Search results for: clinical samples

Authors: Jia Xue, Frederica G. Lamar, Siyu Lin, Jennifer G. Lamori, Samendra Sherchan

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Brackish water samples from Lake Pontchartrain in Louisiana were assessed for the presence of pathogenic amoeba Naegleria fowleri, which causes primary amoebic meningoencephalitis (PAM). In our study, quantitative polymerase chain reaction (qPCR) methods were used to determine N. fowleri, E. coli, and Enterococcus in water collected from Lake Pontchartrain. A total of 158 water samples were analyzed over the 10-month sampling period. Statistically significant positive correlation between water temperature and N. fowleri concentration was observed. N. fowleri target sequence was detected at 35.4% (56/158) of the water samples from ten sites around the Lake ranged from 11.6 GC/100 ml water to 457.8 GC/100 ml water. A single factor (ANOVA) analysis shows the average concentration of N. fowleri in summer (119.8 GC/100 ml) was significantly higher than in winter (58.6 GC/100 ml) (p < 0.01). Statistically significant positive correlations were found between N. fowleri and qPCR E. coli results and N. fowleri and colilert E. coli (culture method), respectively. A weak positive correlation between E. coli and Enterococcus was observed from both qPCR (r = 0.27, p < 0.05) and culture based method (r = 0.52, p < 0.05). Meanwhile, significant positive correlation between qPCR and culture based methods for E. coli (r = 0.30, p < 0.05) and Enterococcus concentration was observed (r = 0.26, p < 0.05), respectively. Future research is needed to determine whether sediment is a source of N. fowleri found in the water column.

Keywords: brackish water, Escherichia coli, Enterococcus, Naegleria fowleri, primary amoebic meningoencephalitis (PAM), qPCR

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Authors: Spira A., Marabelle A., Kientop D., Moser E., Mumm J.

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Background: Both interleukin-2 (IL-2) and interleukin-10 (IL-10) have been extensively studied for their stimulatory function on T cells and their potential to obtain sustainable tumor control in RCC, melanoma, lung, and pancreatic cancer as monotherapy, as well as combination with PD-1 blockers, radiation, and chemotherapy. While approved, IL-2 retains significant toxicity, preventing its widespread use. The significant efforts undertaken to uncouple IL-2 toxicity from its anti-tumor function have been unsuccessful, and early phase clinical safety observed with PEGylated IL-10 was not met in a blinded Phase 3 trial. Deka Biosciences has engineered a novel molecule coupling wild-type IL-2 to a high affinity variant of Epstein Barr Viral (EBV) IL-10 via a scaffold (scFv) that binds to epidermal growth factor receptors (EGFR). This patented molecule, termed DK210 (EGFR), is retained at high levels within the tumor microenvironment for days after dosing. In addition to overlapping and non-redundant anti-tumor function, IL-10 reduces IL-2 mediated cytokine release syndrome risks and inhibits IL-2 mediated T regulatory cell proliferation. Methods: DK210 (EGFR) is being evaluated in an open-label, dose-escalation (Phase 1) study with 5 (0.025-0.3 mg/kg) monotherapy dose levels and (expansion cohorts) in combination with PD-1 blockers, or radiation or chemotherapy in patients with advanced solid tumors overexpressing EGFR. Key eligibility criteria include 1) confirmed progressive disease on at least one line of systemic treatment, 2) EGFR overexpression or amplification documented in histology reports, 3) at least a 4 week or 5 half-lives window since last treatment, and 4) excluding subjects with long QT syndrome, multiple myeloma, multiple sclerosis, myasthenia gravis or uncontrolled infectious, psychiatric, neurologic, or cancer disease. Plasma and tissue samples will be investigated for pharmacodynamic and predictive biomarkers and genetic signatures associated with IFN-gamma secretion, aiming to select subjects for treatment in Phase 2. Conclusion: Through successful coupling of wild-type IL-2 with a high affinity IL-10 and targeting directly to the tumor microenvironment, DK210 (EGFR) has the potential to harness IL-2 and IL-10’s known anti-cancer promise while reducing immunogenicity and toxicity risks enabling safe concomitant cytokine treatment with other anti-cancer modalities.

Keywords: cytokine, EGFR over expression, interleukine-2, interleukine-10, clinical trial

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Authors: Béla Kovács, Éva Bódi, Farzaneh Garousi, Szilvia Várallyay, Dávid Andrási

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For analysis of elements in different food, feed and food raw material samples generally a flame atomic absorption spectrometer (FAAS), a graphite furnace atomic absorption spectrometer (GF-AAS), an inductively coupled plasma optical emission spectrometer (ICP-OES) and an inductively coupled plasma mass spectrometer (ICP-MS) are applied. All the analytical instruments have different physical and chemical interfering effects analysing food and food raw material samples. The smaller the concentration of an analyte and the larger the concentration of the matrix the larger the interfering effects. Nowadays, it is very important to analyse growingly smaller concentrations of elements. From the above analytical instruments generally the inductively coupled plasma mass spectrometer is capable of analysing the smallest concentration of elements. The applied ICP-MS instrument has Collision Cell Technology (CCT) also. Using CCT mode certain elements have better detection limits with 1-3 magnitudes comparing to a normal ICP-MS analytical method. The CCT mode has better detection limits mainly for analysis of selenium (arsenic, germanium, vanadium, and chromium). To elaborate an analytical method for selenium with an inductively coupled plasma mass spectrometer the most important interfering effects (problems) were evaluated: 1) isobaric elemental, 2) isobaric molecular, and 3) physical interferences. Analysing food and food raw material samples an other (new) interfering effect emerged in ICP-MS, namely the effect of various matrixes having different evaporation and nebulization effectiveness, moreover having different quantity of carbon content of food, feed and food raw material samples. In our research work the effect of different water-soluble compounds furthermore the effect of various quantity of carbon content (as sample matrix) were examined on changes of intensity of selenium. So finally we could find “opportunities” to decrease the error of selenium analysis. To analyse selenium in food, feed and food raw material samples, the most appropriate inductively coupled plasma mass spectrometer is a quadrupole instrument applying a collision cell technique (CCT). The extent of interfering effect of carbon content depends on the type of compounds. The carbon content significantly affects the measured concentration (intensities) of Se, which can be corrected using internal standard (arsenic or tellurium).

Keywords: selenium, ICP-MS, food, food raw material

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Authors: P. Dubcek, B. Pivac, J. Dasovic, V. Janicki, S. Bernstorff

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When grown only to nanometric sizes, metallic particles (e.g. Ag, Au and Cu) exhibit specific optical properties caused by the presence of plasmon band. The plasmon band represents collective oscillation of the conduction electrons, and causes a narrow band absorption of light in the visible range. When the nanoparticles are embedded in a dielectric, they also cause modifications of dielectrics optical properties. This can be fine-tuned by tuning the particle size. We investigated Cu nanoparticle growth with and without surrounding dielectric (SiO2 capping layer). The morphology and crystallinity were investigated by GISAXS and GIWAXS, respectively. Samples were produced by high vacuum thermal evaporation of Cu onto monocrystalline silicon substrate held at room temperature, 100°C or 180°C. One series was in situ capped by 10nm SiO2 layer. Additionally, samples were annealed at different temperatures up to 550°C, also in high vacuum. The room temperature deposited samples annealed at lower temperatures exhibit continuous film structure: strong oscillations in the GISAXS intensity are present especially in the capped samples. At higher temperatures enhanced surface dewetting and Cu nanoparticles (nanoislands) formation partially destroy the flatness of the interface. Therefore the particle type of scattering is enhanced, while the film fringes are depleted. However, capping layer hinders particle formation, and continuous film structure is preserved up to higher annealing temperatures (visible as strong and persistent fringes in GISAXS), compared to the non- capped samples. According to GISAXS, lateral particle sizes are reduced at higher temperatures, while particle height is increasing. This is ascribed to close packing of the formed particles at lower temperatures, and GISAXS deduced sizes are partially the result of the particle agglomerate dimensions. Lateral maxima in GISAXS are an indication of good positional correlation, and the particle to particle distance is increased as the particles grow with temperature elevation. This coordination is much stronger in the capped and lower temperature deposited samples. The dewetting is much more vigorous in the non-capped sample, and since nanoparticles are formed in a range of sizes, correlation is receding both with deposition and annealing temperature. Surface topology was checked by atomic force microscopy (AFM). Capped sample's surfaces were smoother and lateral size of the surface features were larger compared to the non-capped samples. Altogether, AFM results suggest somewhat larger particles and wider size distribution, and this can be attributed to the difference in probe size. Finally, the plasmonic effect was monitored by UV-Vis reflectance spectroscopy, and relative weak plasmonic effect could be explained by uncomplete dewetting or partial interconnection of the formed particles.

Keywords: coper, GISAXS, nanoparticles, plasmonics

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Authors: Simin Khodabakhshi, Hossein Rassi

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Hyperlipidemia refers to any of several acquired or genetic disorders that result in a high level of lipids circulating in the blood. Helicobacter pylori infection is a contributing factor in the progression of hyperlipidemia with serum lipid changes. The aim of this study was to detect of Helicobacter pylori by PCR and serological methods in patients with hyperlipidemia. In this case-control study, 174 patients with hyperlipidemia and 174 healthy controls were studied. Also, demographics, physical and biochemical parameters were performed in all samples. The DNA extracted from blood specimens was amplified by H pylori cagA specific primers. The results show that H. pylori cagA positivity was detected in 79% of the hyperlipidemia and in 56% of the control group by ELISA test and 49% of the hyperlipidemia and in 24% of the control group by PCR test. Prevalence of H. pylori infection was significantly higher in hyperlipidemia as compared to controls. In addition, patients with hyperlipidemia had significantly higher values for triglyceride, total cholesterol, LDL-C, waist to hip ratio, body mass index, diastolic and systolic blood pressure and lower levels of HDL-C than control participants (all p < 0.0001). Our result detected the ELISA was a rapid and cost-effective detection and considering the high prevalence of cytotoxigenic H. pylori strains, cag A is suggested as a promising target for PCR and ELISA tests for detection of infection with toxigenic strains. In general, it can be concluded that molecular analysis of H. pylori cagA and clinical parameters are important in early detection of hyperlipidemia and atherosclerosis with H. pylori infection by PCR and ELISA tests.

Keywords: Helicobacter pylori, hyperlipidemia, PCR, ELISA

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Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

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Background: DCIS accounts for 20% of malignancies diagnosed by the breast screening programme and is primarily managed by surgical excision. There is variable guidance on defining excision margins, and adjuvant treatments vary widely. This study aimed to investigate the clinical outcomes for patients following surgical excision of small volume DCIS. Methods: This single-centreretrospective cohort study of 101 consecutive breast screened patients diagnosed with DCIS who underwent surgical excision. All patients diagnosed with DCIS had radiological abnormalities <15mm. Clinical, radiological, and histological data were collected from patients who had been diagnosed within a 5 year period, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Outcomes included re-excision rates, radiotherapy usage, and the presence of invasive cancer. Results: Breast conservation surgery was performed in 94.1% (n=95). Following surgical excision, 74(73.27%)patients had complete DCIS excision (>2mm margin), 4(4.0%) had margins 1-2mm, and 17(16.84%)had margins <1mm. The median size of DCIS in the specimen sample was 4mm. In 86% of patients with involved margins (n=18), the mammogram underestimated the DCIS size by a median of 12.5mm (range: 1-42mm). Of the patients with involved margins, 11(10.9%)had a re-excision, and 6 of these (50%) required two re-excisions to completely excise the DCIS. Post-operative radiotherapy was provided to 53(52.48%)patients. Four (3.97%) patients were found to have invasive ductal carcinoma on surgical excision, which was not present on core biopsy – all had high-grade DCIS. Recurrence of DCIS was seen in the same site during follow-up in 1 patient (1%), 1 year after their first DCIS diagnosis. Conclusion: Breast conservation surgery is safe in patients with DCIS, with low rates of re-excision, recurrence, and upstaging to invasive cancer. Furthermore, the median size of DCIS found in the specimens of patients who had DCIS fully removed in surgery was low, suggesting it may be possible that total removal through VAE was possible for these patients.

Keywords: surgical excision, breast conservation surgery, DCIS, Re-excision, radiotherapy, invasive cancer

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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Background: Medical knowledge continuously evolves and to help health care providers to stay up-to-date, evidence-based medicine (EBM) has emerged as a model. The practice of EBM requires new skills of the health care provider, including directed literature searches, the critical evaluation of research studies, and the direct application of the findings to patient care. This paper describes the integration and evaluation of an evidence-based medicine course sequence into a Physician Assistant curriculum. This course sequence teaches students to manage and use the best clinical research evidence to competently practice medicine. A survey was developed to assess the outcomes of the EBM course sequence. Methodology: The cornerstone of the three-semester sequence of EBM are interactive small group discussions that are designed to introduce students to the most clinically applicable skills to identify, manage and use the best clinical research evidence to improve the health of their patients. During the three-semester sequence, the students are assigned each semester to participate in small group discussions that are facilitated by faculty with varying background and expertise. Prior to the start of the first EBM course in the winter semester, PA students complete a knowledge-based survey that was developed by the authors to assess the effectiveness of the course series. The survey consists of 53 Likert scale questions that address the nine objectives for the course series. At the end of the three semester course series, the same survey was given to all students in the program and the results from before, and after the sequence of EBM courses are compared. Specific attention is paid to overall performance of students in the nine course objectives. Results: We find that students from the Class of 2016 and 2017 consistently improve (as measured by percent correct responses on the survey tool) after the EBM course series (Class of 2016: Pre- 62% Post- 75%; Class of 2017: Pre- 61 % Post-70%). The biggest increase in knowledge was observed in the areas of finding and evaluating the evidence, with asking concise clinical questions (Class of 2016: Pre- 61% Post- 81%; Class of 2017: Pre- 61 % Post-75%) and searching the medical database (Class of 2016: Pre- 24% Post- 65%; Class of 2017: Pre- 35 % Post-66 %). Questions requiring students to analyze, evaluate and report on the available clinical evidence regarding diagnosis showed improvement, but to a lesser extend (Class of 2016: Pre- 56% Post- 77%; Class of 2017: Pre- 56 % Post-61%). Conclusions: Outcomes identified that students did gain skills which will allow them to apply EBM principles. In addition, the outcomes of the knowledge-based survey allowed the faculty to focus on areas needing improvement, specifically the translation of best evidence into patient care. To address this area, the clinical faculty developed case scenarios that were incorporated into the lecture and discussion sessions, allowing students to better connect the research studies with patient care. Students commented that ‘class discussion and case examples’ contributed most to their learning and that ‘it was helpful to learn how to develop research questions and how to analyze studies and their significance to a potential client’. As evident by the outcomes, the EBM courses achieved the goals of the course and were well received by the students. 

Keywords: evidence-based medicine, clinical education, assessment tool, physician assistant

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Authors: Alireza Mohadesi, Ashraf Salmanipour

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A chemically modified glassy carbon electrode for electrocatalytic determination of sulfide was developed using multiwalled carbon nanotubes (MWCNTs) covalently immobilized with 2,6-dichlorophenolindophenol (DPIP). The immobilization of 2,6-dichlorophenolindophenol with MWCNTs was performed with a new synthetic strategy and characterized by UV–visible absorption spectroscopy, Fourier transform infrared spectroscopy and cyclic voltammetry. The cyclic voltammetric response of DPIP grafted onto MWCNTs indicated that it promotes the low potential, sensitive and stable determination of sulfide. The dependence of response currents on the concentration of sulfide was examined and was linear in the range of 10 - 1100 µM. The detection limit of sulfide was 5 µM and RSD for 100 and 500 µM sulfides were 1.8 and 1.3 %. Many interfering species had little or no effect on the determination of sulfide. The procedure was applied to determination of sulfide in waters samples.

Keywords: functionalized carbon nanotubes, sulfide, biological samples, 2, 6-dichlorophenolindophenol

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Authors: Majid Eslami

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Functionally graded materials (FGMs) exhibit heterogeneous microstructures in which the composition and properties gently change in specified directions. The common type of FGMs consist of a metal in which ceramic particles are distributed with a graded concentration. There are many processing routes for FGMs. An important group of these methods is casting techniques (gravity or centrifugal). However, the main problem of casting molten metal slurry with dispersed ceramic particles is a destructive chemical reaction between these two phases which deteriorates the properties of the materials. In order to overcome this problem, in the present investigation a suspension of 6061 aluminum and alumina powders in a liquid polymer was used as the starting material and subjected to centrifugal force for making FGMs. The size rang of these powders was 45-63 and 106-125 μm. The volume percent of alumina in the Al/Al2O3 powder mixture was in the range of 5 to 20%. PMMA (Plexiglas) in different concentrations (20-50 g/lit) was dissolved in toluene and used as the suspension liquid. The glass mold contaning the suspension of Al/Al2O3 powders in the mentioned liquid was rotated at 1700 rpm for different times (4-40 min) while the arm length was kept constant (10 cm) for all the experiments. After curing the polymer, burning out the binder, cold pressing and sintering , cylindrical samples (φ=22 mm h=20 mm) were produced. The density of samples before and after sintering was quantified by Archimedes method. The results indicated that by using the same sized alumina and aluminum powders particles, FGM sample can be produced by rotation times exceeding 7 min. However, by using coarse alumina and fine alumina powders the sample exhibits step concentration. On the other hand, using fine alumina and coarse alumina results in a relatively uniform concentration of Al2O3 along the sample height. These results are attributed to the effects of size and density of different powders on the centrifugal force induced on the powders during rotation. The PMMA concentration and the vol.% of alumina in the suspension did not have any considerable effect on the distribution of alumina particles in the samples. The hardness profiles along the height of samples were affected by both the alumina vol.% and porosity content. The presence of alumina particles increased the hardness while increased porosity reduced the hardness. Therefore, the hardness values did not show the expected gradient in same sample. The sintering resulted in decreased porosity for all the samples investigated.

Keywords: FGM, powder metallurgy, centrifugal method, polymeric suspension

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Authors: Sherif Sabri, Nael Samir, Mohamed Ali, Ahmed ElSakhawy

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Introduction: There is growing evidence to support the hypothesis that serum matrix metalloproteinase -9 in could be an early predictor of mortality in septic patients. Aim of the work: Study the relationship of matrix metalloproteinase 9 in patients with SIRS in comparison to septic patients in day 0 and day 2. Patients and Methods: This is a prospective observational study conducted on 40 adult critically ill patients staying more than 24 hours in ICU either surgical or medical department, El Fayoum General Hospital in the period from November 2014 to March 2015. Patients met at least two of the criteria for severe inflammatory response syndrome (SIRS). Diagnostic criteria include several clinical and laboratory findings of sepsis induced tissue hypoperfusion or organ dysfunction. Samples were grouped as drawn either at admission, or at day 2 after admission. Results: Patients were divided into two groups: The non-sepsis (SIRS) group, which included 15 (37.5%) patients with no later evidence of sepsis were enrolled as controls. The Sepsis group, which included 25 patients diagnosed to have SIRS with later evidence of sepsis with positive culture. Exploring serum level of MMP-9 in non-survivors and survivors, there was significant increase in non-survivors if compared to survivors at admission p-value 0.001 (mean value in survivors 4.4mg/dl±4.1mg/dl at admission versus mean value in non-survivors 11.9mg/dl±5.8mg/dl) and after two days of admission was also significant increase p-value 0.001 (mean value in survivors 10.9mg/dl ±9.4mg/dl versus mean value in non-survivors 22.6mg/dl±10.4). Conclusion: MMP-9 levels in septic patients have a beneficial role in ICU for high-risk stratification as it is an independent marker of mortality in severe sepsis.

Keywords: matrix metalloproteinase (MMP-9), sepsis, septic shock, systemic inflamatory response syndrome

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Authors: Elizabeth Chinyere Amadi

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Yeast (sacchoromyces cerevisiae) was isolated from the fermenting sap of raffia palm (Raphia hookeri) wine. Different concerntrations of the yeast isolate were used to produce bread samples – B, C, D, E, F containing (2, 3, 4, 5, 6) g of yeast isolate respectively, other ingredients were kept constant. Sample A, containing 2g of commercial baker yeast served as control. The proof heights, weights, volumes and specific volume of the dough and bread samples were determined. The bread samples were also subjected to sensory evaluation using a 9–point hedonic scale. Results showed that proof height increased with increased concentration of the yeast isolate; that is direct proportion. Sample B with the least concentration of the yeast isolate had the least loaf height and volume of 2.80c m and 200 cm³ respectively but exhibited the highest loaf weight of 205.50g. However, Sample A, (commercial bakers’ yeast) had the highest loaf height and volume of 5.00 cm and 400 cm³ respectively. The sensory evaluation results showed sample D compared favorably with sample A in all the organoleptic attributes-(appearance, taste, crumb texture, crust colour and overall acceptability) tested for (P< 0.05). It was recommended that 4g compressed yeast isolate per 100g flour could be used to proof dough as a substitute for commercial bakers’ yeast and produce acceptable bread loaves.

Keywords: isolation of yeast, performance evaluation of yeast, Raffia palm wine, used at different concentrations, proofing of bread dough

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Authors: Ian Marc G. Cabugsa, Zarine M. Hermita

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Phytoextraction capability of T. catappa in contaminated soils was done in the improvised greenhouse. The plant samples were planted to the soil which contained different concentrations of copper. Chelating agent EDTA was added to observe the uptake and translocation of copper in the plant samples. Results showed a significant increase of copper accumulation with the addition of EDTA at 250 and 1250 mgˑkg-1 concentration of copper in the contaminated soils (p<0.05). While translocation of copper was observed in all treatments, translocation of copper is not significantly enhanced by the addition of EDTA (p>0.05). Uptake and translocation were not directly affected the presence of EDTA. Furthermore, this study suggests that the T. catappa is not a hyperaccumulator of copper, and there is no relationship observed between the length of the plant and the copper uptake in all treatments.

Keywords: chelating agent EDTA, hyperaccumulator, phytoextraction, phytoremediation, terminalia catappa

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Authors: Ts. Lazarova, V. Tumbalev, S. Atanacova-Vladimirova, G. Ivanov, A. Naydenov, D. Kovacheva

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Methane is a major Greenhouse Gas (GHG) that accounts for 14% of the world’s total amount of GHG emissions, originating mainly from agriculture, Coal mines, land fields, wastewater and oil and gas facilities. Nowadays the problem caused by the methane emissions has been a subject of an increased concern. One of the methods for neutralization of the methane emissions is it's complete catalytic oxidation. The efforts of the researchers are focused on the development of new types of catalysts and optimizing the existing catalytic systems in order to prevent the sintering of the palladium, providing at the same time a sufficient activity at temperatures below 500oC. The aim of the present work is to prepare mixed Cu-Ag-Pd oxide catalysts supported on alumina and to test them for methane complete catalytic oxidation. Cu-Ag-Pd/Al2O3 were prepared on a γ-Al2O3 (BET surface area = 220 m2/g) by the incipient wetness method using the corresponding metal nitrates (Cu:Ag = 90:10, Cu:Pd =97:3, Cu:Ag:Pd= 87:10:3) as precursors. A second set of samples were prepared with addition of urea to the metal nitrate solutions with the above mentioned ratios assuming increased dispersivity of the catalysts. The catalyst samples were dried at 100°C for 3 hours and calcined at 550°C for 30 minutes. Catalysts samples were characterized using X-ray diffraction (XRD), low temperature adsorption of nitrogen (BET) and scanning electron microscopy (SEM). The catalytic activity tests were carried out in a continuous flow type of reactor at atmospheric pressure. The effect of catalyst aging at 500 oC for 120 h on the methane combustion activity was also investigated. The results clearly indicate the synergetic effect of Ag and Pd on the catalytic activity.

Keywords: catalysts, XRD, BET, SEM, catalytic oxidation

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Authors: Nadia A. Wassif, Bassem S. Nabawy

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This paper gives an account of the petrophysical characteristics and the petrographical descriptions of Tertiary vesicular and amygdaloidal olivine basalt samples from Wadi Wizr in the central Eastern Desert of Egypt. The petrographical studies indicated that the studied vesicular basalt is rich in calcic-plagioclase, augite and olivine in addition to numerous amounts of fine opaque minerals and vesicules filled with carbonate and quartz amygdales. The degree of oxidation and alteration of magnetite and ilmenite were discussed in details. Petrophysically, the studied samples can be grouped into two main groups; the first group of samples is amygdaloidal basalt as the second group is vesicular. The vesicular group (the permeable one) is characterized by fair to very good porosity ‘Φ’, good to very good permeability ‘k’, very low true formation factor ‘F’ and micro to ultra micropores. On the other hand, the amygdaloidal basalt group (impermeable group) is characterized by very low storage capacity properties, fair porosity, negligible permeability, medium to high true formation factor and ultra micorpores. It has been found that; the petrophysical behavior is strongly dependent on the degree of oxidation and alteration; and in particular on the rate of cooling and oxidation of the ore minerals which caused filling in the primarily produced vesicules by low temperature secondary minerals.

Keywords: vesicular, amygdaloidal, basalt, petrophysics, Egypt

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Authors: H. Fazlinejad, A. Halvaee

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In this study, characteristics of ATIG welds using ZnO flux on aluminum was investigated and compared with TIG welds. Autogenously AC-ATIG bead on plate welding was applied on Al1050 plate with a coating of ZnO as the flux. Different levels of welding current and flux layer thickness was considered to study the effect of heat input and flux quantity on ATIG welds and was compared with those of TIG welds. Geometrical investigation of the weld cross sections revealed that penetration depth of the ATIG welds with ZnO flux, was increased up to 2 times in some samples compared to the TIG welds. Optical metallographic and Scanning Electron Microscopy (SEM) observations revealed similar microstructures in TIG and ATIG welds. Composition of the ATIG welds slag was also analyzed using X-ray diffraction. In both TIG and ATIG samples, the lowest values of microhardness were observed in the HAZ.

Keywords: ATIG, active flux, weld penetration, Al 1050, ZnO

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Authors: Joshna Rani S., Ahmadi Banu

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Artificial Intelligence (AI) has a significant task to carry out in the medical care contributions of things to come. As AI, it is the essential capacity behind the advancement of accuracy medication, generally consented to be a painfully required development in care. Albeit early endeavors at giving analysis and treatment proposals have demonstrated testing, we anticipate that AI will at last dominate that area too. Given the quick propels in AI for imaging examination, it appears to be likely that most radiology, what's more, pathology pictures will be inspected eventually by a machine. Discourse and text acknowledgment are now utilized for assignments like patient correspondence and catch of clinical notes, and their utilization will increment. The best test to AI in these medical services areas isn't regardless of whether the innovations will be sufficiently skilled to be valuable, but instead guaranteeing their appropriation in day by day clinical practice. For far reaching selection to happen, AI frameworks should be affirmed by controllers, coordinated with EHR frameworks, normalized to an adequate degree that comparative items work likewise, instructed to clinicians, paid for by open or private payer associations, and refreshed over the long haul in the field. These difficulties will, at last, be survived, yet they will take any longer to do as such than it will take for the actual innovations to develop. Therefore, we hope to see restricted utilization of AI in clinical practice inside 5 years and more broad use inside 10 years. It likewise appears to be progressively evident that AI frameworks won't supplant human clinicians for a huge scope, yet rather will increase their endeavors to really focus on patients. Over the long haul, human clinicians may advance toward errands and work plans that draw on remarkably human abilities like sympathy, influence, and higher perspective mix. Maybe the lone medical services suppliers who will chance their professions over the long run might be the individuals who will not work close by AI

Keywords: artificial intellogence, health care, breast cancer, AI applications

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Authors: Mario Perez-Won, Roberto Lemus-Mondaca, Constanza Olivares-Rivera, Fernanda Marin-Monardez

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This research presents the simultaneous application of high hydrostatic pressure (HHP) and osmotic dehydration (DO) as a pretreatment to hot –air drying of jumbo squid (Dosidicus gigas) cubes. The drying time was reduced to 2 hours at 60ºC and 5 hours at 40°C as compared to the jumbo squid samples untreated. This one was due to osmotic pressure under high-pressure treatment where increased salt saturation what caused an increasing water loss. Thus, a more reduced time during convective drying was reached, and so water effective diffusion in drying would play an important role in this research. Different working conditions such as pressure (350-550 MPa), pressure time (5-10 min), salt concentration, NaCl (10 y 15%) and drying temperature (40-60ºC) were optimized according to kinetic parameters of each mathematical model. The models used for drying experimental curves were those corresponding to Weibull, Page and Logarithmic models, however, the latest one was the best fitted to the experimental data. The values for water effective diffusivity varied from 4.82 to 6.59x10-9 m2/s for the 16 curves (DO+HHP) whereas the control samples obtained a value of 1.76 and 5.16×10-9 m2/s, for 40 and 60°C, respectively. On the other hand, quality characteristics such as color, texture, non-enzymatic browning, water holding capacity (WHC) and rehydration capacity (RC) were assessed. The L* (lightness) color parameter increased, however, b * (yellowish) and a* (reddish) parameters decreased for the DO+HHP treated samples, indicating treatment prevents sample browning. The texture parameters such as hardness and elasticity decreased, but chewiness increased with treatment, which resulted in a product with a higher tenderness and less firmness compared to the untreated sample. Finally, WHC and RC values of the most treatments increased owing to a minor damage in tissue cellular compared to untreated samples. Therefore, a knowledge regarding to the drying kinetic as well as quality characteristics of dried jumbo squid samples subjected to a pretreatment of osmotic dehydration under high hydrostatic pressure is extremely important to an industrial level so that the drying process can be successful at different pretreatment conditions and/or variable processes.

Keywords: diffusion coefficient, drying process, high pressure, jumbo squid, modelling, quality aspects

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Authors: Chia-Feng Yen, Shyang-Woei Lin

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Background: In Taiwan, people with disability can obtain national social welfare services after evaluation. All subsidies and services in- kind are pronounced in People with Disabilities Rights Protection Act. The new disability eligibility determination system base on ICF has carried out five years in Taiwan. There were no systematic outcomes to discuss the relationships between the evaluation results of activity and participation functioning (AP functioning) and ratification of social services for people with disability. The decision-making of welfare resources allocation is in local government, so the ratification could be affected by resource variations in every area (local governments). The purposes of this study are to compare the ratification rate between different areas (the equity of allocation), and to understand the ratification of social services for people with disability after needs assessment stage that can help to predict the resources allocation for local governments in the further. Methods: A cross-sectional study was used, and the data came from Disability Eligibility Determination System in Taiwan between 2013/11/04-2015/01/12. All samples were evaluated by FUNDES-adult version 7th and they all above 18 years old. The samples were collected face to face by physicians and AP evaluators. Result: In the needs assessment stage, the welfare ratification rates are significant differences between these local governments for the samples with the similar impairment and AP functioning.

Keywords: allocation, activity and participation, people with disability, justice

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Authors: Madhuri S. Ghate, Rahul P. Chavhan, Shriya S. Nahar

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Learning objective: •To describe Magnetic Resonance Imaging (MRI) imaging appearances of typical and atypical uterine fibroids with emphasis on differentiating it from other similar conditions. •To classify uterine fibroids according to International Federation of Gynecology and Obstetrics (FIGO) Sub-classifications system and emphasis on its clinical significance. •To show cases with atypical imaging appearances atypical fibroids Material and methods: MRI of Pelvis had been performed in symptomatic women of child bearing age group on 1.5T and 3T MRI using T1, T2, STIR, FAT SAT, DWI sequences. Contrast was administered when degeneration was suspected. Imaging appearances of Atypical fibroids and various degenerations in fibroids were studied. Fibroids were classified using FIGO Sub-classification system. Its impact on surgical decision making and clinical outcome were also studied qualitatively. Results: Intramural fibroids were most common (14 patients), subserosal 7 patients, submucosal 5 patients . 6 patients were having multiple fibroids. 7 were having atypical fibroids. (1 hyaline degeneration, 1 cystic degeneration, 1 fatty, 1 necrosis and hemorrhage, 1 red degeneration, 1 calcification, 1 unusual large bilobed growth). Fibroids were classified using FIGO system. In uterus conservative surgeries, the lesser was the degree of myometrial invasion of fibroid, better was the fertility outcome. Conclusion: Relationship of fibroid with mucosal and serosal layers is important in the management of symptomatic fibroid cases. Risk to fertility involved in uterus conservative surgeries in women of child bearing age group depends on the extent of myometrial invasion of fibroids. FIGO system provides better insight into the degree of myometrial invasion. Knowledge about the atypical appearances of fibroids is important to avoid diagnostic confusion and untoward treatment.

Keywords: degeneration, FIGO sub-classification, MRI pelvis, uterine fibroids

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Authors: M. G. Mostafa, S. M. Helal Uddin, A. B. M. H. Haque, M. R. Hasan

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The study was carried out to understand the hydro-geochemistry and ground water quality in Rajshahi City of Bangladesh. 240 groundwater (shallow and deep tubewell) samples were collected during the year 2009-2010 covering pre-monsoon, monsoon and post-monsoon seasons and analyzed for various physico-chemical parameters including major ions. The results reveal that the groundwater was slightly acidic to neutral in nature, total hardness observed in all samples fall under hard to very hard category. The concentration of calcium, iron, manganese, arsenic and lead ions were found far above the permissible limit in most of the shallow tubewells water samples. The analysis results show that the mean concentrations of cations and anions were observed in the order: Ca > Mg > Na > K > Fe > Mn > Pb > Zn > Cu > As (total) > Cd and HCO3-> Cl-> SO42-> NO3-, respectively. The concentrations of TH, TDS, HCO3-, NO3-, Ca, Fe, Zn, Cu, Pb, and As (total) were found to be higher during post-monsoon compare to pre-monsoon, whilst K, Mg, Cd, and Cl were found higher during pre-monsoon and monsoon. Ca-HCO3 was identified as the major hydro chemical facie using piper trilinear diagram. Higher concentration of toxic metals including Fe, Mn, As and Pb were found indicating various health hazards. The results also illustrate that the rock water interaction was the major geochemical process controlling the chemistry of groundwater in the study area.

Keywords: physio-chemical parameters, groundwater, geochemistry, Rajshahi city

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Authors: Sandip Shrestha, Ann M. Donoghue, Komala Arsi, Basanta R. Wagle, Abhinav Upadhyay, Dan J. Donoghue

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Campylobacter, one of the major cause of foodborne illness worldwide, is commonly present in the intestinal tract of poultry. Many strategies are currently being investigated to reduce Campylobacter counts on commercial poultry during processing with limited success. This study investigated the efficacy of the generally recognized as safe compound, carvacrol (CR), a component of wild oregano oil as a wash treatment for reducing C. jejuni and aerobic bacteria on chicken skin. A total of two trials were conducted, and in each trial, a total of 75 skin samples (4cm × 4cm each) were randomly allocated into 5 treatment groups (0%, 0.25%, 0.5%, 1% and 2% CR). Skin samples were inoculated with a cocktail of four wild strains of C. jejuni (~ 8 log10 CFU/skin). After 30 min of attachment, inoculated skin samples were dipped in the respective treatment solution for 1 min, allowed to drip dry for 2 min and processed at 0, 8, 24 h post treatment for enumeration of C. jejuni and aerobic bacterial counts (n=5/treatment/time point). The data were analyzed by ANOVA using PROC GLM procedure of SAS 9.3. All the tested doses of CR suspension consistently reduced C. jejuni counts across all time points. The 2% CR wash was the most effective treatment and reduced C. jejuni counts by ~4 log₁₀ CFU/sample (P < 0.05). Aerobic counts were reduced for the 0.5% CR dose at 0 and 24h in Trial 1 and at 0, 8 and 24h in Trial 2. The 1 and 2% CR doses consistently reduced aerobic counts in both trials up to 2 log₁₀ CFU/skin.

Keywords: Campylobacter jejuni, carvcrol, chicken skin, postharvest

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Authors: Maja Stefanovska, Svetlana Risteska, Blagoja Samakoski, Gari Maneski, Biljana Kostadinoska

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Aim of this work is to determine the theoretical and experimental properties of filament wound glass fiber/epoxy resin composite pipes with different winding design subjected under bending. For determination of bending strength of composite samples three point bending tests were conducted according to ASTM D790 standard. Good correlation between theoretical and experimental results has been obtained, where sample No4 has shown the highest value of bending strength. All samples have demonstrated matrix cracking and fiber failure followed by layers delamination during testing. Also, it was found that smaller winding angles lead to an increase in bending stress. From presented results good merger between glass fibers and epoxy resin was confirmed by SEM analysis.

Keywords: bending properties, composite pipe, winding design, SEM

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Authors: M. Habibi

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The angular distribution of ion beam emission from the APF plasma focus device (15kV, 40μf, 115nH) filled with nitrogen gas has been examined through investigating the effect of ion beams on aluminum thin foils in different angular positions. The samples are studied in different distances from the anode end with different shots. The optimum pressure that would be obtained at the applied voltages of 12kV was 0.7 torr. The ions flux declined as the pressure inclined and the maximum ion density at 0.7 torr was about 10.26 × 1022 ions/steradian. The irradiated foils were analyzed with SEM method in order to study their surface and morphological changes. The results of the analysis showed melting and surface evaporation effects and generation of some cracks in the specimens. The result of ion patterns on the samples obtained in this study can be useful in determining ion spatial distributions on the top of anode.

Keywords: plasma focus, spatial distribution, high energy ions, ion angular distribution

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Authors: Eda Jazexhiu-Postoli, Gladiola Hoxha, Ada Simeoni, Sonila Biba

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Background Neonatal hypotonia represents a commonly encountered issue in the Neonatal Intensive Care Unit and newborn nursery. The differential diagnosis is broad, encompassing chromosome abnormalities, primary muscular dystrophies, neuropathies and inborn errors of metabolism. Aim of study Our study describes some of the main clinical features of hypotonia in newborns and presents clinical cases of neonatal hypotonia we treated in our Neonatal unit in the last 3 years. Case reports Four neonates born in our hospital presented with hypotonia after birth, one preterm newborn 35-36 weeks of gestational age and three other term newborns (38-39 weeks of gestational age). Prenatal data revealed a decrease in fetal movements in both cases. Intrapartum meconium-stained amniotic fluid was found in 75% of our hypotonic newborns. Clinical features included inability to establish effective respiratory movements and need for resuscitation in the delivery room, respiratory distress syndrome, feeding difficulties and need for oro-gastric tube feeding, dysmorphic features, hoarse voice and moderate to severe muscular hypotonia. The genetic workup revealed the diagnosis of Autosomal Recessive Congenital Myasthenic Syndrome 1-B, Sotos Syndrome, Spinal Muscular Atrophy Type 1 and Transient Hypotonia of the Newborn. Two out of four hypotonic neonates were transferred to the Pediatric Intensive Care Unit and died at the age of three to five months old. Conclusion Hypotonia is a concerning finding in neonatal care and it is suggested by decreased intrauterine fetal movements, failure to establish first breaths, respiratory distress and feeding difficulties in the neonate. Prognosis is determined by its etiology and time of diagnosis and intervention.

Keywords: hypotonic neonate, respiratory distress, feeding difficulties, fetal movements

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Authors: Naqoosh Haidry

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Objective & Goal: Enucleation of the maxillomandibular cysts will lead to the creation of post-surgical bone defects which may take more than a year for complete bone healing. The use of bone grafts is common to aid bone regeneration in large defects. The study aimed to evaluate the healing and bone formation capabilities of polymer of injectable platelet fibrin (i-PRF) and hydroxyapatite (HA) as bone graft substitute in maxilla-mandibular postsurgical defects compared to hydroxyapatite alone. The primary objective was to find out the clinical and radiological assessment of healing postoperatively and compare the outcome of both groups. Material and Methods: After surgical enucleation of 19 maxillomandibular cysts/tumors, either HA or HA+ i-PRF graft was adapted to the defect. Clinical outcome variables such as pain (VAS score), edema, and mucosal color were evaluated on postoperative days 01, 03, and 07 while radiological outcome variables such as volume of defect (cc), density of new bone (HU) on computed tomography were evaluated at 2nd and 4th month. The results obtained were tabulated and compared with the inferential analysis. Results: Clinical parameters seem to be better in the HA + i-PRF group, but the result was non-significant. Radiologically, the mean healing ratios were significantly greater in the HA + i-PRF group (63.5 ± 2.34 at 2nd month, 90.3 ± 7.32 at 4th month) compared to the HA group (57.2 ± 5.21at 2nd month, 80.8 ± 5.33 at 4th month). When comparing the mean density of new bone, there was a statistically significant difference with a mean difference of 95.2 HU more in the HA + i-PRF (623 HU ± 42.9) compared to the HA group (528 HU ± 96.5) in 2nd month. Conclusion: The polymer of i-PRF and HA prepared as the sticky bone yields faster and better bone healing in post-enucleation maxillomandibular bony defects as compared to hydroxyapatite alone based on radiological findings till four months.

Keywords: bone defect, density of new bone, hydroxyapatite, injectable platelet rich fibrin, maxillomandibular cysts, surgical defect

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Authors: Kazem Alirezalu, Javad Hesari, Zabihollah Nemati, Boukaga Farmani

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The application of natural plant extracts which are rich in promising antioxidants and antimicrobial ingredients in the production of frankfurter-type sausages addresses consumer demands for healthier, more functional meat products. The effects of olive leaves, green tea and Urtica dioica L. extracts on physicochemical, microbiological and sensory characteristic of frankfurter-type sausage were investigated during 45 days of storage at 4 °C. The results revealed that pH and phenolic compounds decreased significantly (P < 0.05) in all samples during storage. Sausages containing 500 ppm green tea extract (1.78 mg/kg) showed the lowest TBARS values compared to olive leaves (2.01 mg/kg), Urtica dioica L. (2.26 mg/kg) extracts and control (2.74 mg/kg). Plant extracts significantly (P < 0.05) reduced the count of total mesophilic bacteria, yeast and mold by at least 2 log cycles (CFU/g) than those of control samples. Sensory characteristics of texture showed no difference (P > 0.05) between sausage samples, but sausage containing Urtica dioica L. extract had the highest score regarding flavor, freshness odor, and overall acceptability. Based on the results, sausage containing plant extracts could have a significant impact on antimicrobial activity, antioxidant capacity, sensory score, and shelf life stability of frankfurter-type sausage.

Keywords: antimicrobial, antioxidant, frankfurter-type sausage, green tea, olive oil, shelf life, Urtica dioica L.

Procedia PDF Downloads 168

Authors: Megha, Diksha, Seema Rani, Balwinder Kaur, Harminder Kaur

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Fe₃O₄@SiO₂@SB functionalized magnetic nanoparticles were synthesized and used to detect heavy metal ions such as Pb²⁺, Hg²⁺, and Cd²⁺ in water. The formation of Fe₃O₄@SiO₂@SB nanocatalyst was confirmed by XRD, SEM, TEM, and IR. The simultaneous determination of analyte cations was carried out using square wave anodic stripping voltammetry (SWASV). Investigation and optimisation were done to study how experimental variables affected the performance of the modified magnetic electrode. Pb²⁺, Hg²⁺, and Cd²⁺ were successfully detected using the designed sensor in the presence of various possibly interfering ions. The recovery rate was found to be 97.5% for Pb²⁺, 96.2% for Hg²⁺, 103.5% for Cd²⁺. The electrochemical sensor was also employed to determine the presence of heavy metal ions in drinking water samples, which are well below the World Health Organization (WHO) guidelines.

Keywords: magnetic nanoparticles, heavy metal ions, electrochemical sensor, environmental water samples

Procedia PDF Downloads 54

Authors: A. Lubis, R. Widayanti, Z. Hikmah, A. Endaryanto, A. Harsono, A. Harianto, R. Etika, D. K. Handayani, M. Sampurna

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Neonatal lupus erythematous (NLE) is a rare disease marked by clinical characteristic and specific maternal autoantibody. Many cutaneous, cardiac, liver, and hematological manifestations could happen with affect of one organ or multiple. In this case, both babies were premature, low birth weight (LBW), small for gestational age (SGA) and born through caesarean section from a systemic lupus erythematous (SLE) mother. In the first case, we found a baby girl with dyspnea and grunting. Chest X ray showed respiratory distress syndrome (RDS) great I and echocardiography showed small atrial septal defect (ASD) and ventricular septal defect (VSD). She also developed anemia, thrombocytopenia, elevated C-reactive protein, hypoalbuminemia, increasing coagulation factors, hyperbilirubinemia, and positive blood culture of Klebsiella pneumonia. Anti-Ro/SSA and Anti-nRNP/sm were positive. Intravenous fluid, antibiotic, transfusion of blood, thrombocyte concentrate, and fresh frozen plasma were given. The second baby, male presented with necrotic tissue on the left ear and skin rashes, erythematous macula, athropic scarring, hyperpigmentation on all of his body with various size and facial haemorrhage. He also suffered from thrombocytopenia, mild elevated transaminase enzyme, hyperbilirubinemia, anti-Ro/SSA was positive. Intravenous fluid, methyprednisolone, intravenous immunoglobulin (IVIG), blood, and thrombocyte concentrate transfution were given. Two cases of neonatal lupus erythematous had been presented. Diagnosis based on clinical presentation and maternal auto antibody on neonate. Organ involvement in NLE can occur as single or multiple manifestations.

Keywords: neonatus lupus erythematous, maternal autoantibody, clinical characteristic, multiple organ manifestation

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Authors: Yoon Kyung Song, Seung Won Han, Sang Hyun Hwang, Do Hoon Lee

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Laboratory tests is a significant part for the diagnosis, prognosis, treatment of diseases. Blood collection is a simple process, but can be a potential cause of pre-analytical errors. Vacuum blood collection tubes used to collect and store the blood specimens is necessary for accurate test results. The purpose of this study was to validate Improve serum separator tube(SST) (Guanzhou Improve Medical Instruments Co., Ltd, China) for routine clinical chemistry laboratory testing. Blood specimens were collected from 100 volunteers in three different serum vacuum tubes (Greiner SST , Becton Dickinson SST , Improve SST). The specimens were evaluated for 16 routine chemistry tests using TBA-200FR NEO (Toshiba Medical Co. JAPAN). The results were statistically analyzed by paired t-test and Bland-Altman plot. For stability test, the initial results for each tube were compared with results of 72 hours preserved specimens. Their clinical availability was evaluated by biological Variation of Ricos data bank. Paired t-test analysis revealed that AST, ALT, K, Cl showed statistically same results but calcium (CA), phosphorus(PHOS), glucose(GLU), BUN, uric acid(UA), cholesterol(CHOL), total protein(TP), albumin(ALB), total bilirubin(TB), ALP, creatinine(CRE), sodium(NA) were different(P < 0.05) between Improve SST and Greiner SST. Also, CA, PHOS, TP, TB, AST, ALT, NA, K, Cl showed statistically the same results but GLU, BUN, UA, CHOL, ALB, ALP, CRE were different between Improve SST and Becton Dickinson SST. All statistically different cases were clinically acceptable by biological Variation of Ricos data bank. Improve SST tubes showed satisfactory results compared with Greiner SST and Becton Dickinson SST. We concluded that the tubes are acceptable for routine clinical chemistry laboratory testing.

Keywords: blood collection, Guanzhou Improve, SST, vacuum tube

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Authors: Camille Plant, Katherine McGill, Pek Ang

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Oncology patients face a host of unique challenges, which are physical, psychological and philosophical in nature. This preliminary study aimed to explore the psychiatric morbidity of oncology patients in an outpatient setting at a major public hospital in Australia. The study found that 33 patients were referred to a Psychiatrist by a Clinical Psychologist or treating Oncologist. These patients attended an outpatient Psychiatry appointment at the Calvary Mater Hospital, Newcastle, over a 7 month period (June 2017-January 2018). Of these, 45% went on to have a follow-up appointment. The Clinical Global Impressions Scale (CGI) was used to gather symptom severity scores at baseline and at follow-up. The CGI is a clinician determined instrument that provides an assessment of global functioning. It is comprised of two companion one-item measures: the CGI-Severity (CGI-S) rates mental illness severity, and the CGI-Improvement (CGI-I) rates change in condition or improvement from initiation of treatment. Patients referred to a Psychiatrist were observed to be on average in the Markedly ill approaching Severely ill range (CGI-S average of 5.5). However, those patients who attended a follow-up appointment were on average only Moderately Ill at baseline (CGI-S average of 3.9). Despite these follow patients not being severely mentally ill initially, the contact was helpful, as their CGI-S scores improved on average to the Mildly Ill range (CGI-S average of 2.8). A Mixed ANOVA revealed that there was a significant improvement in mental illness severity post-follow-up appointment (Greenhouse-Geisser .000). There was a near even proportion of males and females attending appointments (58% female), and slightly more females attended a follow-up (60% female). Males were on average more mentally ill at baseline compared to females at baseline (male average M=3.86, female average M=3.56), and males had a greater reduction in mental illness severity on average compared to females (male average M=2.71, female average 3.00). This was approaching significance (.073) and would be important to explore with a larger sample size. Change in clinical condition for follow-up patients was also recorded. It was found that more than half of patients (53%) were observed to experience Minimal improvement in attending at least one follow-up appointment. There was no change for 27% of patients, and there were no patients who were worse at follow up. As this was a preliminary study with small sample size, future research conducted could explore whether there are any significant gender differences, such as whether males experience the significantly greater reduction in symptoms of mental illness compared to females, as well as any effects of cancer stage or type on psychiatric outcomes. Future research could also investigate outcomes for those patients who concurrently access a Clinical Psychologist alongside the Psychiatrist. A limitation of the study is that the outcome measure is a brief item rating completed by the clinician.

Keywords: clinical global impressions scale, psychiatry, morbidity, oncology, outcomes, psychiatry

Procedia PDF Downloads 126