Search results for: report certification

Authors: Happy Zulu

Abstract:

Neuropsychological examination is an important way of formally assessing brain function. While there is so much documentation about the influence that some factors, such as age and education, have on neuropsychological tests (NP), not so much has been done to assess the influence that residency (rural/urban) may have. The specific objectives of this study were to establish if there is a significant difference in mean test scores on NP tests between rural and urban participants and to assess which tests on the Zambia Neurobehavioural Test Battery (ZNTB) are more affected by the participants‘ residency (rural/urban) and to determine the extent to which education, gender, and age predict test performance on NP tests for rural and urban participants. The participants (324) were drawn from both urban and rural areas of Zambia (Rural = 152 and Urban = 172). However, only 234 participants (Rural = 152 and Urban 82) were used for all the analyses in this particular study. The 234 participants were used as the actual proportion of the rural vs urban population in Zambia was 65% : 35%, respectively (CSO, 2003). The rural-urban ratio for the participants that were captured during the data collection process was 152 : 172, respectively. Thus, all the rural participants (152) were included and 90 of the 172 urban participants were randomly excluded so that the rural/urban ratio reached the desired 65% : 35 % which was the required ideal statistic for appropriate representation of the actual population in Zambia. Data on NP tests were analyzed from 234 participants, rural (N=152) reflecting 65% and urban (N=82) reflecting 35%. T-tests indicated that urban participants had superior performances in all the seven NP test domains, and all the mean differences in all these domains were found to be statistically significant. Residency had a large or moderate effect in five domains, while its effect size was small only in two of the domains. A standard multiple regression revealed that education, age and residency as predictor variables made a significant contribution to variance in performance on various domains of the ZNTB. However, the gender of participants was not a major factor in determining one‘s performance on neuropsychological tests. This particular report is part of an ongoing, larger, cutting-edge study aimed at formulating the normative data for Zambia with regard to performance on neuropsychological tests. This is necessary for appropriate, effective, and efficient assessment or diagnosis of various neurocognitive and neurobehavioural deficits that a number of people may currently be suffering from. It has been shown in this study that it is vital to make careful analyses of the variables that may be associated with one‘s performance on neuropsychological tests.

Keywords: neuropsychology, neurobehavioural, residency, Zambia

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Authors: Michelle Hartanto, Risheka Suthantirakumar

Abstract:

Introduction Staff redeployment, increased numbers of acutely unwell patients requiring resuscitation decision-making conversations, visiting restrictions, and varying guidance regarding resuscitation for patients with COVID-19 disrupted clinicians’ management of resuscitation and escalation decision-making processes. While it was generally accepted that the COVID-19 pandemic disturbed numerous aspects of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process in the United Kingdom, a process which establishes a patient’s CPR status and treatment escalation plans, the impact of the pandemic on clinicians’ attitudes towards these resuscitation and decision-making conversations was unknown. This was the first study to examine the impact of the COVID-19 pandemic on clinicians’ knowledge, skills, and attitudes towards the ReSPECT process. Methods A cross-sectional survey of clinicians at one acute teaching hospital in the UK was conducted. A questionnaire with a defined five-point Likert scale was distributed and clinicians were asked to recall their pre-pandemic views on ReSPECT and report their current views at the time of survey distribution (May 2020, end of the first COVID-19 wave in the UK). Responses were received from 171 clinicians, and self-reported views before and during the pandemic were compared. Results Clinicians reported they found managing ReSPECT conversations more challenging during the pandemic, especially when conducted over the telephone with relatives, and they experienced an increase in negative emotions before, during, and after conducting ReSPECT conversations. Our findings identified that due to the pandemic there was now a need for clinicians to receive training and support in conducting resuscitation and escalation decision-making conversations over the telephone with relatives and managing these processes.

Keywords: cardiopulmonary resuscitation, COVID-19 pandemic, DNACPR discussion, education, recommended summary plan for emergency care and treatment, resuscitation order

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Authors: Deepti Mishra, K. K Pant, Xiu Song Zhao, Muxina Konarova

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Catalytic transformation of simplest hydrocarbon methane into benzene and valuable chemicals over Mo/HZSM-5 has a great economic potential, however, it suffers serious hurdles due to the blockage in the micropores because of extensive coking at high temperature during methane dehydroaromatization (MDA). Under such conditions, it necessitates the design of micro/mesoporous ZSM-5, which has the advantages viz. uniform dispersibility of MoOx species, consequently the formation of active Mo sites in the micro/mesoporous channel and lower carbon deposition because of improved mass transfer rate within the hierarchical pores. In this study, we report a unique strategy to control the porous structures of ZSM-5 through a dual templating approach, utilizing C6 and C12 -surfactants as porogen. DFT studies were carried out to correlate the ZSM-5 framework development using the C6 and C12 surfactants with structure directing agent. The structural and morphological parameters of the synthesized ZSM-5 were explored in detail to determine the crystallinity, porosity, Si/Al ratio, particle shape, size, and acidic strength, which were further correlated with the physicochemical and catalytic properties of Mo modified HZSM-5 catalysts. After Mo incorporation, all the catalysts were tested for MDA reaction. From the activity test, it was observed that C6 surfactant-modified hierarchically porous Mo/HZSM-5(H) showed the highest benzene formation rate (1.5 μmol/gcat. s) and longer catalytic stability up to 270 min of reaction as compared to the conventional microporous Mo/HZSM-5(C). In contrary, C12 surfactant modified Mo/HZSM-5(D) is inferior towards MDA reaction (benzene formation rate: 0.5 μmol/gcat. s). We ascribed that the difference in MDA activity could be due to the hierarchically interconnected meso/microporous feature of Mo/HZSM-5(H) that precludes secondary reaction of coking from benzene and hence contributing substantial stability towards MDA reaction.

Keywords: hierarchical pores, Mo/HZSM-5, methane dehydroaromatization, coke deposition

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Authors: Syed Kamran Sami, Saqib Siddiqui

Abstract:

In recent times, flexible supercapacitors retaining high electrochemical performance and steadiness along with mechanical endurance has developed as a spring of attraction due to the exponential progress and innovations in energy storage devices. To meet the rampant increasing demand of energy storage device with the small form factor, a unique, low cost and high-performance supercapacitor with considerably higher capacitance and mechanical robustness is required to recognize their real-life applications. Here in this report, synthesis route of electrode materials with low rigidity and high charge storage performance is reported using 1D-1D hybrid structure of zinc oxide (ZnO) nanorods, and conductive polymer smeared polyvinylidene fluoride–trifluoroethylene (P(VDF–TrFE)) electrospun nanofibers. The ZnO nanorods were uniformly grown on poly (3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT: PSS) coated P(VDF-TrFE) nanofibers using hydrothermal growth to manufacture light weight, permeable electrodes for supercapacitor. The PEDOT: PSS coated P(VDF-TrFE) porous web of nanofibers act as framework with high surface area. The incorporation of ZnO nanorods further boost the specific capacitance by 59%. The symmetric device using the fabricated 1D-1D hybrid electrodes reveals fairly high areal capacitance of 1.22mF/cm² at a current density of 0.1 mA/cm² with a power density of more than 1600 W/Kg. Moreover, the fabricated electrodes show exceptional flexibility and high endurance with 90% and 76% specific capacitance retention after 1000 and 5000 cycles respectively signifying the astonishing mechanical durability and long-term stability. All the properties exhibited by the fabricated electrode make it convenient for making flexible energy storage devices with the low form factor.

Keywords: ZnO nanorods, electrospinning, mechanical endurance, flexible supercapacitor

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Authors: Oluwaseun A. Oyetade, Roelof J. Kriek

Abstract:

The development of effective catalysts for the oxygen evolution reaction (OER) is of great importance to combat energy-related concerns in the environment. Herein, we report a one-step solvothermal method employed for the fabrication of nickel selenide hybrids (NiSe-Ni₃Se₂) and a series of nickel selenide hybrid/multiwalled carbon nanotube composites (NiSe-Ni₃Se₂/MWCNT) as electrocatalysts for OER in alkaline media. The catalytic activities of these catalysts were investigated via several electrochemical characterization techniques, such as linear sweep voltammetry, chronoamperometric studies at constant potential, electrochemical surface area determination, and Tafel slope calculation, under alkaline conditions. Morphological observations demonstrated the agglomeration of non-uniform NiSe-Ni₃Se₂ microspheres around carbon nanotubes (CNTs), demonstrating the successful synthesis of NiSe-Ni₃Se₂/MWCNT nanocomposites. Among the tested electrocatalysts, the 20% NiSe-Ni₃Se₂/MWCNT nanocomposite demonstrated the highest activity, exhibiting an overpotential of 325 mV to achieve a current density of 10 mA.cm⁻² in 0.1 mol.dm⁻³ KOH solution. The NiSe-Ni₃Se₂/MWCNT nanocomposites showed improved activity toward OER compared to bare NiSe-Ni₃Se₂ hybrids and MWCNTs, exhibiting an overpotential of 528, 392 and 434 mV for 10%, 30% and 50% NiSe-Ni₃Se₂/MWCNT nanocomposites, respectively. These results compare favourably to the overpotential of noble catalysts, such as RuO₂ and IrO₂. Our results imply that the addition of MWCNTs increased the activity of NiSe-Ni₃Se₂ hybrids due to an increased number of catalytic sites, dispersion of NiSe-Ni₃Se₂ hybrid nanoparticles, and electronic conductivity of the nanocomposites. These nanocomposites also demonstrated better long-term stability compared to NiSe-Ni₃Se₂ hybrids and MWCNTs. Hence, NiSe-Ni₃Se₂/MWCNT nanocomposites possess the potential as effective electrocatalysts for OER in alkaline media.

Keywords: carbon nanotubes, electrocatalysts, nanocomposites, nickel selenide hybrids, oxygen evolution reaction

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Authors: Hoda Manafian, Stephen Holland

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Silver Springs are one of Florida's first tourist attractions. They are one of the largest artesian spring formations in the world, producing nearly 550 million gallons of crystal-clear water daily that is one of the most popular sites for water-based leisure activities. As part of managing the use of a state park, the state is interested in establishing a baseline count of number of boating users to compare this to the quality of the natural resources and environment in the park. Understanding the status of the environmental resources and also the human recreational experience is the main objective of the project. Two main goals of current study are 1) to identify the distribution of different types of watercrafts (kayak, canoe, motor boat, Jet Ski, paddleboard and pontoon). 2) To document the level of real crowdedness in the river during different seasons, months, and hours of each day based on the reliable information gained from camera versus self-reported method by tourists themselves in the past studies (the innovative achievement of this study). In line with these objectives, on-site surveys and also boat counting using a time-lapse camera at the Riverside launch was done during 12 months of 2015. 700 on-site surveys were conducted at three watercraft boat ramp sites (Rays Wayside, Riverside launch area, Ft. King Waterway) of recreational users. We used Virtualdub and ImageJ software for counting boats for meeting the first and second goals, since this two software can report even the hour of presence of watercraft in the water in addition to the number of users and the type of watercraft. The most crowded hours were between 9-11AM from February to May and kayak was the most popular watercraft. The findings of this research can make a good foundation for better management in this state park in future.

Keywords: eco-tourism, Florida state, visitors' perception, water-based recreation

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Authors: Mayada Mazher, Ahmed Moustafa, Ahmed Abdellatif

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Background: Autophagy is a eukaryotic, highly conserved catabolic process implicated in many pathophysiologies such as wound healing. Autophagy-associated genes serve as a scaffolding platform for signal transduction of macrophage polarization during the inflammatory phase of wound healing and tissue repair process. In the current study, we report a model for the interplay between autophagy-associated genes and macrophages polarization associated genes. Methods: In silico analysis was performed on 249 autophagy-related genes retrieved from the public autophagy database and gene expression data retrieved from Gene Expression Omnibus (GEO); GSE81922 and GSE69607 microarray data macrophages polarization 199 DEGS. An integrated protein-protein interaction network was constructed for autophagy and macrophage gene sets. The gene sets were then used for GO terms pathway enrichment analysis. Common transcription factors for autophagy and macrophages' polarization were identified. Finally, microRNAs enriched in both autophagy and macrophages were predicated. Results: In silico prediction of common transcription factors in DEGs macrophages and autophagy gene sets revealed a new role for the transcription factors, HOMEZ, GABPA, ELK1 and REL, that commonly regulate macrophages associated genes: IL6,IL1M, IL1B, NOS1, SOC3 and autophagy-related genes: Atg12, Rictor, Rb1cc1, Gaparab1, Atg16l1. Conclusions: Autophagy and macrophages' polarization are interdependent cellular processes, and both autophagy-related proteins and macrophages' polarization related proteins coordinate in tissue remodelling via transcription factors and microRNAs regulatory network. The current work highlights a potential new role for transcription factors HOMEZ, GABPA, ELK1 and REL in wound healing.

Keywords: autophagy related proteins, integrated network analysis, macrophages polarization M1 and M2, tissue remodelling

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Authors: Kwan-Ho Kim, Jin-Hong Park

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The multi-valued logic (MVL) circuits, which can handle more than two logic states, are one of the promising solutions to overcome the bit density limitations of conventional binary logic systems. Recently, tunneling devices such as Esaki diode and resonant tunneling diode (RTD) have been extensively explored to construct the MVL circuits. These tunneling devices present a negative differential resistance (NDR) phenomenon in which a current decreases as a voltage increases in a specific applied voltage region. Due to this non-monotonic current behavior, the tunneling devices have more than two threshold voltages, consequently enabling construction of MVL circuits. Recently, the emergence of two dimensional (2D) van der Waals (vdW) crystals has opened up the possibility to fabricate such tunneling devices easily. Owing to the defect-free surface of the 2D crystals, a very abrupt junction interface could be formed through a simple stacking process, which subsequently allowed the implementation of a high-performance tunneling device. Here, we report a vdW heterostructure based tunneling device with multiple threshold voltages, which was fabricated with black phosphorus (BP) and hafnium diselenide (HfSe₂). First, we exfoliated BP on the SiO₂ substrate and then transferred HfSe₂ on BP using dry transfer method. The BP and HfSe₂ form type-Ⅲ heterojunction so that the highly doped n+/p+ interface can be easily implemented without additional electrical or chemical doping process. Owing to high natural doping at the junction, record high peak to valley ratio (PVCR) of 16 was observed to the best our knowledge in 2D materials based NDR device. Furthermore, based on this, we first demonstrate the feasibility of the ternary latch by connecting two multi-threshold voltage devices in series.

Keywords: two dimensional van der Waals crystal, multi-valued logic, negative differential resistnace, tunneling device

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Authors: M. Medrano, M. D. M. S., L. Younes, M. D.

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Introduction: Incidence of tibial hemimelia is 1:1,000,000. Due to pre-existing case studies and literature, there is now a better understanding of the genetics, etiology and pathoanatomy of tibial hemimelia, but an underlying cause is generally unknown. This presentation aims to discuss a rare, congenital lower limb deficiency observed in a patient in order to identify potential prenatal risk factors and future considerations for the patient’s well-being. Observation: A newborn female child, born full term via spontaneous vaginal delivery after induction of labor to unaffected and non-consanguineous parents. The prenatal course was notable for limited and disjointed prenatal care as well as maternal tobacco and marijuana use, anemia of pregnancy, and inadequate weight gain. Prenatal imaging showed lower extremity deformity with the inability to visualize tibia and bilateral clubfeet in the setting of Intrauterine Growth Restriction (IUGR). The patient presented with right equino varus deformity of the foot and right knee joint deformity. Radiological imaging showed the absence of the right tibia and varus angulation of the right foot with dislocation of the tibiotalar joint. Normal femur with lateral and mild anterior displacement of a wide fibula (Weber Type VIIa). Due to the absence of the patient’s tibia and knee extensor mechanism, the patient was not a candidate for reconstructive surgery and ultimately underwent successful right knee disarticulation. Discussion and Conclusion: By utilizing a retrospective chart review of this case, possible risk factors in prenatal care may be identified and add to existing knowledge on etiology. Hopefully, a cause can be clearly identified in the future and, thus, addressed in the prenatal period. In addition, we can investigate the patient’s well-being and adjustment post-operatively to support outpatient management of an uncommon anomaly.

Keywords: Tibial hemimelia, prenatal care, pediatric orthopedics, congenital deformity

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Authors: Surachart Koyadun

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Currently, Plasmodium knowlesi malaria has spread to almost all countries in Southeast Asia. This research aimed to 1) describe the epidemiology of Plasmodium knowlesi malaria, 2) examine the clinical symptoms of P. knowlesi malaria patients 3) analyze the ecology, animal reservoir and entomology of P. knowlesi malaria. 4) summarize the diagnosis, blood parasites, and treatment of P. knowlesi malaria. The study design was a case report combined with retrospective descriptive survey research. A total of 34 study subjects were patients with a confirmed diagnosis of P. knowlesi malaria who received treatment at hospitals and vector-borne disease control units in Songkhla Province during 2021 – 2022. The results of the epidemiological study unveiled the majority of the samples were male, had a history of staying overnight in the forest before becoming sick, the source of the infection was in the forest, and the season during which they were sick was mostly summer. The average length of time from the onset of illness until receiving a blood test was 3.8 days. The average length of hospital stay was 4 days. Patients were treated with Chloroquine Phosphate, Primaquine, Artesunate, Quinine, and Dihydroartemisinin-piperaquine (40 mg DHA-320 mg PPQ). One death was seen in 34 P. knowlesi malaria patients. All remaining patients recovered and responded to treatment. All symptoms improved after drug administration. No treatment failures were found. Analyses of ecological, zoonotic and entomological data revealed an association between infected patients and forested, monkey-hosted and mosquito-transmitted areas. The recommendation from this study was that the Polymerase Chain Reaction (PCR) method should be used in conjunction with the Thick/Thin Film test and blood parasite test (Parasitaemia) for the specificity of the infection, accuracy of diagnosis, leading to treatment of disease in a timely manner and be effective in disease control.

Keywords: human malaria, Plasmodium knowlesi, zoonotic disease, diagnosis and treatment, epidemiology, ecology

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Authors: Jacinta Musyoka, Wesley Too

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Cervical cancer is the second leading cause of cancer-related deaths in Kenya and the second most common cancer among women, yet preventable following prevention strategies put in place, which includes vaccination with Human Papilloma Virus Vaccine (HPPV) among the young adolescent girls. Kenya has the highest burden of cervical cancer and the leading cause of death among women of reproductive age and is a known frequent type of cancer amongst women. This is expected to double by 2025 if the necessary steps are not taken, which include vaccinating girls between the ages of 9 and 14 and screening women. Parental decision is critical in ensuring that their daughters receive this vaccine. Hence this study sought to establish parental willingness and factors associate with the acceptability to vaccine adolescent daughters against the human papilloma virus for cervical cancer prevention in Machakos County, Eastern Region of Kenya. Method: Cross-sectional study design utilizing a mixed methods approach was used to collect data from Nguluni Health Centre in Machakos County; Matungulu sub-county, Kenya. This study targeted all parents of adolescent girls seeking health care services in the Matungulu sub-county area who were aged 18 years and above. A total of 220 parents with adolescent girls aged 10-14 years were enrolled into the study after informed consent were sought. All ethical considerations were observed. Quantitative data were analyzed using Multivariate regression analysis, and thematic analysis was used for qualitative data related to perceptions of parents on HPVV. Results, conclusions, and recommendations- ongoing. We expect to report findings and articulate contributions based on the study findings in due course before October 2022

Keywords: adolescents, human papilloma virus, kenya, parents

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Authors: Yosef Ferede Bogale

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The purpose of this study was to evaluate the degree of customer satisfaction and the variables influencing it in the instance of the Bank of Abyssinia branches in the districts of Arada and Bole in Addis Ababa. The study was carried out utilizing a mixed research approach and a descriptive and explanatory research design in Addis Ababa, the capital city of Ethiopia. Both primary and secondary data were employed in this investigation. The study's target population consisted of 1000 of the bank's most prestigious clients. With a 93% response rate, 265 respondents from both genders in the active age group had higher levels of education and work experience and were in the active age group. Customers of the case bank under consideration comprised the study's target audience. The respondents, who belonged to both gender groups, were in the active age bracket with superior levels of education and work experience. As a result, this investigation discovered that the degree of client satisfaction was assigned a medium rating. Additionally given a middling rating were the company's image practices, employee competency, technology, and service quality. Further, the results also demonstrate that corporate image, employees’ competency, technology, and service quality all positively and significantly affect customer happiness. This study found that, to varying degrees, company image, technology, competence, and high-quality financial services will all improve consumer happiness. According to this report, banks should monitor customer satisfaction and service quality at least twice a year. This is because there is a growing movement among bank service providers for accountability, and measuring these factors is crucial. This study also recommends that banks make every effort to satisfy consumers' expectations to the highest level.

Keywords: customer satisfaction, corporate image, quality service risk, banks

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Authors: Swapnil A. Padvi, Dipak S. Dalal

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The chemistry of tetrazoles has been grown tremendously in the past few years because tetrazoles are important and useful class of heterocyclic compounds which have a widespread application such as anticancer, antimicrobial, analgesics, antibacterial, antifungal, antihypertensive, and anti-allergic drugs in medicinal chemistry. Furthermore, tetrazoles have application in material sciences as explosives, rocket propellants, and in information recording systems. In addition to this, they have a wide range of application in coordination chemistry as a ligand. Deep eutectic solvents (DES) have emerged over the current decade as a novel class of green reaction media and applied in various fields of sciences because of their unique physical and chemical properties similar to the ionic liquids such as low vapor pressure, non-volatility, high thermal stability and recyclability. In addition, the reactants of DES are cheaply available, low-toxic, and biodegradable, which makes them predominantly required for large-scale applications effectively in industrial production. Herein we report the [2+3] cycloaddition reaction of organic nitriles with sodium azide affords the corresponding 5-substituted 1H-tetrazoles in six different types of choline chloride based deep eutectic solvents under mild reaction condition. Choline chloride: ZnCl2 (1:2) showed the best results for the synthesis of 5-substituted 1 H-tetrazoles. This method reduces the disadvantages such as: the use of toxic metals and expensive reagents, drastic reaction conditions and the presence of dangerous hydrazoic acid. The approach provides environment-friendly, short reaction times, good to excellent yields; safe process and simple workup make this method an attractive and useful contribution to present green organic synthesis of 5-substituted-1H-tetrazoles. All synthesized compounds were characterized by IR, 1H NMR, 13C NMR and Mass spectroscopy. DES can be recovered and reused three times with very little loss in activity.

Keywords: click chemistry, choline chloride, green chemistry, deep eutectic solvent, tetrazoles

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Authors: Dovilė Bačėninaitė, Karina Džermeikaitė, Justinas Kirvela, Ramūnas Antanaitis

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Bacteria are often present in the mouth of cattle. Some of them can cause abscesses. Starting with severe swelling of the mouth, muscle spasm, or locked jaw, it can lead to inability to open its mouth, move the neck, cause pain while eating. While the calf is unable to eat properly, it becomes more susceptible to infectious diseases, lower weight gain can be observed. Abscesses can be considered as a continuum of oral disease, whereby early stages of the lumpy jaw could proceed from gingivitis to periodontal disease. In the event of tissue damage, bacteria can enter the bloodstream, even cause sepsis. The most common lesions occur when animals eat sharp grass, coarse fodder, sharp, piercing foreign bodies (this is especially common for calves when they are trying to eat inedible objects). A crossbred Holstein calf presented with a history of proliferative outgrowth in the mandibular region. On clinical examination, needle aspiration, mandibular swelling revealed sticky, white curd-like fluid containing. Pus bacteriology revealed gram-negative cocci. They were sensitive to amoxicillin, cephalexin, enrofloxacin, ceftiofur. Blood morphology was in physiological ranges. The calf was treated surgically. The growth was excised, the puss drained and the wound was flushed with potassium permanganate solution (0,01%). A week after clinical surgery examination was performed. The swelling was decreased. Superficial bacterial infections are often associated with poor hygiene, which should be improved before treatment is commenced. Clipping away dirty hair and gently washing affected areas of skin daily with solutions such as povidone-iodine, potassium permanganate is effective. Appropriate antibiotic therapy, based on sensitivity testing, may be used where there is evidence of systemic illness.

Keywords: calf, abscess, lumpy jaw, pus, Streptococcus, Staphylococcus, Actinobacillus, infection

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Authors: Ademola Azeez

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Background: This study is a two year review of requests pattern for Prostate Specific Antigen (PSA), in a Nigerian tertiary health care institution. Prostate specific antigen was first described about 44 years ago but is still in use today for, diagnosis, monitoring, screening and prognosis of prostatic carcinoma though not-very specific as was widely believed. Prostate cancer is an increasingly important public health problem among adult men worldwide. Nigeria, which was formerly regarded as a low-incidence area by several authors is now witnessing a steep rise in the occurrence of this disease. This has been suggested to be due to increasing availability of screening tests and diagnostic facilities and not necessarily because of increased incidence of the diseases. Many notable Nigerians have died due to this dreaded disease. Methods: All plasma samples for PSA from January 2021-December 2022 were analyzed weekly by abbot autoanalyser, chemiluminescence assay method. Bio-data from request form were collated and analyzed. A total of 385 requests were received for the period under review. Result: There was an increase of request from inception to the last year of review. Smoked food, consumption of local herb and alcohol in order of importance, respectively, appears to be prominent factor in patient requested for PSA. The mean age was 67.years; the youngest was 29, while the oldest was 93years. Age 70 has the highest frequency of 8.5% .Mean PSA was 12.9ng/ml. There was a positive correlation between age and PSA (R=0.255, P < 0.05).Significant increase in PSA with age were reported. Men who retired from active jobs constitute the highest request for PSA test. Conclusion: There was an increasing trend in the proportion of requests with values outside the reference interval especially in patients diagnosed of benign prostatic hyperplasia, prostate cancer, while some routine test for PSA were elevated for the first time .This is in line with earlier report of increasing incidence of prostate cancer in Nigeria despite the increasing knowledge of healthy lifestyle.

Keywords: pattern, PSA, tertiary institution, Nigeria

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Authors: Victor Birikorang Danquah

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Ghana's primary energy supply is heavily reliant on petroleum, biomass, and hydropower. Currently, Ghana gets its energy from hydropower (Akosombo and Bui), thermal power plants powered by crude oil, natural gas, and diesel, solar power, and imports from La Cote d'Ivoire. Until the early 2000s, large hydroelectric dams dominated Ghana's electricity generation. Due to unreliable weather patterns, Ghana increased its reliance on thermal power. However, thermal power contributes the highest percentage in terms of electricity generation in Ghana and is predominantly supplied by Independent Power Producers (IPPs). Ghana's electricity industry operates the corporate utility model as its business model. This model is typically' vertically integrated,' with a single corporation selling the majority of power generated by its generation assets to its retail business, which then sells the electricity to retail market consumers. The corporate utility model has a straightforward value proposition that is based on increasing the number of energy units sold. The unit volume business model drives the entire energy value chain to increase throughput, locking system users into unsustainable practices. This report uses the qualitative research approach to explore the electricity industry in Ghana. There is a need for increasing renewable energy, such as wind and solar, in electricity generation. The research recommends two critical business models for the penetration of renewable energy in Ghana's power sector. The first model is the peer-to-peer electricity trading model, which relies on a software platform to connect consumers and generators in order for them to trade energy directly with one another. The second model is about encouraging local energy generation, incentivizing optimal time-of-use behaviour, and allowing any financial gains to be shared among the community members.

Keywords: business model innovation, electricity generation, renewable energy, solar energy, sustainability, wind energy

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Authors: Yosef Ferede Bogale

Abstract:

The purpose of this study was to evaluate the degree of customer satisfaction and the variables influencing it in the instance of the Bank of Abyssinia branches in the districts of Arada and Bole in Addis Ababa. The study was carried out utilizing a mixed research approach and a descriptive and explanatory research design in Addis Ababa, the capital city of Ethiopia. Both primary and secondary data were employed in this investigation. The study's target population consisted of 1000 of the bank's most prestigious clients. With a 93% response rate, 265 respondents from both genders in the active age group had higher levels of education and work experience and were in the active age group. Customers of the case bank under consideration comprised the study's target audience. The respondents, who belonged to both gender groups, were in the active age bracket with superior levels of education and work experience. As a result, this investigation discovered that the degree of client satisfaction was assigned a medium rating. Additionally given a middling rating were the company's image practices, employee competency, technology, and service quality. Further, the results also demonstrate that corporate image, employees’ competency, technology, and service quality all positively and significantly affect customer happiness. This study found that, to varying degrees, company image, technology, competence, and high-quality financial services will all improve consumer happiness. According to this report, banks should monitor customer satisfaction and service quality at least twice a year. This is because there is a growing movement among bank service providers for accountability, and measuring these factors is crucial. This study also recommends that banks make every effort to satisfy consumers' expectations to the highest level.

Keywords: customer satisfaction, corporate image, quality services risk, bank

Procedia PDF Downloads 62

Authors: Hakan Akgul

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Purpose: The use of firecrackers (i.e., Ramadan Cannon) during the month of Ramadan is a traditional way of indicating that the fasting period is over in Muslim countries. Here, we report the rehabilitation of a case of hand injury with pluridigital fractures due to premature explosion of a Ramadan cannon. Materials and Methods: A 48-year old man admitted to the Emergency Department due to left hand injury as a result of a premature explosion of a Ramadan cannon. The patient was immediately taken to operation room because of the multiple fractures, tendon loss, and soft tissue loss in the left hand. Range of motion (ROM) of joints was measured with goniometer, pain and oedema were measured and splinting was performed. Results: Rehabilitation team took over the patient at postoperative 9th week. During the 3 month rehabilitation, range of motion increased, oedema was taken under control, pain was reduced, the colour of the skin turned to the normal tone. According to the visual analog scale (VAS), pain decreased from 9 to 4. Oedema, around the metacarpofalangeal (MCP) joints, decreased from 27,5 cm to 23,5 cm. Total active range of motion of the wrist increased from 5 degrees to 50 degrees.Total active range of motion of supination and pronation increased from 55 degrees to 70 degrees. Discussion: The rehabilitation of multiple hand injury is quite difficult. Different aspects of trauma should be taken into consideration when rehabilitation is planned. Factors such as waiting for the bone union, wound healing, and use of external fixators may delay rehabilitation process. Joint mobilization, massage for reducing oedema and preventing scar tissue, exercise within the range of motion are efficient measures. Poor patient compliance to treatment may lead to poor outcome. First of all, oedema and scar formation must be taken under control. Removing fixators should not be delayed depending on the bone union, and exercise within the range of motion should be started.

Keywords: explosion, fracture, hand, injury

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Authors: Khaled Mawardi

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Bay laurel (Laurus nobilis L.) is an evergreen of the Laurus genus of the Lauraceae Family. It is a plant native to the southern Mediterranean and widespread in Syria. It is a plant with enormous industrial applications. For instance, they are used as platform chemicals in food, pharmaceutical and cosmetic applications. Herein, we report an efficient extraction of Bay laurel oil from Bay laurel fruits via a comparative investigation of boiled water conventional extraction technique and microwave-assisted extraction (MAE) by microwave heating at atmospheric pressure. In order to optimize the extraction efficiency, we investigated several extraction parameters, such as extraction time and microwave power. In addition, to demonstrate the feasibility of the method, oil obtained under optimal conditions by method (MAE) was compared quantitatively and qualitatively with that obtained by the conventional method. After 1h of microwave-assisted extraction (power of 600W), an oil yield of 9.8% with identified lauric acid content of 22.7%. In comparison, an extended extraction of up to 4h was required to obtain a 9.7% yield of oil extraction with 21.2% of lauric acid content. The change in microwave power impacts the fatty acids profile and also the quality parameters of Laurel Oil. It was found that the profile of fatty acids changed with the power, where the lauric acid content increased from 22.7% at 600W to 30.5% at 1200W owing to a decrease of oleic acid content from 32.8% at 600W to 28.3% at 1200W and linoleic acid content from 22.3% at 600W to 20.6% at 1200W. In addition, we observed a decrease in oil yield from 9.8% at 600W to 5.1% at 1200W. Summarily, the overall results indicated that the extraction of laurel fruit oils could be successfully performed using (MAE) at a short extraction time and lower energy compared with the fixed oil obtained by conventional processes of extraction. Microwave heating exerted more aggressive effects on the oil. Indeed, microwave heating inflicted changes in the fatty acids profile of oil; the most affected fraction was the unsaturated fatty acids, with higher susceptibility to oxidation.

Keywords: microwaves, extraction, Laurel oil, solvent-free

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Authors: Yu-Sheng Lin, Sheng-Teng Huang

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In recent years, the issue of corporate social responsibility has become an enthusiastic discussion and hottest issue around the world. To make the enterprises be sustainable management and sustainable development, more and more enterprises realize that fulfill its corporate social responsibility is the good choice. It is an essential, important issue that the leader needs know how to lead the staff in balance benefit, also emphasize on economic, social and environmental aspects to impact the company, then enhance the consensus. The leader needs to improve cohesion of personnel, and implement the corporate social responsibility in staff behavior, in order to show a performance in the effort of corporate social responsibility of enterprises. The previous literature mostly is committed to comparison of corporate social responsibility in the industry and service industry, regarding to literature of shipping companies were relatively rare. This paper aims to take the domestic and foreign shipping companies of corporate social responsibility reports as the data analysis, and refer to the international convention (GRI) such as association and organization of CSR standard values. Overall comparison with shipping companies of CSR reports, annual reports and other public information, and taking Taiwan shipping companies as the target, respectively, with the international conventions and the world's top ten leading shipping companies to do the comparison and analysis. Shipping companies in Taiwan are bound to the standard that set by the international convention for the first goal diligently and following step is contend with the world's top ten leading shipping companies. There are 3 ~ 5 experts to be involved in interview after the result is completed. They will indicate the superiority and inferiority then provide the opinion, recommendation in the needed action. Through this study, we can explore the importance of corporate social responsibility report for shipping companies, and also provide the clear orientation to external providers to improve corporate social responsibility. In addition, it can provide the academic research and business experts as a reference; finally, serving shipping companies to complete another contribution.

Keywords: Corporate social responsibility (CSR), CSR reports, statistical methods, expert interview method

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Authors: Kristin Lewis, Howard Steele, Anne Murphy, Miriam Steele, Karen Bonuck, Paul Meissner

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The present study examines data collected during the randomized control trial (RCT) of the Group Attachment-Based Intervention (GABI©), a trauma-informed, attachment-based intervention aimed at promoting healthy parent-child relationships that support child development. Families received treatment at Treatment Center and were randomly assigned to either the GABI condition or the treatment as usual condition, a parenting class called Systematic Training for Effective Parenting (STEP). Significant improvements in the parent-child relationship have been reported for families participating in GABI, but not in the STEP control group relying on Coding Interactive Behavior (CIB) as applied to 5-minute video-films of mothers and their toddlers in a free play context. This report considers five additional attachment-relevant 'clinical codes' that were also applied to the 5-minute free play sessions. Seventy-two parent-child dyads (38 in GABI and 34 in STEP) were compared to one another at intake and end-of-treatment, on these five-point dimensions: two-parent codes—the dissociation and ignoring; two child codes—simultaneous display of contradictory behavior and fear; and one parent-child code, i.e., role reversal. Overall, scores were low for these clinical codes; thus, a binary measure was computed contrasting no evidence with some evidence of each clinical code. Crosstab analyses indicate that child fear at end-of-treatment was significantly lower among children who participated in GABI (7% or 3 children) as compared to those whose mothers participated in STEP (29% or 10 children) Chi Sq= 6.57 (1), p < .01. Discussion focuses on the potential for GABI to reduce childhood fearfulness and so enhance the child's health.

Keywords: coding interactive behavior, clinical codes, group attachment based intervention, GABI, attachment, fear

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Authors: Vahid Ramezankhani, Keith J. Stevenson, Stanislav. S. Fedotov

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Lithium-ion batteries (LIBs) play a pivotal role in achieving the key objective “zero-carbon emission” as countries agreed to reach a 1.5ᵒC global warming target according to the Paris agreement. Nowadays, due to the tremendous mobile and stationary consumption of small/large-format LIBs, the demand and consequently the price for such energy storage devices have been raised. The aforementioned challenges originate from the shrinkage of the major applied critical materials in these batteries, such as cobalt (Co), nickel (Ni), Lithium (Li), graphite (G), and manganese (Mn). Therefore, it is imperative to consider alternative elements to address issues corresponding to the limitation of resources around the globe. Potassium (K) is considered an effective alternative to Li since K is a more abundant element, has a higher operating potential, a faster diffusion rate, and the lowest stokes radius in comparison to the closest neighbors in the periodic table (Li and Na). Among all reported materials for metal-ion batteries, some of them possess the general formula AMXO4L [A = Li, Na, K; M = Fe, Ti, V; X = P, S, Si; L= O, F, OH] is of potential to be applied both as anode and cathode and enable researchers to investigate them in the full symmetric battery format. KTiPO4F (KTP structural material) has been previously reported by our group as a promising cathode with decent electronic properties. Herein, we report a synthesis, crystal structure characterization, morphology, as well as K-ion storage properties of KTiPO4F. Our investigation reveals that KTiPO4F delivers discharge capacity > 150 mAh/g at 26.6 mA/g (C/5 current rate) in the potential window of 0.001-3 V. Surprisingly, the cycling performance of C-KTiPO4F//K cell is stable for 1000 cycles at 130 mA/g (C current rate), presenting capacity > 130 mAh/g. More interestingly, we achieved to assemble full symmetric batteries where carbon-coated KTiPO4F serves as both negative and positive electrodes, delivering >70 mAh/g in the potential range of 0.001-4.2V.

Keywords: anode material, potassium battery, chemical characterization, electrochemical properties

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Authors: Vinod Kumar Gupta, Narendrakumar M. Chaudhari, Suchismitha Iskepalli, Chitra Dutta

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Background-The community composition of the human microbiome is known to vary at distinct anatomical niches. But little is known about the nature of variations if any, at the genome/sub-genome levels of a specific microbial community across different niches. The present report aims to explore, as a case study, the variations in gene repertoire of 28 Prevotella reference draft genomes derived from different body-sites of human, as reported earlier by the Human Microbiome Consortium. Results-The analysis reveals the exclusive presence of 11798, 3673, 3348 and 934 gene families and exclusive absence of 17, 221, 115 and 645 gene families in Prevotella genomes derived from the human oral cavity, gastro-intestinal tracts (GIT), urogenital tract (UGT) and skin, respectively. The pan-genome for Prevotella remains “open”. Distribution of various functional COG categories differs appreciably among the habitat-specific genes, within Prevotella pan-genome and between the GIT-derived Bacteroides and Prevotella. The skin and GIT isolates of Prevotella are enriched in singletons involved in Signal transduction mechanisms, while the UGT and oral isolates show higher representation of the Defense mechanisms category. No niche-specific variations could be observed in the distribution of KEGG pathways. Conclusion-Prevotella may have developed distinct genetic strategies for adaptation to different anatomical habitats through selective, niche-specific acquisition and elimination of suitable gene-families. In addition, individual microorganisms tend to develop their own distinctive adaptive stratagems through large repertoires of singletons. Such in situ, habitat-driven refurbishment of the genetic makeup can impart substantial intra-lineage genome diversity within the microbes without perturbing their general taxonomic heritage.

Keywords: body niche adaptation, human microbiome, pangenome, Prevotella

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Authors: Mukhtar Raban

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As part of Nelson Mandela University’s journey of repositioning its learning and teaching agenda, the university adopted and foregrounded a humanizing pedagogy-aligning with institutional goals of critically transforming the academic project. The university established the Humanizing Pedagogy Praxis and Research Niche (HPPRN) as a centralized hub for coordinating institutional work exploring and advancing humanizing pedagogies and tasked the unit with developing and enacting a model for humanizing pedagogy exploration. This investigation endeavored to report on the development and enactment of a model that sought to institutionalize a humanizing pedagogy at a South African university. Having followed a qualitative approach, the investigation presents the case study of Nelson Mandela University’s HPPRN and the model it subsequently established and enacted for the advancement towards a more common institutional understanding, interpretation and application of the humanizing pedagogy. The study adopted an interpretive lens for analysis, complementing the qualitative approach of the investigation. The primary challenge that confronted the HPPRN was the development of a ‘living model’ that had to complement existing institutional initiatives while accommodating a renewed spirit of critical reflection, innovation and research of continued and new humanizing pedagogical exploration and applications. The study found that the explicit consideration of tenets of humanizing and critical pedagogies in underpinning and framing the HPPRN Model contributed to the sense of ‘lived’ humanizing pedagogy experiences during enactment. The multi-leveled inclusion of critical reflection in the development and enactment stages was found to further the processes of praxis employed at the university, which is integral to the advancement of humanizing and critical pedagogies. The development and implementation of a model that seeks to institutionalize the humanizing pedagogy at a university rely not only on sound theoretical conceptualization but also on the ‘richness of becoming more human’ explicitly expressed and encountered in praxes and application.

Keywords: humanizing pedagogy, critical pedagogy, institutional implementation, praxis

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Authors: M. Zeitoun, K. Abdallah, M. Rashwan

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Introduction: A growing body of evidence indicates that apelin, a relatively recent member of the adipokines family, has a potential anti-atherogenic effect. An association between low serum apelin state and coronary artery disease (CAD) was previously reported; however, the relationship between apelin and the atherosclerotic burden was unclear. Objectives: Our aim was to explore the correlation of serum apelin level with coronary calcium score (CCS) as a quantitative marker of coronary atherosclerosis. Methods: This observational cross-sectional study enrolled 100 consecutive subjects referred for cardiac multi-detector computed tomography (MDCT) for assessment of CAD (mean age 54 ± 9.7 years, 51 male and 49 females). Clinical parameters, glycemic and lipid profile, high sensitivity CRP (hsCRP), homeostasis model assessment of insulin resistance (HOMA-IR), serum creatinine and complete blood count were assessed. Serum apelin levels were determined using a commercially available Enzyme Immunoassay (EIA) Kit. High-resolution non-contrast CT images were acquired by a 64-raw MDCT and CCS was calculated using the Agatston scoring method. Results: Forty-three percent of the studied subjects had positive coronary artery calcification (CAC). The mean CCS was 79 ± 196.5 Agatston units. Subjects with detectable CAC had significantly higher fasting plasma glucose, HbA1c, and WBCs count than subjects without detectable CAC (p < 0.05). Most importantly, subjects with detectable CAC had significantly lower serum apelin level than subjects without CAC (1.3 ± 0.4 ng/ml vs. 2.8 ± 0.6 ng/ml, p < 0.001). In addition, there was a statistically significant inverse correlation between serum apelin levels and CCS (r = 0.591, p < 0.001); on multivariate analysis this correlation was found to be independent of traditional cardiovascular risk factors and hs-CRP. Conclusion:To the best of our knowledge, this is the first report of an independent association between apelin and CCS in patients with suspected CAD. Apelin emerges as a possible novel biomarker for CAD, but this result remains to be proved prospectively.

Keywords: HbA1c, apelin, adipokines, coronary calcium score (CCS), coronary artery disease (CAD)

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Authors: Claudio L. M. Souza, Milton Erthal, Aldo Shimoya, Elias R. Goncalves, Igor C. Rangel, Allysson R. T. Tavares, Elias G. Figueira

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The process of choosing a region for the implementation of wind farms involves factors such as the wind regime, economic viability, land value, topography, and accessibility. This work presents results obtained by multi-criteria decision analysis, and it establishes a hierarchy, regarding the installation of wind farms, among geopolicy regions in the state of ‘Rio de Janeiro’, Brazil: ‘Regiao Norte-RN’, ‘Regiao dos Lagos-RL’ and ‘Regiao Serrana-RS’. The wind regime map indicates only these three possible regions with an average annual wind speed of above of 6.0 m/s. The method applied was the Analytical Hierarchy Process-AHP, designed to prioritize and rank the three regions based on four criteria as follows: 1) potential of the site and average wind speeds of above 6.0 ms-¹, 2) average land value, 3) distribution and interconnection to electric network with the highest number of electricity stations, and 4) accessibility with proximity and quality of highways and flat topography. The values of energy generation were calculated for wind turbines 50, 75, and 100 meters high, considering the production of site (GWh/Km²) and annual production (GWh). The weight of each criterion was attributed by six engineers and by analysis of Road Map, the Map of the Electric System, the Map of Wind Regime and the Annual Land Value Report. The results indicated that in 'RS', the demand was estimated at 2,000 GWh, so a wind farm can operate efficiently in 50 m turbines. This region is mainly mountainous with difficult access and lower land value. With respect to ‘RL’, the wind turbines have to be installed at a height of 75 m high to reach a demand of 6,300 GWh. This region is very flat, with easy access, and low land value. Finally, the ‘NR’ was evaluated as very flat and with expensive lands. In this case, wind turbines with 100 m can reach an annual production of 19,000 GWh. In this Region, the coast area was classified as of greater logistic, productivity and economic potential.

Keywords: AHP, renewable energy, wind energy

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Authors: Angelis P. Barlampas

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Purpose of Learning Objective: This case depicts the need for cooperation between the emergency department and the radiologist to achieve the best diagnostic result for the patient. The clinical picture must correlate well with the radiology report and when it does not, this is not necessarily someone’s fault. Careful interpretation and good knowledge of the limitations, advantages and disadvantages of each imaging procedure are essential for the final diagnostic goal. Methods or Background: A patient was brought to the emergency department by their relatives. He was suddenly confused and his mental status was altered. He hadn't any history of mental illness and was otherwise healthy. A computing tomography scan without contrast was done, but it was unremarkable. Because of high clinical suspicion of probable neurologic disease, he was admitted to the hospital. Results or Findings: Another T was done after 48 hours. It showed a hypodense region in both thalamic areas. Taking into account that the first CT was normal, but the initial clinical picture of the patient was alerting of something wrong, the repetitive CT exam is highly suggestive of a probable diagnosis of bilateral thalamic infractions. Differential diagnosis: Primary bilateral thalamic glioma, Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Wilson disease, Leigh disease, West Nile encephalitis, Greutzfeldt Jacob disease, top of the basilar syndrome, deep venous thrombosis, mild to moderate cerebral hypotension, posterior reversible encephalopathy syndrome, Neurofibromatosis type 1. Conclusion: As is the case of limitations for any imaging procedure, the same applies to CT. The acute ischemic attack can not depict on CT. A period of 24 to 48 hours has to elapse before any abnormality can be seen. So, despite the fact that there are no obvious findings of an ischemic episode, like paresis or imiparesis, one must be careful not to attribute the patient’s clinical signs to other conditions, such as toxic effects, metabolic disorders, psychiatric symptoms, etc. Further investigation with MRI or at least a repeated CT must be done.

Keywords: CNS, CT, thalamus, emergency department

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Authors: Nithra Kitreerawutiwong, Sunsanee Mekrungrongwong, Artitaya Wongwonsin, Chakkraphan Phetphoom, Buaploy Phromjang

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Background: Thailand has implemented a district health system based on the concept of primary health care. Since 2014, Family Care Team (FCT) was launched to improve the quality of care through a multidisciplinary team include not only the health sector but also social sector work together. FCT classified into 3 levels: district, sub-district, and community. This system now consists of 66,353 teams, including 3,890 teams at district level, 12,237 teams at the sub-district level, and 50,326 teams at the community level. There is a report regarding assessment the situation and perception on FCT, however, relatively few examined the operationality of this policy. This study aimed to explore the perception of district manager on the process of the implementation of FCT policy and the factors associating to implement FCT in the district health system. Methods/Results: Forty in-depth interviews were performed: 5 of primary care manager at the provincial medical health office, 5 of community hospital director, 5 of district administrative health office, 10 of sub-district health promoting hospital, and 10 of local organization. Semi-structure interview guidelines were used in the discussions. The data was analyzed by thematic analysis. This policy was formulated based on the demographic change and epidemiology transition to serve a long term care for elderly. Facilitator factors are social capital in district health systems such as family health leader and multidisciplinary team. Barrier factors are communication to the frontline provider and local organization. The output of this policy in relation to the structure of FCT is well-defined. Unanticipated effects include training of FCT in community level. Conclusion: Early feedback from healthcare manager is valuable information for the improvement of FCT to function optimally. Moreover, in the long term, health outcome need to be evaluated.

Keywords: family care team, district health system, primary care, qualitative study

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Authors: Kunal K. S., Shwetashri K. R., Keerthan G., Ajinkya R.

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Background: Normal pressure hydrocephalus is a condition caused by abnormal accumulation of cerebrospinal fluid (CSF) within the brain resulting in enlarged cerebral ventricles due to a disruption of CSF formation, absorption, or flow. Over the course of time, ventriculoperitoneal shunt under general anesthesia has become a standard of care. Yet only a finite number of centers have started the inclusion of regional anesthesia techniques for the such patient cohort. Stem Case: We report a case of a 75-year-old male with underlying aortic sclerosis and cardiomyopathy who presented with complaints of confusion, forgetfulness, and difficulty in walking. Neuro-imaging studies revealed disproportionally enlarged subarachnoid space hydrocephalus (DESH). The baseline blood pressure was 116/67 mmHg with a heart rate of 106 beats/min and SpO2 of 96% on room air. The patient underwent smooth induction followed by sonographically guided superficial cervical plexus block and transverse abdominis plane block. Intraoperative pain indices were monitored with Analgesia nociceptive index monitor (ANI, MdolorisTM) and surgical plethysmographic index (SPI, GE Healthcare, Helsinki, FinlandTM). These remained stable during the application of the block and the entire surgical duration. No significant hemodynamic response was observed during the tunneling of the skin by the surgeon. The patient underwent a smooth recovery and emergence. Conclusion: Our decision to incorporate peripheral nerve blockade in conjunction with general anesthesia resulted in opioid-sparing anesthesia and decreased post-operative analgesic requirement by the patient. This blockade was successful in suppressing intraoperative stress responses. Our patient recovered adequately and underwent an uncomplicated post-operative stay.

Keywords: desh, NPH, VP shunt, cervical plexus block, transversus abdominis plane block

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Authors: Mohammadreza Hajialigol, Nargues Falahi Charkhabi, Fatemeh Shahryari, Saadat Sarikhani

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BACKGROUND AND OBJECTIVES Walnut canker is characterized by brown to blackish roundish blotches on the trunks and main branches, necrosis of inner bark and bleeding with dark brown to black-colored exudates. The present study aimed to identify the causative agents of walnut decline by their phenotypic features, approval of pathogenicity, the partial sequencing of the housekeeping genes in Razavi Khorasan. MATERIAL AND METHODS Ten Symptomatic samples were collected from walnut orchards of Razavi Khorasan in 2019. Pathogenicity of all isolated strains was carried out on walnut immature fruits cv. ‘Hartley’ and young green twigs of cv. ‘Chandler’. All pathogenic strains were subjected to physiological, morphological and biochemical tests. 16S rRNA and housekeeping genes (fusA, leuS, and pyrG) were partially amplified and sequenced. RESULTS Eight strains were able to cause necrosis and a dark-colored region in the mesocarp of immature walnut fruits, and three representative strains caused necrosis on young inoculated twigs. Strains utilized starch, however, did not utilized esculin, Tween 20, Tween 80, and gelatin. The partial 16S rRNA gene sequence of strain KH7 indicated 99.63 % similarity to that of Citrobacter braakii ATCC5113T. The phylogenetic analyses based on the partial sequencing of three housekeeping genes, fusA (633 bp), pyrG (305), and leuS (640 bp), demonstrated that strains KH1, KH3, and KH7 belong to C. braakii species in a monophyletic clade with high bootstrap support. CONCLUSION To the best of our knowledge, this is the first report of C. braakii as a new plant pathogen which cause walnut decline. Identification of bacteria associated with walnut decline will eventually improve our understanding of the etiology of the disease and may result in improved management techniques for control.

Keywords: emerging pathogens, Iran, juglans regia, MLSA

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