Search results for: cumulative trauma disorder (CTD)
975 Folliculitis Decalvans: Update
Authors: Abdullah Alyoussef
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Folliculitis decalvans is a rare inflammatory scalp disorder. This paper gives an update to patient management and treatment modalities. Folliculitis decalvans is classified as primary neutrophilic cicatricial alopecia and predominantly occurs in middle-aged adults. The cause of folliculitis decalvans (FD) remains unknown. Staphylococcus aureus and a deficient host immune response seem to play an important role in the development of this disfiguring scalp disease. Lesions occur mainly in the vertex and occipital area. Clinically, the lesions present with follicular pustules, lack of ostia, diffuse and perifollicular erythema, follicular tufting, and, oftentimes, hemorrhagic crusts and erosions. Histology displays a mainly neutrophilic inflammatory infiltrate in early lesions and additionally lymphocytes and plasma cells in advanced lesions. Treatment is focused on the eradication of S. aureus and anti-inflammatory agents. Although the etiology of FD is unclear, S. aureus is almost always isolated from affected areas, and eradication is an important part of therapeutic management, in combination with systemic and ⁄ or topical anti-inflammatory treatment.Keywords: cicatricial alopecia, folliculitis decalvans, tufted folliculitis, erosion
Procedia PDF Downloads 412974 Functional Outcome of Femoral Neck System (FNS) In the Management of Neck of Femur Fractures
Authors: Ronak Mishra, Sachin Kale
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Background: The clinical outcome of a new fixation device (femoral neck system, FNS) for femoral neck fractures is not described properly. The main purpose of this study was to evaluate the functional outcome of the patients of femoral neck fractures treated with FNS. Methods: A retrospective study was done among patients aged 60 years or less. On the basis of inclusion and exclusion criteria a final sample size of 30 was considered. Blood loss, type of fracture internal fixation, and length of clinical follow-up were all acquired from patient records. The volume of blood loss was calculated. The mean and standard deviation of continuous variables were reported (with range). Harris Hip score (HHS) And Post op xrays at intervals(6 weeks, 6 months ,12 months ) we used to clinically asses the patient. Results: Out of all 60% were females and 40% were males. The mean age of the patients was. 44.12(+-) years The comparison of functional outcomes of the patients treated with FNS using Harris Hip Score. It showed a highly significant comparison between the patients at post operatively , 6 weeks and 3 months and 12 months . There were no postoperative complications seen among the patients. Conclusion: FNS offers superior biomechanical qualities and greatly improved overall build stability. It allows for a significant reduction in operation time, potentially lowering risks and consequences associated with surgery.Keywords: FNS, trauma, hip, neck femur fracture, minimally invasive surgery
Procedia PDF Downloads 87973 Synergistic Behavior of Polymer Mixtures in Designing Hydrogels for Biomedical Applications
Authors: Maria Bercea, Monica Diana Olteanu
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Investigation of polymer systems able to change inside of the body into networks represent an attractive approach, especially when there is a minimally invasive and patient friendly administration. Pharmaceutical formulations based on Pluronic F127 [poly (oxyethylene) (PEO) blocks (70%) and poly(oxypropylene) (PPO) blocks (30%)] present an excellent potential as drug delivery systems. The use of Pluronic F127 alone as gel-forming solution is limited by some characteristics, such as poor mechanical properties, short residence time, high permeability, etc. Investigation of the interactions between the natural and synthetic polymers and surfactants in solution is a subject of great interest from both scientific and practical point of view. As for example, formulations based on Pluronics and chitosan could be used to obtain dual phase transition hydrogels responsive to temperature and pH changes. In this study, different materials were prepared by using poly(vinyl alcohol), chitosan solutions mixed with aqueous solutions of Pluronic F127. The rheological properties of different formulations were investigated in temperature sweep experiments as well as at a constant temperature of 37oC for exploring in-situ gel formation in the human body conditions. In addition, some viscometric investigations were carried out in order to understand the interactions which determine the complex behaviour of these systems. Correlation between the thermodynamic and rheological parameters and phase separation phenomena observed for the investigated systems allowed the dissemination the constitutive response of polymeric materials at different external stimuli, such as temperature and pH. The rheological investigation demonstrated that the viscoelastic moduli of the hydrogels can be tuned depending on concentration of different components as well as pH and temperature conditions and cumulative contributions can be obtained.Keywords: hydrogel, polymer mixture, stimuli responsive, biomedical applications
Procedia PDF Downloads 349972 Gc-ms Data Integrated Chemometrics for the Authentication of Vegetable Oil Brands in Minna, Niger State, Nigeria
Authors: Rasaq Bolakale Salau, Maimuna Muhammad Abubakar, Jonathan Yisa, Muhammad Tauheed Bisiriyu, Jimoh Oladejo Tijani, Alexander Ifeanyi Ajai
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Vegetables oils are widely consumed in Nigeria. This has led to competitive manufacture of various oil brands. This leads increasing tendencies for fraud, labelling misinformation and other unwholesome practices. A total of thirty samples including raw and corresponding branded samples of vegetable oils were collected. The Oils were extracted from raw ground nut, soya bean and oil palm fruits. The GC-MS data was subjected to chemometric techniques of PCA and HCA. The SOLO 8.7 version of the standalone chemometrics software developed by Eigenvector research incorporated and powered by PLS Toolbox was used. The GCMS fingerprint gave basis for discrimination as it reveals four predominant but unevenly distributed fatty acids: Hexadecanoic acid methyl ester (10.27- 45.21% PA), 9,12-octadecadienoic acid methyl ester (10.9 - 45.94% PA), 9-octadecenoic acid methyl ester (18.75 - 45.65%PA), and Eicosanoic acid methyl ester (1.19% - 6.29%PA). In PCA modelling, two PCs are retained at cumulative variance captured at 73.15%. The score plots indicated that palm oil brands are most aligned with raw palm oil. PCA loading plot reveals the signature retention times between 4.0 and 6.0 needed for quality assurance and authentication of the oils samples. They are of aromatic hydrocarbons, alcohols and aldehydes functional groups. HCA dendrogram which was modeled using Euclidian distance through Wards method, indicated co-equivalent samples. HCA revealed the pair of raw palm oil brand and palm oil brand in the closest neighbourhood (± 1.62 % A difference) based on variance weighted distance. It showed Palm olein brand to be most authentic. In conclusion, based on the GCMS data with chemometrics, the authenticity of the branded samples is ranked as: Palm oil > Soya oil > groundnut oil.Keywords: vegetable oil, authenticity, chemometrics, PCA, HCA, GC-MS
Procedia PDF Downloads 30971 Influence of Digestate Fertilization on Soil Microbial Activity, Greenhouse Gas Emissions and Yield
Authors: M. Doyeni, S. Suproniene, V. Tilvikiene
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Agricultural wastes contribute significantly to global climate change through greenhouse gas emissions if not adequately recycled and sustainably managed. A recurring agricultural waste is livestock wastes that have consistently served as feedstock for biogas systems. The objective of this study was to access the influence of digestate fertilization on soil microbial activity and greenhouse gas emissions in agricultural fields. Wheat (Triticum spp. L.) was fertilized with different types of animal wastes digestates (organic fertilizers) and mineral nitrogen (inorganic fertilizer) for three years. The 170 kg N ha⁻¹ presented in digestates were split fertilized at an application rate of 90 and 80 kg N ha⁻¹. The soil microorganism activity could be predicted significantly using the dehydrogenase activity and soil microbial biomass carbon. By combining the two different monitoring approaches, the different methods applied in this study were sensitive to enzymatic activities and organic carbon in the living component of the soil organic matter. The emissions of greenhouse gasses (carbon dioxide (CO₂), methane (CH₄), and nitrous oxide (N₂O) were monitored directly by a static chamber system. The soil and environmental variables were measured to determine their influence on greenhouse gas emissions. Emission peaks was observed in N₂O and CO₂ after the first application of fertilizers with the emissions flattening out over the cultivating season while CH₄ emission was negligible with no apparent patterns observed. Microbial biomass carbon and dehydrogenase activity were affected by the fertilized organic digestates. A significant difference was recorded between the control and the digestate treated soils for the microbial biomass carbon and dehydrogenase. Results also showed individual and cumulative emissions of CO₂, CH₄ and N₂O from the digestates were relatively low suggesting the digestate fertilization can be an efficient method for improving soil quality and reducing greenhouse gases from agricultural sources in temperate climate conditions.Keywords: greenhouse gas emission, manure digestate, soil microbial activity, yield
Procedia PDF Downloads 137970 Rethinking the Air Quality Health Index: Harmonizing Health Protection and Climate Mitigation
Authors: Kimberly Tasha Jiayi Tang, Changqing Lin, Zhe Wang, Tze-Wai Wong, Md. Shakhaoat Hossain, Jian Yu, Alexis Lau
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Hong Kong has practiced a risk-based Air Quality Health Index (AQHI) system that sums hospitalization risks associated with short-term exposure to air pollu-tants. As an air pollution risk communication tool, it informs the public about the current air quality, anchoring around the World Health Organization's (WHO) 2005 Air Quality Guidelines (AQGs). Given the WHO's recent update in 2021, assessing how Hong Kong’s air quality risk communication can be en-hanced using these updated guidelines is essential. Hong Kong’s AQHI is lim-ited by solely focusing on short-term health risks, which could lead the public to underestimate cumulative health impacts. Therefore, we propose the intro-duction of a composite AQHI that reports both long-term and short-term health risks. Additionally, the WHO interim targets will be considered as anchor points for various health risk categories. Furthermore, with the increasing ozone levels in Hong Kong and Southern China due to improved NOx mitigation measures, it has been a challenging task in balancing health protection against climate mitigation. However, our findings present a promising outlook. Despite the rise in ozone levels, the combined health risks in Hong Kong and Guang-dong have seen a decline, largely due to reductions in NO2 and PM concentra-tions, both having significant health implications. By shifting from a concentra-tion-based approach to a health risk-based system like the AQHI, our study highlights the prospective of harmonizing health protection and climate mitiga-tion goals. This health-focused framework suggests that rigorous NOx controls can effective-ly serve both objectives in parallel.Keywords: air quality management, air quality health index, health risk management, air pollution
Procedia PDF Downloads 72969 A Study of Level of Happiness in Orphans of Patna District
Authors: Riya Kartikee, Uday Shankar
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Background –.Happiness refers to a range of the balance of positive and pleasant emotions of joy, pride, contentment, gratitude, and living with ethics. Happiness is an experience combined with a sense that one’s life is good, meaningful, and worth a while, but in the context of orphans who have lost their birthgivers, their parents who play an important role in bringing necessities and comfort to them, but many terms of the above phases are missing in the life of orphan So, stress increases because of lack of love, attention, sympathy, care, they experience many kind of trauma and also in some cases their lives get worst as they face some physiological abuse, sexual abuse, they are forced to have stress at a not only mentally but physically also in the context of Patna, Bihar where many people are below poverty line, lack of resources is a normal condition for the Orphanages.AIM- The present study was intended to study the level of Happiness among the orphans of Patna District, also it was attempted to find the role of happiness in their lives as an individual.Method- The sample of 70 Orphans in the age group of 12 to 18 years were taken from the orphanages of Patna district-Apnaghar, Rainbow homes, etc. Purposive sampling was used in the study, There has been one research tool used in the study, which is Happiness scale by Dr.R.L Bhardwaj and Dr.Poonam R Das. Results- Results have revealed that Orphans have possessed a very low level of happiness and unhappiness was related due to their living conditions in the orphanage.Conclusion-It can be stated that the Level of happiness is an important missing determinant in the lives of orphans.Keywords: happiness, orphans, patna, orphanage
Procedia PDF Downloads 171968 Factors Associated with Oral Cavity Colonization by Candida albicans
Authors: Nwafia Ifeyinwa Nkeiruka, Nwafia Walter Chukwuma
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Since the early 1980’s fungi have emerged as major causes of human diseases, especially among immunocompromised. The most commonly isolated yeast is Candida albicans and constitutes the 4th most common nosocomial BSI in humans. It is progressive and cumulative and become more complex over time.It can even lead to leaky gut syndrome that causes food and environmental allergies. It is worthy of note that all the available data on oral Candida risk factors in humans were documented essentially using data from studies conducted in other areas, hence there is need for comparative and complementary information from the South eastern part of Nigeria. Method: 200 subjects of all age groups of both sexes were randomly examined,by swabbing their palatine mucosa and dorsal tongue with sterile cotton wool,then cultured into Sabouraud dextrose agar plates supplemented with antibiotics and incubated aerobically at 37 degree for 48 hrs. Identification of Candida albicans was done by germ tubes tests, chlamydospores production on cornmeal agar supplemented with 1% Tween 80.Sugar and nitrogen assimilation test using API 20C Auxanogram and potassium nitrate agar. Results: Out of 30 samples that were positive for candida, 15 (50%) were candida albicans. Using the anova test (P < 0.05) this variation is significant (P = 0016). followed by C. dublinensis 3 (13%), C. tropicalis 3 (10%), C. pseudotropicalis 3 (10%), C, glabrata 2 (7%), C. parapsilosis 2 (7%) and lastly C. krusei 1 (3%).However, 53% of the patients were female while 47% were male. Among the HIV positive isolates.67% were HIV isolates not on drugs while 33% positives isolates were on drugs and the percentages of candida species in these patients were as follows C. albicans were 45% followed by C. glabrata and C.tropicalis which were 17% each, C.parapsilosis, C.dubliensis and C.pseudotropicalis were all 8% each. Conclusion: Oral Candidiasis is a marker of systemic diseases and in some cases, it may be the first clinical presentation. There is need for more intensive clinical and laboratory monitoring and possible early intervention to prevent the reoccurrence and resistance to treatment.Keywords: oral cavity, Candida species, oral Candidiasis, risk factors
Procedia PDF Downloads 363967 Central Palmar Necrosis Following Steroid Injections for the Treatment of Carpal Tunnel Syndrome: A Case Report
Authors: M. Ridwanul Hassan, Samuel George
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Aims: Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature. Methods: We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken. Results: On examination, she had a 0.5 cmx1 cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest. She was admitted for intravenous antibiotics and underwent a debridement, washout, and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one month following her operation. Conclusions: This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.Keywords: hand surgery, complication, rare, carpal tunnel syndrome
Procedia PDF Downloads 112966 Attachment Patterns in a Sample of South African Children at Risk in Middle Childhood
Authors: Renate Gericke, Carol Long
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Despite the robust empirical support of attachment, advancement in the description and conceptualization of attachment has been slow and has not significantly advanced beyond the identification of attachment security or type (namely, secure, avoidant, ambivalent and disorganized). This has continued despite papers arguing for theoretical refinement in the classification of attachment presentations. For thinking and practice to advance, it is critically important that these categories and their assessment be interrogated in different contexts and across developmental age. To achieve this, a quantitative design was used with descriptive and inferential statistics, and general linear models were employed to analyze the data. The Attachment Story Completion Test (ASCT) was administered to 105 children between the ages of eight and twelve from socio-economically deprived contexts with high exposure to trauma. A staggering 93% of the children had insecure attachments (specifically, avoidant 37%, disorganized 34% and ambivalent 22%) and attachment was more complex than currently conceptualized in the attachment literature. Primary attachment did not only present as one of four discreet categories, but 70% of the sample had a complex attachment with more than one type of maternal attachment style. Attachment intensity also varied along a continuum (between 1 and 5). The findings have implications for a) research that has not considered the potential complexity of attachment or attachment intensity, b) policy to more actively support mother-infant dyads, particularly in high-risk contexts and c) question the applicability of a western conceptualization of a primary maternal attachment figure in non-western collectivist societies.Keywords: attachment, children at risk, middle childhood, non-western context
Procedia PDF Downloads 192965 The Efficiency of the Resin for Steel Concrete Adhesion
Authors: Oualid Benyamina Douma
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Repair is always the result of the appearance of apparent disorder or aggravation of a mass. Which had hitherto been considered minor if not negligible: The work was not done according to plan. So; the examination of causes can lead to thinking about repair. While the application of the epoxy resin has become a hot topic. In this context, we conducted an experimental campaign (48 specimens are tested beakout) whose objective is based on three points: 1- Highlight the importance and influence of important parameters (compressive strength of concrete anchorage length and diameter of the steel bar) on routes (steel-concrete and steel–concrete epoxy resin) 2- Understanding the influence of the parameters mentioned above on the relationship that may exist between the peel strength and slippage. 3- Faces of cracks and failure modes. This study shows that passage of a compressive strength of 40 MPa to 62 MPa increases the adhesion between the steel bar and concrete and for specimens with or without epoxy resin. The loading force was increased form 40 to 81 kM kN, a rate if increase in loading over 100% In addition, for specimens with and without epoxy resin. increased breakout force through a specimen without a specimen with resin ranging from 20% to 32%.Keywords: epoxy resin, peel strength, anchors, slip diameter steel rod, anchor plain concrete and concrete with moderate resistance
Procedia PDF Downloads 433964 DNA Methylation 6mA and Histone Methylation Involved in Multi-/Trans-Generational Reproductive Effects in Caenorhabditis elegans Induced by Atrazine
Authors: Jiechen Yin, Xiang Hong, Ran Liu
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Atrazine (ATR), a widely used triazine herbicide, is an environmental endocrine disruptor that can cause health problems. However, whether there are multi/trans-generational reproductive impacts of ATR have not been studied to our best knowledge. Therefore, in this study, Caenorhabditis elegans was used as a preferable model organism to identify the multi/trans-generational reproductive toxicity of ATR. L1 larvae were exposed to different concentrations (0.0004–40 mg/L) of ATR for 48 h. Successive generations (F1 to F5) were fed without ATR and consecutive exposure. The results showed that ATR exposure during P0 decreased fecundity, including a reduction in fertilized eggs, oocytes, and ovulation rate, delayed gonadal development, and decreased the relative area of the gonad arm and germ cell number. Furthermore, continuous ATR exposure (P0–F5) causes a significant increase in reproductive toxicity in subsequent generations, although no significant toxicity occurred in the P0 generation after exposure to environmental-related concentrations, suggesting that ATR exposure might have cumulative effects. Likewise, parental exposure to ATR caused transgenerational toxicity impairments. Interestingly, reproductive toxicity not development toxicity was transmitted to several generations (F1–F4), and the F2 generation showed the most notable changes. QRT-PCR results showed that genes related to DNA methylation 6mA (damt-1, nmad-1) and histone H3 methylation (mes-4, met-2, set-25, set-2, and utx-1) can also be passed on to offspring. The function of H3K4 and H3K9 methylation were explored by using loss-of-function mutants for set-2, set-25, and met-2. Transmissible reproductive toxicity was absent in met-2(n4256), set-2(ok952), and set-25(n5021) mutants, which suggests that the histone methyltransferases H3K4 and H3K9 activity are indispensable for the transgenerational effect of ATR. Finally, the downstream genes of DNA methylation and histone H3 methylation were determined. ATR upregulated the expression of ZC317.7, hsp-6, and hsp-60. Mitochondrial stress in parental generation dependent transcription 6mA modifiers may establish these epigenetic marks in progeny.Keywords: ATR, Caenorhabditis elegans, multi-/trans-generation, reproductive toxicity
Procedia PDF Downloads 71963 Experiences and Perceptions of Parents Raising Children with Autism
Authors: Tamene Keneni, Tibebu Yohannes
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The prevalence of autism spectrum disorder (ASD) in general and autism in particular is on the rise globally, and the need for evidence-based intervention and care for children with autism has grown, too. However, evidence on autism is scanty in developing countries, including Ethiopia. With the aim to help fill the gap and paucity in research into the issue, the main purpose of this study is to explore, better understand, and document the experiences and perceptions of parents of children with autism. To this end, we used a qualitative survey to collect data from a convenient sample of parents raising a child with autism. The data collected were subjected to qualitative analysis that yielded several themes and subthemes, including late diagnosis, parents’ reactions to diagnosis, sources of information during and after diagnosis, differing reactions to having a child with autism from siblings, extended family members, and the larger community, attribution of autism to several causes by the community, lack of recognition and open discussion of autism and lack of appropriated public educational and health care services for children with autism and their parents. The themes and subthemes identified were discussed in light of existing literature, and implications for practice were drawn.Keywords: ASD, autism, children with autism, raising children with autism
Procedia PDF Downloads 169962 Evaluating Language Loss Effect on Autobiographical Memory by Examining Memory Phenomenology in Bilingual Speakers
Authors: Anastasia Sorokina
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Graduate language loss or attrition has been well documented in individuals who migrate and become emersed in a different language environment. This phenomenon of first language (L1) attrition is an example of non-pathological (not due to trauma) and can manifest itself in frequent pauses, search for words, or grammatical errors. While the widely experienced loss of one’s first language might seem harmless, there is convincing evidence from the disciplines of Developmental Psychology, Bilingual Studies, and even Psychotherapy that language plays a crucial role in the memory of self. In fact, we remember, store, and share personal memories with the help of language. Dual-Coding Theory suggests that language memory code deterioration could lead to forgetting. Yet, no one has investigated a possible connection between language loss and memory. The present study aims to address this research gap by examining a corpus of 1,495 memories of Russian-English bilinguals who are on a continuum of L1 (first language) attrition. Since phenomenological properties capture how well a memory is remembered, the following descriptors were selected - vividness, ease of recall, emotional valence, personal significance, and confidence in the event. A series of linear regression statistical analyses were run to examine the possible negative effects of L1 attrition on autobiographical memory. The results revealed that L1 attrition might compromise perceived vividness and confidence in the event, which is indicative of memory deterioration. These findings suggest the importance of heritage language maintenance in immigrant communities who might be forced to assimilate as language loss might negatively affect the memory of self.Keywords: L1 attrition, autobiographical memory, language loss, memory phenomenology, dual coding
Procedia PDF Downloads 119961 Domestic Rooftop Rainwater Harvesting for Prevention of Urban Flood in the Gomti Nagar Region of Lucknow, Uttar Pradesh, India
Authors: Rajkumar Ghosh
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Urban flooding is a common occurrence throughout Asia. Almost every city is vulnerable to urban floods in some fashion, and city people are particularly vulnerable. Pluvial and fluvial flooding are the most prominent causes of urban flooding in the Gomti Nagar region of Lucknow, Uttar Pradesh, India. The pluvial flooding is regarded to be less damaging because it is caused by heavy rainfall, Seasonal rainfall fluctuations, water flows off concrete infrastructures, blockages of the drainage system, and insufficient drainage capacity or low infiltration capacity. However, this study considers pluvial flooding in Lucknow to be a significant source of cumulative damage over time, and the risks of such events are increasing as a result of changes in ageing infrastructure, hazard exposure, rapid urbanization, massive water logging and global warming. As a result, urban flooding has emerged as a critical field of study. The popularity of analytical approaches to project the spatial extent of flood dangers has skyrocketed. To address future urban flood resilience, more effort is needed to enhance both hydrodynamic models and analytical tools to simulate risks under present and forecast conditions. Proper urban planning with drainage system and ample space for high infiltration capacity are required to reduce urban flooding. A better India with no urban flooding is a pipe dream that can be realized by putting household rooftop rainwater collection systems in every structure. According to the current study, domestic RTRWHs are strongly recommended as an alternative source of water, as well as to prevent surface runoff and urban floods in this region of Lucknow, urban areas of India.Keywords: rooftop rainwater harvesting, urban flood, pluvial flooding, fluvial flooding
Procedia PDF Downloads 85960 Phytoremediation of Textile Wastewater Laden with 1,4-Dioxane Using Eichhornia crassipes: A Sustainable Development Approach
Authors: Hadeer Ibrahiem, Mahmoud Nasr, Masarrat M. M. Migahid, Mohamed A. Ghazy
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The release of textile wastewater loaded with 1,4 dioxane into aquatic ecosystems has been associated with various human health risks and adverse environmental impacts. In parallel, phytoremediation has been recently employed to treat highly polluted wastewater because various plant species tend to produce certain enzymes as a defense mechanism against a toxic environment. To our best knowledge, this study is the first to investigate the ability of phytoremediation using Eichhornia crassipes for the removal of various pollutants, including 1,4 dioxane, from textile wastewater. A phytoremediation system composed of Eichhornia crassipes was acclimatized for 10 d, and then operated in four lab-scale hydroponic systems, viz., negative control, positive control, and two different 1,4 dioxane concentration (400 and 500 mg/L). After 11 d of operation, the phytoremediation system achieved removal efficiencies of 67.5±3.4%, 89.4±4.4%, 83.6±3.8% for 1,4 dioxane (at initial concentration 400 mg/L), chemical oxygen demand (COD) (at initial concentration 679 mg/L), and cumulative heavy metals, respectively. The removal of these pollutants was mainly supported by the phyto-sorption and phytodegradation mechanisms. The economic feasibility of this phytoremediation system was validated by estimating the capital and operating costs, requiring 4.6 USD for the treatment of 1 m3 textile wastewater. The study concluded that the phytoremediation process could be used as a practical and economical approach to treat textile wastewater laden with various organic and inorganic pollutants. Due to the observed pollution reduction and human health protection, the study objectives would fulfill the targets of SDG 3 “Good Health and Well-being” and SDG 6 “Clean Water and Sanitation”. Further studies are required to (i) investigate the ability of plant species to withstand higher concentrations of 1,4 dioxane for an extended operation time and (ii) understand the biochemical pathways for the degradation of 1,4 dioxane via the action of plant enzymes and the associated microbial community.Keywords: 1, 4 dioxane concentrations, hydrophytes, Eichhornia crassipes, phytoremediation effectiveness, SDGs, textile industrial effluent
Procedia PDF Downloads 101959 Defense Mechanism Maturity and the Severity of Mood Disorder Symptoms
Authors: Maja Pandža, Sanjin Lovrić, Iva Čolak, Josipa Mandarić, Miro Klarić
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This study explores the role of symptoms related to mood disorders salience on different types of defense mechanisms (mature, neurotic, immature) predominance. Total of 177 both clinical and non-clinical participants in Mostar, Bosnia & Herzegovina, completed a battery of questionnaires associated with defense mechanisms and self-reported depression and anxiety symptoms. The sample was additionally divided into four groups, given the level of symptoms experienced: 1. minimal, 2. mild, 3. moderate, 4. severe depression/anxiety. Participants with minimal anxiety and depression symptoms use mature defense mechanisms more often than other three groups. Immature mechanisms are most commonly used by the group with severe depression/anxiety levels in comparison with other groups. These differences are discussed on the dynamic level of analysis to have a better understanding of the relationship between defense mechanisms' maturity and degree of mood disorders' symptom severity. Also, results given could serve as an implication for the psychotherapeutic treatment plans.Keywords: anxiety/depression symptoms, clinical/non-clinical sample, defense mechanism maturity, dynamic approach
Procedia PDF Downloads 457958 Mode II Fracture Toughness of Hybrid Fiber Reinforced Concrete
Authors: H. S. S Abou El-Mal, A. S. Sherbini, H. E. M. Sallam
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Mode II fracture toughness (KIIc) of fiber reinforced concrete has been widely investigated under various patterns of testing geometries. The effect of fiber type, concrete matrix properties, and testing mechanisms were extensively studied. The area of hybrid fiber addition shows a lake of reported research data. In this paper an experimental investigation of hybrid fiber embedded in high strength concrete matrix is reported. Three different types of fibers; namely steel (S), glass (G), and polypropylene (PP) fibers were mixed together in four hybridization patterns, (S/G), (S/PP), (G/PP), (S/G/PP) with constant cumulative volume fraction (Vf) of 1.5%. The concrete matrix properties were kept the same for all hybrid fiber reinforced concrete patterns. In an attempt to estimate a fairly accepted value of fracture toughness KIIc, four testing geometries and loading types are employed in this investigation. Four point shear, Brazilian notched disc, double notched cube, and double edge notched specimens are investigated in a trial to avoid the limitations and sensitivity of each test regarding geometry, size effect, constraint condition, and the crack length to specimen width ratio a/w. The addition of all hybridization patterns of fiber reduced the compressive strength and increased mode II fracture toughness in pure mode II tests. Mode II fracture toughness of concrete KIIc decreased with the increment of a/w ratio for all concretes and test geometries. Mode II fracture toughness KIIc is found to be sensitive to the hybridization patterns of fiber. The (S/PP) hybridization pattern showed higher values than all other patterns, while the (S/G/PP) showed insignificant enhancement on mode II fracture toughness (KIIc). Four point shear (4PS) test set up reflects the most reliable values of mode II fracture toughness KIIc of concrete. Mode II fracture toughness KIIc of concrete couldn’t be assumed as a real material property.Keywords: fiber reinforced concrete, Hybrid fiber, Mode II fracture toughness, testing geometry
Procedia PDF Downloads 326957 Measurement and Monitoring of Graduate Attributes via iCGPA Implementation and ACADEMIA Programming: UNIMAS Case Study
Authors: Shanti Faridah Salleh, Azzahrah Anuar, Hamimah Ujir, Rohana Sapawi, Wan Hashim Wan Ibrahim, Noraziah Abdul Wahab, Majina Sulaiman, Raudhah Ahmadi, Al-Khalid Othman, Johari Abdullah
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Integrated Cumulative Grade Point Average or iCGPA is an evaluation and reporting system that represents a comprehensive development of students’ achievement in their academic programs. Universiti Malaysia Sarawak, UNIMAS has started its implementation of iCGPA in 2016. iCGPA is driven by the Outcome-Based Education (OBE) system that has been long integrated into the higher education in Malaysia. iCGPA is not only a tool to enhance the OBE concept through constructive alignment but it is also an integrated mechanism to assist various stakeholders in making decisions or planning for program improvement. The outcome of this integrated system is the reporting of students’ academic performance in terms of cognitive (knowledge), psychomotor (skills), and affective (attitude) of which the students acquire throughout the duration of their study. The iCGPA reporting illustrates the attainment of student’s attribute in the eight domains of learning outcomes listed in the Malaysian Qualifications Framework (MQF). This paper discusses on the implementation of iCGPA in UNIMAS on the policy and strategy to direct the whole university to implement the iCGPA. The steps and challenges in integrating the exsting Outcome-Based Education and utilising iCGPA as a tool to quantify the students’ achievement are also highlighted in this paper. Finally, the ACADEMIA system, which is a dedicated centralised program ensure the implementation of iCGPA is a success has been developed. This paper discusses the structure and the analysis of ACADEMIA program and concludes the analysis made on the improvement made on the implementation of constructive alignment in all 40 programs involves in iCGPA implementation.Keywords: constructive alignment, holistic graduates, mapping of assessment, programme outcome
Procedia PDF Downloads 208956 Boko Haram Insurgence and Denial of War Crime against Civilians in the Northeast, Nigeria
Authors: Aleburu Rufus Edeki
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The activities of Boko Haram terrorist group have become worrisome in Nigeria. Boko Haram killed innocent civilians, destroyed schools, churches, military barracks, police stations, and other government establishments. The federal government of Nigerian Military engaged in counter-insurgency to curtail the activities of Boko Haram militant. The engagement of the military led to mass killing across the Northeast region. The reported cases of mass-killing led to petition written to the International Criminal Court by the civil society organization as a result of denial by the military authorities of their involvement. The investigation carried out by the International Criminal Court awash by denial of military involvement in war crimes. As a result of this denial, the ICC called for further investigation of war crimes by the military. This study was carried out among fifty-eight participants. In-depth interviews were conducted among the following participants: civilians 41; human rights commission 5 and civil society 12. This study revealed that professional ethics is associated with denial of military involvement in mass killing in the region. This study also revealed that denial is associated with personality. It was also found that social attributes such as trauma, shame, ostracism, criticism, and punishment are found with denial. It is therefore concluded in this study that protection is needed for war actors, so that situation of denial is minimal in post-conflict truth findings.Keywords: Boko Haram, crime, insurgence, war
Procedia PDF Downloads 137955 Suburban Large Residential Area Development Strategy with an Example of Liangzhu Culture Village in Hangzhou
Authors: Liang Fang
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The development of the large suburban residential area is a product of the leap development during the rapid urbanization process in China. On the process of the large-scale development of large settlements in a short time, various problems arose in the suburban residential area, such as spatial layout being disorder, basic facilities construction lagging behind and being unreasonable, residential neighborhood space and street culture missing. Aimed at the contradictions mentioned above, exploring a way is imminent to construct appropriate residential area. We select a typical Liangzhu Culture Village in Hangzhou and put forward functional composite residential area of fine development strategy, along which business promotes and assists community autonomy and then a good community culture is constructed. All in all, the development and construction mode, contributing to an all-people and full-time participation, is beneficial to create a harmonious community of sustainable development, which gives good implication to a single enterprise development city real estate projects.Keywords: community autonomy, development and construction mode, functional composite, suburban large residential area
Procedia PDF Downloads 358954 Treatments for Overcoming Dormancy of Leucaena Seeds (Leucaena leucocephala)
Authors: Tiago Valente, Erico Lima, Bruno Deminicis, Andreia Cezario, Wallacy Santos, Fabiane Brito
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Introduction: The Leucaena leucocephala known as leucaena is a perennial legume shrub of subtropical regions in which the forage shows favorable characteristics for livestock production. The objective of the study was to evaluate the influence of methods for overcoming dormancy the seeds of Leucaena leucocephala (Lam.). Materials and Methods: The number of germinated seeds was evaluated daily at the germination criterion radicle protrusion (growth, with about 2 cm long, the emerged seedlings of all). After the counting of the number of germinated seeds daily, the following characteristics were evaluated: Step 1: Germination count which represents the cumulative percentage of germinated seeds on the third day after the start of the test (Germ3); Step 2: Percentage of germinated seeds that correspond to the total percentage of seeds that germinate until the a seventh day after start of the test (Germ7); Step 3: Percentage of germinated seeds that correspond to the total percentage of seeds that germinate until the fifteenth day after start of the test (Germ15);Step 4: Germination speed index (GSI), which was calculated with number of germinated seeds to the nth observation; divided by number of days after sowing. Step 5: Total count of seeds do not germinate after 15 days (NGerm).The seed treatments were: (T1) water at 100 ºC/10 min; (T2) water at 100 ºC/1 min; (T3) Acetone (10 min); (T4) Ethyl alcohol (10 minutes); and (T5) intact seeds (control). Data were analyzed using a completely randomized design with eight replications, and it was adopted the Tukey test at 5% significance level. Results and Discussion: The treatment T1, had the highest speed of germination of seeds GSI, differed (P < 0.05). The T5 treatment (control) was the slowest response, between treatments until the seventh day after the beginning of the test (Germ7), with an amount of 20% accumulation of germinated seeds. The worst result of germination it was T5, with 30% of non-germinated seeds after 15 days of sowing. Acknowledgments: IFGoiano and CNPq (Brazil).Keywords: acetone, boiling water, germination, seed physiology
Procedia PDF Downloads 199953 The Effect of Progressive Muscle Relaxation and Sleep Hygiene Education to Change Sleep Quality Index Scores of Patient with Breast Cancer
Authors: Ika Wulansari, Yati Afiyanti, Indang Trihandini
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Sleeping disorder experienced by patients with breast cancer can affect the physical, mental, health, and well-being. This study examines the effect of progressive muscle relaxation training and sleep hygiene education to change sleep quality scores of the patient with breast cancer. The study design using quasi-experiment with pre-post test within the control group, involving 62 breast cancer patients using consecutive sampling method in Jakarta. Statistical test results with independent t-test showed a significant difference in score of sleep quality between in intervention group and the control group (6,66±3,815; 9,30±3,334, p-value = 0,005). Progressive muscle relaxation exercise and sleep hygiene education proven to be affective to change the patients sleeping quality, so that it can be an alternative therapeutic option to overcome sleeping disorders.Keywords: sleeping disorders, breast cancer, progressive muscle relaxation, sleep hygiene education
Procedia PDF Downloads 315952 Adalimumab Therapy for Inflammatory Discitis Associated with Spondyloarthropathy
Authors: Liu Yuhong, Hussen Mansai, Mei Chunli
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Inflammatory discitis is a sterile inflammatary disease that typically presents with abnormalities in two adjacent vertebral bodies and the intervening disk. Diagnosis this disorder is usually difficult and ideal management remains controversial. In this report,we examine a case of inflammatory discitis in a 56 year old female in which treatment with adalimumab ameliorated symptoms. The 56-year-old female patient developed repeatedly inflammatory discitis in the past three years, presenting with severe back pain, an elevated C-reactive protein and erythrocyte sedimentation rate, radiological erosive changes in vertebral and intervertebral disk of the spine. Surgical treatment, antibiotics and non steroidal anti-inflammatory drugs(NSAIDs) were used, but the patient still suffered from recurrent onset of unbearable backache. Three years later from the patient’s first admission,adalimumab was prescribed due to the third occurrence of Anderson lesions, which she had been suffering from for years. Soon after the same day of adalimumab therapy, her symptoms had a dramatic improvement. On the following day she could stand and walk slowly, her CRP and ESR were decreased to nearly normal levels in 4 weeks. Human leukocyte antigen (HLA)-typing analysis revealed a positive result for HLA-B27, the patient’s inflammatory discitis was considered to be associated with spondyloarthropathy.Keywords: adalimumab, inflammatory discitis, spondyloarthropathy, patient
Procedia PDF Downloads 253951 Functional Compounds Activity of Analog Rice Based on Purple Yam and Bran as Alternative Food for People with Diabetes Mellitus Type II
Authors: A. Iqbal Banauaji, Muchamad Sholikun
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Diabetes mellitus (DM) is a metabolism disorder that tends to increase its prevalence in the world, including in Indonesia. The development of DM type 2 can cause oxidative stress characterized by an imbalance between oxidants and antioxidants in the body Increased oxidative stress causes type 2 diabetes mellitus to require intake of exogenous antioxidants in large quantities to inhibit oxidative damage in the body. Bran can be defined as a functional food because it consists of 11.39% fiberand 28.7% antioxidants and the purple yam consists of anthocyanin which functions as an antioxidant. With abundant amount and low price, purple yam and bran can be used for analog rice as the effort to diversify functional food. The antioxidant’s activity of analog rice from purple yam and bran which is measured by using DPPH’s method is 12,963%. The rough fiber’s level on the analog rice from purple yam is 2.985%. The water amount of analog rice from purple yam and bran is 8.726%. Analog rice from purple yam and bran has the similar texture as the usual rice, tasted slightly sweet, light purple colored, and smelled like bran.Keywords: antioxidant, analog rice, functional food, diabetes mellitus
Procedia PDF Downloads 193950 Comparing the Quality of Electronic and Paper Do-Not-Resucscitate Forms in Hosptail
Authors: Anmol Patel
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Cardiopulmonary resuscitation is medical intervention which should be considered for all inpatients; with a patient centred approach, open communication and accurate documentation of clinical decisions. National enquiries have shown that in a significant number of cases CPR was attempted when it was considered inappropriate. In these circumstances attempting to prevent a natural death and subjecting a patient to trauma at the end of life would deprive them of a dignified death. Anticipatory “do not attempt CPR (DNACPR)” decisions aim to prevent this for those considered appropriate. As a legal document, these forms are required to be completed accurately and thoroughly. The aim of this study was to evaluate the difference in quality of DNACPR forms completed using electronic versus paper formats. A retrospective review of DNACPR forms and related documentation was completed in two District General Hospitals in South-East England, one of which uses electronic forms, while the other uses paper red forms. 50 completed forms from each hospital were analysed to assess for legibility, and quality of completion of all subsections of the form, including communications with family, relatives and the Multidisciplinary team. The hospital using paper forms showed a 40-44% rate of completion of sections relating to communication with patients and family, compared to 70% with the hospital using electronic forms. Similar trends were observed with other sections of the form. Conclusion: This study suggests that the implementation of electronic DNACPR forms significantly improves clinical practice and promotes better open communication with patients, family and the MDT.Keywords: DNACPR, resuscitation, DNAR, patient communication
Procedia PDF Downloads 78949 Brain-Derived Neurotrophic Factor and It's Precursor ProBDNF Serum Levels in Adolescents with Mood Disorders: 2-Year Follow-Up Study
Authors: M. Skibinska, A. Rajewska-Rager, M. Dmitrzak-Weglarz, N. Lepczynska, P. Sibilski, P. Kapelski, J. Pawlak, J. Twarowska-Hauser
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Introduction: Neurotrophic factors have been implicated in neuropsychiatric disorders. Brain-Derived Neurotrophic Factor (BDNF) influences neuron differentiation in development as well as synaptic plasticity and neuron survival in adulthood. BDNF is widely studied in mood disorders and has been proposed as a biomarker for depression. BDNF is synthesized as precursor protein – proBDNF. Both forms are biologically active and exert opposite effects on neurons. Aim: The aim of the study was to examine the serum levels of BDNF and proBDNF in unipolar and bipolar young patients below 24 years old during hypo/manic, depressive episodes and in remission compared to healthy control group. Methods: In a prospective 2 years follow-up study, we investigated alterations in levels of BDNF and proBDNF in 79 patients (23 males, mean age 19.08, SD 3.3 and 56 females, mean age 18.39, SD 3.28) diagnosed with mood disorders: unipolar and bipolar disorder compared with 35 healthy control subjects (7 males, mean age 20.43, SD 4.23 and 28 females, mean age 21.25, SD 2.11). Clinical characteristics including mood, comorbidity, family history, and treatment, were evaluated during control visits and clinical symptoms were rated using the Hamilton Depression Rating Scale and Young Mania Rating Scale. Serum BDNF and proBDNF concentrations were determined by Enzyme-Linked Immunosorbent Assays (ELISA) method. Serum BDNF and proBDNF levels were analysed with covariates: sex, age, age > 18 and < 18 years old, family history of affective disorders, drug-free vs. medicated status. Normality of the data was tested using Shapiro-Wilk test. Levene’s test was used to calculate homogeneity of variance. Non-parametric Tests: Mann-Whitney U test, Kruskal-Wallis ANOVA, Friedman’s ANOVA, Wilcoxon signed rank test, Spearman correlation coefficient were applied in analyses The statistical significance level was set at p < 0.05. Results: BDNF and proBDNF serum levels did not differ between patients at baseline and controls as well as comparing patients in acute episode of depression/hypo/mania at baseline and euthymia (at month 3 or 6). Comparing BDNF and proBDNF levels between patients in euthymia and control group no differences have been found. Increased BDNF level in women compared to men at baseline (p=0.01) have been observed. BDNF level at baseline was negatively correlated with depression and mania occurence at 24 month (p=0.04). BDNF level at 12 month was negatively correlated with depression and mania occurence at 12 month (p=0.01). Correlation of BDNF level with sex have been detected (p=0.01). proBDNF levels at month 3, 6 and 12 negatively correlated with disease status (p=0.02, p=0.008, p=0.009, respectively). No other correlations of BDNF and proBDNF levels with clinical and demographical variables have been detected. Discussion: Our results did not show any differences in BDNF and proBDNF levels between depression, mania, euthymia, and controls. Imbalance in BDNF/proBDNF signalling may be involved in pathogenesis of mood disorders. Further studies on larger groups are recommended. Grant was founded by National Science Center in Poland no 2011/03/D/NZ5/06146.Keywords: bipolar disorder, Brain-Derived Neurotrophic Factor (BDNF), proBDNF, unipolar depression
Procedia PDF Downloads 244948 Evaluation of P300 and CNV Changes in Patients with Essential Tremor
Authors: Sehur Sibel Ozkaynak, Zakir Koc, Ebru Barcın
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Essential tremor (ET) is one of the most common movement disorders and has long been considered a monosymptomatic disorder. While ET has traditionally been categorized as a pure motor disease, cross-sectional and longitudinal studies of cognition in ET have been demonstrated that these patients may have cognitive dysfunction. We investigated the neuro physiological aspects of cognition in ET, using event-related potentials (ERPs).Twenty patients with ET and 20 age-education and sex matched healthy controls underwent a neuro physiological evaluation. P300 components and Contingent Negative Variation (CNV) were recorded. The latencies and amplitudes of the P300 and CNV were evaluated. P200-N200 amplitude was significantly smaller in the ET group, while no differences emerged between patients and controls in P300 latencies. CNV amplitude was significantly smaller at Cz electrode site in the ET group. No differences were observed between in the two groups in CNV latencies. As a result, P300 and CNV parameters did not show significant differences between in the two groups, does not mean that there aren't mild cognitive changes in ET patients. In this regard, there is a need to further studies using electro physiological tests related to cognitive changes in ET patients.Keywords: cognition, essential tremor, event related potentials
Procedia PDF Downloads 287947 The Link between Childhood Maltreatment and Psychological Distress: The Mediation and Moderation Roles of Cognitive Distortion, Alexithymia, and Eudemonic Well-Being
Authors: Siqi Fang, Man Cheung Chung
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This study examined the inter-relationship between childhood maltreatment, cognitive distortion, alexithymia, eudemonic well-being, and psychological distress. One hundred and eighty-two university students participated in the study and completed an online survey comprising the Childhood Trauma Questionnaire, Cognitive Distortion Scale, Toronto Alexithymia Scale, Psychological Well-Being Scale, and General Health Questionnaire-28. Hierarchical multiple regression analysis showed that child maltreatment, perceptions of hopelessness and helplessness, preoccupation with danger, personal growth, and purpose in life predicted psychological distress. However, alexithymia was not a significant predictor. Further analysis using the regression models with bootstrapping procedure showed that feeling hopeless, helpless and preoccupation with danger mediated the path between child maltreatment and psychological distress. Meanwhile, coping with beliefs in personal growth and life purpose moderated the mediation effects of distorted cognition on psychological distress. To conclude, childhood maltreatment is associated with psychological distress. This relationship is influenced by people’s perceptions of life being hopeless, helpless or dangerous. At the same time, the effect of hopelessness, helplessness, and feelings of danger also depends on the degree of using coping strategies of positive psychological functioning.Keywords: alexithymia, childhood maltreatment, cognitive distortion, eudemonic well-being, psychological distress
Procedia PDF Downloads 344946 Prevalence, Median Time, and Associated Factors with the Likelihood of Initial Antidepressant Change: A Cross-Sectional Study
Authors: Nervana Elbakary, Sami Ouanes, Sadaf Riaz, Oraib Abdallah, Islam Mahran, Noriya Al-Khuzaei, Yassin Eltorki
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Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Most patients with MDD in the mental health setting have been labeled incorrectly as treatment-resistant where in fact they have not been subjected to an adequate trial of guideline-recommended therapy. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Avoiding irrational practices such as subtherapeutic doses of IAD, premature switching between the ADs, and refraining from unjustified polypharmacy can help the disease to go into a remission phase We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. This was a retrospective cross- sectional study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using two unadjusted and adjusted cox regression models. A total of 487 patients met the inclusion criteria of the study. The average age for participants was 39.1 ± 12.3 years. Patients with first experience MDD episode 255 (52%) constituted a major part of our sample comparing to the relapse group 206(42%). About 431 (88%) of the patients had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. Switching was consistently more common than combination or augmentation at any timepoint. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. Five independent variables (age, bothersome side effects, un-optimization of the dose before any change, comorbid anxiety, first onset episode) were significantly associated with the likelihood of IAD change in the unadjusted analysis. The factors statistically associated with higher hazard of IAD change in the adjusted analysis were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. The findings of this study can have direct clinical guidance for health care professionals since an optimized, evidence-based use of AD medication can improve the clinical outcomes of patients with MDD; and also, to identify high-risk factors that could worsen the survival time on IAD such as young age and comorbid anxietyKeywords: initial antidepressant, dose optimization, major depressive disorder, comorbid anxiety, combination, augmentation, switching, premature discontinuation
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