Search results for: solubility and dissolution improvement

Authors: Jawaad Saleem, Hannah Wright, Peter Sommerville, Adrian Hopper

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Introduction: Inpatient falls are the most commonly reported patient safety incidents, and carry a significant burden on resources, morbidity, and mortality. Ensuring adequate post falls management of patients by staff is therefore paramount to maintaining patient safety especially in out of hours and resource stretched settings. Aims: This quality improvement project aims to improve the current practice of falls management at Guys St Thomas Hospital, London as compared to our 2016 Quality Improvement Project findings. Furthermore, it looks to increase current junior doctors confidence in managing falls and their use of new guidance protocols. Methods: Multifaceted Interventions implemented included: the development of new trust wide guidelines detailing management pathways for patients post falls, available for intranet access. Furthermore, the production of 2000 lanyard cards distributed amongst junior doctors and staff which summarised these guidelines. Additionally, a ‘safety signal’ email was sent from the Trust chief medical officer to all staff raising awareness of falls and the guidelines. Formal falls teaching was also implemented for new doctors at induction. Using an established incident database, 189 consecutive falls in 2017were retrospectively analysed electronically to assess and compared to the variables measured in 2016 post interventions. A separate serious incident database was used to analyse 50 falls from May 2015 to March 2018 to ascertain the statistical significance of the impact of our interventions on serious incidents. A similar questionnaire for the 2017 cohort of foundation year one (FY1) doctors was performed and compared to 2016 results. Results: Questionnaire data demonstrated improved awareness and utility of guidelines and increased confidence as well as an increase in training. 97% of FY1 trainees felt that the interventions had increased their awareness of the impact of falls on patients in the trust. Data from the incident database demonstrated the time to review patients post fall had decreased from an average of 130 to 86 minutes. Improvement was also demonstrated in the reduced time to order and schedule X-ray and CT imaging, 3 and 5 hours respectively. Data from the serious incident database show that ‘the time from fall until harm was detected’ was statistically significantly lower (P = 0.044) post intervention. We also showed the incidence of significant delays in detecting harm ( > 10 hours) reduced post intervention. Conclusions: Our interventions have helped to significantly reduce the average time to assess, order and schedule appropriate imaging post falls. Delays of over ten hours to detect serious injuries after falls were commonplace; since the intervention, their frequency has markedly reduced. We suggest this will lead to identifying patient harm sooner, reduced clinical incidents relating to falls and thus improve overall patient safety. Our interventions have also helped increase clinical staff confidence, management, and awareness of falls in the trust. Next steps include expanding teaching sessions, improving multidisciplinary team involvement to aid this improvement.

Keywords: patient safety, quality improvement, serious incidents, falls, clinical care

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Authors: Richard L. Summers

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The advanced computational analysis of biological systems is becoming increasingly dependent upon an understanding of the information-theoretic structure of the materials, energy and interactive processes that comprise those systems. The stability and survival of these living systems are fundamentally contingent upon their ability to acquire and process the meaning of information concerning the physical state of its biological continuum (biocontinuum). The drive for adaptive system reconciliation of a divergence from steady-state within this biocontinuum can be described by an information metric-based formulation of the process for actionable knowledge acquisition that incorporates the axiomatic inference of Kullback-Leibler information minimization driven by survival replicator dynamics. If the mathematical expression of this process is the Lagrangian integrand for any change within the biocontinuum then it can also be considered as an action functional for the living system. In the direct method of Lyapunov, such a summarizing mathematical formulation of global system behavior based on the driving forces of energy currents and constraints within the system can serve as a platform for the analysis of stability. As the system evolves in time in response to biocontinuum perturbations, the summarizing function then conveys information about its overall stability. This stability information portends survival and therefore has absolute existential meaning for the living system. The first derivative of the Lyapunov energy information function will have a negative trajectory toward a system's steady state if the driving force is dissipating. By contrast, system instability leading to system dissolution will have a positive trajectory. The direction and magnitude of the vector for the trajectory then serves as a quantifiable signature of the meaning associated with the living system’s stability information, homeostasis and survival potential.

Keywords: meaning, information, Lyapunov, living systems

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Authors: Yuan Yang, Mickey Lam

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Oral dissolvable films have been considered as a unique alternative approach to conventional oral dosage forms. The films could be administrated via the gastrointestinal tract as conventional dosages or through sublingual/buccal mucosa membranes, which could enhance drug bioavailability by avoiding the first-pass effect and improving permeability due to high blood flow and lymphatic circulation. This work has described a state-of-art technic using nano-emulsion/nano-suspension as a precursor for the film to enhance the bioavailability of BCS class II drugs. The drug molecules are consequentially processed through the emulsification, gelation, and film-casting processes. The gelation process is critical to stabilizing the nano-emulsion for the film-casting as well as controlling the drug release process. Furthermore, the size of the nanoparticle on the film has a strong correlation with the size of the micelles in the precursor and the condition of the gelation process. It has been discovered that nanoparticle from 200 nm to 300 nm has shown the highest permeability for sublingual administration. In one example shown in work, the bioavailability of a low solubilize drug has been increased from 10% to 24% via sublingual administration of the film. The increasing of the bioavailability was thought to be associated with the enhancement of the diffusion process of the drug in the saliva layer above the mucosa membrane and the fact that the presents of the emulsifier help lose the rigid junction of the mucosa cells.

Keywords: oral dissolvable film, nano-suspension, nano-emulsion, bioavailability

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Authors: Beatriz Martinez-Pastor, Maria Nogal, Alan O'Connor

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During the last years, the number of extreme weather events has increased. A variety of extreme weather events, including river floods, rain-induced landslides, droughts, winter storms, wildfire, and hurricanes, have threatened and damaged many different regions worldwide. These events have a devastating impact on critical infrastructure systems resulting in high social, economical and environmental costs. These events have a huge impact in transport systems. Since, transport networks are completely exposed to every kind of climatological perturbations, and its performance is closely related with these events. When a traffic network is affected by a climatological hazard, the quality of its service is threatened, and the level of the traffic conditions usually decreases. With the aim of understanding this process, the concept of resilience has become most popular in the area of transport. Transport resilience analyses the behavior of a traffic network when a perturbation takes place. This holistic concept studies the complete process, from the beginning of the perturbation until the total recovery of the system, when the perturbation has finished. Many concepts are included in the definition of resilience, such as vulnerability, redundancy, adaptability, and safety. Once the resilience of a transport network can be evaluated, in this case, the methodology used is a dynamic equilibrium-restricted assignment model that allows the quantification of the concept, the next step is its improvement. Through the improvement of this concept, it will be possible to create transport networks that are able to withstand and have a better performance under the presence of climatological hazards. Analyzing the impact of a perturbation in a traffic network, it is observed that the response of the different links, which are part of the network, can be completely different from one to another. Consequently and due to this effect, many questions arise, as what makes a link more critical before an extreme weather event? or how is it possible to identify these critical links? With this aim, and knowing that most of the times the owners or managers of the transport systems have limited resources, the identification of the critical links of a transport network before extreme weather events, becomes a crucial objective. For that reason, using the available resources in the areas that will generate a higher improvement of the resilience, will contribute to the global development of the network. Therefore, this paper wants to analyze what kind of characteristic makes a link a critical one when an extreme weather event damages a transport network and finally identify them.

Keywords: critical links, extreme weather events, hazard, resilience, transport network

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Authors: Laxuman Thakuri

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Despite the large number of in-depth case studies focused on policy analysis, institutional arrangement, and collective action of common property resource management; how the local institutions take the pricing decision of forest products in community forest management and what kinds of effects produce it, the answers of these questions are largely silent among the policy-makers and researchers alike. The study examined how the local institutions take the pricing decision of forest products in the lowland community forestry of Nepal and how the decisions affect to equitable distribution of benefits and livelihood improvement which are also objectives of Nepalese community forestry. The study assumes that forest products pricing decisions have multiple effects on equitable distribution and livelihood improvement in the areas having heterogeneous socio-economic conditions. The dissertation was carried out at four community forests of lowland, Nepal that has characteristics of high value species, matured-experience of community forest management and better record-keeping system of forest products production, pricing and distribution. The questionnaire survey, individual to group discussions and direct field observation were applied for data collection from the field, and Lorenz curve, gini-coefficient, χ²-text, and SWOT (Strong, Weak, Opportunity, and Threat) analysis were performed for data analysis and results interpretation. The dissertation demonstrates that the low pricing strategy of high-value forest products was supposed crucial to increase the access of socio-economically weak households, and to and control over the important forest products such as timber, but found counter productive as the strategy increased the access of socio-economically better-off households at higher rate. In addition, the strategy contradicts to collect a large-scale community fund and carry out livelihood improvement activities as per the community forestry objectives. The crucial part of the study is despite the fact of low pricing strategy; the timber alone contributed large part of community fund collection. The results revealed close relation between pricing decisions and livelihood objectives. The action research result shows that positive price discrimination can slightly reduce the prevailing inequality and increase the fund. However, it lacks to harness the full price of forest products and collects a large-scale community fund. For broader outcomes of common property resource management in terms of resource sustainability, equity, and livelihood opportunity, the study suggests local institutions to harness the full price of resource products with respect to the local market.

Keywords: community, equitable, forest, livelihood, socioeconomic, Nepal

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Authors: Sridhar S, Govinda Raj Mandela, Aruna Mangalpady

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In the present day scenario, Indian underground mines are moving towards full scale mechanisation for improvement of production and productivity levels. These mines are employing a wide variety of earth moving machines for the transportation of ore and overburden (waste). Low Profile Dump Trucks (LPDTs) have proven more advantageous towards improvement of production levels in underground mines through quick transportation. During the operation of LPDT, different kinds of vibrations are generated which can affect the health condition of the operator. Keeping this in view, the present research work focuses on measurement and evaluation of Hand Arm Vibrations (HAVs) from the steering system of LPDTs. The study also aims to evaluate the HAVs of different job components of a work cycle in operating LPDTs. The HAVs were measured and evaluated according to ISO 5349-2: 2001 standards, and the daily vibration exposures A(8) were calculated. The evaluated A(8) results show that LPDTs of 60 and 50 tons capacity have vibration levels more than that of the Exposure Action Value (EAV) of 2.5 m/s2 in every job component of the work cycle. Further, the results show that the vibration levels were more during empty haulage especially during descending journey when compared to other job components in all LPDTs considered for the study.

Keywords: low profile dump trucks, hand arm vibrations, exposure action value, underground mines

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Authors: Onabajo Paul

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The testing and assessment of physical fitness of school-aged adolescents in Nigeria has been going on for several decades. Originally, these tests strictly focused on identifying health and physical fitness status and comparing the results of adolescents with others. There is a considerable interest in health and performance fitness of adolescents in which results attained are compared with criteria representing positive health rather than simply on score comparisons with others. Despite the fact that physical education program is being studied in secondary schools and physical activities are encouraged, it is observed that regular assessment of students’ fitness level and health status seems to be scarce or not being done in these schools. The purpose of the study was to assess the heath and performance fitness of adolescents in middle-income schools in Lagos State. A total number of 150 students were selected using the simple random sampling technique. Participants were measured on hand grip strength, sit-up, pacer 20 meter shuttle run, standing long jump, weight and height. The data collected were analyzed with descriptive statistics of means, standard deviations, and range and compared with fitness norms. It was concluded that majority 111(74.0%) of the adolescents achieved the healthy fitness zone, 33(22.0%) were very lean, and 6(4.0%) needed improvement according to the normative standard of Body Mass Index test. For muscular strength, majority 78(52.0%) were weak, 66(44.0%) were normal, and 6(4.0%) were strong according to the normative standard of hand-grip strength test. For aerobic capacity fitness, majority 93(62.0%) needed improvement and were at health risk, 36(24.0%) achieved healthy fitness zone, and 21(14.0%) needed improvement according to the normative standard of PACER test. Majority 48(32.0%) of the participants had good hip flexibility, 38(25.3%) had fair status, 27(18.0%) needed improvement, 24(16.0%) had very good hip flexibility status, and 13(8.7%) of the participants had excellent status. Majority 61(40.7%) had average muscular endurance status, 30(20.0%) had poor status, 29(18.3%) had good status, 28(18.7%) had fair muscular endurance status, and 2(1.3%) of the participants had excellent status according to the normative standard of sit-up test. Majority 52(34.7%) had low jump ability fitness, 47(31.3%) had marginal fitness, 31(20.7%) had good fitness, and 20(13.3%) had high performance fitness according to the normative standard of standing long jump test. Based on the findings, it was concluded that majority of the adolescents had better Body Mass Index status, and performed well in both hip flexibility and muscular endurance tests. Whereas majority of the adolescents performed poorly in aerobic capacity test, muscular strength and jump ability test. It was recommended that to enhance wellness, adolescents should be involved in physical activities and recreation lasting 30 minutes three times a week. Schools should engage in fitness program for students on regular basis at both senior and junior classes so as to develop good cardio-respiratory, muscular fitness and improve overall health of the students.

Keywords: adolescents, health-related fitness, performance-related fitness, physical fitness

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Authors: Diana Serbezeanu, Ionela-Daniela Carja, Tachita Vlad-Bubulac, Sergiu Sova

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New phosphorus-containing monomers having methoxy end functional groups were prepared from methyl 4-hydroxybenzoate and two different dichlorides with phosphorus, namely phenyl phosphonic dichloride and phenyl dichlorophosphate. The structures of the monomers were confirmed by FTIR and NMR spectroscopy. The assignments for the 1H, 13C and 31P chemical shifts are based on 1D and 2D NMR homo- and heteronuclear correlations (H,H-COSY (Correlation Spectroscopy), H,C-HMQC (Heteronuclear Multiple Quantum Correlation and H,C-HMBC (Heteronuclear Multiple Bond Correlation)) and 31P-13C couplings. The monomers exhibited good solubility in common organic solvents. Dimethyl sulfoxide was to be a good solvent to grow crystals of considerable size which were investigated by X-ray analysis. One of these two new monomers presented thermotropic liquid crystalline behaviour, as revealed by differential scanning calorimetry (DSC), polarized light microscopy (PLM) and X-ray diffraction (XRD). The transition temperature from crystal to liquid crystalline state (K→LC) was 143°C and from the LC to isotropic state (LC→I) was 167°C. Upon heating, bis(4-(methoxycarbonyl)phenyl formed fine textures, difficult to be ascribed to smectic or nematic phases. Upon cooling from the isotropic state, bis(4-(methoxycarbonyl)phenyl exhibited a mosaic-type texture. X-ray diffraction measurements at small angles (SAXS) of bis(4-(methoxycarbonyl)phenyl showed two peaks at 1.8 Å and 3.5 Å, respectively suggesting organization at supramolecular level.

Keywords: phosphorus-containing monomers, polarized light microscopy, structure investigation, thermotropic liquid crystalline properties

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Authors: Mazita Mohd Diah, Anton V. Dolzhenko, Tin Wui Wong

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Nanoparticles, being small with a large specific surface area, increase solubility, enhance bioavailability, improve controlled release and enable precision targeting of the entrapped compounds. In this study, chitosan as polymeric permeation enhancer was conjugated to a polar pro-drug, carboxymethyl-5-fluorouracil (CMFU) to increase the skin drug permeation. Chitosan-CMFU conjugate was synthesized using chemical conjugation process through succinate linker. It was then transformed into nanoparticles via spray drying method. The conjugation was elucidated using Fourier Transform Infrared and Proton Nuclear Magnetic Resonance techniques. The nanoparticle size, size distribution, zeta potential, drug content, skin permeation and retention profiles were characterized. The conjugation was denoted using 1H NMR by new peaks at signal δ = 4.184 ppm (singlet, 2H for CH2) and 7.676-7.688 ppm (doublet, 1H for C6) attributed to CMFU in chitosan-CMFU NMR spectrum. The nanoparticles had profiles of particle size: 93.97 ±35.11 nm, polydispersity index: 0.40 ± 0.14, zeta potential: +18.25 ±2.95 mV and drug content: 6.20 ± 1.98 % w/w. Almost 80 % w/w CMFU in the form of nanoparticles permeated through the skin in 24 hours and close to 50 % w/w permeation occurred in first 1-2 hours. Without conjugation to chitosan and nanoparticulation, less than 40 % w/w CMFU permeated through the skin in 24 hours. The skin drug retention likewise was higher with chitosan-CMFU nanoparticles (15.34 ± 5.82 % w/w) than CMFU (2.24 ± 0.57 % w/w). CMFU, through conjugation with chitosan permeation enhancer and processed in nanogeometry, had its skin permeation and retention degree promoted.

Keywords: carboxymethyl-5-fluorouracil, chitosan, conjugate, skin permeation, skin retention

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Authors: Sonveer Singh, Sanjay Agrawal, D. V. Avasthi, Jayant Shekhar

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The aim of this paper is to improve the efficiency of photovoltaic thermal (PVT) system with the help of Genetic Algorithms with multi-objective function. There are some parameters that affect the efficiency of PVT system like depth and length of the channel, velocity of flowing fluid through the channel, thickness of the tedlar and glass, temperature of inlet fluid i.e. all above parameters are considered for optimization. An attempt has been made to the model and optimizes the parameters of glazed hybrid single channel PVT module when two objective functions have been considered separately. The two objective function for optimization of PVT module is overall electrical and thermal efficiency. All equations for PVT module have been derived. Using genetic algorithms (GAs), above two objective functions of the system has been optimized separately and analysis has been carried out for two cases. Two cases are: Case-I; Improvement in electrical and thermal efficiency when overall electrical efficiency is optimized, Case-II; Improvement in electrical and thermal efficiency when overall thermal efficiency is optimized. All the parameters that are used in genetic algorithms are the parameters that could be changed, and the non-changeable parameters, like solar radiation, ambient temperature cannot be used in the algorithm. It has been observed that electrical efficiency (14.08%) and thermal efficiency (19.48%) are obtained when overall thermal efficiency was an objective function for optimization. It is observed that GA is a very efficient technique to estimate the design parameters of hybrid single channel PVT module.

Keywords: genetic algorithm, energy, exergy, PVT module, optimization

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Authors: Jangje Park, So Young Kim

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The market demand for audio quality in mobile devices continues to increase, and audible buzz noise generated in time division communication is a chronic problem that goes against the market demand. In the case of time division type communication, the RF Power Amplifier (RF PA) is driven at the audio frequency cycle, and it makes various influences on the audio signal. In this paper, we measured the ground bounce noise generated by the peak current flowing through the ground network in the RF PA with the audio frequency; it was confirmed that the noise is the cause of the audible buzz noise during a call. In addition, a grounding method of the microphone device that can improve the buzzing noise was proposed. Considering that the level of the audio signal generated by the microphone device is -38dBV based on 94dB Sound Pressure Level (SPL), even ground bounce noise of several hundred uV will fall within the range of audible noise if it is induced by the audio amplifier. Through the grounding method of the microphone device proposed in this paper, it was confirmed that the audible buzz noise power density at the RF PA driving frequency was improved by more than 5dB under the conditions of the Printed Circuit Board (PCB) used in the experiment. A fundamental improvement method was presented regarding the buzzing noise during a mobile phone call.

Keywords: audio frequency, buzz noise, ground bounce, microphone grounding

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Authors: Shabnum Shaheen, Nida Haroon, Farah Khan, Sumera Javad, Mehreen Jalal, Samina Sarwar

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Coffee Senna is pharmaceutically very important and used for multiple health disorders such as gastric pains, indigestion, snakebites, asthma and fever, tuberculosis and menstrual problems. However, its immense medicinal value and great demand lead to adulteration issue which could be injurious for users. Some times its adulterant Seena weed (Senna occidentalis L.) is used as its substitute which definitely not as effective as Coffee Senna. Hence, the present study was undertaken to provide some tools for systematic and pharmaceutical authentication of a shrubby plant Coffee Senna (Cassia occidentalis Linn.). These parameters included macro and micro morphological characters, anatomical and palynomorph characterization, solubility, fluorescence and phytochemical analysis. By the application of these parameters acquired results revealed that, these two plants are distinct from each other. The Coffee Seena was found to be an annual shrub with trilobed pollen, diacytic, paracytic and anisocytic stomata whereas the Seena weed stands out as an annual or perennial herb with spheroidal and circular pollen and paracytic type of stomata. The powdered drug of Coffee seena is dark grayish green whereas the powdered drug of Seena weed is light green in color. These findings are constructive in authentic identification of these plants.

Keywords: coffee senna, Senna weed, taxonomic evaluation, pharmaceutical markers

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Authors: Pankaj K. Jha, Ajeet K. Jha, Pravin Mishra

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Goat raising is a popular livestock sub-commodity of mixed farming system in Nepal. Besides food and nutritional security, it has an important role in the economy of many peoples. Goat breeding through AI is commonly practiced worldwide. It is a very basic tool to speed up genetic improvement and increase productivity. For the goat genetic improvement program, the government of Nepal has imported some specialized exotic goat breeds and semen. Some progress has been made in the initiation of selective breeding within the local breeds and practice of AI with imported semen. Importance of AI in goats has drawn more attention among goat farmers. However, importing semen is not a permanent solution at national level; rather, it is more important to develop and establish its own frozen semen production technique. Semen quality and its relationship with fertility are said to be a major concern in animal production, hence accurate measurement of semen fertilizing potential is of great importance. The survivability of sperm cells depends on semen quality. Survivability of sperm cells is assessed through visual and microscopic evaluation of spermatozoal progressive motility and morphology. In Nepal, there is lack of scientific information on seminal attributes of buck semen, its dilution, cooling and freezing technique under management conditions of Nepal. Therefore, the objective of this review was to provide brief information about breeding system, semen production and artificial insemination in Nepalese goat.

Keywords: artificial insemination, goat, Nepal, semen

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Authors: André C. Silva, Débora N. Sousa, Elenice M. S. Silva, Thales P. Fontes, Raphael S. Tomaz

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Starches are widely used as depressant in froth flotation operations in Brazil due to their efficiency, increasing the selectivity in the inverse flotation of quartz depressing iron ore. Starches market have been growing and improving in recent years, leading to better products attending the requirements of the mineral industry. The major source of starch used for iron ore is corn starch, which needs to be gelatinized with sodium hydroxide (NaOH) prior to use. This stage has a direct impact on industrials costs, once the lowest consumption of NaOH in gelatinization provides better control of the pH in the froth flotation and reduces the amount of electrolytes present in the pulp. In order to evaluate the gelatinization degree of different starches and flour were subjected to the addiction of NaOH and temperature variation experiments. Samples of starch (corn, cassava, HIPIX 100, HIPIX 101 and HIPIX 102 commercialized by Ingredion) and flour (cassava and potato) were tested. The starch samples were characterized through Scanning Electronic Microscopy and the amylose content were determined through spectrometry, swelling and solubility tests. The gelatinization was carried out through titration with NaOH, keeping the solution temperature constant at 40 ^oC. At the end of the tests, the optimal amount of NaOH consumed to gelatinize the starch or flour from different botanical sources was established and a correlation between the content of amylopectin in the starch and the starch/NaOH ratio needed for its gelatinization.

Keywords: froth flotation, gelatinization, sodium hydroxide, starches and flours

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Authors: Sonam Kumari

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Tuberculosis is the deadliest disease worldwide. Millions of people lose their lives every year due to this disease. It has turned lethal due to the erratic nature of its causative organism, Mycobacterium tuberculosis (Mtb). Mtb tends to enter into an inactive, dormant state and emerge to replicating state upon encountering favorable conditions. The mechanism by which Mtb switches from the dormant state to the replicative form is still poorly characterized. Proteome studies have given us an insight into the role of certain proteins in giving stupendous virulence to Mtb, but numerous dotsremain unconnected and unaccounted. The WhiB family of proteins is one such protein that is associated with developmental processes in actinomycetes. Mtb has seven such proteins (WhiB1 to WhiB7). WhiB proteins are transcriptional regulators; they regulate various essential genes of Mtbby binding to their promoter DNA. Biophysical parameters of the effect of DNA binding on WhiB proteins has not yet been appropriately characterized. Interaction with DNA induces conformational changes in the WhiB proteins, confirmed by steady-state fluorescence and circular dichroism spectroscopy. ITC has deduced thermodynamic parameters and the binding affinity of the interaction. Since these transcription factors are highly unstable in vitro, their stability and solubility were enhanced by the co-expression of molecular chaperones. The present study findings help determine the conditions under which the WhiB proteins interact with their interacting partner and the factors that influence their binding affinity. This is crucial in understanding their role in regulating gene expression in Mtbandin targeting WhiB proteins as a drug target to cure TB.

Keywords: mycobacterium tuberculosis, TB, whiB proteins, ITC

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Authors: K. G. R. M. Jayathilake, S. Rudra

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Wood degradation in hot compressed water is modeled with a Computational Fluid Dynamics (CFD) code using cellulose, xylan, and lignin as model compounds. Model compounds are reacted under catalyst-free conditions in a temperature range from 250 to 370 °C. Using a simplified reaction scheme where water soluble products, methanol soluble products, char like compounds and gas are generated through intermediates with each model compound. A modified multistage shrinking core model is developed to simulate particle degradation. In the modified shrinking core model, each model compound is hydrolyzed in separate stages. Cellulose is decomposed to glucose/oligomers before producing degradation products. Xylan is decomposed through xylose and then to degradation products where lignin is decomposed into soluble products before producing the total guaiacol, organic carbon (TOC) and then char and gas. Hydrolysis of each model compound is used as the main reaction of the process. Diffusion of water monomers to the particle surface to initiate hydrolysis and dissolution of the products in water is given importance during the modeling process. In the developed model the temperature variation depends on the Arrhenius relationship. Kinetic parameters from the literature are used for the mathematical model. Meanwhile, limited initial fast reaction kinetic data limit the development of more accurate CFD models. Liquefaction results of the CFD model are analyzed and validated using the experimental data available in the literature where it shows reasonable agreement.

Keywords: computational fluid dynamics, liquefaction, shrinking-core, wood

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Authors: Ila Gupta

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The government hospitals in India by and large lack the necessary aesthetic therapeutic components, both in their interior and exterior space designs. These components especially in terms of color application are important to the emotional as well as physical well being of the patients and other participants of the space. The preliminary survey of few government hospitals in Uttarakhand, India, reveals that the government health care industry provides a wide scope for intervention. All most all of the spaces do not adhere to a proper therapeutic color scheme which directly helps the well-being of their patients and workers. The paper aims to conduct a survey and come up with recommendations in this regard. The government hospitals also lack a proper signage system which allows the space to be more user-friendly. The hospital spaces in totality also have scope for improvement in terms of space/landscape design which enhances the work environment in an efficient and positive way. This study will thus enable to come up with feasible recommendations for healthcare and built environment as well as retrofitting the existing spaces. The objective of the paper is mainly on few case studies. The present ambience in many government hospitals generally lacks a welcoming ambience. It is proposed to select one or two government hospitals and demonstrate application of appropriate and self-sustainable color schemes, placement of artifacts, changes in outdoor and indoor space design to bring about a change that is conducive for cognitive healing. Exterior changes to existing and old hospital buildings in depressed historic areas signify financial investment and change, and have the potential to play a significant role in both urban preservation and revitalization. Changes to exterior architectural colors are perhaps the most visible signifier of such revitalization, as the use of color changes as a tool in façade and interior improvement programs. The present project will provide its recommendations on the basis of case studies done in the Indian Public Health Care system. Furthermore, the recommendations will be in accordance with the extended study conducted in Indian Ayurvedic, Yogic texts as well as Vastu texts, which provides knowledge about built environments and healing properties of color.

Keywords: color, environment, facade, architectural color history, interior improvement programs, community development, district/government hospitals

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Authors: Matt Stichter

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Moral development requires learning from one’s failures, but that turnsout to be especially challenging when dealing with moral failures. The distress prompted by moral failure can cause responses ofdefensiveness or disengagement rather than attempts to make amends and work on self-change. The most potentially distressing response to moral failure is a shame. However, there appears to be two different senses of “shame” that are conflated in the literature, depending on whether the failure is appraised as the result of a global and unalterable self-defect, or a local and alterable self-defect. One of these forms of shame does prompt self-improvement in response to moral failure. This occurs if one views the failure as indicating only a specific (local) defect in one’s identity, where that’s something repairable, rather than asanoverall(orglobal)defectinyouridentity that can’t be fixed. So, if the whole of one’s identity as a morally good person isn’t being called into question, but only a part, then that is something one could work on to improve. Shame, in this sense, provides motivation for self-improvement to fix this part oftheselfinthe long run, and this would be important for moral development. One factor that looks to affect these different self-attributions in the wake of moral failure can be found in mindset theory, as reactions to moral failure in these two forms of shame are similar to how those with a fixed or growth mindset of their own abilities, such as intelligence, react to failure. People fall along a continuum with respect to how they view abilities – it is more of a fixed entity that you cannot do much to change, or it is malleable such that you can train to improve it. These two mindsets, ‘fixed’ versus ‘growth’, have different consequences for how we react to failure – a fixed mindset leads to maladaptive responses because of feelings of helplessness to do better; whereas a growth mindset leads to adaptive responses where a person puts forth effort to learn how to act better the next time. Here we can see the parallels between a fixed mindset of one’s own (im)morality, as the way people respond to shame when viewed as indicating a global and unalterable self-defect parallels the reactions people have to failure when they have a fixed mindset. In addition, it looks like there may be a similar structure to pride. Pride is, like shame, a self-conscious emotion that arises from internal attributions about the self as being the cause of some event. There are also paradoxical results from research on pride, where pride was found to motivate pro-social behavior in some cases but aggression in other cases. Research suggests that there may be two forms of pride, authentic and hubristic, that are also connected to different self-attributions, depending on whether one is feeling proud about a particular (local) aspect of the self versus feeling proud about the whole of oneself (global).

Keywords: emotion, mindset, moral development, moral psychology, pride, shame, self-regulation

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Authors: Anupam Sibal

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Whatever is measured tends to improve. With a view to objectively measuring and improving clinical quality across the Apollo Group Hospitals, the initiative of ACE @ 25 (Apollo Clinical Excellence@25) was launched on Jan 09. ACE @ 25 is a clinically balanced scorecard incorporating 25 clinical quality parameters involving complication rates, mortality rates, one-year survival rates and average length of stay after major procedures like liver and renal transplant, CABG, TKR, THR, TURP, PTCA, endoscopy, large bowel resection and MRM covering all major specialties. Also included are hospital acquired infection rates, pain satisfaction and medication errors. Benchmarks have been chosen from the world’s best hospitals. There are weighted scores for outcomes color coded green, orange and red. The cumulative score is 100. Data is reported monthly by 43 Group Hospitals online on the Lighthouse platform. Action taken reports for parameters falling in red are submitted quarterly and reviewed by the board. An audit team audits the data at all locations every six months. Scores are linked to appraisal of the medical head and there is an “ACE @ 25” Champion Award for the highest scorer. Scores for different parameters were variable from green to red at the start of the initiative. Most hospitals showed an improvement in scores over the last four years for parameters where they had showed scores in red or orange at the start of the initiative. The overall scores for the group have shown an increase from 72 in 2010 to 81 in 2015.

Keywords: benchmarks, clinical quality, lighthouse, platform, scores

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Authors: Bheeshma B., Mathivanan N., Manoj Deepak M., Prabhu Thangaraju, K. Venkatachalam

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This study involves the effect of autologous blood injection for patients who had degeneration of the origin of extensor carpi radialis brevis which was confirmed radio logically and by ultrasound examination and failed cortisone injections to the lateral epicondylitis. In this prospective longitudinal series involves pre-injection assessment of grip strength, pain, and function, using the patient-rated tennis elbow evaluation. In this study, blood from the contralateral limb is taken and injected into the affected limb with the help of ultrasound guidance and then the patient wore a customized wrist support for five days, after which they were commenced with stretching, strengthening, and massage programme with an occupational therapist. In these patients assessment was done after six months and then finally at 12 months after injection, using the patient-rated tennis elbow evaluation. 50 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not. Our study thus concludes that autologous blood injection show significant improvement in pain and function in patients with chronic lateral epicondylitis, who did not have relief with cortisone injection.

Keywords: lateral epicondylitis, autologous blood injection, conservative treatment, plasma-rich proteins (PRPs)

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Authors: Yasser Y. Lenis, Daniela Garcia Gonzalez, Cristian Solarte Bacca, Diego F. Carrillo González, Amy Jo Montgomery, Dursun Barrios

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Introduction: Artificial insemination in bovines helps to promote genetic improvement and can positively impact the rural economy. The Colombian armed conflict has forced a large portion of the rural population to abandon their territory, affecting their education, family integration, and economics. Justification: The achievement of education in rural populations was one of the Millennium Development Goals (MDGs) made by the United Nations. During the last World Summit on Sustainable Development (WSSD), it was concluded that most of the world’s poor, illiterate and undernourished population lives in rural areas; therefore, access to education is considered one of the most significant challenges for governments in countries with developing economies. Objectives: To study the effects of training in artificial insemination and rural management on the perception of knowledge and the level of knowledge in rural residents affected by the armed conflict in Nariño, Colombia. Methods: The perception of knowledge and the theoretical-practical knowledge of 63 rural residents were evaluated on the topics of bovine agribusiness management, artificial insemination, and genetic improvement through the application of three surveys. 1) evaluated the perceived level of knowledge each rural resident had about each topic using the Likert scale, 2) evaluated the theoretical knowledge before training, and 3) evaluated the theoretical knowledge upon completion of training. Results/discussion: Of the surveyed rural residents, 54% stated that they knew how business management improved the performance of their bovine agribusiness, 54% answered the pre-training knowledge test correctly, while 83% correctly answered the post-training knowledge test. Only 6% of surveyed residents perceived that they had prior knowledge of artificial insemination and reproductive anatomy topics. Before training, 35% of surveyed residents answered correctly on these topics, while upon completion of training, 65% answered correctly. Regarding genetic improvement, 11% of participating rural residents stated that they knew this subject. The correct answers on this topic went from 57% to 89% before and post-training. Conclusion: Rural extension programs contribute to closing knowledge gaps in relation to the use of reproductive biotechnologies and bovine management in rural areas affected by armed conflict.

Keywords: agribusiness, insemination, knowledge, reproduction

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Authors: Supriya Ambawat, Subaran Singh, C. Tara Satyavathi, B. S. Rajpurohit, Ummed Singh, Balraj Singh

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Pearl millet [Pennisetum glaucum (L.) R. Br.] is an important staple food of the arid and semiarid tropical regions of Asia, Africa, and Latin America. It is rightly termed as nutricereal as it has high nutrition value and a good source of carbohydrate, protein, fat, ash, dietary fiber, potassium, magnesium, iron, zinc, etc. Pearl millet has low prolamine fraction and is gluten free which is useful for people having a gluten allergy. It has several health benefits like reduction in blood pressure, thyroid, diabe¬tes, cardiovascular and celiac diseases but its direct consumption as food has significantly declined due to several reasons. Keeping this in view, it is important to reorient the ef¬forts to generate demand through value-addition and quality improvement and create awareness on the nutritional merits of pearl millet. In India, through Indian Council of Agricultural Research-All India Coordinated Research Project on Pearl millet, multilocational coordinated trials for developed hybrids were conducted at various centers. The gene banks of pearl millet contain varieties with high levels of iron and zinc which were used to produce new pearl millet varieties with elevated iron levels bred with the high‐yielding varieties. Thus, using breeding approaches and biochemical analysis, a total of 167 hybrids and 61 varieties were identified and released for cultivation in different agro-ecological zones of the country which also includes some biofortified hybrids rich in Fe and Zn. Further, using several biotechnological interventions such as molecular markers, next-generation sequencing (NGS), association mapping, nested association mapping (NAM), MAGIC populations, genome editing, genotyping by sequencing (GBS), genome wide association studies (GWAS) advancement in millet improvement has become possible by identifying and tagging of genes underlying a trait in the genome. Using DArT markers very high density linkage maps were constructed for pearl millet. Improved HHB67 has been released using marker assisted selection (MAS) strategies, and genomic tools were used to identify Fe-Zn Quantitative Trait Loci (QTL). The draft genome sequence of millet has also opened various ways to explore pearl millet. Further, genomic positions of significantly associated simple sequence repeat (SSR) markers with iron and zinc content in the consensus map is being identified and research is in progress towards mapping QTLs for flour rancidity. The sequence information is being used to explore genes and enzymatic pathways responsible for rancidity of flour. Thus, development and application of several biotechnological approaches along with biofortification can accelerate the genetic gain targets for pearl millet improvement and help improve its quality.

Keywords: Biotechnological approaches, genomic tools, malnutrition, MAS, nutricereal, pearl millet, sequencing.

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Authors: A. Haddick, A. Soltan

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Background: During the period of recovery from an operative obstetric procedure, a woman is not only at risk of the life-threatening complications accompanying labour but also those associated with surgery and anaesthesia. It is speculated that women in the recovery area may receive a lower standard of care over a night shift. Thus obstetric recovery room care should be evaluated regularly to ensure all women receive an equally high standard of care 24/7. Aim: The aim of this audit was to undertake an audit in the Liverpool Women’s Hospital on the care in recovery, and to ascertain the extent to which the standards were met. This audit included the full audit cycle. Method: Standards were taken from the AAGBI, RCOA, NICE and CNST guidelines. There were 12 standards including appropriate documentation of vital signs and appropriate length of stay after surgery. Notes from 100 patients were analysed from March 2011-March 2012. There were 52 day notes and 48 night notes; these were accessed to gain the relevant data. In the re audit 35 notes were accessed from March 14-September 14. Results: The Liverpool Women’s Hospital met in total 10 of these standards. 10 were met during the day shift (83%) and 0 met during the night shift. In the re audit, there was a significant improvement in the standards met at night. 9 of the standards were met during the day and 7 of the standards were met at night. Clearly there are still improvements to be made. Conclusions: In the original audit, an audit action plan was formulated. This was following discussion of the results of this audit in an MDT meeting and presentation with a consultant Obstetrician, the head of Midwifery, the head of Obstetrics theatres and a recovery nurse. This audit will be further discussed in the Liverpool Woman's Hospital in July 2015 for further implementation for improvement.

Keywords: care, recovery, room, women

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Authors: Khaled Alshamari

Abstract:

Synthesized partially phosphorylated polyvinyl phosphate derivative (PPVP) was functionalized to extract Zirconium (IV) from Egyptian zircon sand. The specifications for the PPVP composite were approved effectively via different techniques, namely, FT-IR, XPS, BET, EDX, TGA, HNMR, C-NMR, GC-MS, XRD and ICP-OES analyses, which demonstrated a satisfactory synthesis of PPVP and zircon dissolution from Egyptian zircon sand. Factors controlling parameters, such as pH values, shaking time, initial zirconium concentration, PPVP dose, nitrate ions concentration, co-ions, temperature and eluting agents, have been optimized. At 25 ◦C, pH 0, 20 min shaking, 0.05 mol/L zirconium ions and 0.5 mol/L nitrate ions, PPVP has an exciting preservation potential of 195 mg/g, equivalent to 390 mg/L zirconium ions. From the extraction–distribution isotherm, the practical outcomes of Langmuir’s modeling are better than the Freundlich model, with a theoretical value of 196.07 mg/g, which is more in line with the experimental results of 195 mg/g. The zirconium ions adsorption onto the PPVP composite follows the pseudo-second-order kinetics with a theoretical capacity value of 204.08 mg/g. According to thermodynamic potential, the extraction process was expected to be an exothermic, spontaneous and beneficial extraction at low temperatures. The thermodynamic parameters ∆S (−0.03 kJ/mol), ∆H (−12.22 kJ/mol) and ∆G were also considered. As the temperature grows, ∆G values increase from −2.948 kJ/mol at 298 K to −1.941 kJ/mol at 338 K. Zirconium ions may be eluted from the working loaded PPVP by 0.025M HNO₃, with a 99% efficiency rate. It was found that zirconium ions revealed good separation factors towards some co-ions such as Hf⁴+ (28.82), Fe³+ (10.64), Ti⁴+ (28.82), V⁵+ (86.46) and U⁶+ (68.17). A successful alkali fusion technique with NaOH flux followed by the extraction with PPVP is used to obtain a high-purity zirconia concentrate with a zircon content of 72.77 % and a purity of 98.29%. As a result of this, the improved factors could finally be used.

Keywords: zirconium extraction, partially phosphorylated polyvinyl phosphate (PPVP), acidic medium, zircon

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Authors: Savvas Varitis, Panagiotis Kavouras, George Kaimakamis, Eleni Pavlidou, George Vourlias, Konstantinos Chrysafis, Philomela Komninou, Theodoros Karakostas

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Tannery industry produces high quantities of chromium containing waste which also have high organic content. Processing of this waste is important since the organic content is above the disposal limits and the containing trivalent chromium could be potentially oxidized to hexavalent in the environment. This work aims to fabricate new vitreous and glass ceramic materials which could incorporate the tannery waste in stabilized form either for safe disposal or for the production of useful materials. Tannery waste was incinerated at 500oC in anoxic conditions so most of the organic content would be removed and the chromium remained trivalent. Glass forming agents SiO2, Na2O and CaO were mixed with the resulting ash in different proportions with decreasing ash content. Considering the low solubility of Cr in silicate melts, the mixtures were melted at 1400oC and/or 1500oC for 2h and then casted on a refractory steel plate. The resulting vitreous products were characterized by X-Ray Diffraction (XRD), Differential Thermal Analysis (DTA), Scanning and Transmission Electron Microscopy (SEM and TEM). XRD reveals the existence of Cr2O3 (eskolaite) crystallites embedded in a glassy amorphous matrix. Such crystallites are not formed under a certain proportion of the waste in the ash-vitrified material. Reduction of the ash proportion increases chromium content in the silicate matrix. From these glassy products, glass-ceramics were produced via different regimes of thermal treatment.

Keywords: chromium containing tannery ash, glass ceramic materials, thermal processing, vitrification

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Authors: Feyza Tatar, Alime Cengiz, Dilara Sandikçi, Muhammed Dervisoglu, Talip Kahyaoglu

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Blueberries are known for their bioactive properties such as high anthocyanin contents, antioxidant activities and potential health benefits. However, anthocyanins are sensitive to environmental conditions during processes. The objective of this study was to evaluate the effects of spray drying conditions on the blueberry microcapsules by Plackett-Burman experimental design. Inlet air temperature (120 and 180°C), feed pump rate (20% and 40%), DE of maltodextrin (6 and 15 DE), coating concentration (10% and 30%) and source of blueberry (Duke and Darrow) were independent variables, tested at high (+1) and low (-1) levels. Encapsulation efficiency (based on total phenol) of blueberry microcapsules was the dependent variable. In addition, anthocyanin content, antioxidant activity, water solubility, water activity and bulk density were measured for blueberry powders. The antioxidant activity of blueberry powders ranged from 72 to 265 mmol Trolox/g and anthocyanin content was changed from 528 to 5500 mg GAE/100g. Encapsulation efficiency was significantly affected (p<0.05) by inlet air temperature and coating concentration. Encapsulation efficiency increased with increasing inlet air temperature and decreasing coating concentration. The highest encapsulation efficiency could be produced by spray drying at 180°C inlet air temperature, 40% pump rate, 6 DE of maltodextrin, 13% maltodextrin concentration and source of duke blueberry.

Keywords: blueberry, microencapsulation, Plackett-Burman design, spray drying

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Authors: Belete B. Beyene, Ayenew M. Mihirteu, Misganaw T. Ayana, Amogne W. Yibeltal

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Modification of synthetic porphyrins is one of the promising strategies in an attempt to get molecules with desired properties and applications. Here in, we report synthesis, photophysical characterization and antibacterial activity of 5, 10, 15, 20-tetrakis-(4- methoxy carbonyl phenyl) porphyrin M(II); where M = Co, Fe, Ni, Zn. Metallation of the ligand was confirmed by using UV–Vis spectroscopy and ESI-Ms measurement, in which the number of Q bands in absorption spectra of the ligand decreased from four to one or two as a result of metal insertion to the porphyrin core. The antibacterial activity study of the complexes toward two Gram-positive (Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (s. pyogenes)) and two Gram-negative (Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae)) bacteria by disc diffusion method showed a promising inhibitory activity. The complexes exhibited highest activities at highest concentration and were better than the activity of free base ligand, the salts, and blank solution. This could be explained on the basis of Overton's concept of cell permeability and Tweed's Chelation theory. An increased lipo-solubility enhances the penetration of the complexes into the lipid membrane and interferes with the normal activities of the bacteria. Our study, therefore, showed that the growth inhibitory effect of these metalloporphyrins is generally in order of ZnTPPCOOMe > NiTPPCOOMe > CoTPPCOOMe> FeTPPCOOMe, which may be attributed to the better lipophilicity and binding of the complex with the cellular components.

Keywords: porphyrins, metalloporphyrins, spectral property, antibacterial activity, synthesis

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Authors: Ahmed Ramadhan Al-Obaidi, Jassim Alhamid

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In this investigation, the flow pattern, characteristics of thermal-hydraulic, and improvement of heat transfer performance are evaluated using a numerical technique in three dimensions corrugated pipe heat exchanger. The modification was made under different corrugated pipe geometrical parameters, including corrugated ring angle (CRA), distance between corrugated ring (DBCR), and corrugated diameter (CD), the range of Re number from 2000 to 12000. The numerical results are validated with available experimental data. The numerical outcomes reveal that there is an important change in flow field behaviour and a significant increase in friction factor and improvement in heat transfer performance owing to the use of the corrugated shape in the heat exchanger pipe as compared to the conventional smooth pipe. Using corrugated pipe with different configurations makes the flow more turbulence, flow separation, boundary layer distribution, flow mixing, and that leads to augmenting the performance of heat transfer. Moreover, the value of pressure drop, and the Nusselt number increases as the corrugated pipe geometrical parameters increase. Furthermore, the corrugation configuration shapes have an important influence on the thermal evaluation performance factor, and the maximum value was more than 1.3. Numerical simulation can be performed to predict the various geometrical configurations effects on fluid flow, thermal performance, and heat transfer enhancement.

Keywords: corrugated ring angle, corrugated diameter, Nusselt number, heat transfer

Procedia PDF Downloads 143

Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

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This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

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Authors: Liudmila Garzanova, Lidia Ananyeva, Olga Koneva, Olga Ovsyannikova, Oxana Desinova, Mayya Starovoytova, Rushana Shayahmetova, Anna Khelkovskaya-Sergeeva

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Objectives. The age of the disease onset could have an impact on the effect of therapy in systemic sclerosis(SSc). Late-age onset in SSc could have a more severe course of the disease and worse clinical effects on therapy. The aim of our study was to evaluate changes in skin fibrosis on rituximab(RTX) therapy in patients with SSc and different ages of the disease onset. Methods. 151 patients with SSc were included in this study. Patients were divided into groups depending on the age of the disease onset: group 1 - younger than 30 years (40 patients(26%), group 2 - 31-59 years (90 patients(60%) and group 3 – more than 60 years (21 patients(14%). The mean follow-up period was 13±2.3month. The mean age was 48±13years, female-83% of patients, and the diffuse cutaneous subset of the disease had 52% of patients. The mean disease duration was 6.4±5years. The cumulative mean dose of RTX was 1.5±0.6grams. Patients received RTX as a therapy for interstitial lung disease. All patients received prednisone at a dose of 11.6±4.8mg/day, immunosuppressants received 48% of them. The results at baseline and at the end of the follow-up are presented in the form of mean values. Results. There was a significant decrease of modified Rodnan skin score(mRss) in all groups: in group 1 - from 10.2±8 to 7.7±6.5(p=0.01); in group 2 - from 9±7.2 to 6.2±4.7(p=0.0001); in group 3 - from 20.5±14.1 to 10.8±9.4(p=0.001). There was a significant decrease of the activity index (EScSG-AI): in group 1 from 2.5±1.8 to 1.3±1.1; in group 2 – from 3.2±1.6 to 1.5±1.2; in group 3 – from 4.2±2.1 to 1.3±1. Conclusion. There was a significant improvement in skin fibrosis in a year after initiation of RTX therapy regardless of the age of the disease onset. The improvement was more pronounced in the group with late-age onset of the disease, but these data require further investigations.

Keywords: skin fibrosis, systemic sclerosis, rituximab, disease onset

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