularity, and sustainability. Additionally, it seeks to develop a conceptual framework that can guide practitioners and serve as a basis for future research. The review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. A total of 78 articles were analyzed, utilizing the Scopus and Web of Science databases. The analysis involved summarizing and systematizing the conceptualizations of circularity and its relationship with the circular economy and long-term sustainability. The review provided a comprehensive overview of the interconnections between circular economy, circularity, and sustainability. Key themes, theoretical frameworks, empirical findings, and conceptual gaps in the literature were identified. Through a rigorous analysis of scholarly articles, the study highlighted the importance of integrating these concepts for a more sustainable future. This study contributes to the existing literature by integrating and linking the concepts of circular economy, circularity, and sustainability. It expands the theoretical understanding of how these concepts relate to each other and provides a conceptual framework that can guide future research in this field. The findings emphasize the need for a holistic approach in achieving sustainability goals. The data collection for this review involved identifying relevant articles from the Scopus and Web of Science databases. The selection of articles was made based on predefined inclusion and exclusion criteria. The PRISMA protocol guided the systematic analysis of the selected articles, including summarizing and systematizing their content. This study addressed the question of how circularity is conceptualized and related to both the circular economy and long-term sustainability. It aimed to identify the interconnections between these concepts and bridge the gap in the existing literature. The review provided a comprehensive analysis of the interconnections between the circular economy, circularity, and sustainability. It presented a conceptual framework that can guide practitioners in implementing circular economy strategies and serve as a basis for future research. By integrating these concepts, scholars, and professionals can enhance the theoretical and practical methods in pursuit of a more sustainable future. The findings emphasize the importance of taking a holistic approach to achieve sustainability goals and highlight conceptual gaps that can be addressed in future studies.

Keywords: circularity, circular economy, sustainability, innovation

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Authors: Sunil Sangwan, Narayan Chandra Nayak

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Over the last few decades, Indian banking system has achieved remarkable growth in its credit volume. However, one of the most disturbing facts about this growth is the uneven distribution of financial services across regions. Having witnessed limited success from all the earlier efforts towards financial inclusion targeting the rural poor and the underprivileged, provision of microfinance, of late, has emerged as a supplementary mechanism. There are two prominent modes of microfinance distribution in India namely Bank-SHG linkage (SBLP) and private Microfinance Institutions (MFIs). Ironically, such efforts also seem to have failed to achieve the desired targets as the microfinance services have witnessed skewed distribution across the states of the country. This study attempts to make a comparative analysis of the geographical skew of the SBLP and MFI in India and examine the factors influencing their regional distribution. The results indicate that microfinance services are largely concentrated in the southern region, accounting for about 50% of all microfinance clients and 49% of all microfinance loan portfolios. This is distantly followed by an eastern region where client outreach is close to 25% only. The north-eastern, northern, central, and western regions lag far behind in microfinance sectors, accounting for only 4%, 4%, 10%, and 7 % client outreach respectively. The penetration of SHGs is equally skewed, with the southern region accounting for 46% of client outreach and 70% of loan portfolios followed by an eastern region with 21% of client outreach and 13% of the loan portfolio. Contrarily, north-eastern, northern, central, western and eastern regions account for 5%, 5%, 10%, and 13% of client outreach and 3%, 3%, 7%, and 4% of loan portfolios respectively. The study examines the impact of literacy rate, rural poverty, population density, primary sector share, non-farm activities, loan default behavior and bank penetration on the microfinance penetration. The study is limited to 17 major states of the country over the period 2008-2014. The results of the GMM estimation indicate the significant positive impact of literacy rate, non-farm activities and population density on microfinance penetration across the states, while the rise in loan default seems to deter it. Rural poverty shows the significant negative impact on the spread of SBLP, while it has a positive impact on MFI penetration, hence indicating the policy of exclusion being adhered to by the formal financial system especially towards the poor. However, MFIs seem to be working as substitute mechanisms to banks to fill the gap. The findings of the study are a pointer towards enhancing financial literacy, non-farm activities, rural bank penetration and containing loan default for achieving greater microfinance prevalence.

Keywords: bank penetration, literacy rate, microfinance, primary sector share, rural non-farm activities, rural poverty

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Authors: Purnima Anjali Mohanty, Mousumi Padhi

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Background of the study: In the background of the passage of the Transgender Bill 2016, which is the first such step of formal recognition of the rights of transgender, the Hijras have been recognized under the wider definition of Transgender. Fascinatingly, in the Hindu social context, Hijras have a long social standing during marriages and childbirths. Other than this ironically, they live an ostracized life. The Bill rather than recognizing their unique characteristics and needs, reinforces the societal dualism through a parallelism of their legal rights with rights available to women. Purpose of the paper: The research objective was to probe why and to what extent did they identify themselves with the feminine gender roles. Originality of the paper: In the Indian context, the subject of eunuch has received relatively little attention. Among the studies that exist, there has been a preponderance of studies from the perspective of social exclusion, rights, and physical health. There has been an absence of research studying the self-identity of Hijras from the gender perspective. Methodology: The paper adopts the grounded theory method to investigate and discuss the underlying gender identity of transgenders. Participants in the study were 30 hijras from various parts of Odisha. 4 Focus group discussions were held for collecting data. The participants were approached in their natural habitat. Following the methodological recommendations of the grounded theory, care was taken to select respondents with varying experiences. The recorded discourses were transcribed verbatim. The transcripts were analysed sentence by sentence, and coded. Common themes were identified, and responses were categorized under the themes. Data collected in the latter group discussions were added till saturation of themes. Finally, the themes were put together to prove that despite the demand for recognition as third gender, the eunuchs of Odisha identify themselves with the feminine roles. Findings: The Hijra have their own social structure and norms which are unique and are in contrast with the mainstream culture. These eunuchs live and reside in KOTHIS (house), where the family is led by a matriarch addressed as Maa (mother) with her daughters (the daughters are eunuchs/effeminate men castrated and not castrated). They all dress up as woman, do womanly duties, expect to be considered and recognized as woman and wife and have the behavioral traits of a woman. Looking from the stance of Feminism one argues that when the Hijras identify themselves with the gender woman then on what grounds they are given the recognition as third gender. As self-identified woman; their claim for recognition as third gender falls flat. Significance of the study: Academically it extends the study of understanding of gender identity and psychology of the Hijras in the Indian context. Practically its significance is far reaching. The findings can be used to address legal and social issues with regards to the rights available to the Hijras.

Keywords: feminism, gender perspective, Hijras, rights, self-identity

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Authors: Nilson Rogério Da Silva, Ingrid Casagrande, Isabela Chicarelli Amaro Santos

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Introduction: People with Autism Spectrum Disorder (ASD) may face difficulties in social inclusion in different segments of society, especially in entering and staying at work. In Brazil, although there is legislation that equates it to the condition of disability, the number of people at work is still low. The United Nations estimates that more than 80 percent of adults with autism are jobless. In Brazil, the scenario is even more nebulous because there is no control and tracking of accurate data on the number of individuals with autism and how many of these are inserted in the labor market. Pereira and Goyos (2019) found that there is practically no scientific production about people with ASD in the labor market. Objective: To describe the experience of people with ASD inserted in the work, facilities and difficulties found in the professional exercise and the strategies used to maintain the job. Methodology: The research was approved by the Research Ethics Committee. As inclusion criteria for participation, the professional should accept to participate voluntarily, be over 18 years of age and have had some experience with the labor market. As exclusion criteria, being under 18 years of age and having never worked in a work activity. Participated in the research of 04 people with a diagnosis of ASD, aged 22 to 32 years. For data collection, an interview script was used that addressed: 1) General characteristics of the participants; 2) Family support; 3) School process; 4) Insertion in the labor market; 5) Exercise of professional activity; (6) Future and Autism; 7) Possible coping strategies. For the analysis of the data obtained, the full transcription of the interviews was performed and the technique of Content Analysis was performed. Results: The participants reported problems in different aspects: In the school environment: difficulty in social relationships, and Bullying. Lack of adaptation to the school curriculum and the structure of the classroom; In the Faculty: difficulty in following the activities, ealizar group work, meeting deadlines and establishing networking; At work: little adaptation in the work environment, difficulty in establishing good professional bonds, difficulty in accepting changes in routine or operational processes, difficulty in understanding veiled social rules. Discussion: The lack of knowledge about what disability is and who the disabled person is leads to misconceptions and negatives regarding their ability to work and in this context, people with disabilities need to constantly prove that they are able to work, study and develop as a human person, which can be classified as ableism. The adaptations and the use of technologies to facilitate the performance of people with ASD, although guaranteed in national legislation, are not always available, highlighting the difficulties and prejudice. Final Considerations: The entry and permanence of people with ASD at work still constitute a challenge to be overcome, involving changes in society in general, in companies, families and government agencies.

Keywords: autism spectrum disorder (ASD), work, disability, autism

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Authors: Ilija Kelepurovski, Stefan Lazorovski, Pece Petkovski, Marian Anakievski, Svetlana Petkovska

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Introduction: Benign prostatic hyperplasia (BPH) is a common condition that affects men over the age of 50 and is characterized by an enlarged prostate gland that can cause lower urinary tract symptoms (LUTS). Uroflowmetry and cystoscopy are two commonly used diagnostic tests to evaluate LUTS and diagnose BPH. While both tests can be useful, there is a risk of overusing cystoscopy and underusing uroflowmetry in the evaluation of LUTS. The aim of this study was to compare the use of uroflowmetry and cystoscopy in a prospective cohort of 100 patients with suspected BPH or other urinary tract conditions and to assess the diagnostic yield of each test. Materials and Methods: This was a prospective study of 100 male patients over the age of 50 with suspected BPH or other urinary tract conditions who underwent uroflowmetry and cystoscopy for the evaluation of LUTS at a single tertiary care center. Inclusion criteria included male patients over the age of 50 with suspected BPH or other urinary tract conditions, while exclusion criteria included previous urethral or bladder surgery, active urinary tract infection, and significant comorbidities. The primary outcome of the study was the frequency of cystoscopy in the evaluation of LUTS, and the secondary outcome was the diagnostic yield of each test. Results: Of the 100 patients included in the study, 86 (86%) were diagnosed with BPH and 14 (14%) had other urinary tract conditions. The mean age of the study population was 67 years. Uroflowmetry was performed on all 100 patients, while cystoscopy was performed on 70 (70%) of the patients. The diagnostic yield of uroflowmetry was high, with a clear diagnosis made in 92 (92%) of the patients. The diagnostic yield of cystoscopy was also high, with a clear diagnosis made in 63 (90%) of the patients who underwent the procedure. There was no statistically significant difference in the diagnostic yield of uroflowmetry and cystoscopy (p = 0.20). Discussion: Our study found that uroflowmetry is an effective and well-tolerated diagnostic tool for evaluating LUTS and diagnosing BPH, with a high diagnostic yield and low risk of complications. Cystoscopy is also a useful diagnostic tool, but it is more invasive and carries a small risk of complications such as bleeding or urinary tract infection. Both tests had a high diagnostic yield, suggesting that either test can provide useful information in the evaluation of LUTS. However, the fact that 70% of the study population underwent cystoscopy raises concerns about the potential overuse of this test in the evaluation of LUTS. This is especially relevant given the focus on patient-centered care and the need to minimize unnecessary or invasive procedures. Our findings underscore the importance of considering the clinical context and using evidence-based guidelines. Conclusion: In this prospective study of 100 patients with suspected BPH or other urinary tract conditions, we found that uroflowmetry and cystoscopy were both valuable diagnostic tools for the evaluation of LUTS. However, the potential overuse of cystoscopy in this population warrants further investigation and highlights the need for careful consideration of the optimal use of diagnostic tests in the evaluation of LUTS and the diagnosis of BPH. Further research is needed to better understand the relative roles of uroflowmetry and cystoscopy in the diagnostic workup of patients with LUTS, and to develop evidence-based guidelines for their appropriate use.

Keywords: uroflowmetry, cystoscopy, LUTS, BPH

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Authors: Fei Jia, Xingjian Bai, Xiaowei Zhang, Wenjie Yan, Ruitong Dai, Xingmin Li, Jozef Kokini

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Pseudomonas aeruginosa is a Gram-negative, aerobic, opportunistic human pathogen that is present in the soil, water, and food. This microbe has been recognized as a representative food-borne spoilage bacterium that can lead to many types of infections. Considering the casualties and property loss caused by P. aeruginosa, the development of a rapid and reliable technique for the detection of P. aeruginosa is crucial. The whole-cell aptasensor, an emerging biosensor using aptamer as a capture probe to bind to the whole cell, for food-borne pathogens detection has attracted much attention due to its convenience and high sensitivity. Here, a low-field magnetic resonance imaging (LF-MRI) aptasensor for the rapid detection of P. aeruginosa was developed. The basic detection principle of the magnetic relaxation switch (MRSw) nanosensor lies on the ‘T₂-shortening’ effect of magnetic nanoparticles in NMR measurements. Briefly speaking, the transverse relaxation time (T₂) of neighboring water protons get shortened when magnetic nanoparticles are clustered due to the cross-linking upon the recognition and binding of biological targets, or simply when the concentration of the magnetic nanoparticles increased. Such shortening is related to both the state change (aggregation or dissociation) and the concentration change of magnetic nanoparticles and can be detected using NMR relaxometry or MRI scanners. In this work, two different sizes of magnetic nanoparticles, which are 10 nm (MN₁₀) and 400 nm (MN₄₀₀) in diameter, were first immobilized with anti- P. aeruginosa aptamer through 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)/N-hydroxysuccinimide (NHS) chemistry separately, to capture and enrich the P. aeruginosa cells. When incubating with the target, a ‘sandwich’ (MN₁₀-bacteria-MN₄₀₀) complex are formed driven by the bonding of MN400 with P. aeruginosa through aptamer recognition, as well as the conjugate aggregation of MN₁₀ on the surface of P. aeruginosa. Due to the different magnetic performance of the MN₁₀ and MN₄₀₀ in the magnetic field caused by their different saturation magnetization, the MN₁₀-bacteria-MN₄₀₀ complex, as well as the unreacted MN₄₀₀ in the solution, can be quickly removed by magnetic separation, and as a result, only unreacted MN₁₀ remain in the solution. The remaining MN₁₀, which are superparamagnetic and stable in low field magnetic field, work as a signal readout for T₂ measurement. Under the optimum condition, the LF-MRI platform provides both image analysis and quantitative detection of P. aeruginosa, with the detection limit as low as 100 cfu/mL. The feasibility and specificity of the aptasensor are demonstrated in detecting real food samples and validated by using plate counting methods. Only two steps and less than 2 hours needed for the detection procedure, this robust aptasensor can detect P. aeruginosa with a wide linear range from 3.1 ×10² cfu/mL to 3.1 ×10⁷ cfu/mL, which is superior to conventional plate counting method and other molecular biology testing assay. Moreover, the aptasensor has a potential to detect other bacteria or toxins by changing suitable aptamers. Considering the excellent accuracy, feasibility, and practicality, the whole-cell aptasensor provides a promising platform for a quick, direct and accurate determination of food-borne pathogens at cell-level.

Keywords: magnetic resonance imaging, meat spoilage, P. aeruginosa, transverse relaxation time

Procedia PDF Downloads 152

Authors: Peter J. Fusco, Dave M. Mathew, Chris Mathew, Kenneth H. Levy, Kathryn S. Varghese, Stephanie Salazar-Restrepo, Serena M. Mathew, Sofia Khaja, Eamon Vega, Mia Polizzi, Alyssa Mullane, Adham Ahmed

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Background: Laparoscopic (LS) removal of neuroblastomas in children has been reported to offer favorable outcomes compared to the conventional open thoracotomy (OT) procedure. Critical perioperative measures such as blood loss, operative time, length of stay, and time to postoperative chemotherapy have all supported laparoscopic use rather than its more invasive counterpart. Herein, a pairwise meta-analysis was performed comparing perioperative outcomes between LS and OT in thoracoabdominal neuroblastoma cases. Methods: A comprehensive literature search was performed on PubMed, Ovid EMBASE, and Scopus databases to identify studies comparing the outcomes of pediatric patients with thoracoabdominal neuroblastomas undergoing resection via OT or LS. After deduplication, 4,227 studies were identified and subjected to initial title screening with exclusion and inclusion criteria to ensure relevance. When studies contained overlapping cohorts, only the larger series were included. Primary outcomes include estimated blood loss (EBL), hospital length of stay (LOS), and mortality, while secondary outcomes were tumor recurrence, post-operative complications, and operation length. The “meta” and “metafor” packages were used in R, version 4.0.2, to pool risk ratios (RR) or standardized mean differences (SMD) in addition to their 95% confidence intervals in the random effects model via the Mantel-Haenszel method. Heterogeneity between studies was assessed using the I² test, while publication bias was assessed via funnel plot. Results: The pooled analysis included 209 patients from 5 studies (141 OT, 68 LS). Of the included studies, 2 originated from the United States, 1 from Toronto, 1 from China, and 1was from a Japanese center. Mean age between study cohorts ranged from 2.4 to 5.3 years old, with female patients occupying between 30.8% to 50% of the study populations. No statistically significant difference was found between the two groups for LOS (SMD -1.02; p=0.083), mortality (RR 0.30; p=0.251), recurrence(RR 0.31; p=0.162), post-operative complications (RR 0.73; p=0.732), or operation length (SMD -0.07; p=0.648). Of note, LS appeared to be protective in the analysis for EBL, although it did not reach statistical significance (SMD -0.4174; p= 0.051). Conclusion: Despite promising literature assessing LS removal of pediatric neuroblastomas, results showed it was non-superior to OT for any explored perioperative outcomes. Given the limited comparative data on the subject, it is evident that randomized trials are necessary to further the efficacy of the conclusions reached.

Keywords: laparoscopy, neuroblastoma, thoracoabdominal, thoracotomy

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Authors: Dagmara A. Niedziela, Mark P. Murphy, Orla M. Keane, Finola C. Leonard

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Staphylococcus aureus is the most frequent cause of clinical and subclinical bovine mastitis in Ireland. Mastitis caused by S. aureus is often chronic and tends to recur after antibiotic treatment. This may be due to several virulence factors, including attributes that enable the bacterium to internalize into bovine mammary epithelial cells, where it may evade antibiotic treatment, or evade the host immune response. Four bovine-adapted lineages (CC71, CC97, CC151 and ST136) were identified among a collection of Irish S. aureus mastitis isolates. Genotypic variation of mastitis-causing strains may contribute to different presentations of the disease, including differences in milk somatic cell count (SCC), the main method of mastitis detection. The objective of this study was to investigate the influence of bacterial strain and lineage on host immune response, by employing cell culture methods in vitro as well as an in vivo infection model. Twelve bovine adapted S. aureus strains were examined for internalization into bovine mammary epithelial cells (bMEC) and their ability to induce an immune response from bMEC (using qPCR and ELISA). In vitro studies found differences in a variety of virulence traits between the lineages. Strains from lineages CC97 and CC71 internalized more efficiently into bovine mammary epithelial cells (bMEC) than CC151 and ST136. CC97 strains also induced immune genes in bMEC more strongly than strains from the other 3 lineages. One strain each of CC151 and CC97 that differed in their ability to cause an immune response in bMEC were selected on the basis of the above in vitro experiments. Fourteen first-lactation Holstein-Friesian cows were purchased from 2 farms on the basis of low SCC (less than 50 000 cells/ml) and infection free status. Seven cows were infected with 1.73 x 102 c.f.u. of the CC97 strain (Group 1) and another seven with 5.83 x 102 c.f.u. of the CC151 strain (Group 2). The contralateral quarter of each cow was inoculated with PBS (vehicle). Clinical signs of infection (temperature, milk and udder appearance, milk yield) were monitored for 30 days. Blood and milk samples were taken to determine bacterial counts in milk, SCC, white blood cell populations and cytokines. Differences in disease presentation in vivo between groups were observed, with two animals from Group 2 developing clinical mastitis and requiring antibiotic treatment, while one animal from Group 1 did not develop an infection for the duration of the study. Fever (temperature > 39.5⁰C) was observed in 3 animals from Group 2 and in none from Group 1. Significant differences in SCC and bacterial load between groups were observed in the initial stages of infection (week 1). Data is also being collected on cytokines and chemokines secreted during the course of infection. The results of this study suggest that a strain from lineage CC151 may cause more severe clinical mastitis, while a strain from lineage CC97 may cause mild, subclinical mastitis. Diversity between strains of S. aureus may therefore influence the clinical presentation of mastitis, which in turn may influence disease detection and treatment needs.

Keywords: Bovine mastitis, host immune response, host-pathogen interactions, Staphylococcus aureus

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Authors: Yaron Covo, Tamar Kofman, Shira Palti

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Over the recent decades, debates about the engagement of fans in football governance have focused on the club level and national level, emphasizing the significance of fans’ involvement in increasing the connection of clubs with the community, and in safeguarding the transparency, accountability, and clubs’ financial stability. This paper will offer a different conceptual justification for providing fans with access to decision-making processes in football. First, it will suggest that the participation of fans is necessary for addressing discriminatory practices against women in football stadiums. Second, it will argue that fans’ involvement in football governance is important not only at the club and national level but also at the global level, relying on the principles of Global Administrative Law. In contemporary men’s football, female fans face different forms of discrimination. Iranian women are still prohibited from attending football games at the domestic level; In Saudi Arabia, female fans are only permitted to enter designated family areas; Qatar – the host of the 2022 FIFA world cup – requires women to attend matches wearing modest clothing. Similarly, in Turkey, Lebanon, UAE, and Algeria, women face cultural barriers when attending men’s football games. In other countries, female fans suffer from subtle discrimination, including micro-aggressions, misogyny, sexism, and noninstitutionalized exclusion. Despite the vital role of fans in world football and the importance of football for many women’s lives, little has been done to address this problem. While FIFA recognizes that these discriminatory practices contradict its statutes, this recognition fails to materialize into meaningful change. This paper will argue that FIFA’s omission stems from two interrelated characteristics of world football: (1) the ultra-masculine nature of the game; (2) the insufficient recognition of fans’ significance. While fans have been given a voice in various football bodies on the domestic level, FIFA has yet to allow the representation of fans as stakeholders in world football governance. Since fans are a more heterogeneous group than players, the voices of those fans who do not fit the ultra-masculine model are not heard. Thus, by focusing mainly on male players, FIFA reproduces the hegemonic masculinity that feeds back into fan dynamics and marginalizes female fans. To rectify this problem, we will call on FIFA to provide fans and female fans in particular, with voice mechanisms and access to decision-making processes. In addition to its impact on the formation of fans’ identities, such a move will allow fans to demand better enforcement of existing anti-discrimination norms and new regulations to address their needs. The literature has yet to address the relationship between fans’ gender discrimination and global football governance. Building on Global Administrative Law scholarship and feminist theories, this paper will aim to fill this gap.

Keywords: fans, FIFA, football governance, gender discrimination, global administrative law, human rights

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Authors: Yesim Sucullu Karadag, Pinar Kurt, Sule Bilen, Nese Subutay Oztekin, Fikri Ak

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Background: Primary cervical dystonia is thought to be a purely motor disorder. But recent studies revealed that patients with dystonia had additional non-motor features. Sensory and psychiatric disturbances could be included into the non-motor spectrum of dystonia. The Basal Ganglia receive inputs from all cortical areas and throughout the thalamus project to several cortical areas, thus participating to circuits that have been linked to motor as well as sensory, emotional and cognitive functions. However, there are limited studies indicating cognitive impairment in patients with cervical dystonia. More evidence is required regarding neurocognitive functioning in these patients. Objective: This study is aimed to investigate neurocognitive profile of cervical dystonia patients in comparison to healthy controls (HC) by employing a detailed set of neuropsychological tests in addition to self-reported instruments. Methods: Totally 29 (M/F: 7/22) cervical dystonia patients and 30 HC (M/F: 10/20) were included into the study. Exclusion criteria were depression and not given informed consent. Standard demographic, educational data and clinical reports (disease duration, disability index) were recorded for all patients. After a careful neurological evaluation, all subjects were given a comprehensive battery of neuropsychological tests: Self report of neuropsychological condition (by visual analogue scale-VAS, 0-100), RAVLT, STROOP, PASAT, TMT, SDMT, JLOT, DST, COWAT, ACTT, and FST. Patients and HC were compared regarding demographic, clinical features and neurocognitive tests. Also correlation between disease duration, disability index and self report -VAS were assessed. Results: There was no difference between patients and HCs regarding socio-demographic variables such as age, gender and years of education (p levels were 0.36, 0.436, 0.869; respectively). All of the patients were assessed at the peak of botulinum toxine effect and they were not taking an anticholinergic agent or benzodiazepine. Dystonia patients had significantly impaired verbal learning and memory (RAVLT, p<0.001), divided attention and working memory (ACTT, p<0.001), attention speed (TMT-A and B, p=0.008, 0.050), executive functions (PASAT, p<0.001; SDMT, p= 0.001; FST, p<0.001), verbal attention (DST, p=0.001), verbal fluency (COWAT, p<0.001), visio-spatial processing (JLOT, p<0.001) in comparison to healthy controls. But focused attention (STROOP-spontaneous correction) was not different between two groups (p>0.05). No relationship was found regarding disease duration and disability index with any neurocognitive tests. Conclusions: Our study showed that neurocognitive functions of dystonia patients were worse than control group with the similar age, sex, and education independently clinical expression like disease duration and disability index. This situation may be the result of possible cortical and subcortical changes in dystonia patients. Advanced neuroimaging techniques might be helpful to explain these changes in cervical dystonia patients.

Keywords: cervical dystonia, neurocognitive impairment, neuropsychological test, dystonia disability index

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Authors: Ponghyung Lee

Abstract:

This study seeks to investigate the variations occurring to Korean consonantal variations center around laryngeal features of the concerned sounds, to the exclusion of others. Our fundamental premise is that the weak contrast associated with concerned segments might be held accountable for the oscillation of the status quo of the concerned consonants. What is more, we assume that an array of notions as a measure of communicative efficiency of linguistic units would be significantly influential on triggering those variations. To this end, we have tried to compute the surprisal, entropic contribution, and relative contrastiveness associated with Korean obstruent consonants. What we found therein is that the Information-theoretic perspective is compelling enough to lend support our approach to a considerable extent. That is, the variant realizations, chronologically and stylistically, prove to be profoundly affected by a set of Information-theoretic factors enumerated above. When it comes to the biblical proper names, we use Georgetown University CQP Web-Bible corpora. From the 8 texts (4 from Old Testament and 4 from New Testament) among the total 64 texts, we extracted 199 samples. We address the issue of laryngeal feature variations associated with Korean obstruent consonants under the presumption that the variations stem from the weak contrast among the triad manifestations of laryngeal features. The variants emerge from diverse sources in chronological and stylistic senses: Christianity biblical texts, ordinary casual speech, the shift of loanword adaptation over time, and ideophones. For the purpose of discussing what they are really like from the perspective of Information Theory, it is necessary to closely look at the data. Among them, the massive changes occurring to loanword adaptation of proper nouns during the centennial history of Korean Christianity draw our special attention. We searched 199 types of initially capitalized words among 45,528-word tokens, which account for around 5% of total 901,701-word tokens (12,786-word types) from Georgetown University CQP Web-Bible corpora. We focus on the shift of the laryngeal features incorporated into word-initial consonants, which are available through the two distinct versions of Korean Bible: one came out in the 1960s for the Protestants, and the other was published in the 1990s for the Catholic Church. Of these proper names, we have closely traced the adaptation of plain obstruents, e. g. /b, d, g, s, ʤ/ in the sources. The results show that as much as 41% of the extracted proper names show variations; 37% in terms of aspiration, and 4% in terms of tensing. This study set out in an effort to shed light on the question: to what extent can we attribute the variations occurring to the laryngeal features associated with Korean obstruent consonants to the communicative aspects of linguistic activities? In this vein, the concerted effects of the triad, of surprisal, entropic contribution, and relative contrastiveness can be credited with the ups and downs in the feature specification, despite being contentiousness on the role of surprisal to some extent.

Keywords: entropic contribution, laryngeal feature variation, relative contrastiveness, surprisal

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Authors: Emily Wood, James K. Westphal, Itamar Lerner

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Background: Polysomnography (PSG) recordings are regularly used in research and clinical settings to study sleep and sleep-related disorders. Typical PSG studies are conducted in professional laboratories and performed by qualified researchers. However, the number of sleep labs worldwide is disproportionate to the increasing number of individuals with sleep disorders like sleep apnea and insomnia. Consequently, there is a growing need to supply cheaper yet reliable means to measure sleep, preferably autonomously by subjects in their own home. Over the last decade, a variety of devices for self-monitoring of sleep became available in the market; however, very few have been directly validated against PSG to demonstrate their ability to perform reliable automatic sleep scoring. Two popular mobile EEG-based systems that have published validation results, the DREEM 3 headband and the Z-Machine, have never been directly compared one to the other by independent researchers. The current study aimed to compare the performance of DREEM 3 and the Z-Machine to help investigators and clinicians decide which of these devices may be more suitable for their studies. Methods: 26 participants have completed the study for credit or monetary compensation. Exclusion criteria included any history of sleep, neurological or psychiatric disorders. Eligible participants arrived at the lab in the afternoon and received the two devices. They then spent two consecutive nights monitoring their sleep at home. Participants were also asked to keep a sleep log, indicating the time they fell asleep, woke up, and the number of awakenings occurring during the night. Data from both devices, including detailed sleep hypnograms in 30-second epochs (differentiating Wake, combined N1/N2, N3; and Rapid Eye Movement sleep), were extracted and aligned upon retrieval. For analysis, the number of awakenings each night was defined as four or more consecutive wake epochs between sleep onset and termination. Total sleep time (TST) and the number of awakenings were compared to subjects’ sleep logs to measure consistency with the subjective reports. In addition, the sleep scores from each device were compared epoch-by-epoch to calculate the agreement between the two devices using Cohen’s Kappa. All analysis was performed using Matlab 2021b and SPSS 27. Results/Conclusion: Subjects consistently reported longer times spent asleep than the time reported by each device (M= 448 minutes for sleep logs compared to M= 406 and M= 345 minutes for the DREEM and Z-Machine, respectively; both ps<0.05). Linear correlations between the sleep log and each device were higher for the DREEM than the Z-Machine for both TST and the number of awakenings, and, likewise, the mean absolute bias between the sleep logs and each device was higher for the Z-Machine for both TST (p<0.001) and awakenings (p<0.04). There was some indication that these effects were stronger for the second night compared to the first night. Epoch-by-epoch comparisons showed that the main discrepancies between the devices were for detecting N2 and REM sleep, while N3 had a high agreement. Overall, the DREEM headband seems superior for reliably scoring sleep at home.

Keywords: DREEM, EEG, seep monitoring, Z-machine

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Authors: Thao Nguyen, Maximiliano Hyon, Sany Rajagukguk, Anna Melkonyan

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Introduction: Type 2 Diabetes is a well-established risk factor for severe SARS-CoV-2 infection. Uncontrolled hyperglycemia in patients with established or newly diagnosed diabetes is associated with poor outcomes, including increased mortality and hospital length of stay. Objectives: Our study aims to compare three different glycemic management strategies and their association with clinical outcomes in patients hospitalized for moderate to severe SARS-CoV-2 infection. Identifying optimal glycemic management strategies will improve the quality of patient care and improve their outcomes. Method: This is a retrospective observational study on patients hospitalized at Adventist Health White Memorial with severe SARS-CoV-2 infection from 11/1/2020 to 02/28/2021. The following inclusion criteria were used: positive SARS-CoV-2 PCR test, age >18 yrs old, diabetes or random glucose >200 mg/dL on admission, oxygen requirement >4L/min, and treatment with glucocorticoids. Our exclusion criteria included: ICU admission within 24 hours, discharge within five days, death within five days, and pregnancy. The patients were divided into three glycemic management groups: Group 1, managed solely by the Primary Team, Group 2, by Pharmacy; and Group 3, by Endocrinologist. Primary outcomes were average glucose on Day 5, change in glucose between Days 3 and 5, and average insulin dose on Day 5 among groups. Secondary outcomes would be upgraded to ICU, inpatient mortality, and hospital length of stay. For statistics, we used IBM® SPSS, version 28, 2022. Results: Most studied patients were Hispanic, older than 60, and obese (BMI >30). It was the first CV-19 surge with the Delta variant in an unvaccinated population. Mortality was markedly high (> 40%) with longer LOS (> 13 days) and a high ICU transfer rate (18%). Most patients had markedly elevated inflammatory markers (CRP, Ferritin, and D-Dimer). These, in combination with glucocorticoids, resulted in severe hyperglycemia that was difficult to control. Average glucose on Day 5 was not significantly different between groups primary vs. pharmacy vs. endocrine (220.5 ± 63.4 vs. 240.9 ± 71.1 vs. 208.6 ± 61.7 ; P = 0.105). Change in glucose from days 3 to 5 was not significantly different between groups but trended towards favoring the endocrinologist group (-26.6±73.6 vs. 3.8±69.5 vs. -32.2±84.1; P= 0.052). TDD insulin was not significantly different between groups but trended towards higher TDD for the endocrinologist group (34.6 ± 26.1 vs. 35.2 ± 26.4 vs. 50.5 ± 50.9; P=0.054). The endocrinologist group used significantly more preprandial insulin compared to other groups (91.7% vs. 39.1% vs. 65.9% ; P < 0.001). The pharmacy used more basal insulin than other groups (95.1% vs. 79.5% vs. 79.2; P = 0.047). There were no differences among groups in the clinical outcomes: LOS, ICU upgrade, or mortality. Multivariate regression analysis controlled for age, sex, BMI, HbA1c level, renal function, liver function, CRP, d-dimer, and ferritin showed no difference in outcomes among groups. Conclusion: Given high-risk factors in our population, despite efforts from the glycemic management teams, it’s unsurprising no differences in clinical outcomes in mortality and length of stay.

Keywords: glycemic management, strategies, hospitalized, SARS-CoV-2, outcomes

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Authors: Mathieu Hemono, Sophie Puig-Malet, Patrick Zylberman, Avner Bar-Hen, Rainer Sauerborn, Stefanie Schütte, Niamh Herlihi, Antoine Flahault et Anneliese Depoux

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Since the IPCC released its first report in 1990, an increasing number of peer-reviewed publications have reported the health risks associated with climate change. Although there is a large body of evidence supporting the association between climate change and poor health outcomes, the media is inconsistent in the attention it pays to the subject matter. This study aims to analyze the modalities and rhetoric in the media concerning the impact of climate change on health in order to better understand its role in information dissemination. A review was conducted of articles published between 1990 and 2015 in the francophone newspapers Le Monde and Jeune Afrique. A detailed search strategy including specific climate and health terminology was used to search the newspapers’ online databases. 1202 articles were identified as having referenced the terms climate change and health. Inclusion and exclusion criteria were applied to narrow the search to articles referencing the effects of climate change on human health and 160 articles were included in the final analysis. Data was extracted and categorized to create a structured database allowing for further investigation and analysis. The review indicated that although 66% of the selected newspaper articles reference scientific evidence of the impact of climate change on human health, the focus on the topic is limited major political events or is circumstances relating to public health crises. Main findings also include that among the many direct and indirect health outcomes, infectious diseases are the main health outcome highlighted in association with climate change. Lastly, the articles suggest that while developed countries have caused most of the greenhouse effect, the global south is more immediately affected. Overall, the reviewed articles reinforce the need for international cooperation in finding a solution to mitigate the effects of climate change on health. The manner in which scientific results are communicated and disseminated, impact individual and collective perceptions of the topic in the public sphere and affect political will to shape policy. The results of this analysis will underline the modalities of the rhetoric of transparency and provide the basis for a perception study of media discourses. This study is part of an interdisciplinary project called 4CHealth that confronts results of the research done on scientific, political and press literature to better understand how the knowledge on climate changes and health circulates within those different fields and whether and how it is translated to real world change.

Keywords: climate change, health, health impacts, communication, media, rhetoric, awareness, Global South, Africa

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Authors: Adesuwa Omorede, Rufai Haruna Kilu

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Affective motivation (motivation that is emotionally laden usually related to affect, passion, emotions, moods) in the workplace stimulates individuals to reinforce, persist and commit to their task, which leads to the individual and organizational performance. This leads individuals to reach goals especially in situations where task are highly challenging and hostile. In such situations, individuals are more disposed to be more creative, innovative and see new opportunities from the loopholes in their workplace. However, when individuals feel displaced and less important, an adverse reaction may suffice which may be detrimental to the organization and its performance. One sector where affective motivation is eminently present and relevant, is the mining industry. Due to its intense work environment; mostly dominated by men and masculinity cultures; and deliberate exclusion of women in this environment which, makes the women working in these environments to feel marginalized. In Ghana, the mining industry is mostly seen as a very physical environment especially underground and mostly considerd as 'no place for a woman'. Despite the fact that these women feel less 'needed' or 'appreciated' in such environments, they still have to juggle between intense work shifts; face violence and other health risks with their families, which put a strain on their affective motivational reaction. Beyond these challenges, however, several mining companies in Ghana today are working towards providing a fair and equal working situation for both men and women miners, by recognizing them as key stakeholders, as well as including them in the stages of mining projects from the planning and designing phase to the evaluation and implementation stage. Drawing from the psychology and gender literature, this study takes a narrative approach to identify and understand the shifting gender dynamics within the mine works in Ghana, occasioning a change in background disposition of miners, which leads to more women taking up mine jobs in the country. In doing so, a qualitative study was conducted using semi-structured interviews from Ghana. Several women working within the mining industries in Ghana shared their experiences and how they felt and still feel in their workplace. In addition, archival documents were gathered to support the findings. The results suggest a change in enrolment regimes in a mining and technology university in Ghana, making room for a more gender equal enrolments in the university. A renowned university that train and feed mine work professional into the industry. The results further acknowledge gender equal and diversity recruitment policies and initiatives among the mining companies of Ghana. This study contributes to the psychology and gender literature by highlighting the hindrances women face in the mining industry as well as highlighting several of their affective reactions towards gender inequality. The study also provides several suggestions for decision makers in the mining industry of what can be done in the future to reduce the gender inequality gap within the industry.

Keywords: affective motivation, gender shape shifting, mining industry, women miners

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Authors: Pampita Chakraborty, Sukumar Mukherjee

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This study was done to determine the bacteriological profile and antibiotic resistance of the isolates and to find out the potential risk factors for infection with multidrug-resistant organisms. Diabetic foot ulcer is a major medical, social, economic problem and a leading cause of morbidity and mortality, especially in the developing countries like India. 25 percent of all diabetic patients develop a foot ulcer at some point in their lives which is highly susceptible to infections and that spreads rapidly, leading to overwhelming tissue destruction and subsequent amputation. Infection with multidrug resistant organisms (MDRO) may increase the cost of management and may cause additional morbidity and mortality. Proper management of these infections requires appropriate antibiotic selection based on culture and antimicrobial susceptibility testing. Early diagnosis of microbial infections is aimed to institute the appropriate antibacterial therapy initiative to avoid further complications. A total of 200 Type 2 Diabetic Mellitus patients with infection were admitted at GD Hospital and Diabetes Institute, Kolkata. 60 of them who developed ulcer during the year 2013 were included in this study. A detailed clinical history and physical examination were carried out for every subject. Specimens for microbiological studies were obtained from ulcer region. Gram-negative bacilli were tested for extended spectrum Beta-lactamase (ESBL) production by double disc diffusion method. Staphylococcal isolates were tested for susceptibility to oxacillin by screen agar method and disc diffusion. Potential risk factors for MDRO-positive samples were explored. Gram-negative aerobes were most frequently isolated, followed by gram-positive aerobes. Males were predominant in the study and majority of the patients were in the age group of 41-60 years. The presence of neuropathy was observed in 80% cases followed by peripheral vascular disease (73%). Proteus spp. (22) was the most common pathogen isolated, followed by E.coli (17). Staphylococcus aureus was predominant amongst the gram-positive isolates. S.aureus showed a high rate of resistance to antibiotic tested (63.6%). Other gram-positive isolates were found to be highly resistant to erythromycin, tetracycline and ciprofloxacin, 40% each. All isolates were found to be sensitive to Vancomycin and Linezolid. ESBL production was noted in Proteus spp and E.coli. Approximately 70 % of the patients were positive for MDRO. MDRO-infected patients had poor glycemic control (HbA1c 11± 2). Infection with MDROs is common in diabetic foot ulcers and is associated with risk factors like inadequate glycemic control, the presence of neuropathy, osteomyelitis, ulcer size and increased the requirement for surgical treatment. There is a need for continuous surveillance of resistant bacteria to provide the basis for empirical therapy and reduce the risk of complications.

Keywords: diabetic foot ulcer, bacterial infection, multidrug-resistant organism, extended spectrum beta-lactamase

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