Search results for: primary immuno deficiency

Authors: Md. Kamrul Hassan, Ari Pappinen

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Wood energy is the single most important form of renewable energy in many parts of the world especially in the least developing countries in South Asia like Bangladesh. The last portion of the national population of this country depends on wood energy for their daily primary energy need. This paper deals with the estimation of wood fuel at the current level and identifies the challenges and strategies related to the development of this resource. Desk research, interactive research and field survey were conducted for gathering and analyzing of data for this study. The study revealed that wood fuel plays a significant role in total primary energy supply in Bangladesh, and the contribution of wood fuel in final energy consumption in 2013 was about 24%. Trees on homestead areas, secondary plantation on off forest lands, and forests are the main sources of supplying wood fuel in the country. Insufficient supply of wood fuel against high upward demand is the main cause of concern for sustainable consumption, which eventually leads deterioration and depletion of the resources. Inadequate afforestation programme, lack of initiatives towards the utilization of set-aside lands for wood energy plantations, and inefficient management of the existing resources have been identified as the major impediments to the development of wood energy in Bangladesh. The study argued that enhancement of public-private-partnership afforestation programmes, intensifying the waste and marginal lands with short-rotation tree species, and formulation of biomass-based rural energy strategies at the regional level are relevant to the promotion of sustainable wood energy in the country.

Keywords: Bangladesh, challenge, supply, wood energy

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Authors: Bahadir Batar, Elif Serdal, Berna Erdal, Hasan Ogul

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Micro-ribonucleic acids (miRNAs) are small short non-coding ribonucleic acid molecules about 22 nucleotides long. miRNAs play a key role in response to chemotherapeutic agents. WW domain-containing oxidoreductase (WWOX) gene encodes a tumor suppressor protein. Loss or reduction of Wwox protein is observed in many breast cancer cases. WWOX protein deficiency is increased in triple-negative breast cancer (TNBC). TNBC is a heterogeneous, highly aggressive, and difficult to treat tumor type. WWOX loss contributes to resistance to cisplatin therapy in patients with TNBC. Here, the aim of the study was to investigate the potential role of miRNAs in cisplatin therapy resistance of WWOX-deficient TNBC cells. This was a cell culture study. miRNA expression profiling was analyzed by LightCycler 480 system. miRNA Set Enrichment Analysis tool was used to integrate experimental data with literature-based biological knowledge to infer a new hypothesis. Increased miR-182 and decreased miR-214 were significantly correlated with cisplatin resistance in WWOX-deficient TNBC cells. miR-182 and miR-214 may involve in cisplatin resistance of WWOX-deficient TNBC cells by deregulating the DNA repair, apoptosis, or protein kinase B signaling pathways. These data highlight the mechanism by which WWOX regulates cisplatin resistance of TNBC and the potential use of WWOX as a predictor biomarker for cisplatin resistance.

Keywords: cisplatin, microRNA, triple-negative breast cancer, WWOX

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Authors: Chinonso Jude Ugwu

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This study examines education as a global business, primarily focusing on the boom of college students worldwide. It adopts a mixed-technique approach, using primary and secondary data sources. Primary data was obtained using questionnaires and interviews focusing on international college students, academic staff, and recruitment corporations from pre-determined universities in the United States, the United Kingdom, and Australia. The secondary information was collected from relevant literature, professional reports, and databases. The study ascertained that the boom in worldwide college students is a huge trend within the training enterprise, arising primarily from the growing call for better education worldwide. The studies additionally found that different factors are responsible for the decision of international students to consider studying abroad, such as high schooling satisfaction, cultural exposure, professional opportunities, and the popularity of universities. Furthermore, the study highlights the challenges college students face worldwide, including economic difficulties, social and cultural adjustments, and visa regulations. Based on the findings, the study concludes that Education as a Global Business is a profitable enterprise with substantial potential. However, universities and governments should handle global college students’ demanding situations by creating welcoming surroundings promoting diversity and inclusivity. The study recommends that universities put money into programs and offerings that assist worldwide college students’ welfare. Governments should ease visa regulations to inspire more extraordinary worldwide college students to observe abroad.

Keywords: education, business, profitability, global students

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Authors: Seyed Sadegh Naseralavi, Sadegh Balaghi, Ehsan Khojastehfar

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Time history seismic analysis is supposed to be the most accurate method to predict the seismic demand of structures. On the other hand, the required computational time of this method toward achieving the result is its main deficiency. While being applied in optimization process, in which the structure must be analyzed thousands of time, reducing the required computational time of seismic analysis of structures makes the optimization algorithms more practical. Apparently, the invented approximate methods produce some amount of errors in comparison with exact time history analysis but the recently proposed method namely, Complete Quadratic Combination (CQC) and Sum Root of the Sum of Squares (SRSS) drastically reduces the computational time by combination of peak responses in each mode. In the present research, the Basic Modal Displacement (BMD) method is introduced and applied towards estimation of seismic demand of main structure. Seismic demand of sampled structure is estimated by calculation of modal displacement of basic structure (in which the modal displacement has been calculated). Shear steel sampled structures are selected as case studies. The error applying the introduced method is calculated by comparison of the estimated seismic demands with exact time history dynamic analysis. The efficiency of the proposed method is demonstrated by application of three types of earthquakes (in view of time of peak ground acceleration).

Keywords: time history dynamic analysis, basic modal displacement, earthquake-induced demands, shear steel structures

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Authors: Maitri Dave

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Coronaviruses (CoV) is such infectious virus which has impacted globally in a more dangerous manner causing severe lung problems and leaving behind more serious diseases among the people. This pandemic has affected globally and created severe respiratory problems, and damaged the lungs. India has reported the first case of COVID-19 in January 2020. The first wave of COVID-19 took place from April to September of 2020. Soon after, a second peak is also noticed in the month of March 2021, which in turn becomes more dangerous due to a lack of supply of medical equipment. It created resource deficiency globally, specifically in India, where some necessary life-saving equipment like ventilators and oxygenators were not sufficient to cater to the demand-supply ratio effectively. Through carefully examining such a situation, India began to execute the process of vaccination in the month of January 2021 and successfully administered 25,46,71,259 doses of vaccines till now, which is only 15.5% of the total population while only 3.6% of the total population is fully vaccinated. India has authorized the British Oxford–AstraZeneca vaccine (Covishield), the Indian BBV152 (Covaxin) vaccine, and the Russian Sputnik V vaccine for emergency use. In the present study, we have collected all the data state wisely of both first and second wave and analyzed them using MS Excel Version 2019 and SPSS Statistics Version 26. Following the trends, we have predicted the characteristics of the upcoming third wave of COVID-19 and recommended some strategies, early actions, and measures that can be taken by the public health system in India to combat the third wave more effectively.

Keywords: COVID-19, vaccination, Covishiled, Coronavirus

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Authors: Manish Subedi, Bijay Bartaula, Ashok R. Pant, Purbesh Adhikari, Sanjib K. Sharma

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Background: The pattern of glomerular disease varies worldwide. In absence of kidney disease/Kidney biopsy registry in Nepal, the exact etiology of different forms of glomerular disease is primarily unknown in our country. Method: We retrospectively analyzed 175 cases of renal biopsies performed from dated September 2014 to August 2016 at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Results: The commonest indication for renal biopsy was nephrotic syndrome (34.9%), followed by Systemic lupus erythematosus with suspected renal involvement (22.3%). Majority of patients were in the 30-60 year bracket (57.2%), with the mean age of the patients being 35.37 years. The average number of glomeruli per core was 13, with inadequate sampling in 5.1%. IgA nephropathy (17%) was found to be the most common primary glomerular disease, followed by membranous nephropathy (14.6%) and FSGS (14.6%). The commonest secondary glomerular disease was lupus nephritis. Complications associated with renal biopsy were pain at biopsy site in 18% of cases, hematuria in 6% and perinephric hematoma in 4% cases. Conclusion: The commonest primary and secondary glomerular disease was IgA nephropathy and lupus nephritis respectively. The high prevalence of Systemic lupus erythematosus with lupus nephritis among Nepalese in comparison with other developing countries warrants further evaluation. As an initial attempt towards documentation of glomerular diseases in the national context, this study should serve as a stepping stone towards the eventual establishment of a full-fledged national registry of glomerular diseases in Nepal.

Keywords: glomerular, Nepal, renal biopsy, systemic lupus erythematoses

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Authors: Rasha Shoumar

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Background: Since the onset of the Syria crisis in 2011, Jordan has hosted many Syrian refugees, many of which are residing in urban and rural areas. Vulnerability of refugees has increased due to the COVID-19 pandemic, adding to their already existing challenge in access to medical services, rendering them vulnerable to the complications of untreated medical conditions and amplifying their risk for severe COVID-19 disease. To improve health outcomes and access to health care services in a COVID-19 context, IOM (The International Organization for Migration) provided health services including awareness raising, direct primary health care through mobile teams and referrals to secondary services were extended to the vulnerable populations of refugees. Method: 6 community health volunteers were trained and deployed to different governorates to provide COVID-19 and non-communicable disease awareness and collect data rated to non-communicable disease and access to medical health services. Primary health care services were extended to 7 governorates through a mobile medical team, providing medical management. The collected Data was reviewed and analyzed. Results: 2150 refugees in rural areas were reached out by community health volunteers, out of which 78 received their medications through the Ministry of Health, 121 received their medications through different non-governmental organizations, 665 patients couldn’t afford buying any medications, 1286 patients were occasionally buying their medications when they were able to afford it. 853 patients received medications and follow up through IOM mobile clinics, the most common conditions were hypertension, diabetes, hyperlipidemia, anemia, heart disease, thyroid disease, asthma, seizures, and psychiatric conditions. 709 of these patients had more than 3 of the comorbidities. Multiple cases were referred for secondary and tertiary lifesaving interventions. Conclusion: Non communicable diseases are highly prevalent among refugee population in Jordan, access to medical services have proven to be a challenge in rural areas especially during the COVID-19 era, many of the patients have multiple uncontrolled medical conditions placing them at risk for complications and risk for severe COVID-19 disease. Deployment of mobile clinics to rural areas plays an essential role in managing such medical conditions, thus improving the continuum of health care approach, physical and mental wellbeing of refugees and reducing the risk for severe COVID-19 disease among this group, taking us one step forward toward universal health access.

Keywords: COVID-19, refugees, mobile clinics, primary health care

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Authors: Muganyizi Jonas Bisheko, G. Rejikumar

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Reducing post-harvest losses could be a sustainable solution to enhance the food and income security of smallholder farmers in developing countries. While various research institutions have come up with a number of innovative post-harvest technologies for reducing post-harvest losses, most of them have not been extensively adopted by smallholder farmers. Despite this gap, the synthesized information about the major constraints of post-harvest technology is scarce. This study has been conducted to fill this gap and show the implications of the findings for future post-harvest research. The developed search strategy retrieved 2201 studies. However, after excluding duplicates, title, abstract and full article screening, a total of 41 documents were identified. The major findings are: (i) there is an outstanding deficiency of systematic evidence of the effect of climate change, off-farm income and sources of post-harvest information on the adoption of improved post-harvest technologies; (ii) there is very limited information on adoption constraints pertaining to matters of policy, rules and regulations; (iii) there is very thin literature on behavioral constraints associated with limited adoption of improved post-harvest technologies; (iv) most of the studies focused on post-harvest storage technologies (47%) followed by overall post-harvest management practices (25%), processing technologies (19%) and packaging technologies (3%). Much of the information was found on Cereals (58%), especially maize (44%); (v) geographically, Sub-Saharan Africa accounted for 79% of the reviewed interventions, while South Asia occupied only 21%. The findings of this review are intended to guide various post-harvest technologists and decision-makers in addressing the challenge of huge post-harvest losses.

Keywords: constraints, post-harvest loss, post-harvest technology , smallholder farmer

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Authors: A. S. Akinbani

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Overdependence on petroleum is causing set back in Nigeria economy. Field survey was carried out to assess the profitability and production of selected arable crops in six selected towns and villages of Ondo southwestern. Data were collected from 240 arable crop farmers with the aid of both primary and secondary data. Data were collected with the use of oral interview and structured questionnaires. Data collected were analyzed using both descriptive and inferential statistics. Forty farmers were randomly selected to give a total number of 240 respondents. 84 farmers interviewed had no formal education, 72 had primary education, 50 farmers attained secondary education while 38 attained beyond secondary education. The majority of the farmers hold less than 10 acres of land. The data collected from the field showed that 192 farmers practiced mixed cropping which includes mixtures of yam, cowpea, cocoyam, vegetable, cassava and maize while only 48 farmers practiced monocropping. Among the sampled farmers, 93% agreed that arable production is profitable while 7% disagreed. The findings show that managerial practices that conserve the soil fertility and reduce labor cost such as planting of leguminous crops and herbicide application instead of using hand held hoe for weeding should be encouraged. All the respondents agreed that yam, cowpea, cocoyam, sweet potato, rice, maize and vegetable production will solve the problem of hunger and increase standard of living compared with petroleum product that Nigeria relied on as means of livelihood.

Keywords: farmers, arable crop, cocoyam, respondents, maize

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Authors: Stefana Francisca Lupu, Jasmin Chantah, Mara Krone, Ingo Roden, Stephan Bongard, Gunter Kreutz

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Long-term music interventions could enhance both musical and nonmusical skills. The present study was designed to explore cognitive, socio-emotional, and musical development in a longitudinal setting. Third-graders (N = 184: 87 male, 97 female; mean age = 8.61 years; 115 native German and 69 migrant children) were randomly assigned to two intervention groups (music and maths) and a control group over a period of one school-year. At baseline, children in these groups were similar in basic cognitive skills, with a trend of advantage in the control group. Dependent measures included the culture fair intelligence test CFT 20-R; the questionnaire of emotional and social school experience for grade 3 and 4 (FEESS 3-4), the test of resources in childhood and adolescence (FRKJ 8-16), the test of language proficiency for German native and non-native primary school children (SFD 3), the reading comprehension test (ELFE 1-6), the German math test (DEMAT 3+) and the intermediate measures of music audiation (IMMA). Data were collected two times at the beginning (T1) and at the end of the school year (T2). A third measurement (T3) followed after a six months retention period. Data from baseline and post-intervention measurements are currently being analyzed. Preliminary results of all three measurements will be presented at the conference.

Keywords: musical training, primary-school German and migrant children, socio-emotional skills, transfer

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Authors: Samira Khalaji, , Fenneke Klein Jan, Kay-E. Gottschalk, Eugenia Makrantonaki, Karin Scharffetter-Kochanek

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Biological aging is a multi-dimensional process that takes place over a whole range of scales from the nanoscopic alterations within individual cells, over transformations in tissues and organs and to changes of the whole organism. On the single cell level, aging involves mutation of genes, differences in gene expression levels as well as altered posttranslational modifications of proteins. A variety of proteins is affected, including proteins of the cell cytoskeleton and migration machinery. Previous work quantified the expression of cytoskeleton proteins on the gene and protein levels in senescent and young fibroblasts. Their results show that senescent skin fibroblasts have an upregulated expression of the intermediate filament (IF) protein vimentin in contrast to actin and tubulin, which are downregulated. IFs play an important role in providing mechanical stability of cells. However, the mechanical properties of IFs depending on cellular senescence or age of the donor has not been studied so far. Hence, we employed passive microrheology on primary human dermal fibroblasts from female donors with age of 28 years (young) and 86 years (old) as model of in vivo aging and human normal dermal fibroblast from 11-year old male with CPD 17-35 (young) and CPD 58-59 (senescence) as a model of in vitro replicative senescence. In contrast to the expectations, our primary results show no significant differences in the viscoelastic properties of fibroblasts depending on age of the donor or cellular replicative senescence.

Keywords: aging, cytoskeleton, fibroblast, mechanical properties

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Authors: Naila Awan, Shahrukh Inam

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This study was conducted to highlight the role of basic health units in district Swabi, which provides primary health services to the people of district Swabi having four tehsils. Tehsil Swabi was selected purposively for the study. Three villages were purposively selected from district Swabi. A sum of 110 respondents was randomly selected for interview i.e., 27 from Botakaa, 39 from Gulatee, and 44 from Darra Cham, using proportion allocation sampling technique. A pretested and well-designed interview schedule was used to collect as per the objective and Chi square test was applied to find an association between the quality of medicines and health improvement. The output of the test shows that the government was doing its best and providing enough facilities to the individuals at the healthcare units, and they were utilizing them. These resources were easily accessible to the people of the community. Medicines provided by the government were of good quality and quantity. There were also school health sessions and community health sessions (SHS/CHS) to deliver useful information and awareness regarding health problems and diseases were conducted. The staff of the BHU was present at work time and was performing their duties. The respondents seemed satisfied with their behavior and the duty of the staff. However, there were no emergency resources existing at the BHU after the working hours of the medical staff. It is recommended that government should provide appropriate quantity and quality of medicines to the basic health units so that these healthcare units don’t have to face any shortages regarding medicines at the end of the month. In addition, laboratory and blood testing facilities need to be provided in the basic health units, and also the infrastructure should be made suitable, satisfactory, and more functional.

Keywords: community health session, basic health units, outpatient department, tuberculosis

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Authors: Nick Weir, Robert Stevens, Alan Hargreaves, Martin McGinnity, Chris Tinsley

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Hydrophobic materials have previously demonstrated the ability to elevate cell-cell interactions and promote the formation of neural networks whilst aligned nanofibers demonstrate the ability to induce extensive neurite outgrowth in an aligned manner. Hydrophobic materials typically elicit an immune response upon implantation and thus materials used for implantation are typically hydrophilic. Poly-L-lactic acid (PLLA) is a hydrophobic, non-immunogenic, FDA approved material that can be electrospun to form aligned nanofibers. Primary rat cortical neurons cultured for 10 days on aligned PLLA nanofibers formed 3D cell clusters, approximately 800 microns in diameter. Neurites that extended from these clusters were highly aligned due to the alignment of the nanofibers they were cultured upon and fasciculation was also evident. Plasma treatment of the PLLA nanofibers prior to seeding of cells significantly reduced the hydrophobicity and abolished the cluster formation and neurite fasciculation, whilst reducing the extent and directionality of neurite outgrowth; it is proposed that hydrophobicity induces the changes to cellular behaviors. Aligned PLLA nanofibers induced the formation of a structure that mimics the grey-white matter compartmentalization that is observed in vivo and thus represents a step forward in generating organoids or biomaterial-based implants. Upon implantation into the brain, the biomaterial architectures described here may provide a useful platform for both brain repair and brain remodeling initiatives.

Keywords: hydrophobicity, nanofibers, neurite fasciculation, neurite outgrowth, PLLA

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Authors: K. S. Kan

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The main purpose of this paper is to deepen the current understanding of how a Teaching English as a Second Language (TESL) teacher trainee self is constructed. The present aim of Malaysian TESL teacher education is to train teacher trainees with established English Language Teaching methodologies of the four main language skills (listening, reading, writing and speaking) apart from building them up holistically. Therefore, it is crucial to learn more of the ways on how these teacher trainees construct their professional selves during their undergraduate years. The participants come from a class of 17 Semester 6 TESL students who had undergone a 3-month’s practicum practice during their fifth semester and going for their final 3 month’s practicum period from July 2018 onwards. Findings from a survey, interviews with the participants and lecturers, documentations such as the participants’ practicum record-books would be consolidated with the supervisory notes and comments. The findings suggest that these teacher trainees negotiate their identities and emotions that react with the socio-cultural factors. Periodical reflections on the teacher trainees’ practicum practices influence transformation.The findings will be further aligned to the courses that these teacher trainees have to take in order to equip them as future second language practitioners. It is hoped that the findings will be able to fill the gap from the teacher trainees’ perspectives on identity construction dealing. This study is much more significant now, in view of the new English Language Curriculum for Primary School (widely known as KSSR, its Malay acronym) which had been introduced and implemented in Malaysian primary schools recently. This research will benefit second language practitioners who is in the language education field, as well as, TESL undergraduates, on the knowledge of how teacher trainees respond to and negotiate their professional teaching identities as future second language educators.

Keywords: construction of selves, professional identities, second language, TEST teacher trainees

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Authors: Chia Han Lee

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Without energy, the economy would grind to a halt. Germany's prosperity and security depend on a reliable and affordable energy supply. In recent years, Germany's energy policy has undergone major changes. Due to the sharp turn in energy, Germany cannot extend the service of nuclear power plants and can only find a rapid transition energy source: natural gas for a limited time. This study attempts to use processes of decision entrapment behavior and document analysis to explain research questions. Through primary and secondary information such as official reports, parliamentary minutes, media interview records, and speech records, the author sorted out the important events experienced by the three coalition governments (Gerhard Schröder, Angela Merkel, and Olaf Scholz) and the relationship between Nord Stream 1 and Nord Stream 2 with primary and secondary sources. Also, compare it with the processes of decision entrapment behavior, which designed in this study, and divide it into four stages to explore its key elements one by one. In this regard, the following conclusions are drawn: First, from the perspective of processes of decision entrapment behavior, Merkel’s government firmly believes that she can overcome difficulties because of her past experience in crisis management capabilities. However, the outbreak of war between Ukraine and Russia was beyond Merkel's planning. Second, in the face of the crisis, the Scholz’s government increased the import of natural gas from other countries and began to import liquefied natural gas to make up for the energy gap of Russian natural gas.

Keywords: german research, nord stream gas pipeline, energy policy, processes of decision entrapment behavior

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Authors: K. Krizova

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This objective of this article is to present concrete that differs by the size of the aggregate used. The set of concrete contained six concrete recipes manufactured as traditional vibrated concrete containing identical basic components of concrete. The experiment focused on monitoring the resulting properties of hardened concrete, specifically the primary strength and modulus of the concrete elasticity and the developing parameters from 7 to 180 days were assessed.

Keywords: aggregate, cement, concrete, elasticity modulus

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Authors: Haaris Khan, Farhad Udwadia

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South Asians are the fastest-growing immigrant population in Canada and are 3-4 times more likely to develop diabetes. In a primary care setting, language barriers continue to persist as a prominent obstacle when delivering crucial health information. Given the abundance of languages in the South Asian community and the varying levels of English fluency, there is compelling evidence that these language barriers can adversely impact health outcomes. The microvascular and macrovascular complications of poor diabetic management are well established and universally recognized. However, these are often difficult concepts to grasp for even individuals fluent in English. In order to lessen the burden of language barriers, we developed a comprehensive guide in various languages that discuss the complications and screening guidelines for diabetic and prediabetic patients. The guide is presented in the form of a pamphlet, with an electronic version being constructed as well, that provides basic information on diabetic retinopathy, neuropathy and nephropathy as well as the screening recommendations. We also conducted a review of the literature around the topic and incorporated our findings into our project. Our goal is for primary care physicians to have this resource and to be able to provide the link or pamphlet to patients in need. Our presentation also provides a comprehensive overview of some of the other barriers that individuals in the South Asian community face when seeking care. Given the staggering number of individuals in the South Asian community with diabetes and the morbidity and mortality associated with diabetes and its complications, effective community-specific strategies are needed to mitigate the potential consequences of poor diabetes management.

Keywords: diabetes, patient education, ophthalmology, vascular surgery

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Authors: Jason Ceavers, Travis Thompson, Juan Torres, Ramanakumar Anam, Alan Wong, Andrei Carvalho, Shane Quo, Shawn Alonso, Moises Cintron, Ricardo C. Carrero, German Lopez, Vamsi Garimella, German Giese

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Introduction: Advance directives (AD) are essential for patients to communicate their wishes when they are not able to. Ideally, these discussions should not occur for the first time when a patient is hospitalized with an acute life-threatening illness. There is a large number of patients who do not have clearly documented ADs, resulting in the misutilization of resources and additional patient harm. This is a nationwide issue, and the Joint Commission has it as one of its national quality metrics. Presented here is a proposed protocol to increase the number of documented AD discussions in a community-based, internal medicine residency primary care clinic in South Florida. Methods: The SMART Aim for this quality improvement project is to increase documentation of AD discussions in the outpatient setting by 25% within three months in medicare patients. A survey was sent to stakeholders (clinic attendings, residents, medical assistants, front desk staff, and clinic managers), asking them for three factors they believed contributed most to the low documentation rate of AD discussions. The two most important factors were time constraints and systems issues (such as lack of a standard method to document ADs and ADs not being uploaded to the chart) which were brought up by 25% and 21.2% of the 32 survey responders, respectively. Pre-intervention data from clinic patients in 2020-2021 revealed 17.05% of patients had clear, actionable ADs documented. To address these issues, an AD pocket card was created to give to patients. One side of the card has a brief explanation of what ADs are. The other side has a column of interventions (cardiopulmonary resuscitation, mechanical ventilation, dialysis, tracheostomy, feeding tube) with boxes patients check off if they want the intervention done, do not want the intervention, do not want to discuss the topic, or need more information. These cards are to be filled out and scanned into their electronic chart to be reviewed by the resident before their appointment. The interventions that patients want more information on will be discussed by the provider. If any changes are made, the card will be re-scanned into their chart. After three months, we will chart review the patients seen in the clinic to determine how many medicare patients have a pocket card uploaded and how many have advance directives discussions documented in a progress note or annual wellness note. If there is not enough time for an AD discussion, a follow-up appointment can be scheduled for that discussion. Discussion: ADs are a crucial part of patient care, and failure to understand a patient’s wishes leads to improper utilization of resources, avoidable litigation, and patient harm. Time constraints and systems issues were identified as two major factors contributing to the lack of advance directive discussion in our community-based resident primary care clinic. Our project aims at increasing the documentation rate for ADs through a simple pocket card intervention. These are self-explanatory, easy to read and allow the patients to clearly express what interventions they desire or what they want to discuss further with their physician.

Keywords: advance directives, community-based, pocket card, primary care clinic

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Authors: Kamila Duś-Szachniewicz, Kinga M. Walaszek, Paweł Skiba, Paweł Kołodziej, Piotr Ziółkowski

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Cell adhesion is of fundamental importance in the cell communication, signaling, and motility, and its dysfunction occurs prevalently during cancer progression. The knowledge of the molecular and cellular processes involved in abnormalities in cancer cells adhesion has greatly increased, and it has been focused mainly on cellular adhesion molecules (CAMs) and tumor microenvironment. Unfortunately, most of the data regarding CAMs expression relates to study on cells maintained in standard oxygen condition of 21%, while the emerging evidence suggests that culturing cells in ambient air is far from physiological. In fact, oxygen in human tissues ranges from 1 to 11%. The aim of this study was to compare the effects of physiological lymph node normoxia (5% O2), and hyperoxia (21% O2) on the expression of cellular adhesion molecules of primary diffuse large B-cell lymphoma cells (DLBCL) isolated from 10 lymphoma patients. Quantitative RT-PCR and immunohistochemistry were used to confirm the differential expression of several CAMs, including ICAM, CD83, CD81, CD44, depending on the level of oxygen. Our findings also suggest that DLBCL cells maintained at ambient O2 (21%) exhibit reduced growth rate and migration ability compared to the cells growing in normoxia conditions. Taking into account all the observations, we emphasize the need to identify the optimal human cell culture conditions mimicking the physiological aspects of tumor growth and differentiation.

Keywords: adhesion molecules, diffuse large B-cell lymphoma, physiological normoxia, quantitative RT-PCR

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Authors: Francesca Risplendi, Li-Chiang Lin, Jeffrey C. Grossman, Giancarlo Cicero

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Desalination is one of the most employed approaches to supply water in the context of a rapidly growing global water shortage. However, the most popular water filtration method available is the reverse osmosis (RO) technique, still suffers from important drawbacks, such as a large energy demands and high process costs. In addition some serious limitations have been recently discovered, among them, the boron problem seems to have a critical meaning. Boron has been found to have a dual effect on the living systems on Earth and the difference between boron deficiency and boron toxicity levels is quite small. The aim of this project is to develop a new generation of RO membranes based on porous graphene or reduced graphene oxide (rGO) able to remove salts from seawater and to reduce boron concentrations in the permeate to the level that meets the drinking or process water requirements, by means of a theoretical approach based on density functional theory and classical molecular dynamics. Computer simulations have been employed to investigate the relationship between the atomic structure of nanoporous graphene or rGO monolayer and its membrane properties in RO applications (i.e. water permeability and resilience at RO pressures). In addition, an emphasis has been given to multilayer nanoporous rGO and rGO flakes based membranes. By means of non-equilibrium MD simulations, we investigated the water transport mechanism permeating through such multilayer membrane focusing on the effect of slit widths and sheet geometries. These simulations allowed us to establish the implications of these graphene based materials as promising membrane properties for desalination plants and as boron filtration.

Keywords: boron filtration, desalination, graphene membrane, reduced graphene oxide membrane

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Authors: Xuejiao Shao, Jianguo Chen, Xiaolong Fu

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In this paper, the elastoplastic strain correction factor computed by software of ANSYS was modified, and the fatigue usage factor in air was also corrected considering in water under reactor operating condition. The fatigue of key parts on control rod drive mechanisms was analyzed considering the influence of environmental fatigue caused by the coolant in the react pressure vessel. The elastoplastic strain correction factor was modified by analyzing thermal and mechanical loads separately referring the rules of RCC-M 2002. The new elastoplastic strain correction factor Ke(mix) is computed to replace the original Ke computed by the software of ANSYS when evaluating the fatigue produced by thermal and mechanical loads together. Based on the Ke(mix) and the usage cycle and fatigue design curves, the new range of primary plus secondary stresses was evaluated to obtain the final fatigue usage factor. The results show that the precision of fatigue usage factor can be elevated by using modified Ke when the amplify of the primary and secondary stress is large to some extent. One approach has been proposed for incorporating the environmental effects considering the effects of reactor coolant environments on fatigue life in terms of an environmental correction factor Fen, which is the ratio of fatigue life in air at room. To incorporate environmental effects into the RCCM Code fatigue evaluations, the fatigue usage factor based on the current Code design curves is multiplied by the correction factor. The contribution of environmental effects to results is discussed. Fatigue life decreases logarithmically with decreasing strain rate below 10%/s, which is insensitive to strain rate when temperatures below 100°C.

Keywords: environmental fatigue, usage factor, elastoplastic strain correction factor, environmental correction

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Authors: Ossama Salman

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Background and objective: Sacroiliac joint pain is a common cause for chronic axial low back pain, with up to 20% prevalence rate. To date, no effective long-term treatment intervention has been embarked on yet. The aim of our study was to compare steroid block to radiofrequency ablation for SIJ pain conditions. Methods: A randomized, blind, study was conducted in 30 patients with sacroiliac joint pain. Fifteen patients received radiofrequency denervation of L4-5 primary dorsal rami and S1-3 lateral sacral branch, and 15 patients received steroid under fluoroscopy. Those in the steroid group who did not respond to steroid injections were offered to cross over to get radiofrequency ablation. Results: At 1-, 3- and 6-months post-intervention, 73%, 60% and 53% of patients, respectively, gained ≥ 50 % pain relief in the radiofrequency (RF) ablation group. In the steroid group, at one month post intervention follow up, only 20% gained ≥ 50 % pain relief, but failed to show any improvement at 3 months and 6 months follow up. Conclusions: Radiofrequency ablation at L4 and L5 primary dorsal rami and S1-3 lateral sacral branch may provide effective and longer pain relief compared to the classic intra-articular steroid injection, in properly selected patients with suspected sacroiliac joint pain. Larger studies are called for to confirm our results and lay out the optimal patient selection and treatment parameters for this poorly comprehended disorder.

Keywords: lateral branch denervation, LBD, radio frequency, RF, sacroiliac joint, SIJ, visual analogue scale, VAS

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Authors: Kréhi Serge Agbli, Samuel Portebos, Michaël Salomon

Abstract:

Here a methodology is considered aiming at evaluating the economic benefit of the provision of a primary frequency control unit using a Battery Energy Storage System (BESS). In this methodology, two control types (basic and hysteresis) are implemented and the corresponding minimum energy storage system power allowing to maintain the frequency drop inside a given threshold under a given contingency is identified and compared using DigSilent’s PowerFactory software. Following this step, the corresponding energy storage capacity (in MWh) is calculated. As PowerFactory is dedicated to dynamic simulation for transient analysis, a first order model related to the IEEE 9 bus grid used for the analysis under PowerFactory is characterized and implemented on MATLAB-Simulink. Primary frequency control is simulated using the two control types over one-month grid's frequency deviation data on this Simulink model. This simulation results in the energy throughput both basic and hysteresis BESSs. It emerges that the 15 minutes operation band of the battery capacity allocated to frequency control is sufficient under the considered disturbances. A sensitivity analysis on the width of the control deadband is then performed for the two control types. The deadband width variation leads to an identical sizing with the hysteresis control showing a better frequency control at the cost of a higher delivered throughput compared to the basic control. An economic analysis comparing the cost of the sized BESS to the potential revenues is then performed.

Keywords: battery energy storage system, electrical network frequency stability, frequency control unit, PowerFactor

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Authors: Aminu Bashir Mohammad, Agwu Ezera, Abdulrazaq G. Habib, Garba Iliyasu

Abstract:

Background: Drug resistance tuberculosis (DR-TB) continues to be a challenge in developing countries with poor resources. Routine screening for primary DR-TB before commencing treatment is not done in public hospitals in Nigeria, even with the large body of evidence that shows a high prevalence of primary DR-TB. Data on drug resistance and its genetic determinant among follow up TB patients is lacking in Nigeria. Hence the aim of this study was to determine the prevalence and genetic determinant of drug resistance among follow up TB patients in a tertiary hospital in Nigeria. Methods: This was a cross-sectional laboratory-based study conducted on 384 sputum samples collected from consented follow-up tuberculosis patients. Standard microbiology methods (Zeil-Nielsen staining and microscopy) and PCR (Line Probe Assay)] were used to analyze the samples collected. Person’s Chi-square was used to analyze the data generated. Results: Out of three hundred and eighty-four (384) sputum samples analyzed for mycobacterium tuberculosis (MTB) and DR-TB twenty-five 25 (6.5%) were found to be AFB positive. These samples were subjected to PCR (Line Probe Assay) out of which 18(72%) tested positive for DR-TB. Mutations conferring resistance to rifampicin (rpo B) and isoniazid (katG, and or inhA) were detected in 12/18(66.7%) and 6/18(33.3%), respectively. Transmission dynamic of DR-TB was not significantly (p>0.05) dependent on demographic characteristics. Conclusion: There is a need to strengthened the laboratory capacity for diagnosis of TB and drug resistance testing and make these services available, affordable, and accessible to the patients who need them.

Keywords: drug resistance tuberculosis, genetic determinant, intensive phase, Nigeria

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Authors: Mojtaba Mirmontazemi, Habibollah Dadgar

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Bone is the most common metastasis site in some advanced malignancies, such as prostate and breast cancer. Bone metastasis generally indicates fewer prognostic factors in these patients. Different radiological and molecular imaging modalities are used for detecting bone lesions. Molecular imaging including computed tomography, magnetic resonance imaging, planar bone scintigraphy, single-photon emission tomography, and positron emission tomography as noninvasive visualization of the biological occurrences has the potential to exact examination, characterization, risk stratification and comprehension of human being diseases. Also, it is potent to straightly visualize targets, specify clearly cellular pathways and provide precision medicine for molecular targeted therapies. These advantages contribute implement personalized treatment for each patient. Currently, NaF PET/CT has significantly replaced standard bone scintigraphy for the detection of bone metastases. On one hand, 68Ga-PSMA PET/CT has gained high attention for accurate staging of primary prostate cancer and restaging after biochemical recurrence. On the other hand, FDG PET/CT is not commonly used in osseous metastases of prostate and breast cancer as well as its usage is limited to staging patients with aggressive primary tumors or localizing the site of disease. In this article, we examine current studies about FDG, NaF, and PSMA PET/CT images in bone metastases diagnostic utility and assess response to treatment in patients with breast and prostate cancer.

Keywords: skeletal metastases, fluorodeoxyglucose, sodium fluoride, molecular imaging, precision medicine, prostate cancer (68Ga-PSMA-11)

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Authors: Maryam Ghavam Sadri, Kimia Moiniafshari

Abstract:

Objectives: The prevalence of Autism in the world has taken on a growing trend. Autism is a neuro-developmental disorder that is identified at the age of three. Studies have been shown that nutritional management can control nutritional deficiencies in Autism. This review study aimed to assess the role of nutritional management strategies for Autism in children has been made. Methods: This review study was accomplished by using the keywords related to the topic, 68 articles were found (2000-2015) and finally 15 articles with criteria such as including dietary pattern, nutritional deficiencies and Autism controlling were selected. Results: The studies showed that intake of vitamins D, E, and calcium because of restricted diet (casein and gluten free) in autistic children is less than typically developing children (TYP) (p value ≤ 0.001) and as a result of restrictions on the consumption of fresh fruits and vegetables, vitamin C and magnesium intake is less than TYP children (p value ≤ 0.001). Autistic children also get omega-3 less than TYP children. Studies have shown that food sources rich in omega-3 can improve behavioral indicators, especially in reducing hyperactivity (95% CI = -2.2 - 5.2). Zinc deficiency in these children leads to a high serum level of mercury, lead and cadmium. As a result of the repetitive dietary pattern, Sodium intake in autistic children is more than TYP children (p value < 0.001).Because of low food variety in autistic children, healthy eating index (HEI) is less than TYP children (p value = 0.008).Food selectivity in Autism due to repetitive and restricted dietary pattern and nutritional deficiencies. Conclusion: Because of restricted (casein and gluten free) and repetitive dietary pattern, the intake of some micronutrients are denied in autistic children. The nutritional strategy programs appear to help controlling of Autism.

Keywords: autism, food selectivity, nutrient intake, nutritional strategies

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Authors: Sizhu Wang, Cuisong Tang, Lin Zhang, Guangyu Tang

Abstract:

Objective: We aimed to detect the composition of bone marrow fatty acids early after ovariectomized (OVX) surgery and explore the potential mechanism. Methods: Thirty-two female Sprague-Dawley (SD) rats (12 weeks) were randomly divided into OVX group and Sham group (N=16/group), and received ovariectomy or sham surgery respectively. After 3 and 28 days, eight rats in each group were sacrificed to detect the composition of bone marrow fatty acids by gas chromatography–mass spectrometry (GC–MS) and evaluate the trabecular bone microarchitecture by micro-CT. Significant different fatty acids in the early stage of post-menopausal osteoporosis were selected by OPLS-DA and t test. Then selected fatty acids were further studied in the process of osteogenic differentiation through RT-PCR and Alizarin Red S staining. Results: An apparent sample clustering and group separation were observed between OVX group and sham group three days after surgery, which suggested the role of bone marrow fatty acids in the early stage of postmenopausal osteoporosis. Specifically, myristate, palmitoleate and arachidonate were found to play an important role in classification between OVX group and sham group. We further investigated the effect of palmitoleate and arachidonate on osteogenic differentiation and found that palmitoleate promoted the osteogenic differentiation of MC3T3-E1 cells while arachidonate inhibited this process. Conclusion: Profound bone marrow fatty acids changes have taken place in the early stage of post-menopausal osteoporosis. Bone marrow fatty acids may begin to affect osteogenic differentiation shortly after deficiency of estrogen.

Keywords: bone marrow fatty acids, GC-MS, osteoblast, osteoporosis, post-menopausal

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Authors: Benselama Amel, Ounane S. Mohamed, Bekki Abdelkader

Abstract:

A collection of 20 isolates from fresh Nodules of the legume plant Lablab purpureus was isolated. These isolates have been authenticated by seedling inoculation grown in jars containing sand. The results obtained after two months of culture have revealed that the 20 isolates (100% of the isolates) are able to nodulate their host plants. The results obtained were analyzed statistically by ANOVA using the software statistica and had shown that the effect of the inoculation has significantly improved all the growth parameters (the height of the plant and the dry weight of the aerial parts and roots, and the number of nodules). We have evaluated the tolerance of all strains of the collection to the major stress factors as the salinity, pH and extreme temperature. The osmotolerance reached a concentration up to 1710mm of NaCl. The strains were also able to grow on a wide range of pH, ranging from 4.5 to 9.5, and temperature, between 4°C and 40°C. Also, we tested the effect of the acidity, aluminum and ferric deficit on the Lablab-rhizobia symbiosis. Lablab purpureus has not been affected by the presence of high concentrations of aluminum. On the other hand, iron deficiency has caused a net decrease in the dry biomass of the aerial part. The results of all the phenotypic characters have been treated by the statistical Minitab software, the numerical analysis had shown that these bacterial strains are divided into two distinct groups at a level of similarity of 86 %. The SDS-PAGE was carried out to determine the profile of the total protein of the strains. The coefficients of similarity of polypeptide bands between the isolates and strains reference (Bradyrhizobium, Mesorizobium sp.) confirm that our strain belongs to the groups of rhizobia.

Keywords: SDS-PAGE, rhizobia, symbiosis, phenotypic characterization, Lablab purpureus

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Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

Abstract:

 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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Authors: Ahmad Pervez

Abstract:

We investigated predation potential and food preference of different life stages of a predaceous ladybird Coccinella septempunctata L. (Coleptera: Coccinellidae) using a nutritive food (mustard aphid, Lipaphis erysimi) and a toxic food (cabbage aphid, Brevicoryne brassicae). We gave monotypic prey, L. erysimi, then B. brassicae to all life stages and found that second, third and fourth instars and adult female C. septempunctata daily consumed greater number of former prey. However, the first instar and the adult male equally consumed both the prey. In choice condition, each larva, adult male and female consumed mixed aphid diet separately in three proportions (i.e. low: high, equal: equal and high: low densities of L. erysimi: B. brassicae). We hypothesized that life stages of C. septempunctata will prefer L. erysimi regardless of its proportions. Laboratory experiment supported this hypothesis only at the adult level showing high values of β and C preference indices. However, it rejects this hypothesis at the larval level, as larvae preferred B. brassicae in certain combinations and showed no preference in a few combinations. We infer that mixing of nutritive diet in a toxic diet may possibly overcome the probable nutritive deficiency and/or reduces the toxicity of toxic diet, especially to the larvae of C. septempunctata. Consumption of high proportion of B. brassicae mixed with fewer L. erysimi suggests that mixed diet could be better for the development of immature stages of C. septempunctata.

Keywords: Coccinella septempunctata, predatory potential, prey preference, Lipaphis erysimi, Brevicoryne brassicae

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